Dr Vinay .H.R FLEXIBLE INTERNSHIP-2002.pdf
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COMMUNITY HHUTH LMBNIN6 PBOBMHE
FLEXIBLE INTERNSHIP - 2Z> O 4/.
At COMMUNITY HEALTH CELL - CHC
[March - April 2008]
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Mentor: Dr Ravi Narayan
By: Dr Vinay .H.R
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Preface
It dates back to my UG days at Bangalore medical college when I developed link with
CHC for materials (posters and charts of public health) needed for display in our health
awareness exhibition for general public- “MEDEX”. So, that’s how I had come to know of CHC
and its activities. That was a stage when I was having vague idea of the approach I would adopt
to pursue my ambitions. Though I had interest in community health and in particular mental
health light from my school days, but could never find a mentor to guide, link to progress and
opportunity to launch myself, restricting my views and field of work to personal diary notes.
Standing 2 months away from what can be described as a major step towards my long
term objective of working in the field of psychiatry, I couldn’t have asked for more than
finding a short term fellowship at Community Health Cell that too in the area of mental health.
Finishing MBBS in 2004,1 had to work for 3 yrs for self sustenance and meanwhile was trying
in PG entrance exams. I got selected for a PG diploma course in psychiatry at NIMHANS this
time and was expecting to join it by the Is' week of May. So it was worthwhile that I had some
kind of exposure in terms of getting to know the socio-cultural scenario with respect to mental
health that I am going to enter after my post graduation. That’s when CHC paved way to
pursue my intentions. The complexity that stood before me was to set forth the learning
objectives for the brief stay at CHC since the magnitude of learning to be done to understand
social aspects of mental health was too high to be covered in 2 months. More over the frame of
mind I had was that of a sailor standing before an ocean and merely glancing at it. After a brief
interaction with Dr Ravi Narayan, community health advisor at CHC, I found it an apt way to
break free from inertial frame of mind to work in a community health learning program. While
discussing with him I got to know the process of understanding the society is a continuous one
and ever-changing, hence one need not be perplexed. The realistic way to make use of the time
at CHC lied m understanding basic concepts of community health, the health situation in India
with a special consideration to mental health and experiences & ground realities by having
closer look at various community health initiatives. Hence I went ahead along with a friend of
mine (Dr. Keerthi sundar) who had similar objectives and had got seat at NIMHANS even, to
various organizations working in the field of community health which also addressed mental
health directly or indirectly. Apart from these, we had discussions with individuals who had
expertise in this field to have proper orientation.
1 otally it was a good learning experience and I am thankful to Dr Ravi Narayan, for
guiding and creating opportunity to rediscover myself. I solicit my thanks to Dr Thelma
Narayan, who mentored us in the absence of Dr.Ravi. I am also indebted to Mr E.Premdas and
Dr Sukanya. our coordinator and training associate respectively in supporting us to have
pleasant stay and meaningful learning experiences. Our special thanks to Dr Ajay Kumar,
psychiatrist at Hospet for introducing to us the different perspective of community psychiatry
and for showing us the avenues in the same. I also thank other CHC staff for helping us in
smooth functioning at CHC and various organizations mentioned hereafter for their help in
tiying for our objectives. Though the duration of fellowship was too less to schedule to cover
whole of our objectives, it was quite enough to understand concepts of community health and
get oriented to current health system and the needs & services with particular interest to mental
health. In short the feeling that I became a better person and a better health professional after a
brief stint was far more satisfying than disappointments of unfulfilled objectives and
expectations due to time constraints.
2
Learning objectives
• Getting introduced to the concepts of “Community Health
and to know the various community health initiatives in the
country, and to visit few of them.
• Orientation about current status of health care services and
health policy with particular interest on mental health and the
role of mental health as a part of broader canvas of
Community Health.
• To deepen the knowledge of Mental Health needs in India
and the health services catering them in both governmental
and non-governmental sectors.
