Abraham Thomas - CHLP 2003 second report.pdf
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Internship in Community Health and Development
At Community Health Cell, Bangalore
CPHE
I dedicate this report to my forefathers,
who moulded today
To my parents who let me dream, to
my teachers who set me free, and to
the people who let me be....
/. S'.--'
--
The state of
The Public Health System
The Public Transport System
Our future Generation
Contents
_____ *_____
2.
1.
The paradigm shift and the selection process
Introduction to Community Health & Orientation
3. Learning at Community Health Cell
A c tivities
Survey on TTZ viewing habits and the role of Science in Rural India
•
75RO proposes to launch A science Channel — Consultations on Incorporating Health H’SS
Jan Swasthya Abhiyan National Working Group Meets
4.
Setting Objectives & Planning the Year of Fellowship
5.
The Journey with Sangbamitra
Major Thrust areas
Helping The Self-help Groups to get a control of their own health & indeed guide others
‘Integration - A vision” with Fr. John Vattamattom
Revitalisation ofthe Public Health System — A struggle against the wind
Traditional Healers
Practitioners ofHealth (Naidhyulu)
Soul Searching & Learning
6.
7.
Making Sense ofit All
Primary Health, Community Health & Public Health
People’s Health Movement, Jan Swasthya Abhiyan & “The Alma Ata”
The shortcomings, the strengths and successes of Peoples movements
8.
Future of the Fellowship
____***____
rV*° m Community Health and Development
1. The paradigm shift and the selection process for the internship
I had already made up my mind before 1 met anyone that 1 would take up rural living and do
something in rural settings City life to me was becoming drag and was choking me from within.
However while I worked at St. Johns Medical College and Hospital I began to like it because of its
lush green campus, vast unoccupied areas of greenery, the wildlife (snakes and rodents) within, and
of course the very creative students. 1 was working there with the Health Informatics Department as a
research assistant on generating and editing information from various online medical databases. 1
enjoyed the work and made a number of friends in that one-year’s time. 1 had taken up the job to
support myself, use the time there for weighing the various options in front of me. and making a
rational decision on my future and 'career'. Perhaps, it was the most sensible thing I did in my life.
This is relevant to our internship scheme because it has the gift of helping one through a journey of
exploration and experimentation.
I remember it all. It was all so slow and definite. A friend named Sumithra, who is a Associate
Professor at St. Johns Medical College, told me about Community Health Cell. She told me that there
are committed people in tire place who support young students and graduates in taking up small
projects on health based in villages. She also introduced me to Dr. Xavier, who too is a professor in
the Department of Pharmacology, whom she assumed had been associated with CHC. When he spoke
to me. he told me that this place is good approach, if I had a certain degree of clarity about the kind of
work I would like to do. and about my area of liking.
1 have always observed that most parents take decisions for their children because their children don't
earn and support themselves and then there is the 'duty'- of parents. In fact, if parents don't discharge
their children's duties, the children w'ould with minimal support take up very creative careers in all
aspects. It is unfortunate that most students take up either engineering or medicine. I was also a
sufferer of such a decision-making, which led me to become a dentist. I smile now, now that I know it
is over.
It took me another 4 months before I came down to Community Health Cell, when I met Mr.
Gopinathan for the first time. 1 knew nothing about a fellowship/intemship scheme, but 1 knew that
they would help me to find a place where 1 can work and contribute my bit. 1 was glad to know' that a
internship program existed and that is designed to help people chose a vocation in community health
and development. Interestingly, Gopi took down my numbers and said he w'ould get back to me soon.
I was called for interviews after a few days, where Dr. C.M. Francis, Dr. Ravi Narayan, and Dr.
Paresh and Dr. Thelma interviewed me.
It was the only interview I had attended, where they asked me about my interests and dreams, about
mv family, about what made my family settle down in .Andhra Pradesh and many more things
irrelevant to my area of study. In fact, before 1 left Thelma asked me to write a small essay on what
made me to approach a rural health and development program. Before day break, the next day. I had
finished writing an account of the influences and inspirations that made me choose an alternative
profession to dentistry.
This is how the essay went..
---- TJeorPyll at the (Community I-lealth Clell
|t was really nice to have met [j)r.
community health (2.eH-
| helnia ano to have come to know a little more oh the
Here. | am giving a brief- account of- the influences on mu life that got me interested in the
Field or community health and promotion of health. | come From a small town/f anchayat in
Andhra | radesh. : his is m;j 20"' year away from home as | have been out in the boarding
during school and college. Holidays and the First seven years in Pjadur have had a
tremendous et+ect on my thinking process. Interestingly they didn’t manifest in earnest.
Now, | simply want to be involved in the process oF improving the living conditions, health
and the general life oF many people. |n addition, | don’t see myselF being able to make a
proFit From my work or rather prefer that monthly pay packet. Interestingly, sometimes |
dream oF a community health research centre in my village.
We were a Family oF seven until recently when my grandmother passed away. My Father
grew up in Andhra Pradesh and my mother in P_erala. My father (£)r. M-S- Thomas) is a
general practitioner in our own town (J^odur). Ivodur is a gram Panchayat and taluk. My
Father did his schooling, college and went to the university in Andhra unlike my mother who
was in K_erala in the meantime. My Family migrated to Andhra in the late JOs after my
grandfather did his medicine From Stanley Medical Qollege during his work with the
leprosy mission in (Lundalpet. Later he settled down in Lodurin the late 4-Os before which
he was working with the mission hospital in jpenigunta. | be urgent need For a doctor in
ILodur probably made him move to [Lodur. He was a sincere and nice person From what |
have heard. He had a school constructed for the primary school, a post office for the
postal department, an office For the distnct education office, and a telephone exchange. |
sometimes wonder how broader his views were and how high his reach was. H'S sudden
illness and death was quite a shock to my Family because my Father wasjust married and had
just started work at the CTC- (Christian Lellowship Hospital) and three of his sisters
were still not marned. My Father moved back to (Lodur to continue his father’s work. He
worked with the Lions (Tub and the Lepr°sy Mission until they shut doors. He helped
some of the early missionary medical services that were set up in the eafly seventies From
P?enmark, the CJS ar|o Cjermanq. {Turing this time, he however did have a private practice
(OH t^at is only a outpatient setup. His patients still get their pentids (sarabhai
chemicals) and rarely does he prescribe higher molecules. \'Ve do not use pesticides in our
garden and rarely do we use chemical manure. Our chickens at home are healthy and
resistant to disease, and one chicken is about 1 I years old and continues to lay or two at
times. \'Ve are hapt?u in our village setup. However, the scenario today is totally
contradictory. the .Tigers use pesticides indiscriminately-, the use of chemical Fertilizers
over organic manures seems to re Fast gripping the farmers. | he source of clean drinking
water seems to be Fast disappeanng because the ground water has been totally exhausted.
Healthcare is a Farce in the town because the doctors have turned into agents for the
specialists in neighbouring | irupathi and Madras. \<Vhat really disturbs me even more is the
ack of rains ano proper Mango crops has worsened the socio-economic status or the
people which has degraded rhe health status over time. Ignorance and lack of basic
amenities is pusning many to suicce
acaressed very soon.
| hese ever-constant detenoration needs to be
| his responsibility has to be taken by someone sometime, and the
Buck should stop here.
] am encouraged by the work of many around me and by my instincts to think that community
health needs and the general social needs can be met with constant effort From the part of
many individuals. Moreover, with the large knowledge back of many responsible individuals
in specific communities can be tapped to identify problems, solutions and also help
formulation of policy and later monitor its implementation.
| he encouragement of my parents has been very good and also been constant and ever
refreshing. | hey supported me in vanous boarding schools and university too. | have been
on my own since a year and | have been
Johns Med ical O°lle£.e. I came into ^)t. Johns
to actually do a study on oral microbes in November 2001 and worked under [Jr.
Macaden fo a penod of 4- months. Later, when the project failed to kick off due to financial
problems, | spent a few months unemployed. N°w, this is my IO"1 month of work in the
Health Informatics (Jroup of the Division of Nutrition. Here we generate fact sheets for
the L ondon J^chool of Hygiene and | ropical Medicine. VVe research a subject and make
medical literate in layman terms. | have learned the art of searching the medical evidence
validating the same. | have gained a good hold in using computers to my advantage. |n fact, |
have gained a lot more than rust this.
\\hat | really want you to in earnest is your valuable advice and guidance. | would definitely
need you to help me gather a perspective and direction to my work and study. | would be
benefited in many ways by working with OHC-i firstly, | would learn the ground level field
work, the problems faced by every health worker on the field at various stages. |n addition, |
would learn the method of forging partnerships, networking with other organizations having
Croup discussions, planning, etc. | horae | would be able to do an internship with CHC and
be a part of its activities.
ne important feature of CHC and its new branches has given me a small idea of the
croader objective of the CHC I would be happy to hear from you and work with you in
the days to come. | would like you to know that currentjob has helped me sustain myself
during the last year, and | would be glad to continue this part time if you have no ejection.
specialists in neighbouring | irupathi and Madras. \'Vhat really disturbs me even more is the
ack oi- rains anc. proper Mango crops has worsened the socio-economic status oh the
neopL which has degraded the health status over time. Ignorance and lack of basic
amenities is pushing many to suicide.
acoresseo very soon.
| hese ever-constant deterioration needs to be
| his responsibility has to be taken by someone sometime, and the
buck should stop here.
I am encourageo by the work of many around me and by my instincts to think that community
health needs and the general social needs can be met with constant effort from the part of
many inoividuais. Moreover, with the large knowledge back of many responsible individuals
in specific communities can be tapped to identify problems, solutions and also help
formulation of policy and later monitor its implementation.
| he encouragement of my parents has been very good and also been constant and ever
refreshing. | hey supported me in vanous boarding schools and university too. | have been
on my own since a year and | have been 5^- Johns M«d ical (Joliege. | came into Ljt. Johns
to actually do a study on oral microbes in November 2001 and worked under [Jr f^agini
Macaden fo a penod of + months. I_ater, when the project failed to kick off due to financial
problems. I spent a few months unemployed. Now, this is my I O
month of work in the
Health Informatics (Jroup of the Division of Nutntion. Here we generate fact sheets for
the |_ondon School of Hygiene and | topical Medicine. We research a subject and make
medical literate in layman terms. | have learned the art of searching the medical evidence
validating the same. | have gained a good hold in using computers to my advantage. |n fact, |
have gained a lot more than just this.
