Health for the Millions, Vol. 9, No. 1-3, Feb. - June, 1983.pdf
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Health
Association
India
FEBRUARY 1983
_______________ _
HEALTH CELL
I Block
dlW)
find Nurses
RUTH HARNAR
Making Nursing Relevant
Is this the only kind of nursing we need ?
In 1975, the CAHP-TNAl Nursing Survey in India
The curriculum for general nursing schools was to
was published, the result of a detailed research done be revised to qualify nurses to work in rural areas.
byCAHP (Coordinating Agency for Health Planning),
Schools were asked to take seriously the obligation
and still is the only definitive study of its kind in India. to provide actual village experience. Motivation was
It is interesting to note that the recommendations again of the greatest importance. It was suggested
made by the Steering Committee of Nurses and the that Practical Nurse Courses should be started.
Board of Directors of CAHP differed. The latter felt
Text books translated into local languages were
that more radical change was necessary to meet the
needed for the purpose along with other teaching
needs of the people in India (CAHP Recommenda
materials. To provide teachers for this level of workers,
tions).
local nurses were to be helped to get necessary train
The CAHP (nowVHAI) recommendations suggest ing for teaching and special orientation to be given
ed that pilot projects be started for auxiliary level forteaching the ANMs.
(ANM) health workers to experiment with the Indian
In 1975, a Nursing Education Consultant joined
Nursing Council syllabus, in the simplest possible
the
staff of VHAI. Among her responsibilities related
settings with only 6-8 students, and where the need
to
curriculum
change, the first one was "helping to
is greatest—in such states as Orissa, Bihar, UP and
MP. It also suggested that the local language should revise the present educational programmes for nursing
be used and motivation and attitude for community personnel at all levels". Other related tasks had to do
with improving present courses for nurses and health
health care stressed.
HEALTH FOR THE MILLIONS/FEBRUARY 1983
1
team members and finding ways of motivating nursing
personnel at all levels for work in community nursing
and primary health care.
What has been Accomplished
Any kind of change is difficult to bring about and
there are several factors in nursing in India which
exaggerate the difficulty. Nurses have had a very low
status in a country where women working outside the
home, with all people of all castes and groups (includ
ing both sexes), was unacceptable to the majority of
people. Nurses in their struggle for status have found
that higher levels of education, including a degree
and specialising in teaching or administration, helped
to win respect. On the other hand, as in medical edu
cation, 'public health' had no appeal at all, especially
since it required young girls to live in villages unpro
tected, and as strangers—to visit peoples' homes, in
many places, is almost a social taboo.
"AITEAI" model
In the situation described, any sudden change
ordered by the 'powers that be' is likely to be strongly
resisted. Therefore the steps in the AITEAI model,
standing for AWARENESS, INTEREST, TRIAL,
EVALUATION, ACCEPTANCE and INTEGRATION
are necessary although they are time consuming. The
work of VHAI through the nursing consultant and
many others seems to fit into this pattern.
Awareness
Since 1975, and indeed up to the present, VHAI
has taken every possible opportunity to inform nurses
Measuring how they grow.
Creating awareness and acceptance.
at all levels, of the present health situation in India and
other developing countries; of the failure of the health
systems and health professionals to reach the people
with adequate health care; and about the trends and
changes in health delivery systems in the country. It
pointed out the danger of nurses being completely
absorbed in the care of the sick if active efforts were
not made to find the most appropriate role for nurses
in primary health care along with the need of learning
to work as a team, accepting village people also as
members of the team.
Articles were written for the nursing journals,
speeches were presented in conferences, opportunities
were accepted to become resource persons in work
shops and seminars of other organisations.
VHAI implemented a plan which involved several
types of workshops and courses in 1976-79. In about
3| years, VHAI planned and participated in about 50
workshops, seminars and shoit courses related to
Community Health and Development. Most of these
were deliberately planned to give information and
experience that would help to motivate nurses and
others to take action in their work and in teaching
nursing students to increase interest and knowledge
of community health.
In addition, six two-week
workshops in various areas of India were held for
Nursing Tutors on 'increasing the community health
content in the present nursing curriculum/
Two major occurrences in 1977 influenced the
change process in nursing curriculum. First, the VHAI
Nursing Consultant accepted a 10-week assignment as
a short-term consultant with the SEARO WHO to
direct a Regional Workshop on 'Community Oriented
Nursing Education' and to prepare guidelines on
bringing this change about.
HEALTH FOR THE MILLIONS/FEBRUARY 1J83
The second influence was a new curriculum for
ANM schools brought out by the Indian Nursing
Council. This was intended to prepare 'Health Workers'
(Male and Female) to fit into the Primaiy Health
Centres and sub-centres under the multi-purpose
health workers' scheme. A real attempt was made to
increase the community health related content in the
course including more weeks of experience in the field
practice. But, a political decision forced them to
shorten the course from the two-year ANM course to
18 months despite there being three times as many
teaching hours minimum required. Each State was
asked to change the ANM Schools into Health
Workers' Schools with the new curriculum and to
shorten the course to 18 months, raising entrance
requirements from Vllth pass to Xth pass.
Interest
There began to be evidence of greater awareness
and more Interest among nurses in community nursing.
For example, in 1977, a long series of continuing
education, short courses were held in RAK College of
Nursing. Only one or two were related to Community
Health. In 1 978, 5 short courses in a row were in this
field, including training and preparation of nurses,
nutrition, communication in health education and
training, and utilization of Village Health Workers.
table. Some of the participants also wrote articles—
and shared with other nurses. One result of the Work
shops was a draft pamphlet listing different kinds of
practical experiences which nursing schools could
plan for providing community health experience in the
present General Nursing course.
With WHO-UNICEF stress on Primary Health Care,
to be made available for all, and Indian endorsement
of this as a goal for health services, further impetus
has been given to the gathering interest. There have
been two national conferences of the Public Health
Nurses Section of the Trained Nurses Association of
India, the second in August 1981 using the ICSSR/
ICMR report Health for AH: An Alternative Strategy
as a basis for the sessions, including a lively panel
discussion on change required in Nursing Education.
The themes of the Education Section's National Con
ference, and the October, 1981 Quadrennial Confer
ence of the TNAI were 'The Role of Nurses in Primary
Health Care'.
Perhaps the most immediate interest has been
aroused by the sudden imposition of the INC's new
Health Worker's ANM curriculum in 1977. Some
States have not yet accepted or implemented the
scheme. Many private ANM schools closed down
because they felt it was not possible for them to
implement the change. Lack of facilities, staff, text
books and the shortened duration of the course which
had been so greatly expanded in both theory and
practice requirements, were serious problems.
The ANM-Health Worker's Project
Training can be entertaining too !
More and more requests came to us for help in
planning experience for nursing students in the rural
field, as to how to work with the community, how to
motivate-nurses for community health and what to
teach.
The workshops for Nursing Tutors resulted in
increased interest and willingness to try something
new—even though many problems seemed insurmoun
HEALTH FOR THE MILLIONS/FEBRUARY 1983
In response to anguished appeals for help from
some ANM schools, VHAI set up a small project to
see what could be done. Five ANM schools in three
States, Madhya Pradesh, Bihar and Orissa, indicated
an interest in participating at a workshop held in the
second half of 1978. In April 1979, a refresher course
for tutors from these schools was held. New methods
of teaching were tried out, discussions and observa
tion of field experience were held. But the major effort
of the tutors was to reorganise the syllabus of the
INC, including all content under five major concepts
as integrated subjects. These are : Keeping the Body
Healthy, Understanding Ourselves and Relating to
Others, Keeping the Family Healthy, Introduction to
Community Health and Development, and Restoration
of Aealth.
Midwifery was a more or less unchanged sixth
subject. For each of these integrated subjects, the
participants stated behavioural objectives and listed
3
competencies needed to accomplish each objective.
Content, however, covered all that was included in the
INC syllabus. It was also felt that the duration of the
course should remain two years.
Three schools were under the Mid-India Board of
Examiners of Nurses (of the Nurses League, Christian
Medical Association of India). The MIBE obtained
permission from the INC Secretary to experiment with
the revised course. They tried to follow the outlines
for the next year, finding that there were many repeti
tions of content under various subjects. The subject
'Understanding Ourselves and Relation to Others' was
most difficult because it was mostly new material and
very theoretical. We are working on a complete re
writing of this subject. The MIBE now use these sub
jects for final examinations, including a high propor
tion of questions (now all multiple choice) on a wide
variety of preventive and community health related
situations.
The most recent step on the Health Workers' Cur
riculum has been to simplify the outlines and to share
the progress made between the MIBE and the Board
of Nursing Education, CMAI—South India Branch.
The next step, since this Board has also accepted the
recognised syllabus of the six integrated subjects
based on major concepts, is to have the author of
the old Textbook for ANMs, Miss Audrey Chalkley,
rewrite the textbook on this revised course, using the
Government's Health Workers' Manuals and VHAI's
adaptation of Where There is no Doctor as companion
textbooks. She has already begun the work, VHAI
staff members have assisted in preparing detailed out
lines for eight chapters of Part I, Community Health
and Development.
General Nursing Curriculum
It is very fortunate that the VHAI Nursing Educa
tion Consultant had already worked closely with the
MIBE for thirty years. So collaboration with this
body has been facilitated, not only for the ANM pro
ject, but also for study and revision of the General
Nursing curriculum. In a year and a half, three curri
culum revision workshops have been held, with study
carried out in the interim. Following the guidelines
prepared as a part of VHAI consultant's short term
consultancy with WHO, the MIBE members have
developed a Community Health Oriented Curriculum
including a new Philosophy and Objectives (accepted
by the Board members). Subjects have been design
ed to prepare the nurse for 'preventive' health care at
various levels in various settings. The organization
of the subjects is based on the steps in the Nursing
4
Can we demystify this even further ?
Process (Assessment, Planning and Implementation of
Nursing
Interventions and Evaluation).
Defining
subject objectives and competences and writing out
lines is now in process. This was begun in a work
shop for Tutors of all MIBE schools.
In addition to work on revision of the general
nursing course, the MIBE has studied the relationship
between general education patterns (104-2-1-3), the
vocational "4-2" subjects and the Health Workers,
and Nursing Courses. They have made several re
commendations including recognition of the new
Health Worker (ANM) 2-year course as equivalent to
10 4-2 required for admission to nursing schools.
The Board also recommends that this course become,
as soon as practical, a pre-requisite for general nurs
ing, thus creating a nursing "career ladder" with
several points where the nurse could leave the educa
tion programme to work.
All of these recommendationsand proposals have
been sent to the INC for consideration. The WHO
assigned an Indian nurse as a short farm consultant
to work on the Health Workers Curriculum Guide.
In August 1982, The Indian Nursing Council called
a workshop on revision of the General Nursing curri
HEALTH FOR THE millions/FEBRUARY 1983
culum. Representatives of the MIBE and SIB were
among the nurses leaders representing almost all of the
States. The VHAI nursing consultant was asked to
coordinate the workshop and is a member of the follow
up committee. The recommendations sent to the INC
were carefully considered and a revised syllabus has
been sent to the INC which is very mush more com
munity health oriented than the present course. This
syllabus is now undergoing the process necessary to
have it accepted by all State Nursing Councils,. The
workshop has strongly recommended to the INC spon
sor workshops in the States to reorient and prepare
all nursing tutors, for the change. It has been sugges
ted to the INC that the Government request help from
the WHO for this purpose. It will take time to make
the new curriculum a reality, but the first necessary
steps have been taken.
This new syllabus will be for hospitals related
general nursing courses. The INC has earlier made a
revision of the B.Sc. Nursing course, and most nursing
colleges have implemented changes.
Post Certificate Nursing
Inspired, partly at least, at a VHAI Workshop for
Tutors held at Indore, a Canadian faculty member of
the MIBE Graduate School for Nurses, took further
studies in Community Health Nursing on her furlough.
She has returned to the Graduate School and led a
revision of teaching methods and content in the various
courses, with the help from the faculty and others.
Community Health concepts are introduced from
the beginning of the Ward Sister courses in a week
long workshop on 'The Nurse as a Citizen'. Through
out the various subjects, every opportunity is used to
stress communication skills, interpersonal relation
ships, assessment of society, and of peoples' needs, etc.
The 'Public Health Nursing' course is so different that
its students wish the name is changed to 'Community
Health Nursing.' Students of the Tutor's course who
come from ANM-Health Worker Schools have the
opportunity to really study and develop their skills in
teaching the new syllabus—and many are using the
VHAI revised subject outlines. Teaching materials from
A Comparison of the Present I.N.C. General Nursing Syllabus
with the Proposed Draft I.N.C. General Nursing and New M.I.B.E. Curricula
The General Nursing Curriculum as revised by the I.N.C. Workshop of August 1982 and Follow-up Committee
is as yet incomplete and tentative. The proposed draft will be sent to the States and Nursing Councils.
Following is a comparison of the proposed curriculum with the present I.N.C. General Nursing Syllabus and
the new course planned by the M.I.B.E.
This comparison is for study purposes and should not be taken as the final curriculum.
Proposed Indian Nursing
Council Draft
Present I.N.C.
Curriculum
Hours
Proposed
Hours
Mibe Curriculum — New Curriculum
First Year Basic Sciences (Applied to Nursing)
1.
Health and Life Processes
20
2.
Basic Science Concepts
40
3.
Hygiene : Personal and Environmental
80
Anatomy and Physiology
80
30
Physics and Chemistry
40
30
Microbiology
35
Hygiene : Personal and
Environmental
Total Hours for Basic Sciences
(Normal and Abnormal)
180
Behavioural Sciences (Applied)
20
Psychology
50
4.
Applied Psychology and Mental Hygiene
15
Sociology and Economics
30
6.
Sociology and Economics
10
New
Health Education and
Communication Skills
(3)
8.
Health Teaching on Hygiene
Sanitation, etc.
Language and Communication Skills.
13.
Preventive Nutrition
Total Hours for Behavioural Sciences
30
110
Community Health
30
Nutrition
50
New
Epidemiology and Health Statistics ...
20
7.
(8)
Major Health Problems
Searching for and using information.
6.
Survey and study methods. Use of data
and records. Problem solving
5.
Philosophy of Health Care Development
and Social Justice
20
Health and Social Services of India
20
11.
15,35
Family Health Care and
Mother and Child Care
80
(13)
(15)
New
Family Welfare and Human Sexuality
40
20
Community Nursing
60
Maternal and Child Care
Health Care and Education
Assessing, planning and implementing
care of patients in home and village
17.
Rehabilitation Methods and work of
Social Agencies
(18)
Introduction to Medical Science
15
20
Health Assessment and Treatment of
Common Disorders
30
Emergency Nursing & First Aid
Total Hours for Community Health
Working with the Health Team and
Community Organization
1.
Physical and Health Assessment
10.
Early Diagnosis and Treatment of Common
Ailments and Disorders
300
HEALTH FOR THE MILLIONS/FEBRUARY 1983
Proposed Indian Nursing
Council Draft
Present I.N.C.
Curriculum
Hours
Mibe Curriculum—New Curriculum
Proposed
Hours
Clinical Nursing
150
160
Foundations of Nursing
Total Hours in the First Year
(15) Assessing, Planning and Implementation
of care of patients and children
750
Second Year
Clinical Nursing
200
(Comprehensive) Medical-Surgical
Nursing, including Pharmacology
and Communicable Diseases
15
Psychiatric Nursing and
Mental Health
15
Paediatric Nursing
Total Hours in Second Year
Understanding the needs and problems of
patients with Medical-Surgical conditions
300
14.
30
(15) Assessing, Planning and implementing of
care or patients and children
70
16.
Technique of Evaluation of patients'
responses to nursing care
—
(Maternal Care)
22.
Professional adjustments
400
Third Year
120
6 Months Midwifery
(5th Semester) after Nursing
80
Professional Subjects (Internship)
10
History of Nursing
10
5
Trends in Nursing
10
18
20
Nursing Legislation
10
Professional adjustments ...
10
Management in Nursing
20
...
••
>>
Administration in Nursing
(16) Evaluation of patient care (on ward and
community)
20.
Determination of Patients
response to care
21.
Research or Study/project on nursing care
Evaluation and measurement in learning
problems in hospital or community health
care programme.
808
Total Hours in Third Year
140
Total Hours
1290
Curriculum and training figured at the annual meeting
The "24-1" Nursing Curriculum, multi-purpose health worker's course and village health worker’s
training was the major subjects for discussion at the 2-day general body meeting of AP VHA which
was held in Vijayawada on February 4 and 5, 1983.
HEALTH FOR THE MILLIONS/FEBRUARY 1983
7
fcontd. from page—5)
VHAI are made available to them (as well as to many
other post-basic and degree nursing students). Since
the course is given largely in Hindi, the nurses from
the northern States of India can receive special help.
Evaluation
This step has just begun since the MIBE schools
have tried out the revised ANM (Health Workers')
curriculum planned with VHAI assistance. This ex
perience and reports have led to the acceptance of
integrated subjects scheme by other schools of the
Board of Nursing Education (SIB) Examinations for
both years of the course were carried out in April, 1 982
by the MIBE. It will take several years of experience
and more time for assessment of the performance of
those who have taken this new course in the field to
determine needed revisions and effectiveness of this
experiment.
It is fortunate that the VHAI nursing consultant
has the opportunity to work on a WHO project on
developing and field testing tools for assessing perfor
mance of Health Workers at various levels. This know
ledge and experience will be shared with Nurse
Examing Board, and Nursing Tutors.
groups before the step of ACCEPTANCE is reached.
The INC welcomes continued experimentation by the
MIBE and SIB.
In the meantime, MIBE is proposing, and has
asked VHAI, to help plan a central experimental
health workers' school in a village with simple but
adequate facilities and few students to try out the new
curriculum from 'scratch'. The thought is that the
student can spend most of one year in a village sett
ing, going to the Primary Health Centre or rural hospi
tal only when fam’ly members with whom she is work
ing, need to go. The second year would be midwifery
and most of the 'Resto'ation to Health Course' would
be spent in a rural hospital or PHC. After either
year she could leave to work. Efforts are to be made
to have this course accepted by the State Education
Boards as equivalent to 4-2 and possibly the graduates
would receive the Higher Secondary School Certi
ficate. In any case, MIBE schools of Nursing will
accept them as nursing students in the hospital based
schools. To enter a degree nursing programme, she
might have to pass a six months course in sciences
and language—offered at the Nursing College.
Acceptance and Integration
These two steps of the AITEAI model are still in
the future. Much more will need to be done on the
TRIAL, and EVALUATION steps—by many different
Progress has been made in moving nursing edu
cation towards a community health oriented curri
culum. Much needs to be done, the challenges are
exciting and I, Ruth Harnar, VHAI Nursing Consul
tant, wish I could start again with another 35 years to
work for change !
Looking for a Change
Opportunities
An orthopaedic surgeon and his wife, an M.D.
Gynaecologist, would like to work in a mission hospi
tal. The surgeon's special interest is surgery of sco
liosis and the hand. Write to Dr. Indrajit Mitra, M.S.,
FRCS (ED.), FRCS (Eng.), Dr. (Mrs) Shiksha Mitra
M.D.D. Obst, P-13 Recol Park, Shahid Kshudiram
Sarani, Durgapur—713209, W. Bengal.
*
♦
*
We Need You
Vocational Training Centre for physically handi
capped—-(Orthopaedically handicapped)—major Com
ponent, deaf and mute, wants a dedicated superin
tendent for the centre who will look after the training,
hostel and the welfare of the trainees. Wages offered
Rs. 700/- p.m. (all inclusive). Free single accommoda
tion. Write to Nagaland Gandhi Ashram, P.O. ChuchuYimlang-798614, Dist. Mokokchung, Nagaland.
8
The International Nursing Services Association will
conduct a 10-week course in community health and
development for medical and para-medical workers
involved in community health and interested in train
ing village health workers. The course begins on
June 13, 1983 (applications due by April 10, 1983).
Contact : Programme Director, INSA/IND|A, Rural
Health and Development Programme, 2 Benson Town,
Bangalore 560046.
One international organisation working in rural
area in Bihar (Community Health Programme and
training of traditional healers) is looking for a medical
officer preferably and one administrator. Apply with
bio-data for both posts to Director, "ANKURAN",
Gudri
Mahalla,
Chatra
(Hazaribagh
District,
Bihar-825401.
For Sale
1979 Model Mahindra & Mahindra F.C.-260-D/
4WD AMBULANCE DIESEL VAN which is in good
running condition is for sale with stretcher. For
details please contact, Director, Centre for Rural
Health and Social Education, A/ll, Ashok Nagar,
Tirupathur 635601.
HEALTH FOR THE MILLONs/FEBRUARY 1983
Book Review
RENU KHANNA
Helping People Learn
Helping Health Workers Learn : A book of methods, aids, and ideas for instructors at the village level.
By David Werner and Bill Bower. Hesperian Foundation, Palo Alto, 1982, Pages 600. Available from VHAI.
[Note to the reader : In the following review, extracts from the book are specifically indicated by
a book symbol and two horizontal lines above and below.]
'Helping Health Workers Learn' (HHWL) is the latest book written by David Werner (author of 'Where
There Is No Doctor') and Bill Bower of the Hesperian Foundation. The contents of the book make it almost
into a complete handbook for the training of health workers at the village level.
One section of the book is devoted to initiating the health workers into the use of 'Where There Is No
Doctor'. Whereas the focus of the earlier book is 'medical' (it is a handbook that village health workers
can follow to diagnose and treat common ailments of people), the focus of HHWL is educational
and political. It contains a varied collection of methods, aids and ideas that can be used as examples to aid
learning of health workers. In the very first sentence, the authors warn, "This is not a 'recipe book'...this is
a collection of examples and ideas, of group experiences and outrageous opinions, of 'triggers to the imagina
tion.' It is an invitation to adventure and discovery."
And so it is ! Very few readers will be able to contain their excitement and enthusiasm while they
are reading the book. During the days I was reading it, I was invited to facilitate a training session for a
group of nursing sisters and supervisors. The topic to be discused was 'In-charge Nurse as a Change Agent'.
Inspired and enthused by the contents of the book, I ventured to conduct one of the most creative and satisfying
(to me as well as to the participants) sessions in my training with health workers. It can be a 'sparker-off' of
creative ideas in anyone involved in training at any level.
Aristotle, "Father of Science," wisely said...
HOW CAN I TEACH BUT TO A FRIEND ?
How something is taught is just as important as
what is taught.
And the most important part of how something is
taught is the caring, respect, and shared concern
that go into it.
The main reason why the book is so convincing is that it is based on real-life and practical experiences.
The experiences are of the authors and of their friends in over thirty-five countries in the world.
Project Piaxtla
The core material in HHWL has been developed through Project Piaxtla. This is a small community
based health programme in the mountains of Western Mexico. The project began in a fortuitious way. In
1964, David Werner, a biologist and school teacher, was wandering through the area observing the birds and
plants. He was impressed by the friendliness and self-reliance of the mountain people. As he observed
and talked to them, he became aware of and concerned about their health problems. He had no medi
cal training-but he thought that his scientific background and the people's resourcefulness and skills would
be effective tools to combat the health problems. So he returned to the USA, equipped himself with some
medical knowledge and experience and came back to Mexico. He stayed on for 10 years. When he felt that
he was no longer needed and the programme would evolve further without any outsiders, he moved out.
HEALTH FOR THE MILLIONs/fEBRUARY 1983
9
Today 16 years after it began, the programme is being managed entirely by local villagers. The project
serves over 100 villages, some of which are two days by mule back from the training and referral centre in the
village of Ajoya. The people of Project Piaxtla consisting of persons many of whom have never been to
school can take care of about 98% of the health problems they see. They have been able to build into them
selves a wide range of medical skills—they can take x-rays; do simple lab. investigations; village 'dentics' clean
teeth, extract, drill, and fill cavities. For severe problems beyond their capacity, the team has slowly developed
an effective referral system to the nearest city.
The project has evolved through three stages—curative, preventive and social. When even .with
curative emphasis, the same illnesses continued to appear, people started thinking about prevention. The
team began programmes of vaccinations, sanitation, nutrition classes, child spacing and community gardens.
Even these did not help. Analysis revealed that root causes of poor health were related to issues like land
ownership, high interest rates on loans and other ways the strong profit from the weak. And so the focus of
the heelth team shifted to the social and political issues. Today the team's primary concern is to increase the
self-confidence of their people to help them to be able to withstand the powers and pressures of oppressors,
the rich and the powerful.
The 16 years of evolution of the programme has been rich in learning for all those involved. They
began with a certain set of problems. As they went about seeking solutions, the problems changed their
facets. In the process of grappling with the many faceted issues, the project team analysed and reanalysed,
changed their approaches and methodologies of working with people. Many of the learning methods described
in this book are a result of the action research of the people of Piaxtla and of other peoples like them all over
the world. The approach that has been taken, seems to be one of learning and growing from critical analysis
of mistakes rather than feeling inhibited and stopping after making a mistake.
The contents of this book is a primer on the politics of health, with the focus on the problems of the
poor. It starts with a statement of the political nature of the book and ends with a call for courage and action.
The book is divided into five parts with 27 chapters. Each part begins with a brief introduction.
Part One and the first ten chapters deal with 'Approaches and Plans'—how to plan and conduct a train
ing programme. The first chapter lays the foundation of the philosophy of learning vs. teaching. The authors
point out that 'educa tion of change' as, opposed to 'education of authority' is the art not of PUTTING IDEAS
INTO people's heads, but of DRAWING IDEAS OUT. The three approaches to education—to conform, reform
and transform—are excellently summarised. Those of us who have been fortunate to experience all these three
approaches in our lives will agree how accurate this summary is.
Three Approaches to Education
The chart gives a summary of three approaches to teaching. It may help instructors to eva
luate their own teaching approach. But we do not recommend that this analysis be given
to health workers. Analysing stories and role plays will work better. So pass by this chart if
you want.
CONVENTIONAL
PROGRESSIVE
LIBERATING
Function
to CONFORM
to REFORM
to TRANSFORM
Aim
Resist change.
Keep social order stable.
Change people to meet society's Change society to meet
people's needs.
needs.
Strategy
Teach people to accept and
'fit in' to the social situation
without changing its unjust
aspects.
Work for certain improvements
without changing the unjust
aspects of society.
10
Actively oppose social in
justice, inequality, and cor
ruption. Work for basic
change.
HEALTH FOR THE MILLIONS/FEBRUARY 1983
From the book HHWL—Contd.
Intention
toward
people
CONVENTIONAL
PROGRESSIVE
LIBERATING
CONTROL them —
especially poor working
people—farm and city.
PACIFY or CALM
them —
especially those whose hard
ships drive them to protest or
revolt.
FREE them—from oppression,
exploitation and corruption.
BEHAVIOR
CHANGE
General
approach
AUTHORITARIAN
(rigid top-down control)
PATERNALISTIC
(kindly top-down control)
HUMANITARIAN and
DEMOCRATIC
(control by the people)
Effect on
OPPRESSIVE—rigid
central
people
authority allows little or no
and the
participation by students and
Community community.
DECEPTIVE—pretends to be
supportive, but resists real
change.
SUPPORTIVE—helps people
find ways to gain more control
over their health and their
lives.
How
Basically passive. Empty constudents
tainers to be filled with stan(and people dard knowledge.
generally)
are viewed
Basically irresponsible.
Must be cared for. Need to be
watched closely.
Basically active. Able to take
charge and
become selfreliant.
Can and must be tamed.
Able to participate in specific Responsible when treated with
activities when spoon fed.
respect and as equals.