• On personal front, to enhance communication skills, analytical
ability and responsibility handling through a mentoring
process.
3
CONTENTS OF REPORT
1
Visit to ARSA (Association for promoting social action)
An enthusiastic start to CHLPH!
2. State level annual convention of sexual minorities
Totally new world we never bothered to know.
3. Brief interaction with Dr Mohan K Isaac
Pleasure in meeting an achiever in our field.
4. Bosco Mane (Bangalore Oniyavara Seva COota)
Action group for children on street
5. An open discussion by P. Sainath with public
Awareness of agrarian crisis in the country
6. Richmond fellowship society, RFS (India)
Building better life for world's most stigmatized people!!
7. Our first presentation
Honing communication skills
8. A Forum discussion on vulnerabilities of sexual minorities
Of course, they are part ofsociety!!
9. Visit to Manochethana and Manodaya at Hospet
Grossly unmet mental health needs in rural places
10. SAKHI resource centre, Hospet
Resourceful for adolescent girls and working women
11. An interaction with Dr. Sarah Bhattacherjee
Where to draw line in doctor patient relationship?
12. A brief discussion with Dr. Rakhal Gaitonde
A rethink in current model of mental health care!!
13. Medico pastoral association, Bangalore
Pioneering the care ofpeople with mental health problems
14. Fedina
To empower the aged to demand what is rightfully theirs!!
15. Basic needs
Who are the sane and who are the insane?
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‘Association for Promoting Social Action’ (APSA^Bangalore
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APSA is an urban development organisation with a focus; on
Introduction and background: - APSA is an
street children, child labourers and other
child centred community development^ ^tion abandoned children, runaway children etc.)_
in five slum areas and the street children of
children in distress (child victims o p
APSA's work is directed towards (chi )
h participation of traditionally deprived
the city. They believe that deve ogment wtthtto
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My observations
we were lucky in that we got i"lr°d£,£^“fotX! WuM™''' &
,01 to know that the organization is currently_eater ng^to u«> P
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SCHOOL which happened to be the recent
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education for 160 ex-child labourers, street "n^a
out of mainstream
who stay inNammane The education pr
sufficiently accustomed to the
education is non-formal but when the ch
&
mainstream education at a
learning environment they are encouraged to eith g
the 7th Standard
government or a private school. Often t ls/'jL^sPta dard There are five classes in the Dream
exams but APSA also offers education up to 1
a
ject of the of the government
School: National Child Labour Projec. (NCLP) cl JP
informal edlication: a class for
of India), in which ex-child labourers betw en 1044 benet
“crisis” children who have been rescued th
b£ing prepared for the 7 std
B0“d- “,he “io”1 “
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Open Schools.
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Gaining center for street
come t0 Nammane from workplaces, the
From there we were taken to
Intervention Center for children m acut" d‘^
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few in narrating their odd experiences.
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We then moved into APSA’s state of the art training center KAUSHALYA, which has >
need directed training as a strategy against poverty and unskilled, underpaid child labor. The skill
training project is part of five year rehabilitation continuum that takes the children from their
field projects through a process of professional development. The residential training at
Nammane ranges from 6 to 18 months and finally a follow-up team takes over the responsibility
of providing support for the graduate in the first two years of employment. Their students are as
competent as university graduates and are employed in the same workplaces. In the past decade,
over 2,000 former child labourers have graduated and been suitably placed. Skills taught vary
with the market demand. Currently, training programs include: Desktop Publishing,
Tailoring.Screen Printing and Stationery Making and electrical work.
Then came the most interesting part of the visit, MAKKALA SAHAYA VANI - the
Child Help Line. It collaborates with the Bangalore City Police to rescue, counsel and
rehabilitate children in acute distress. The counseling center is at the Police Commissioner’s
office and all the police patrol vehicles of the city are prepared for rescue operations. There is
assistance for crisis resolution and provision for emergency residence and care for those in need
through Nammane. We did listen to task force personnel about their hand on experiences
wherein they had rescued children under demanding conditions. One of them said in lighter vein
how it has become difficult for them to handle many mischievous calls made to the toll free
phone no. We got to know that with MSV, APSA has designed a training module to bring police
personnel and children together to learn about each other and that serving as a major trainer for
the City Police, they have trained 1,700 personnel while also working regularly with three police
stations in follow-up training sessions.