What | really want you to in earnest is your valuable advice and guidance. | would def'ini tely
need tjou to help me gather a perspective and direction to my work and study. | would be
benefited in many ways by working with CHCi firstly, | would leam the ground level field
work, the problems faced by every health worker on the field at various stages. |n addition, |
would leam the method of forging partnerships, networking with other organizations having
group discussions, planning, etc. | hone | would be able to do an internship with CMC and
ze a part of* its activities.
ne important Feature oi- OHC- ar,d its new branches has given me a small idea or the
preader objective or the CMC I would be happy to hear from you and work with you in
the days to come. | would like you to know that currentjob has helped me sustain myself
during the last year, and | would be glad to continue this part time if you have no objection.
Dut ii
tine time constraints seem pressurising, | would stop working at the Health
Inf ormatics Group."
The most interesting thing that happened to my life in that period of time, between attending the
interview and being told 1 was selected for the internship, was an increase in my "Total Happiness
Index 1 thought exen if this internship scheme doesn’t come through. I still know who 1 should be
associated with in the future In short, it was wonderful to meet a group of highly committed people
with a great sense of creativity and communication and their selection methodology was genuine.
simple and open. 1 knew then that the philosophy of Gandhi still lives and it is possible to contribute
to positive changes in the field of community health and development.
The internship programme structured for me began on 3 June 2003.
The orientation programme made helped to a large extent in my transition as a clinical person to a
community health person. Clinically one tries to see things in black or white and see the disease as a
separate entity and not as a part of a holistic entity.
Paradigm shift
Medical Model
Indix idual
Patient
Disease
Providing
Drugs Technology
Professional Control
Social Model
Community
People
Health
Enabling
Knowledge/Social Process
Demystification
This change of course was impending within but truly it was nurtured at the CHC and while w'orking
with Fr. John Vattamattom. The orientation programme was to a large extent useful to make the
feliows/mtems feel at home and also discover the areas of community health they like, or they are
more likely to enjoy.
It is still possible!!
Gandhiji in Bonala Kondapur, an interior Village in Chegunta Mandal of Medak District
•indhi is seen in many of the major \illages. but in different forms and shapes, in different moods, sometimes.
-'ed while sometimes he is absolutely malnourished. Il all depends on the state of mind of the local sculptor
; ~e way he perceives today's Gandhiji
2. Introduction to Community Health & Orientation
A new chapter began on the 3,J of June 2003. I had committed myself to a six-month program that
would help me to learn about community health and development, and to develop my skills as well as
strengthen my beliefs.
We first met all the staff members of CHC by then, but not at a one to one level. When classes were
held on various issues, they opened the Pandora’s Box on community health and we had the
opportunity to meet the staff members of CHC ask them about their initiatives and areas of interest.
We were five of us simultaneously undergoing orientation programme. Two supported by Ratan Tata
trust and the other three were volunteers in community health. This programme was designed to
perceive our notion on 'community'’, ‘health’, ‘disease’ etc. Some of the biases each of us carried were
highlighted to let us understand the broader concepts of health. Our medicalized views on health and
treatment were challenged with examples, discussions, and also skits (role play). Our concern and
sensitivity towards the underprivileged, sick, exploited, and the neglected was strengthened and often
challenged. That was a three-week orientation program on community health and development. lie
were also given ample amount of inputs to make sure that we don't idealize the concept of community
health that our perceptions should be amiable to changes according to the local needs and pace.
Classes were taken
A broader understanding of health - Community Health, Health Challenges, understanding
doctors/healers roles, Community health needs, People’s Health Movement/ Globalization etc.
Communicable and Non-Communicable diseases
Alcoholism
Gender and Health,
Food and Nutrition
Traditional and Western Medicine - Philosophical paradigm
Working w ith Communities - Various approaches
Lifeskills
After short lecture classes one spent time in the Information Center at CHC. The Librarian, Mr. Swami.
helps fish out the most untraceable book and has a good knowledge of the books and journals available.
On the lighter side, these classes were a lot more interactive and resourceful than many of my classes in
university and school.
through the three weeks of input sessions. 1 could perceive the differences between primary health,
community health and public health. But there was no concrete understanding of the whole picture still.
1 knew there were components of primary health and public health sphere spoke of a larger picture of
health, but the community health angle was still unclear as it had to do with community and I hadn’t
lived in one while I worked on health and healthcare.
The question that always struck me was "health for ail by 2000” and 1 asked my self always ’what made
them come to this date'? Or was it just a round figure where they went totally wrong? I guess now I
know the seriousness with which the nations came together that day, that time. And most important of
all, meeting the people who were involved with the times of “health for all” who must have been as old
as we are today w'as certainly touching and symbolic.
An egg-shaped graph on the economic brackets of people living India brought about a new perspective
in my thinking because it was striking. Since this graph was prepared by Marg, a market survey group,
it shows that there is a huge market of rich Indians who are in the bracket of upper middle class, the
upper and the elite classes. This market survey also was useful to those thinking to change a
disproportionately growing society' into a more equitable one. This graph differed evidently from the
earlier triangular graphs depicting a small elite class of Indians.
The stark contrasts between rural India and urban India was certainly on my mind but certainly not
reiniorced as it is today, after a year in rural Andhra Pradesh. In all, the state of health in India made me
open my eyes wider to the issues surrounding us. One of the most touching and paining issues we
discussed was female foeticide practice in India, and the alarming rates of such atrocities in the Hindi
Heartland of our country' - The Central. Northern and Northwest India. Dr. Mira Shiva, a senior staff of
the VHAI (Voluntary Health Association of India) said that some informal studies done by observers in
New Delhi showed a male to Female Ratio/1000 (MFR) as being as low as 650 for every 1000 male
live births. This certainly reflected Urban Indian’s adoption of the greed, and the obscene culture of
male glorification. Unfortunately no one opens their eyes to their own stand against life and the values
of life.
The National Working Group (NWG) meeting of the JSA (Jan Swasthya Abhiyan) was the best
introduction to community' health and a Public Health Perspective of the country’s healthcare and health
system's state in INDIA. This group worked upon the activities being planned for the year ahead with
specific attention to the Right to Healthcare Campaign and the National Human Rights Commissions
interest to take up such a campaign forward. They also discussed the International Health Forum
preceding the World Social Forum in January 2004 at Mumbai and the activities for the same. There
was an emphasis on the planning, approaches, and who takes which responsibility for the activities
planned. They thought at the meet that a lot of young people need to be infused into the Movement and
that its very essential for the growth and long-term success of the Movement.
Dr. Antia, Senior Surgeon in Plastic Surgery and community health specialist of the Foundation
for Research in Community’ Health was particularly vocal about the negative impact of the
increasing role of the World Bank in determining the course of the world’s healthcare and health
systems. The destructive trends were disturbing and needed to be stemmed at the earliest he
opined.
The networks across India that had been contributing to the Movement briefly explained their own
activities that brought about strengthening of the movement. CHAI. CMA1. the BGVS state units and
the FMRA1 had very innovative and extensive programmes in the direction. CHAI (the Catholic Health
Association of India) of Tamil Nadu had collected more than five hundred thousand signatures for the
RIGHT TO HEALTH CAMPAIGN under the slogan "Health for All NOW!"
The future of the communications between the partners was discussed in detail to enhance the. links
between the various partners of JSA and the PHM. These experiences strengthened my own belief
about the progress and conduct of Movements in India and elsewhere.
5. Learning at the Community Health Cell
Aould be meamnee.-; u I do not start with the strength of the community health cell, for they arc
'Unpliciry. ethic.-.. —_ues, and strong vision. It is indeed a great opportunity for voung people like
. to interact and item :rom skilled and seasoned ‘community and public health professionals' like
... C. M. Francis.
Ravi Narayan and Dr. Thelma Narayan. Dr. Paresh Kumar, sociologist, was
Particularly tnsightru. -to community dynamics and approaches. The Communin' Health Cell team
c misting of Mr. Prznnad, Mr. Rajendran, Mr. Rajan Patil and Mr. S. J. Chander would be certainly
Reserving oi their inputs. advices, cooperation and help. Dr. C. M. Francis’s contribution to the cause
1 : community heaitr =at soil continues to date is a testimony to those young people pursuing a
pc.tr s internship. Tm library and documentation centre is particularly extensive and exhaustive.
B ' oks and journals tn social, political, economic & cultural determinants of health are surelv the
strength of the program The staff members of the organization are particularly helpful in taking care
or .ill the other mimic retails. Though there are some weaknesses in terms of computer networks
and stable and constant access to the Internet, the overall resources available at the centre are worthy
of mention.
.'■.tier classes, we vistcd various initiatives (by mostly NGOs) as a part of our learning by doing.
Among them were the rtrtiarives with street children by APSA (Association for the Promotion of
Social Action), the Ctmmunity based approach to tackle alcoholism (CHATA), an initiative of
the Community Health. fell, and slum schools initiatives and Life skills education of slum vouth bv
c '.'.iboration with Wndd Vision, a group working on education in these slums. We had also the
chance to meet some x the Religious Nuns working with women’s empowerment in slum areas.
APSA has been workrar with street children from over three years and has made headway in getting
into the hearts of the children in the Jayanagara area. These children were often from very poor
households, who were nther orphaned due to disease or strife in family, or were let to fend for
themselves from a ver early age. Some of them ran away from home due to petty quarrels or
bemuse of a constant rusunderstanding at home. Here they have a group of so called friends, who
w ..id lend a shoulder r. a certain extent, while they earn by themselves by begging and doing petty
f.tv.urs.
youngest of the
...
we met during one of our visits was a 6-year-old boy. He also was into
-.g the eraser sol.::;:-.. On a regular basis, these children earned much more than what a coolie
: earn tn a who'.-.
