Kamath_Nidhi.pdf
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2021-22
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Community Health Learning Programme
A Report on the Community Health Learning
Nidhi Kamath
Experience
School of Public Health Equity and Action
(SOPHEA)
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Acknowledgments
I extend my deepest gratitude to the core team for giving me the opportunity to become a part of
the CHLP 2021-2022. I offer my special thanks to Guru, Balaji, Denis, Radhika, Abu, Uma, and
Karthik.
I am particularly grateful for the assistance and support provided by Denis, Radhika, and Abu. I
would like to thank all the learning facilitators for sharing their rich knowledge and experience.
A special gratitude to my mentor, Adithya for constantly encouraging and motivating me, and
providing valuable guidance and feedback for the project.
Special thanks to my team Virya, and all the fellow travelers of the program for an enriching
learning experience. I also express my deepest appreciation to the teachers, and students of the
Zilla Parishad School, Bori located in Gadchiroli for participating and supporting me in my final
project. I am extremely grateful to my mother for being my biggest pillar of support and strength.
Finally, I would like to offer my sincere gratitude to Ravi and Thelma for their transformational
leadership and truly being one of our most inspirational role models. Thank you- Much more
than words can say!
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Content page
EXECUTIVE SUMMARY……………………………………………………………………………………….4
PART A
1. Introduction…………………………………………………………………………………………………….5
2. Purpose of joining CHLP………………………………………………………………………………………5
3.What were my learning objective and were they met?........................................................................................6
4. Learning and reflections from the modules…………………………………………………………………....6
5. Mentorship process and reflections…………………………………………………………………………....8
6. Project learning experiences…………………………………………………………………………………...8
7.Take away from CHLP and looking ahead……………………………………………………………………..9
PART B
1.Background…………………………………………………………………………………………………….11
2.Objectives of the community health initiative…………………………………………………………………12
3.Description of the intervention and implementation…………………………………………………………...12
4. Impact of the community health action……………………………………………………………………......13
5.Learning from community project………………………………………………………………………….......13
CONCLUSION……………………………………………………………………………………………….......14
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Executive Summary
CHLP has been an enriching learning experience. Coming from an engineering background and
pursuing Gandhi fellowship with the community in Gadchiroli, my main purpose of joining
CHLP was to build my knowledge, skills and gain a deeper understanding of the community
health perspective in the context of the pandemic.
The COVID-19 conversations and the orientation sessions played an important role in getting to
know my fellow travelers and understanding the rich history and the impact created by
SOCHARA. Overall, the modules gave me deep insights and knowledge on various aspects of
community health, in the context of COVID-19. The learning modules have truly deepened my
understanding of the social paradigm of community health. It was inspiring to learn from the best
learning facilitators in the country who have worked at the ground-level and also advocated for
policy changes at various national and international levels. Apart from the knowledge and rich
experience of the learning facilitators, I recognized their humility, dedication, commitment, and
willingness to learn. I wish to impart these qualities along with the knowledge and insights
gained in the future.
My mentor has truly been my friend, philosopher, and guide. I would like to thank the core team
for the mentorship process and connecting me with Adithya. My chosen community action
project was ‘An educational intervention of health and climate change in Z.P Upper Primary
school, Gadchiroli’. It gave me an opportunity to reconnect with the school virtually and
implement a short community action project in the school. The educational intervention mainly
included short lectures, animated videos, and engaging discussions implemented by the teacher
in the class regarding the basic concepts of climate change and the various health impacts of
climate change. Evaluation was done through pre-intervention baseline assessment and postintervention endline-assessment. I was happy to see the positive results of the evaluation.
Moreover, the teachers expressed that the students enjoyed the sessions and were curious to
know more about the topic. This intervention was a small step towards creating awareness
among the students regarding climate change and health.
Overall, CHLP has been a journey inwards along with exploring community health guided by the
principles of social justice and equity. I would like to thank the core team for giving me the
opportunity to be a part of CHLP 2021 and the SOCHARA family. I hope to continue my
journey with SOCHARA and together work towards the goal of “Health for All”!
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PART-A
1. Introduction
I was born and brought up in the coastal city of Mangalore in Karnataka. My mother who is
currently a practicing medical doctor and my late father who was also a doctor were my role
models. From a very young age, I saw them serving selflessly and dedicating their lives towards
the betterment of their patients and the community.