Apart from these projects there are other initiatives taken up by APSA like:
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Child Labor Project - it comprises pioneering preventive and rehabilitative programs
for urban child labourers.
Slum outreach project - The objective of these federations is to create an opportunity
for local slum dwellers to come together at the city level as one force in their efforts to
gain basic facilities, dignity and human rights. Activities in this project are based on the
principles of‘Right to Awareness’, ‘Political empowerment’, and ‘Economic
empowerment’.
The Disability Project - APSA has undertaken a Therapeutic and Social inclusion
Project for about seventy children with disabilities in seven Bangalore slums, providing
mobility aids, physiotherapy, occupational therapy, appropriate active
Technology and opportunities for integrated schooling, vocational training and
employment.
Inchara (The Bird song) - Here children learn to employ cultural activities as tools for
struggle and social mobilization.
VIKAS - Vikas is a student awareness-raising program that orients and motivates youth
to participate in development work for the poor.
Navajeevana Nilaya - is an enabling environment for young women at risk, providing
them with residential support during the first year of their employment together with
opportunities to development of skills necessary for them to live confidently and
independently without compromising their security.
Juvenile Justice - for capacity building of Juvenile Justice Functionaries of Karnataka
state in collaboration with the Department of Women and child development,
Government of Karnataka.
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My reflections
1 got to know about the migrant population in Bangalore and their needs as temporary
inhabitants. The very purpose they have migrated from some other place denotes the socio
economic status they hail from and the magnitude of stress they would undergo at work &
residence. Besides their unmet basic requirements, the eventual suffers are their children who
face the problems like neglect of parents, absent schooling, malnourishment, improper hygiene,
abuse, proneness to substance use etc. So, APSA is aptly serving the weaker section of urban
slums thus indirectly addressing the mental health needs of a part of community. Here the work
is within the community at the grassroots, with the privileged sections of the society and with the
government towards preventing exploitation and marginalization of the underprivileged and the
purpose is to evolve social paradigms based on values of justice and nondiscrimination with
those already in exploitative situations. The psychosocial support is in the form of ensured
schooling and residence for distressed children, vocational opportunities for older children.
For an enthusiast in mental health profession it was a good learning experience to know
the mental conflicts and uniqueness in response of each child facing adversity. The tent schools,
compulsory schooling for children below 14 yrs and legal restrictions for child labour at
governmental setup along with non formal education in this organization, for children to bring
back into mainstream are collectively laudable efforts as this is the stage when a child is prone to
develop behavioral problems. One more instance of governmental and nongovernmental faculty
working in liaison is in CHILDLINE, a rescue squad for children in distress. This again proves
the fact that it’s this kind of joint efforts which will a go a long way in uplifting health care
delivery status. It was a chilling experience in itself to listen to first hand experiences from the
members of rescue squad when they made particular mentions about rescuing children from
noted and highly influential personalities in the society. It seemed that’s where the knots are
loose even in the legal system of ours. But given the circumstances of moral deterioration in
political scenario, surprisingly this project has seen considerable success may be due to
transformation in mass psychology that indeed children need special attention and every child
has right to live his childhood. One more thing which was obvious throughout our stay at this
organization is that it is the facilitating attitude rather than instructing or imposing ways that has
to be followed by professionals involved in child care.
As it is known mental health does not exist in isolation but has various dimensions to it
like cultural, social, financial, vocational, political, legal etc, it was worthwhile to note that they
were all addressed here in this organization in the form of INCHARA for cultural activities.