FEAR—Teacher is an abso
lute, all-knowing boss who
stands apart from and above
the students.
GRATITUDE—Teacher is a
friendly, parent-like authority
who knows what is best for
the students.
TRUST—Teacher is a 'facili
tator' who helps everyone
look for answers together.
Who
The Ministry of Education (or
decides
Health) in the capital.
what should
be learned
The Ministry, but with some
local decisions.
The students and instructors
together with the community.
what the
students
feel about
the teacher
Teaching
method
Main way
of learning
O The Teacher lectures.
O Teacher educates and enter- O Open-ended dialogue, in
O Students ask few questions.
tains students.
which many answers come
O Often boring.
O Dialogue and group dis
cussions, but the teacher
decides which are the
'right' answers.
from people's experience.
Everyone educates each
other.
PASSIVE—students receive
knowledge. Memorization of
facts
More or less active. Memorization still basic.
ACTIVE—everyone
contributes. Learning through doing
and discussing.
HEALTH FOR THE MILLIONS/FEBRUARY 1983
II
From the book HHWL—Contd.
Important
subjects of
concepts
covered
Flow of
knowledge
and ideas
CONVENTIONAL
PROGRESSIVE
LIBERATING
* the strengths and rightness
of the present social order
# national history (distorted
to make 'our side' all
heroes)
* rules and regulations
• obedience
# anatomy and physiology
• much that is not practical
or relevant—it is taught
because it always has been
• unnecessary learning of big
words and boring infor
mation
• integrated
approach to
development
• how to make good use of
government and profes
sional services
• filling out forms
• desirable behaviour
• simple practical skills (often
of
little
use—such as
learning 20 bandages and
their Latin names).
• critical analysis
• social awareness
• communication skills
• teaching skills
• organization skills
• innovation
• self-reliance
• use of local resources
• local customs
• confidence building
• abilities of women and
children
• human dignity
• methods that help the
weak grow stronger
school or
health
system
school or
health
system
I
♦
teacher
mostly
one
way
I
♦
teacher
students
both ways
students
Area of
studying
students 7-qroup^school or
leader health
system
The classroom.
How does
the class
sit ?
The classroom and other con
trolled situations.
Life—the classroom
itself.
is
life
♦
•
Class size
Often LARGE. Emphasis on
quantity, not quality of edu
cation.
Often fairly small, to encourage
participation.
Often SMALL, to encourage
communication and apprentice
ship learning.
Attendance
Students have to attend.
Students often want to attend
because classes are enter
taining and they will earn more
if they graduate. 'Incentives'
are given.
Students want to attend
because the learning relates to
their lives and needs, and
because they are listened to
and respected.
Organised and directed by
teacher. Many games and
techniques
used to bring
people together.
Cooperative—students
help
each other. Those who are
quicker assist others.
LATfi
Group
interaction
2
Competitive (cooperation bet
ween students on tests is
called cheating).
e
e
HEALTH FOR THE MILLIONS/FEBRUARY 1983
From the book HHWL—Contd.
CONVENTIONAL
PROGRESSIVE
LIBERATING
Purpose of
exams
Primarily to 'weed out' slower
students; grades emphasised.
students pass.
Others fail.
Variable, but generally tests
are used to pass some and fail
others.
Primarily to see if ideas are
clearly
expressed
and
if
teaching methods work well.
No grades. Faster students
help slower ones.
Evaluation
Often superficial—
by education or health system,
Students and community are
the objects of study.
Often over-elaborate—
by education or health 'ex
perts'. Community and students participate in limited
ways.
Simple and continual—
by community, students and
staff. Students and teachers
evaluate each others' work
and attitudes.
At the end
of training,
students
are given...
0 diplomas
© irregular
police-like
supervision
After train- to his supervisor, the health
ing, a health authorities, the government
worker is
accountable
diplomas
uniforms
salaries
'supportive'
supervision
mainly to the health authorities, less so to local authorities
and the community
O encouragement
to work
hard and keep learning
O supportive assistance when
asked for.
mainly to the community—
especially the poor, whose
interests he defends.
In chapter 2, while discussing the selection of health worker—the authors state, 'persons with only>
few years of schooling often make more reliable, more community—strengthening health workers than those
who have had more formal education' and that 'teaching skills may more important than an extensive background
in medicine and health care'. They say that 'the most important quality to look for when selecting a health
worker is the persons concern for social justice.'
Chapter 3 is concerned with planning a training course. Here again we are reminded of the peoplecentred approach—the importance of beginning the planning process from the people : their needs and concerns.
As we go along further through this pa rt, we see that there are three places of learning in a training
course : the classroom, the community and the clinic or health centre. All three are equally important and even
in the classroom the most effective form of learning is through actual experience of the participants.
TWO WAYS OF
LOOKING AT HEART
Which is more important
to Community Health ?
START WITH COMMUNITY,
NOT ANATOMY I
HEALTH FORTHE MILLIONS/FEBRUARY 1983
13
IF STUDENTS ARE SIMPLY TOLD THAT:
AN ENLARGED
BUT IF THEY. ARE HELPED TO DISCOVER WHY:
THE SPLEEN HELPS
SPLEEN MAY BB A
CLEAN THE O'.COD CP
SIGN OF CHRONIC
PEAD RED BLOOD CELLS.
MALARIA ,$o MHC
now WHO CAN TCLLWE
YOU SUSPECT
MALARIA, DON'T
SOMETIMES GETS SlO
FORGET TO CHECK
A
WHEN
THE SPLEEN !
PERSON
HAS NIALARIA?
BECAUSE THE
PARAS ITES
DESTROY
THEY WILL NOT KNOW THE REASON
AND MAY SOON FORGET.
THEY WILL UNDERSTAND BETTER
AND BE MORE LIKELY TO REMEMBER.
Advantages of Involving Students in the Evaluation Process
The word 'evaluation' generally evokes images of punishment and fear in most of us. In chapter 9, the
authors point out that examinations and evaluation can be a learning process. The use of drawings, dramatics
and even visitors forevaluation are pointed out.
Evaluation completes the circle and allows things to advance. Part one ends with th© chapter on the
ways in which health workers can find support for themselves and how they can continue to update their
knowledge and skills.
♦ Evaluation by students helps instructors learn how effective and appropriate their
teaching is.
* Two-way evaluation helps instructors relate to student health workers as equals. Then
the health workers will be likely to show the same respect for others when they teach
people in their communities.
* Two-way evaluation helps every one to question the accepted social norms or 'rules of
the game' that keep the poor on the bottom. It helps people gain the confidence and
courage to criticise authority and defend the interests of the weak.
* Taking part in evaluation during the course gives student health workers, the practice
and skill they will need for evaluating their work in their communities.
It is not the number of latrines built or babies weighed that determines a health worker’s
effectiveness. Rather it is the people’s growing awareness of their ability to meet their needs
for themselves. In the long run, health is determined more by human qualities than by
physical quantities. Evaluation that focuses largely on numbers often tends to forget this.
When conducting an evaluation, remember that
UNITY CAN BE MORE IMPORTANT THAN NUMBERS.
Teaching Aids and Methods
Part two of the book deals with the different teaching aids and methods—storytelling, drawings, and
photos, role plays and sociodramas and some appropriate technologies, both 'hard and soft'.
The number of ways in which common materials around us can be used to impart learning is simply
amazing! The authors say that the participants should make their own teaching aids. In this way they discover
answers for themselves and learning becomes an adventure. Again, the message is, build on the skills the
people have—help them to increase their levels of self-respect and self-confidence. As much as possible,
demonstrations should be done through people or real objects rather than through drawings on paper and in
animate models. When you can draw on the human body, don't use chart paper !
The text is sprinkled with many stories —some are true, some are make believe. Although the stories
are set in many different parts of the world, their appeal is universal. And they serve the purpose of providing
some learning. The chapter on storytelling shows different ways in which stories can be told—through
pictures, role plays, and puppet shows.
Involving of participants and community members in role plays, sociodramas and village theatre are
powerful tools for social action. These help dramatically in increasing awareness of self and confidence levels
of the people. Apart from the one chapter on roleplaying in this section, the book discusses the use of village
theatre in getting people ready for social action. Ajoya communities' examples of women acting out the problem
of drunkenness and going on to realistically deal with it, is inspiring. Entertainment is more powerful than prea
ching. There are helpful hints for ways to get people thinking and acting. Here are some from the book :
*Make-believe action on stage,
can lead to real action in the
community; encourage people
to speak in their own words
(and not memorising parts);
persons dressed up as animals
always bring laughter; include
the audience in the act.
*
WEALTH FOR THE MILLIONs/fEBRUARY 1983
15
Child Health Workers
Part four of the book is devoted to the most important part of health work in a community —activities
with mother and children. In this section, the chapter that I liked best is'Children as Health Workers'. This is
based on the Child-to-child Programme. Children can be a very important link in the health promotion. They
are captive audience for new ideas, their imagination and enthusiasm can be fired. They are loving and gene
rous. They can be the carriers of many healthy practices into their homes. The story of Abdul and Seri illustrates
the effectives of a child as a health worker.
I DON’T CARE WHAT
Child-to-child
People including parents, often have very fixed ideas about
managing common illnesses, Is it fair to ask children to take home
new ideas that may conflict with the beliefs and customs of their
parents ? Could this weaken children's respect for their or for local
traditions ? Or will it make parents angry with the children and
perhaps, with the school ?
These are valid questions. In many areas, for example, parents
believe it is harmful to give a child with diarrhoea anything to eat
and drink. They argue from experience that giving food or drink to
the child may make him have another watery stool more
quickly. How, then, can a boy or girl convince parents that, even
though the sick child continues to have diarrhoea or to vomit, it is
very important to give lots of liquid and also food ?
YOUR TEACHER SAID •
IF YOU GIVE FOOD OR
DRINK TO THE BABY
WITH DIARRHEA
YOU’LL
KILL HER '
JK/7Z the new ideas children learn from Childto-child, pin them in trouble at home ?
Abdul and Seri
A Children's Story from Indonesia
Abdul ran home from school almost as fast as on
the day his sister Seri had been born. As soon as he
saw her in the court-yard, his eyes lit up, for although
Abdul was already 8 years old, he loved to play with
his little sister.
Seri was only one and a half years old. She would
clap her hands in delight when he made funny faces
at her, or giggle when he counted her toes. He had
16
helped her with her first steps, picking her up gently
when she tumbled.
But what was wrong today ? Usually Seri toddled
straight for her favorite Abdul with her arms outstret
ched. But now she just sat on the porch and gazed
at him with dull eyes. Quickly he lifted her up to his
hip. He noticed that she must not have had her usual
bath before he came home, because she had an un
pleasant smell about her.
HEALTH FOR THE MILLIONS/FEBRUARY 1983
From the Book HHWL—Contd.
Their grandma greeted him with a tired voice.
Worried, Abdul asked her, "Is Seri sick ? Why does
she act like this ?" "She had several watery bowel
movements today," answered Grandma, "and she's
been very fussy, Abdul. You must not let her have
any food or drink so that the diarrhoea will stop and
-she will get better."
hardly believe that one level teaspoon of sugar and a
pinch of salt in a glass of boiled water would be the
right thing to give Seri, but she was determined to let
Abdul try.
and one pinch
of SALT
Abdul thought for a moment, and then he took a
deep breath. "But Grandma," he cried out, "my
teacher told me that a watery stool can be very
dangerous. If the body loses water, it's like a plant
that isn't watered. First it gets weak, and then it dies!
We have to give Seri enough to drink so she won't be
weak like this."
As soon as the water was cool enough for Seri to
drink, Abdul added a level teaspoon of sugar and a
pinch of salt. He stirred the drink and offered it to
Seri. She was so thirsty that she gulped the whole
glass! Abdul made her another glass, adding the right
amount of sugar and salt again. Grandma watched
with surprise as Seri drank the whole second glass as
well.
Grandma could feel how much Abdul believed in
what he was saying, and she was very proud that her
grandchild had a chance to go to school and learn
new things. But still, no one had ever given any food
or drink to a child with watery stools as long as she
could remember. Then, while Abdul looked at her with
pleading eyes and waited for her response, she
thought of one of her own dear children she had lost
after only 2 days of watery stools. And what about
little Tini next door, who had died the same way ?
Grandma sighed and said gently to Abdul, "Perhaps
your teacher is right. Maybe we should try a new way.
What does she say we ought to do ?"
Abdul looked at his grandmother with new respect,
put Seri into her arms, and urged her to follow him.
Quickly, he put some water on to boil and afterwards
(while they waited for it to cool) he told Grandma
the simple recipe that would help Seri. Grandma could
HEALTH FOR THE MILLIONS/FEBRUARY 1983
Suddenly, Seri vomited and Grandma looked as if
she were about to scold Abdul. "My teacher says not
to worry if the child vomits in the beginning. Just try
again, "he said. He mixed a third glass for Seri, but
this time he urged her to drink it more slowly.
From the book HHWL—Contd.
Abdul had just helped Seri finish another glass of
the Special Drink, when his mother arrived home from
her trip to the market, "How is Seri?" she asked
Grandma anxiously. Seri moved toward her mother's
voice, her eyes bright with recognition. "Why, she's
much better, I see. I'm so relieved. Not giving her
anything to eat or drink must have helped her."
"Oh, no," said Grandma, smiling at Abdul. ' We've
tried a new way, and look how Seri has changed
since this morning. Abdul, tell your mother what
you've given Seri." "I'll wait till you nurse her.
Mother. She'll be even happier then," answeredAbdul.
When the glass was finished, Seri clapped her
hands and began to squirm, Vying to get off
Grandma's lap. Burbling at Abdul, her eyes darted
after him as he got out a biscuit. Finally wriggling off
Grandma's lap, Seri walked toward Abdul with arms
out to take the biscuit. Suddenly, much to Grandma's
dismay, Seri made another watery bowel movement.
The next day, Abdul got to school early. He shylytold his teacher that he had tried the recipe she had
taught the class to use in case anybody in their families
had watery stools. His teacher was very happy that
Abdul had remembered to use 1 level teaspoon of
sugar and a pinch of salt in the glass of boiled water.
She was even happier to know that, although Seri had
had a watery stool two more times that day, today the
diarrhoea had stopped completely.
"Make sure she keeps drinking and eats some
extra meals so she'll be just as strong as she was
before," the teacher cautioned Abdul. "You've really
learned well."
"Don't worry, Grandma, she's already so much
better," said Abdul. "Look how eager she is to have
the biscuit. And she's still thirsty I She's trying to
reach the glass."
7F”
Abdul glowed inside. When school was over that
day, he ran home with a happy heart to find Seri want
ing to play, her arms outstretched and her eyes shin
ing, waiting for a new game.
health for the millions/february
1983
Nutrition
The chapter on nutrition throws some new light on the causes of malnutrition. Ways in which health
workers can help people analyse their food problems and better meet their needs are sought. The absurdity of
expert wisdom in solving people's hunger problems is told in no uncertain terms.
Community-based
nutrition
education
should not focus on
changing people's bad
habits.
Rather,
it
should try to recog
nise and strengthen
those food habits and
traditions that are
healthy.
The educational app
roach needs to be a
process in which the
health workers and
the people learn and
explore new possibi
lities together.
HEALTH FOR THE MILLIONS/FEBRUARY 1983
19
dence and skills necessary to work together to change the situation ?
The different stages of awareness —magic, naive, critical and fanatic—are well captured.
D iffe re n t S ta g e s o f A w a re n e s s
Part five of the book focusses on 'Health in relation to Food, Land and Social Problems.' The authors
examine the way in which health is influenced by human relationships : What are the problems that result from
greed, unfair distribution of land and resources and a social structure that favours the few at the expense of the
many ? How can health workers learn about these problems and help people to gain the awareness, self-confi
Form the book HHWL—Contd
1. Magic awareness. At this stage, people explain the events and forces that
shape their lives in terms of myths, magic, or powers beyond their understanding and
control. They tend to be fatalistic, passively accepting whatever happens to them as
fate or 'God's will'. Usually they blame no one for the hardships and abuses they suffer.
They endure these as facts of life about which they cannot (and should not) do anything.
Although their problems are great—poor health, poverty, lack of work, etc.—they com
monly deny them. They are exploited, but are at the same time dependent upon those
with authority of power, they fear and try to please. They conform to the image of
themselves given to them by those on top. They consider themselves inferior, unable
to master the skills and ideas of persons they believe are 'better' than themselves.
2. Naive awareness. A person who is naive has incomplete understanding.
Persons at the naive stage of awareness no longer passively accept the hardships of
being 'on the bottom'. Rather, they try to adapt so as to make the best of the situation
in which they find themselves. However, they continue to accept the values, rules,
and social order defined by those on top (authorities, big landholders, etc.). In fact,
they try to imitate those on top as much as possible. For example, they may adopt the
clothing, hair styles, and language of outsiders, or choose to bottlefeed rather than
breastfeed their babies. At the same time, they tend to reject or look down upon their
own people's customs and beliefs. Like those on top, they blame the hardships of
the poor on their ignorance and 'lack of ambition'. They make no attempt to critically
examine or change the social order.
3. Critical awareness. As persons begin to develop critical awareness, they look
more carefully at the causes of poverty and other human problems. They try to
explain things more through observation and reason than through myth or magic.
They start to question the values, rules, and expectations passed down by those in
control. They discover that not individuals, but the social system itself, is responsible
for inequality, injustice, and suffering. They find that it is set up to favour the few at the
expense of the many yet they see that those in power are in some ways also weak,
and are also 'dehumanised' by the system. Critically aware persons come to realize
that only by changing the norms and procedures of organised society can the most
serious ills of both the rich and the poor be corrected.
As their awareness deepens, these persons also begin to feel better about them
selves. They take new pride in their origins and traditions. Yet they are self-critical
and flexible. They do not reject either the old or the new, but try to preserve from each
what is of value. As their self-confidence grows, they begin to work with others to
change what is unhealthy in the social system. Their observations and critical reasoning
ead them to positive action.
HEALTH FOR THE MILLIONs/FEBRUARY 1983
21
From the book HHWL—Contd
In addition to the 3 levels or stages just discussed, Freire describes another level,
which he calls'fanatic awareness'. This is a step beyond naive awareness, but off themain track of development toward critical awareness.
4. Fanatic awareness. Fanatic means extreme beyond reason. A fanatically aware
person (or group of persons) rejects completely those in power and everything they rep
resent, without trying to separate the good from the bad. At the same time, he often
returns to the traditional customs, dress and beliefs, but in an exaggerated form. Whereas
the outlook of persons with critical awareness is mostly positive, that of fanatics is often
destructive. Their opinions tend to be rigid, not flexible. Their actions seem to result
more from hatred than from understanding. Rather than learning and communicating
with others as equals, they tend to repeat the standard radical doctrines of their popular,
yet powerful, leaders.
Persons at a fanatic level of awareness are not self-critical, independent thinkers as
are those with critical awareness. They are captive to the ideas of their power-hungry
leaders. In some way, they are still servants and products of the social system against
which they rebel. If and when they succeed in overthrowing the social order, the new
system they set up may in some ways be as rigid and unjust as the old system it replaces.
For all this, the fanatic is closer to critical awareness than someone in the naive stage
and. if given the right short cut, may reach it sooner.
In truth, of course, no one is wholly at one stage of awareness or another. Many of
us are fatalistic about some things, naive about others—critically aware about others and
at times a bit fanatic. Still, to reflect on these stages can be useful.
WHAT DO YOU .
THiuid of this
I INSTRUCTION?)
/V£V£R FOLLOW INSTRUCTIONS
,
WITHOUT QUE5TI0NIW& THEM.
Tthimk rrtt STILL WISE
RIGHT J THERE ARE
CERTAINLY
MOT WHAT WB
WERE TAUGHT
IM SCHOOL.!
TIMES WHEN
INSTRUCTIONS
should BE
FOLLOWED exactly,
WITHOUT QUESTION,
FOR EXAMPLE,
WHEN THE DOCTOR
PRESCRIBES A
j
MEDlCIME.
y
workers and
villagers have
It) DO IF WB ARB
EVER. GOING TO
STAND UP FOR.
OOP. RAftHTS •
22
TO QUESTION. EVEN
DOCTORS KAKE mistakes.
ZI STILL THINK
THAT TO ALWAYS
DO WHAT YOU
ARE TOLD IS THE
BEST WAY TO
STAY OUT OF
TROUBLE
e nice Thing
ABOUT THIS
INSTRUCTION IS
THAT YOU DONI
ALWAYS HAVE
ID FOLLOW IT.
IT AShS YOU
TO QUESTION
WHAT IT SAYS
AND U3E YOUR
OWN JUDGEMENT.
HEALTH FOR THE MILLIONS/FEBRUARY 1983
Readability
What makes this book so readable ? One reason lies in the language and style. The authors are almost
talking to us through the pages. The language used is simple in everyday English. The rules of good writing of
the Barbiana school boys are well followed from their book, 'Letter to a School Teacher', Penguin Books,
England.
There is a beautiful discussion of Paulo
Freire's methods of conscientization and
adult literacy and how these have been used
in various places. This chapter was a
revelation in how the Freirian approach
can be communicated in simple words
rather than the characteristic Freirian peda
gogy I The authors very aptly say,
'Learn from Friere's Wisdom'. But, for
everyone's sake, avoid his language 1 The
method is the message. The authors take
•pains to stress that the purpose of helping people become more critically aware is not to breed anger or
discontent. Rather it is to enable people to take positive action.
Suggestions for good writing
Rules of good writing (by the school boys of
Barbiana) :
A group of school boys from poor farm families
in Italy has written a powerful book called Letter To A
Teacher. In this book, they point out that "the
peasants of Italy were left out when a school for them
was being planned." The boys state their reasons for
feeling that "school is a war against the poor." They
say the school system often makes the children of the
poor feel worthless, lazy, or stupid. These Italian
school boys join hands with the children of the world,
saying :
"In Africa, in Asia, in Latin America, in Southern
Italy, in the hills, in the fields, even in the cities,
millions of children are waiting to be made equal. Shy
like me; stupid like Sandro; lazy like Gianni. The best
of humanity."
These farm boys have taught themselves to write
•well, and in doing so have found strong means of
self-defense. Their immediate goal is "to understand
others and to make oneself understood." Their rules
of good writing should be a help to any group work
ing on a news sheet or trying to develop writing skills.
HEALTH FOR THE MILLIONs/FEBRUARY 1983
* Have something important to say, something
useful to everyone, or at feast to many.
* Know for whom you are writing.
* Gather all useful materials.
* Find a logical pattern with which to develop the
theme.
* Eliminate every useless word.
* Eliminate every word not used in the spoken
language.
* Never set time limits.
write with
a pencil
and eraser
not a pen
23
Whenever an out-of-the-ordinary word is introduced, it is explained in the foot-note. This kind of simple
writing is an education to many development workers who often resort to jargon and cliches while discus
sing their work and ideologies.
How do we write ?
This is the way we do it I
To start with, each of us keeps a notebook in his
pocket. Every time an idea comes up, we make a note
of it. Each idea on a separate sheet, on one side of
the page.
Then one day we gather together all the sheets of
paper and spread them on a big table. We look
through them, one by one, to get rid of duplications.
Next, we make separate piles of the sheets that are
related, and these will make up the chapters. Every
chapter is subdivided into small piles, and they will
become paragraphs.
The boys of Barbiana at work
At this point we try to give a title to each para
graph. If we can't, it means either that the paragraph
has no content or that too many things are squeezed
into if. Some paragraphs disappear. Some are broken
up.
While we name the paragraphs, we discuss their
logical order, until an outline is born. With the out
line set, we reorganise all the piles to follow its pattern.
"JARGON” MEANS
LANGUAGE
SPECIAL
EXPERTS USE,AND
••cliche" means a
TWAT
phrase
is SO OVERUSED
THAT
IT
We take the first pile, spread the sheets on the
table, and we find the sequence for them. And so we
begin to put down a first draft of the text.
We mimeograph that part so that we each can have
a copy in front of us. Then, scissors, paste, and
colored pencils. We shuffle it all again. New sheets
are added. We mimeograph again.
A race begins now for all of us to find any word
that can be crossed out, any excess adjectives, repeti
tions, lies, difficult words, overly long sentences, and
any two concepts that are forced into one sentence.
We call in one outsider after another. We prefer
that they not have had too much school. We ask
them to read aloud. And we watch to see if they
have understood what we meant to say.
We accept their suggestions if they clarify the text.
We reject any suggestions made in the name of
caution.
24
HEALTH FOR THE MILLIONS/fEBRUARY 1983
The second point of appeal is the visuals. Very good use of photographs, line drawings, sketches and
cartoons have been made. In keeping with the values that the book is trying to spread, many illustrations have
been done by Pablo Chavez, a health worker of Project Piaxtla. Pablo's contribution symbolises that every
person —however weak or poor he may otherwise be —has the hidden talents and potential that can be evoked
and fruitfully used. Another point to be noted about the illustrations is that they typify various parts of the
world —as you flip through the pages, you can see Indians, Indonesians, Africans, Polynesians, Mexicans and
many others. And the most important point about the illustrations is that they are also used for humour—and
the message is driven home all the more strongly.
The book as a whole
A major attraction of the book is that it is honest and forthright. Opinions, seemingly outrageous, are
said without arrogance or the false modesty of the good. This book is an exercise in assertiveness, for those
who are timid. It is a humbling experience for those armed with degrees, money power and grandiose
visions.The text is rich with examples and anecdotes from many corners of the world. The learning process is
aided through these different experiences rather than by stating just one viewpoint. In fact the 'We-know-itall' self-righteousness that can be a danger in such a book is completely missing in HHWL. Instead, the authors
repeatedly caution readers and instructors against accepting the contents of the book without any questioning.
Again when we consider the 'Living out of the values', we see this being done in sharing of power—
the power of information. All through the book, the reader is referred to further sources of reading material
and teaching aids. Helpful persons and organizations are very generously recognised and acknowledged.
And so there is little more to say—except that I find this book a living example of the use to which each
human being's inherent love, compassion and creativity can be put to.
Reading materials available
□ "Health education methods and materials in
primary health care" is the theme of the December
1981 issue of the newsletter, Appropriate Technology
for Health. Items include a health game for children
(Togo), a teaching calendar to help eradicate rats
(Barbados), theatre for spreading health messages
(Zambia), and a discussion of illustrations in health
literature. For a free copy of the newsletter, write :
The Editor, ATH Newsletter, World Health Organiza
tion, 1211 Geneva 27, Switzerland.
□ The London School of Hygiene and Tropical
Medicine has published the results of field testing of
its weight-for-height chart. For a copy of the repoit
write : Julia Verney, Department of Human Nutrition.
London School of Hygiene, Keppel Street (Gower
Street) London WCIE 7HT, UK.
□ A recent issue of Haiti Sante, a new quarterly
magazine published by the Centre d'Hygiene familiale
de Haiti, carries an article entitled, "Your child and his
dentist." The article explains the special dental prob
lems of children : teething, oral hygiene, baby teeth,
and other subjects. For a free copy, write : Centre
d'Hygiene familiale, 10, fere Impasse Lavaud, BP 430,
Port-au-Prince, Haiti.
.•HEALTH FOR THE MILLIONs/fEBRUARY 1983
□ "Women,
Health and Development" and
"Women and Disability" are the titles of a new series
of information kits distributed by the World Health
Organization (WHO). The kits contain articles, guide
lines, bibliographies, and other information aimed at
making the public aware of women's needs. For a free
copy in English (French and Spanish editions will be
available later this year), write : The Division of Public
Information, WHO, 1211 Geneva 27, Switzerland.