I pursued my Bachelor’s in the field of Chemical Engineering from Manipal. My undergraduate
degree reinforced the importance of research and innovation in tackling environmental health
issues through interdisciplinary internship experiences. I then wanted to work at the grassroots
level, so that I could integrate with the marginalized communities and understand their needs to
bring about societal change. With this in mind, I pursued a two-year Gandhi Fellowship program
under the Piramal School of Leadership in the tribal district of Gadchiroli, Maharashtra.
During the “village immersion” program in the Gandhi fellowship, I got an opportunity to live
with a tribal community. I witnessed first-hand, the health inequities faced by the community.
Low literacy, lack of healthcare facilities and a disproportionate burden of diseases were some of
the major issues they faced. Another public health challenge, I encountered, during this period,
was the habitual consumption of tobacco by school children and adults. Mothers fed tobacco to
their toddlers to decrease hunger which resulted in malnourishment. Moreover, the social norm
amongst the tribal community at Gadchiroli forced menstruating women to live in unhygienic
‘menstrual huts’.
The trials and tribulations faced by the community deeply concerned me. Further, the COVID19 pandemic exacerbated the challenges faced by the community. In order to make an effort to
address some of these issues, I learnt their vernacular language and became cognizant of their
social norms. I then set up some community-based service initiatives. While I experienced
immense satisfaction from my successful initiatives, I also came across problems that were not
immediately actionable. During the Gandhi fellowship, I was humbled by the unconditional love,
hospitality and kindness, which motivated me to give back to the community from the abundance
that I had received. I realized that I belonged to the minority who are privileged and I had the
responsibility to pay it forward.
2. The purpose of joining CHLP
After my fellowship experience in Gadchiroli, I realized that while there were a few challenges I
could solve through my initiatives, there were several public health challenges that required
specific knowledge, skills and mentoring. The communities were also battling the challenges
posed by the first-wave of the unprecedented COVID-19 pandemic. My main purpose of joining
the CHLP program was to build my knowledge, skills and gain a deeper understanding of the
community health perspective in the context of the pandemic from the holistic curriculum of the
program.
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3. What were my learning objectives and were they met?
My personal learning objective for the program was to determine the linkages between COVID19 pandemic and environmental health, and communicate scientifically through effective report
writing. My broader learning objectives included broadening my understanding on the various
concepts and approaches of community health as well as the various linkages associated with
both the health and the heath system. Through the course of the program, I’m happy that most of
my learning objectives were successfully met.
4. Learning from modules and how I applied the learning in my work.
Reflections on use of the LMS, videos and participation in live online sessions. How was a
balance between work, life and the CHLP maintained?
It has been an enriching learning experience to listen, understand, learn, and reflect from the rich
and diverse experiences and insights of the learning facilitators, core team members and my
fellow travelers. Initially, I was able to commit and dedicate time to attend all the live sessions,
team meetings and share reflections on behalf of the team. I sincerely apologize for being unable
to attend the live sessions and contribute fairly due to the time difference after I began my MPH
course with a specialization in Global Health at the University of Alberta, Canada. I’m grateful
that the course was offered online and all the material and live session was recorded. I’m happy
that I could apply my learning from the CHLP modules to my present course work at the
University and share my perspectives in class discussions. I would like to thank the core team
once again for being accommodative and supportive at all times.
Initially, the COVID-19 conversations and the orientation sessions played an important role in
getting to know each other and understand the rich history and the impact created by
SOCHARA. It helped me to understand the structure of the program and also know more about
CHAI and MISEREOR. During the orientation session, I remember Lino from MISEREOR
sharing that SOPHEA translates to wisdom in Greek and I truly feel that the wisdom gained
through the program is exceptional compared to any formal training or course. Apart from the
knowledge and rich experience of the learning facilitators, I recognized their humility,
dedication, commitment, and willingness to learn. I wish to imbibe these qualities along with the
knowledge and insights gained in the future. I was also able to start developing my leadership
skills by becoming the group moderator in our small groups at the beginning of the course. The
interaction and group work within the team has also been a very good learning experience.
Personally, the CHLP has been a journey inwards along with exploring community health guided
by the principles of social justice and equity.