They never compromise three basic tilings - food, cigarettes, beedies, and
*ol and the erase: • t-iiuon. The staff members of APSA had fallen in love with these children,
and often wondered wrat they would do without them after a while. ‘Wednesdays’ were special to
the children, as they woiid come to a meeting point at Jaynagar 4,h Block, near the Bus Station. The
}. Learning at the Community Health Cell
ould be meaning^:'- tf I do not start with the strength of the community health cell, for they are
simplicity, ethic.-.. ■_ces, and strong vision. It is indeed a great opportunity for voung people like
... to interact ana it™ trom skilled and seasoned ‘community and public health professionals’ like
C. M Francis. _z Xavi Narayan and Dr. Thelma Narayan. Dr. Paresh Kumar, sociologist, was
particularly insighrm. -to community dynamics and approaches. Tire Community Health Cell team
c misting ot Mr. Pre:::.ad, Mr. Rajendran, Mr. Rajan Patil and Mr. S. J. Chander would be certainlv
ceservmg of their inpirz. advices, cooperation and help. Dr. C. M. Francis’s contribution to the cause
: communin' heaitr. mat still continues to date is a testimony to those young people pursuing a
'. etrs internship. Tn: dbrary and documentation centre is particularly extensive and exhaustive.
E- oks and journals or social, political, economic & cultural determinants of health are surelv the
strength of the program The staff members of the organization are particularly helpful in taking care
o: all die other min-ae retails. Though there are some weaknesses in terms of computer networks
and stable and constarr access to the Internet, the overall resources available at the centre are worthy
of mennon.
Ai'.er classes, we visiter various initianves (by mostly NGOs) as a part of our learning bv doing.
Among them were the r.iriatives with street children by APSA (Association for the Promotion of
Social Action), the Community based approach to tackle alcoholism (CHATA), an initiative of
the Community Health fell, and slum schools initiatives and Life skills educanon of slum youth bv
c 'daborauon with \X trdd Vision, a group working on education in these slums. We had also the
chance to meet some -j: the Religious Nuns working with women’s empowerment in slum areas.
APSA has been workmr with street children from over three years and has made headway in getting
into the hearts of the thildren in the Jayanagara area. These children were often from very' poor
h. .iseholds, who were ether orphaned due to disease or strife in family, or were let to fend for
themselves from a ver early age. Some of them ran away from home due to perry quarrels or
l.w.'.'.use of a constant msunderstanding at home. Here they have a group of so called friends, who
w .id lend a shoulder r. a certain extent, while they earn by themselves by begging and doing petty
fave urs.
'.oungest of the
we met during one of our visits was a 6-year-old boy. He also was into
... 'mg the eraser soim.m. On a regular basis, these children earned much more than what a coolie
w
.id earn in a who'.-.
They never compromise three basic tilings - food, cigarettes, beedies, and
:>>1. and the erase: ■: tition. The staff members of APSA had fallen in love with these children,
and often wondered wtar they would do without them after a while. ‘Wednesdays’ were special to
the children, as they woiid come to a meeting point at Jaynagar 4lh Block, near the Bus Station. The
children tried not to miss tins meeting and often openly said that this was (he only window they have
attention APSA tried to give them legal support, counselling, and space to settle their
differences amicable.
Xc ob.cn cd from close quarters that these children were quick learners, and absolutely uninhibited.
I hex had no re>en ations to talk about the police, violence, sex, and drugs. The children seemed to
be affected at a deeper level and were lacking genuine love and concern, which is probably the result
of an unending saga of homelessness, abuse, harassment, hate, revenge, fights, drugs, hurt and
resentment. Their behaviour is the sum of societal neglect and gross lack of empathy.
Today, we are at a crucial stage when we stand on many such human time bombs such as these
children who are finding their own meanings, their own paths, and evidently their own destinies.
When antisocial elements in society get their hands on them, they would benefit from their
confidence and hurt for illegal purposes such as violence, theft, drug trafficking, and commercial sex.
APSA is trying hard to rehabilitate them and to take them off the streets after counselling them
adequately. Only a few have undergone a change of heart. As I think of those children mv heart
sinks; even their basic Right to Life is under question. Hardly any of these children see the
daylights or adulthood and responsible Living. Most die young due to disease as a result of lack of
care, support systems and societal rejection. Very little is understood of the number of street children
who have come out doing well on their own, or rather nothing is documented. Some of the bovs end
up working as ‘hit-men’ and ‘local goondas’.
It would be miraculous, if we can rehabilitate such children in a rural setting with
employment and schooling together, where their strengths are to be identified and their
skills nurtured to be able to bring “the best citizens possible” out of them.
Communitv Health Based Approach To Tackle Alcoholism (CHATA)
Communin' Health Cell had almost over one and a half years ago took up a pilot study to assess the
effectiveness of a communin' health based approach to tackle alcoholism. Mr. Rajendran had
initiated the studv and action research on the approach with the help and support of other staff
members of the Community Health Cell team.
Tins programme mainlv aims at strengthening the support mechanisms in small communities prone
to alcohol abuse and alcohol related problems. One of the methods adopted was to build close
contact with the local communities through women’s forum meetings through which women shared
with one another their experiences with alcoholic husbands and children and gave a hearts account of
their problems therebv. This process moved the women communin' and made them take decisive
steps in convincing their husbands and children to try to stop die habit with help. Most often, it was
ot usin,, lore and concern, which yielded better results. Force and confrontation was
.cd tn this piocess. This tickled not only community participation tn the programme but also
a great deal ot participation tn other community developmental activities such as construction ot
roads, drains, and latrines. Hie people who underwent detoxification treatment at the National
Institute ol Mental Health and Neuro Sciences (NIMHANS) were themselves communitv witnesses.
Sudhamanagar Slum is a classic example of a success story in the little effort against the dreaded
epidemic of alcoholism.
A study in NIMHANS of a 20 year follow of persons treated with hospital based care at the institute
showed that only one of the 20 persons followed up continued to live as a alcoholic, while 10 died
and the others were unavailable in their earlier places of stay. This depicts partlv the ineffectiveness
of hospital-based rehabilitation or rather its failure.
Some of the observations one would make at this point of the study on the reasons for the
increasing trend of alcohol consumption would be
The increased dissatisfaction among the marginalized about their social standing and a
disgruntlement after looking at the disparity between the affluent and themselves
Escapism from reality and real life
The unmet need of healthcare among the marginalized which has led a number of persons to a
cycle of debt
The major problem is the exposure to alcohol in one’s youth as a part of peer pressure and
group-decision making
The increased number of oudets serving alcohol and the setting up of targets by the State
Government for which the traders even serve alcohol on credit to meet the requirement
In fact, the number of retail oudets for alcohol has had a steep four-fold rise in the past few
years
Lack of life skills and lack of basic self regulatory and self moderating capacity among the people
due to utter povertv and lack of information
As a part of the fellowship, I certainly made the most by learning from Rajendran, his
captivating style of communitv-based communication, his empathy, and his dedication to
the cause of those under the grip of alcoholism.
Real-life Life-skills
Communitv Health Cell team member, Rajendran, also imparts life skills to
adole. cents in the slums. World Vision is working in the Rajendra Nagar slum area mainly
concentrating on education and vocational training of adolescent girls. Identification of children tor
the lite skill education was not difficult here.
Ihi lite skills were imparted as a part of the tailoring class these girls attended at the school. The
responses to the classes were tremendous, and the outcome of the classes was sometimes
unbelievable
Once, a girl asked Rajendran how it was possible to make her father stop drinking and also stop
hitting her mother. She lived in a slum and was from a familv of five. After asking a few questions,
Rajendran observed that she wasn’t very affectionate with her father though she loved him, and here
was an opportunity for her to help him out with his problem.
He asked her to change her behaviour towards him. He asked her to go to him, sit next to him, give
him a hug or hold him. He asked her to tell her father that he ought to show his love to them. The
girl did so in the following days, and there was a miraculous outcome; the man quit his habit of
drinking and promised to stay away from the habit. This sounds like a testimony in church, but this
isn’t that at all. It is a miracle we often forget we are capable of performing. This was a witness to the
fact that life skill education has enormous potential to help adolescents and young adults to face,
solve and overcome hurdles in life, to make the right decisions and to take appropriate measures in
stress situations.
The Anti-Tobacco Campaign
The Community Health Cell team has been working extensively on the issue of tobacco and poverty.
Chander, who heads the initiatives along with consultations with the other team members, has been
networking with various other NGOs and CBOs in strengthening the movement. College students
are being roped in through interactive classes and talks on the ill effects and the social paradigm of
the problem. Anti-tobacco rallies and demonstrations have been held with the networks. This has
been an ongoing activity of Community Health Cell for many years. Its pace and strategy have been
well worked out to improve the current trend of the movement.
Movements and Campaigns
The People’s Health Movement which took shape after the Dhaka summit of the People’s Health
Assembly in the year 2000 was of great significance to me especially while considering the strength
with which it dialogues with Government both at state and international levels. The National
movement called the ]an Swasthya Abhiyaan has taken of at vanous state levels.
Meet Sr. Celina and a Group of Nuns
A group of nuns located very close to the Ragiguda Slum
near JP Nagar of Bangalore helped us by taking us around
a slum and introducing us to many of the families, with whom they closely worked on economic
empowerment initiatives. Some of the women (of the slum) themselves agreed that since the
economic empowerment programs were linked to the education of their children, their children’s
education got a higher pnornv The initiatives of the religious nuns we were able to give us an in
depth view of the economic empowerment programs among the urban poor.
Observations |
Many y oung adults and old were suffering from Tuberculosis (both history and
symptoms suggested)
Housing was poor and there was overcrowding in almost all the homes
Mam w omen li\ cd on beedi-making and aggarbatthi-making for their livelihood
\X omen deserted by their husbands too lived in the slum while taking care of their children and
earning
A lot of children were yet to be enrolled tn schools and had not been sent to Anganwadi centres
either
The narrowness of the streets and the lack of space brings about frustration among children who
enjoy space and freedom
A lot or children were however yet to be enrolled in schools and had not been sent to
Anganwadi centres either
Slum dwellers are a lot more close knit and warm and always offered a seat or something to drink
soon after some time in conversation
Slum dwellers are generally more resilient and strong. They have developed mechanisms to face
the everyday struggles to survive and live too
There are issues like goondaism and exploitation that are not spoken about. The slum dwellers
remain under the grip of unscrupulous elements who often exploit of the weakest of the them
(Women, Children, the old, and the deserted)
This exposure to various urban issues sure put forward many questions in my mind and had a
tremendous impact on the wav I speak with street children, alcoholics, house helps, vegetable
vendors, auto drivers, and rickshaw pullers. Each one of them has a story behind her/him, a
true-life storv that is under constant question, which still goes on, because it has to. These
growing numbers of displaced people living in ciues strikes me as a spill over of a rural neglect and
rural impoverishment.