□ The World Health Organization (WHO) is field
testing its new manual, Training the Disabled in the
Community : An experimental manual on rehabilitation
and disability prevention for developing countries. The
manual contains training material for the disabled and
their families, for policy makers and planners, local
supervisors, community leaders, and teachers. If you
wish to obtain a copy for field-testing purposes, write :
Dr. J. Krol, Medical Officer, Rehabilitation Programme,
WHO, 1211 Geneva 27, Switzerland. For others the
mannual is available from WHO for $ 20.00.
□ "Diarrhoea Management" is the title of a slide
set that presents new ideas about oral rehydration. The
set, which includes a detailed instruction sheet, is
intended mainly for community nurses, hospital nurses,
and other health workers. For information write :
Foundation for Teaching Aids at Low Cost (TALC),
Institute of Child Health, 30 Guilford Street, London
WC1N 1EH, UK.
25
What do the people value most ?
The people in the community value trust and equality. They
value participation. They value their tradition, culture and
time-honoured customs. Any institution in a poor society
which respects these values of the people will probably have
more success.
Nothing perhaps provokes a community more, in India,
in the long run, than seeing a posh hospital coming up,
when the problems of the people are more basic malnutrition,
hunger and unemployment. Worse still, is the management
of the hospital which lives in total isolation from the real
problems of the surrounding community and continues to
believe in the myth of promoting health care if many voluntary
hospitals have failed, it is because (a) not asking the question
'what do our friends value' ? and (b) answering the question
unsatisfactorily.
However, some enlightened health professionals have
identified the more correct answers. Hence, among them there
is a trend towards promoting community health, towards incre
asing the participation of people so that they assume respon
sibility for their own health; and attempts to integrate health
with economic development and well-being. It is thus, only
in response to some of the time-tested traditions of people,
that there is now a movement towards using local herbs and
medicines, and a healthy respect for faith-healing. It is in
response to the economic status of the community, that
health institutions have to continuously explore ways of
lowering the cost of health care.
The affluent expect routine curative care from the hospital.
The poor of the community expect wisdom and solace from
the people who manage the institution. The later constitute
majority. Hence, it makes sense to respond accordingly.
(from the VHAI book : Management Process in Health Care)
26
Letter from a Friend
Dr W. V. Rane
Pune Journal of
Continuing Education
2117 Sadashivpet
Pune 411 030
October 15, 1982
Dear Dr. Mira Shiva,
Your background paper for Drug
Information Sharing on the Clioquinol Controversy gives a list of
products containing clioquinol.
In my opinion most of these drugsare taken for relatively short
time, whereas drugs like Uni
enzyme (Unichem) are taken for
life-time (in fact it has become a
habit forming drug also due to
inclusion
of
diphenhydramine
hydro-chloride i.e. benadryl the
rein) and are likely to cause more
harm than those mentioned by you.
The funniest part is that MIMS
issue Vol 1 No 2 gives the formula
tion of Unienzyme that does not
show iodochlo rohydroxyqui noli
ne, whereas product
packet of
Patch No. 23978 dt. May 1982 gives
the composition with 125 mg idochlorohydroxyquinoline per tablets.
There are persons who take two to
four tablets
every day which
otherwise means they are taking
250 to 500 mg of iodochlorohy
droxy quinoline every day for
years together.
It is therefore essential that we
be aware and boycott all these
enzyme preparations that give
clioquinol in some form or the
other. Thanking you,
Your sincerly,
Dr. W.V. Rane
Pune Journal of
Continuing Education
HEALTH FOR THE MILLIONS/feBRRARY 1983
NIRMALA & SATYA
More Team-Bhilding
Monday the 20th of December 1982 was an im
portant day in the history of Bhildesh and of VHAI.
Seventeen participants from eleven health centres
(situated in the Bhil tribal belt of Rajasthan, M.P. and
Maharashtra) nervous yet excited, received their certi
ficates on the successful completion of the first 15
month Community Health Team Training (CHTT) Pro
gramme organised and conducted by VHAI. For
us at VHAI, the long and arduous 15 months were
over, but the journey had only just begun for the
participants.
Who is doing what ?
Sr. Felix and Sr. Jessie from Palasdor, M.P. have
begun the monumental work of collecting information
on and testing herbal medicines and are helping the
village people to grow trees for fuel, fodder and food.
Sr. Alex and Sr. Melanie from Jamburi, Rajasthan
have started a Savings Scheme for women, and are
doing creditable work on adult education in one
village. Sr. Bernadine, from Bhandaria, Rajasthan
has started a programme of giving health education to
the children in the mission hostel in her centre. Sisters
Cecily and Arul from Shirpur, Maharashtra, have orga
nised Mahila Mandals in two villages and are making
efforts to involve the other villages in their project
area. Sisters Placida and Cyrilla from Maska Mahuri,
Rajasthan have developed an interest in home reme
dies and are running adult education classes for men
and women separately in one village. Sisters Christo
pher and Francis from Dungarpur, Rajasthan, have
started an MCH Programme without food distribution
in one village. Sr. Hycintha from Mokumpura, Raja
sthan has started two Balwadis in two villages and is
running a night school for children around her centre.
Sisters Fidelis and Agnella from Ambapada, Rajasthan
have taken a big step in staying in a village far away
from their centre and are in the process of building up
a leadership with the people. Mrs. Tulsi Rufus from
Jobat, M.P. is sharing information on various Govern
ment Schemes with the village people and helping
the people to make use of these schemes despite her
massive workload in the hospital. Mrs. Bishi Sadiq
from Amkut, M.P. has started an under five programme
and is giving health education to the boarding children
in her centre. Sr. Grace from Japadhra, M.P. has
been instrumental in getting an adult education pro
gramme started in one village.
We believe that the CHTT has equipped these
sHEALTH FOR THE MILLIONS/FEBRUARY 1983
health workers well for this journey—for the contri
bution that they have been making and will make
towards achieving justice in health care.
What was new ?
Born out of the training experiences of VHAI's
Community Health Team and feedback from previous
participants, this 15-month course had many novel
features:
1. Eight out of the 11 centres sent two of their
staff as participants.
2. An agreement was signed between the parti
cipants and their sponsors that the participants
will not be transferred for atleast three years
inclusive of the time period of the course.
3. Other team members from each of the centres
took part in the regional meetings.
4. Five regional meetings were held during the
15-month period, at intervals of 2-3 months.
The topics discussed at these meetings were:
Baseline survey and maintaining records,
methods of audio visual commuication, adult
education, upgrading diagnostic skills and
rational therapeutics and economic, schemes.
5. VHAI resource persons visited each of the
centres twice, once, during the earlier part of
the course and a second time during the 14th
month. The aim of these visits was to help
the participants with their work, understand
their situation better and build up better rap
port with the rest of the team members.
6. Participants from each centre took up a long
term study, for which they collected data and
analysed the results. The topics included stu
dying the customs of the tribals on a specific
health issue, herbal and home remedies used
by the tribals and the testing of the effective
ness of the oral rehydration therapy without
medicines for children with diarrhoea.
Word about the CHTT seems to have spread far
and wide. We have already been requested by four
separate groups for a CHTT in their regions. However,
it is unfortunate that due to lack of personnel at the
VHAI office we are unable to meet these requests.
When we launched this CHTT programme it was
hoped that the State VHAs would be able to identify
resource persons at the State level and be able to
organize a CHTT on their own. We hope this plan
will materialise in 1983.
27
ull/' | pom
Bihar
Interest Free Loan for Drought
Affected
BVHA will provide a maximum of Rs. 2,000/- to
any member institution as loan for installation of Chapa
kal or for digging wells to meet the serious drought
situation.
BVHA had bumper enrollment of members during
1982. The BVHA annual meeting theme will be
'Health through communications' and will be held on
March 4 and 5.
Kerala
West Bengal
The West Bengal Voluntary Health Association
(WB VHA) is in the process of developing a central
and moving library, information unit and purchase and
sale unit for different health and development related
books and materials. The information divis;on is open
from 10 A.M. to 5 P.M. on all days except Saturdays
and Sundays at WBVHA, 8 Sarojini Naidu Sarani,
Calcutta-700017.
Cheaper medicines : Orders for INH P.A.S. at
Rs. 22/- per 100 tabs. INH (100 mg) at Rs. 25/- per
1000 tabs may be placed to WB VHA.
WBVHA can provide you a list of centres where
laboratory technology courses are being run. Write to
the Executive secretary, WB VHA, for further infor
mation.
Kerala VHS Executive Secretary, Mr. K.M George,
has resigned from his post.
Gujarat
Tamilnadu
"Health Care Through Cooperation and Coordina
tion" was the theme of the TN VHA General Body
meeting held at Ambilikkai on February 25 and
26, 1983. A panel discussed the legal aspects bind
ing the voluntary agencies and the health care delivery
systems in the context of the new Health Policy of the
Government of India.
A one-week workshop on 'Nature Cure' is to be
held at Udumalpet from February 28 to March 5. This
will include yoga asanas, understanding of five ele
ments and their connection to health and cure; practice
demonstrations on hydro, helio fasting and mud thera
pies will also be given.
TNVHA will cooperate actively with the week long
NANI campaign on 'Breast Feeding' to be held in
Madras.
Maharashtra
Maharashtra will host the next G.B. meeting of
VHAI at Nagpur from March 15-16, 1983. The theme
will be "VHAI—Past, Present and Future".
28
The Gujarat VHA annual convention and general
body meeting took place on November 27-28, 1982,
at Baroda. Fifty one participants from 33 institutions
met, discussed, exchanged views and planned some
common themes for GVHA. The theme of the meeting
was an evaluation of GVHA as an active body after
10 years of activities and programmes. Some of the
proposals for courses in 1983 that emerged from the
discussions were caste problem and how to approach
it; what is people's participation, and 'what can we do
with landless labourers'.
Karnataka
'Health Education in Hospitals'
Karnataka VHA held a workshop and exhibi
tion on "Health Education in Hospitals" as part of
their General Body meeting on February 20, 1983.
HEALTH FOR THE MILLIONS/FEBRUARY 1983
COMMUNITY HEALTH CELL
326, V Main, I Block
Koramangala
Bangalore-560034
India
STRESS
THE psychosomatic
LINK
L
-^ol. IX
No. 2
A
Bimonthly
of
the
Voluntary
Health
Association
COMMUNITY HEALTH CELL
326, V Main, I Block
Koramangala
Bangalore-560034
India
STRESS
THE PSYCHOSOMATIC
LINK
of
India
APRIL 1983
HEALTH FOR THE MILLIONS
Vol. IX
No. 2
April 1983
In this issue
1
Stress Management
10
Stress of Life
12
Drug Disinformation
13
Further Reading on Stress
16
Managing Drug Supply
20
Letter from a Friend
22
Health Workshop
24
News from the States
25
New Books
Editor
: S. Srinivasan
Executive Editor : Augustine J.
Veliath
Production
: Alex J. Dass
News & Events : Purabi Pandey
Assistance
: P. George
Circulation
: L. K. Murthy
Owned and published by the
Voluntary Health Association of
India, C-14, Community Centre,
Safdarjung Development
Area,
New Delhi-110016, and printed
at Prinfsman,
Stressing a Fact
Stress is a fact of life. We are under stress from the moment of our
birth till we breathe our last. At times, the many of us are so accustomed
to our stressful ways of living that we do not know how to relax. Life is
dull and boring on days we do not have any work—for those of us who
have the luxury of work and a weekly off.
However, stress like death seems to be a great leveller. It hits all,
poor and rich. A handful do not buckle. For the poor in this country,
stress comes in many forms: oppression, exploitation, deprivation of basic
needs, injustices and atrocities heaped on them. Add to that, corruption
and greed and the high aspiration models of the middle class and the rich.
In the latter world-view, the more you can consume the better it is for you
and the economy of the world. That of course leads one to compete (or
grab) for everything including basic needs.
There are several things wrong with this world view. Our forests
are vanishing, rivers are poisoned and the world is going up in smoke
precisely because of this compete and grab and produce more of mostly
useless thmgs (like ornaments and after shave lotions). This world view
also results in the tendency to go for fancy hospitals with fancier equip
ments, of prescribing multiple drugs and ordering too many lab tests.
The second most stressed group (after the poor) in this country
is women—stresses owing to in-laws, unemphathising husbands, insensi
tive children and the weight of tradition. If one removes malnutrition,
these must be the greatest causes for physical disease and mental break
down among women. Aspiring scholars in the field could do more studies
to prove this fact.
Do we have to wait for the day when these stresses will result in an
even greater breakdown of our country, or should we work for radical
changes in our perceptions and actions? It is a serious health question.
—S. Srinivasan
NOTE : VHAI's telephone nos. have changed to 668071
668072
o
This article traces the cause of stress, in modem life
and its effect on the bodies and minds of persons.
....... .
neecj for assessjng stressors and personality types
as a dasis for evolving change is discussed. The
importance of setting up stress clinics to design new life-styles, thus reducing harmful levels of stress is
explored. Reduction of stress by exercise, diet, psychotechnologies, meditation, biofeedback and relaxation
Stress Management
training are covered.
Most illnesses occur in stage three, which is when
When we think of soc'al and environmental sensiti
vity and of all the ways in which we pollute the earth, repair fails. When the diet is adequate, a person can
perhaps stress is th? greatest cause of all twentieth go for years withstanding tremendous stress with little
century diseases. This is caused by murders, thefts, apparent harm. If the raw materials are insufficient to
threats—all over the world in th ? cities and the villages meet the needs, there comes the stage of exhaustion,
—in trains, buses and on the roads, in broad daylight, disease develops and eventually death threatens.
etc., people are attacked. And this is only one kind of During every illness we are in one of these three phases
stress—then we h?ve shortages of all kinds, standing of stress, and to regain our health, our diets must be
in queues, inflation with no calling, unemployment, planned accordingly.
graft and bribing. Yet another stress is, as a people,
we have lost our sense of worth derived from the
Eustress and Distress
exercise of individual craftsmanship. Being a woman
Stress is good and needed for people to grow to
is a heavy stress, especia’ly in countries where they
are kept subordinate to men in all ways. Traffic jams, their full potential. So when we talk of stress manage
exhaust from vehicles and delays a'e heavy stressors. ment, we do not mean eliminating all stress. The
And above all, change can stress people and we arc primary stress response is the fight or flight response.
living in an age of rapid change and so this stress on The reaction has helped ensure our survival and any
modern men and women tells on their health —frustra threat, physical or symbolic can bring about this res
tion and unhappiness grate together to make them ponse. Now while physical or arousal to physical
threat is appropriate, physical arousal to symbolic
sick in body and in spirit.
threat is inappropriate. It is of longer duration, is not
Hans Selye has done the most work in the effect easily dissipated and is physically detrimental to the
of stress on man. His research lab at the University of body.
Montreal is an international centre for stress research.
He has described the GAS, General Adaptation
Syndrom? in three phases—(1) the alarm reaction (2)
the stage of resistance and (3) the stage of exhaustion.
(See figure below):
Level of Normal
Hans Selye says that stress is a process that enables
the body to resist the stressor in the best possible way
by enhancing the functioning of the organ system best
able to respond to it. He calls optimal stress levels
eustress, and this reaches a maximal point where
stress increases health and performance. He calls
overload, distress, where stress increases, but health
and performance decrease. This can be seen in the
graph below.
Resistance
Alarm
Reaction
Stage of
Resistance
1 Stage of
Exhaustion
Three phases of GAS
Optimal Stress in Relation to Overload
HEALTH FOR THE MILLIONS/aPRIL
1983
In order to recognise distress, you should be aware
of the three types of stress manifestations:
7. Mood and disposition signs: Worry, overexcited,
insecure, insomnia, confused, forgetful, uncom
fortable, ill at ease, and nervous.
2. Visceral signs: Stomach upset, heart palpitations,
profuse sweating, moist hands, feeling faint or light
headed, face hot or flushed, experience of cold
chills.
3. Musculoskeletal signs: Fingers and hands shake
or tremble, cant sit or stand still, twitches,
headache, tense, stiff muscles, stuttering, stam
mering. stiff neck.
Selye says, "You know we are still evolving from
the Neanderthal Mold; the trouble is, our problems
evolve quickly, but our bodies evolve slowly, very
slowly. People like to assume that the body always
works intelligently. But this is not so. The body is like
the mind. It, too, gets confused and makes mistakes."1
Where stress is concerned, what usually happens is
that mind and body make the same mistakes together.
Selye says that stress is the non-specific response of
the body to any demand made upon it; it can be
pleasant or unpleasant. Stress is not something to be
avoided; complete freedom from stress is death.
All illnesses have a psychosomatic component. All
disorders are psychosomatic, in the sense that both
mind and body are involved in their aetiology.
Disorders are created oct of a complex interaction
of social factors, physical and psychological stress, the
personality of the person and the inability of the
person to adapt adequately to pressures.
We can develop profiles of personality and be
haviour to see how people bring on sickness and then
we can see how to inteivene and change these dys
functional behaviours. The most comprehensive work
in the area of personality and cardiovascular disorders
is that of Friedman, Rosenman, and their colleagues in
their Type A and Type B behaviour as they relate to
coronary disease.2
Two Stress Types
Type A
Type B
Excessive competitive drive
No need to measure self against peers
Continual sense ot time urgency
Takes time for quiet contemplation. One thing at a
time
Feeling of always having to meet deadlines
Works for personal satisfaction
Easily aroused hostility
Reflects and thinks through problems
Hurry "sickness" even in leisure. Tense, energetic,
impatient for rapid results
Can relax without guilt, Creative
No time for genuine leisure
Values leisure just for enjoying life's greatest pleasures
Their self-esteem is a function of their productivity
Self-esteem is total, for being, not linked to doing
only
Aggressive and extroverted, dominates the conver
sation and gatherings
Thoughtful, original, less abrasive with others
J
2
Me Gtrade,_ Walter. and Ann Aikman. Stress, a Bantam Book
1974, pg. 102
2 Friedman, M„ and R. Rosenman. Type A Behaviour and Your
Heart, New York: A A. Knopf, 1974
HEALTH FOR THE MJLLIONS/aPRIL
1983
Conceals a deepseated insecurity
Understands strengths and weaknesses and accepts
them
III defined long-range life goals. Sets unachievable
goals
Ambitions based on well thought out goals that are
achievable
Esteems superiors more than peeis
Confident and secure with both superiors and peers
Never happy, focuses on today's successes, never sure
about values, seeks continual confirmation of his
worth
Achieves a life style approaching genuine happiness
Speaks quickly, unable to wait for the other to com
plete a thought Fiercely impatient
Listens carefully and patiently
Makes more errors in judgement
Makes better decisions, well thought out
Stereotyped responses to problem solving
Responses are geared specifically to each problem
High stress mode, less conducive to health main
tenance
Low stress mode, more conducive to health main
tenance
Admits to less fatigue when stressed
Admits fatigue and takes needed rest and breaks
Unaware of bodily needs
Aware of and meets bodily needs for rest, relaxation,
food, love etc.
Interferes if others are too slow
Permits others to grow at their pace
Predisposed to cardiovascular disease
Leads to high level wellness
Type-A personality is the most difficult to work with, because it is the lifestyle that is stressful.
Need for Stress Clinics
The result of the above research implies, for
instance that any cardiac patient would need coun
selling in methods of behaviour modification and
attitude reorientation as a part of their treatment to
reduce stress. Nurses need to be trained to assess the
psychological, physiological and social status of the
pat ent. Health team members need to gather details
regarding life style, act’vities and coping modes. Then
by identifying the sources of stress, we can sensitise
the person to crucial body signals and show how to
take steps to reduce stress. Individual or group therapy
can be used to teach meditation, progressive relaxa
tion, yoga, hypnosis, biofeedback, exercise and proper
diet.
HEALTH FOR THE MILLlONs/APRIL
.1983
A holistic approach teaches people the connection
between behaviour, attitudes and the autonomic
neurophysiological functions. This is far more effective
than merely giving drugs to regulate blood pressure.
These drugs often produce side effects which can be
more disturbing than the disorder itself. In addition,
the cost of drugs and the need to keep taking them
for an extended time, makes this treatment unsatis
factory. as well as out of the reach for the poor.
Stress clinic teams need to teach people that relax
ing means more than going to a movie, gardening.
reading a favourite book, playing tennis, etc. We need
deep relaxation to induce physiological changes, such
as meditative practices, biogenics and Yoga. These
require diligent practice in order to be effective.
3
In our work with groups for stress management, we
help them identify the stressors in their life: job related
stressors, and stressors within the individual, and
within the family. Then we have them identify the
symptoms they experience from each stressor. Next
we get them to think of potential ways they can alle
viate the stress, the obstacles to alleviation and finally
a new plan for their life. They come up with a whole
range of choices which bring their life. They come up
with a whole range of choices which bring far more
happiness to their lives.
Personality Change
Persons with Type A personality are helped by us
to design structures for their time, setting priorities
that are appropriate and more human. They start in
dulging in activities which enhance their spontaneity
and inner joy. They set goals that are achievable
which are both long and short run. They take back all
their power, taking responsibility for their thoughts,
words, feelings and actions.
Many people are in distress because of poor selfesteem and depression. Here, growth groups are given
an opportunity to change their personality. They
learn to :
1. Verbalize their positive qualities. 2. Accept
compliments 3. Not register unwarranted criticism.
4. Practice assertiveness: accounting for discounts.
5. Verbalize needs. 6. Ask for what they need.
7. Nurture self. 8. Use emotions constructively
9. Change attitudes, values, diet, exercise, ability to.
relax etc. 10. Change personality traits and life-style.
Relaxation
To quiet the mind and achieve relaxation, you must
achieve transquility. This can be done by shifting to
altered states of consciousness. These may be induced
by religious or spiritual states, meditation, floating in
water, extreme muscle relaxation, taking depressant
drugs, or having deep pressure applied as in massage.
There are twenty or more different state of conscious
ness, but the following five are most often recognised:
Level 1 Deep sleep without dreams
Level 2 Sleep with dreams
Level 3 Waking sleep or identification
("I- Coping")
Level 4 Self-transcendence : relative ego/essness,
free from anxiety and defences.
4
Level 5
Objective or cosmic consciousness : state
of oneness with God and the universe, the
spirit exists in harmony with the Spirit in
all things.
Some of the techniques which aim at a self trans
cendent, altered state of consciousness through mind
direction or control are yoga, meditation, muscular
relaxation, autogenics and biofeedback. These are
systems for a deliberate change in consciousness
which integrate left and right brain and are called
Psychotechnologies, other examples are : 7. Sensory
isolation or overload, because sharply altered input
causes a shift in consciousness. 2. Music : sometimes
combined with imagery, meditation, chanting, paint
ing, sculpting, pottery, etc. 3. Psychodrama. 4. Con
templation of nature. 5. Self-help and mutual help
networks. 6. Hypnosis Neurolinguistic Programming.
7. Meetings which attempt to break the cultural trance
and open the person to new choices. 8. Dream Jour
nals. 9. Logotherapy, Gestalt therapy. 10. Sports :
mountain climbing, wilderness retreats, solitary flying,
sailing. Of these, meditation is the simplest, most
direct and the most popular road to the fourth level
of consciousness.
Meditation
The word 'meditation' means 'to heal'. The healing
potential in meditation moves from directing to letting
go through the following stages of mind and body
involvement :
Directing
Posture
Concentration
Immobility
|
Contemplation
Discipline
|
Visualization
Body------------------------------------- ------------------------- Mind
Relaxation
Passive attention
Non-doing
I
Absorption
Spontaneous movement |
Faith
Letting Go
There are many meditative techniques, but all have
two phases :
1. to quiet the body
2. to quiet the mind
Concentration is essential in all systems of meditation.
Through meditation the "inner self", the "higher self",
"th(e oversoul", "the diving within", is awakened and
the energy and power from it pours into the stream of
daily activity, providing guidance and a strengthening
of the will to choose the "better way".
HEALTH FOR THE MILLIONs/aPRIL
1983
Some simple relaxation exercises
These exercises were developed by Vinod K. Bhalla. Quoted in
Controlling Stress and Tension : A Holistic Approach by Daniel
Girdano and George Everly Prentice Hal!. 1979.
The Trunk : Extensor muscles of the spines : Push
the chest forward until you have hollowed the back
strongly, .lift a little more : and let go.
Breathing
Lie down flat in a quiet place with a soft pillow
under your head, and under your knees. Remove any
tight clothing.
Abdominal muscles : Pull in the abdominal
Breathing excercises should not only precede the
muscles until they are flat...pull a bit more...rest and
other exercises but should be an integral part of each
relax
exercise.
Upper Extremities
Upper costal breathing : Place your hands on
the upper third of your chest wall, cross your hands at
Hold each 5 seconds, do each 5 times
the wrists with the finger tips resting comfortably over 7. Adduction of shoulder joints : Straighten the arms
the collarbone. Keeping your abdominal wall relaxed,
against your sides., press tightly.
inhale through your nose, expanding your upper lungs 2. Finger and Wrist Extension : Straighten the fingers
as fully as poss ble. Hold the breath for 3-5 seconds
and pull hack the wrists hard . 5 seconds.. relax.
and then let go slowly through the mouth. Repeat 5-6
times. Rest between each breath.
Middle costal breathing : Place your fingers on
the middle one-third of the chest wall below the sixth
rib. Inhale through your nose, expand, the mid-chest
region as fully as possible. Hold 3-5 seconds, exhale
slowly through the mouth. Repeat 5-6 times and then
relax quietly.
Diaphragmatic Breathing : Take a deepbreath
and let the belly be pushed out by the diaphragm,
thus allowing the lower lobes of the lungs to inflate
fully. Ho'd 3-5 seconds and exhale. Repaat 5-6 times 3. Flexion of the Fingers and Wrists : Clench your
fists and cur! your wrists inward.
Lower Extremities
Allow 30 seconds rest in between each exercise.
Do these in three successive movements :
1. The ankle : Bend up the feet, .pull hard••• (Dorsi
flexion) let go.
4.
Plantar Flexion of ankle joints. Push the feet
downwards as far as you can...push harder...relax.
3. Extension of knee and hip : Straighten the knees
as much as possible...nowpress the legs down into
the mittress...hard...harder . now ralax.
2
HEALTH FOR THE MILLIONs/aPRIL
1983
Shoulder shrug: Shrug your shoulders high...
higher ...touch your ears.
5
Head, Neck and Face
Reducing Stress by Exercise and Diet
7. Facial exercise: Clench the teeth together. Now
draw up the facial muscles very tightly "-tighter /
and relax.
Spoits and exercise are needed to relieve pent-up
aggressive drives. By physical action we feel better.
Exercise not only dispels one form of stress in our
lives, it also enables us to bear up better against stress
in general. Conditioning the body prepares it to with
stand the assault of a virus or a spell of overwork, or a
quarrel, etc. A deep receptive peace comes with being
tired after physical exercise. Doctors are not prescrib
ing running, jumping rope, long brisk walks, swimm
ing, bicycling, strenuous rowing, handball, squash and
basketball. These activities fortify the bod/ against
stress. Each person has to work out their own pro
gramme of sports and exercises.