VIKAS for social aspect, SLUM outreach project to take care of financial dimension,
KAUSHALYA for vocational rehabilitation, CHILD LABOUR project and juvenile justice
serving the political and legal components. There was also a sexual health project based on the
philosophy that sexuality is a natural part of life. Its slogan is ‘happy, healthy, and responsible’
and is based on the inviolability of certain sexual rights and responsibilities. It aims to look at
sexuality and sexual health holistically as a part of the lives of street and slum children rather
than just focusing on aids prevention. The project aims to provide a comprehensive set of
materials that can be used and an intervention model that can be replicated by NGOs in South
India to raise awareness of the importance of sexual health and diminish the taboo attached to
such issues.
7
State level annual convention of sexual minorities
(March 18th, 2008)
Introduction and Background: - The convention was meant for collectivization and
mobilization of sexual minorities in voicing their problems, rights and needs. It was an extension
of last year’s event wherein they had initiated the efforts to bring the sexual minorities into
mainstream on par with others. The NGO s which supported and participated in the movement
was Samara. Suraksha and Sangama.
My observations
As it was a state level convention, there were people ranging from Gulbarga, shimoga to
mangalore. Among them were the homosexuals, bisexuals, transsexuals, kothis, hijdas, DD s, F
to M, M to F, jogappas etc. together they constituted the sexual minorities called by different
names at their local places. Most of them had undergone humiliations; disregard and abuse hence
were waiting for a platform to vocalize in their own way.
The objectives they had set are:
> Any sexual act if done with mutual consent between adults should not be regarded
as offence. It is repeal to sec 377.
> Sexual minorities should not be discriminated at workplaces, educational
institutes, health and social services like ration cards, passports, voting rights..etc
The surgery and the process of sex conversion should be made available to those
who seek.
Government should see to it that sexual minorities are not abused by police/
Goondas and legal consideration to be given to those who had sex conversion.
> There should be separate scheme for sexual minorities in education, employment,
loans, residence and health services ( HIV affected)
> There should be a public awareness about existence of sexual minorities and the
need for unbiased & de-stigmatizing attitude towards them to be inculcated in
textbooks.
My reflections
The very nature of ambiguity in physical and mental orientation towards sex makes these
sexual minorities vulnerable to stresses & mental ill health in their life. So, obviously one sees
increased incidence of mental illness as compared to general population. Hence, it becomes
important to cater to this part of the community if positive mental health has to be maintained in
the community. Of course their basic needs of life if meted out resolve the problem more than a
half. The majority of their demands deserved to be fulfilled like ration cards, voting rights etc
and non discrimination at workplaces, educational institutes, health services. While asking for
the unbiased and de-stigmatizing attitude by general public seems logical, but the demand to
legalize any sexual act when done with mutual consent between adults is a bit controversial and
needs inputs from various groups before consideration as it could affect the fundamental moral
and societal structure. Frankly there are doubts over feasibility of sexual minorities mingling
with mainstream in coming days as their preoccupation with sexual thoughts and acts keeps them
apart from others. The reason may be the very difference that differentiates them from other
general population i.e. sexual identity becomes overvalued ideas in them to an extent it becomes
hindrance in interacting with mainstream.
8
Brief interaction with Dr Mohan K Isaac
(March 24th. 2008)
Introduction: - Dr Mohan K Isaac, Former Professor of psychiatry at NIMHANS with
area of interest and achievements - community psychiatry; currently is also the president of
We^were lucky in that we had the chance to meet the person who had written the
foreword for the book we were till then referring for our visits to various NGO s related to
mental health. Though it was a brief one, we could gain the information regarding what to oo
for in NIMHANS and how to make best use of it. Even based on our own backgrounds, we
received suggestions in terms of various avenues available in psychiatry that may suit us. With
the reminder to inculcate social model along with biological model in health we were
encouraged to continue our own interests like visits and interactions with professionals
experienced in same field.