People of villages are proud of their own villages for the slightest reason. They have an identity, have
and address of dieir own, a land sometimes of dicir own, and most often a family and friends whom
thev know from birth. Here in the cities, they don't often have a sense of belonging or it takes a
while before such a belonging is felt. It is often the case with us too; we don’t feel like staying tn a
new place beyond two or three days, or a maximum for a week. But, under circumstances that are
pressing, we would often have to suppress our inner dislike for the place and continue to stay.
Observation shows, most ot the health problems have an underlying social context and socio
economic link that triggers them off In the truest sense, a larger displacement oi the rural poor and
an extreme growth oi cities cannot be immediately prevented, but needs careful thought and political
will tor tins to be gradually phased out, or even be firstly discouraged.
Community7 Health Gyan
As children we used pencils thereby7 knowing that we could change things when
they7 went wrong; an eraser was a simple answer.
As grownups, we have begun to believe that we can’t change things, now that we
use indelible ink.
There is need for simple living, sacrifice and dedication to change today.
Otherwise, our future generations would be destroyed by our poor attitude
abraham
4.
Setting Objectives & Planning the Year of Fellowship
Atlei much internal churning, and thought I came to set of objectives that I set for
mxselt ioi the one xear. A lot of it was in hope that I would be able to add and chance
these objectixes slightly from lime to time, since I am bound to change my views and
immediate objectives too.
Dr. Ravi Narayan, my mentor and friend, helped me to put my objectives into sub
headers to understand and classify the kinds of objectives.
Internal
A.
•
To leam how Health is a part of development and to explore a vocation in
•
To be under the guidance of able and experienced hands and to share their
Community Health taking into consideration wholesome health
dreams, experiences, approaches, failures and successes
•
To build my own capacity' and to change certain beliefs and assumptions that
•
To have a years time for soul searching on my stand in order to deepen my own
may be harmful
understanding of the powerhouses that affect health at various levels
Community Health (General Learning)
B.
•
To integrate various aspects of Health with general sustainable development
.
To internalise the aspects of equity, distribution of healthcare, and the access to
.
To understand the larger determinants of health and disease for developing
.
To understand and resist exploitative medical, pharmaceutical and other
healthcare.
necessary safeguards
healthcare practices which impoverish middle and low-income groups
.
To study the structure and function of the Public Health system as also of the
Private healthcare system and understand the merits and demerits of each of
them for planning an alternate system, where both coexist (perhaps) devoid of
malpractice and negligence
C.
Community Health (Field Learning)
1 o biing about and promote local innovations in community based
health
systems and integrated development
1 o be in a community based 'health and development’ programme for removing
biases that comes from distance learning.
To try various approaches to reach village communities and to first understand
•
their pace of life, they’re needs and aspirations, before planning and
intervention.
To learn how concepts of Health can be kept simple, comprehensive and fair.
•
Networking
D.
•
To share the enthusiasm and commitment with other persons and organizations
in the field of Health and Development
To network with them and build capacities and plan a more streamlined
and united approach for affecting greater challenges in policy that bring
equity in access and distribution
Communication
E.
.
To understand and learn to the use of media to get across the concepts and
practices in simple and effective healthcare models
5. 7/?e Journey with Scuighaniitrc
Here is a brief account of the one year of efforts from Sanghamitra towards strengthening of the
sub-centres in Chegunta Mandal. This is to give you a brief idea of the activities in the project
that concluded end of August. In all these activities I have worked as a part of the team and
always associated with the planning and implementation of these programmes.
In addition to the sub-centre revitalization programme the most important of the health initiatives
taken up by Sanghamitra was the community eye health programme. This programme was
planned and proposed to the Sight Savers International, which then came into operation in April
2004. It was indeed a good experience for me to have been able to help in the project planning,
and implementation. This showed me some of the most difficult areas in development including
that of Human Resources and Human relations.
Today every village in the Mandal has a village health committee, self help groups that monitor
their functioning and youth activists who report some of the gaps in the health system and howone could change things.
1.
During the project period Sanghamitra strengthened the village level awareness on the
public health system through daily village visits to meeting with Self Help Groups and
the village Janani Committees. These village meetings contributed to increasing
awareness among women about the health facilities, the sendees available and also
regarding the duties of the public health personnel.
2.
Most villages and hamlets in the Mandal were covered during the project period for
purpose of strengthening the people changing their perceptions of the public health
system. The Janani Committees became the main contact points of the villages during
the vear for all health related activities in the 36 villages and the 8 major hamlets. The
village JANANI COMMITTEES have been imparted knowledge about the services of
the public health system that are due to the public as a state responsibility and not as a
welfare measure.
3.
The JANANI committee members today help the health workers from both the public
health department but also from NGOs and other Governmental Societies such as Velugu
and DWCRA to conduct surveys, report deaths and report case studies of denial of
healthcare in public and private healthcare facilities.
4.
Though the time frame prescribed by the project to empower village Janani Teams
Village Health Committees and the Community Advisory Boards to take up the complete
responsibility of locally monitoring the services was realized to be quite insufficient
considering the slower pace of village life and the village reactivity to programmatic
implementation of the project.
5.
The project holder, Sanghamitra, facilitated people to make complaints regarding the
poor sendees in the Public Health system in the area. These efforts initially brought about
criticism from the Government Staff, but over time all the staff members realized that the
project inten'ention was intended to bring back transparency in the services of the Public
Health System.
Today, many of the staff members continue to collaborate with the
project holder and the Janani Team Members in activities that improve the health
conditions of the people.
6.
The health committees in some of the villages brought to the notice of Sanghamitra cases
of denial of healthcare in many different places.
Integration - A vision with Fr. John
Integration has been Fr. John’s dream from the time he was working with the Catholic Health
Association of India (CHAI) as the director. As the founder and secretary of the organization
Sanghamitra Fr. John is hopeful that the objectives with which they setup Sanghamitra would be
realized some day. Fr. John always says that the deeper meaning of integration must be
understood by the people, the leaders and the administration. So, he always begins with the staff
of Sanghamitra lavs emphasis on their role of integrating the health sector, the developmental
sector, the agricultural sector, the forest and environmental sectors, the education sectors and the
administrative structure. He believes that true development would take place only when there is
unison among these sectors.
During this one year...
•
The sub centre revitalization programme
•
I was closely associated with the village library project that covered a population of
20000.
•
The community eve health programme covering a population of over two hundred
thousand
•
Identification of children who are in the risk of being trafficked
•
Working and interviewing Street sex workers
NB: Programme reports set as annexure
The Land and Plenty of Talents
Tapped or Untapped?
The Mandal ot'Chegunta is known for its diverse population and peaceful coexistence - different castes.
religions, sects and economic strata, alike. This coexistence had contributed to the growth and
development of the society in diverse ways.
Chegunta and its neighbouring mandals flourished once with weavers, artisans, basket makers.
shoemakers, dressmakers, potters and acrobats. The strength of these art forms came from generations
of dedication, steadfast local improvisations and a constant demand for the various products. The
market and demand for these products and art forms had existed locally for many hundred years but
unfortunately died a sudden death. The sudden changes in the open markets, mass industrial production.
and lack of preparedness among artisans and neglect of such small industries impoverished the artists
and lead a number of them to migration and suicide. Some of the well to do persons took to other
lucrative professions. Today some of these professions lack the critical mass to voice their concerns
about their difficult lives and dying professions. These people are also best at their own trade and
profession. They are less inclined to other forms of livelihood opportunities and this warrants
intervention from many quarters including those of Governmental agencies, NGOs, local bodies.
women's collectives and surely that of the communities in which they live.
The Last Man Standing
The Weaver Community engaged in the making of cloth, sarees, dress material, dying and embroidery
have only one person in the whole of three blocks (as far as the knowledge of the people of the
community *(Padma Shali) continuing the profession of their ancestors. Shri. Baia Narasaiah is the
last man standing, and does the long learnt art in pride. He does not produce many items but takes care
that he does not stop spinning wheel. His wife is a proud and worried woman, who describes the pace
of his work as "sacred". She again lightly puts it as “Nela oka pogu” (one yam a month).
The Sanghamitra team that visited elderly man were touched by his sincerity, humbleness and
simplicity, not to forget his hospitality. He said, he could teach this profession to patient, and eager
youth who could carry on this profession. He said that women could well carry out this profession
forward if they were given the necessary training and support. Shri. Bala Narasiah is the last man
standing against the onslaught of the effects of industrialization, neo-liberal economic policies and
globalisation.
Wooden Wonders
What was passed on from the fathers and forefathers of Mr. Md Sarvar Hussain today still holds hope
and livelihood for the 20 families of Chettlathiminaipally. Wooden handicrafts - such as Units for
garlands and wooden ornaments. Door knobs. Koolattam sticks. Dolls, and other small artistic carved
wooden implements. The art from must have originated from the Mughal time and has a history of more
that 150 years in this region. This art from provides a round the year employment and has an excellent
export possibility in the years to come. Today, it is limited to Hyderabad but if explored, this art from
can build into a very good small scale industry' and the results for the communities needs no mention.
Mr. Md Sarvar Hussain, and Mr. Md Kausar Hussain of Chettahhimmaipally have a lot of promise in
store and we could well take them to higher strides through integration and support.
Bangles of Pearls
Chandampet has been long known for making bangles with pearl and precious stone inlay work. Today,
as many as One thousand of such artisans have migrated from Chandampet for better prospects to other
areas thus leaving the local economy in shambles. The support system in the local economy was
devastated a few years ago w'hen the market economy came into full thrust and industrial production of
less exotic and cheap bangles were produced on a mass scale in various parts of the country. The local
traders did not have the necessary inputs on aggressive marketing and were suffocated with the
breakdown of their market.
Today, there is hope again with women involved in DWCRA SHG groups taking the lead in reviving
the production lines of the profession. We hope that their effort have a long way to go and lots to
promise the local economy and the pride of the people of Chandampet.
Potters with Empty Coffers
The potters the region have another miserable story to tell.... There are many potters and the new age
pottery' has not left them with much. The changes in the wants of the people and the changes in the
lifestyle of the people has left them with little. The main employment generating source was earthen
roof material. The roofs of concrete, which do not conform to the climatic conditions and health of the
people, have decreased the demand for earthen roof material to an all time low. to almost nothing. Brick
houses and concrete jungles in the area have not only affected the growth of the industry but also
changed the economic support systems of the people of the area. Lack of knowledge and stagnation
among the potters and other social factors has brought them to this pitiable situation.