Diet is very important in stress management. What
you eat can give you tremendous energy as well as
protect you from degenerative disease, such as arterio
sclerosis, high blood pressure and diabetes. If can
2. Rotation: shut the eyes-.-now roll the head slowly
also help your body build its resistance to infect ous
forward then slowly backward ...Roll the head to
disease. Many people either overeat or stop eating
the right, then slowly to the left...rest...repeat five
when they are under heavy stress. This is because as
times.
babies, mothers feed the baby when it cries and the
baby gets confused between intense emotional states
and hunger. How well we respond to stress depends
to a considerable degree on our ability to produce
pituitary and adrenal hormones. If the diet has been
inadequate in protein, vitamin E, or the B vitamins,
riboflavin (vitamin B2) pantothenic acid, or cholin,
sufficient pituitary hormones cannot be produced.
Vitamin E, which is more concentrated in the pituitary
gland than in any other part of the body, is thought to
be particularly essential, it prevents both the pituitary
and adrenal hormones from being destroyed by
oxygen.
The adrenal cortex is even more sensitive to die
tary deprivation. A pantothenic acid deficiency causes
the glands to shrivel and to become filled with blood
and dead cells; co.t'sone and other hormones can no
longer be produced, and the many protective changes
characteristic of stress do not occur. The pituitary,
adrenal and sex hormones are all made from choles
terol, but without pantothenic acid, cholesterol cannot
ba replaced in the glands after once being used up. If
generous dosages of pantothenic acid, cholesterol
cannot be replaced in the glands after once being used
up° If generous dosages of pantothenic acid are given,
adrenal hormones can be produced normally within
24 hours. However, when the deprivation has been
prolonged, a period of repair is necessary and reco
very is slow and uncertain.
HEALTH-FOR THE MILLIONS/APRIL
1983
A slight deficiency of linolic acid or vitamins A, B2,
or E can also limit hormone production and cause a
degeneration of the adrenal cortex; hence each is as
essential as pantothenic acid. The need for Vitamin C
is tremendously increased by stress and if under
supplied, the glands quickly hemorrhage and the out
put of hormones is markedly decreased. Vitamin C
accelerates the rate of cortisone production, appears to
improve its utilisation and delay its breakdown and
alleviates many of th? ’imtatons resu'tmg from a pan
tothenic acid deficiency. Because Vitamin C detoxifies
harmful substances formed in the body during stress,
greater-than-normal quantities are lost in the urine at
this time.
Antistress factors are found in liver, especially pork
liver, wheat germ, some yeasts, kidneys, soy flour
from which the oil has not removed, and the pulp of
green leafy vegetables. Sick people should add as
many of these foods as possible into their daily diets.
A symptom of an illness or even a disease itself is
often nothing more than the body's reaction to stress.
Drugs increase nutritional requirements. Many drugs
cause severe liver damage. Some drugs interfere with
digestion and absorption of all foodstuffs and most
vitamins and minerals, resultingin deficiencies which
cause some damage to every part of the body.
Several drugs, such as sulfanilamide and aminop
terin called vitamin antagonists, are effective because
they replace vitamins in cells and enzyme systems
without parforming their functions; when these drugs
are no longer needed, their toxic effects can be over
come by eating foods rich in
B vitamins. Dicumarol, given to retard blood clotting, inactivates
vitamin A; and its effectiveness can be increased by
giving th s vitamin. The toxicity of isoniazid, used in
treating tuberculosis, is prevented by vitamin B6.
Penicillin a’so increases the need for vitamin BG and
can cause brain damage which this vitamin is said to
p-event. Young children given the antibiotic tetracyc
line, develop urs:ghtly yellow pigmentation on their
teeth, thought to be due to the destruction of vitamin E.
Streptomycin makes manganese unava:lable and
keeps it from being used in many vital enzyme systems,
thus causing piralysis, convulsions, blindness, ar.d
deafness in infants, and dizziness, ear noises, and loss
of hearing in ad alts, all said to be prevented if manga
nese supplied by wheat germ is added to the diet.
The diuretics (and also the sulfonamides and certain
antacid medications) frequently cause kidney damage,
and they, benzedrine, some antibiotics, and several other
HEALTH FOR THE MILLIONs/aPRIL
1983
drugs increase blood clotting, particularly dangerous
for persons susceptible to heart disease. This tendency
may at times be counteracted by vitamin E, which also
prevents certain drugs from injuring the heart muscle.
Dozens of drugs cause anemia by destroying
nutrients needed for blood building and/or by break
ing down red blood cells, but exactly how the diet
should be varied to cope with each of the drugs is not
known. Approximately 1,000 promising new drugs
are released each year to be tested on patients; neither
the physician nor the manufacturer knows what toxic
effects may appear, and the patient is usually unaware
that an untested drug is being given him.
Drugs induce stress
All drugs, by their toxicity, induce a condition
of stress, which particularly increases the need
for vitamin C, pantothenic acid, the antistress
factors, and perhaps for every body's requirement.
Because most drugs can damage the liver, the
body's demands for protein and vitamin E are also
especially high. The more adequate the diet can be
made, therefore, the more effective the drug, and the
shorter the time it need be taken.
So there is a need to take self-responsibility for
each drug taken, to be aware of side effects and make
up for all deficiencies. Theie is also the need to
know proper diet requirements and to meet the needs
of the body in stress and illness. For too long we have
over relied on drugs as the cure, now we see the need
for non-drug therapies in the release of excess stress
and stress related illness.
'The desire to take medicines is perhaps the greatest feature which
distinguishes man from Animals-Sir William Osler
This is not to put down the existing medical sys
tem, but to use it appropriately. A new lifestyle would
include proper diet and exercise.
It .would include preventive measures, such as
checking weight and keeping it within the normal
range. It would include checking your blood pressure
at least annually to see if there is any change from
the normal.
Have your cholesterol determined annually. Every
person with a high blood cholesterol is a potential
candidate for a heart attack, a stroke, high blood pres
sure, and/or various abnormalities resulting from pro
longed faulty circulation. For this reason, I believe
that every individual, regardless of age, should have
an annual blood cholesterol determination. If this
figure is above 180 miligrams, immediate steps should
be taken to lower it. Untold suffering and innumerable
premature deaths could be prevented, were such a
procedure followed.
There is no evidence that cholesterol alone causes
general atherosclerosis strokes, or heart attacks, but
an elevated blood cholesterol invariably accompanies
these abnormalities. Neither is fuel indicator on a car
responsible when the tank is empty, but it indicates
trouble ahead which can be prevented.
The more ill the person, the more frequently food
should be served and the smallerthe means should be,
yet the greater are nutritional requirements. This situa
tion is like having an overdrawn bank account when
current bills are soaring; deposits must be large enough
to cover both past overdrafts and present needs.
Temporary aids to digestion such as enzymes, hydro
chloric acid and lecithin may be used; curds and
acidophilus milk or culture can change the intestinal
flora; and supplements, which require no digesting,
should be heavily relied upon.
Supplements : Ideally, every nutiient should be
furnished by foods alone, and when no food is refined
and all are grown on excellent soils, supplements are
not needed. Nutritional supplements are expensive,
yet they pay for themselves by reducing medical,
dental, drug, and hospital bills.
Biofeedback
Biofeedback is an exercise in relaxation which
develops self awareness and self control. Biofeedback
is a system of monitoring bioelectrical signals emitted
from the body and transforming that information to
visual and or auditory signals that allow the individual
to become aware of internal activities which are asso
ciated with relaxation and calmness. Brain wave bio
feedback also depends on the art of passive concen
tration. In this, alertness may be maintained, but con
centration itself does not include tension and anxiety.
In the practice of medicine, biofeedback is an edu
cational tool to provide information about performance
of mind-body functions. It has an extensive potential.
It can inform about a stomach acidity, white blood
cell levels, stomach contractions, diarrhoea, constipa
tion, heart rate, blood pressure, skin temperature, body
temperature, muscle tension, etc. But biofeedback is
more than just a means of self-monitoring physiologi
cal status. It can be used to promote self-exploration,
self-awareness and self-control. Barbara Brown in
New Mind, New Body describes biofeedback as an
interaction with the interior self". We can find that
what we are thinking (our beliefs, attitudes, and
opinions) influence body processes. Thus biofeedback
training is a reconditioning or relearning process. One
experiences thought which is clear of imagination and
anticipation, allowing greater concentration and result
ing in an increased sense of self: self-concept, selfesteem, and self-realization. It leads to greater creati
vity, deeper insights, enhanced discipline and increased
self-control.
Principles of Biofeedback
Biofeedback is based on three basic principles :
1.
Any neurophysiological or other biological function
which can be monitored and amplified by electronic
instrumentation and fed back to a person through
any of his five senses can be regulated by that
person.
2.
Every change in the physiological state is accom
panied by an appropriate change in the mental
emotional state, conscious or unconscious and
conversely.
3.
Meditative deep relaxation is condusive to esta
blishing voluntary control (of ANS, autonomic
nervous system) by/'allowing the person to become
aware.-of- subliminal. imagery, fantasies,, and
sensations.
•_
->
Looking for Change
An MBBS Doctor of Indian Origin from Rangoon,
Age 30, looking for Employment in India. Four Years
Experience. Not Particular about the. kind of hospital
or community health organisation- Write to • Dr. Sou
Thain (a) Kishore Kumar, 53, 133rd St. Tamwe P.O.,
Rangoon, Burma.. • .
8
'health for the millions/april
1983
Three phases of Biofeedback
Relaxation Training
There are three phases in biofeedback
1.
1.
Physical or physiological phase: the release of
energy (physical, chemical, thermal, electrical—
usually all of these) which can be measured with
the appropriate device.
2. Psychophysiological phase : Mind and body con
trolling the energy-releasing process; coordination
of voluntary, involuntary, and endocrine systems.
3.
Psychological or learning phase : Voluntary control
or conditioning process in which biofeedback
becomes an essential link.
Phase one is measured by machines initially which :
test the electrical charge in muscles
test the movement of cellular secretions (as in hor
monal, gastrointestinal and cardiovascular stress)
c. Test the heat generated (temperature)
a.
b.
Most biofeedback systems measure the shift of elec
trolytes and thus measure muscle contraction as an
electrical phenomenon. When you are sufficiently
aware of your internal processes, you do not need
machines. But can use physical means.
Neuromuscular relaxation trains not only the
muscles, but the nervous system components
which control muscle activity. The benefits are :
a. you can practise it anywhere
b. you can get in 30-60 minutes a day
c. you can use it for biofeedback
d. mind control
e. reduction in body tension.
2. Another form of relaxation training is
autogenics :
This name means only self generating. It is simply
a conditioned pattern of responses which become
associated with the particular thoughts. Unfortu
nately, many people have become more conditioned
to negative thoughts than to positive ones. The
technique of autogenic relaxation was developed
to help condition relaxation.
Very closely related to Autogenics is Biogenics,
popularized by Dr Normal Shealy, mainly in the
relief of pain.
Summary
This article shows how all of us are under tension
and pressure, living a hurried, anxious life and feeling
stressed. As one reads the article, one sees various
techniques for relieving distress. Psychosomatic illness
2. be aware that they might desire to change that
is seen as a window into the inner working of the mind
image.
and the body. Characteristics of personality as a factor
3. believe that they are capable of changing that in disease are discussed. And all this information helps
image.
in designing and implementing a new life style leading
4. Experience the change, growth and control so that us to a high level of wellness. The need to set up
they know they are changing.
stress management clinics in OPD's and Health
Centres as a help to the doctor treating stress diseases
The Biofeedback learning laboratory should create
is highlighted. The challenge is to identify and train
an optimal situation for relaxation.
staff to take up this important work.
1. The instrument provides instant feedback, cognitive
mechanism associate the feedback with the viscera!
feeling, and perhaps a mechanism for reproducing
that state will develop.
In order to use biofeedback people need to :
1. be aware that the image reflected is theirs.
2. Develop memory patterns for the response.
3. Control over any visceral activity can be learned.
Regulation of autonomic nervous system activity
involves a subtle and little undeistood psychological
process of volition or will. It contains two steps :
1. Deep relaxation; 2. Becoming aware of the
presence of interna! imagery, fantasies, and sensations,
and the manner in which they effect physiological
functioning
{This Article first appeared in the Journal of CMAl. March 1982
-Ed. Hfni)
HEALTH FOR THE MILLIONS/APRIL
1983
9
The Stress of Life
Research over the last fifty years has led to the consideration of stress as an important factor in under
standing why certain diseases occur as they do. To a large extent, they make meaningless the dualism of
functional, hysterical, psychosomatic illness used as the antithesis of organic disease. Graham and his collea
gue have analysed systematically the verbal reports made by patients as they responded psychologically with
affection or emotion to a stimulus situation or life event (See table below). His formulation that specific
attitudes and physiological patterns are two dimensions of a disease are the most salient discoveries of the past
thirty years in stress research. Resistance to disease could be increased by working on the underlying attitudes,
that is, by changing to more positive attitudes.
Disease and Verbal Statements of Attitudes
Disease
Attitude
Metabolic Edema
This person feels that he is carrying a heavy load and wants somebody
else to carry all or part of it. He has too much on his shoulders, has too
much responsibility; he wants others to take their share of it.
Hypertension
This person feels threatened with harm and has to be ready for anything.
He feels in danger; anything could happen at any time from any side. He
has to be prepared to meet all possible threats; he has to be on guard.
Regional Enteritis
This person feels that he has received something harmful and wants to
get rid of it. He has been given or has received something damaged or
inferior. He feels that he has been poisoned. He wants the situation to
be finished, over and done with, disposed of.
Raynaud's Disease
This person wants to take hostile physical action. He wants to hit or
strangle; he wants to take action of any kind. He has to do something.
This person feels that he is taking a beating and is helpless to do any
thing about it. He is being knocked around, hammered on; he is being
mistreated or unfairly treated.
Hives
Nausea and Vomiting
This person feels that something wrong has happened and probably feels
responsible. He wishes it had not happened, is sorry it happened and
wishes he could undo it. He wishes things were the way they were
before. He wishes he had not done it.
Acne
This person feels that he is being picked on and wants to be left alone.
He is being nagged.
Hyperthyroidism
This person feels that he might lose somebody or something he loves and
takes care of and is trying to prevent the loss. He is trying to hold on to
a loved one who is being taken away.
Psoriasis
This person feels that something constantly gnawing at him and that he
has to put up with it.
Asthma
This person feels that he is left out in the cold and wants to shut the per
son or situation out. He feels unloved, rejected, disapproved of, shut out,
and wishes not to deal with the person or situation. He wishes to blot it
or him out and not to have anything to do with it or him.
10
HEALTH FOR THE MILLIONs/aPRIL
1983
Attitude
Disease
Eczema
This person feels that he is being frustrated and can do nothing about it.
He feels interfered with, blocked, prevented from doing something; he
feels unable to make himself understood.
Constipation
This person feels that he is in a situation from which nothing good could
come but keeps on with it grimly. He feels things will never get any
better but has to stick with it.
Multiple Sclerosis
This person feels that he is forced to undertake some kind of physical
activity and does not want to. He has to work without help, has to
support himself and usually others. He does not want to and wishes help
or support.
Ulcerative Colitis
This person feels that he is being injured and degraded and wishes he
could get rid of the responsible agent. He is being humiliated; he wants
the situation to be finished, over and done away with, disposed of.
Backache
This person wants to run away. He wants to walk out of there, to get
out.
Migraine
This person feels that something has to be achieved and relaxes after the
effort. He has to accomplish something, is driving himself, striving. He
has to get things done. A goal has to be reached. Then he lets down,
stops rhe driving.
Duodenal Ulcer
This parson feels that he is deprived of what is due to him and wants to
get even. He does not get what he should, is owed, or promised. He wants
to do to some other person what the other person has done to him.
Rheumatoid Arthritis
This parson feels that he is tied down and wants to get free. He feels
restrained, restricted, confined, and wants to be able to move around.
Anaemia
This person feels like exploding. His focus of attention is on controlling
feelings of anger, not on the feeling itself or the object of the anger.
Heartburn
This person is getting what he wants.
Tuberculosis
Despite a valiant effort this person feels overwhelmed by circumstances.
Proxysmal Auricular
Tachycardia
This person feels that things are not proceeding according to schedule
and that they should be speeded up. Typical statements : "Let's get
going; let's get things started."
Diabetes
This person is starving to death in the midst of plenty. He is surrounded
by most of the things that have meaning but his perception is that none
is available to him.
Diarrhoea
This person sees himself faced with a meaningful task and wishes it
were over, finished, or done with. He wishes impending events were
behind him.
Source : David T Graham, William J. Grace, and Thomas H. Holmes. See Graham, D.T., and Graham, F.K. Specific Relations of
Attitude to Physiological Change. Progress report. Madison : University of Wisconsin School of Medicine. 1961.
HEALTH FOR. THE MILLIONS/APRIL
1983
I I
BOOK NEWS
Drug Disinformation
Bitter Pills-Medicines and the Third World Poor,
by Dianna Melrose, is published by Oxfam at £ 4.95.
Distributed by Third World Publications. Review
copies are available on request from the Press Office,
Oxfam, 274 Banbury Road, Oxford.
In Bitter Pills-Medicines and the Third World Poor
Dianna Melrose investigates alarming facts regard
ing drug introduction and distribution from the pers
pective of the poor, drawing on her own field research,
evidence from the manufacturers involved and Oxfam's
wide experience of poverty and ill-health in the Third
World,.
and primary health care rather than to costly hospital
services. The private drug market should be controlled
to safeguard health and priority given to purchase and
manufacture of essential drugs. Rich world govern
ments should actively encourage Third World govern
ments to adopt the WHO recommendations which, in
theory, they have supported. They could help Third
World governments make informed choices about
drug risks and benefits by making more information
available at little cost, and introducting controls to
discourage exports of dangerous and inessential drugs.
Official health aid should not be tied to purchases of
expensive products and high-technology medical
services; and voluntary agencies should strengthen
community health projects which do not rely on im
ported drugs. Manufacturers should take full respon
sibility for ensuring that their products are used safely
and effectively in the Third World and respond to the
real health needs of the poor by marketing low-priced
essential drugs. For Copies of this book, write to
VHAL
The poor suffer disproportionately from ill-health.
A few dozen essential 'generic' d.ugs could be used
to save millions in the poorest countries from unneces
sary suffering and death. The know-how to make
these key generic drugs has been available for decades.
The rich world dominates drug production. Aggres
sive promotion means that the most expensive brand
name drugs usually sell best. The poor are therefore
forced to pay unnecessarily high prices and subsidise
new drugs for the rich. This book documents the
abuses caused by weak contro!s and reveals that some
TRADITIONAL HEALING
manufacturers-including some based in Britain—are
not as sciupulous as they should be in ensuring that
patients and prescribers get full information on their
Traditional Healing and Contemporary Medicine will
products. Some even resist moves to introduce
be the theme of an international conference to be
tougher controls in the Third World that they must
comply with in Britain. The book describes some of held in Washington D.C. USA from June 13-15,
1983.
the positive initiatives taken at local, national and
international levels to rationalise the use of drugs as
At this conference, the nature and efficacy of each
pa»t of a broader strategy for better health—recognising
approach
as well as the extent to which each has
that disease which is rooted in poverty can only be
learned
and
can learn from the other, w:ll be made.
combatted by an onslaught on poverty itself. It
documents the major obstacles that Third World Of interest would be presentations that document the
governments face in tiying to crack down on the drug successful utilization of indigenous praotioners, e.g.
market. Rich world manufacturers and their govern traditional birth attendants, as well as adaptation of a
ments have lobbied to block changes that would western technology to traditional societies Examples
from both developed and developing country settings
benefit the poor.
are welcome. For more information write to Dr Cuitiss
Practical suggestions for change are addressed to Swezy, Program Director, Natioral Council for Inter
three groups : Firstly, if the poor are to benefit, Third national Health 2121 Virginia Avenue, N.W. Suite 303,
World governments must give priority to preventive Washington D.C, 20037.
12
HEALTH FOR THE MILLIONS/APRIL
1983
Further Reading on Stress
1
Cannon, W.B. The Wisdom of the Body. New
York: W.W. Noiton & Co. 1932 Selye, H. Stress.
Montreal: Acta, Inca, 1950
2
—The Stress of Life. New York, To’onto,
London,: McGraw-Hill Book, Co., Inc., (956
3
—The
Chemical Prevention of Cardiac
Necrosis. New York: Ronald Press Co., 1958
8
Cannon, W.B. Bodily Changes in Pain, Hunger,
Fear and Rage. Boston: Charles T. Branford Co.,
1953. Excellent summary of the author's classic
observations on the somatic manifestations of acute
emotions, particularly regarding the effect of
fear, rage, hunger, and thirst upon the sympathetic
nervous system and adrenaline secretion.
9
Dunbar, F. Emotions and Bodily Changes. New
Apply, M.H., and Trumbill, R., eds. Psychological
York: Columbia University Press, 1947. Survey of
Stress: Issues in Research. New York: Appletonthe literature between 1910 and 1945 on Psycho
Century-Crofts, 1967. Conference on psycho'ogical
somatic interrelations (2,400 refs).
stress, York University, Toronto, Canada, with the
participation of numerous specialists who gave 10 Dunn, W.L., Jr., ed. Smoking Behavior: Motives
and Incentives. Introduction by Hans Selye. New
papers on the technican aspects of the G A S in
York: John Wiley & Sons, 1973. An international
relation to psychosomatic medicine.
symposium on why people smoke, with special
5 Bajusz E., ed. Physiology and Pathology of
reference to the relaxation derived from th s hab.'t
Adaptation Mechanisms. Oxford, London, Edin
at time of mental tension.
burgh: Pergamon Press, 1969. Technican mono
graph with independent articles by numerous 11 Farber, S.M.; Mustacchi, P.; and Wilson, R.H.L.,
eds. Man Under Stress. Berkeley, Los Angeles:
specialists in adaptation. One large section deals
University of California Press, 1964. Proceedings
with
"The
PITUITARY
ADRENOCORTICAL
of a symposium organised by the University of
SYSTEM, ITS REGULATION AND ADAPTIVE
California. A group of physicians, surgeons and
FUNCTIONS", and another with "REGULATION
basic research men (among them Brock Chisholm,
OF 'ADAPTIVE HORMONES', Other than ACTHZ"
Rene Dubes, Seymour Farber, Stanley Sarnoff,
Additional presentations are concerned with neuroHans Selye, Paul Dudley White) discussed the
endoctrine regulatory adaptation mechanisms and
various aspects of stress, particularly in relation to
adaptation to changes in environmental tempera
the philosophy of life, social environment, cardio
ture.
vascular disease, space medicine, etc. Most of the
6 Baron, R.A. The Tyranny of Noise. New York
speakers refrained from highly technical discus
Evanston, III., San Franc'sco, London: Harper &
sions, but key references to scientitic papers are
Row, Publishers, 1971. Very readable summary on
given.
the price you pay for the stressor effect of various
types of noise characteristic of our civilization. 12 Gross, N.E. Living with Stress. Forewo:d by
Hans Selye. New York: Toronto, London: McGrawSpecial attention is given to the noise of urban
Hill Book, Co , Inc., 1958. Summary, in lay lan
life, the abusive use of technology, and aviation
Statistics on noise in terms of health and dollars.
guage, of the stress concept and its application to
Technical means to avoid or minimize nose.
daily life.
4
7
Basowitz, H., Persky. H., Horchin, S.J ., and Grinken 13
R.R. Anxiety and Stress New York, Toronto,
London: McGraw-Hill Book Co., Inc., 1954, Welldocumented monograph on anxiety, especially in
relation to stress and the G.A.S.
HEALTH FOR THE MILLIONs/aPRIL
1983
Kennedy, J.A. Relax and Live, Englewood Cliffs,
N.J. : Prentice-Hall, Inc., 1953. Advice on how to
relax and avoid disease, given in lay language.
One section is devoted to the relationship between
aging and the G.A.S.
13
14
Kerner, F. Stress and Your Heart. Introduction 21
by Hans Selye. New York: Hawthorn Books, Inc.,
1962. Practical advice on the avoidance of cardio
vascular disease resulting from stress, based princi
pally on the technical monographs of Hans Selye.
Liebman, S., ed. Stress Situations, Philadelphia,
Montreal: J.B. Dippincoft Co , 1955. Anthology of
publications on emotional reactions to the stress of
frustration illness, catastrophes, marriage, fertility
and sterility, divorce, death and suicide presented
in highly simplified lay language.
Kraus, H. Backache, Stress and Tension: Their
Cause, Prevention and Treatment. New York: 22 McKenna, M. Revitalise yourself! The techni
Simon and Schuster, Inc., 1965. Illustrated popular
ques of staying youthful. Foreword by J.A.
book on the role of stress in causing backache,
Bailey. New York: Hawthorn Books, Inc., 1972.
with advice concerning physical therapy, mainly
Monograph containing practical advice, in popular
exercise, to combat this complication.
terms, on how to stay fit. A special section deals
with "STRESS AND ITS AGING EFFECTS" in the
light of the G.A.S and throughout the well-illus
16 Kryter, K.D. The Effects of Noise on Man.
trated text frequent attention is called to the bene
New York, London: Academic Press, Inc., 1970.
ficial effects of the revitalising stressors, especially
Detailed technical monograph on the effects of
exercises.
noise upon the ears and the body as a whole, with
a comparatively short section on "STRESS AND
Menninger, K. "Regulatory devices of the ego
HEALTH" (1914 refs)
20
23
*
under major stress." Int. J. Psychoanal. 35
(1962): 412-420. Psycho-analytical study of the
17 Lazarus, RS. Psychological Stress and the
stress syndrome as a mental homeostatic reaction.
Coping Process. New York, Toronto, London:
It is concluded that "in its effort to control dange
McGraw-Hill Book Co., 1966. Detailed and very
rous
impulses under such circumstances and hereby
competent discussion of stress in relation to psy
prevent
or retard the disintegrative process which
chology, with special reference to the problem of
threatens, the ego initiates emergency regulatory
coping with threatening situations Correlations
devices which fall into five hierarchically arranged
between the adaptive mechanism of the central
specifically characterised groups, representing in
nervous system and the G.A.S. are given adequate
creasingly greater degrees of failure in integration."
attention throughout this volume.
15
18
Leithead, C.S., and Lind, A.R. Heat Stress and 24
Heat Disorder. London: Cassell and Co., Ltd.,
1964. Review of the literature and personal obser
vations on the assessment, management and con
trol of heat stress and the diseases that may result
from exposure to high temperatures.
19
Levi, L. Stress—Sources, Management and
Prevention. Foreword by Hans Selye. New York:
Liveright Publishing Corporation, 1967. Very read- 25
able volume on the sources, management and pre
vention of stress, emphasizing both the purely
medical and psychological aspects of everyday
experiences.
20
14
--------- ; Mayman, M.; and Pruyser, P. The vital
balance: The life process in mental health
and illness. New York: The Viking Press, Incl.,
1963. Well-documented treatise with an extensive
bibliography on psychosomatic medicine. Special
emphasis is placed upon coping devices in every
day life, aggression, neurotic behaviour and the
importance of a psrsonal relationship between
physician and patient.
Mitchell, H H. and Edman, M. Nutrition and
climatic stress. Springfield, III.: Charles C.
Thomas, Publisher, 19^1. Technical discussion of
observat'ons on stress caused by cold, heat, high
altitude and acceleration in relation to the nutrition
of man (more than 750 refs.)
Levine, S. "Stress and Behaviour." Sci. Amer.
224 (1971): 26-31. Very readable popularised '26 Moss, G.E. Illness, Immunity and social inte
raction: The dynamics of biosocial resonation.
review on the role of pituitary and adrenal hor
mones in the regulation of behaviour during the
New York, London, Sydney, Toronto: John Wiley
8-Sons Inc., 1973. Effect of social interactions
G.A.S. z/lt may be that effective behaviour depends
upon the development of illness and immunity.
upon some optimum level of stress."