I also attended Dr Shirdi's memorial. It was truly a celebration of his life. I was inspired to see
the remarkable work done by Dr Shirdi and the innumerable lives he had touched. In one of the
videos shown, he mentioned that we are all spiritual beings having a human experience and he
always tried to speak to the spiritual part of the person. Towards the end, I felt very grateful to be
a part of the SOCHARA family.
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The modules on mental health as well as palliative care have particularly influenced me deeply. I
would like to reflect deeper on these two modules.
The overview of mental health and self-care techniques was particularly helpful. The various
community mental health models gave me an understanding of the best practices in community
mental health and the importance of treatment and healing within communities. In particular, the
concept of the Dawa and Dua program shared during one of the live sessions was an inspiration
to learn about the impact of working in collaboration with the community. In one of the case
studies shared, I was shocked to know about the intensity of the mental health problem in India
and it would take around 124 years to address the mental health needs of our country. In the past,
I have come across some of my friends going through various mental health issues and I never
knew how to offer help. The modules have now given me a better understanding of the types,
treatment, management of the common mental illness which will be helpful in identifying and
referring. The child and adolescent mental health module gave me an understanding of the
importance of early treatment which could be life-changing for the child, empowering parents
and solving the root cause/ core issues to solve the problem entirely. I’m currently taking an
elective on maternal and child mental health as a part of my course. The learnings from the
module has helped me to understand the concepts better and deepened my perspectives. The
addiction session was overwhelming. It was shocking to see that the treatment gap was the
highest for alcohol addiction. In one of the ALM’s shared, the opinion - "while there is no silver
bullet, open discussions and education is always a great starting point" was particularly
motivating. I have personally experienced the impact of addiction in my family. I’m grateful to
have attended the sessions which has helped me understand to change my perspectives and turn
the negative emotions to positive actions. The concept of engaging with men and understanding
their perspective in the context of addiction as shared by Thelma during one of the sessions
helped me to further change my perspective and see the situation through a different lens.
Further, the module on environment and health gave me an overview of the mental health
impacts on the community due to climate change.
The sessions on communication in both the mental health module as well as the palliative care
module was very helpful. I learnt the importance of active listening and whole-body listening. In
particular, I learnt the need to listen to the other person non-judgmentally and not invalidating
their experience by comparing it to others. Also, the importance for self-care. In the palliative
care module, it was interesting to know that pain was more than just physical pain. Total pain
included the physical, psychological, socioeconomic, and spiritual aspects. The modules helped
me get a deeper perspective on all the aspects of pain. The importance of functionality was a
helpful concept to know. As shared in the module, a simple conversation to the elderly person
addressing their spiritual issue, such as “I need you and without you there will be a huge gap in
my life” will give more meaning to the elderly person’s life than just telling “You don’t have to
be useful”. I felt that this was an important learning as I have seen elderly people going through
this phase and it can help me communicate with them better.
The various modules helped to understand the core-concepts in community health and deepened
my perspectives on the various determinants of health including the social, economic, political,
cultural, and ecological determinants of health. I realized that these determinants played an
important role in understanding the root causes of health challenges beyond the conventional
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bio-medical framework. Reflecting on my experience in Gadchiroli- I had met a person in a
medical camp who was infected with TB in a remote village. He was frail and very ill. The nurse
kept expressing her frustration that the person is not taking medications despite knowing the
consequences. That day, I wondered why can’t the person take medicine? It was a simple
solution. The CHLP program has helped me change my thinking and understanding the multiple
layers associated beyond the biomedical approach. When I look back now, I think of the same
person and his situation in a different lens.
Overall, the modules gave me deep insights and knowledge on various aspects of community
health, in the context of COVID-19. Coming from a non-health-science background, the various
modules helped me to understand the basic concepts of community health. It was interesting for
me to learn about diverse topics ranging from child and adolescent health to health movements.
The learning modules have truly deepened my understanding of the social paradigm of
community health. It was inspiring to see that the learning facilitators worked at the ground-level
and also advocated for policy changes at various national and international levels.