Prospects for them seem bright when we see the brighter side—
Tile making units, brick making units and other small handicraft from making units of clay and mud
can change the bleak future of the community....
Baskets of hopelessness
Basket making tribes in the area are underpaid and have been at the mercy of bargains and daily
troubles. The skill passed on to them from generations is still being utilized to the maximum today...
We need to bring hope to these people through a well thought strategy that would bring sustained
equality in pay and earning. Improvement of skill through skill development classes and training
programmes can bring much entry into the markets of cities and local minds.
Women neglected, society demolished
Women in the area have taken to beedi making putting their mental, social, physical, and spiritual
health on a thin line.... We need to bring back the life of the people and identify with them closely, as
close as to the heart. The changes in the economic patters, markets and the new age needs kept in mind
we need to change things positively and for good. Women need to be not just empowered economically
but also given their due in society' through out programmes....
We need to bring back the glory of the skill in the area and involve the women in this effort to the
maximum...
Schools of Weaving.'Units for Bricks, Units for Wooden implements and basket making industries have
lots to promise... Aggressive marketing and education of local consumers of self sustainability of
economies is the need of the HOUR.
Dr. Abraham Thomas
Intern, Community Health Cell. Bangalore
Place: Chegunta, Medak District
B.Kondapur Village, Chcgunta Mandal, Medak District
The Janani Team
Bonal S C
1
Sarpanch. Chairperson
Sri. Karingula Mallawa
2
ANM, Convener
Smt. M.Sarala Kumari
3
Ward Member
Smt. Paleti Laxmi
4
Angamvadi Worker
Smt. R.Napurnima
5
Self-Help Group
Members
Smt. Srkali Mangamma
Smt. Chanda Mangamma
6
Mother’s Committee
President
Smt. Boya Padma
7
Youth Activist
Preferably Adolescent
Rangammapari Swapna
Action Plan area of ANM including all the Hamlets and Tandas
1.
2.
3.
4.
B.Kondapur_________________________
Bonal_______________________________
Pulimadu____________________________
Kistapur ft)
ANM Signature
Sarpanch, B.Kondapur
Pl IC Medical Officer
Mandal Development Officer
7.
Soul Searching
7 here is a lot or truth out there: ire just need to realize them... [_ive them and see what »c
need r our In es. take them and earn) them for others to see. ~[~ruth is what will change hearts,
not intellectual exercises —
/ made this up ©
There is a philosophy of Disease, the realization of‘Self during illnesses, the knowledge of
civilizations, the philosophy of simple and holistic health, the humility of healers, simplicity
of their thought, the need for sacrifices in life, the acceptance of natural death, and the
simplicity of healing, which are the utmost lessons of health in the Indian context.
We have a rich culture that has a beautiful methodology of dealing with sickness and the
soul way of dealing with losses, disease or disability. For example, we need to appreciate the
concept of community based healing of the mental illnesses in manv parts of the country.
Though we are on a warpath trying to ape the western hospital based care, we need to keep
the ever more simple and effective approaches of healthcare in the reach of all people. All!
In September 2003 I began my journey with rural India’s health, where fresh air, simple
living, nutritious and fresh food, and love were in abundance. I surely did not look for what
they did not have. ‘People - sure did not have my ‘know it all attitude’.
These were some of the most intriguing times of my life, when I was left to myself in a
relatively underdeveloped region in terms of investments and industry and left to feel
with the people what their everyday lives had to offer, the processes in place, the systems
which were either or not in place, and to see the patterns of livelihood opportunities and
future trends that were to come.
The experience alongside Sanghamitra work in the area was particularly enriching
because the organization is young with its set of teething problems, and with its own
philosophy that's evolving with in-depth involvement in communities. One of the man}
things 1 learnt to be patient while looking at bringing about changes in systems. Patience
is a virtue that has to be picked up whenever possible and this would be particularly
useful to those working with the public health system, because of the intrinsic slow
speeds with which things take their course. But. there is of course the need for a
systematic involvement of communities in taking up health and development at all levels
beginning from the villages up to the district and state than leaving anything to chance.
------- children we did know that ive could change situations since we used pencils
and erasers...but as we grow old we begin to believe that we cannot change things
because we use indelible ink and we just feelsuffocated without finding solutions.
—/ made it up
8.
The future of the fellowship
The fellowship
programme planning
economics, public health planning, financing, globalization and public health, disaster
management, etc. or rather new areas such as public health and media, animation,
communication strategies, creative writing, text book writing for school children. | he
spirit of CMCli nkmg between activism and policy advocacy should be strength.
expands operations to other states or regions through these linkages.
1 he lellowship programme should be dynamic and accommodating to the interests of the
individuals, which it does today. The programme is certainly aimed at bringing a dialogue
between various players in this fast changing world for healthy futures in order to safeguard
the interests of people who otherwise become spectators of destructive changes. Public health
in India is still in the process of searching for the right answers to many complex situations.
Community based health programmes that are self sustainable with equal participation of the
State needs to be brought about with ardent efforts of young individuals who dedicate their
lives to bring about the much needed changes. It is important to keep in mind the time it took
for many organizations to build their capacities to the extent they have come, which would
remind future generations that one needs to live not just for today or a lifetime, but for the
future of the world surrounding generations.
This association through my internship with Community Health Cell has made a tremendous
impact on my life. I thank each one my guides and team members of CHC, Sanghamitra. and
all those who were associated with me for giving me the insights I have today and I believe
we would work together in this journey together.
1 thank each one of you for being a part of my life. I thank Matthew Abraham especially for
having been an excellent support during this year as a colleague and friend.
Sanghamitra--Sight Savers International
Comprehensive EyeCare Services (CES) Project, Medak District
A BRIEF ACCOUNT OF PROJECT IMPLEMENTATION
The project was initiated with the selection and training of 12 Eye Health Workers, one
Supervisor and the Coordinator of the project at ICARE, LVPEI, Hyderabad. The tnreeweek long training programme was carefully crafted to cater to the need of the CEHWs
and Supervisory Staff members. One supervisor joined the team on 12 May 2004 (He is
trained in community eye care and community based rehabilitation at ICARE LVPEI and
was involved for six years with various initiatives in community eye care and community
based rehabilitation programmes of LVPEI in conjunction with SSI)
THE PROJECT TEAM
Project Director: Fr. John Vattamattom, SVD
COMMUNITY EYE HEALTH WORKERS
Pulaboina Devanand,
Rukhsana Sultana
Pembanhi Laxman
Koppunnuri Veerapa
Kondal Reddy
Kolupula Anasuya
K. Radhakrishnan
THE NEXT STEP AFTER THE TRAINING
After the training programme. Sanghamitra conducted a Door-to-Door 'mock baseline
survey' on Eye Health for three days in the neighbouring villages of its operational arec.
This was done primarily to evaluate the CEHWs’ performance at field level and to
ensure efficacy of the actual baseline survey.
During this period, Sanghamitra arranged few training sessions with "Velugu” Resource
Persons, "Local Doctors" and other In-house staff members regarding the local terrain,
habits, diseases, and socio-economic and sociological aspects of the area. This helped
the CEHWs to understand the spirit of Sanghamitra and to know the other activities, with
which Sanghamitra is actively involved. This also helped in bringing about integration of
various activities of the organization.
The baseline survey on eye health began immediately after the return of the staff from
their training at LVPEI.
For undertaking the survey Sanghamitra prepared the following materials_______
Baseline Survey Forms with translation [to Telugu) (Provided by SSI)____________
Consolidation Forms and lists (Provided by SSI)_____________________________
Area Revenue Details
____________________________________________
Population and other details from Previous Surveys of the Velugu Project (APRP)
PHC and sub-centre Details____________________________________________
Route Maps__________________________________________________________
Lists of Primary and Secondary Schools___________________________________
Lists of Auxiliary Nurses and Anganawadi Teachers_________________________
Details available with Sanghamitra about differently able children
PHYSICAL PERFORMANCE
I. Resources Built
Activities
Total Number of review Meetings
Total Number of Awareness campaigns conducted at village level along
with the baseline door-to-door survey
Digital Video Recoraing of the survey and educational programmes on eye
health
Meetings with Velugu Project personnel (Govt. Of Andhra Pradesh, Society
for Elimination of Rural Poverty (SERP))
Orientation of CEHWs to tapping local resources in project area
8
10
1 1
2
3
II. Eye Care Activity
Summary of Door-to-Door Survey
33 j
Total Number of Villages covered
Total Number of Households Surveyed
Details
Total population
covered
Total number of curable
cases
Total Number of
Incurable cases
6228
Adults
Male Female
Children
Male Female
Total
Male Female
Grand
Total
11947
12040
5365
5222
17312
17262
34574
2332
3235
224
269
2556
3504
6060
34
21
3
1
37
22
59
TO DATE THE COMPREHENSIVE EYE CARE SERVICES PROGRAMME HAS ACHIEVED THE
FOLLOWING:
-
-
-
33 Villages and 18 hamlets have been covered through door-to-door survey
A total revenue population of forty-six thousand (approximately) has been
covered during this period. A total of 6928 households and a population of
34,574 participated in the survey.
59 Incurable cases of blindness were identified so far (these cases need
screening and further evaluation before Community Based Rehabilitation
Programme, (CBR) is begun
A large number of cases of Vitamin A deficiency were also identified
Many other eye-related diseases were seen and have been recorded for
interventions at various stages.
[NB: The reasons for a difference between the
revenue population and the actual
covered population were found to be the following:
1. Migration to other places in search of work as
a result of continuous drought conditions for the
last 7 years
2. Owing to people engaging in daily labour, and
3 Summer vacation]
THE BASELINE SURVEY - HOW WE WENT ABOUT
The team of CEHWs were detailed for conducting the baseline survey in groups of 4-8
members. They have been covering an average of 25 households per day per person
initially owing to lack of experience in conducting the survey and the learning involved.
This has now been improved and it is targeted to touch 50 plus houses per day per
CEHW. The lack of cycles and motorbikes was supplemented by using auto-rickshaws
and other means of transport.