HEALTH FOR THE MILLIONS/aPRIL
1983
Orr, W.H. Hormones, Health and happiness.
New York: The Macmillan Co., 1954. Popular des
cription of the role of endocrine glands in disease
with a special chapter on the alarm reaction.
speed aircraft, and industry. Mainly based on the
author's empirical observations and many impres
sive quotations from the daily press. Strictly
scientific publications are only occasionally cited.
Page, R.C. How to lick executive stress. New 32
York; Simon & Schuster; An Essandess Special
Edition, 1966. A medical consultant to various
governmental and industrial management gioups
and former Chairman of the Boaid of the Occupa
tional Health Institute gives advice in simple
language on how to apply the stress theory to
problem of executives in overcoming the constant
pressures of their occupations. No reference is
made to technical l.'terature.
33
29 Scott, J.D. Aggression, Chicago; University of
Chicago Press, 1958. Popularised description of
the factors regulating aggressive behaviour, with
only cursory reference to the G.A.S.
30 Soreson, S. The quest of wholeness, Reykjavik: 34
Prentsmidja Jons Helgasonar, 1971. An evaluation
of the yoga discipline from the point of view of
neurophysiology with special reference to the
stress syndrome.
35
31 Still, H. In quest of quiet, Harrisburg, Pa.: Stack
pole Books, 1970. Popular description of the harm
which can be infliced by no;se of the city, high
Tanner J.M., ed. Stress and psychiatric dis
order. Oxford: Basil Blackwell & Mott, Ltd , 1960.
Second Oxford Conference of the Mental Health
Research Fund, with contributions from many
specialists in the psychological and somatic aspects
of the stress concept. The main subjects in man
and animals; physiological responses to stressors;
prevention and treatment of psychiatric stress
reactions.
Toffler, A. Future shock. New York: Random
House, Inc., 1970. Avery readable popular book
about the stressor effect of the continuous changes
in modern society and the way in which we adapt
—or fail to adapt—to the future (359 refs.)
27
28
Community Health in Urban Setting
A female community health worker needed to join
a South Gujarat based tribal women's organziation,
'Amari Mandali'. Should be conversant in Gujarati.
Good opportunity for self-development and creative
participation. Write for more details to Amari Mandali,
Post Box 13, Fort Songadh, Surat, Gujarat 394670.
VHAI Scholarships Available
VHAI has two sources of scholarships and scholar
ship loans. The executive board has approved their
use as described below. Applicants may apply for
more detailed information on those who will be
eligible and for applications.
The Ed and Anne Scholarship Fund :
This is a memorial fund in the name of Mr Ed
Nabert and Sr Anne Cummins, pioneers in establish
ing VHAI. Scholarships are of two types : (a) Up to
Rs 1,000 scholarship or loan is available for short
courses, workshops and seminars run by VHAI, State
VHAs or others in India, approved by VHAI. These
1.
HEALTH FOR THE MILLIONs/aPRIL
1983
Wiggers, C.J. Physiology of shock. London:
Oxford University Press, 1950. Technical treaties
on shock, with a few pages on its relationship to
the alarm reaction.
Wolff, H.G. Stress and disease. Springfield, III.:
Charles C. Thomas Publisher, 1953. Brief resume
in semitechnical language on the relationship
between stress and disease (210 refs).
courses must be relevant to the needs of India.
(b) One award of Rs 7,000 each year will be made to a
student of the Diploma in Community Health Manage
ment designed by VHAI and RUHSA, which opens
in July 1983 at RUHSA. Ed and Anne were closely
associated with the planning for the course.
2. VHAIjSwiss Development Cooperation Fund for
the Diploma in Community Health Management
Up to six scholarship loans of 7,090 will ba made
each year to sponsored candidates who are accepted
for the Diploma in Community Health Management.
Eligibility
Scholarships and loans will be available only
to persons sponsored by member institutions, or
who are individual members of State Regional
VHAs. Preference will be given to applicants
who are from weaker sections of the society
and small projects or programmes. Applicants
will be routed through State Regional VHAs
which will certify the bonafide memberahip of
the sponsor or applicant.
15
Book Review
RENU KHANNA
Managing Drug Supply
Developed by Management Sciences for Health in collaboration with USAID and WHO
Published in 1981.
This is a 590 page (size 11” x 8.5") manual
dealing with the selection, procurement, distribution
and use of pharmaceuticals in primary health care. It
is a result of collective efforts of around a dozen
persons, who put the 23 chapters together. To com
pile this, the authors have been in touch with indivi
duals and organisations all over the world and have
been getting first hand experience of those concerned
with improving pharmaceutical supply management.
Through this manual, the authors hope that scienti
fic management practices would be applied to the
drug supply process. Their goal is to help in eradicating
the problems of high costs and chronic shortages in
the area of drugs supply. While describing the scienti
fic management process as applied to drugs supply,
the authors also reveal some interesting and success
ful innovations of individual developing countries. The
contents of the manual are meant for macro levels —
health planners and decision-makers at the govern
ment level. Several concepts and practices, however
can be adapted at lower ihan government levels. The
authors describe the manual as an 'idea book'. Its
primary objectives are
to help health decision
makers to :
Cost $18.50
plus shipping charges.
This danger has been largely avoided by the neat
organisation of contents. Six sections have been
made They concentrate on : I Overview, II Selection,
III Procurement, IV Distribution, V Use and VI Manag
ing the system. Each chapter begins with a synopsis
and ends with a telegraphic summary. 'Country Stu
dies' illustrate the concepts which are introduced in
the chapter being applied in the developing countries
— some of these are very educative. The appendices
contain interesting explanation of certain concepts
(like, for instance, bioava’lability of drug products, and
techniques of inventory control calculation). The
appendices also cover important information sources
(like for example, quality control laboratories, techni
cal assistance for local production and training pro
grammes for pharmaceutical logistics). Another con
tribution of the appendices is a set of simple formats
that can form a part of management information
systems.
To help the health planner evaluate his/her own
systsm, some loosely shuctured assessment questions
are given in each chapter. These help in a quick review
of the strengths and weaknesses of the reader's own
supp’y system. References for further reading are
given at the end of each chapter and an annotated
selected bibliogrophy is given at the end of the book.
(7) Identify and clarify the major functions and com
ponents of an effective drug supply system;
(2) Assess existing supply services in terms of
The book ends very interestingly—with an index
resources, strengths and weaknesses;
of common drug supply problems. Possible solutions
(3) Design and implement improvements in drug
supply systems, combining management princi to these problems are given along with references to
ples with an understanding of the conditions ■ the appropriate chapters and sections of the manual.
unique to each situation.
With its length and range of contents, the book
could easily be seen as unwieldy and cumbersome.
16
The manual has dealt in great detail with all
aspects of selection, procurement, distribution, use
and management of drugs. While some topics seem
HEALTH FOR THE MILLIONS/APRIL
1983
not worthy of so much attention, (eg. 'Packaging for
Patient Use' in Chapt. V.B. Dispensing) the details in
seme others are capable of providing a new perception
(viz. Factors for non-compliance in use of medicines)
by patients Chapt. V.C. Patient Use).
All the contents of this book will not be useful to
the many small voluntary health care organisations.
The individual health organisation would need to do a
lot of sifting and sorting of most of the concepts—
highly relevant to these would be the ideas contained
in the three chapters on Promoting Rational Drug Pre
scribing; Dispensing and Patient Use. The chapters
on 'Cost Reduction' and 'Training Programme to
Improve Pharmaceutical Logistics' are excellent for
training organisations like VHAI, NlHFW CHA,
CMAI.
Seeing the ills of the other government distribution
systems, it seems too much to hope that our govern
ment's drug diritribution system would use this for
self-evaluation and self-improvement. The application
of the concepts outlined in this manual at the macro
level would require a lot of coordination. Coordination
is what is lacking between our government's different
departments—the right hand often does not know
what the left is upto.
If voluntary health organisations joined hands and
organised a central store, they could benefit by using
many ideas propagated here. The Catholic Hospital
Association's Central Purchasing Services (CPS) is
taking up the coordination of drugs supplies between
some Catholic hospitals and pharmaceutical suppliers.
Types of Irrational Drug Use
Occurs if a drug is prescribed when :
Types cf Irrational Drug Use
* a less expensive drug would provide comparable efficacy and
safety
Extravagant
Prescribing
* symptomatic treatment of mild conditions diverts funds from treat
ing serious illness
* a brand name is used where less expensive equivalents are avail
able
* the drug is not needed
* the dose is too large
* the treatment period is too long
* the quantity dispensed is too long
* the quantity dispensed is too great
treatment
Over-prescribing
for the current course of
Incorrect Prescribing
* the drug is given for an incorrect diagnos s
* the wrong drug is selected for the indication
* the prescription is prepared improperly
* adjustments are not made for co-existing medical, genetic, environ
mental, or other factors
Multiple Prescribing
♦ two or more medications are used when one or two would achieve
virtually the same effect
* several related conditions are treated when treatment of the primary
condition will improve or cure the other conditions
Under-prescribing
* needed medications are not prescribed
* dosage is inadequate
* length of treatment is too brief
* Adapted from Working Party, Council of Europe, 197 6, and quoted in Managing Drug Supply.
HEALTH FOR THE MILLIONs/APRIL
•
’' t
»t.
1983
W
Comparision of Organisational Models for Managing Drug Supply
Model
Economies of Scale
Centralised * Potential large (bulk
Model
purchasing, inventory
consolidation, vehicle
maintenance)
* Large initial capital in
vestment possible for
facilities, equipment
Staff Utilisation
Communication and
Coordination
Im age and prestige of
Supply Management
Drug Utilisation
Patterns
Observations
Promotes staff specia
lisation
* Prone to communica
tion break-downs
* High visibility and
prestige
* Standard and rational
therapeutic guidelines
possible
Uses limited numbers
of professionals
efficiently
* Coordination difficlut
* Most effective in small
to medium programmes;
complete centralisation
difficult in large country
* Dependable systems of
communication and
transportation are
prerequisites
* Decision-making
remote from user
* Responds slowly to
requests
* Good structure for
development of new
programmes
Directorate ♦ Some economies (esp.
Model
bulk purchasing)
* Allow specialisation
centrally managed areas
* Some communication
break-downs
* Supply management
recognised as important
* Some standardisation
possible
* May respond slowly to
special requests
* Large capital invest
ment (central store,
vehicles) not necessary
* Useful transition model
from decentralised to
centralised
* Reliable system of com
munication are needed
* Reasonable alternative
where individual pro
grammes, areas, or facili
ties resist centralisation
HEALTH FOR THE MILLIONS/APRIL
Decentra- * Few (much duplication
lised Model of facilities)
•
* Low capital investment
* Little specialisation
possible
* Rapid, flexible commu
nication and coordination
* Qualified staff diffused
and inefficiently used
* Planning and decision
making close to user
High operating costs
due to duplicate staff
functions
Low, visibility, low
important
* Unlikely to rationalise
or improve therapy
* Existing inefficiencies
readily perpetuated
♦ Most effective in large,
geographically-diverse
country
* Useful where there are
many individual pro
grammes of geographic
units, each with strong,
effective management
* Each independent pro
grammes, are, or facility
must have ready access
to reliable, economical
supply sources; best in
countries with welldeveloped, competative
local suppliers
1983
Source : Managing Drug Supply.
VHAI and a few individual organisations are also
involved in a similar effort called LOCOMP. These
efforts should lead to timely deliveries of good quality
drugs at optimum prices. More such networks need to
be created to withstand the exploitative forces of the
multinational corporations and find new sources of
supply.
For those with interests in low cost drugs and
rational therapeutics and scientific management, this
Manual is rather welcome. Many groups are attempt
ing to disseminate any information that can bring
down the costs of health care and make it available to
more and more people—to a large extent, the contents
of 'Managing Drug Supply' could help in this
objective.
Indian Council of Social Science
Research Publications
Orientation Course in Mother and
Child Care
Surveys of research
(i) Accounting Theory (ii) Demography, (iii) Eco
nomics, 7 vo’s (iv) Geography 2 vols. (v) Manage
ment, 2 vols. (vi) Political Science, 3 vols. (vii)
Psychology (viii) Public Administration 2 vols. (ix)
Sociology and Social Anthropology, 3 vols. (x) Second
Survey of Research in Psychology, 2 Fts.
Gandhi Bibliographies (English, Hindi, Sanskrit &
Urdu)
Union Catalogue of Social Science Periodicals!
Serials 32 Vols.
Other publications
1. The Status of Women (i) Literacy and Employ
ment (ii) Household and Non-household Economic
Activity (iii) Shifts in Occupational Participation 19611971. 2. Banking Policy in India : An Evaluation 3. A
Long Way to Go 4. Functional Classification of India's
Urban Areas by Factor-Cluster Method 1961-75.
5. Shifts in the Function of Cities and Towns of India
1961 -71. 6. Population and Areas of Cities. Towns and
Urban Agglomerations 1972-1971.7. Man and Land in
South As;a 8. Soviet Studies in Social Sciences, etc.
Journals
It is meant for middle level administration, super
visions and who wish to update their skills.
For more information, contact :
CINI-Child in Need Institute
Vill. Daulatpur, P.O. Amgachi
Via Joka, Dist. 24 Parganas,
West Bengal, India.
WANTED
Prem Sewa Hospital Utraula offers love and
medical care to many unfortunate people in rural
Uttar Pradesh.
For this we need the help of
1. One Lady Doctor M.B.B S.
(i) ICSSR Journal of Abstracts and Reviews: Eco
nomics (ii) ICSSR Journal of abstracts and Reviews:
Geography (iii) ICSSR Journal of Abstracts and
Reviews: Political Science (iv) ICSSR Journal of
Abstracts and Reviews: Sociology and Social Anthro
pology, (v) Indian Dissertation Abstracts (vi) Indian
Psychological Abstracts (vii) Research Abstracts
Quarterly.
For complete catalogue and details regarding facili
ties provided by SSDC, please contact The Director,
Social Science Documentation Centre, LC.S.S.R,
35 Ferozshah Road, New Delhi 110001.
HEALTH FOR THE MILLJONs/aPRIL
>
The Course will begin on 2nd May, 1983 It will
be for one month.
f
1983
2. One teacher for
Medium
newly established
English
Kindergarten and Primary School.
Applications with relevant details can be sent to :
Administrator
Prem Sewa Hospital
Utraula
Gonda Dt., U.P. 271604
19
Letter from a Friend
Some Experiences with Community Development
through Exhibitions
St. Luke's Hospital, Hiranpur is now a medium
sized general rural hosp’tal. It celebrated 50 years
of existence and growth in 1979. There is nothing
veiy unique about it, except, perhaps, that it is in the
Santal Parganas District in Bihar which has recently
been reported as the most backward District in all
India I Maybe, maybe not. But it is not earmarked by
the Bihar Government, with UNICEF and other outside
assistance, for considerable development in the next
few years. The present district is to be elevated to a
commissionary with four districts and could thus bene
fit from all the attendant opportunities for administra
tive improvement which such a change could bring
about.
We all know that the basic emphasis for rural
development is not mere administrative change, but
more effective education at the village level. In the
circumstances of today that means mass education for
which there is an 'appropriate technology', and this is
what we are experimenting with
Perhaps I should
also say that a second important emphasis for volun
tary agencies is that they should cooperate with
government agencies working in the same field as
much as possible. This is what we are trying to do
by working with our local government officers in mass
education programmes like our exhibition. The idea
was given to me by a similar programme I heard about
near Bareilly, so I claim no originality.
I should also mention here that we are lucky to
have a very friendly and cooperative B.D.O. at present,
■and that obviously makes a big difference.
The purpose of the exhibition was to let villagers
see just what is offered by government departments to
help him their development. In Bihar at least, there
is a surprising amount being offered, atleast on paper.
If all the government programmes of the past ten years
for Santal Parganas had really been implemented, then
S.P. would be forging ahead.
Stalls were provided by the following depaitments
and agencies : agriculture, snimal husbandry, forestry,
khadi, weaving, tusar silk, family planning, State Bank
of India, Gramin Bank.
20
The last two persuaded a number of people to
start savings accounts. From us, there were stall on
leprosy, blood transfusion and book stall on health
and development subjects Christian literature.
This year we made a few changes. We held the
exhibition a month earlier to avoid intense heat and the
danger of more storms. We held it for three days and
gave certificates for the best and most informative
stalls. This, we believe, had educational value at least
to the stall holders. We took note of : i. efficiency in
starting and running the stall ii. regularity of staff
attendance throughout the day.
(We found some
stalls left unattended at slack periods of the day).
iii. effectiveness of attracting attention, getting across
the message of what they can offer and how it may
be obtained iv. signs of departmental enthusiasm, for
example the forestry man asked for the 'mike' to pub
licise his work at the end of the public meeting. No
other stall holder asked. He also asked for a photo to
be taken—someone had a camera—of his stall as he
was the first cirtificate winner and wanted to show his
D.F.O. what he had done.
The public meeting was held at sunset on the first
day and gave opportunity for the B.D.O. of our two
local blocks and ourselves to explain the purposes of
the exhibition and government programmes for the
area. This was when the forestry man also spoke, and
then B.D.O. gave invitation to any other stall holders
to do the same. We gave a summary of the hospital
in the last twelve months, including patient statistics,
hoping to promote better hospital-public relations and
to counter some false informat:on we knew was circu
lating. On other evenings, we had various cultural
entertainments, with a very well-presented puppetshow, and a slide show about leprosy put on by Mr
Narayan and the team of the Bihar Leprosy Education
Programme by courtesy of Dr M. Owen.
Just prior to this exhibition we had joined with two
other hospitals in the S.P. to man a health stall at a
b’g annual public mela near our district headquarter
town. This, again, was a new venture for us all and
gave us quite a few lessons to learn. We sought to
do this programme under the banner of the Bihar
Voluntary Health Association as we are all three mem
ber institutions. We applied for a stall to the D.C.
health for the millions/april
1983
Here are a few points which I learnt personally, and
have not seen in print anywhere, though this may be
because I have not seen the right books.
There is a clear difference between mass education
and group education. They required quite different
approaches. In mass education there is no room for
detail. Large eye-catching posters, and a few wellchosen slogans or pithy statements are enough, and a
maximum of two subjects by any one team. We tried
to cover four subjects in our tiny booth. It was too
much. T.B. and leprosy would have been enough.
Flash cards and other aids of that nature only go with
small groups.
Stalls need to be spacious enough for displaying
large posters so that they can easily be seen. Inci
dentally they should also be on tougher paper than
those we have from VHAI, Red Cross or Vellore unless
you can afford to put them all in covered frames. We
found our stall too small, but it was all we were given.
We considered the use of a vertical cylinder in one
corner of the stall which could be rotated. Posters
etc. could be fixed on and form a short educative
sequence for use when space is limited.
Loudspeakers are probably not a good thing in
mass crowd conditions except as the main feature at
a pre determined time. Unusual means of public dis
play can draw attention as mass media, e.g. large
posters on material suspended from gas-filled balloons.
Even elephants are know to have been used ! 1
Sanwich-board men can attract attention from a
passing crowd.
Probably the best mass medium for surging crowds
is a well-planned sequence on frames in a tent with
clear circulating walk-ways. Each demonstration
picture or model must have clearly legible explanatory
text in the local language (s), as explanation by a stall
staff member becomes impractical at 'rush hours' and
interested individuals find themselves being pushed
on by the people surging in behind them. I have seen
F.P.,
and leprosy demonstrations done very
effectively in this way. I hope to develop a mobile
tented exhibition on the basics of rural development,
for taking round to public gatherings. I ha/e seen how
much damage can be done by irresponsible and un
taught development workers seeking to run a develop
ment project.
Development is the current 'bandwagon', and
everyone is climbing on regardless, I fear for the
HEALTH FOR THE MILLIONS/APRIL
1983
future, unless properly trained sympathetic people are
in charge, who are honestly more concerned to help
the target population than they are to earn some fame
for themselves. What I have heard called 'the jeep
approach' is certainly most detrimental to a develop
ment programme, promoting no mutual understanding
or respect at all.
Satisfactory staff amenities are called for if the
mela lasts more than a day or two. We had a dis
cussion among our helpers and they felt that a long
day in a restricted stall with dust blowing all the time
and a hot atmosphere amongst the mela crowds
demands good stamina, and some opportunities for
quiet rest. There was no shortage of food at the mela,
but it was all at inflated prices. Our staff felt it would
be best to have a place nearby for rest and feeding,
and even cooking for themselves.
We kept changing our staff every two or three days
largely to give more people this education experience.
Another hospital went to the other extreme and kept
one man on all the eight days. Our staff felt there
should be one or two trained people to maintain con
tinuity, while junior people could come and go. They
felt their lack of experience and a lack of adequate
training. I concede their point. The eight-day man
had other things to say 1 Actually we had two trained
leprosy PMWs, there all the time, one first half, and
the other second half. They probably should have
been instructed to be 'in charge' more definitely, or
a doctor should be present as a leader.
We noticed both at our exhibition and at the mela
the tendency to leave the stalls in the hands of junior
people of the department as if running such events
was beneath the dignity of or did not require the pre
sence of senior officers, doctors or others. Such
senior officers were conspicuous by their absence, or
present only for shoit periods. We felt this could give
the impression that seniors are not interested. The
staff miss encouragement. We had a doctor present
every day, thinking of extra information they could
give, more than leadership. We might change this
next year.
These were some of our experiences and the
things we learnt from a few days as beginners in mass
education.
BEL Thompson
St Luke's Hospital
Hiranpur
NEWS
Sr CAROL HUSS
One Month Holistic Health Workshops
For the past few years we have been increasingly
disillustioned with the results achievable through for
mal organizations. Even the best, start out with the
right ideas, but soon get bogged down with oppres
sive structures, paitly politics, jealously and intrigue.
What is needed is new forms of working together
which can avoid the pitfalls of the past and go ahead
in uncha'ted waters to make visions realities. One
way we try to meet this need is by educating people
to form networks of like minded people free to try out
a variety of new approaches to bring in a just society.
So during 1982, we ran two one month Holistic
Health Workshops to train interested people.
Philosophy of the Networks
The network would consist of a small band of
committed men and women, ready to initiate, innovate,
and try out new things. They must be courageous
and ready to fake risks, even the risk to life, to bring a
better way of life to the multitudes who are now
marginated. They must be self-educated, knowledge
able, and scholarly in their approach, and able to count
on each other for support when the ire of the wea’thy
begins to descend.
Holistic Health Training Programme
We used several questionnaires to diagnose where
each person was initially in terms of total health. Then
in groups they saw new ways of living and set goals.
Then they began living the new insights. We called
this New Life-Styling sessions. It is based on self
responsibility for high level wellness.
The one month courses included the following
topics : Meaning of life, basic dimensions of holistic
health, stress management, better eyesight without
glasses, eye exercises, non drug therapies, therapeutic
massages, hydrotherapy, accupressure, pulse diagnosis
and treatment, touch for health, therapeutic touch,
zone therapy, reflexology (foot) healing, yoga/yoga
nidra, biogenics exercises, opening meridians, ait and
music therapy, commonly used home remedies and
herbal medicines, their uses and preparation, nutrition
—relation to health, disease, and therapy, new forms
of power, self responsibility—designing new life style,
films on holistic health, environmental health and
social awareness, natural childbirth, environmental
sensitivity, organic farming, nutritional aspects of
agricultural practices, drug issues, meditation, psycho
synthesis, assertiveness training, death and dying and
identifying and dealing with psychosomatic problems.
Members of the group healed themselves and
each other by applying the therapies taught as needed.
Ceitificates were given for the course, and separate
certificates to those who passed the test for Touch For
Health.
The content of the two one month courses was
different, as we learned by experience from the first
programme. Also we geared the content as much as
possible to the needs of the group. In the first work
After the workshops, I had a chance to visit several
shop, we combined staff training (VHAl) with that of
participants
to see how their Networks were functionl
other participants. We found that it is preferable to
separate staff training in future programmes. We ing. i was thrilled to see the variety and scope of their
began both workshops with a Meaning Of Life ques innovations. In one general hospital, they had started
tionnaire which each participant filled out and then a Holistic Health Clinic. It started almost by accident.
we discussed it in sm-ll groups. These discussions A participant told me the following story : A patient
were very fruitful in helping people find or enhance was discharged from the allopathic side—doctors
the meaning of their life and this search ran right couldn't cure him. He was a school teacher and
through the month and helped each participant enrich couldn't raise his right arm to hold chalk. He was
the meaning of life, improve their relations with others, dragging his right leg and his face looked depressed
and set goals to live out their new meaning. The and melancholic He'd been sick for the past four years
interelationship of man to the universe, and our role and in and out of the hospital. He couldn't work and
in caring for the cosmos was beautifully brought out things were going from bad to worse at home. His
wife had died four years back and left him with four
in many different sessions.
22
HEALTH FOR THE MILLIONS/aPRIL
1983
daughters. His family forced him to marry again so
the girls would be cared for. He did, but never really
accepted the new wife. He expressed it as : "I have a
woman to look after me, but my children have
nobody! " The first treatment in the Holistic Health
Clinic was to test his muscles in Touch For Health and
strengthen those which were weak. When we told
him that was wrong and what we were doing, a faint
smile came on his face—he was happy we had found
something wrong —he began to speak more. All dur
ing the therapy, we counselled him on new ways to
respond to the tensions in his life. Foot Reflexology
helped him relax and we gave extra pressure on tender
spots. We talked about the importance of good nutri
tion, with plenty of raw foods and sprouts and showed
his wife how to grow them. As he improved, his will
to live, and meaning in life revived and he cooperated
fully in his recovery. We taught him breathing and
other exercises together with massage. We instructed
his wife also in all his treatment and their relationship
. ic .-IB.
r.jm-
LJ'.-W v i. ■ ■■ H'.m u
greatly improved. By the end of one week he was
back teaching in school. He was so happy he spread
the news far and wide and many other people came to
us for healing."
We had three participants from the Health For a
Million project in Trivandrum. They are teaching the
same topics to their staff and incorporating it in their
ongoing programme. They called us for a three day
advanced Holistic Health workshop and worked as
staff with us. The mothers in the Mahila Samajams
are so happy with this knowledge about how to keep
themselves and their families healthy. Whereever I
go, I see participants using herbal medicines and non
drug therapies.
One partic:pant has started a holistic health ashram
which is meeting local needs. As I travel about the
count-’y my greatest satisfaction is visiting and en
couraging new networks—and linking them—in this
great work of world change and peace and order.
?■ n-M. ■
Opportunity
4 Posts of Laboratory Technicians
Guiart, U.P., Andhra Pradesh)
Natural Life Camp
Residential, intensive, life natural training camp
during May end. To live a simple natural life with a
natural diet—to learn and apply nature cure—to
practice yoga—to listen on philosophy—to learn and
enjoy swimm'ng, trekking, bhajan and sath sangh.
Please apply now for details to Udumalai Life
Natural Society, C/o Sarvothaya Sangam, Dhali Road,
Udamalpet, Coimbatore Dist, Tamil Nadu, 642 126.
(Karnataks,
5 Posts of physiotherapist Technicians (Karntaks,
Gujarat, U.P., Andhra Pradesh and Bihar)
Those employed in Damian Foundation on Govern
ment scales are Likely to be absorbed in Government
services within 5 years.