5. Mentorship process and reflections
I consider myself fortunate to have Adithya as my mentor. Adithya has been extremely
supportive and always motivated and encouraged me during our meetings. The reading materials
and blog posts shared by Adithya have been inspiring. Honestly, it was challenging for me to
adjust and cope with the new environment in Canada. I wasn’t able to commit fully to the
process as much as I expected initially due to several challenges. I’m really thankful to Adithya
for being so kind and supportive. Every meeting, Adithya would remind me to prioritize my
health first and taught me the importance of prioritization. He always provided valuable and
prompt feedback on my initial draft plan and the pre-test questionnaire. I’m also grateful that
Adithya has agreed to guide me after the completion of the CHLP program. My mentor has truly
been my friend, philosopher, and guide. I would like to thank the core team for the mentorship
process and connecting me with Adithya.
6. Project learning experience
‘An educational intervention of health and climate change in Z.P Upper Primary school,
Gadchiroli’ was my short community action project. I am thankful to the teachers and students of
the school for supporting and participating in the project. I would like to thank my mentor for
constantly motivating me and providing valuable feedback. I had meetings with the teachers
virtually for the planning of the project. The educational intervention mainly included short
lectures, animated videos, and engaging discussions implemented by the teacher in the class
regarding the basic concepts of climate change and the various health impacts of climate change.
Evaluation was done through pre-intervention baseline assessment and post-intervention endlineassessment. I was happy to see the positive results of the evaluation. Moreover, the teachers
expressed that the students enjoyed the sessions and were curious to know more about the topic.
This intervention was a small step towards creating awareness among the students regarding
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climate change and health. In the future, I would like to continue the project and involve the
community as we had planned initially.
7. Take away from CHLP and Looking Ahead -Where do I go from here?
Throughout the course, there were several AHA moments and inspiring words by learning
facilitators which I have captured belowSandeep Pandey (Social Movements)
“Fortunately, there is light. Light has a source (Put on a switch, light a candle, put a
torch on). But, darkness does not have a source and is essentially the absence of light
(You cannot put a switch on and make a room dark. You can only hide the light to make it
dark). That is my hope. It is only hope that is there and we despair only when we lose
hope. So, only positive things have source and they are real things. Sometimes, we get
depressed because we lose hope. A human being, inspite of however religious/ fatalistic
he/she may be, nobody gives up effort. Everybody tries to improve their situation. We are
all driven by positive spirit. We cannot live if we are driven by negative spirit/emotion. It
is only our positive spirit and emotion which drives us. That is the only hope. Even if in a
transitory phase, we may be pushed backwards, ultimately we will move forward because
it is the only thing which moves life. I always remind myself that only light has a source
and darkness does not have a source. Darkness is the absence of light and Light will
appear.”
Augustine Veliath (Communication for health)
“A health communicator, speaks with passion and listens with intensity and is constantly
alert for new ideas and perspectives that would lead to a more just world”
“Meet the unique Advocate in Everyone”
“Listening is the heart of communication and compassion is the heart of listening”
Dr. Suhas Chandran (Mental Health)
“You don’t have to only become a doctor to make a difference”
Dr. Denis (One-on one meeting)
“Being an introvert doesn’t stop you from being a leader, and most importantly, a leader
puts people’s interests first. The main focus of the leader is on the people.”
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Dr. Regi George (Comprehensive Primary Health Care)
“We always talk about the public and private sector. But, we never think about the
people sector. People are our huge power and we should depend upon them. People can
make changes. Our job as community health workers is to instill our knowledge into the
collective community memory”
Swami Dayapuranananda (Voluntary health sector)
“It is our choices that show what we truly are. Far more than our abilities”
“ASK principle from management. We have the knowledge. We need the skills. Most
importantly, we need to have the attitude (first in the ASK) to create change. Without the
right attitude you can’t make a change”
Dr. Ravi Narayan (Orientation)
“Change history to herstory!”
“If you are not confused, you are not thinking. If you are not thinking, you are not
learning”
“You can’t be a part of the solution, if you don’t know that you are a part of the
problem”
Dr. Thelma Narayan (Research methodologies)
“Research as a tool for the liberation and transformations of People’s health”
“People’s participation in health research as subjects and not objects will help bring
positive changes in the health system and addressing SDH”
Sunita Chandrasekhar (Health Technology and innovations)
“Our best friends for life-“What, Why, Where, When and How”
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PART- B
Community Health Action Project
An educational intervention of health and climate change in Z.P Upper primary school,
Gadchiroli
1. Background
Gadchiroli is a predominantly tribal district located in the North-eastern part of Maharashtra. The
district is further divided into 12 blocks. The school selected for my intervention is situated in a
village named Bori, located in the Aheri block of the district. The Zilla Parishad (Z.P) Upper
Primary school has a total student population of 100 from grade 1 to grade 7. The majority of the
students in the school belong to the Madia Gond community. Hindi, Marathi, Telugu, Gondi,
Madiya are the common languages in the school. The main source of livelihood for the
community is agriculture. The village is located very close to the state border of Telangana. In
recent years, due to various challenges in agriculture, seasonal migration to Telangana have been
increasingly common.