ACTIVITIES PLANNED FOR JULY
Conducting awareness programmes about the project and on Eye Health in the
context of the baseline survey findings
2. Planning meetings with ICDS/Anganwadi Teachers regarding immunization
programme linkages and IEC activities on Eye Health
3. Conducting training programmes on eye health for Anganwadi Teachers and
ANMs
4. Conducting community based education programmes on Eye Health for Self
Help Groups (Formed by Sanghamitra and Govt, agencies), Village
Panchayatiraj Members, and Primary School Teachers
5. Identification of resources and resource mobilization for screening programmes
6. Conducting community screening programmes
7. Initiation of referral services to LVPEI through planning and Molls (An introductory
letter to the Director of LVPEI in this regard expected)
8. Launching of the CES Project at Block level
1.
Concurrently, the baseline survey will continue in Toopran and Ramaymapet
Mandals.
Dr. Abraham Thomas
Intern in Community Health and Development
Sanghamitra
RGF Village uoranes
Second Quarterly Report (January to March 2004)
Project No; 6/2003
-•
1300/VL
sanghamitra
Village Libraries
1
2
1
PROCESS INDICATORS
—
’
10
9
8
5
4
3
--------
Cluster Code
...___________________
Ub?ary Code
_________________ —
RGF Rural library
Vallabhapurani
RGF Rural library,
1 RGF Rural Library,
Vallabapurarn
B. Kondapur
Wadlaram
Village
B. Kondapur
Wadlaram Village
Chegunta
Village,
Chegunta Mandal
Mandal
Chegunfa Mandal
Medak District
Medak District
Medak District
Pin. 502 248
Nome and Address ol lira
library
RGF Rural Library,
Chandalpet
Candalpel Village
Chegunta Mandal
Medak District
RGF Rural library,
Poddashlvunoor.
Peddashlvunoot
Village
Chegunta andal
Medak District
RGF Rural library,
Reddlpally
Reddlpally Village
Chegunta Mandal
Medak District
Pin: 502 255
RGF Rural library,
Gollapally
Gollapally Village
Chegunta
Mandal
Medak District
Pin: 502 247
RGF Rural library,
Bhlmraopally.
Bhlmpraopally
Village,
Chegunta Mandal
Medak District
RGF Rural Library,
Karnalpally
Karnalpally
Village
Chegunta
Mandal
Medak District
RGF Rural library,
Upperpally
Upperpally
Village
Chegunfa
Mandal
Medak District
D. Krishna
1
Nome of the Librarian
Mujammll Md.
T. Yadagirl
R. Sudhakar
D. R. Sunanda
Mallesh
V. Mahlpal Reddy
B. Ravi Kumar
R. Swapna
B. Vanaja
Date of Establishment
02 1003
03.10.03
07.10.03
08.10.03
09.10.03
12 10.03
10.10.03
22.10.03
22.10.03
Total Number of Paying
Members
Male:
Female:
33
33
30
30
32
32
30
30
31
31
50
50
40
40
30
30
Total Number of Readers
40
35
40
25
25
30
15
15
13
30
1
f neouragement
Encouragement
Encouragement
Encouragement
Encouragement
Encouragement
Encouragement
Encouragement
Encouragement
t neouragement
1
259
255
249
256
249
295
288
282
247
254
1
Steps taken to increase
Membenhlp
Number of Books Received
from RGF HI date
Number of Books Received
from other sources during the
quarter
Total Number of books In the
library____________
1 23.1003
58
259
255
249
256
249
295
288
282
247
254
Type of books preferred
General
Knowledge. Books
on Religions,
^ovel$Compelilion
Magazines.
V/eekHes, Fiction.
B Ed. Resource
Ma,erial
General
Knowledge.
Books on
Religions, Novels,
Competition
Magazines.
Weeklies. Fiction,
B Ed. Resource
Material
General
Knowledge,
Books on
Religions, Novels,
Competition
Magazines.
Weeklies. Fiction.
B Ed. Resource
Material
General
Knowledge.
Books on
Religions, Novels.
Competition
Magazines.
Weeklies, Fiction,
B Ed. Resource
Material
General
Knowledge, Books
on Religions,
Novels.
Competition
Magazines.
Weeklies. Fiction,
B Ed. Resource
Material
General
Knowledge.
Books on
Religions. Novels.
Competition
Magazines,
Weeklies. Fiction,
B Ed. Resource
Material
General
Knowledge,
Books on
Religions. Novels.
Competition
Magazines.
Weeklies, Fiction.
B Ed. Resource
Material
General
Knowledge, Books
on Religions,
Novels.
Competition
Magazines.
Weeklies. Fiction,
B Ed. Resource
Material
General
Knowledge.
Books on
Religions, Novels
Competition
Magazines,
Weeklies, Fiction,
B Ed. Resource
Material
General
Knowledge, Bocks
on Religions.
Novels.
Competition
Magazines,
Weeklies. Fiction.
B Ed. Resource
Material
Names of News
Papers/Magazines reaching the
library
Eenadu
Eenadu
Eenadu
Eenadu
Eenadu
Eenadu
enadu
Yes
e$
0
Are the Newspapers/
Magazines reaching the library
Yes
regularly
Average daily readership for
Newspoperj/Mogazlnus
Mole:
40
Female:
Children:____________________ _in_____
Number of Library ( nmniilleo
Mootings Hold
Any important dot <•.■<.m liikon
by Ilia library commlllutis
Eenadu
Eenadu
Eenadu
Vaarlha
Andhra Jyolhl
Deccan
Chronicle
Maqx: Swathl
Yes
Yes
35
40
10
to
03
03
03
03
Yes
Yes
Yes
Yes
Yes
25
25
30
30
20
3
06
05
10
15
)5
>3
>3
»3
’*
__ j
< •
I
|
the library Committee
Monthly:
Annual:
Any other:
Monthly. Minimum
b- './
Monthly
Minimum Rs. 5/-
Monthly. Migimum
Rs.5/
Monthly.
Minimum Rs 5/-
Monthly. Minimum
Rs 5/
Monthly.
Minimum Rs 5/-
ponthfy.
Minimum Rs 5/
Monthly Minimum
Rs 5/
Monthly
Minimum Rs 5/
Month!/ Mp-mum
Rs 5/
Timings of the Ubrory as
decided by the library
committee
(J/uO - 0900 hrs
1700 1900 hrs
0800- 1000 hrs
1800 - 2000 hrs
0700 - 0900 hrs
1700- 1900 hrs
0700 - 0900 hrs
0700 - 0900 hrs
1800 - 2000 hrs
0630 - 0830 hrs
1700- 1900 hrs
0700 - 0900 hrs
1800 - 2000 nrs
0700 - 0900 hrs
1700 - 1900 hrs
0700 - 0900 hrs
0630 - 0830 hrs
1700-1900 hrs
Steps taken to mobilize
resources to collect donations
In cash/in any other form
Personal
interaction
Personal
interaction
Personal
Interaction
Personal
Interaction
Personal
Interaction
Personal
Interaction
Personal
interaction
Personal
interaction
Personal
interaction
Amount In Bank / PO tin dale
Rs.500.00
Rs.3S0.00
Rs. 100.00
Rs.480.00
Rs.360.00
Rs.800 00
Rs.750.00
Rs.757.00
Rs 325 00
Additional Activities being
'undertaken in the library
Republic Day
Celebrations
Republic Day
Celebrations
Republic Day
Celebrations
Republic Day
Celebrations
Republic Day
Celebrations
Republic Day
Celebrations
Republic Day
Celebrations
Steps taken to sustain the library
-
-
-
-
-
-
Any other Information /
problem that you wish to share?
-
Amount of Fee / Rne I
Donation collected In the
quarter
-
-
-
-
Nolei:
1.
Despite ropeoicd efforts, the members of the libraries ore not paying their membership dues regularly
2.
The members are more Interested in reading Newspapers than books.
3.
Educated women and girls have slopped using the libraries in all villages, perhaps because of Iho societal restrictions.
School going children have not been utilizing the facilities In the last two months on account of their annual examinations.
5.
The library In Reddlpally is noi doing well, os tar as payment of membership fee is concerned, though the readership Is comparatively higher.
6.
The librarian at Bhlmraopally. B Mallosh, has tell the services owing Io personal reasons. The library Committee Is now on Iho look out for a replacement.
7.
The Gollapally Library has been shifted Io a panchayot-ownod building in the village from a private owned building. However, the condition of the panchayal building Is poor.
8.
The members of the Vallabhapuram library are planning Io raise a sum of Rs. 2500.00 as donation lor the library.
------------------- ----------------------------- ---- ------------------ XXXXXXXXXX
-
------------------- ---- ---------------------
Rs.380.00
Republic Day
Celebrations
1
Dear Mr. Vasanthram.
pvnlnta break up of the expenses Meghamala would incur in the next three years. The monthly
t P i i x C°U ° Pe 'ncreased the need be, but otherwise, I don't want it to be that she gets used
to a lot of money she wasn't all these days
Thank you
Abraham
SI.
Expenditure
Amount
Yearly Total
Refundable
1.
College fees annually
2350.00
1800.00
(SC scholarship)
550.00
2.
Hostel admission fee annually and deposit
2750.00
1300 00
1450 00
3.
Monthly Hostel fees and Mess Bill
1150.00
Nil
13,800.00
4.
Monthly Personal expenses
400.00
Saving for the month
4800.00
5.
Monthly expenses on stationery and purchases for
material in labs and college
250.00
NA
6.
Coordination expenses for Sanghamitra annually
1800.00
7.
Clothes
1800.00
1000.00
23,700.00
Total Support Required
Total scholarship received annually
3000.00
3100.00
Th e Science Chan n e I
process in progress
tn launch satellites and longer to make them useful to common people. As a
J
country.
' cffoi t. ISRO plans to launch a Science Channel that would be accessible across the
To bring about participation and uniformity of character in the vision of the Channel, DECU
(Dexelopment Education and Communications Unit) of the Indian Space Research Organization has
initiated a contact programme all over the country. DECU had brainstorming sessions in various cities
across the country with think tanks, scientists, students, farmers, union leaders, filmmakers, writers
and people from the mass media. These sessions were held in Mumbai, Bangalore, Kolkorta, Gauhati,
Delhi and Ahmedabad with the help of Ms. Chondita Mukherjee, a renowned docu-film maker and
thinker.
