Jaison K Sebastian CHLP 2015-13-FR 161.pdf
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2015-16
Community Health Learning Programme
A Report on the Community Health Learning
Experience
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School of Public Health Equity and Action
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building community health
Society for Community Health Awareness Research and Action
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building community health
Society for Community Health Awareness Research and Action
CELEBRATFMG COMMUNITY HEALTH!!!
Cowwanitg Health Learning Progranwne (CHLP) 2015' - f16
dccisoM K Sebetsfticm
TABLE OF CONTENTS
ACKNOWLEDGEMENT
I
TABLE OF CONTENTS
II
IIV
INTRODUCTION
V
LEARNING OBJECTIVES
CHAPTER - 1
THE COLLECTIVES
1
THE NEW INNINGS BEGINS HERE
1
UNLEARNING, LEARNING AND RELEARNING
2
COMMUNITY
3
HEALTH
4
MENTAL HEALTH
4
LEARNING
5
TOWARDS HEALTH FOR ALL
5
FROM KNOWN TO THE UNKNOWN
6
BUILDING BLOCKS
6
FROM FLOOR MOPPER TO TAP TURNER OFF!
6
PARADIGM SHIFT
7
AXIOMS OF COMMUNITY HEALTH
8
SOCIAL VACCINE
9
DETERMINANTS OF HEALTH AND SEPCE ANALYSIS
9
GLOBALISATION
10
UNDERSTANDING ALMA ATA DECLARATION
11
COMMUNITISATION
12
HEALTH FOR ALL NOW!
14
ADD-ONS
14
REFLECTIONS AND LEARNING
19
CHAPTER - 2
FIELD EXPERIENCE
211
MY JOURNEY THROUGH THI
21
COMMUNITY HEALTH PROGRAMME
23
UNDERSTANDING COMMUNITY
27
COMMUNITY VISITS
31
MEETINGS
32
ii
A NOTE!
33
THULIR
35
ACCORD
36
PERSONAL EXPERIENCES AND REFLECTIONS
38
CHAPTER - 3
RESEARCH REPORT
40
INTRODUCTION
40
TITLE OF THE STUDY
42
OBJECTIVES
43
RESEARCH METHODOLOGY
43
LIMITATIONS
43
FINDINGS
455
CAUSES OF MIGRATION
466
PSYCHOLOGICAL ASPECTS
477
SOCIAL ASPECTS
499
COPING MECHANISM
511
DISCUSSION
522
CONCLUSION
544
REFERENCE
555
ANNEXURE- 1
566
ANNEXURE- 2
588
ANNEXURE-3
599
THE PHOTO JOURNAL
60
iii
INTRODUCTION
Into the light; finding a path...
Well, ‘7 am a postgraduate in social work nowf I kept telling to myself. I tried my best to
convince myself that “I am a professional^ Deep within 1 was not convinced enough to
getting into a profession, as I felt that I was not competent enough to commit myself to any
profession. Meanwhile I wished to study further but I didn’t know what exactly to study. But
what is next? I was clueless. I kept asking myself what I should do now. I was getting all the
more confused and distressed as all my batch mates one after another getting in to jobs and
finding their grounds. Thanks to my parents that they gave me full freedom to follow my
convictions but unfortunately they were not in a position to guide me either. All that they
wanted and expected was that I get a good job somewhere, earn enough and get settled.
During these confusing and most agonising days, out of the blue, I remembered the
conversation I had with Mr.Sabu; then a facilitator at SOCHARA. He had come to our
college to conduct a work shop on research methodologies. I can vividly recall how
passionate and enthusiastic he was while introducing the organisation he was then associated
with. He also enquired with us if anyone was interested to join the fellowship programme on
community health. To be frank, 1 didn’t know anything about community health then nor
took time to understand what it was. However, I was still not convinced that I should apply
for the fellowship. Meanwhile I contacted my HOD, Dr.Thanuja Thomas and asked her for
guidance and it seemed that she was quite positive about joining the programme and
connected me with Mr.Sabu. She also reminded me that one of my batch mates Ms.Nisha had
done her block placement at SOCHARA. She shared her experiences of a short stay at the
organisation and insisted me to join the fellowship.
Subsequently, after the initial dilemmas in deciding on to start a new journey to the unknown,
I wrote to SOCHARA. The reply to my letter came after a while and I was asked to get ready
for a Skype interview; first of its kind to then. During the interview 1 expressed my interest to
join and it went on well, it seemed that they were interested in me. I hopefully waited for a
confirmation. Almost after a week while going through the e-mails, to my excitement I found
it. I was asked to be in Bangalore for a personal interview.
Thus, here I am, into the light, finding a path... Time for the show now...
iv
Learning objectives
I joined SOCHARA with little knowledge about community health. So it was to explore
community health, to try the career options in the field as I was a fresh postgraduate with no
field experience and adequate competence. But as the fellowship progressed day by day,
there were bundles of learning and new experience started coming in. Hence, the objectives
of the fellowship shifted to more about understanding health in different perspectives, as a
result of it, there were many other objectives evolved. Some of them are furnished belwo;
•
To understand health from different perspectives, and its concepts in a holistic
manner.
•
To understand community health approaches and perspectives, and SOCHARA’s
involvement in community health.
•
To develop skills necessary for a scholar activist.
•
To experience rural life and feel the ground realities and learn from it.
•
To practice paradigm shifts with a balloonist view.
There were also other objectives that are somehow related to the above mentioned. As the
journey still continues, there is space for new objectives too.
V
Chapter — 1
The collectives
The new innings begins here...
I was all set for the match. The preparation for a long test match began as I landed up in
SOCHARA on 7th February 2015. I fell in love with the stadium, i.e. the SOCHARA campus
at the first sight itself.
There were a few members of the team management and would be
fellow players who were moving around the ground talking each other and greeting one
another. To be honest I was quite tense and was going through lots of mental containments as
I was an amateurish young player badly wanted to get into the team. I somehow regained my
sense and by the time someone came to me and we introduced each other. I was offered a
chair to comfort myself until I was called for the fitness check-up. It was time for the fitness
test and I was quite tense. I knew that my mind was going blank but somehow I regained the
control of the mind. I was at the cabin and for the first time I sat before the team
management. First of all I was welcomed cordially and they introduced themselves as Ravi,
Mohammad, Chander; Thelma joined us after a while. The check-up began, from the initial
struggles as they cheered me to feel free and open up I felt at ease and the process went on for
almost an hour. I couldn’t fully comprehend what was going on but still towards the end of
the conversations I was feeling good and energised. It came to an end and I was asked to
move to the parlour and wait for the final decision. As I walked back, once again my mind
went blank and I waited eagerly to hear the result.
I waited and waited, after a while here comes the good news. Thank god, I am in!!!
The warm up sessions...
With lots of excitement and enthusiasm I was on the ground, i.e. the classroom, for the first
day. It took a few days to redeem myself from the initial discomforts of meeting and being
with strangers; strangers then, not any more. I got rid of it as I started mingling with the other
players (fellows) and introducing one another. It was all the more thrilling to know that my
fellow travellers were from different comers of the country and with a verity of educational
back grounds and experiences as well. They were from Meghalaya, Manipur, Madhya
Pradesh, Orissa, Karnataka, Tamil Nadu and from my own state Kerala. They are doctors,
dentists, psychologists, a lawyer, an MBA and many social workers who are of my kind;
1
Later on, in SOCHARA very often I started hearing the term community. Each one of us time
over and again listened to people and reflected in oneself to comprehend the true meaning of
the word. All that I had learnt was once again reaffirmed when I was sent to the field for
about 6 months. “Now with full conviction 1 can say that community is nothing but it is when
I, YOU and THEY come together to form “WE^.'
Health
My post-graduation had led me to understand health in general as I was getting specialised in
medical and psychiatric social work. I had to be thorough with the WHO definition of heath
to get through the exams; the WHO definition of heath, which says “health is a state of
complete physical, mental and social wellbeing and not merely the absence of disease or
infirmity". Like any other lay man I knew health in terms of disease, medicine, doctors,
nurses, hospital and so on, until I joined the fellowship.
The first paradigm shift in my learning process began as I was initiated to reflect on the
definition. I was prompted to understand health in a holistic manner. The process of
unlearning just began and the true meaning of health started to unfold itself through the
discussions and reflections we had over a period of time. Subsequently, my understanding of
health now is “wellbeing”, that is to say the life itself.
Mental health
Mental health has been an area of my interest from the post-graduation time onwards. My
knowledge and understanding were refined and polished through the fellowship. It has helped
me to understand the concepts and underlying issues form a different perspective altogether.
“Being born as a lady who is poor and mentally ill is the scariest thing in India" states
Mr.Keshav Desiraju, IAS
former Principal Secretary, Ministry of Health and Family
Welfare, Govt of India in his key note address
(during the December 2015 CHLP
Dissemination Meeting) was an eye-opener. This statement alone is enough to understand the
importance of mental health. Being mentally healthy is closely associated with determinants
of health. Hence, addressing the determinants and working on them is the need of the hour;
this is the challenge I wish to undertake here after.
4
Learning
For me, Learning was just the acquisition of knowledge and skills through the conventional
methods that is by-hearing something from the text books, studying whatever the teachers
taught in the class rooms, or even learning something like how to operate a computer, a new
mobile phone etc.
But now, I am convinced that learning is not the above said alone, rather there is a lot more.
Learning through experiences, reflecting and internalising what I see, hear, think, doubt,
doing and responding. It is “Inside Learning” through a process of blending brain and heart
together. Hence, learning is also unlearning what is already learnt, learning what is new and
re-learning what is necessary.
Towards Health for all
It was for the first time I heard the slogan “health for all” in SOCHARA. At the beginning it
sounded a fancy caption but as the days went on and the sessions progressed I could
understand the depth and breadth of the concept. I learnt that it was not just a caption but a
dream followed by many. Later on I have learnt that SOCHARA and health for all are
inseparable and this is what flows through its veins and the people who are in the
organisation. It was one of the most discussed topics in the class and each session opened up
our understanding about the hard-core realities about health. Many other sessions were in one
or the other ways were related to the topic and it added new dimensions to the concept
discussed.
The global charter for Health of the People’s Health Movement has noted that: “Health is a
social, economic and political issue and above all a fundamental human right. Inequality,
poverty, exploitation, violence and injustice are at the roof of ill health and the deaths ofpoor
and a marginalized person ... Health is primarily determined by the political, economic,
social, and physical environment and should, along with equity and sustainable development,
be a top priority in local, national, and international policy making. ”
It is enough to critically analyse the above quoted words to understand the disparities and
gaps we face in making health for all a reality. We are in chaos. Our systems are still not
ready or competent enough to deal with the realities as they are dominated by the negative
forces like globalisation, privatisation, neoliberalism and many more. Hence, here is the
relevance of civil societies like SOCHARA who row against the currents to reach the goal.
5
How do we do it? Is the question now and I have tried to put together how SOCHARA has
tried it.
From known to the unknown...
I began my new phase of life in SOCHARA, an experiment with a new concept called
“community health”. It was a journey from the things I thought I knew to the things
unknown. Even though I couldn’t fully apprehend what was going on, yet certainly the
experiences turned into more than I ever imagined; a paradigm shift in my own attitudes,
thoughts and perceptions towards different concepts, theories, and ground realities. Placing
“health” at the centre of the paradigm shift I underwent, there were many more things that
followed.
I hope to bring them all together under a series of headings.
Building blocks...
For anything to last long, it should be built extremely well. The blocks that are used to build
also must be strong enough to with stand any adverse catastrophes. “Health” as the comer
stone we need powerful blocks to build communities that prevails against all adverse events.
