Lakshmi Premkumar CHLP 2008-6-FR 33.pdf
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Community Health Learning Programme
2008
9
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Community Health Learning Programme
June 2008 to February 2009
REPORT
Lakshmi Premkumar
intern, community Health cell
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Overview of CHC Fellowship
I joined the CHC Fellowship in May 2008 with little idea of what the fellowship held for
me. I was told it was a space for all involved individuals to learn and grow during the 9
month long internship.
I had worked for a year- with a grass root farmer's organisation, Gonur West
Agriculturist's Development Union, in Mettur providing support in terms of research,
legal and scientific input. Details on Mettur have been provided in the objectives section.
An important aspect of our work was monitoring and following through environmental
incidents such as gas leaks, effluent spills, and illegal toxic dumps. Monitoring helped to
keep these incidents in check and put in a system of documentation. Considering the
impacts of severe pollution on health and the fact that in such scenarios health impacts go
undocumented a health monitoring system needed to be in place. To seek inputs and
explore possibilities of initiating a health monitoring system, I took up the Community
Health Cell's internship learning program. I planned to continue my responsibilities with
die work in Mettur during die period of the fellowship program.
The following is an account of my experience and learning during the five months that I
was part of the fellowship. For reasons explained below I discontinued from the program
after five months
Orientation Program - I attended the month long orientation program along with 8 other
individuals in May 2008 in Bangalore. The orientation program dealt with diverse issues
both within and outside the parameters of the health system. Discussing matters of health
in relation to factors such as caste, gender, class, economy, trade, neo-liberal policies, and
culture made it possible to understand the diverse issues within a context. The program
attempted to provide a broad framework of intertwined disciplines.
Learning from the Orientation:
Learning, as I say it, means
Information that helped construct/break down perspectives.
- Simple, yet concrete, ideas to which I was opened up to.
Perspectives which I gained as a result of the discussions held.
Introspection as a result of new information, ideas and perspectives.
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I found the classes on understanding local and cultural practices in health
exceptionally useful as it opened me up to break down the superiority that allopathy
practices had held in my mind.
I was able to understand, to a fair extent, tire Health System of India, i.e. the various
planes of decision making and execution that make up the system and the parameters
used to assess and measure the effectiveness of the health system in various states.
The Field Trips to Southern and Northern Karnataka were remarkable and motivating.
Many of the experiences were first-time and first-hand. With prior briefing about the
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day's plan, all of us headed out with an eye for detail and returned with varied
observations and experiences to share with the rest. Tire time was spent visiting
various organisations, alternate employment projects, community programs, mining
sites, PHCs, Sub-centers, Balwadis, etc. Discussions in the evenings and the next
morning help reiterate tire purpose of our visits.
Tire ongoing struggles by women in Jagruthi Mahila Sangattan in Potnal, their attempts
at breaking gender barriers, and their fight for basic rights both in their homes and in
their villages was inspiring. The path for achieving the same caused
Tire mines in Hospet reflected tire stark reality of mindless industrialisation and its
negative impacts on both tire working class communities and the environment,
breaking tire myth that progress is linked with capitalism.
I also found the visit to PHCs interesting. For one, it was the first time I was even
attempting to see the health system, its failures and successes, for what it really was,
instead of dismissing it with the waive of the hand for its many shortcomings.
Also as a class, we discussed a range of topics and concepts that interested me and
those I learnt from, such as drug control and use, corporatisation or privatisation of
health care, shock doctrine, collective consciousness.
Learning Objectives
After the month long orientation program, I drafted out my learning objectives along with
my mentor, Rakhal Gaitonde's assistance, for the nine month internship program. The
following are the objectives I set.
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To understand how issues of community health and environmental health are dealt by
the
communities,
through
community based modules especially in
struggles/campaigns/ movements. To understand community' perspectives on
environmental health and issues of participation, accountability, etc, within
communities. How are these different from 'expert1 perspectives and how these
differences effect the implementation of programs / campaigns?
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To understand the role of women from communities who are working on the issue of
health in their community.
- How are such groups formed? What is tire need for such groups?
- Did the interest on Community health come from the women?
- What are their primary' objectives on health?
- What are the dynamics of such a working group?
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Evolving a group of women in Mettur who would work on issues of Community'
Health and Environmental Health. I vizualise this collective to be more than a group of
women who will be able to take care of basic health needs of the community.
- This group will receive basic health training in relation to the kind of problems
they face in their community as a result of Industrial pollution.
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- Will understand the linkages between industrial pollution, the health problems
they face and the other consequences there on.
- Will see an agenda of making the public health system in Mettur more accountable
and provide better services
- Will monitor and document the health problems in their communities.
- Will also have an agenda of mobilizing other women from their community to
participate in their struggle for a clean environment, better health sendees.
WHY METTUR?
Mettur is a town (taluk) in Salem District of Tamilnadu. River Kaveri, the life line of north
and central Tamilnadu, enters the south Indian state through Mettur. The Mettur Dam
which forms the Stanley Reservoir, built in 1934, is a major source of drinking water. Once
an agricultural and fishing area, Mettur now hosts a number of Chemical industries.