An open discussion with public by P.Sainath
(March 27th, 2008)
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Introduction: - The 2007 Ramon Magsaysay Award winner,
substantial work on the livelihoods and poverty of India's rural poor, Sainath has been playing a
crucial role in changing the nature of the development debate not just in India but also across the
world. He is known to spend as much as 300 days a year in the rural interior and had been doing
so for the past 14 years. Currently he is the Rural Affairs Editor and Mumbai C hief ot Buicau i
The Hindu. Heartbreaking as they are, suicides - over 90, last month - are only a symptom o e
larger and deep agrarian crisis, reminded the award-winning journalist, touching on the role
played by our policy-makers and politicians.
My reflections
The initial talk was focused much on factual aspects of suicidal deaths in larmers ot
Andhra, Maharashtra and various parts of Karnataka. After that the concept of agrarian crisis was
briefed out. With appropriate illustrations the scenario of India shining with poverty was pu
forward It was also made clear that the suicidal crisis is not just to do with alcoholism and
illiteracy and the farmer’s suicidal issue has multifaceted causes like economic divide, policy
loopholes, and stressful agricultural practices. To wind up the presentation he stressed.on nee
for connectivity between ‘mass media’ and the ‘mass reality thus emphasizing the role ol media
in making the citizens understand or draw opinion regarding ongoing issues.
,
The statements were good in the sense that it awakens the system and victims,
but a lot of round figuring & magnification of statistics does seem to happen, all wit goo
intention to shift the balance towards establishing economic equity. This open discussion wi
public again stressed the need of legal, political and financial stabilization if mental ill health is
to be prevented on large scale.
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Bosco Mane ( Bangalore Oniyavara Seva COota )
(March 25th, 2008)
Introduction and background: - Of paramount concern is the growing phenomenon of street
and working children in all major cities in India. The alarming pace of urbanization and the
proportionately weakening fabric of our social structure and policies are what are forcing such a
large number of children everyday into the cities. Their mission is to enable these street and
working children enjoy their childhood, strengthen ties with their own families where possible
and provide the impetus to join the mainstream of society.
Children, primarily up to 18 years who land up in the street or who have made the streets their
home form their target group. Rag picking, sweeping, cleaning vehicles, picking vegetables, shoe
shining, reserving tickets, painting and stitching seats are occupations which enable street
children earn money. Besides, some work as coolies, construction workers, street vendors,
parking boys and sellers of lottery and cinema tickets. Often, they can resort to begging too.
My observations
As it was in APS A, I had the second opportunity to try and orient myself to the psyche of
street children & children having conflict with law. First we were introduced to the BOSCO
mane, a half way home to street children below 14 years who are persuaded to come away from
the streets. At this centre, boys enjoy maternal/paternal care, affection, concern and true
fellowship. Some of them are send to other institutions for formal education while others attend
training in carpentry, welding, two wheeler repair, tailoring, electrical and book binding. We
were allowed to spend time with those children and personnel while they were involved in their
daily routine activities. We had orientation talk by one of the staff and became aware of the
services that are available at BOSCO mane like counseling, home placement, tracing missing
children, education and job placement. About 80-90 children are helped to return home every
month. Staff/volunteers take up this onerous task and counsel children and their parents on
staying together. There is also a provision of rehabilitation of children on the street by partnering
them in their daily struggle to grow off the street into the socially contributing and economically
independent young people, building up a powerful movement capable of challenging those
situations that leave the young abandoned on the streets. BOSCO believes that every child on
the street is a unique young person with strengths and talents.
BOSCO also works in symphony with APSA child line and dept of police in rescuing
children in trouble. I volunteered myself to attend a case as a part of special juvenile police unit
which Bosco has undertaken and on firsthand experience, I could understand the complexities
involved in handling juvenile crimes.
My reflections
The family life experiences of most of these children is often much worse than life on the
streets and counseling that is undertaken here offers an opportunity to talk about the past and is
an indispensable element which restores their confidence. Children are therefore encouraged to
return home if the home circumstances are conducive. I got the second opportunity apart from
APSA to understand the psyche of street children and the children having conflict with law.