Once it is done the communities can be compared with the house that is built on the rock so
that when the rain fell, and the floods came, and the winds blew and beat on that house, but it
did not fall, because it had been founded on the rock. And, not like the house built on the
sand. And the rain fell, and the floods came, and the winds blew and beat against that house,
and it fell, and great was the fall of it.
To build such communities in the modem world we live in, we need knowledge and expertise
along with other ingredients that compliments, gained through learning and field experiences
that is as powerful as a two edged sword that pears in to anything that comes as hindrances.
The journey through CHLP has equipped me and each fellow traveller with such knowledge
and experiences. Some of those are as following.
From floor mopper to tap turner off!
What a change! This is what I am supposed to be. ^Are you a floor mopper or a tap turner
off? ” I had no clue and was a little disturbed when Ravi asked this question to us. Every one
of us sat back and thought for a while to understand the hidden essence of the question. He
went on to explain what each of these words meant to the budding community health fellows.
It was the same he went through when he was asked the same question decades back and now
6
I have seen and experienced the effect it had on him; a total conversion! I now know that I
am in the process of the same conversion. The relevance of CHLP becomes evident, when the
people around us are trained or even wish to be floor moppers, I am trained to be a tap tuner
off.
What does it mean to be a tap turner off?
It simply means that when I am trained and taught to deal with illnesses, disabilities and any
other health conditions in an orthodox manner using all the modem facilities and
interventions available, I am counted one among the floor moppers. Whereas, when I start to
understand and address the root causes and the cause of the conditions mentioned above and
put my heart and mind together to deal with it, with the available and most suitable resources,
I become a tap turner off!
As 1 reflect on being a tap turner off, the first thought that comes to my mind is that whether I
can be a tap turner off in my own humble ways. If so, what all will be the obstacles that I
should encounter on my way. I am pretty sure that the world we live in will not easily let any
of us to be a catalyst of change as the forces that stand against us much stronger and deep
rooted than we ever imagine. “So being trained as a scholar activist, the challenges before
me are many. Yet, lam prepared to take up the challenge and go forward”
Paradigm shift
It was one of the terms I kept hearing throughout the fellowship. Though it was not so
soothing to hear in the beginning because it called for a change, yet as the learning
progressed the term became more clear and self-explanatory. The vigour with which Ravi
talks on Paradigm Shift is enough to trigger any of us to adapt to this change. In the context
of community health and health for all, paradigm shifts meant a transition from bio-medical
model of health to social model of health. Similarly, it called for change in looking at and
understanding realities from different perspectives other than from the conventional frames.
There are seven of them proposed by SOCHARA and they are as following:•
A shift in focus from individual to community
•
A shift in dimensions from physical and pathological to broader psychosocial,
cultural, economic, political and ecological dimensions.
•
A shift in technology from drugs and vaccines to education and social processes.
7
health apart from the above mentioned. There is an element of health in everything and when
anything happens to the above mentioned it affects the health of an individual somehow. The
social determinant of health is an important concept of community health that helped me to
reflect on the underlying factors to look, learn and to understand and not to jump into a
conclusion. My field experiences have strengthened the idea of applying SEPCE analysis of
health to get a deeper understanding of health challenges going beyond the orthodox bio
medical and techno-managerial framework. Hence, being trained as a community health
fellow it is expected of me to bring an element of health in everything I think and do. It also
urges me to act upon it, where ever I am and in whatever I do.
Globalisation
The term globalisation sounded very appealing until I joined the fellowship. I could imagine
a world without boundaries, where I can video call my cousins and friends in the foreign
countries, where I have the luxury of travelling around the world in aeroplanes and in Toyota,
Mercedes and other luxury cars, where I can get anything at my finger tip using latest models
of mobiles and tablets, where I can have the comfort of wearing clothes and accessories of
NIKE, PUMA, ADIDAS and other international products, where in can eat and drink
products from the US, the UK and form anywhere further. Our life style has changed and
became more westernised. I never could connect globalisation with health. This was all I had
in mind as I admired globalisation.
But, as the fellowship progressed my understanding was demystifying. There was a bundle of
learning coming in and it helped to understand globalisation form a community health
perspective; a paradigm shift. Now I understand the politics and under currents of it and how
it had impacted health at large. The negative side/effects of it are many. Some of them are
that it tries to reduce the control of government at various levels, instead it promotes the role
of private sector and a cut-throat competition has become the order of the day at all levels of
life. It hinders the welfare activities and tried to establish health, education, etc. as
expenditure/liability rather an investment. At this point health becomes a reality only for
those who can pay. Its effects are seen in the agricultural sector; its outcome is alarming;
increase in farmer’s suicide and mass shift in the cultivation of food crops to cash crops. It
also adds fuel to the perils of climate change, poverty, non-communicable diseases and so on.
Organisations like World BanK (WB) and International Monetary Fund (IMF) who promised
10
aid have turned into agents of trade. Consequently, globalisation is nothing new but
capitalism incarnated in a new form; it is the economics of greed! Rich becomes richer at the
cost of the poor. Hence, we can rightly say that we are dealing with a new epidemic called
globalisation.
At this point,
to
tackle these issues what we needed
is
a globalisation,
a
‘‘vasudeivakudumbamfrom below. So that an equitable, sustainable, peoples lead
globalisation a celebration of life in its diversity will become possible one day.
Understanding Alma Ata Declaration
Alma Ata (1978) is a revolutionary declaration which was held in Alma Ata, USSR, for the
first time in history where 125 countries came in the place Alma Ata, came together and
dream that it would be possible by 2000 A.D. basic ‘health for all’ would be achieved which
meant water supply, sanitation, vaccination, mother and child care and primary health care.
In the conference the prime focus was on comprehensive primary health care and to promote
health for all by 2000 A.D. In the conference, health was the main subject and according to it
health is a complete physical, mental and social wellbeing and not merely the absence of
diseases and it is a fundamental right to all the individuals regardless their race, gender, caste,
class.
In the declaration, further discussion was talked that people have the right and duty to
participate individually and collectively in the planning and implementation of health care
and the government also have the responsibility to ensure access health care to its people.
There should be an inter-sectoral collaboration with other departments within the government
system and there should be reduction in armaments and to concentrate more on peace. It also
talked about equity and health and not only for the people who can pay; and health also is a
fundamental right
Primary health care is an essential health care base on practical, scientifically sound, socially
acceptable method and technologically made universally accessible to individuals and family
in the community (WHO). It should be the first contact with the community and it should
address the main problems in the community, to provide, to prevent, curative and
rehabilitative services.
11
Communitisation
The term evolution is a part and parcel of human history. We have been witnessing it in
different walk of our lives. Healthcare has also evolved over a period of time. It had taken
different forms and it is still in the process of evolving. Communitisation it is a space created
by the health care delivery system
for the
community to participate in planning ,
implementing and monitoring the health programmes. It was first used in the National Rural
Health Mission (NRHM).
India has come up with a number of significant programs in health and one of the most
promising among them is NHRM (2005). It is modified into NHM now. Though primary
health care was adopted as an approach to achieve this goal, yet the importance of community
participation Community participation in one of the four pillars of Primary Health Care and
was recognized as an inevitable part of working towards health for all. It is a combination of
various elements like maximum community and individual self-reliance and participation in
the planning, organization, cooperation and control of primary health care, making fullest use
of local, national and other available resources. When all these elements are actualized in its
fullest, the journey towards health for all becomes more realistic and less uncertain.
In my opinion “Communitisation” is nothing but enabling and empowering people to take
charge of one’s own health. Eventually, it will lead to the establishment of healthy
communities around the globe. As and when this is established we find transformed
individuals and communities ready for more actions. Now, to reach this stage, it requires
sincere and wholehearted commitments and efforts from both the individuals and the
authorities. If the general public feels indifferent and thinks that the state should do
everything for them, then it becomes all the more difficult just because it requires both
individual and collective participation and action.
Further to understand what communitisation means, it is necessary to know various role
players in the process. It includes the VHSCs, ASHAs, the involvement of local self-
government and community based organizations (NGOs). Placing the community at the
center, each of them has their own specific roles to play. Ideally, they are expected to enable
and empower the individuals and community as a whole to participate, involve and engage in
planning, action and evaluation of activities (projects). Another interesting characteristic of
communitisation is that the peoples involved in the processes are mostly selected from within
12
the respective communities (expect for a few at upper levels of authority) and this will have
direct and positive impacts on the success of the programme.
Finally, communitisation has yielded good results and has brought changes in the health care
approaches and even more in the lives of common people regarding their health. Yet my
experience in the field and the experiences shared by the other fellows form different parts of
the country give me an impression that the notion of communitisation has not reached its
optimum level. I don’t really understand whom to blame for; is it the state and the authorities
that are under the clutches of corruption and inadequate governance or disparity/gap between
the rich and the poor and their indifferences, lack of awareness or ignorance or the so-called
influences like the capitalistic globalization trends?
Gender and health
Though health is a common condition of human being, yet it is unevenly experienced and
lived. There are both known and unknown players who make the situation even worse. It has
been prevalent form the time immemorial. Though the humanity has progressed so much in
terms of technology, lifestyle, knowledge accumulation and much more, yet many of these
evils are still persistent in different forms and levels. Hence, its load on the lives of humanity
is immeasurable. Being raised and lived in patriarchal society, my understanding and
perceptions were biased. Even after going through postgraduate level of education, word
gender always was attached with connotations male who is dominant to female and the
question of a third gender never been a part of a casual thought even.
It was a new beginning as the sessions preceded many of my misconceptions and biased
thoughts started diminishing and the realities were unfolding itself. Now, my understanding
is that gender is relational and refers not simply to women or men but to the relationship between
them. To understand the gender bias and gender based disparities in health it is enough to
visit any of our public health systems or it is even enough to talk to a so-called educated man.
Most of them wouldn’t be able to agree to the gender equality principles, even if one agrees;
somewhere deep within will have certain disagreements on the same. Otherwise, a person
should be well oriented and towards the issue so as to have a genuine outlook on the same. At
the end of the fellowship the understanding on the issue has changed and this would help me
in dealing with the gender realities in a more comprehensive manner.
13
Snehadaan
Snehadaan is a must visit place in Bangalore for understanding institutional care HIV/AIDS.
This is where one can meet a community so committed to the cause of persons living with
HIV and AIDS. The work they do is admirable and exemplary. Anyone who visited
Snehadaan will find an answer to the question of how do an organisation provide a
comprehensive and holistic health care to the sick. Snehadaan is working to be a positive
force in addressing the comprehensive needs of the HIV infected persons, ensuring their
dignity and overall quality of life, by motivating, caring, supporting and rehabilitating them,
with a priority for the palliative care of those who are in the end stage of the disease. The visit
also helped me to refresh my awareness and understanding about the disease.
Their work with the children infected with HIV is amazing. I still can recall a few of the faces
of children I met on my visit. Their future might be uncertain and their past a cruel reality.
But children at Snehadaan live their present with zest. It was also an opportunity to reflect on
the plight of those diseased who are unreached and no one to care for. I think that one the
many ways in which we can tackle this deadly health condition is through proper sex
education at different levels of education.
Swanthana
Visit to Swanthand was painful. It is a home run by the Daughters of St. Camillus (Nuns) for
girls who are mentally challenged and have multiple disabilities. The inmates are girls who
are found abandoned in the city’s railway and bus yards, filthy drainage pipes, and garbage
bins, public market waste dumps, left to fend for themselves by their loved ones, brought by
the local police. The visit made me think of the plight of abandoned mentally and physically
challenged children. Why are they abandoned? Who should be blamed for this? ....are certain
questions that went through my mind. I returned from Swanthana admiring the work they do
providing the less privileged a holistic care.