Apply to : Damian Foundation Secretary AL 189,
12th main 1st Street MADRAS 600 040
ANNOUNCEMENT
A Prize of Rs. 10001-
Indian Academy of Pediatrics has announced a prize of rupees one thousand for an ESSAY
COMPETITION ON
BREASTFEEDING
WHY, WHEN AND HOW
for the III year, IV year and V year MBBS students and interms of recognised Medical
Colleges.
Four copies of the Essay of not more than 2500 words in double space on one side of fullscap
paper by Registered Mail are to be sent. For essay competition entry form, write to the Secre
tary, Indian Academy of Pediatrics, Kailash Dharshan, Kennedy Bridge, Bombay-400007. Last
date for receipt of the entry is 15th June 1983.
health for the millions/APRIL
1983
< '
—
Bihar
A Damien Leprosy Project
On February 10, 1983 there was some excitement
at a lonely place along the G.T. Road, between
Dehri-on-Sone and Sasaram (Rohtas District, Bihar,
India).
The governor of Bihar laid the foundation stone
of the Rural Health Centre, a Damien Foundation
Project, at Rudrapura,
Under the scheme of participation with the govern
ment of India, Damien Foundaton is establishing
this centre with the collaboration of the Bihar govern
ment It will be handed over to the State after 5-7
years. Rohtas district has been chosen as it has the
highest p-evalence of leprosy in the State, according
to official figures.
Collaboration with an existing voluntary organisa
tion (Gandhr Kusth Nivaran Pratishthan, Akhlaspur)
and government institutions has already developed.
Priority will be given to the treatment of infectious
cases with combined therapy, health education and
training.
The inauguration was preceded by a few days of
leprosy information camp conducted by Dr. M. Owen
and her team of leprosy education workers, a public
function, an exhibition, a puppet show and projection
of slides in collages, schools and social clubs. This
preliminary work and the publicity given in surround
ing villages brought a good attendance to the meet
ing. On the next day, some new cases of leprosy
were attended to at the government dispensa’y in the
presence of Primary Health Workers (PHWs).
------------------------------------------------------------------------
Eastern Region VHA
On January 26-27, 1983, a meeting of the Execu
tive Secretaries of Bihar VHA, WB VHA and Mr S.
Srinivasan from VHAI took place. The meeting was
the annual eastern region VHAs meeting. Mr D P
Poddar of WB VHA shared that about 100 health
workers have been trained by WB VHA in community
health through four workshops. The need for evalua24
tion of the impact of the training was stressed. Among
other notable activities of WB VHA ware that the West
Bengal VHA is now in aposition to supply lowcost
medicines to member institutions.
The Bihar VHA has been regularly channelising
polio, DPT, TT, BCG vaccines and dapsone to member
institutions from the government supply. The Execu
tive Secretary, Mr Zaman said that BVHA was spon
soring an one-year lab technology course at Kurji Holy
Family Hospital. He said an one-year X-Ray Techni
cian's Course is also likely to be sponsored by Bihar
VHA. Future activities of BVHA include a 15-month
community health team training programme to start
from August 1983.
Both Mr Podar and Mr Zaman are involved with
"Ankuran", an organisation near Gaya to promote low
cost production and distribution of herbal and allopa
thic medicines, and to start a one-year barefoot phar
macist's course.
Madhya Pradesh
Marjorie Hill reports on the MPVHA VHWs Con
ference : Some had to brave insults of well-dressed
passengers who demanded their seats on the train.
And with a last minute change in venue, finding the
conference in Bhopal city was not easy I The high
lights of the conference were the productions of the
VHWs themselves. Many of the dramas prepared on
health teaching were excellent. Everyone found the
exhibits of materials used in health teaching most
interesting; these varied from printed posters and Hash
cards to puppets and other things made by the VHWs
as teaching aids. One group brought their exhibit of
herbal medicines used in their area effectively for
healing. Participation in the learning games was good.
There was a lot of variety in the problem-solviog Role
Play : there were as many illustrations of ways Village
Health Wo-kers could work as theie were groups doing
the role-play. Then there was the tour of Bhopal city,
with the exhibit on of Tribal Art at Bharat Bhavan and
the excited recognition that "This is the work of our
own villages !“ In the closing programme VHWs
were asked to exp-ess something of their feeling about
the three days. Many spoke of how much they had
learned and how they planned to share this learning
back home. The climax came when one women
whose language was not Hindi, and who had been
afraid to speak at all during much of the conferance,
got up in front of everyone to tell how much these
three days had meant to her I
HEALTH FOR THE MILLIONs/aPRIL
1983
**********
*
*
*
Maintenance Help Available
Trained maintenance help will be available from
July—August 1983 as eight participants of VHAI's health
equipment maintenance programme (HEMAT) graduate.
They would have completed a 2-j-1 years of training in
electrical work, refrigeration, air conditioning, carpentry,
plumbing, simple hospital equipment, building latrines,
how to tap alternate sources of energy and simple medi
cal electronics. For details of graduates' biodata and other
details, write to: S. Srinivasen, programme coordinator,
VHAI.
Management Process
in Health Care
S. Srinivasan, (ed.) pages 534, 1982, Rs. 58
This is a book on management of health care institutions. Written by a team
of people with training and experience in administration, this book is meant for
managers and those interested in the art of management. This book will
interest all who are interested in organising for health—be it in a hospital, a dispensary, a community health
programme or a special care home for the handicapped.
The book is meant as a guide. It can be used as a text-book or a reference for basic principles and
practices. It seeks to put together notes, cases and articles and present the Indian experience of health
care management. It focuses more on the process of planning, activating and reviewing. There is
less emphasis on the tools and techniques of management. But it would give you an idea of the availability
of these tools and techniques, and the situations where they could be applied.
Edited by S. Srinivasan of the Health Care Management team of VHAI, the book is a beautiful ex
ample of the team effort it advocates.
To order (add Rs. 8/- postage), write to VHAI.
*
*
*
19 going on 19
pages 500
1,000 Illustrations
Rs. 19/-
If you still do not have the Hindi version of Where There is No Doctor, this
is the time to order. Thanks to a well wisher. We are able to offer another
3,000 copies at Rs. 19 4- Rs. 7, postage instead of the usual 29/- + postage.
Order your copies now. Till stocks last.
—
No. 3
A
Bimonthly
of
the
Voluntary
Health
Association
^PvTMUNITY HEALTH CELL
326, V Main, I Block
Koramangala
Bangalonj-560034 India
JUNE 1983
India
From
Bernard Shaw0
Health
>7s
RA
and
the
of
=3 ■■ ::
uUT
WAS<
Megiwig:
of
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Life-I
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Double Issue
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:~5™ I
HEALTH FOR THE MILLIONS
To Live or not to Live
In his classic. The Will to Live, (Prentice-Hall, Inc., 1966),
Dr Arnold A Hutschnecker, documents how we choose a physical illness
because of ar. underlying emotional disturbance. For instance, tiredness
I without any exertion on our part is a sign that energies are being used
up within us in an inner struggle between self-destruction and the will
to live. More often than not, illness results as an unconscious tempol
rary (in some cases permanent) surrender of the will to live. When
In this double issue
illness prolongs or repeats it is but a form of slow suicide. People
only when they want to die. "We may have reason to live, without^B
wish to live, and in a struggle between reason and emotion, emc^B
1 Logotherapy and Meaning
seem always to win’', says Hutschnecker.
6 My Search for Meaning in Life
It is this oneness of body and mind, which doctors continued
ignore
and which seems to be the key to the secret of a person's illness,
12 Meaning and Organisations
or for that matter wellness.
15 Getting Meaning from Dreams
The will to live in a sick person has to therefore become an active
ally in all external medical and pharmacological efforts to make a person
18 New Depth Psychology
well.
The will to live is strengthened in a person if he/she has a meaning
21 News
to his/her life. How do we go about finding meaning in life, meaning in
24 Meaning and Cancer
our work, in suffering and in love, so that we can live our lives to the full;
35 The Man who Planted Trees
and not merely exist? To answer this question, though in part, this issue
of Health for the Millions presents several related articles. We discuss
41 A Profile in Courage
briefly the work of Viktor Frankl and his logotherapeutic school, and the
43 To Work for What
work of the new depth psychology school. In the latter context, we
discuss the Journal method of Progoff, a method that can be helpful in
46 For Further Reading
finding meaning in one's life. The interpretation of dreams to find mean
ing is also discussed through the personal example of one of our
47 Development Marketing
friends.
People who have been able to give powerful meaning to their
lives are men and women of prophetic vision. They help transform the
society around them. Alternatively they help provide new meanings and
interpretations of the world around. Sr. Philomene Marie who shares
: S. Srinivasan
Editor
her vision and her meaning in this issue, is one such. The story of the
man who planted a million trees in solitude, and the good work of
Executive Editor : Augustine J.
Schumacher (whose book, 'Good work’, we review) are other examples.
Veliath
The relationship between a lack of meaning and disease comes out
Production
: Alex J. Dass
most lucidly in the cancer work of the Simontons. Some of our collea
gues and friends repeated their work (that of the Simontons) at Pune
News & Events : Purabi Pandey
with some very poor patients. The results are exciting, to say the least.
Assistance
: P. George
Their report is presented in this issue. There is promise of similar work
with leprosy and TB patients. This is opportunity for some enterprising
Circulation
: L. K. Murthy
healing professionals to take the challenge.
Organisations are like human beings, living entities. They too die
and wither away like human beings when meaning and purpose ebbs out
Owned and published by the of them. This aspect of organisations is explored in yet another article in
‘ Voluntary Health Association of thisissue- D
-S. Srinivasan
India, C-14, Community Centre,
Omission Regretted. The author of the main article, 'Stress
Safdarjung Development
Area,
New Delhi-110016, and printed Management', in HFM, April 1983, was Sr. Carol Huss. The omission of
this fact is regretted. —Editor, HFM
at Printsman,
Vol. IX No. 3, 4, June-August 1983 j
—RENU KHANNA
Logo Therapy and Meaning
(This article discusses the various aspects of logotherapy as outlined by
its founder, Viktor Frankl. The meaning of life, work, love, and suffering
are also briefly discussed. The need for including the logotherapeutic
approach to healing is emphasised. A few logotherapeutic techniques
are also briefly mentioned.)
'Whoever has a reason for living endures almost
any mode of life', said Nietzche. This is a recognised
and accepted fact—even by the medical profession.
Doctors are oftentimes surprised by the patient who
fights the most adverse conditions and clings onto the
slender thread of life—he is living because he still has
an agenda, an unfinished task. He has a meaning for
his life, and therefore a will to live.
Logotherapy—'logos', a Greek word for 'meaning—
focuses on the meaning of human existence as well
as on man's search for such a meaning. According to
logotherapy, this striving to find a meaning in one's
life is a primary motivational force in man—you can
take away everything that a man possesses, but as
long as he has his own meaning for his life, he will
live.
What is this meaning of life?
Viktor Frankl, world famous psychiatrist and lead Noos or Spirit
ing proponent of existential analysis, draws on his
In his work on logotherapy, Frankl started with
personal experiences as a long-time prisoner in the his view of man as a 'whole' having three aspects—
bestial Nazi concentration camps, and describes what
he means by meaning in life. Frankl's theories have
a deep ring of authenticity resulting as they do from
the experiences of deepest suffering. He was a man
who lost his mother, father, brother and wife—all his
dear ones except a sister—in the concentration camps.
How could he—every possession lost, every value
destroyed, suffering from hunger, cold, humiliation,
brutality, hourly expecting extermination—find life
worth preserving? In his book 'Man's Search for
Meaning, Frankl says that the probable reason for his
surving the conditions in the camp (where the chances
of survival were 20 : 1) was that the manuscript of his
book 'Doctor and the Soul' (containing the first draft of
Logotherapy) was confiscated. The desire to rewrite the somatic, psychic and spiritual. Logotherapy deals with
manuscript was what assisted him to survive through or rather, starts from the 'spiritual'—the aspect which
the rigors of the concentration camp. Also it is in this is concerned with values which pull a person along
very experience of deepest suffering that he found life's path. Man is not pushed or driven by values as
a reason for living—observing his mates and fellow if he had no control, rather he has the freedom to
prisoners, he found that while many succumbed to choose his actions in line with the values that he
the awful conditions in the camp, those who struggled wants to realise. In this aspect of freedom, lies the
to live were the ones who clung tenaciously to their unique feature of human existence, that is, responsi
own personal reason for living. He conveited this bleness, the responsibility to choose from a myriad
potentially fatal experience in his life into an oppor possibilities how one would think, feel and act, how
tunity for reinforcing his discovery of what made one would respond to life. Life questions man and
man can answer by responsibly choosing and decid
people tick.
HEALTH FOR THE MILLIONS/jUNE
1983
1
ing. Human freedom is not a 'freedom from...' but a
'freedom to . . .'—a freedom to accept responsibility.
As soon as one thinks in these terms, life's trials
(so perceived) become easier to respond to.
This age of anxiety, gives rise to a collective
anxiety neurosis which has four symptoms:
1.
Planless day-to-day living—'why should I
act, why should I plan? Sooner or later the
nuclear bomb will wipe out everything!'
2.
Fatalistic attitude toward life—man feels him
self to be the helpless result of outer circum
stances and inner conditions. He thinks
planned action is impossible.
3.
Collective thinking—man drowns himself in
the masses; he abandons himself as a free and
responsible being.
4.
Fanaticism—while the collectivist ignores his
own personality, the fanatic ignores that of the
other man, the man who thinks differently.
The fanatic is a slave to a particular ideology.
Ultimately, all these four symptoms can be traced
back to man's fear of responsibility and his escape
from freedom. Freedom means freedom in the face of
three things: (1) the instincts; (2) inherited disposi
tion; and (3) environment.
However, instincts do not possess man—man has
the freedom to accept or reject them. Research on
heredity has shown how high is the degree of human
freedom in the face of predisposition. For example,
twins may build different lives on the basis of identi
cal traits—one as a criminal and the other as a crimi
nologist. And thirdly, environment does not make a
man—everything depends on what man makes of it—
his attitude towards it.
When a person cannot find a concrete meaning in
persona! existence, he faces a situation of existential
frustration. This can result in noogenic neuroses i.e.
neuroses having their origin not in psychological but
the spiritual dimension of human existence. Noogenic
neuroses may also result from conflicts between
various values.
(ii)
by experiencing a value, that is, experiencing
aspects of Truth, Beauty, Goodness and realis
ing experiential values
(iii)
by suffering, that is, by realising attitudinal
values.
The meaning of one's life in realising creative values
comes not from the 'greatness' of the task but how
one regards and performs his or her own task. A
mother's routine of cooking and washing performed
with love and caringness is superior to, say, the exis
tence of a surgeon who performs his highly specialis
ed work without being sufficiently conscious of the
tremendous responsibility he bears. It is not the
radius of the activity which is important but how one
fills the circle of his/her tasks—how responsibly one
performs them.
Deep experiences of emotion—wonder and awe of
seeing a sunset, joy of deep intimate contact wirh
another person, sharing in the grief of a child who has
lost a pet—can also give meaning to one's life. In
fact, there are some parsons whose aim in life is to
experience all aspects of life deeply, to increase their
sensitivity and receptivity to all that life has to offer.
Often a single moment can retroactively flood an entire
life with meaning; the peaks decide the meaningful
ness of the life.
Even when life is not fruitful in creation nor rich
in experience it proves to be basically meaningful. The
meaning comes from how a person realises the 'atti
tudinal' values—what attitude she takes towards the
limiting factors upon her life. The opportunity to rea
lise such attitudinal values is always present when
What is meaning of life ?
ever a person finds himself confronted by a destiny
According to logotherapy, this meaning of life can
toward which he can act only by acceptance. The way
be discovered in three ways.
in which he accepts the unalterable fate, his courage
(i) by doing a deed, that is, by realising 'creative' and destiny in suffering and pain are a measure of
human fulfilment. I am reminded of a friend a young
values
2
HEALTH FOR THE MILLIONS/jUNE
1983
widow of around 32 years. Her husband was an alco
holic—he died as a result of too much drinking. She
accepts this painful reality and moves on in life, draw
ing strength of purpose from this very fact. She has
devoted her life's work to research in the area of reha
bilitation of alcoholics.
As soon as we add attitudinal values to the list of
possible categories of values, it is evident that human
existence can never be intrinsically meaningless. As
long as a person remains conscious, he is under obli
gation to realise values, as long as he has conscious
ness he has responsibleness. This remains with him
until the last moment of his existence.
In life the opportunities to address oneself to this
or that group of values vary from hour to hour—at
one time we are called upon to enrich the world by
our actions. At another to enrich ourselves by our
experiences. Life challenges us by putting before us
different situations—how do we respond ?
but what benefits it can get them. There are some
others who demean their own work—the grass is
green on the other side—the work that their brother
or colleague is doing is greater, is more important.
The meaning of life is unique for every person and
each person has to discover it for himself—no other
person can tell us what our purpose in life is. At best
they can help us in the process of discovering it for
ourselves.
In the ultimate analysis, it is not what work one
does that matters, it is how one does it—the sincerity
of efforts, the commitment to the goal and the satis
faction or joy of the process contribute towards
making work meaningful.
Considering the meaning of life in terms of realis
ing the values described above, certain fundamental
aspects of our lives like our work, our relationships of
love, and the reality of suffering take on new
meanings.
Meaning of Work
For work to be innately satisfying and meaningful,
one has to like the work that one is involved in It must
give an oppitunity for the flowering of one's natural
talents and special gifts; it must be in consonance
with one's fundamental values. Often times people
escape into work—their meaning of life lies only in
their work; the achievement of their tasks; they don't
experience the joy derived from the process of work
ing or from relating with people or just 'being'—their
preoccupation is with 'doing'. On the other hand, there
are people who skim through life without making any
meaingful contribution to the earth or any segment
of humanity. To both these kinds of persons, we may
quote the German novelist, Alice Lyttkens, 'Where
love is lacking, work becomes a substitute, where
work is lacking, love becomes an opiate.'
Some people also use their work as competition
ground through which they can gain personal fame
and glory. It is not the work itself that is important
HEALTH FOR THE MILLIONS/jUNE
1983
Meaning of Love
Love in the deepest sense of the word, implies a
spiritual relationship with another person. It permits
us to see the spirtual core of the other person, the
reality of the other's essential nature and his value
potentialities. Love helps the beloved to become as
the lover sees him. As Goethe says, 'If we take people
as they are, we make them worse. If we treat them as
if they were what they ought to be, we help them
become what they are capable of becoming'. To love
another means to enrich both—our own self, because
we experience another's personality as a world in
itself and this extends our own world, the other be
cause he is nurtured by our love, and grows and
flowers to those potential values.
Meaning of Suffering
As long as we suffer, we remain psychically alive.
Without any suffering, any tension, there is a tendency
for human beings to get into a rut. Suffering leads to
maturity—we grow spiritually stronger and richer
because of it. We can understand the problems of
others better, having gone through the same problems
ourselves. This does not mean that because we grow
3
Suffering in this sense is an opportunity, an opport
unity for something. Like Dostoevsky, the only fear
we are likely to have then, is the fear that we may
not be worthy of our torment.
stronger and richer, we should create suffering for
ourselves. On the other hand, suffering helps to
realise the highest values of human existence only
when absolutely necessary and inevitable.
Some Techniques of Logotherapy
Paradoxical Intention
Somebody once remarked that the patient as the
sufferer, is superior to the doctor. 'A doctor who is
sensitive', says Frank!, 'to the imponderables of a situa
tion will always feel a kind of shame when attending
a patient with an incurable disease, or a dying person.
For the doctor himself is helpless, incapable of wrest
ing this victim from death. But the patient has become
a hero who is meeting his fate and holding his own
by accepting it in tranquil suffering. That is upon a
metaphysical plane, a true achievement—while the
doctor in the physical world, in his physician's realm,
has his hands tied, is a failure.'
Many therapists have tried paradoxical intention
with many different cases—with considerable success.
The procedure must encourage the patient to develop a
sense of detachment towards his neurosis—by laugh
ing at it. Paradoxical intention is carried out in as
humourous a setting as possible. The neurotic who
learns to laugh at himself may be on the way to self
management, perhaps cure; says Allport in 'The Indivi
dual and His Religion'.
According to logotherapy, pathogeneses in phobias
and obsessive-compulsive neuroses is partially due to
the increased anxieties, obsessions and compulsions
that is caused by the attempt to avoid anxieties or
fight obsessions and compulsions. A phobic person
usually tries to avoid the situation in which his anxiety
rises while the obsessive compulsive tries to suppress Dereflection
and thus to fight his threatening ideas. In both cases
This technique is used in cases of hyper-reflection
there is 'anticipatory anxiety.' This brings about pre —excessive reflection—on a problem. There is a com
cisely what the patients fears. For example, a patient pulsive inclination to self observation. Through de
with a problem of stuttering became very anxious and reflection, the patient learns to 'ignore' his symptoms
nervous every time he had to speak. When he became and focuses on the positive aspects. The patient is
conscious and anxious, he stuttered more.
dereflected from his disturbance to the task at hand.
He must be reoriented toward his specific vocation
The logotherapeutic treatment for this kind of a
and mission in life, he must be confronted with the
case is ‘paradoxical intention.' Through this, the phobic
logos of his existence.
patient is invited to intend, even if only for a moment,
For endogenous depression, logotherapy must
precisely that which he fears. The treatment consists
support the patient so that he may believe that his
of a reversal of the patient's attitude—his fear is re
suffering will pass. The patient must be prevented
placed by a paradoxical wish—the wind is taken out
from making any value judgements while in a state of
of the sails of the phobia. The patient must cease to
depression. Instead he should say to himself. 'What
flee from or fight his symptoms—in fact, he must even
ever I see is grey. Though the sky may be cloudy
exaggerate them. The symptoms will diminish and
momentarily, the sun still exists. Like wise I cannot
the patient is no longer haunted by them. In the above
see the meaning of life during the depressive phase,
case of the stuttering boyz the therapist succeeded in
yet the meaning exists.'
getting the patient to say "Oh, I'm afraid that I'll stutter
Logotherapy cannot be applied with equal success
on a 'b' or a 'p' I Well today, I think I'll stutter
to all patients. Nor is every doctor equally capable of
through the whole alphabet for a change I' Within two
handling it with equal skill. It is justifiable to combine
sessions, he was able to resume classroom recitation
logotherapy with
other methods—autosuggestion,
without any speech difficulty.
behaviour modification, etc.
4
HEALTH FOR THE MILLIONS/jUNE 1983
Logotherapy and the Healing
Professional
What message does Frankl's theories have for
modern health? The most valuable contribution that
a doctor or nurse can make to their patients is to help
them to see the silver lining, help them to discover a
meaning for their sickness.
Recently we visited a leprosy colony.
The
manager of this colony is an educated leprosy patient.
Twenty years ago, while he was studying in college,
his legs got burnt in a Diwali cracker fire. He did not
feel the burning at all and thus discovered he had
leprosy. His parents—quite well-to-do—sent him to
CMC Vellore and there he was told that the disease
was quife advanced. The young boy was filled with
despair and did not want to live any more. The doctor
who was treating him went beyond the treatment of
his somatic disease—he talked to the young boy and
discovered what his state of mind was. He encouraged
the boy to dedicate his life to the cause of service to
other leprosy patients—he was amongst the very
few educated persons who contracted leprosy—he
could play an important and necessary role in looking
after others struck by the same disease. This made
sense to the young boy—he changed his attitude and
accepted the responsibility. During the last 20 years
he has emerged as a leader and a dynamic organiser
of a thriving leprosy colony near Delhi.
More and more we are realising that not only the
psychological or emotional aspects of man's existence
need to be attended to by the doctor or the nurse,
but also the connections to the spiritual aspects need
to be made. People need to be encouraged to see
what benefits they can derive from their disease or
affliction People do not die but for old age. More
people kill themselves before their time. A person not
only gets sick and worse due to germs but also because
of personal problems and the secret tragedies in his/
her heart. For true healing to take place, it has to be
total—physical, mental and spiritual. Till the day
health professionals recognise this and make it a part
of their treatment, the healing profession would be
seeing only a part of man, and that is a tragedy.
What is Logotherapy?
Logotherapy is perhaps the only therapy who's
philosophy and aim is to treat the human being in
his/her wholeness. Logotherapeutic techniques seek
to begin from the spiritual depths of the person; they
do not rule out the possibility of a deeper reason for
HEALTH FOR THE MILLIONs/jUNE
1983
his somatic and psychic complaint and actually help
the patient to explore this.
Logotherapy regards its assignment as that of
assisting the patient to find meaning in his life. In as
much as logotherapy makes him aware of the hidden
'logos' of his existence and to become aware of what
he longs for in the depth of his being, it is an analyti
cal process. To this extent logotherapy resembles
psychoanalysis. However, in logotherapy there is
attempt to make something conscious again. It does
not restrict its activity of instinctual facts within the
individual's unconscious. But it also cares for spiritual
realities such as the potential meaning of his existence
to be fulfiled as well as his will to meaning. 'Logo
therapy is different from psychoanalysis in that it con
siders man as a being whose main concern consists in
fulfilling a meaning and actualising values, rather than
mere gratification and satisfaction of drives and
instincts or in merely reconciling the conflicting
claims of id, ego and superego, or in the mere adapta
tion and adjustment to society and environment.'
(Victor Franklin Man's Search for Meaning).
Logotherapy tries to make the patient fully aware
of his own responsiblenesss. Therefore it must leave
to him the option for what, to what or to whom he
understands himself to be responsible. The logothera
pist neither teaches nor preaches—his role consists in
the broadening and the widening of the field of the
patient so that the whole spectrum of meaning and
values becomes conscious and visible to him.
New Journal
Journal of Rural Paediatrics
Continuing education for doctors is a felt but
seldom met need. Journal of Rural Paediatrics
edited by Dr Anil Mokashi attempts to bridge this
gap. Helpful and much needed practical guidelines in
paediatric care in the rural situation have been given
attention to in this journal. Not only in suggesting
and improving methods of treatment but also
helping the rural doctor to an on-going evaluation
of one's own skills and knowledge by administra
tion of short and quick questionnaire followed by
the correct answers in each issue.
Annual subscription is Rs. 12/-. Please write to
Dr Anil Mokashi, MD, DCH, Consulting Paediatrician,
Baramati Dist., Pune 413 103, India.
5
SR. PHILOMENE MARIE
My Search for Meaning in Life
The study and refl action of our Medical Mission
Sisters' comm an purpose made it clear to me that the
present form of religious life will not help us to
achieve what we stand for, that is, to live the Gospel
way of life—to be with the poor and the oppressed.
Jesus became man to re-establish manhood—to make
us children of God. To continue His mission, the
institutionalised, structured
religious life was a
hindrance to me. The sociopolitical analysis done in
our institutions, showed clearly the nature of this
institutionalised violence. We are part of an oppressive
structure. The present sociopolitical and economic
structure is built for the capitalists. Their values are
opposed to the values of the Gospel. Therefore I
could not find meaning for my life being an adminis
trator of a voluntary hospital. Our concern in the
institution was to take care of the victims of the
present structure and continue maintaining the system.
Any change attempted there seemed to me like put
ting a new patch on old cloth. No radical change was
possible. I was fully convinced of it.
fight for bringing the Kingdom of God—kingdom of
peace, justice and love, there won't be any salvation
for men. I hope to be pait of this group.
At present we as a team are involved in conscientising the fishermen of their situation and joining with
them in their struggles for their rights to live a human
life. Each struggle deepens their understanding of the
present structure and the part played by the social,
economic and religious systems.