Various
student-volunteers,
professors,
and
representatives
of Non-governmental
Organizations helped in the success of the extensive and detailed consultations.
Community Health Cell too took part in the initial consultations, and later in the planning and
facilitation of the two-day workshop at Bangalore. It took the lead in planning and formulating the
framework of the content on health content on the proposed Science Channel. Dr. Sanjay Biswas.
Professor of Mechanical Engineering at the Indian Institute of Science (IISc) was the key organizer of
the initial brainstorming and planning of'the workshop. He also led the team in the final 2-day
workshop held at ’Ashirwad’, on St. Marks Road in Bangalore.
.4 survey was done in Andhra Pradesh prior to the consultations at Bangalore to bring out
information on TV viewing among the southerners (Telugus, Kannadigas, Konkanis, Tamils,
Malayalies and other linguistic minorities). CHC took the lead in doing the survey on rural TVviewing. This was crucial in giving shape to inputs for the health content on the channel.
The survev was conducted in Koduru. a block division in Cuddapah District of Andhra Pradesh: here
a lot of issues related to TV viewing were brought to light.
Aims of the Survey
- To elicit the TV viewing patterns among rural populations.
- To evaluate the needs of TV viewers of rural areas & to elicit their understanding and its
applications in their lives
- To evaluate their likes and dislikes about TV programs
- The role of TV in their lives today
Report on the Deliberations of the Health Group for the
Science Channel
The composition of the health discussion group
1. Dr. Uma Sri, health communicator and specialist trainer in health
communication
(Village school exercises and interactive learning through visuals),
Worked with and organization called THREAD in Orrissa
2. Elizabeth Vallikad, Former professor at the KIDVA1 Institute Of
Oncology, Bangalore. Currently head of the Department of Gynaecology
at St. Johns Medical College,-Bangalore
3. Dr. Srinivasa Murthy, Professor and Head of Psychiatry, NIMHANS
(National Institute Of Mental Health And Neuro-Sciences), Bangalore
Specializes in behavioral psychiatry and life skill education to children
and adults
4. Dr. Sanjeev Jain, Professor of Psychiatry, NIMHAMS
5. Dr. Rajan Patil, Community Health Cell (Homeopathic Doctor,
Epidemiologist, Specialist in Vector borne diseases such as Malaria, Kala
Azar and Dengue)
6. Vajranna, (A village health activist)
7. Sachin Dsouza (Intern, St. Johns Medical College and Hospital, founder of
the Forum 19. (1). (a) which deals with various Current Issues, Health
Issues, Rights issues and Awareness among various student groups across
Bangalore.
8. Suvama Deshpande, Video Production Unit (DECU)
9. Michael John, Film Maker, worked as a film maker with CHAD, Vellore
on Leprosy and health related issues
10. Prof. Dr. Vidhyanand, Professor, Indian Institute of Science
11. Nirupama Sharma (Health Consultant), and
12. Dr. Abraham Thomas, Dentist, Fellow at the Community Health Cell,
Bangalore
The discussions were documented by a number of Students from Srishti
School of Art ad Design
1. Nithya Rao,
2. Shamin Dsouza,
3. Seema,
4. Ekta,
5. Natasha, and
6. Thomas,
(Students of Communication and Design)
thp Hicr n'
S1OUP
students helped not only with the documentation of
nrnc. \ 'SlOns Ult a^so
contributing innovative ideas and methods for the
p csentation of the various TV programmes on health. Their inputs are very
‘ ua e, am their doubts on health issues lent 'great strength' to the
discussions.
&
°
Di. Abraham Thomas, Focal Person for the Health discussions, moderated the
various discussions. He is a Ratan Tata Fellow for Community Health, at
Community Health Cell, Bangalore.
MINUTES OF THE FIRST DAY CONSULTATIONS
The initial discussions were aimed at identification of areas of health that require
immediate attention and address. Various persons at the group discussions
introduced themselves to each other and made themselves comfortable in the
discussion group.
,
Prof. Dr. Vijayanand of the Indian Institute of Science suggested a documentary
series with the use of the Normal Functions of the Body since basic physiological
functions are interesting and is very important to know. During the later part of
the discussions on women's health we found that this programme could be
incorporated in education on the biological development of the foetus, genetic
influences, and growth and development.
Dr. Srinivasa Murthy suggested that community health should be an important
part of the channel and be dealt with at three different levels
1. Grass Roots (the people of India)
a. Rural
b. Urban
2. Non- Professional, (for the health workers at Village Level, Block Level, at
Panchayat level and Anganwadi worker's level)
3. Professional, (for doctors, nurses, technicians, druggists, etc.)
He also said that Mental Health was a very important subject for the channel and
the professionals and the government have neglected mental health and the
issues around it - eg. Dependence, Schizophrenia, geriatric mental health, myths and
misconceptions on mental health, etc.
Dr. Elizabeth Vallikad suggested 'women's health as a pressing issue that has to
be addressed with urgency through immediate action and constant intervention'.
She gave startling statistics of the incidence of female genital tract cancers
(cervical cancer) and the high prevalence of this condition among Indian women;
the commonest causes of death due to this cancer are late detection and neglect.
^ecessi*:- or science, scientific understanding of health and effective health
ie glass loot level was identified as an important step in the situation in
nc 1a. uggested bv Dr. Sanjeev Jain, this concept was agreed upon bv the
participants.
or.
,
Dr. Sriniv asa Murthy also suggested that the channel should be working towards
broadcasting (telecasting??)
- Three important areas
1. General information on health issues (health being a integral part of life focusing on primary education, primary health, clean water, good
housing, nutritious food - not drugs and treatment)
2. Controversial health issues through discussion and researched material,
and
3. Specific validated health information
He also stressed the need to study areas of traditional medicine such as Unani,
Ayurveda, Homeopathy, and other Holistic Medical practices in India and to use
the channel to bring about the best of these areas and eliminate malpractices and
misconceptions. Dr. Rajan Patil, who is a graduate of homeopathy, suggested the
necessity to research various areas of holistic medicine and bring out the best the
various fields can offer.
Dr. Elizabeth Vallikad added, “There is a great deal of unlearning that we must
undergo to accept and to be open to the knowledge and methods of traditional
medicine. Eg, traditionally postmenopausal women supplemented calcium to
diet and avoided osteoporosis, instead it is compensated with so many drugs
and supplements today that are not only expensive but unnecessary".
To address the general myths about health and healthy living many participants of the
discussions thought the channel needs. The concept of buying health through medicines
was an important misconception identified even in the survey done in Koduru, Andhra
Pradesh as a part of the run up to the workshop.
Dr. Sanjeev Jain suggested that there is a need to understand the anthropological
aspects of belief systems and addressing them on those platforms, an important
step towards effectively dealing with the mindset of the people.
The issues of gender and gender inequality in health access have been proven
through PHC and hospital records in the past. Dr. Vallikad suggested it was
important to bring about social equality of health.
She emphasized on the alarming rates of female foeticide and infanticide
among the richest states in India (Punjab "754 females per 1000 males") as well
as an alarming decrease in the female ratio in Kerala, which is traditionally a
emale friendly state. This suggests the negative use of high-end diagnostics
(usually ultrasound machines) meant to be used in foetal monitoring.
r. Vallikad said, "The regulation of these diagnostic centers as well as
implementation of laws stringently needs publicity and popular support
through channels such as these". Making doctors responsible and aware of the
consequences also needs special attention she said. At the policy level, attention
must be paid on such criminal practices and their social implications and should
be a salient feature of the health component of the channel.
Another major topic raised by Dr. Sanjeev Jain was the tendency of the Indian
Medical Education to cater only to the deeper pockets, making health
inaccessible to lower economic groups. The corporatization of health services
and the corporate model of health care were discussed along with the influence
of the global economy on our traditional and neo-healthcare systems. The
transparency of these decisions and changes, and what they mean to the health
of the common man was considered to be an important issue that needs to be
researched and broadcast on the channel.
The necessity to integrate traditional approaches to health and health care and
the medical sciences was another area of the discussion that was greatly
emphasized.
The entry of health insurance and the corporate influence on policy of funding
public health care systems was an important aspect of our health discussions. Dr.
Sanjeev Jain and the students of the Srishti School Of Art And Design suggested
these issues be discussed in open forums on TV for participation, for allowing
feedback or criticism. (Eg. Big Fight)
Dr. Elizabeth Vallikad recommended that the influences of the environment on
health be an essential focus of the channel because of the advent of the new age
diseases which often find no causative agent behind the disease. To sum this up
the areas such as
1. New age diseases (BARS, HIV, EBOLA, Viral Gastroenteritis)
2. Ecological medicine, and
3. Investigative medicine
Dr. Sanjeev Jain and Dr. Elizabeth Vallikad recommended these steps to keep
pace with the various aspects of the diseases and their control.
The students from the Srishti School of Art suggested consumer Rights and the
necessity to educate the public via discussion forums on TV and Design and was
backed by Dr. Srinivasa Murthy.
i- anjeev Jain suggested that the evolution of health care practices in India
loin the traditional practices to the current day practices need to be studied and
c ocumented. In addition, the evolution of the National Institutes such as CMCe loie, AIIMS-New Delhi, J1PMER- Pondycherry, St. Johns Medical Collegeangalore,. CMC-Ludhiana, JJ Hospital-Bombay, and many others need to be
understood and documented via the Channel.
-- Many rural health centers and rural models of development and health should
also be documented. The Jamkedh example of integrated development and
empowerment can be an example of community participation.
Dr. Vallikad wanted the art of medicine to come out from the shadow of the science
of medicine for the greatef interest of bringing back the largely lost glory.
Geriatrics, a neglected subject in our country, is another important subject that
requires the attention of both the people and the policy makers because the large
middle aged population of our country' would constitute a large chunk (1/5*°'
the population) in 20 years. Therefore, education regarding care of the old need
to be addressed through the channel.
Dr. Vallikad suggested that Road traffic accidents, health hazards of various
kinds (Industrial, Agricultural, etc.), are important issues to be addressed openly
instead of cautioning through warnings.
—Drunken driving, for example, is a very common practice in India, whereas in
Europe or the US, enforcement is an effective deterrent.
Medical Ethics - regarding the current practice of medicine, the unethical
prescription of drugs by doctors was seen as very critical problem. In contrast,
practicing medicine by the oath one takes, and the need to be highlighting this
with real life stories was suggested by Dr. Thomas and Dr. Dsouza.