APD (Association of People with Disability)
I was lucky to meet Ms. N S Hema, the founder of the organization a couple of days before
we actually visited APD. What a personality! She is an adorable change maker. Though being
a victim of polio at a very young age, yet she overcame her disability with sheer
determination and hard work to be a light for thousands of persons with disability. You don’t
now find the vigour with which she lived her youthful years but she is still convinced about
16
her dream of APD. I can still recall the conversation we had, it was so inspiring that she
convinced me the joy in serving the poor and the unreached especially the disabled.
Once you are in APD you will feel that disability is no more a big issue if every disabled had
an opportunity be in a place like this. They work towards to create an inclusive society, where
people with disabilities are accepted into the mainstream economy and social life. A culture
and eco system where they can earn, live and sustain with dignity and respect. It was a rare
opportunity to be with the empowered and enabled individuals and listen to their success
stories and get inspirations. The need for the early intervention in disability was one of my
key learning from the visit.
Alumni meet
It gives me immense joy and confidence as I look back on two days of SOCHARA family
gathering at St. Johns. It was not just a gathering but a celebration of community health in
SOCHARA family. The gathering was blessed with the presence of eminent pioneers from
the field of community health; Dr.Chandra, Fr. Claude, Fr. John, etc. The meeting was all the
more enriched with the presence of personalities like Sri. Keshav Desiraju, Dr. D K.
Srinivasa, and so on. There were also many others who joined us from various walks of life
who are in to community health or wish to be a part in the movement towards achieving
“Health for all”.
As I reflect on the two days gathering, the first thing that comes to my mind is the faces of
“young people” like Dr.Chandra, Fr.Claude whose presence itself mirrored their deep rooted
commitment to serve the people in need. The interactions with them made me realise how
much committed and optimistic one should be to follow once passions in life. It also helped
to realize how humble and simple one would become as his/her horizons of experiences and
knowledge broadens. The other personalities I met with and interacted also gave me a feeling
that I should learn a lot from the experience of people who have travelled the paths that are
less travelled. The sessions and discussions that happened during the meeting helped me to
have a better understanding on various topics like “integrating mental health with primary
health care”, “importance of mentoring”, “health equity in India”, and so on. The experience
sharing sessions by the mentors and the alumni fellows opened up my curiosity to explore the
different areas where a community health practitioner can engage or render services. It was
also an opportunity to meet with like-minded people and share ideas and experiences.
17
Both Ravi and Thelma were at their best in establishing SOCHARA as we see it now. Their
works are being paid off as there are many fellow travellers who dedicate their lives towards
establishing the goal “health for all”. I should also admit the efforts and hard works of all the
staff and the current fellows that eventually transfonned a gathering into a community
celebration.
Bhoomi Habba (Earth Festival)
Bhoomi Habba was a weekend spent in a serene setting of Visthar, an NGO committed to
empowering women, children and other marginalised sections of the society. The purpose of
the Habba was to celebrate ‘Just peace’. The objective of the festival was to increase
peoples’ awareness on issues pertaining to justice and peace. The atmosphere was electric as
people from different walks of life and from different comers of the country came together to
share experiences, discuss, and make a difference. Bhoomi Habba was listening to folk
music, enjoying local theatre, visiting a doll and poster exhibition, tasting traditional cuisines
including local North Karnataka specialities, watching documentaries like ‘Radiation Stories:
Koodankulam’ on the on-going struggle in Koodankulam, all this and more. The poster
exhibition gave glimpses of victims by the Bhopal Gas Tragedy and each picture conveyed a
story more powerful than the numbers and statistics that describe the world’s worst industrial
disaster. The exhibition of dolls made from scrap and cloth represented facets of domestic,
social and religious life of an ‘excluded’ India. It was a memorable day and rare opportunity
of fun and learning.
Anubhav series and Journal club
During the first collective a number of presentations on the Anubhav series of publications
were held. Each of them introduced unique successful organization’s working at grass root
levels. It was a time to leam from the experience of pioneers. It also introduced various
models of community based development programmes along with various other activities.
Journal club was a time to critically analyse and reflect on different journal articles, books,
write ups and more. This process has helped to develop critical analysis skills and also to
learn about various streams of thoughts.
FRLHT (Foundation for Revitalisation of Local Health Traditions)
The visit FRLHT was another unique experience. The campus was so green, full of medicinal
plants from around the country and well maintained; I felt like I was in the lap of nature. The
18
vision of FRLHT is to revitalise Indian Medical Heritage and thereby enhance the quality of
medical relief and healthcare in rural and urban India and globally by creating institutions for
knowledge generation, dissemination and community outreach. It has a university named
Trans Disciplinary University (TDU) and Institute of Ayurveda and Integrated Medicine
(I-AIM) as the healthcare services arm of TDU. Though I had heard about AYUSH, it was
through this visit I understood about in detail. The works they do in the campus on
documentation of local health traditions and the research conducted are remarkable. The need
and importance of Introducing local health practices (home remedies) as the 4th tyre in the
Indian Health System was a food for thought.
Community celebrations
SOCHARA is not a place of learning alone, but a place of fun and celebrations too. We never
missed to celebrate any cultural, religious celebrations, birthdays and special events.
Celebrations started with HOLI, the celebration of love; first time in my entire life. I
remember Ravi’s statement, r we are here to celebrate community.Each of these
celebrations was a time to reflect and learn something new. The most important learning of
all these celebrations was that every one of us knew what is “we-feeling” all about. There
were also lessons of sharing, caring, feeling, mutual understanding, and more. At the end of
the fellowship I sum up all my experiences as a culmination of community celebration.
Reflections and Learning
CHLP was an awesome experience. It was a holy space to learn, reflect, practice, experience
and to celebrate a whole lot of things. Some of my reflections are as following;
•
Community health approaches are context relevant, optimistic and pragmatic practices
as we move towards “health for all.”
•
There are many hindrances and negative forces that block our path towards the goal.
Some of them have to be fought and defeated, alternative ways to be taken to get
away with other obstacles.
•
The need of the hour is empowered and enabled individuals and communities along
with just and equitable policies and governance, by the governments, active health
movements supported by civil societies to tackle the challenges existing and
emerging.
19
•
“Scholar Activist” is the new role I have chosen at the end of the fellowship and I
should establish myself through my deeds and life, placing community at the centre of
focus. To fulfil this role I should go to the people live with them, love them, learn
from them, start with what they know, build on what they have. To do so I should
further develop my intrapersonal and interpersonal skills.
•
A shift from microscopic view to balloonist view and from floor mopper to tap turner
off is the paradigm shift happening in me.
•
I have learned that there is an element of Health in everything and without health
everything is nothing.
•
Understanding health in a holistic manner and working on the determinants of health
would yield better results.
•
I believe that change is a slow and gradual process hence, we should work patiently
and committed so that our dream will come true one day.
One year of CHLP journey has come to an end. There were many things happened; paradigm
shift in my own convictions and attitude towards health is the best that happened. I am sure
that this report is not enough to describe the things I have learned, unlearned, relearned and
experienced over a year. Though the fellowship has completed, yet the journey towards our
common goal continues. I can confidently say that I am prepared for journey through the
paths less travelled as a scholar activist. The real journey starts now and I hope that I will be
able to make small steps with in my capacity towards the goal!
References
•
Jan SwasthyaSabha. Health for All Now: The People’s Health Sourcebook. AIDIndia, Chennai; 2004
•
The SOCHARA Team. Social Justice in Health: Multiple Pathways towards Health
for All. SOCHARA-SOPHEA, Bangalore; 2014
•
People’s Health Movement. Health for All Now! Revive Alma Ata. PHM Secretariat,
Bangalore.
•
www.sochara.org
•
www.phmovement.org
•
www.communityhealth.in
20
Chapter - 2
Field Experience
My journey with THI
It was an experience of a lifetime to be at THI (Tribal Health Initiative). It was a time to
experience the ground realities and to be a part in the daily life of Sittilingi. I learnt a lot
about Maleivasi community life, their culture, traditions, festivals, economics and politics of
the villages, health issues among both men and women including children and elderly,
reflected on the existing government health systems of the land, listened to the voices of
youth regarding issues they face, their lives and above all THFs interventions and its
outcomes. It was also a time to apply and practice almost all the learning I had during the
collectives in the field. I learnt a lot from them too. After the initial dilemmas and struggles to
adjust to the new place, I picked up the rhythm.
THI other than providing health care has various other initiatives. Community health
approaches are used extensively in their works and Health Auxiliaries (HA) are the best
example of it. They view health as a state of mental, social and economic well-being and not
the mere absence of disease. Their health interventions go beyond merely providing curative
and preventive medical services. The farming and craft initiatives .are directly connected to
maintaining health and well-being in the communities they serve. This is supported by the
Educational Initiative, Thulir and the Technology Initiative.
Tribal Health Initiative (THI)
Amid quacks and blindfolded ignorant endeavours of the common people, which hardly
cured any diseases or ailments, Dr.Regi George and Dr.Lalitha in 1993, seeing the need of a
proper health care centre in Sittilingi, formed the Tribal Health Initiative (THI). Sittilingi is a
remote village in Dharmapuri district, 90 km away from Salem town in Tamil Nadu, which
used to be a horrible place where tribal people used to do black magic and apply fake
injections to cure people. This is when the young doctor couple took the initiative. They went
ahead to provide medical services to the people of Sittilingi, leaving their promising careers
in the cities. Dr.Regi George is an anaesthesiologist and Dr.Lalitha is a gynaecologist. They
are now fondly called “Ji and Tha” by the people. They were inspired by Mahatma Gandhi
and the vision of “Health for All”. Along with them now THI has Dr. Ravi and his wife
21
Prema, the Head nurse who extend their selfless service to the people of Sittilingi. All of
them are so humble and exemplary in their own ways. The commit with which they work is
admirable and they are great visionaries too. I consider it as a golden opportunity to be part of
their initiative for a couple of months.
THI, as of 2016, has grown to be now a 24-beded hospital with a labor room, neonatal unit,
operation theatre, diagnostic laboratory and imaging facilities, a community health outreach
program, an organic farming initiative, school health programme and a craft initiative which
aims to revive traditional Lambadi embroidery.
THTs approach to medical care went one step ahead in educating the people and ‘helping the
tribals help themselves’. They wanted to create a general understanding about health and
health issues and make the natives acquainted with basic first aid. Today, over 36
neighbouring villages are benefiting from the Tribal Health Initiative that sprung at Sittilingi.
And, the NGO doesn’t pertain only to the domain of medical facilities. They organize
educational program, cultural activities and community development initiatives.
VISION
The vision is that (ithe people of Sittilingi valley and Kalrayan Hills lead a better quality of
life".
They hope to attain the highest possible level of physical, mental and social health. To
enhance their socio-economic status while retaining their pride, self-respect and self-reliance
and ensuring their active participation in programmes meant for their welfare and to create an
atmosphere highly conducive for the growth and development of local cultures and customs.
MISSION
The mission for the people of Sittilingi and the Kalrayan Hills is
•
To be an educator to protect and promote health and improve basic knowledge levels.
•
To provide affordable and acceptable basic health care services to the area.
•
To be a facilitator to help people undertake collective action for their welfare
•
To provide a support system to help people come back to sustainable methods of
farming
22
•
To facilitate peoples knowledge about their rights and responsibilities and help them
exercise
•
To help them acquire additional skills and assist them in achieving self-reliance
through small scale entrepreneurship
•
To provide support for the social upliftment while retaining and building on their
local cultural strengths
VALUES
The basic values for their work is Faith in the people and their wisdom Sincerity, honesty and
total commitment in work, Secular and non-political to respect the dignity of every
individual.