After going through two separate visits to the organization I had the impression that though the
efforts are on to Enable Street & working children to enjoy their childhood, but there is lack of
addressing to the root cause of the phenomenon.
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Richmond Fellowship Society, (India) RFS
(March 28th, 2008)
Introduction and background: - The Fellowship offers rehabilitation facilities for people with
chronic mental illness like Schizophrenia and Bipolar Affective disorder (manic depressive
illness), through residential facilities like halfway home, long stay home (Group Home) and a
non-residential day care facility. The therapeutic community approach is followed for
facilitating the process of rehabilitation.
My observations
"Asha" Halfway Home
Asha” is Sanskrit for “hope”, and is an apt name for this urban halfway home. At Asha,
residents enjoy safe and structured therapeutic programmes within a home-like
environment. Qualified mental health professionals supervise a range of activities that
include counseling, creative expression, leisure time, home maintenance, or group
meetings. Asha can house up to 10 males and 10 females, whose stay might range from
six months to one year. There is a monthly fee for the services provided
"Jyothi" Group Home
Jyothi” in Sanskrit means, “Light”. This long stay home caters to those who have been
treated in therapeutic communities and need long-term support to function in society.
Jyothi can admit up to 6 male and 6 female patients. The duration of their stay can range
from over a year to life long support, as per the needs of the resident / family. This home
is run on contributions made by the families of residents, which include a refundable
interest-free deposit and a monthly fee.
"Chetana" Day Care Centre
“Chetana”, “Awakening” in Sanskrit, is a day care centre that offers vocational training
for persons with schizophrenia, chronic epilepsy, affective disorders, or mild mental
retardation with behavioural problems. Courses of training include tailoring, embroidery,
plastic moulding, printing, typing, and introduction to computer skills. Chetana also
serves as a sheltered workshop by providing a safe and supervised work environment for
clients with disabilities, who cannot find employment outside.
My reflections
The following interventions offered in this organization are of course the ideal
rehabilitative options for chronic mental illness like schizophrenia Personal hygiene
and maintenance of living space, compliance in taking medication, work habit, leisure
time utilization time and money management, individual and family therapy, social
skills, interpersonal relationship and communication skills, home management,
crisis management, relapse prevention and insight facilitation.
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One of the commonest causes for these illnesses becoming chronic is lack of
proper knowledge of the disease and the inability of the families to accept that some
one dear to them is actually suffering from a psychiatric illness. Knowledge about the
disease, need for medication, duration of treatment and the management of common
crisis situation whenever they appear, form part of the rehabilitation programme. This
is done at a very opportunity for individuals and families so that their knowledge and
acceptance will go a long way in the recovery. This will eventually help in the
resident’s ability to accept the disease and the need for long treatment, thereby
gaining insight into the problem.
Our first presentation
(April 2nd, 2008)
To hone the communication skills by presenting the study and holding discussions with
Dr Thelma and other CHC members; and to get feedback regarding the work done so far.
khy reflections
As it was my learning objective on personal front to improve the communication
skills it became a basic exercise for me to present the study so far and interact
analytically with significant others. There were few things for relearning like realizing
the benefits of doing systematically and significance of documenting and the need of
going through reading materials to have background knowledge to discuss
A Forum discussion on vulnerabilities of sexual minorities
(April 3rd, 2008)
Introduction and background:- Display of documentary films and interactive session by Mr.
Manohar from ANEKA. an organization fostering advocacy efforts for the rights of sex workers,
sexual minorities, and people living with HIV and Dalit women. The event was held with a
support from lawyer’s collective which holds weekly sessions of public interest.