My life and work with the oppressed is liberating
me from my selfishness, my ego, and giving me an
opportunity to be fully alive with them. There is an
inner force compelling me to risk all security and
power and find my security in God and man. There
is a process of healing happening to me while I
struggle for wholeness for the world. It is in this
process I discovered the links between Marxism and
religion.
In my life, when I am convinced of a thing, I
always give my whole life energy for it. When I
believed taking care of the victims was our mission,
I was fully committed to it. Therefore, I could not be
comfortable in an institution. I searched for a meaning
ful and authentic life. On the basis of the analysis of
the Indian situation, I reflected—if God is the father
of all men—if all men are created in His image and
likeness, if the Son of God has come to bring life in
abundance to all men, how could He allow the
majority of His children to live in such inhuman situa
tions?
Our Medical Mission Sisters' constitution says to
search for the root causes of so much evil in the
world—these reflections deepened my convictions
and I decided to leave the hospital and join the
oppressed group—the fishermen of Trivandrum dis
trict. Through my four years experience with them,
and my entering into their struggles, my understand
ing of the present oppressive and exploitative struc
tures has deepened. The church and religious orders
seem to be supporting these structures. I am fully
convinced that unless a new group evolves who can
6
HEALTH FOR THE MILLIONs/jUNE
1983
Marxism and Religion
Marxism is a scientific and historical analysis of
society. It is based on materialism and humanism.
Its ultimate goal is social transformation. It interprets
society to change it. It has an ideology in favour of
the poor, the oppressed, the marginated, the outcastes, etc. It has faith in man. On the other hand,
Christianity is a vision—a world view. Its base is
faith, belief in God.
Marx's criticism comes as a part of societal analy
sis. Marx is not criticising the prophetical content
of Christianity. He is critical of the way it was
practised in the West. Marx's main criticism was that
religion is the sign of the oppressed. When they
accept their plight as fate, God given, they have no
hope in this world. So they look for the other world.
Thus they will not try to change the situation. The
belief that through one's own struggle, power, and
activities, one can transform the situation is destroyed
by religion, by its teaching that all struggle in this
life will be rewarded in the next world. This is why
Marx called religion, the opium of the people.
His criticism has to be seen as the criticism of the
existing church. The church today stands mainly for
private property, amassing of wealth. On the other
hand, Marx believes in the abolition of private pro
perty.
Atheism and Theism
Theists lose their prophetical content when they
stand for the status quo and institutionalisation. They
are atheists in practice. One really has to understand
the practical atheism of the theists, Also one has to
understand the practical theism of the atheists (for
instance, the Good Samaritan). Marx never asked
anyone to become an atheist. What he asked is to
create a tomorrow which is free from exploitation,
poverty and inequality. In all religions God—the
highest Being, is honored and glorified while man is
neglected and oppressed.
Without giving living wages to the workers, a
'Birla' builds temples spending lakhs of rupees. Also
in the name of God, churches are built, feasts are
celebrated, offerings are given while the poor are
exploited, and oppressed, forgetting the fact that all
men are created in the image and likeness of God.
The living gods (men) have no place in society, while
lifeless statues are honored and glorified.
Divided World and Dogma
Do we really believe in God as our Father? The
HEALTH FOR THE MlLLIONs/jUNE
1983
world is torn into so many religions, castes, ideolo
gies, etc. What we need today is a secular approach.
Both believers and non-believers have faith. We have
to respect each other. Only in such a context, we can
destroy communalism, divisions, etc.
Every movement when it begins, has a prophetical
content. But as years pass by, it loses its prophetical
content and gets institutionalised. Once it is institu
tionalised, it talks in terms of 'dogmas' and absolutes.
This happened to Christianity. This is happening to
Marxism too. What is vital today is to recreate the pro
phetical character both in Marxism and Christianity.
They have to bridge the gap between theory and
practice. There we need each other for the good of
man. We cannot say anathema to each other. We need
to dialogue—need to learn from each other.
Materialism and Atheism
The church often speaks of materialism negatively.
Dialectical materialism tries to understand the econo
mic base of society. Deep down in dialectical material
ism there is humanism—respect for man. It wants to
make man responsible for himself. Materialism is
personalised. On the other hand (at the practical
level), in the church, we find a deep rooted attach
ment to wealth and private property. Marx points out
the evil in wealth when it is amassed and used for
oneself. In this sense the practising historical church
is more materialistic than the so-called atheist. Here
we have to understand atheism in the classical sense.
Freud was an atheist. But the church had no problem
in teaching Freudian psychology. Jawaharlal Nehru
was an atheist. But the church did not have any pro
blem in collaborating with Nehru. Then why is there
such hesitation towards Marxism ? Marxist analysis
is very threatening. It calls for restructuring of society.
Hence such opposition.
The church must try to learn the Marxist analysis
of society as complementary to the prophetical stand
of Jesus. It is essential to work with the poor. So the
emergence of Liberation Theology. This is a new area
of collaboration. In Latin America and South Africa,
bishops and priests have taken up arms against those
who deny freedom and justice to men, and who mas
sacre men for their own interest. There are leaders
who really struggle for the liberation of men, those
who consider that human life is the most precious gift.
Their numbers must increase and this 'Army' has to
fight, struggle, suffer and die so that a new world can
be created where freedom, justice and love reign.
7
Interview with Sr. Philomene Marie
on her involvement in a fishing village
in Trivandrum district
Sr. Philomene Marie (popularly known as PM) has
been a Medical Mission Sister for 34 years. She
began as a pharmacist. Then, she was the first student
to apply and complete MBA in Health Care Adminis
tration at Delhi University in 1974. After this, she was
Administrator of St. Thomas Hospital, Chetipuzha,
Changanacherry. She was also Secretary of Kerala
Voluntary Health Service (KVHS), for four years and
worked tirelessly to change the health care system
and get hospitals to move out into the community and
meet real health needs. During this period she saw
clearly that her work in the hospital would never
achieve what she wanted —rather it was perpetuating
an unjust system—so she moved out to a fishing
village, Mampally, in Trivandrum district where she
has been since 1978.
In July 1982, I (Sr. Carol Huss) interviewed her
forHealth for the Millions. Sr. Philomene Marie regard
ing her work and life in this drastic change. On my
return to Pune, I wrote up the essence of the interview
as follows :
Hfm: What do you think you have accomplished
since you went to Mampally ?
PM: I have been in Mampally for the past four
years. Initially I was in and out too often, for KVHS
work; I was on the district assembly; a governing
board member for two of our hospitals; and a member
of our general chapter. So meetings took up the
greatest chunk of my time. It was only the last two
years we got fully involved in Mampally. (We being
Thresiamma, Mercy, Patricia, Rosamma and myself).
Initially we concentrated on simple living and get
ting acquainted. Our view at that time was more on
community development and developing relationships.
We started with organising women's groups. One of
the first work we took up was a nursery school. This
was to take care of children left unattended when
mothers have to take fish to the market. We had a
continuous training programme for teachers—they
learned how to make up catchy rhymes and songs and
dance that would teach the children their rights from
the very beginning.
There was a gradual development of our own
thinking as we became more deeply involved. Always,
there were struggles—people couldn't get medical
care, compensation wasn't given for damages to the
fishing equipment. Trawlers came inside the 5 km.
zone limit and took away the fishermen's livlihood.
In the recent Anjengo-Poothura fights, when 120
houses were destroyed nothing was done to help the
people. For these reasons, we saw the utter import
ance of organising the people to demand their rights.
This was a slow and difficult process, as they had
never even known they had rights. We began with
meetings for conscienfisation, teaching, sharing.
The rich get their demands satisfied through the
power of their purse. But the poor man's strength is in
the masses. So we organised them and formed fisher
men's unions to demand their rights through dhamas
and picketing, etc. This paralyses the functioning of
the system. This is what we call political involvement.
Politics is a part of our life. We cannot stay out of
politics when we struggle with people.
There are many instances where we had to organise
the people for dharnas, picketing, protest marches, etc.
Some examples are :
1. We organised the people to demand for the
increase of compensation given to the dependents of
those who die at sea, compensation for damaged
fishing equipment, etc. There are provisions given
for these, but it rarely reaches the people. Often it
stays with the fisheries department as unused
budget.
8
HEALTH FOR THE MILLIONS/jUNE
1983
2. The fisherwomen were organised to demand
transportation facilities. These women have to carry fish
on their heads for selling to places 1 0-15 kms. away.
After a long struggle three buses were provided. We
continue the struggle for more buses.
3. Another long struggle was to improve the
facilities at the Primary Health Centre. Nowadays at
the government offices and at the local and taluk
hospitals, our needs are attended to as they are afraid
of us going for demonstrations.
4. Last year there was a continuous 34-day
struggle for banning trawling during the spawning
(egg laying) season. The trawlers destroy eggs and
small fish. This is causing a decrease of resources of
the sea. This is going to affect the life of the traditio
nal fishermen. Three priest leaders: Fathers Tom
Kochery, C.S.SR., Paul V., S.J., and Jose Kaleekal,
and three lay leaders fasted and did sathyagraha at
the secretariat, while other people got organised and
paralysed the railways, the airport, the national high
way and many of the government offices. Finally the
struggle was called off, at the promise of the fisheries
minister to appoint a commission to study the issue and
give a report within three months. We demanded that
our representative should be one of the members of the
commission. After three months, no report came. We re
sumed our struggle. Because of that, finally the report
was submitted. But there was a division in the opinion
of the members. All the members, except Congress-I,
who were representing the fishermen demanded bann
ing trawling, while the Congress-I and the officials and
the representatives of boat owners and the scientists
were for not banning trawling. Before the struggle
started, the government banned trawling through an
order by the director of the fisheries with advice from
the scientists. After six days, through the pressure of
the trawler owners, they withdrew the order. Also
you see what stand they took in the commission's
report. The very same director of fisheries took a
contradictory stand supporting the trawler owners and
Congress-I. From this you see how the scientists
and officials become the plaything of the ruling
class. These same scientists in their previous studies
showed clearly that trawling is causing destruction of
fish resources and trawlers should be banned.
At this juncture we started our struggle. So far no
favourable order has come and still we are continuing
our struggle joining the political parties who support
our demands.
At the present time we have taken over three large
HEALTH FOR THE MILLIONs/jUNE
1983
areas—organising and conscientising them
We
work with the Mahila Samajams and run three nurse
ries. I am the taluk secretary which has seven units
of the fishermen's union. I also help with the
accounts and audit of the Trivandrum District
Fishermen's Union. In this work, accounting, organis
ing, planning, etc, my MBA is useful.
Our other involvements include running a small dis
pensary in our house. It is done in a very simple way.
This is a good way to establish relationships. Most
of the time we advise them to use home remedies.
We also educate them on preventive and promotive
health care and on the bad effects of modern medi
cine. We go with patients to Taluk and Medical
College hospitals as alone they may not yat get the
attention needed.
We take all the opportunities to get all possible
loans from the banks for buying fishing equipment
and for the women to buy and sell fish.
Our involvement in the parish is in teaching cate
chism on Sundays, preparing children for First Commu
nion, preparing couples for marriage, etc. Except for
the Mother and Child Programme, nothing much is
done through the parish for the people. We are in
charge of this too.
HfM : I heard that many of you signed a paper
supporting the Marxist Party and it raised quite a
furore among Church officials and some families.
PM: Yes, actually many signed the paper, but
they only published the name of priests and sisters.
One bishop also signed. The newspapers wanted to
show that some church leaders are for the poor. But
it caused a lot of misunderstanding.
Fr. George
Koonthanam used to teach in the seminary. Fr. Michael
Karrimattom, Fr. Koothothil and Fr. Mutlangattil used
to teach at Pastoral Orientation Centre, Ernakulam —
all were discontinued for being too revolutionary.
They all write for 'Jeevadhara'. So actually the
Bishops at times help people decide that they'll be
with Christ outside the church structures, through
their fear of people rocking the boat. Many of our
sisters also don't understand our signing this paper.
But all of us at Mampally agree that we are cowards
if we don't put our names on the line. One thing I
want to be very clear. We are not Marxist Party
members, we are not card holders. We keep our
freedom, but at the same time we do suppoit the
Marxist ideology and the Marxist Party when they
fight for the poor and stand for them. We signed
supporting the leftist front, led by the Marxist Party.
9
The front was composed of Congress (S), Muslim
League and the Kerala Congress (Socialist). Let us
also not forget some of those who are in the Right
Front now, were with the leftist front last time, e g.
Congress (A), Kerala Congress (M). Then some of
the bishops, e.g. Palai Bishop, did not have any prob
lem in supporting K.M. Mani.
People call us Marxists and communists—while
we are only using Marxist analysis and methods as
tools for analysing the society. We are helping people
to live a more human life as the Gospel says:
announce the Good News to the poor. The good
news is that Jesus came to bring them life in all its
fullness. The popes in their encyclicals also use quotes
from Marx. The history of the church shows that the
church always entered politics. In this election time
many bishops and priests publicly asked the people to
vote for Congress-1.
Everybody has politics. Even in silence and the
socalled neutral stand, one is supporting the status
quo. The bishops and the church either through
silence or by a public stand, support the status-quo —
the ruling class, the power structure. Often the church
took a stand against the poor. The church rarely parti
cipated in the struggles of the poor. The church has
silenced, isolated, and ex-communicated many of
those who stood with the poor. The leaders and the
church seem to have problems only when priests and
religious stand with the poor and fight for the poor.
Only then it is called 'politics'! Otherwise the church
will not understand politics. Its 'neutral' stand,
'silence' and even the public support of the Right
Front by giving statements like 'Don't vote for the
Communists'., are they not politics ? Even when priests
publicly canvas for the Right Front! Everybody has
politics. The only question remains: What politics?
Politics in favour of the poor or politics in favour of
the rich ? The church says anathema when one is
involved in the struggles of the poor. The church gives
an okay, or is silent, when one is in favour of the
rich.
10
When you organise people you have to support
them. You can't stop and say, now you go ahead. We
are happy to be with the people in their struggles. Our
constitution says, we exercise a prophetic role by
pointing to new areas of concern and to new responsi
bilities as they evolve with the times. This is what we
are doing—reforming, reshaping situations. "In com
munity with them, we search for the evils which are
at the root of so much suffering so that together we
can transform the world as we join with others who
struggle for freedom, justice and love". As prophets,
we often speak against the structured church—with its
big institutions which are the seats of injustices—all of
which only serve the rich.
Hfm: What has contributed most to the develop
ment of your thinking in this new line of approach ?
PM: There are so many inputs I hardly know
where to begin. We meet with people dealing with
oppressed groups for discussion and reflection. Some
times these are led by theologians; sometimes by
scripture scholars, sociologists, anthropologists, philo
sophers, politicians, economists etc. We attended one
such course in Calicut, 'People for Revolutionary
Action'—in which Fr. Mulanghat spoke on 'With Christ
outside the camp'. He showed that we are very far
away from living the Gospel. He talked about the
Eucharist not as a mere symbol, but we must live the
breaking and giving in our lives. We make so much of
disrespect to the Eucharist, but often don't open our
mouths to protest the injustice and oppression of our
brothers. When Tom Kochery was in jail, and we visit
ed him, we felt we ware living our Mass, he giving
himself and we ours, And the church showed little
concern, it was the fishermen's union that took up his
defense.
Father Kappen's books on 'Jesus and Freedom'
was helpful to us especially where it is said the
church is not allowing us to be living bread. Every
thing is dished up and too well cooked. Youngsters
don't seem to take to the traditional church services so
much, but are very much attracted to our liturgies to
gether. Thomas Merton says that the original meaning
of liturgy was a political activity, a publicwork, a con
tribution made by a free citizen.
Through such reflections we see we are on the
right path. One objection outsiders raise is that we
don't always go peacefully. We'd like that too, but it
does not work. We see that taking a stand is the only
way—people are disappearing, many are being killed,
most are dying a slow death from oppression, so we
have to fight. We have no intention of killing anyone.
HEALTH FOR THE MILLIONS/JUNE
1983
but the mob can get out of hand at any time, not that
we plan it. With the Congress government, the leaders
are likely to be jailed to stop our movement and then
we'd have to support their families while they're in
jail. Now we don't have funds, but when we really
live fully as Christian communities' if one family
suffers, the community supports them. We have to
grow more in this giving and sharing and forming
Christian communities.
In the courses, reflections, and seminars there is a
beautiful blend of activists and intellectuals. Theolo
gians come down from their clouds and give and take
with us from the field. We dialogue back and forth,
both enriching each other. They need us and we need
them to complete each other. This input from time to
time keeps everyone growing deeper into the role of
prophets, We are learning how to become contemplatives of action—bringing social justice.
Hfm: How do you manage financially ?
PM: Finances are difficult. The fishermen's unions
have to beg. They have coupons asking for donations
—and people help us. All this work costs money. I
used to think we should never ask for funds, all should
come from the people. But now I see that this is
impossible, at least initially. Seminars are funded by
separate grants. Tom is accused and blamed for wast
ing funds, they think he gets a lot of money. They
think we also get big funds. We have to pay the
teachers, we subsidise their salaries, many children
can't pay the fees, we keep them anyway. Children
pay 3/- per month when they can. We pay travel to
attend meetings and training programmes etc. for
teachers and leaders.
We are conscientising the poor on how people
cheat them. The rich retaliate by accusing us of living
on the church, of acting out of self interest, or vested
interest. Those with vested interest in the church
speak and incite others against us. We find it so
difficult, such a slow growth—when people are starv
ing, others try to keep them quiet. When you give a
dog a bone, they chew on it and keep quiet. Govern
ment gives little bit, like free rations for a week,
then people keep quiet, they get something. The
officials get annoyed at our protests and demands, so
when the people come for things, they tell them: 'Go
back to Tom and the sisters, they'll fulfill your needs.
If you were not fighting with them, we'd give you
things.
The middle men are losing because of our work.
Two co-operative societies are functioning in our area
HEALTH FOR THE MILLIONs/jUNE
1983
now, organised and run by the fishermen, so we have
to expect criticism and outright resistance from those
whose source from the poor, is drying up. The criti
cism that is most cutting, is that we are accused of
immorality. There are also a lot of people to defend
us. We have to fight for our own right too. Some
times we feel depressed, with people shouting or
speaking against us. One day they shouted that we
are communists. I turned and said, 'I am a citizen and
have every right to do as I choose'. Then they said,
'You are getting 300 rupees from the church. So you
should listen to the church/ Then our friends came
and sided with us.
During election we were accused of going house to
house canvassing for Marxist votes, and of going to
the party office. Actually we did not do this. The Congress(l) party was really buying votes spendind a lot
of money. We did try to conscientise the people on
the actual situation.
Hfm Interviewer's comments : / truly enjoyed
our interview. It reinforced my belief that PM is a
Prophet, much as Fr. George Koonthanam refers
to in Jeevadhara, March-April, 1982, “An Indian
Understanding of Prophet Amos Today"—don't miss
reading it. The Mampa Uy community is living out a
new way of experiencing the Bible message of justice
for the poor. A world without sin is not a utopia
never to be experienced, but a possibility to be fought
for. They are finding that by being a leaven in a com
munity, people can cease being selfish, merciless, and
self serving and can find fullness in loving their neigh
bour. The Mampally group are building a new world
of justice which is governed by love—the law which
God has written on every man's heart. It is here that
law and government are not only superfluous, they are
an obstacle. Talking to PM helped me see the many
ways in which Marx and the Bible are agreeing—
rather than focusing on the inconsistencies such as
atheistic basis and no belief in a hereafter.
11
S.
SRINIVASAN
Meaning and Organisations
Organisations are like human beings. They are
born, they mature and die. Sometimes they undergo
an evolutionary transformation into a different species
or undergo a reincarnation (because of past karma).
What are organisations? An organisation is a group
of people coming together for some goals and aspira
tions. These goals and aspirations are very clear in
some organisations, in some they are very diffused or
are confused.
The health of the organisat’on is affected accord
ingly. An organisation which has clear superordinate
goals that are shared by all the people working in it
is an organisation with a strong sense of meaning for
its existence. Good and effective organisations make
meaning for their workers. They also provide mean
ing for those who come into contact with them.
An organisation's meaning emerges from a com
plex of reasons. The group of workers in the organi
sation can define their vision by mutual sharing and
provide meaning. More often the meaning of an
organisation is transmitted by the needs of the com
munity and how it responds to these needs, by the
values and aspirations of its leaders, by the conduci
veness of the organisational climate, and most impor
tantly by the psychological health and creativity of its
workers.
Among the first type (Type 1) are foundations and
trusts which can generato their funds, and are devoted
to research, art, ideology or religion. Some political
parties and religious movements are of this type.
Such organisations may lead to work for work's
sake; may become narrow minded in vision and may
ultimately die out. On the other hand these may be
organisations which are made up of pioneers, working
in the frontiers of knowledge, human ideals and
human experience.
In the second type (Type 2) are organisations pro
viding satisfaction to their workers and meeting some
of the needs of the people in the environment effec
tively. In this type are political parties with a strong
mass base and cadres, vibrant consumer forums, and
health organisations inspiring great challenge for
their workers and also meeting the health require
ments of the community.
To be sure not all organisations are stricty Type 1
or Type 2. They could be a mixture of both types.
In almost every organisation, there is the mix of the
useful and the useless, the effective and the ineffec
tive, the socially relevant and socially irrelevant (and
sometimes the socially destructive).
Organisations with meaning are basically of two
types: organisations that make meaning for their own
workers only, and those that make meaning for their
workers and for the people in the environment.
Organisations that make meaning for the people in the
environment and not for their own workers do not
Voluntary health organisations usually aspire to
be Type 2 when they are born. They may indeed be
Type 2 in actuality. Sooner or later, many of them,
start acquiring Type 1 characteristics. Some of them,
like for instance many voluntary hospitals and com
munity health projects, are predominantly Type 1 but
continue to delude themselves to be Type 2. Many
of them cease to make meaning for their own workers
but for the pay packet. It is best for such voluntary
organisations to close down. But they do not. Why
fast long.
does this happen ?
Two Types
12
HEALTH FOR THE MILLIONS/.JUNE
1983-
Rise and Fall
Limping Along
Why do organisations cease to make meaning at a
deep spiritual level for both the environment and their
own workers?
Most VHOs get grounded in the above phase of
growth. The organisation ceases to inspire and give
meaning to the worker's life. Creative tasks are still
occasionally done but because of isolated individuals
or groups (who in any case would either soon cease
being creative or soon cease being a part of the organi
sation), and not as a result of an integrated organisa
tional striving towards purposeful behaviour. The
leadership, in this stage can be very schizophrenic
about the VHO goals, and at worst garble tasks in
increasing red-tape and justifications.
To get at the answers, let us proceed our inquiry
specifically with the respect to voluntary health organi
sations (VHOs).
At this point two things can happen to the VHO:
continueto limp along with poor meaning to itself
and/or to the environment, or just die out. Alternati
vely, the organisation can use this as a passing phase,
a period of search—the classical dark night of the soul
in search of its meaning, a period of redemptive suffer
ing for more stable growth and fulfilment.
When a VHO is born and attracts competent
people (who join at great personal opportunity cost and
'sacrifice'), the predominant values of the people are
committment, involvement, openness, creativity, com
munication, activity and accomplishment. The focus is
on the task and the superordinate goal. Many of the
workers may not have a high concern for money and
prosperity. Soon the VHO becomes 'established' and
the focus is on power and role, the superordinate goal
is diffused. If there is a bardwagon going along, a lot
of people are jumping on it. The values and concerns
that are now dominant change to low trust, low equa
lity and low concern for intimacy; the decision making
becomes more centralised, creativity, vision and wis
dom are not encouraged; the focus is on department
alisation, position power, channels of reporting, and
flouting of democratic norms (in extreme cases). The
leadership passes on to mediocre, uninspiring or runof-the-mill persons. The VHO in this stage would be
eager to cooperate with the government of India on
all its plans, probably kow-tow to the ruling party
and in general uncritically endorse other VHOs,
government policies, etc. The leadership is afraid of
self criticism, and so are many workers, for fear of
rocking the boat. The predominant physical concerns
for the VHO workers at this stage would be comfort,
privacy and privileges. In the later stages of this
phase of growth, the original superordinate goals are
either forgotten or mechanically repeated in brochures,
annual reports and annual general body meetings.
HEALTH FOR THE MILLIOns/jUNE
1983
Redemption ?
The third phase then, if achieved, will be a period
of increasing meaning and fulfilment for the VHO. In
this phase the focus is both on the person and the
task, than on roles and configurations. Caring, shar
ing, involvement, openness, empathy, understanding,
good planning, communication, agreed monetary
rewards, quiet strength and contemplative activity are
the other characteristics of the VHO in this phase.
Very few VHOs in India are probably in this phase.
Most of them are nuffed out because of lack of funds,
long before their spiritual odyssey comes to mature
fruit. We may observe here, funding agencies with
meaning do not fund organisations which have no
meaning or are confused about if.
13
Good organisations have great meaning. It is the
challenge of all workers, and especially the leaders, to
create opportunities for meaning and fulfilment. There
is a demand placed on those who work, to recognise
meaninglessness of their organisations when it occurs,
and do something about it creatively. Sometimes the
most creative act may be withdrawal and closure of
the organisation. This is an act of courage. Those who
perform such courageous acts of organisational harakiri
will probably understand why the Japanese place such
a high value on this form of suicide.
Solar Equipment Fabrication and Maintenance
Course
Application are now being accepted for :
There are also organisations which start as Type 1
but evolve into Type 2. This is like the initially selfcentred person coming to awareness, and sharing his
clarity and purpose with others in his mature years.
The travel of organisational character is a journey in
time. Meaning evolves over a period of time.
VHAI in its effort to encourage alternate energy
sources to institutions and programmeswill conduct
the first of a series of training courses focussing on
solar energy in collaboration with Institute of
Engineering and Rural Technology from October 29 to
November 29, 1983.
The series of training programmes are planned to
train people from voluntary institutions to fabricate
and maintain alternative energy equipments. Each
course will be geared towards one specific sourse of
alternative energy. Trainees will thus master a parti
cular technique/skill. The October course will enable
trainees to fabricate
a) Solar cookers of different types, solar water heaters,
solar stibs and solar ovens.
b) Impart training for maintenance
c)
Make them aware of the value of solar energy and
how it can be utilized in their institutions
d)
to help them introduce solar energy in the commu
nity.
Persons eligible for the course are
a)
anyone working in maintenance or related depart
ment in a voluntary institution
b)
who has finished ITI training or a matriculate or
equivalent with science background or with atleast
5 years experience in a maintenance department
c)
one having working knowledge of English.
Aptitude and experience in manual work is a must.
Last date for application to VHAI is September 10,
1983.
Nurse Anaesthesia Course
VHAI Nurse Anesthesia Course to begin :
South India : September 1983 at Bethesda Hospital
P.O. Ambur, Tamil Nadu
North India : January 1984 at Frances
Newton
Hospital,
P.O. Firozepore, Punjab
Applications available at :
Voluntary Health Association of India
C-14 Community Centre
Safdarjang Development Area or
New Delhi 11001 6
Mary K. MeNabb
Bethesda Hospital
P.O. Ambur
Dist. North Arcot
Tamil Nadu-635802
Information concerning the VHAI Nurse
Anesthesia Course :
Number of certificates given to date
...57 (March 1983)
Number working towards
certificate
...30
Total
87
Certificate holders who are active in
anesthesia
Certificate holders in India not giving
anesthesia
Certificate holders gone abroad
(One of these persons is in anesthesia)
••• 48
•••
—
5
4
WOMEN'S HEALTH
Xavier Institute of Communications—Bombay has prepared five sets of slides on WOMEN'S
HEALTH. They are available at VHAI. For further information contact VHAI.