Community Health Programme
One of THI’s signature programmes is the health outreach programme. It provides simple
curative, preventive, educative and rehabilitative services to around 33 villages in the
Sittilingi valley and the Kalrayan Hills. This programme caters to a tribal population of over
16000 tribals.
Health Workers
They are the back bone of the tribal hospital. During the early periods of the organization,
they started training local girls as health workers who are now able to diagnose and treat
common problems, assist in surgeries, conduct deliveries, and go into villages to provide
ante-natal and child care. The dedication with which they work amazed me. It was interesting
to know that they knew almost everyone in the valley and also are aware of all that is
happening around them.
They also conduct monthly mobile clinics for all pregnant women and under five children.
This has been the most essential factor in significantly bringing down infant and maternal
mortality and morbidity in the area. They are part of each and every activities happening in
THI.
Health Auxiliaries
They are the true heroes of the land and an integral part of THI’s health activities. The health
auxiliaries are older women chosen by the community from each village. Some illiterate,
some barely educated, these women are trained for a year in basic medical care, hygiene and
23
first aid among others. She offers advice on good nutrition, hygiene, birthing practices and
simple ailments, maintain records on important health events in the village and act as
facilitators for all community development work. She also has tablets for dispensing to
tackling certain health condtions at the village level.
Every month, Health Auxiliaries gather at the THI campus for a day, to meet with each other.
At these meetings, they discuss the health of their villages, reporting births and deaths of
village members, and other relevant information. These meetings also allow for their
continuing education opportunities.
Senior citizen clinics
With the intention of reaching the unreached and witnessing the plight of old aged people
THI initiated this programme. They are able to reach over 500 senior citizen of the valley. All
they have to do is to pay a nominal annual fee of 100 rupees and can avail any facilities of the
hospital for the whole year. Aged people otherwise left uncared and unnoticed can now relay
on the hospital team when they visit the village one a month.
It was one of my memorable experiences in Sittilingi as I had the opportunity to visit the aged
along with the hospital team almost every week to different villages. It was also an
opportunity for the elderly of the respective villages to come together, meet each other and
talk each other.
School health programme
This is a recent initiative by the organisation. I never missed a chance to accompany the team
to visit the schools. The school, where they have introduced the school health programme
were 90 kilometre away from the base hospital. It was also an opportunity to explore and to
know the interior tribal villages of Kallrayan hill ranges. There were no buses to reach the
villages. Villagers had to come down 20 kilometres to board in the bus. This alone is enough
to understand the life in those villages. Through this programme they have tried to introduce
basic health education, sowing the seeds of personal hygiene and sanitation into children’s
minds. These children being first generation learner meant a lot to their loving parents. In a
sense, they have now become ambassadors in what could become a major change in these
remote tribal villages.
The following are the testimonies form the children I interacted with during the field visits:-
24
•
A girl studying in class nine after learning about Tuberculosis from the programme
managed to convince her father, who was suffering from chronic cough to go and get
it checked at the hospital.
•
Two students have convinced their parents to build toilets in their houses, after
learning about health problems from open defecation.
The farming initiative
People from the local Malavasi communities have lived by rain fed subsistence farming and
the produce of their forests for a very long time. Traditionally they grew about fifteen
different varieties of crops suited to the environment and had ample food the whole year
around. This tradition has been displaced by the pressures of a modem consumerist economy
to grow cash crops. These crops are water intensive and people are forced to use chemical
fertilisers and pesticides in an attempt to maximise returns. Eventually the tribal farmer finds
himself in a situation where he is easily exploited.
Nutrition and livelihood are two factors that contribute significantly to an individual’s health.
Thus, when the people of the surrounding villages started bringing their farming troubles to
THI’s attention, an opportunity for growth became apparent and TH I expanded its programs
to include a farming initiative. Ji and Tha knew that “unless we start dealing with the
determinants of health, we would not be able to bring the tribal community to achieve a
better health status. ”
Working with the credibility they had already gained in the
community, TH I began teaching the farmers various organic techniques, aimed at saving the
cost of chemical pesticides, increasing the farmers’ yields, and improving the health of the
consumers. Since its inception in 2005, the Tribal Farming Initiative has grown to include
the following components/ programs:
•
Formation of SOFA (Sittilingi Organic Farmers Association), an association of
farmers currently practicing organic methods, and is in the process of receiving
organic certification from the government. Currently there about 200 farmers who are
registered of which half have got ‘organic certification’ from the Govt, of Tamil
Nadu. Now they are a registered company.
•
Creation of the SVAD (Sittilingi Valley Agricultural Development) brand, under
which 25 organic products are sold in various cities in south India
•
Formation of Women’s Self-Help Groups (SHGs), which perform value-addition
processing, increasing the profit margin for specific products
25
•
Creation of Seed Banks, ensuring the survival of various minor millets and other
traditional seeds, which were at risk of extinction due to the increased demand for rice
and decreased demand for other similar sources
Craft Initiative
The Craft Initiative enables local Lambadi women to become economically self-reliant while
preserving their traditional embroidery. Their products are sold under the brand name Porgai,
which means ‘pride’ in their dialect. The local Lambadi tribals migrated from the north of
India several hundred years ago. They have their own distinctive dialect, costume and
traditions. Their tradition of embroidery was very nearly lost. Only a few of the older women
remembered how to make the distinctive designs. This tradition has now been revived by the
Tribal Craft Initiative, with the older women teaching the younger women. They collectively
work under the organisation and about 60 artisans work now under the umbrella ‘Porgai
Artisans Association’.
This initiative is based on the principles of
•
Preserving the magic of their age old Lambadi embroidery
•
Respect for the artisan and fair wages for their time and skill
•
Empowering rural women by adding to their income
•
Reviving a dying traditional craft
•
Encouraging future generations to take pride in their culture
A visit to Neyyamalai
It was a soothing experience to visit the new project area named Neyyamalai. We had a great
off road jeep ride to the top of the hills. They had no roads till 6 months back except for the
rocky, uneven path paved into the mountainside, which motorbikes could traverse with
difficulty. Electricity too arrived just 6 months back, before which the Government had put
up solar panels in each house, which provided one night light per hut. For many years the
tribals from this remote hill range brought down their sick in hammocks made of bamboo and
old sheets and then either caught the infrequent buses or pay through their nose and hire a
jeep to come to Tribal Hospital. TH I wanted to reach out to them, as no health personnel
were ready to go there.
Once you are on the top of the hills, it is lovely. We spoke to a group of people who had
gathered near the local temple and asked them about the conditions there, their health, food
26
and agriculture. Water is often scarce and by common agreement all hand pumps are chained
and locked except for a few hours in the morning. Neyymalai's stepped hill sides. Cooking
hut is part of every house. There is no access to medical facilities and it is either the medical
shops in Thumbal for minor illness or Tribal Hospital for major illness. By default, most
agriculture is organic, but there is huge exploitation by the middle men as the tribals are not
able to bring the produce down to the plains, whereas the middle men employ tractors or
jeeps. The food is still mainly traditional as they still grow and eat a lot of millets, so they are
all relatively healthy. They keep cattle, poultry, and goats and go for the occasional
undercover hunt to supplement their nutrition.
Neyyamali is a new frontier for THI, where they try to extend their services to the people
who are unreached, and underprivileged. It is a perfect example of traversing the paths less
travelled and it has proven true of THI.
Understanding community
PHYSICAL ASPECTS:
Situated between the Kalrayan hills and Sitteri hills, Sittlingi is a scenic village in the valley.
Sittlingi is surrounded by hills all around and is close to Dharmapuri, Salem and Villupuram
district. Sittlingipanchayat comprises of 21 villages and are bordered by streams all around.
Has close to 50,000 population and most of them have at least 2-3 acres of land. Most people
live in their fields than as a community in the village. Each village has its own temple and
deity they worship. The entire village usually meet up in the temple for the thiruvizha (temple
festival). For the 21 villages there are 2 PHC about 14 kilometers apart. There are about 5
primary schools and two secondary schools. No colleges or vocational study centre are
available.
HEALTH STATUS:
Before TH I came to this area, lack of medical facilities was one of the major problems. There
were no functional PHCs [Primary Health Centre] in the area. The IMR (infant mortality rate)
was 146/1000. Most sick people in the villages had to walk 3-5 km. to the road to catch the
bus. Any emergency needing surgery or specialist treatment is 100 km away in Salem. After
TH I started its activities, now there is a vast improvement in Health facilities.
OCCUPATION:
27
The predominant occupation is agriculture. Agriculture is mainly rain-fed. They grow
traditional millets like bajra, com, ragi& pulses without irrigation. Pesticides and fertilizers
are used only for newer crops like hybrid rice and cash crops and not for the traditional crops.
A few families (mostly non-tribal) have started growing cash crops like sugarcane and
industrial tapioca now. Sheep and cattle rearing is the second major occupation. Many men
have migrated to Kerala and Tirupur (garment industries) in search of work. Many people
work as casual labourers - Daily wages for men are Rs.300 and for women Rs.200. Almost
all families own land and a house to live. Family size mostly ranges from 5 to 8.
FOOD:
Bhajra or ragi porridge or rice with rasam and sambar is the normal meal. With the
introduction of free rice through PDS families now mostly go for rice and rice related foods.
Vegetables are not included much in their food. Vegetables are available but they don’t make
use of them as they sell it of in the market. Generally vegetables are grown in their own land
during the rainy season; otherwise Vegetables are bought on weekly market days and the
vegetables available in the weekly market are tomato, potato, brinjal, cabbage & beetroot.
They keep cattle, poultry, and goats and go for the occasional undercover hunt to supplement
their nutrition. Through the organic farming initiative THI is trying to bring back the earlier
food practices among the new generation.
HOUSING:
Most people have their own houses. There are different types of houses mainly three types of
them. They are kooraveedu (kacha), medhaveedu(semi kacha) and periyaveedu (packka) the
Koora houses have low mud walls with hipped roofs thatched with hay or sugarcane leaves.
Houses have lofts for storage. They have a "panthal” or a covered space in front of the house
which is basically a framework of bamboo or country wood poles covered with bamboo and
shoots & leaves of a plant called "Velarithalai" (the peculiarity of this plant is that the leaves
do not drop away from the shoot after drying for a considerable length of time). This space is
the most important space in the house- besides keeping the house cool it also functions as the
living room. Cooking is mostly indoors and is done on the traditional wood stoves. The
smoke is considered beneficial to drive away insects and to keep the house warm in winter. In
the recent years, many of the houses are getting renovated and furnished into concrete houses.
28
SANITATION:
The tribal hamlets are generally kept clean and are in fact cleaner than other rural villages of
Tamilnadu. Water supply is mostly from govt, built bore wells (hand pumps) or from open
wells. Open-air defecation is a popular practice. The govt, has recently provided a water
closet for each house. These have been fitted near the houses, with no walls around, no
proper septic tank and no water supply. None of them are being used. A few of the newly
built houses have well maintained toilets. The younger generation especially school and
college going girls are in the opinion that they should have toilets while the elder generation
is not so much convinced about having toilets attached to home.
EDUCATION STATUS:
Most of the elder generation - men and women are illiterate. Till the last decade, the school
dropout rate was high among children, but now education seems to be a priority for most
parents. Most children now go to the government schools in spite of the difficulties in
reaching the school and poor quality of the facility. Most government schools have one or
two rooms staffed with one or two teachers. Teachers mostly live in Harur (40 km. away) and
their work schedule is guided by bus timings- they come around 10.30/11 am. And leave by 3
pm. Quality of education imparted is generally is comparatively poor. In the recent years
youngsters go to colleges. 2-3 college buses form Selam come and goe every day carrying the
students. A bachelor degree in arts or science is the highest level of education they get but it
doesn’t necessarily help them to get a job.