Industrialisation in Mettur began as early as 1936, and today according to the Tamilnadu
Pollution Control Board there are 71 industries (many, if not most being chemical
manufacturing units) operating in the area.
Most of the industries are clustered around three Panchayats - P.N. Patti, Veerakalpudur
and Gonur. The combined population of these Panchayats is 55,855. Since die early 1960s,
local communities have reported incidents of pollution and pollution induced damage to
agriculture and the health of livestock as well as humans. Over the last five decades,
villagers have filed numerous complaints and several agencies, both private and
governmental, have analysed water and soil and have found them to be contaminated by
high dosages of toxic chemicals.
Much of the damage done to Mettur's environment may well be irreversible. The
Tamilnadu Pollution Control Board and tire District Administration have failed miserably
in administering their duties. The Police and the District Administration continue to
dismiss local concerns about pollution as a law and order issue, and continue to view
complainants as extremists and trouble-makers. It is in such a context that Gonur West
Agriculturist's Development Union, a local body of farmers, decided to organize
themselves and fight the case against pollution both in courts and on the streets. I have
been working along with this organization since 2007.
Evidence at hand indicates the extensive nature of damage already caused. The fact that
the environment is contaminated by a range of complex and highly toxic and persistent
chemicals, including mercury, organochlorines and potential dioxins and furans qualifies
categorization of Mettur as a Toxic Hotspot. While this has huge environmental
consequences, there also is likely to be major detrimental effects on human health.
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In tlie view of the authorities, lack of evidence or information amounts to a lack of a
problem. Therefore there is a need to gather and document environmental and health
impacts. Consequently Community Health Monitoring program in Mettur was proposed
in 2007.
WHY WOMEN??
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From our experience in working with communities, we observed that women were in
most cases twice burdened as compared to tire men. They are tire ones who stay the
longest in die polluted environment while the men go out to a different environment
for work. Women are always tire care takers of sick children and family members. This
being tire case we saw more long standing anger in the women about tire levels of
pollution and the spread of ill health, which would push them to work towards
fighting for better living conditions.
Also, Mettur being a rural area, meant that women were not a part of the process of
struggle against the industries. They are merely used by tire men as a show of strength
for solidarity, when huge numbers are required. Given the numerous restrictions that
women have, it was necessary to organize the women and get them involved in die
process. We felt that, healdi, being a problem dealt primarily by women, would be a
point on which they can be organized.
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My limitation during the fellowship:
I discontinued from the fellowship during the second phase as I was unable to meet the
requirements and commitments of the fellowship alongside the already existing
responsibilities of my work in Mettur. I was unable to blend the objectives set in the course
of this fellowship into a work plan, though the objectives themselves were essentially
drawn from tire campaign in Mettur. The time lines set for the objectives and the need to
achieve a few step in those directions at every point conflicted with the pressing needs of
the campaign.
However I present here the outcomes from the experience of pursuing the objectives in
Mettur for a period of three months.
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Community Health Monitoring - In September 2008, I initiated discussions with
women in villages in Gonur and Veerakkal Pudur Pachayat around the issue of
pollution and its impacts on environment, health and livelihood. These focus group
discussions were organised by members of Self Help Groups. However, after a
couple of meetings it was evident that though health was a major problem, it was
not an organising tool. The people of Mettur were passive recipients to the slow
poisoning effects that the chemicals had on their and their children's Eves. The
problem was not new and nor did it hit them at any one point at a magnitude
causing immense immediate damage. It was simply one of the many problems, that
have slowly and steadily, creeped into their lives.
Lack of trust - The need to fight for their rights and the feeling of being wronged by
the Government and the corporations were expressed by many women during the
discussions. On the flip side, given that the situation has existed for more than 3
decades the women are apprehensive of all groups, primarily from within the
community, that sprout up in an effort to organise the villagers to fight the
polluting companies. In the past, many if not most groups, after gamering initial
support from the community members, amassed personal gratification from the
company and reduced the struggle to a mere sum of money. The company and its
henchmen, among the communities, used this weakness to rubbish all efforts to
mobilize by other villagers.
As discussions continued, lack of adequate water was identified as a critical
problem in both panchayats. Work on fighting for supply of water started within
the Gonur West Agriculturist's Development Union. In a span of 3 months, they
equipped 5 villages with regular water supply.
The primary fallout of this experience for me lies in my understanding of working
towards political change. I have come to believe, that despite work such as
monitoring of environment and health being essential, it does not serve as a tool of
organising. Such work will serve its purpose, within such a framework of a
struggle, only if it is supplementary to a larger political organising effort. The
reason why I am vary of Community Environmental Monitoring or Community
Health Monitoring exercise serving as an organising tool, is because the experience
raises a question as to "what is one organising towards?" Is it for better health care,
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is it for a clean environment, or is it for tire company to shut down? It is difficult to
achieve die larger vision i.e., organising tire community to fight for their right to
control their economy and resources if it is planned as a fallout of a focused
monitoring exercise.
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Community Health Cell (Functional Unit
85/2, 1st Main, Maruthi Nagara, M/
Bengaluru - 560068
+ 91-80-25531518/25525372
Email: chint
Website: www.sochara.or^
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