My reflections
As it was known from earlier visits to convention of sexual minorities, the tendency of
these people to get physically abused & by the virtue of their own habits of high risk behavior
they are more vulnerable to acquire HIV or other STDs. So it was necessary that the initiative
should come from them in obtaining the facilities to have safe sex and to get educated regarding
sexuality & how to make it a responsible act by following safe strategies. The basic
understanding about the mode of spread, preventive aspects, early diagnosis and treatment of
common STDs & HIV is a prerequisite as like in general population. Apart from vulnerabilities
to STDs the sexual minorities are also easy victims to abuse, domination which in turn is a
hazard to their mental health. Mass education is a good method to bring awareness and
coordinate the health services based on felt needs.
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Visit to Manochethana and Manodaya at Hospet
(04th to 06th April, 2008)
Introduction and background:Punyakoti Foundation
Not only the common people, but also practising doctors in the region have become
increasingly aware of mental retardation. Dr.Ajay Kumar, who earned, an M D degree in
Psychiatry from Kasturba Medical College, Manipal, took up the cause with all
professional seriousness. The spontaneous society responds and impetus embolded him to
launch ‘Punyakoti Fundation’ to organize several professional mental health services
Manochetana
Manochetana, a day-care center, started in a very humble surrounding, has become a
certain pointer for Punyakoti Foundation. The inner decor, with appropriate visuals and
designs to energise the mindset of the children and the outer ambience with ideal garden,
lawn, foundation, crazy path, pergolas and a large open-air shed - each one meticulously
designed and executed - make the environs immediately endearing and absolutely
functional. Each component is obviously mentally challenged-friendly; everything in its
place and every place has a rationale. Manochetana is active from 10.00am to 4.00 pm,
five days a week. Children are picked up and dropped at home by authorized Employees.
Manodaya
Manodaya is psychiatric centre setup offering OPD and inpatient services lor the
mentally ill people in and around bellary, hospet & koppal districts. Dr Ajay Kumar, the
consultant psychiatrist manages single handedly the hospital and a special clinic for
deaddiction.
My reflections
Mental retardation also considered as punishment for the caregivers for their sins
in previous lives, is medically speaking, arrested or mal development of brain or their
intellectual ability causes being several. What I got to know from the brief visit that the
complications during delivery or even during antenatal period are the major ones along
with hereditary predisposition contributing to mental retardation or syndromal disease in
in children. This again establishes the role of maternal health care in prevention of mental
ill health in children. Perhaps the obstetrics health services which are deficient in rural
areas of Karnataka are to be blamed for mishappens at the time of delivery.
Manochethana focuses on rehabilitation aspect of MR in that it not only lessens
the burden of caregivers by offering day care and activity scheduling for mentally
challenged children but also counseling & later active involvement of care giver/ parents
in rehabilitation of those children. Although no dramatic change would be expected, here
I could sense the logical/ plausible explanations behind this special school be it the
location, architecture of building, furniture, instruments and routine activities ambience
or the pleasurable surroundings. Every thing seemed to be contributing for stimulatory
response in disabled children unlike other rehabilitation centers. Manodaya, the
psychiatric care centre, is trying to resolve the grossly unmet mental health needs in
northern Karnataka and impressed us to consider the option of practicing psychiatry in
rural setups.
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SAKHI resource centre, Hospet
It's a resource centre for women and an organization addressing various social issues.
Under the able leadership of Mrs Bhagyalakshmi, the centre serves its purpose of counseling and
guidance to adolescent girls for their problems like relationship conflicts, abuse, rights violation
etc. Though we had a very brief session with their members it was quite informative conveying
the scenario in and around hospet in relation to status of women in the community.
An interaction with Dr. Sarah Bhattacherjee
Dr Sarah is a professor in community medicine dept, at CMC Vellore. The discussion we
had was in regarding the need for doctors to bear in mind how patients look at their own situation
and complexities of ethics involved in the care of terminally ill and destitute. By quoting the
experiences she had in her illustrious career, she could really open up new line of thinking or
perspective which seemed admirable for us. We could find answer to our query like where to
draw line between leaving the choice to patients and advising them in what we doctors think is
right. I he interaction had a good bearing and relevance in that psychiatrists are going to face
such circumstances more often than any other specialties.