SOCIAL PROBLEMS:
Till a decade ago, dowry was not known there. The bridegroom had to pay a bride price to the
bride. Now with the migration of non-tribal into the area and the migration among the tribal
youth and adults, the dowry system has started. Girls are married off immediately after
attaining puberty. Female infanticide and alcoholism are the other problems prevalent there.
Borrowing money from moneylenders at high interest rates is common. Youth out of school
and unemployed or working as migratory labour also are matter of concern. All of it is
fuelled by incidents like failure of rain and increased need for money to meet the demands of
modem life.
29
OTHER INTERVENTIONS IN THE VILLAGE:
The Govt initiated women’s self-help groups have been formed in all the villages. Every
village has one or two such groups with around 20 members in each group. The Forest
Department too has started some Women’s saving groups in some villages. The main
activities of these groups are related to savings and loans. Other Village issues are not usually
dealt with or discussed in these groups. The Christian missionaries have been working here
for many decades now and there are many converts to Christianity.
THfs presence over 20 years has made significant shifts in the lives of people and the
community as a whole. They have an affordable, available, accessible, and accepted medical
care at their disposal. The organic farmers association along with the Porgai association has
led to the creation of SHGs. Almost all the employees of the organization is form the
communities and most of the development works are also done by them.
FACILITIES AVAILABLE:
Most villages are electrified. There is telephone connectivity and mobile networks but they
are unreliable. The change was visible with almost every one having a mobile. The younger
generation has tried to get a latest touch phone with android version at their disposal. Some of
them spent their savings of a full year to buy the latest phone available in the market. Post
office, Panchayat office, Tea shops, ration shop and a small grocery shop with minimal
provisions, an anganvadi, a primary, middle and high school, and creche are available in
Sittilingi. Most tribal hamlets do not have all of these facilities and people walk to Sittilingi.
For Photocopying, workshops, bigger grocery shops, Bank, Electricity office, Cinema theatre
and Police Station- one has to travel to Kottapatti 12 km. away. Vegetable and Fruit Markets,
Bakery, Dental clinics. Government offices, fuel gas refills, etc. one has to travel out of their
villages. For all bigger hospitals, stationery items, clothes shops, construction materials and
everything else, one has to go to Salem (90km)
INFRASTRUCTURE:
Most villages are well connected by roads, built by the pradhanmantri gram sadakyojana.
The roads are well maintained. Public transport is still a problem as hardly 4-6 buses are
available the whole day. There are government schools, PDS stores, anganvadi’s and other
government buildings along with few private shops exist. The tribal hospital and Thulir
School add beauty to the valley.
30
PATTERNS OF SETTLEMENT:
Most people live in their fields than as a community in the village. They prefer doing so as it
is easier to work in their fields. There is a clear distinction between the tribal villages and
non-tribal villages. There are two villages that are populated exclusively by the SC
community (Lambadi group). And there is a village comprising entirely of BC population.
DEMOGRAPHICS:
Sittilingi is located in Harur, Dharmapuri Tamil Nadu. It is a valley surrounded by the
Kalrayan hills and Sitteri hills. People from all age groups are seen here, most of them are
scheduled tribals, except two Lambadi villages and one OBC village. The language spoken is
Tamil and Lambadi community has their own language. The Sex ratio is almost equal.
Education has picked up momentum now, especially college education.
COMMUNITY LEADERS;
The formal leader is the Panchayat leader Smt.Thenmozhi elected by general election. In the
case of informal leaders, each village has an ooruthalaivar, a kangani and gounder. Ji and
Tha are also considered leaders now by many.
COMMUNITY VISITS
Government has provided the village with good infrastructure. To understand more about
them I visited 2 PHCS, a few schools and anganwadis.
Kottapati PHC- A well maintained building with all facilities was seen. It caters to population
of 20,000 people in a 15 km radius. Two allopathic doctors and a siddha doctor have been
appointed there. Other staff also included a nurse, a health inspector, pharmacist, lab
technician and cleaning staff. They are also doing some national programs on Yaws
eradication and on Non communicable diseases. They also have a fully equipped ambulance
with two EMT. They have an OPD of almost 100-150 patients per day.
Belanoor PHC- This is in a rented building with not much facility. Only one doctor, a nurse
and a cleaner have been appointed till now. It caters to a population of 15,000 populations for
a radius of 8 kms. They have an OPD of about 40-50 patients per day.
Primary school Belanoor- They had a good building with clean toilets. It caters to about 70
school kids for classes between 1-5. Two teachers have been appointed. They have very well
31
maintained records about the students. Mid-day meal is prepared in the campus and provided
to the students every day.
Middle school Sittilingi- Good school building with separate classrooms for all classrooms
and science lab and computer lab. About 5 teachers have been appointed for 150 students for
classes 6-8. Here also mid-day meal is prepared and served every day.
Anganwadi Belanoor- A small room and a kitchen have been constructed for the purpose of
anganwadi. Around 12-15 kids under 5 years of age are enrolled. They also are provided with
lunch under the Mid-day meal scheme. Regular ANC check-ups also take place and the
women are provided with Sattumaavu. One anganwadi worker and cleaning cum cooking
staff were present.
Medical pluralism- I also got to visit traditional healers, snake bite healer and a traditional
bone setter. People in the village still utilise the traditional practices of healing although it
looks like dying. Dais is also present and at home birth is still practised by some.
MEETINGS
I got to meet a lot of groups and people who visited THE It was very interesting, informative
and inspirational to meet them.
MRSK- A team from Odisha Bissamcuttack visited THI to especially help out with the new
educational institute Thulir to be started in Sittlingi. There was a good exchange of ideas
about education and community development. It was inspirational to see young boys and girls
from tribal villages in Odisha who were trying to make changes in their villages.
GUDALUR- A group of people especially farmers came to THI to spread awareness about
Forest Act and rights of the people living in the forest. It was a new information and
extremely useful to the farmers in Sittlingi. The farmers in Sittlingi also talked about organic
farming and gave them tips about starting it.
MADURAI COMMUNITY DEVELOPMENT COLLEGE- 15 students from the college
visited THI to understand the working and the impact made by the organisation on the
villages. The students were from different places in India and from different educational
background. They were also given a motivating talk by Dr.Regi George and Dr.Lalitha.
32
FOREIGN MEDICAL INTERNS - there were as many as 15 medical students from
Germany and UK, one each from South Africa and Australia. It was also a time to interact
with them and to know about their culture, practices, health care system, life style, interest in
exploring the rural India and so on.
A note!
He was a healthy, hardworking and only earning member of the family till two days back.
But now he is just crawled up in a hospital bed with burns all over his shoulders and neck and
arms. The mistake he did was he was lying down below a shelf with a lightened kerosene
lamp. It fell on him when he was fast asleep probably dreaming about a sophisticated fantasy
world and just caught fire. Of course the fire doesn't know it is a real person. So was he
unlucky to lie down at the wrong place? Was he unlucky to be asleep which made him not
aware of his painful agony he is facing now?
I believe he was just unlucky to be in one of the villages in INDIA which doesn't have
electricity in 2015 when we are talking about net neutrality, he was unlucky to still rely on
kerosene lamps when we are trying to settle down in the next planet and he was unlucky
enough to reach his emergency care after half a day when we are learning to use robotic
surgeries. (Written along with Dr.Sangeetha on Face Book)
The youth meeting
Inception of the idea
During my second field visit to THI, I went there with a blank mind. After the initial dilemma
I was quite convinced that I should do something solid. I had a series of discussions with both
my mentors, Dr. Ravi and Kumar; we decided to focus on the youth in the valley. We knew
that they are going through a tough time and something had to be done! THI had a great
interest in the development of youth program and they were waiting for a right opportunity.
So it was time that they knew that I could easily get along with the youth, I was given the
responsibility to gather the youth together for a day. The days that followed were tough as I
had to go around the villages interacting with the youth and informing them about the event.
It was a great experience and learnt a lot about the village and the plight of the youth in the
valley. Everyone had something to tell and each of them was excited as they felt that THI has
a special interest in them.
33
The meeting
Well, the Youth meeting happened on a fine Sunday (9/8/2015) and 55 youths from the nearby
villages participated. The meeting was a much awaited one and also the first of its kind in the
entire valley. We had a guest Mr.Guru from CMC Vellore who guided the gathering along
with the hospital team. Krishna and Anu of Thulir shared their experiences in working with
the children and the youth in the valley. They were at their best as they dealt with many of
them and are concerned for them. They went on to ignite the young minds talking extensively
on different aspects of “job/work”. They tried to bring out the misconceptions and myths
regarding village life and how the adivasi communities conceived jobs. We did it through
interactive sessions so that the participants could express their thoughts and concerns. As the
meeting progressed the youth were split into different groups and were asked to discuss
among themselves and to note down the strengths and weakness they thought they had as
individuals and as a group. Later on as they presented it by turn, they were guided to
transform the strength they possessed into action and the weakness to strengths.
The meeting was basically to bring together the youth in the valley to identify various
problems they face in their day to day life and to introduce the idea of developing youth
groups for their own good. It was amazing to see the young people participating in the
activities and sessions with much eagerness and enthusiasm. We split them into four different
groups and guided them to note down the strengths and weakness they think that they have,
from a personal perspective and as a community’s point of view. Each team came up with
various points and we had an open discussion thereafter. The meeting ended with a
fellowship meal (Sittilingi’s special organic millet meals) prepared and served by the women
group which was so delicious and healthy.
All went on well; Ji and Tha have conveyed that they always had a special concern for the
youths of Sittilingi and will be always at their disposal. They also promised that THI will
spend and share it’s time and energy to uplift the younger generation of the valley. As I sit
back and write it, 1 cannot believe that I had become an instrument in bringing the youth
together for initiating a youth development programme. I think it was because I could get
along with them easily that they turned out for the meeting.
34
THULIR
A centre for learning in Sittilingi village
1 met another couple in Sittilingi, forgoing the luxuries of the city to be with and serve the
people in need. When, Anuradha and Krishna moved to Sittilingi in 2003, their idea was to
create a space for learning that would be tailored to the local needs. With the help of Tribal
Health Initiative they conducted a survey of the villages, and visited local schools to
understand what was needed. To their surprise they found that almost all children below 14
were enrolled in schools! The parents were quite keen on schooling and so children were
religiously sent to schools even when there were no teachers to speak of or any learning
happening. They also found that most children dropped out of formal schooling at class 8 to
10 levels, often after failing exams. These teenagers consequently had very low self-esteem,
lacked basic academic skills, were frustrated and mostly migrated to nearby towns to work in
the textile industry. Schooling had, however, convinced them that farming or any kind of
work with the hands is inferior and something to be ashamed of. In this context they decided:
1. Try to improve academic skills of school going children
2. Try to see what can be done for teenagers who had stopped schooling.
Thus Thulir started off as a post- school Learning Centre. They tried to design activities that
reflect Meaningful Education, they believe, must comprise of a balanced mix of skills that
involve
•
The “hands”: the ability to shape materials and make useful objects.
•
The “head”: reading, writing, reasoning and critical thinking.
•
The “heart”: aesthetic sensibility, and a sensitivity to the environment that should
Their efforts have earned results in the lives of many young people in the valley.