Source: http://vayunandana.com/about-vayunanadana.html
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2. Objective of the community health initiative
The overall aim of the project was to improve the knowledge, attitude, and practice regarding
climate change and health among the students. During the planning phase of the project, three
broad objectives were as follows•
Initiating discussions and stimulating thinking regarding climate change and health in the
classroom
•
Students identifying local problems due to climate change and potential solutions after a
discussion with the community
•
Small initiative/ action undertaken by the students at the end of the project
3. Description of the intervention and implementation, community engagement process
Initially, during the planning phase of the project, the following steps were outlined
Prior to the implementation1) Virtual discussion for planning with the teachers
2) Developing short climate change and health modules
3) Designing interactive/ fun activities
4) Developing a pre-intervention baseline assessment and a post-intervention endline assessment
which included the same questions as the pre-intervention baseline assessment and an additional
section where the students will write a short-note about their understanding of the topic
Implementation5) Students completing the pre-intervention baseline assessment
6) Conducting interactive and engaging sessions through various modules
7) Recap and reflection after every session
8) Students completing the post-intervention endline assessment
Post-Implementation9) Debrief with the teachers and students virtually
10) Analyzing the assessment results
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Due to various challenges, including my time difference and closures of the school due to the
pandemic, I was unable to implement the project exactly as planned above. However, in a short
time frame, I tried to do the best that I could.
First, I had a virtual discussion with the teachers regarding the project. I was happy to see their
enthusiasm and support for the project. During our initial discussions, we decided to include the
basic concepts of climate change followed by health impacts. Short animated videos were
selected and finalized for the sessions. The pre-intervention baseline assessment included the
questions on these basic concepts of climate change and health impacts of climate change. The
post-intervention endline assessment included the same questions as the pre-intervention baseline
assessment and an additional section where the students wrote a short-note about their
understanding of the topic. The questions were translated from English to Marathi. I would like
to thank my mentor for providing valuable feedback on the assessment questions.
The students from grade 7 (n=15) completed the pre-intervention baseline assessment. The
teacher conducted interactive sessions. The initial session covered the basic concepts of climate
change. The sessions included a short lecture by the teacher followed by short videos and an
interactive discussion in class. The following sessions included animated videos describing the
various impacts of climate change on health, followed by a discussion in class. Finally, a postintervention endline assessment was completed by the students.
Students watching short animated videos
4. Impact of the community health action
The pre-intervention baseline assessment and the post-intervention endline assessment was used
as the method of evaluation. The teacher sent the results of the assessment digitally. The pre-test
and post-test scores were analysed. The figure below shows the graph of the percentage of
questions answered correctly for each question for the pre-test and post-test assessment.
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Percentage (%) of correct
responses
100
80
60
40
20
0
Q1
Q2
Q3
Q4
Q5
Q6
Q7
Q8
Q9
Q 10
Questions
Pre-test
Post-test
Figure 1: Pre-test and post-test results
The results indicated an increase in the percentage of correct responses for all the questions. The
intervention led to an increase in the student’s knowledge and awareness on climate change and
its associated health impacts. The feedback from the teachers was positive. During my virtual
meeting with the teachers, they expressed that the students enjoyed the sessions and they were
happy to see their interest and curiosity.
In the future, I would like to continue the project and involve the community as planned in the
initial phase. One of the ideas proposed by the teachers was conducting sessions and having a
discussion with the parents during the SMC (School Management Committee) meetings. Further,
a small project/action will be taken by the students in their community.
Conclusion
Overall, CHLP has been an enriching learning experience. I would like to thank the core team
for giving me an opportunity to become a part of CHLP 2021. I look forward to continuing my
journey with SOCHARA and working towards the goal of “Health for all”.
Thank you!
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