A brief discussion with Dr. Rakhal Gaitonde
Dr. Rakhal Gaitonde is a Community Health Physician researching occupational and
environmental health and above all our CHC team member. Only after discussing with him that I
realized the real need to inculcate social model along with biological model of mental illness by
psychiatrists and even other mental health professionals. Though there is much literature
evidence of drugs used in psychiatric illness causing the most of the desired effects, still it is the
social & cultural factors which play important role in altering the course of illness, rehabilitation,
intake of medication etc. we were advised to go through few of the literature about societal
organization & culture in relation to illness. By the end of discussion we became aware of the
recent efforts towards adoption of social model of mental health.
Medico pastoral association (MPA), Bangalore
Introduction and background:- Medico-Pastoral Association (MPA), the first voluntary
organization to step into the then unexplored territory of rehabilitating mentally ill persons in
India. MPA also addresses areas of suicide prevention, counseling, promotion of mental health
and encourages family and community participation.
My reflections
One of very few NGOs working for people with mental illness & also supposed to be the
pioneers in field, MPA was recommended by Dr Mohan K Isaac as an organization to visit if
someone is focusing on social and rehabilitation aspect of mental. After brief introduction
from administrator, a psychiatric social worker was assigned to guide us through the
infrastructure, the staff & the target group and the daily routine activities. Like in RFS, the
target group comprised of chronically mentally ill patients particularly schizophrenia, bipolar
disorder etc. though the organization serves only the affordable and already stabilized
patients it caters to a subset of vastly prevalent mentally ill population. Two other
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observations that needed mention were - there is need to accept rather than universalize the
level of restoration of functional ability in few patients and the monotonous routine does
create a ‘tiring’ phenomenon in both the personnel and the patients.
Fedina
. A .
Introduction and background:- FEDINA is Foundation for Educational Innovations in Asia, a
secular non-governmental, non-profit organization established in 1983 with its head quarters in
Bangalore. FEDINA works towards the empowerment ot the marginalized groups o our socie .
: tribals, dalits, poor women, landless labourers, and slum dwellers.
My reflections
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Though fedina covers most of the marginalized groups as mentioned m its mission, w
were only able to observe the functioning of personnel involved in care of the elderly. Wi
e
rapid urbanization and lifestyle changes the joint family becoming extinct & the one_of
aftermath is aged being sidelined and their welfare is becoming an issue nowadass. 11c medical
social and psychiatric illness related to aging make the situation worse. It is really challenging
the near total dependency raises doubts over continued support from caregivers.
Basic Needs
Introduction and background:- Basic Needs India is a registered non-governmental
organization established in 2001 in Bangalore, India. The goal of Basic Needs India is to
initiate programmes which actively involve mentally ill people and their caregivers and
enable them to satisfy their basic needs and have their basic rights respected, in so doing,
to stimulate supporting activities by other organizations and to influence public opinion
Basic Needs works with Community Based Organizations (CBOs) and non-goyernmental
organizations (NGOs) in Karnataka, Andhra Pradesh, Tamil Nadu, Bihar and Jharkhand.
pSe
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million of the population. Whilst this number is no where near as bad as many other countries,
all of these psychiatrists are based in cities. This becomes a problem when 75% of the P0P^0n
lives in rural areas. Only treatment given in the few government hospitals is free. Many peopl
have to pay for their treatment and for their medication. For the third of the population who iv
below the poverty line, getting long-term treatment for a mental illness is a major problem as
viullly afTtheir
and dme is spent simply trying to survive. Some government pohc.es on
mental health do exist but these are really only on paper and have not yet been p.operly
implemented Apart from these inferences we were made to understand that NGO s should
complement rather than trying to substitute government sector. 'I heir ‘Community mental health
and development programme’ for rural areas and its effectiveness is yet to be seen along wi
their suggestible model of mental health system in public sector.
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