Comments
When Thulir started, Anu and Krishna were hesitant to start a school. They chose to start a
resource center that could have various activities and reach out to more number of children,
school going, out of school etc. and also involve the youth in various ways - helping with the
activities of the center, training sessions for the youth on various livelihood skills etc.
In my view, Thulir has been able to create such a space where children and youths can come
and participate in different activities. Not any space, but a vibrant learning space for the
35
children who come in the evenings, after school. The beauty of this environment is that there
is no force or pressure on the children who come here. The adults offer whatever they have
and can and children are free to make what they want of it. And it is okay to be doing nothing
as well. Not everyone has to participate in the song, balloon making, painting, or origami
sessions. Everyday unfolds in a different way and there is no “schedule.” Consequently,
children who do come on any given day are engrossed in whatever it is that they are doing
individually or in a group.
The post school programme that Thulir ran for many years is a unique opportunity to explore
the role of work in education. The idea of hands on work as part of the learning process at
Thulir brings in useful vocational skills. Young adivasi people have been benefited by being
able to acquire skills that come in handy to make a living in the village or elsewhere. Over
the years, they have tailored learning to suit individuals and specific groups, experimented
with different mix of skills. So some years the emphasis was on construction skills [masonry,
plumbing, electrical wiring etc.], while on other years it was on electronics, and bamboo
crafts; and on still other year teaching preschool children, crafts, soap making etc. the hands
on work based programme have given confidence to the students to tackle academic exams
which they could not earlier. Many decided to continue higher studies enrolling in class 11 in
schools outside of the valley, some even at the age of 19 and 20! Some have gone on to
Colleges for degree courses. Thanks to Thulir that Sittilingi now also have some of the best
masons, electricians, plumbers, and farmers who were trained by Thulir.
ACCORD
I was lucky to visit ACCORD (Action for Community Organisation, Rehabilitation and
Development) in Gudalur. I spent almost a week and tried to explore the activities of the
organisation. The people I met were accommodative and willing to share their experiences. In
accord one can find adivasis both men and women who are empowered and enabled. It all
started way back in November 1985, when Stan and Mari started ACCORD as an activist
group in response to the rampant land alienation of the adivasis in the Gudalur Valley and to
help the adivasis organise themselves in order to assert our human rights - especially land
rights and out of the realisation that the adivasis of the valley were being cheated and
exploited.
36
The vision: - To help the adivasi community of the Gudalur Valley in the Nilgiris district of
Tamil Nadu to take control of their own lives.
They knew for sure that adivasis had to retrieve the ancestral lands taken away from them by
force and deceit and believed firmly that adivasis had a genius of their own and that if people
could regain their dignity, pride and self-esteem, they could once more take charge of their
own lives. Thus they started working for human rights, health, education, housing and
culture. And their mission is to redesign the systems necessary for that, to help the adivasi
community cope with the onslaught of modernity on their way of life and to prepare them to
emerge from their forest retreats with their heads held high, Proud of their culture and their
people. Now, Accord is basically a resource centre and a catalyst for various activities
happening in and around the campus and they are AdivasiMunnetraSangam (AMS), Ashwini
hospital, Vidyodaya School, Maduvana estate and so on.
Comments
I find the organisation very interesting and unique. The starting of all these initiatives was
through an adivasi movement, a collective effort and participation of people who no longer
want to be slave of anybody and it has grown to such heights. It was also a get together of
different adivasi groups named Mullukurumbas, Bettakurumbas, Faniyas and Kattunayakas
for a common cause. The fight they began still continues in different ways.
They grew and developed with ACCORD and the areas of growth and development are:
Health aspects of the adivasis are taken care by the base hospital where all the nurses are
adivasi women and the health animators at community level are chosen from the adivasi
community by the village sangams. They are well trained to cater the health needs of their
people. Education; Taking the children to the schools and teaching them in their own
languages were the tasks of the adivasi education volunteers. They set up a school named
Vidyodaya were the adivasi children were given a holy space to leam and it has initiated
drastic changes in the lives of many. Economics; to meet the economic needs the poor
adivasis they came together and decided to have a tea plantation where they own the land and
share the profits of their hard works and this has initiated other developmental activities too.
Most importantly the ownership of each activity is in the hands of the adivasis.
I could easily connect to the learning from the collective with the things happening in
Gudalur. It was like the perfect example of a community health approach and they actually
37
practice it. Everything from the Axioms of community health to addressing the determinants
of health to maintaining sustainability in the commitment undertaken was evident. These
efforts are paying off now as the communities started regaining their identity and initiating a
holistic development in their lives.
Personal Experiences and Reflections
Almost 5 months of stay at THI and a week stay at ACCORD was more than my
imaginations and expectations. The interactions with the local communities’, outsiders, the
persons who have become an instrument of change, my personal experiences and
explorations have helped me to get a relatively clear picture of what is happening around me.
I have tried to put some of them here...
Both the organisations are trying to do the best towards the dream ‘Health For AH’ and others
can learn lot from their experiences.
Considering THI; in the past 10 years, the Valley has been undergoing rapid changes.
Whereas earlier farming activity was mainly for family’s food consumption and therefore
was mostly rain-fed food crops comprising of a lot of millets, of late there is a lot of cash
crop cultivation like sugar cane, turmeric, tapioca, paddy etc.
There are other changes to, increasing mechanisation in the farms, more shops servicing local
needs, improved running of schools, so more children pursuing high school, proliferation of
cable TV, cell phones, increasing consumerism etc.
There are opportunities now locally for increasing income levels as a result of migration, cash
crops, new service sector, organic farming, etc. But there is also increasing pressures to
continue academic learning to join high school outside the Valley and to continue “college”
education; with the hope of getting jobs.
Since Health care and Education opportunities has increased with the availability of
Ambulances, easy connection to the city etc., and life style changes happening there is now
increased need for cash.
While basic health and hygiene has improved (though open defecation is prevalent still),
there have been changes in diet from millets to polished rice and less physical effort in
38
Farming due to mechanisation. Consequently there is an increase in life style diseases such as
hyper tension and diabetes.
Alcohol abuse is on the increase and so is domestic violence. There are an alarming number
of suicide attempts, especially among the youth.
As in any other communities, migration has become a part of their lives; it is fuelled by
various events such as continuous monsoon failure, low price for the agriculture products, life
style changes accelerated by the modem technologies, increased need for cash and so on.
References:
www.adivasi.net
•
www.tribalhealth.org
•
www.thulir.org
39
Chapter - 3
RESEARCH REPORT
A study on the psychosocial impacts of seasonal migration on Maleivasi
youth in Sittilingi.
Introduction
Migrations have occurred throughout human history. Migration occurs at a variety of scales.
People move for a variety of reasons. Human migration is the movement by people from one
place to another with the intention of settling temporarily or permanently in the new location.
The movement is typically over long distances and from one country to another, but
internal migration is also possible.
Seasonal migration
Seasonal migration is very common in agricultural cycles. They are likely to move from
place to place in search of employment, or to continue returning to the same place year after
year. Such circular flows encompass migrants who may stay at their destination for six
months or more at a time. Scholars have long characterized this migration as a type in which
the permanent residence of a person remains the same, but the location of his or her economic
activity changes (www.migrationpolicy.org).
Migration in India
According to the 2011 Census of India, more than two-thirds (69 percent) of India’s 1.21
billion people live in rural areas and this population account the most to migration. The
Census does differentiate internal migration within districts, between districts in the same
state, and across states. In 2001, inter-district migrants accounted for 76.8 million migrants,
and there were 42.3 million interstate migrants. Therefore, about 191 million people—or 19
percent of the total Indian population—were migrants from other districts or other states. The
NSS counted 15 million short-term migrants, but other estimates have placed the number at
about 100 million (www.indianstatistics.org).
40
About two out of ten Indians are internal migrants who have moved across district or state
lines—a rate notable for the sheer numbers who move within a country with a population that
tops 1.2 billion. A significant share of internal movements is driven by long-distance and
male-dominated labor migration. These flows can be permanent, semi-permanent, or
seasonal. Internal migrants have widely varying degrees of education, income levels, and
skills, and varying profiles in terms of caste, religion, family composition, age, and other
characteristics. Micro-surveys suggest that most migrants are between ages 16 and 40,
particularly among semi-permanent and temporary migrants, whose duration of stay may
vary between 60 days and one year (national-sample-survey).
Tribal migration
Scheduled Tribes (STs) are indigenous, have their own distinctive culture, geographically
isolated and are low in socio-economic conditions. For centuries, the tribal groups have
remained outside the realm of the general development process due to their habitation in
forests and hilly tracts.
Scheduled tribes and castes—the tribal and caste groups that are explicitly protected in
India’s constitution because of their historic social and economic inequality—are overrepresented in short-term migration flows (www.migrationpolicy.org). And most labor
migrants are employed in a few key subsectors, including construction, domestic work,
textile and brick manufacturing, transportation, mining and quarrying, and agriculture.
6
Migration and youth
For young people, the decision to migrate is often related to important life transitions, such as
obtaining higher education, starting work or getting married. Migration can have a positive
impact on young people by opening up new opportunities. However, for some young people,
the migration process confronts them with particular challenges and confers to them certain
vulnerabilities. These vulnerabilities include discrimination based on gender, migration
status, ethnicity or religion; poor working conditions ; lack of access to basic social services
such as health; risks associated with sexual and reproductive health; and lack of social
protection (www.un.org). Many migrants—especially those who relocate to a place where the
local language and culture is different from that of their region of origin—also face
harassment and political exclusion Therefore, the migration experience can end up
41
representing either an opportunity or a risk for young people and can either lead to their
development or the very opposite, depending on policies and measures supporting them.
Migration in the context of Sittilingi
Sittilingi is a medium size village located in Harur of Dharmapuri district, Tamil Nadu with
total 367 families residing. The Sittilingi village has population of 1474 of which 752 are
males while 722 are females as per Population Census 2011. Most of the people natives to
Sittilingi belong to the the Malayali tribes, the name derived since the valley is surrounded on
all sides by hills, ie, “malai” in Tamil. In Sittilingi the predominant occupation is agriculture.
Agriculture is mainly rain-fed. They grow traditional millets like bajra, corn, ragi (millets) &
pulses without irrigation. A few families (mostly non-tribal) have started growing cash crops
like sugarcane and industrial tapioca now. Sheep and cattle rearing is the second major
occupation. Many men have migrated to Kerala and Tirupur (garment industries) in search of
work. Many people work as casual labourers - Daily wages for men are Rs.300 and for
women Rs. 150. Almost all families own land and a house to live (from the meetings I had
with the labors during the earlier field visits).
According to THI, in the recent past the youths in the valley have gone through different
challenging situations and one of them is migration. Though the educational and the
economic status have improved considering the past, yet the youths fail to meet the
expectations and the demands of modem society. In this they either stay back home doing
nothing or are forced to go out of the village to earn and meet the needs. The testimonies
given by the youths in the youth meetings tell about the seriousness of difficulties they face in
their daily lives and the inability to tackle them effectively. The young women are usually
married off and they do not migrate like their male counterparts. The hospital records give us
an alarming increase in the number of suicidal cases which adds fuel to the present scenario.
This is the context in which i wished to do the study.
Title of the study
A study on the psychosocial impacts of seasonal migration on the Maleivasi youths in
Sittilingi, Dharmapuri, Tamilnadu.
Aim of the study
To identify the psychosocial issued face by the Maleivasi youths in Sittilingi who are
seasonal migrants.
42
a
Objectives
1. To identify psychological impacts experienced by the young seasonal migrants at the
place of migration.
2. To identify the social impacts experienced by the young seasonal migrants at the
place of migration.