Dr. Rajan Patil suggested that communicable diseases have remained important
healthcare issue draining our economy, and how they are sidelined. Educating
people through the health component of the channel would be a novel way of
reaching those who actually' know very little about many diseases including
Malaria, Kala Azar, Filariasis, TB, Typhoid, etc.
He suggested that programmes on the causes of disease, prevention, and their
cures could be very informative and useful.
E<n the fact that common malaria (malarial parasite) carrying mosquitoes breed
in stagnant water over the sunshades, old buckets, and utensils lying outside.
This can be avoided avoiding stagnant water and designing sunshades without a
collection compartment (making it flat).
i. anjeex Jain suggested that the evolution of health care practices in India
horn the traditional practices to the current day practices need to be studied and
c ocumented. In addition, the evolution of the National Institutes such as CMC\ elloie, AIIMS-New Delhi, JIPMER- Pondycherry, St. Johns Medical CollegeBangalore,. CMC-Ludhiana, JJ Hospital-Bombay, and many others need to be
understood and documented via the Channel.
— Many rural health centers and rural models of development and health should
also be documented. The Jamkedh example of integrated development and
empowerment can be an example of community participation.
Dr. Vallikad wanted the art of medicine to come out from the shadow of the science
of medicine for the greatei1 interest of bringing back the largely lost glory.
Geriatrics, a neglected subject in our country, is another important subject that
requires the attention of both the people and the policy makers because the large
middle aged population of our country would constitute a large chunk (1/5* of
the population) in 20 years. Therefore, education regarding care of the old need
to be addressed through the channel.
Dr. Vallikad suggested that Road traffic accidents, health hazards of various
kinds (Industrial, Agricultural, etc.), are important issues to be addressed openlv
instead of cautioning through warnings.
—Drunken driving, for example, is a very common practice in India, whereas in
Europe or the US, enforcement is an effective deterrent.
Medical Ethics - regarding the current practice of medicine, the unethical
prescription of drugs by doctors was seen as very critical problem. In contrast,
practicing medicine by the oath one takes, and the need to be highlighting this
with real life stories was suggested by Dr. Thomas and Dr. Dsouza.
Dr. Rajan Patil suggested that communicable diseases have remained important
healthcare issue draining our economy, and how they are sidelined. Educating
people through the health component of the channel would be a novel way of
reaching those who actually know very little about many diseases including
Malaria, Kala Azar, Filariasis, TB, Typhoid, etc.
He suggested that programmes on the causes of disease, prevention, and their
cures could be very informative and useful.
Eg: the fact that common malaria (malarial parasite) carrying mosquitoes breed
in stagnant water over the sunshades, old buckets, and utensils lying outside.
This can be avoided avoiding stagnant water and designing sunshades without a
collection compartment (making it flat).
ie issue of immunization, its common misconceptions, and realities could be
incorporated into the popular scheme of soaps or family dramas, which would
catch the attention of the public.
Di. Abraham Thomas added that International issues on health and the amd the
changing rationale of treatment and drugs should be another focus. Debates on
populist as well as controversial pro-rich policies, the issue of "Health For All"
(and when the dream would be realized) and many other issues of international
issues open to debate can be a part of the health component of the channel. In
addition, policy level changes as a response to global pressures can be made
debatable and open to the knowledge and approval of the public via this
channel.
At the end of the first day of discussions, the team decided to have two areas of
health for detailed discussions, so as to give shape to these areas from the stage
that they are left at, at a later stage/date.
We therefore decided that the issues of mental health and women and child
health could be a major focus with the presence of eminent specialists from the
field of Psychiatry and Gynecology. The fact that these areas need
comprehensive and reinforced approaches to tackle such issues were discussed
and agreed upon during the discussions. These areas, according to Dr. Sanjeev
Jain, have been neglected and misunderstood by the general public all over the
country for decades.
The women's health issue was initially discussed based on the different
presentation formats we thought would be most important for airing the
channel.
Filmmaker's opinion: Dr. Michael (SRISHTI) was of the opinion that we cannot
make programmes overnight, because we do not have the resources or the
material to formulate the content in excessive detail. He saw the need for a more
comprehensive framework of the two topics being discussed and elaborated
upon, which would then be valuable to decision-makers to take up issues and
further make them into films or documentaries, or animations, or debates and
discussions. He said, that the immediate need is to work out a blueprint of the
two issues identified that would actually form the guidelines for the health
component of the channel.
This wonderful suggestion from Michael helped us focus on women's physical
and mental health with a focus on the issues as well as guidelines.
Di. Uma Sri was keen that health problems of women be a part of a family drama
or based in homes to help people identify with issues as well as retain the
knowledge imparted to them. She said that various aspects of women's health
could be incorporated at many stages and situations. The need to catch the
attention and interest of women across the country was necessarily emphasized.
She said, "Diseases of various kinds, illnesses and issues such as death can be
depicted in family dramas".
Dr. Vallikad emphasized the necessity of bringing awareness about women and
Women's Rights to all sections of society, and every woman. Encouraging
sensitivity to everyday discrimination against women and inculcating a sense of
equality among men and women should be a major focus of health and
development. Many students from the Srishti school of Art and Design opined
that gender issues should be debated and also discussed in open forums to learn
people's perspectives.
The group suggested that The Woman's Life be divided into the following
stages:
1. Preconception (normal biology of the reproductive system, the sequential
changes, the question of contraception, sexually transmitted diseases, and
a whole lot of healthy practices with a great deal of emphasis on the age
related issues of health of a woman and the best age for pregnancy)
2. Conception The biological aspect of conception, fertilization and further
development,
■ The question of finding the right time and planning a
pregnancy, making most of the preparations for the new
life
■ The truth that the birth of a girl is determined by the male
and not the female
3.
Pregnancy
■ The pressing issues of nutrition, immunization,
monitoring, other related issues
■ Foeticide and the issues of illegal sex determination
■ Legal issues and accountability
■ Ethical issues
■ Social Issues and the long-term implications on Society' and
Human Value Systems
4.
Birth
Biology of birth, normal delivery, emergencies and complications)
The issue of birth in the context of family and friends and debatable issues of
various groups of people across the country and abroad.
The girl child's life and her health could be best dealt by presenting it stages.
The stages are
a. Neonatal Period
b. Infancy
c. Preschool (years of immunization)
5.
6.
Childhood
■
■
■
■
School Age
■
Diarrhoeal diseases
Mental health
Child Abuse
Discrimination and Rights Issues
The difference of how the male child's life is better planned
than the girl's life
■ Growth and development and the understanding of one's
own sexuality
■ Abuse issues
■ Development of breasts and the biological reasons and
changes
7.
8.
Menarche
Graduation and further development
Being ready for marriage and issues of health and development that
influence the development and growth of humans
9. The role as an adult, single woman and health issues of the single woman
10. As a mother and a companion
11. As a mother of growing children and their problems. Etc.
(The students of Srishti thought of this concept together with Dr. Vallikad
and Dr. Unia Sri)
The programmes made in this sequential order can actually bring about
interest in the understanding of the health among women and men about
individual and group issues.
Dr. Vallikad was specifically suggested that the sociological part of gradual
changes in a girl's life, which is brought about by the influence of elders in
families, should be recorded. The fact that the girl child often finds her perplexed
o recognize herself an untouchable during her menstrual periods (still practiced
m many part of the country and rural areas).
venson; The very issue of accepting that is required to withstand pain and that
pain is normal should be eliminated front everyone's mind, including the
Romans mind. This is proven by the fact that women come with advanced
problems as a result of self-neglect during the initial symptoms, whether it is
dental pain, abdominal pain, cancerous growth, or abnormal discharge from the
reproductive tract. Giving the girl child the knowledge, and people, the
understanding of biological changes, health and disease, and their purpose and
nature, can break this kind of conditioning.
On the second day, we had consultations with the two eminent staff members of
the National Institute of Mental Health and Neurosciences, (NIMHANS), Dr.
Sanjeev Jain and Dr. Srinivasa Murthy.
Mental Health Discussions and Conclusions
At about 9:15 on the 5th July, the health group met up in the NIMHANS premises
in the Psychiatry7 Department. Dr. Sanjeev Jain had prepared for the
consultations the previous day some of his views on mental health and the
current mental health practices in India. He also was keen on the sociological and
religious aspect of mental health and its relevance to our country in helping to
shape and build support systems for the mentally ill.
He shared with us many basic needs in approaching the aspect of mental health
in the context of the health component of the channel.
Guidelines:
1. One has to regard the existing discourse of mental health (the social,
religious and medical belief systems) with that of practice and practicality.
He said that there should be a dialogue between the beliefs and truths.
2. Increase the common knowledge of the general population on mental
illnesses and normal deviation.
He was keen that the biological aspect of the working of the brain needs to be
recorded and shown in order to improve awareness on the brain functions as - a
very simple but still so complex system that controls many functions. This, he said.
could be done interestingly, bv comparing the human brain with that of the fly, or the
worm or even that of other mammals.
At the same time he was keen on stressing on the fact that early detection of
mental illnesses can be key to a cure. He also emphasized that the cure is
available on an outpatient basis and that often drugs and therapy can help
li\ ing among mentally ill. These, he suggested can be done bv changing
e e>Ln'-ia^ niedias (movie) perception on mental illnesses, and therefore the
geneial belief of the general population.
1 le posed the question 'Why is Mental Health Care a Neglected field"?
■ Clinical issues
■ Controversial issues, and
■ People's awareness
The fact that medical science says it can treat schizophrenia 100% with drugs and
therapy is debatable. The drug policy is such that schizophrenic patients do not
avail of free medicines is another area that needs to be discussed according to Dr.
Sanjeev Jain.
—This could be an issue for discussion, and the question of irrationality of policy should
be rectified with debate and dialogue.
Geriatric mental health is another area Dr. Sanjeev Jain believes needed
immediate focus as most old people are kept at home and treated with total
ignorance of the condition. The issue that most of our country' has no treatment
facilities for Alzheimer's is another issue he wanted to expose this via the
channel. Comparativelv, India was behind many Southeast Asian countries with
a lower GDP in the mental health care facilities for Alzheimer's.
The two-day meet concluded with the presentations of the summary of the
discussions and an overall perspective of the doctors, intellectuals, students,
freethinkers, media persons, and others.
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