3. To identify various coping mechanisms evolved due to seasonal migration among the
migrants.
Research Methodology
The study was a qualitative study as the study looks into the psychological and behavioural
aspects of the youth in Sittilingi resulting from seasonal migration.
Data collection technique and tool
The data was collected from primary sources and the respondents were selected through
purposive sampling. The study was conducted using in-depth interview as a data collection
technique and interview guide as a tool.
Study area and population
The area of the study was three villages named Sittilingi, Moolasittilingi and Nambangadu.
The sample size was 10 in number and was selected based on the purposive sample. Any
Maleivasi youth who are aged between 20 to 30 both married and unmarried who were
willing to be a respondent was included in the study.
Data analysis
The data collected through in-depth interviews was analysed manually using the principles of
thematic analysis.
Limitations
Time limit for conducting the study is considered as a major limitation of the study. The
study was conducted within one month. In order to extract the information regarding
psychosocial impacts requires spending much more time in field. Another major constrain
was a lack of proper communication facilities and a lack of fluency in Tamil. It was Diwali
and the people were in a festive mood. The findings would have been better and more
detailed if I could interview the family members and key informants to understand the
43
impacts better and also conducted FGDs to understand communities perception regarding the
topic. The study is small and pertaining to Sittilingi alone so the finding of the study cannot
be generalised.
Scope of the Study
A further study can be conducted to understand the problem better and thereby THI can think
of necessary steps to be taken, as they wish to intervene with the youth of the valley.
44
Findings
Number
Age
i
,n
Land
iMgjog
month
Migration
1
26
5th
wood cutter
Married
3 acres
15000
3
Eranakulam, Kerala
2
22
12th
wood cutter
Unmarried
1 Acre
15000
2
Malapuram, Kerala
3
24
12th
construction worker
Unmarried
2 Acres
14000
4
Aluva, Kerala
4
22
BA(ENGLISH)
supervisor at a garment
Unmarried
Nil
12000
1
Tiripur, Tamilnadu
factory
5
22
12th
works at power loom
Unmarried
1 acre
12000
3
Tiripur, Tamilnadu
6
26
8th
works at power loom
Married
2 acres
15000
6
Tiripur, Tamilnadu
7
27
10th
construction worker
Married
Nil
15000
2
Bangalore, Karnataka
8
26
8th
wood cutter
Married
2 Acres
18000
7
Malapuram, Kerala
9
26
9th
wood cutter
Married
2 Acres
20000
7
Vadakara, Kerala
10
21
12*h
construction worker
Unmarried
3 Acres
10000
2
Vengara, Kerala
45
Causes of migration
The causes of migration are complex. There are more people depending on agriculture than land
can support, along with this there is climate change due to tremendous decrease of monsoon and
untimely rain falls, uneconomic land holdings, poverty, unemployment and indebtedness in the
villages. Besides, a fairly large class of landless agricultural labourers has long been in existence;
how do they live?
In the case of Sittilingi, a seasonal migrant community all the above said are somewhat true. The
testimonies of respondents affirms how once a self-reliant agrarian community people had to
migrate to earn livelihood and to run their families. Here, the main cause of migration is due to
the failure of monsoon on consecutive years and the untimely rain falls that spoils the crop
massively. “We do not have enough rain for years now. The monsoon has failed. The rain god
has failed us, how do we live? ” says a respondent. Another respondent says “even if it rains, I
cannot predict when it rains. The rain comes as it wishes and spoils the crops ”. In the words of
another respondent “there is no proper rain for last 6-7 years, streams, wells and ponds have
dried up, how can we saw the seeds? ”
The loss of land owing to the accumulation of debt, the concentration of the land into a few rich
land lords who are either locals (maleivasitribals) or the newcomers (non-tribals) also have been
a cause. A respondent says “we have only a little land, we sold off the land to pay the debts
In the words of a respondent “/ don 't have any land. Even if I -work at someone else's field, I get
only Rs 300 a day and I don ’t get -work every day. How can I take care of my family? How can
we live? “ These landless rural labourers are the first to feel the pain of agricultural distress, and
improved means of transport enable them to leave the villages in search of work and higher
wages in the urban areas,
Some have also migrated to industrial areas in quest of work further as in the case of youths who
have gone through some sort of higher level of education; a basic degree is the highest. In the
words of a respondent “/ have completed the college, with my degree I cannot do anything here,
I have go to the town to get a job” Besides sometimes the villagers may seek employment in the
46
towns to evade the village money-lenders or to earn enough for building a new house and to own
personal vehicles, cattle or more land.
Psychological aspects
When we consider migration, it is definitely not easy to moving to a new place. Many people do
it, and many cities have been built at the cause of migrants, but that doesn’t mean that changing
from own locality to a totally strange enviromnent is a smooth task. The stress of the move and
adjustment to the new place, as well as the loss of so much from the old life and place, can lead
to anxiety and depression along with other psychological problems amongst migrants.
Psychological aspects are those that affect thoughts, emotions, behaviour, and memory, learning
ability, perceptions, understanding and coping mechanisms.
In its simplest terms the migration of a person places him in a situation involving psychological
adjustments greater in degree than he is accustomed to making, and often they are new in kind. If
the environment he has left is quite similar to that which he enters, his adjustments are few and
relatively easy; hence he is not likely to suffer any very serious disintegration of character, nor is
he likely to cause much disturbance in the life of the group and the community into which he
enters. If, on the other hand, the adjustments are many and difficult, because of wide differences
in various cultural and social patterns between migrant and native.
Missing family and friends
Often the hardest thing for a new migrant to cope with is the loss of family and friends. This can
cause an empty longing that is hard to relieve and that can lead to depression. It also can lead to
absenteeism at the work place. This was evident from the respondents’ statements. “When I go
for work I cannot be with my family, I cannot be with my children. I miss my friend and the
village”. Thus says a respondent.
Stress
The presence of stress at work is almost unavoidable in many works, especially when one is a
migrant labour. It is a kind of experience that entails a threat to something of value to the
individual. It was evident among the respondents. A respondent explains, “If I stay back I can be
47
with my wife and children. I will be happy. But when I am at the work place I think of my family.
I get tensed often. Even if I have any tensions I have to keep it in mind and work. Sometimes it
hurts a lot. If not I cannot work... I lose my concentration, I feel sick. ” This statement clearly
states the stress condition of the respondent. Stressful experiences can of course be of varying
magnitude and duration, which may make some of them more difficult to deal with. Moreover,
individuals are not equally equipped to deal with stress.
Guilt feeling
It is seen from the interviews that the seasonal migrants especially those who are married and
having children go through feelings of guilt. A respondent says, ‘"Normally to leave the family
and go to work is difficult. When the child falls sick, i cannot be with her. Ifeel pity myself. If I
was with her, she wouldfeel better.” Thus, this sort of feeling can affect their work.
Change in behaviour
Behavioural change happens over a period of time, especially to those individuals who have
developed in one cultural context when they attempt to re-establish their lives in another one. It
can be both positive and negative.
The respondents have expressed that they have gone through some sorts of behavioural changes.
These changes have been related to the way of communication, alcohol and tobacco consumption
and they became “decent and polite”. The respondents expressed that they started behaving
better when compared to their stay in the village. Similarly alcohol and tobacco consumption the
respondents have experienced a reduction in alcohol and tobacco consumption. Other than that
they have stated that they have become “decent” - in dealing with people. They also mentioned
that they have started mingling with the strangers.
Respondent states, “/ have also learnt to talk politely and also to behave well. ” Another
respondent’s response is “7/ we go out we can earn more. We can develop our general
knowledge. We can learn some new things... ” yet another respondent says, ""now I know what is
happening around us. I have learnt to talk politely and to mingle with people. ” These were some
of the responses from the interview.
48
Abuse
The respondent as they shared their experiences in the place they migrated have mentioned that
they have faced certain hard moments. In the words of a respondent who works in the power
loom factory, “/ work in a power loom. It’s a difficult job. So much heat inside and I cannot
manage some times. People are tough there. The manager tortures often. ” A respondent who is a
wood cutter says, “Sometimes trees fall on the houses and we get scolded. And we have to hear
slangs from the house owners and the people around.” Another man who is in a construction site
reports, llMy employer is good generally but at times when something goes wrong he fires us. If
we do anything wrong we get scolded. Sometimes we are slapped even... ” The respondent
expressed their helplessness they have gone through when they have to migrate and work in
unknown places.
Social aspects
Man cannot live in isolation with the society. Everyone is shaped by the society in which he is
bom, live and die. Social aspects refer to the effects on relationships, traditions, culture and
values, family and community, also extending to the economic realm and its effects on status and
social networks. This study has taken into consideration some of the social aspects and we
examine how it has impacted the lives of seasonal migrants of Sittilingi. They had gone through
mixed experiences and each of those experiences had its own impacts on their life. Especially
when they have to leave their own village to go and work in a faraway place under totally strange
employers in an unknown society, it is for sure that they go through a number of strange
experiences. Some of them are listed below.
Difficulty at the work place
When a migrant has to leave his own village and find a place to live in the place he migrated to,
finds it difficult to adjust with the situations. They are now in a new place working under people
who are strangers to them. The respondents are reported to have gone through mixed experiences
at the work place. The respondents were employed mainly in power loom industry, construction
sites, wood cutting and manual works. People who work in the power looms are reported to have
tough time as one of the respondents says, "I have to work from morning 8 to night 8, and there
is lot ofsound and heat, the work load is too high and there is no support from others.” Some of
49
them also complained about facing difficulty with the supervisor; in the words of a respondent,
“The work load is high and the supervisor tortures often. “ Some of them also shared that it is
difficult to get the wages on time and sometimes they have to keep asking the employer and they
keep changing the dates.
Whereas, it was quite different in the case of respondents who were employed into wood cutting
in Kerala said that though they had language problems in the beginning, yet the employers were
generally good and the places they worked were also adjustable. They also said that they had
enough freedom to move around and mingle with people. In the words of a respondent, “my
employer takes me in his car and we have food together. ’’ They have also expressed that they
like the places and the surrounding and the local people in the place they migrated to.
Difficulties at the place of stay
A migrant who leaves their own homes and move to strange places to work finds it difficult to
find a place to stay. The place they are migrated is strange and different in all aspects when
compared to their native. Until they migrate they lived in a comfortable zone along with the
family members and relatives. But now they are in a totally different place and have to live with
the strangers. The respondents are reported to have gone through mixed feelings as they talked
about their place of stay. Some of them complained of high rent, others said the room is too
congested and other complained about not getting enough water and so on. They added that they
often regret for leaving their villages whenever they face any difficulties. One of the respondents
who work in a power loom industry at Tiruppur reports that, “I live with other 6 people. Our
room is too small and we don’t have proper water connection too. Another respondent a wood
cutter in Kerala said that, “the room rent is too high so we have to live in many number in one
room. “ Some of the respondents who are wood cutters in Kerala reported to have faced difficulty
with the neighbours at their place of stay.
Economic improvement
Better wages is one of the reasons behind migration and it is true in the case of Sittilingi migrants
too. Many of the respondents reported that as they have migrated they started earning more and
as a result they have something for themselves now. The wages are most often the two to three
times higher than what one would otherwise earn in the village. Many of them send a portion of
50
the earnings regularly to home. Many of them also reported to have started savings. Some of
them were able to pay back the debts they had. A few of them have bought a new motor bike, in
the words of a respondent, “I have bought a new bike after going for work to Thiripurl" There
are also people who have started building new home; a respondent said that he has been working
in Kerala for around 7 years and “I have built a home now” Many of the people who were
employed in the wood cutting field and they are reported to earn rupees 1000 to 1500 a day
according to the work experience. One of them states, “/ get 1500 rupees a day, after all the
spending I can save around 15000 a month. ”
Meanwhile there are respondents who say that they don’t have any savings or economic
improvement but still they manage to live on. They expressed that if they hot not found a job
they and their family would be in debt and in poverty.
Family being happy
Family is an integral part of every individual. It is true in the case of migrants too. When a
family feels happy because of one who earns for them, it is a great feeling for that individual. In
the case of a migrant, though he has to go through tough time, when he/she knows that the family
is happy it becomes a great comfort to the migrant. The interviews reveals that there are different
situations where the family being happy. Some of them are the economic improvements, better
productivity of the individual, change in the behaviour and attitudes. One of the respondents’
states. ''My family is happy now, 1 sent them money and we are living better now. ” migrants who
are not married say that their parents are happy now because if they were to stay back in the
village they would have become local rowdies and since they have gone to earn they are no more
a part of any such activities. Though most reasons of happiness are economic improvement yet
there are also other impacts like behavioural changes that bring happiness in the family.
Coping mechanism
Among the migrant labours the phenomena of coping mechanism is clearly visible. Migrants use
different coping strategies at the same time.
In the case of the seasonal migrants from Sittilingi migrating to other places itself is a coping
mechanism used. “If I stay in the village, I don ’t earn anything and don ’t want see my family
51
starving. So I go to work in Kerala;” Thus says a respondent. Another respondent says “who will
give us employment in the village. I don’t have anything to cultivate either. So I have to keep
aside the pleasure and fun of being with the family and go to work.
When they feel Extreme physical exhaustion they resort to have drinks and smoke as a coping
strategy. This is evident from the words of a respondent as he states, ‘7 climb the trees, cut it
down and load it to the vehicle, when it is night I get unbearable body pain, I don’t get sleep at
night. I drink at night so that I can sleep for sometimes at least. ”
Some of the other coping strategies used by them are going for films, going for sightseeing on
free days, sleeping the whole day and so on.
Discussion
The purpose of the study was to understand the psychosocial impacts of migration due to
seasonal migration among the youth in Sittilingi. This was a qualitative study using in-depth
interview as technique. I felt it was appropriate to do in-depth interviews so that I could capture
more personal experiences of the respondents. I had the plan to do FGDs to understand different
aspects of the study better but unfortunately time and situation didn’t allow me to do so. The
challenges were regarding the lack of fluency in Tamil language, not getting respondents on time
and when I got the chance to meet the respondents, most of them were in the hangover of Diwah
celebrations. The study would have been better if I could get adequate time and if the in-depth
interviews were to be done with family members of the migrants and a few key informants of the
village.
Migration is a common phenomenon found throughout the communities around the world. Theie
are different type’s migrations and seasonal migration is one of them. It is commonly found
prevalent among the tribal agricultural communities in the interior rural parts of the world. It is
usually understood as associated to economic aspects of the individuals. But it is undoubtedly
known that it is not only associated to economic aspects alone but there are more aspects to it.
Each of those aspects also has some sorts of impacts in the personal and social life of every
migrant. Each of them will also differ from one to other migrants according to the sorts of
migration he or she enters into. Some of the impacts may have positive effects and outcomes to
52
the individuals whereas; some of them may be with negative effects and outcomes. This study
tries to understand psychosocial impacts on the lives of individuals who are young and who are
seasonal migrants specifically from Sittilingi. Psychosocial aspects and impacts are very vast
understand and it needs time and efforts so I have touched upon only very specific impacts. The
reasons behind migration and the coping mechanisms evolved as the result of migration is also
mentioned here.
There were many reasons mentioned by the respondents such as unemployment, monsoon
failure, huge debts and all of them are fuelled by the demands of the modem day. The increased
need for money to meets the needs of the day is also seen in the tribal villages of Sittilingi. The
reasons behind the migrations are mostly interconnected, as there is a shortage of rain leading to
poor agriculture outcome and to overcome it people approach money lenders and end up in debts
as the same happens in the successive years and as the cycle continue they have on other better
option than migration. At the same time the youngsters who had the opportunity of higher
education wish to get a job suiting their education and they do not want to follow agriculture as
their elders did leading to migration. Most of them end up in some other works like employee at
power looms in Tiruppur, construction workers or wood cutters in Kerala as they find it difficult
to face the cutthroat competition of the modem world. Along with the above mentioned factors
increased demand, better wages, better surroundings and living conditions, proximity are some
push and pull factors that make the migration possible.
Psychological aspects and its impacts is a vast area to understand and so, I have tried to look into
only certain specific areas that the respondents felt most comfortable to talk about. They have
expressed to have experienced positive and negative effects of migration. Every migrant longs to
stay with their family but they cannot, missing family and friends were the most common
complaints and it causes them stress and loses concentration in the work and guilt feeling,
thereby accidents have happened and could happen. Verbal and physical abuse also adds fuel to
the stress and in a long run it can lead to depression. Meanwhile it was evident that as the result
of migration, they have undergone behavioural and attitudinal changes (learnt to be more polite
and decent. It is because they believe that the people migrants meet are said to talk and behave
politely unlike the people in their villages) and also there was a decreasing trend in the alcohol
and tobacco consumption due to work related and economic reasons.
53
Social aspects of migration are relating to relationships, traditions, culture and values, family and
community. It is a vast area to understand so I have tried to understand a few of them
comfortably expressed by the respondents. Problems at work place and at the place of stay are
the most expressed and they are interconnected as they are strangers to the place and have gone
through feelings of discrimination, helplessness, anger, resistance, heavy work load and so on.
They also undergo problems regarding food and accommodation as it is expendable they have to
adjust themselves. In spite of all these people find joy because of the slight economic
improvements personally and in the family.
As a response to all the above mentioned they have adapted to various coping mechanisms.
Finding a place of migration itself was a coping mechanism evolved along with others like
absenteeism form work, going for films and roaming around on free days and even tobacco and
alcohol consumption occasionally. Like in any other case, the seasonal migrants from Sittilingi
undergo similar psychosocial impacts and adapt different coping mechanisms that help them to
get away with the disturbing thought about family, work related stress, and so on.
Conclusion
The study has helped to understand and identify various reasons behind the decision to migrate,
psychosocial impacts and its effects and the coping mechanisms adapted by the young seasonal
migrants of Sittilingi. The study reveals that migration itself was a coping mechanism evolved as
a result of various difficulties like unemployment, increased need for money and failure of
agriculture due to different reasons, faced by them in their native. Though most of them go
through tough situations in the place of migration, yet they had to adjust with it so that they and
their family will have a better life. Monetary benefits are the prime factor that promotes
migration among them. Contrary to the common belief that migration results in higher intake of
alcohol and tobacco products, the study reveals that the level of alcohol and tobacco
consumption has come down among the migrant youth in Sittilingi. The study finds that the
migrants are happy that they have experienced certain behavioural attitudinal changes. Almost
all the migrants wish to come back to the village once they have enough to live on.
54
Reference
1. King R. Towards a new map of European migration. International journal of population
geography. 2002 Mar l;8(2):89-106.
2. Deshingkar P, Start D. Seasonal migration for livelihoods in India: Coping, accumulation
and exclusion. London: Overseas Development Institute; 2003 Aug.
3. Internal Labor Migration in India Raises Integration Challenges for Migrants/MARCH 3,
2014FEATUREBy Rameez Abbas and Divya Varma
4. National Commission For Denotified, Nomadic And Semi-Nomadic Tribes (Ministry Of
Social Justice & Empowerment Government Of India) Report Volume - I June 30, 2008
5. Chatterjee CB. Identities in motion: migration and health in India. Mumbai: Centre for
enquiry into health and allied themes; 2006.
6. www.tribal health. Org
7. 8. Prof. S. T. Hettige, Etal,Understanding Psychosocial Issues Faced
By Migrant Workers and Their Families. Under The Patronage of The Ministry Of
Foreign Employment Promotion And Welfare Supported By The Swiss Agency For
Development And Cooperation; August 2012.
55
Annexure-1
In-depth interview guide
Personal background
1. What is your name?
2. What is your age?
3. What is your educational background?
4. Since when are you migrating to other places for work?
5. What were you doing before migrating?
Reasons for migration
6. What are the reasons for being migrated?
Place, season and duration of migration
7. When do you normally migrate?
8. Where do you migrate to?
9. For how long you migrate?
10. How much do you earn?
11. How do you spend it?
12. Do you have savings?
13. Where do you save your money?
14. Do you support your family?
Life at place of migration
Can you explain about what is life like in the place of migration?
1. Explain about the place where you stay(size of the room, members)?
2. How do you manage food?
3. How far it is from your place of work?
4. What is your work time?
5. How do you spend your free time?
6. Do you go for a film? If so, what sort of film?
7. Who is your favourite film star?
56
8. What recreational activities you participate?
Problems faced in place of migration
1. Can you explain about the difficulties you face at place of stay?
2. Do you miss your family and village?
3. Can you explain about difficulties faced at place of work?
4. What do you do about those problems?
5. What do you do when you fall sick?
•
What are your personal needs?
•
How do you manage your personal needs?
•
What are your future plans?
57
Annexure- 2
Certificate of Consent
Title of the study: -A study on the psychosocial impacts of seasonal migration on the Maleivasi
youths in Sittilingi, Dharmapuri, Tamilnadu.
Name of the researcher: Jaison K Sebastian.
Name of the Institution: SOCHARA, Bangalore.
I have been invited to take part in the A study on the psychosocial impacts of seasonal migration
on the Maleivasi youths in Sittilingi, Dharmapuri, Tamilnadu. I understand that it involves me
taking part in an in-depth interview and focus group discussion. I have been explained the
purpose and procedure of the study. I have been informed that no risk is involved in taking part
in the study and that there will not be any direct benefits for me. I understand that the
information I will provide is confidential and will not be disclosed to any other party or in any
reports that could lead to my identification. I also have been informed that the data from study
can be used for preparing reports and that reports will not contain my name or identification
characteristics. I am aware of the fact that I can opt out of the study at any time without having to
give any reason. I have been provided with the name and contact details of the researcher whom
I can contact.
I have read the foregoing information, or it has been read to me. I have had the opportunity to
ask questions about it and any questions I have been asked and have been answered to my
satisfaction. I consent voluntarily to be a participant in this study.
Name of Participant
Signature of Participant
Date
Thumb print of participant
If illiterate
58
Annexure-3
PARTICIPANT INFORMATION SHEET
Dear Participant,
I, Jaison K Sebastian a fellow (CHLP) at SOCHARA, Bangalore, thank you for your time and
willingness to hear and read about the field study titled “A study on the psychosocial impacts of
seasonal migration on the Maleivasi youths in Sittilingi, Dharmapuri, Tamilnadu.” I intend to do.
This study will be done as part of my fulfilment of the Fellowship program requirement. For any
adverse effect as result of the study, you may inform,
S J Chander
Programme Officer
SCHOOL OF PUBLIC HEALTH EQUITY AND ACTION (SOPHEA)
No. 359, 1st Main, 1st Block, Koramangala,
Bengaluru - 560 034 Karnataka, India
Email: chc@sochara.org
Phone: +91-80-25531518, 25525372/09448034152
Web: www.sochara.org
59
The photo journal
These are some of the pictures randomly clicked during the CHLP journey. Each of these
pictures speaks for themselves.
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Community Health Learning Programme is the third phase
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and is supported by the Sir Ratan Tata Trust, Mumbai and
International Development Research Centre, Canada.
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Bengaluru - 560034
Tel: 080-25531518; www .sochara.org
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