14
HEALTH FOR THE MILLIONs/jUNE
1983
KALASIKHAMANI PROF. C.S. KAMALAPATI
Getting Meaning from Dreams
It is by now fairly well recognised that our dreams
are messengers of meaning. Our unconscious is at
work all the time. It perceives and intuits more than
the conscious self.
A majority of dreams reflect our current concerns,
our preoccupations of the last day or two. Dreams
express themselves in a special kind of language, the
language of symbols and pictures. As C G Jung says,
"...a word or an image is symbolic when it implies
something more than its obvious and immediate
meaning... As the mind explores the symbol, it is led
to ideas that He beyond the grasp of reason."' We use
symbols as an index of our understanding. Symbols
also are an index of how much we do not understand.
The dream is not a passing thing of the night to
be ignored. It is an important expression of the
person's unconscious and its meaning is very neces
sary to be understood for a greater integration of
one's personality. The unconscious through dreams
often offers a person advice or guidance that could be
obtained from no other source.
Dreams are an important source of giving fuller
meaning to a person's life. At their simplest level
dreams can tell us about the most common place
events In our lives. They may tell us about articles we
have misplaced, or dangers that are to come. They
may tell us about the possible ill-health of our body
or of an impending disease. They may point to us in
some cases to the correct diagnosis of illness, when
the diagnosis had been eluding the physician.
For further information on how to get meaning
from dreams, the reader is requested to refer to the
list of readings elsewhere in this issue. We present
below, as an illustration, how one person got meaning
from his persistent dreams during a VHA! workshop.
A Dream Come True
I am a dreamer, a shameless habitual dreamer at
that. My good friends say I dream too much and far
too often, by day or night, sitting or lying, asleep or
awake. The incoming cool breezes on a ten-minute
ride in a Town Bus conjure up a little fantasy behind
my half-closed lids. I have at such moments, a veri
table peep into "the magic casement" of Keats
"opening upon the foam of perilous seas in fairy lands
forlorn". But God save the mark I I wake up from that
twilight consciousness exactly a minute or two ahead
of my destination and easily walk out of the bus, as
if nothing had happened.
There are no superstitious strings attached to my
dreams. Nor do I give much credence to the myriad
dream stories in epic literature. The dream of a maid
in attendance forestalls Sita's liberation from capti
vity, in the Ramayana. Hamlet complains of being
troubled by bad dreams. The imperious Caesar's
assassination on the fateful ides of March was grimly
foreboded in Calpurnia's dream, the night before. The
Pilgrim's Progress, the great Christian allegory, is also
a dreafri. But my dreams strike no such warning bells,
auspicious or ominous in the back parlour of my
consciousness. Truth to say, I am neither afraid nor
ashamed of them.
HEALTH FOR THE MILLIONs/jUNE
1983
But however much I like and enjoy my inner
theatre, there must be a limit to the number of times
the same old picture gets screened to the selfsame
audience. I mean, I am not very happy in having
identical dreams repeated ad nauseam. I like to know,
why and wherefore. I can recapitulate atleast three
dreams which have visited my sleep ad infinitum.
When I woke up, my dreams eluded me their secrets.
In the words of William Cowper :
"What I ardently wished, I long believed
And disappointed still, was still deceived;
By disappointment everyday beguiled
Dupe of TOMORROW even from a Child".
15
The most persistent of my three perennial dreams,
related to immense billows of swirling waters. This
would have remained an eternal mystery, had I not
been to an Advanced TA Workshop sometime in
June 1981. The venue was a sequestered convent
surrounded by huge open spaces, dotted with a few
stray cattle, green fields and stunted trees. The rooms
and halls of that imposing structure were big enough
to run a general hospital. But it was sparsely peopled
by a handful or wizened nuns, a lean pantry staff and
terribly guarded every night by a kennel of fierce
Alsatians.
This sacred Triveni of time, place and person stirred
longings in me for some self-knowledge, by utilising
'the sacrament of the here and now'. So, I made bold
to acquaint the group with my 'Swapna Avastha'.
16
"Again and again/' I said, "I dream of huge
floods, in all sorts of movement, in all possible direc
tions, at all imaginable rates of speed, in all shades of
colours: swollen streams tumbling wild down public
roads, fringed with buildings on either side : some
times leaping steep from beetling mountain tops and
disappearing clean into the bowels of the earth; broad
cataracts and cascades of shimmering white hanging
in the air and dancing in the blowing winds; some
times I see a parched lake bed all cracked up with
drought and Io I the next moment a thick jet of
water erupts and spouts up like an artesian spring
furlongs high into the sky and inundates the entire
terrain : sometimes pellucidly clear water glittering as
if in moonlight, going into a series of circles, eddies
and whirlpools; sometimes brickred; sometimes deep
blue or glittering green, no colours barred; but all the
time I am somewhere in the waterscape, safe and
secure, unaffected and unafraid, placidly watching the
witchery of waters; scenes may shift; speeds may
vary; but Niagaras of water are always there; and of
course the dreamer is invulnerable, let the magical
flood be kneedeep or neckdeep ?"
One warm afternoon after briefly introducing
Freudian and post-Freudian theories of dream-inter
pretation, Sister Carol, our facilitator, suddenly asked
me if I really wanted to get the meaning of my dream.
I said I would be happy to. "Then you must work it
out yourself, in right Gestalt Style. Have you heard of
the double chair method?" She placed two chairs one
facing the other, right in front of the workshop, a
mixed group of twenty people, men and women,
ordained or lay, and wanted me to occupy one. "Now,
imagine your favourite Flood perched on the chair
opposite, and talk to it in all seriousness. Ask why it
frequents your consciousness so often and demand an
explanation", she told me. Talking to an empty chair,
with two scores of eyes looking at me, sounded funny.
I beamed a meaningless smile and hesitated. "Come
"on; begin; you say you are an actor and all that. Your
dream vision is there confronting you. Accost and
challenge it; well, do begin.............. ". This happy
gesture of encouragement steeled my guts and the
ice was broken. There was some trepidation to start
with, but warming up quickly, I spoke in peremptory
tone's. Addressing the opposite chair in the second
person singular, I demanded details. "Who are you?
Why do you visit me so often? Is there anything you
want me to do?", Sister Carol's voice sounding low
and clear as that of a stage manager and prompter,
wanted me to move over to the other chair, change
health for the millions/june
1983
iroles, become the FLOOD and respond to the
DREAMER. Roles switched in a trice and my voice
gave utterance to the feelings of the FLOOD, "What
dolt and duffer are you? For months and years, my
tides are knocking at your gates. And you do nothing
but watch, watch and watch. You are like the savage
in the story wondering what to de with the pearls,
swept und^r his feet by ocean-waves".
The psychodrama gathered momentum and the
audience developed a rapport, as at every step the
dreamer and the dream warmed up into heated alter
cation. Moving fast towards a crescendo THE FLOOD
finally solved the puzzle. It declared in unequivocal
terms. "I am elemental force, the flash flood of crea
tive power on rampage. I am raw energy, liquid
galvinism; chaotic poetic urge on the spree; check
me; arrest and tame me, harness, organise and use
me. Come on, do it. I know you can, but will you?
and when?"
The back of the mystery was thus broken and the
Sphynx lay prostrate after yielding up the secret. I
was called back to the world of hard reality. I wiped
my tearstained eyes, looked away from the phantom
chair to my group, who gave me a big hand. I felt
light as a feather, a big load being eased off my mind.
As I started moving toward my place in the group,
Sister Carol fulfilling her role as facilitator asked me.
"Have you got at the meaning of your dream?" "Yes,
thank you sister." I said, "No thanks for me, please.
I practically did nothing. You woiked it out for your
self. This dream may not visit you again. And in
exactly the same way, you can get your other dream
conundrums also solved". "Yes, sister, I shall remem
ber". Before closing the chapter she caught me in a
silken loop with the significant query, "Would you do
something about the message you got out of this
•experience? I mean, would you enter into a sort of
contract with yourself, in order to translate your dream
Into reality?" The question was unexpected and
naturally I fumbled. "There are only three possible
answers to any question—Yes; No; Not now". She
explained, "What is your choice?" "A categorical
yes", I spurted out; I said what I meant and meant
what I said.
"What you can do or dream you can, begin it; for
boldness has genius, power and magic in it", said
Goethe. The truth of this maxim has become clear
these many months of my creative activity since the
Flood spoke to me those unforgettably inspiring
words. From a dreamer I have matured into a doer.
HEALTH FOR THE MlLLIONs/jUNE
1983
I have since jettisoned many of my rackets and nega
tive attitudes. Many have been straightened and
loopholes plugged. Quite a few milestones have
also been profitably traversed on the royal road to
real achievement. A drama on the grammar of drama,
has virtually been composed in Tamil. Many sections
of my Tamil ballad on TA have been composed,
though somewhat disjointedly and as the mood
seized me. If missing links are composed and fitted
into relevant places, it can see the light of print. A
mini epic in English blank verse is practically ready for
the press. Rightly or wrongly. I labour under the funny
notion that I have greater ease and felicity in handling
English than Tamil and so the work on my magnum
opus, a poem in Tamil on 'God, Man and Modern
Society' is progressing at snail-pace. Nevertheless,
the whole poem has been roughed out on paper. It
only remains for me to pick out piece after piece,
chisel, embellish and polish it, before it can occupy
its relevant niche in the architechonics of my grand
poetic palace. Well, things are happening.
My muse is virile and vibrant; ideas flow to me in
fertile streams; images present themselves thick before
my mind's eye; but vocabulary and semantics of the
Tamil language present hurdles, which consume time.
Sometimes therefore I compare myself to the "tongue
less nightingale, which swelled its throat in pain",
because it had no tongue to translate the native music
of its heart into audible sound. But lo ! a human being
is far superior to a bird. Therefore I am sure I
shall erelong hit upon inevitable words and melodic
utterance in Tamil also, which would make my mag
num opus definitely immoital.
A post-script: the fascinating thing about getting
the meaning of this dream and working out the
message was that the dream never came again.
Just released by VHA1
1.
Better Care During Diarrhoea
2.
Better Eye Care
3.
Better Ear Care
All in English
For copies. Please write to
VHAl Publications Department
17
SR. CAROL HUSS
New Depth Psychology and Meaning in Life
This article outlines the genera! philosophy and
underpinnings of the new depth psychology school of
which Frank/, Progoff are leading representatives, a
school first given fillip by Carl Jung's work. Carl
Jung was probably the bridge between the old and
new depth psychology schools. The author conducts
workshops based on the new depth psychology find
ings. These workshops are useful to shape and
define meaning and wholeness to one's life. For more
details readers could contact the author at Sandipani,
Bibwewadi, Pune~411 037, or read into Progoff's
books.
life, he may deliberately engage in worthwhile activi
ties, in religion, in the arts, or in meditation—which
further enhance his self-worth. Or he may engage in
creative activities in groups or individually that make
him feel good about himself and the life he lives.
There is a yearning in so many people to restore
meaning to their lives, a meaning which the collapse
of the medieval world view has taken from them. Deep
within man is an integrative process at work that
brings together in a living unity the major force-fields
that influence man and his life.
Depth Psychology
Every person is engaged in a struggle to find the
richest meaning for his, her life. Some call it theology,
or philosophy, but all it is, put plain and simply, is
personal growth to the point where a person achieves
the highest appreciation for the inner life of the spirit.
This meaningful inner state is achieved when a person
is in harmony with all of nature—when he finds a
practical working relationship between his own
concept of the universe, cosmology, and of himself
and his psychology.
At the point where cosmology and psychology
meet in the integrative processes of living, a person
creates his own sense of life's meaning. If a person
values his place in creation and the wonder ef his uni
queness, he may be able to discover the self-concept
that can move him towards self-actualisation and a
state of high level wellness—balance of body, mind
and spirit. When a person has found the meaning of
18
New depth psychology undertakes a holistic
approach, sees man as a whole: body, spirit, mind and
emotions, with practical methods to bring about the
wholeness of personality. The goal of new depth
psychology is wholeness and the spiritual growth of
personality. It sees man as having psychological depth
and spiritual magnitude. Thus spiritual tools are need
ed for wholeness, for the health of man. New depth
psychology integrated: old depth psychology, academic
psychology, and medical psychology.
The great difference between the Old Depth Psy
chology (and its four pillars: Sigmund Freud, Alfred
Adler, Otto Rank, and Carl Jung) and New Depth
Psychology is presented below :
The treasure-house of being that enriches the self
concept and with it the inner health of the individual
may be explored at three levels. First would be the
process of therapeutic meditation. Second would be
the perception of creative evolution that is moving
man towards a great sense of worth. Third would be
the transpersonal experience, the psychic overflow or
the sense of meaning that comes with the mystical
HEALTH FOR THE MILLIONs/jUNE
1983
New Depth Psychology
Old Depth Psychology
1.
Tries to explain man by science alone.
Denies the spiritual part of man.
Compaitmentalises man.
1.
Undertakes a holistic appproach. Sees man
as a whole: body, mind, spirit, and
emotions.
2.
Puts responsibility for
psychoanalyst
cure on the
2.
Man is responsible for his own health and
wholeness. We are all whole in depth.
3.
The unconscious is repressed
3.
The unconscious is also
and the stress is on
— affirmative,
— negative aspects
— constructive and
— pathology of personality
— self-actualising.
and
— inhibitions.
4.
Treatment and cure takes long time
and is very expensive. Not available
to the masses. Very few qualified
practioners.
experience. These steps to meaning turn the depths of
the self into a reservoir of beauty and a treasure house
of wonder, awe and fulfilment.
Sensitivity Towards Inward Life
For several years now I have been leading Intensive
Journal workshops basically following the design of
its creator, Ira Progoff. He says, man is technically
highly developed, but sensitivity to the inward life is
relatively undeveloped. So we are unbalanced, and the
vaccum is shown in the lack of personal fulfilment.
The Journal method helps people develop outwardly
and inwardly in cyclical, enriching, integrating circles
HEALTH FOR THE MILLlONs/jUNE
1983
4.
Can be quick, not so expensive, can be
do-it-yourself, and self healing lies within.
which help him reach and experience meaning and
spiritual contact with a source greater than himself.
The Journal is a method of drawing psychological
experience forward and outward to evoke the meaning
in a person's existence. We have become disconnected
with our inner principle of growth, thus we have no
protection from the anxieties which result from the
pressures of our environment. We need to re-establish
the inward connection to protect and sustain us and
connect us to the sources of creativity. We need to
touch and activate the same depth dimension of the
psyche that has been reached by advanced spiritual
disciplines through the ages. We enter our well, a
sacred place, relate to the core and meaning of our
life. We feel a realisation of power that guides and
strengthens us. We can relate to others with more
openness and love.
So we link the conscious with the unconscious by
reconnecting ourselves to our seed, and thus psycho
logy becomes the bridge to spiritual direction, un
folding infinite levels of consciousness. The un
conscious is the seed potential, not yet lived. It is a
great power, the seed grows by nurturing, evoking.
The Journal Workshops establish an atmosphere in
which we can work with the unconscious. Man has
an inherent self balancing principle. By meditation we
can mediate between our outer and inner world. The
deep self is evoked and speaks to us in symbols.
19
Through Process Meditation, Twilight Imagery, and
Dreams we contact our seed.
The Journal is an advanced Jungian technique to
contact the seed potential in man and draw forth the
creative, spiritual and growth principles present there.
It sees man as whole in depth, having in-built selfhealing potential—with creative and homeostatic
mechanisms as a part of his nature. Jung remarks :
"The ever deeper ascent into the unconscious suddenly
becomes as illumination from above." The Intensive
Journal leads further into the frontiers between
psychology and spiritual experience.
Depth psychology in modern times provides the
methodology and techniques by means of which we
can experience meaning and spiritual contact Through
symbols we open the way for a steady enlargement in
the capacity of our personality and for a growing
awareness of the meaning of life. The symbols are
generic to the nature of man. Jung calls the un
conscious, the psyche, the directive principle in
human beings which guides its growth fiom the
moment of conception forward. It is the unitary
principle in human life. It carries the unfolding pur
pose of our life. Modern man has gotten out of touch
with his psyche. He has concentrated too much on
the conscious level which is overdeveloped. He needs
to reconnect to the depth level, and to the spontaneous
expression of goals that are latent there.
Imagery is the content of movement in our psyche
—it may be visual, verbal, auditory, rythmic, olfactory,
intuitive, or generalized. It flows on, awake or asleep,
in dreams, fantasies, and reveries, in conscious
thinking, in prayer, daydreams, art, doodling etc. Depth
psychology is holistic because it is able io meet the
existential need of the modern situation, reconnecting
man to his psyche. It addresses itself to the full range
of human experiences, from the impasses and frustra
tions of personal problems to the fullness of meaning
that merges at the creative edge of personality. I have
integrated ait, music, dance, and poetry into the
Journal workshops as a way to unfold the meaning of
the symbols and imagery.
The Seed of Growth
The wholeness of human personality, its fullness
of spiritual and creative capacities lie hidden in the
depth of the incomplete human being, silently waiting
for an opportunity to emerge. But often these poten
tialities do not wait silently, they press, strain, and
disturb the entire personality until an avenue of ex
pression is open to them. Man suffers most from
20
repressing those urges at the core of his nature, that
require him to be a creative spiritual organism or to
bear the marks of his insufficiency. Holistic psycho
logy has the task of interpreting these tensions in
ways that draw forth their constructive qualities, so
that the energy they generate is not dissipated, but
that it works toward the fulfillment of personality.
Meaningful Suffering
When we get in touch with our spiritual seed, then
our sufferings change, take on meaning and we per
ceive our world in a new context. We can see our
sufferings with the eyes of a superior inward power.
Touching the seed in the depth of ourself draws forth
new insights, ideas, inspirations and meanings in our
life. We touch the deep psychic fount of creativity
within us and thus enter and live in a new atmosphere
of awareness. As we heal ourselves in this way, we
begin to reach out to others, to evoke in them their
deep selves—they are helped to develop their perso
nally to full potential. And as more and more people
are healed, they reach out to society and to the whole
cosmos as they work to check the tide of decay and
personal meaninglessness that is so visible in our
culture. So suffering is seen not as pathology but as
potentiality—we find in it seeds of growth—we draw
foith its meaning and enrich our life with greater
strength and fruitfulness.
People who learn to manage their own attitudes
towards personal responsibility and disciplined action
can contribute significantly to their own well-being.
They will not then find themselves as fractured images
of a fracturing and troubled society. Rather, they see
themselves as the weight that swings the balance to
the side of strength—they create strength to bring
forth a more healthy society. Anyone can resonate
to a problem and add to it. It is a finer order of human
effort to create the skills that overcome problems
through developing the superhealthy person who can
make his contribution to society.
As men alter their relation to life, to the cosmos,
and introduce a new depth of meaningfulness, culture
changes its structure of values and belief. Thus a
transformation of the mentality that constitutes the
basic tone of a culture is a large, generalised, and
gradual process. So as individuals change, gradually
groups change, and communities as a whole. They
enlarge the meaning of life and these new values and
beliefs comprise a social point of view that leads to
collective action.
HEALTH FOR THE MILLIONs/jUNE 1983
noiBK
Kerala
KERALA VHS MOVES INTO ACTION
With the appointment of Mr. J. Varghese as Pro
gramme Officer and the shifting of its secretariat to
Rajagiri College of Social Sciences, the Kerala Volun
tary Health Services hopes to make up for its lack of
productive performance in the past few months. KVHS
held its General Body meeting on July 12. This
was followed up by a workshop on the national
health policy. It proposes to revise the directory of the
voluntary hospitals and dispensaries along the guide
lines proposed by VHAI.
West Bengal
REGIONAL SEMINAR ON HEALTH
POLICY
West Bengal VHA will hold a 2-day Seminar on
the national health policy in September 1983. Anyone
interested in further information about issues to be
discussed, participation forms etc., kindly write to
Executive Secretary, WBVHA, 8. Sarojini
Naidu
Sarani, Calcutta 700 017.
Andhra Pradesh
SCHOOL HEALTH
A workshop on organising school health pro
grammes will be held
from September 7-10.
Dr. Mira Shiva will be the resource person. This will be
held at Jeevan Jyothi, Begumpet, Hyderabad 500 016.
A seminar on Intensive Journal is also proposed
to be held to provide a means of breaking out of old
unwanted habits and patterns of living and expand
the individual's capacity of awareness and functioning.
More details available to those who have completed
the basic T.A. from Executive Secretary, APVHA,
10-3-311/7/2 Vijayanagar Colony, Hyderabad 5C0457,
A.P.
Karnataka
MANAGEMENT TRAINING FOR
REHABILITATION OF THE DISABLED
A group of institutions in South India comprising
of the Association of the Physically Handicapped (APH)
Bangalore; Life Help Centre for the Handicapped,
Madras, Salvation Armv Vocational Training Centre
for the Physically Handicapped, Aramboly, and Worth
Trust, Katpadi, Tamilnadu have taken up the task of
training manpower for the disabled sector, which has
hitherto been neglected. They have launched a 5
month management training programme from May 2—
September 24 at APH Bangalore.
For more information contact : Association of the
Physically Handicapped, Hannur Road, Ringarajapuram,
St. Thomas Town Post, Bangalore-560084.
YOU NEED US ?
Tamilnadu
TRAINING PROGRAMMES
An advanced Transactional Analysis Workshop
was held from July 26 to 30 at the Assissi Ashram,
Pampanvilai,
A. N. Kudy
P. O.,
Kanyakumari
District 629201 conducted by Sr. Carol Huss and her
team, and organised by the TNVAA.
A month's Wholistic Health Training Programme
is announced for August by TNVHA. Those wishing
only to be introduced may attend during the first
week. Faculty is composed of Sr Carol Huss and
team. The training will be given at the Assissi
Ashram. There are limited seats.
HEALTH FOR THE. MILLIONS/jUNE 1983
Doctor Couple
Services of a doctor couple, husband trained as
senior house surgeon in General Surgery orthopaedics
and wife, an obstetrician are available to any Christian
mission hospital. Both can speak Hindi, Telugu and
English fluently. Write to : Dr. B. Anand, MBBS, S/o
Dr. B. Dutt, R. Agraharam, Guntur-522003, Andhra
Pradesh.
Pharmacist
A qualified Pharmacist, looking for employment in
Kerala. Fourteen years experience. Write to : RLLJ,
C/o Voluntary Health Association of India, C-14,
Community Centre, Safdarjung Development Area,
New Delhi-110 01 6.
21
Maharashtra
ROYAL ATTACK
The Royal Commonwealth Society for the Blind
has established 10 projects covering 12 different com
munities in Tamilnadu, Andhra Pradash, Maharashtra,
Gujarat, Madhya Pradesh, Orissa, and Uttar Pradesh.
Attack on blinding malnutrition called Xeropthalmia
has been given a high priority and is incorporated in
the 20 point programme of National Reconstructon
(pt. no. 14) of the Government.
A Central Management Team recruited by the
Royal Commonwealth Society for the Blind has been
trained at London. The campaign launched in 1981
has picked up speed and received full support of the
central and state governments in India. For further
details the society may be contacted at B-T/B-3, 2nd
floor, Ashish, 454, L. Jagmohandas Marg,
Bombay 400 036.
Madhya Pradesh
VHWs COMPLETE TRAINING
The annual training programme for village health
workers was completed at Jobat from May 11-21.
Forty five VHWs and ten nurses and supervisors
attended. Subjects discussed were human and legal
rights, communicable diseases, sewing and cooking
and risk taking. A lawyer, the district health officer
and government doctors, women of the community
and Tushar Roy of MPVHA conducted the discussions.
Training included evaluation. Ms. M. Singh of CMAI
tested the evaluation tools. Sitting and eating together
had bridged caste and group differences. Sixteen
participants from ten projects participated enthusiastic
ally in a workshop on community health and develop• ment from April 11 to 16.
Lathyrism
Participants in a seminar on Kesari dal held at
Nagod, Satna district on May 6 and 7 came to the
conclusion that the use of this dal was not merely a
health issue but was tied up with the socio-economic
and political situation in the Bhundelkhand and
Chattisgarh area where the production was highest.
rights, agriculture, health and is meant for rural people.
Subscription of Rs. 24/- per year may be sent to
Damru Prakashan Pvt. Ltd, 107 Shrinagar Colony,
Indore, M.P. 45 2001.
New Delhi
MEMORANDUM SUBMITTED
The Voluntary Health Association of India, together
with the All India Women's Conference, recently spon
sored a seminar to study the Government's statement
on the National Health Policy, which was tabled in
Parliament during its winter session in 1982. A
memorandum submitted to the Prime Minister urged
that the government should treat the non-governmental
organisations as a valuable partner in the national
effoit to provide health for all by the year 2000 A.D.
In order to achieve a mutually satisfactory partnership,
it was suggested that a joint consultative machinery
be set up at the central as well as the state levels and
regular meetings scheduled to review programmes
consider problems of implementation and otherwise
facilitate cooperation between the official machinery
and the voluntary sector.
There were 110 participants from all over the
country represanting 46 voluntary organisations and
institutions.
AIDS (Acquired Immune Deficiency syndrome)
may invade India
A mystery disease caused by US experiments to
develop new and dangerous biological weapons.
Plans are being hatched to transfer the experiments in
developing countries, some experts believe Pakistan
may become the next proving ground. If this happens
there will be a real danger that AIDS may rapidly
spread in India. WHO says that AIDS may soon
become problem number one I So far there are no
effective cures to fight it. AIDS is caused (or so
scientists suspects) by a new highly pathogenic virus
which ravages the immune system of a human being
by making him practically defenceless against any
infection and in most cases leads to death.
Damru
Samyik Damru : This is a fortnightly Hindi poster
magazine from Indore. It includes information on legal
22
—Patriot 15-7-'83
HEALTH FOR THE MILLIONS/JUNE 1983
Vol. IX
A
No. 4
Health
and
the
Meaning
of
Life
II
Bimonthly
of
the
Voluntary
Health
Association
of
India
AUGUST 1983
SR. CELINE P. AND
SR. CAROL HUSS
Meaning and
Cancer
J3.XrV33L',JBCDWHBKZBaiOSlMVJr
Most scientists consider the terms "will to live"
and "consciousness" as unscientific abstractions.
Physicians prefer the term '“the natural course of the
disease". That there is more to the will to live, ima
gery and consciousness than that meets the eyeballs,
is brought out lucidly in the following article. This is
a report of a holistic approach to the treatment of
cancer (first reported in J-CMAl, March '82)
Two groups of cancer patients followed a 12
session (2 hours each') course on stress reduction and
positive imagery which included such things as art
therapy, music therapy, Yoga and dream techniques.
The method followed the work of the Simontons, Dr.
O. Carl Simonton, a radiation oncologist in Fort
Worth, Texas and his wife Stephanie Mathews—
Simonton (Transactional Analyst), who first started
.using positive imagery techniques in the treatment of
cancer patients in 1969. The therapy, individual or
group, is geared to allow the patient to see how he
can actively participate in his return to health. The
Causes of Cancer
Cancer seems to involve breakdown of one of
the body's most vital functions, the immune response.
Many scientists have investigated the role of stress in
tumor incident (see bibliography). It is known that
prolonged stress tends to weaken the immune system
and produce increased susceptibility to viral as well as
other infections. It is also known that during a pro
longed stress reaction the number of T-lymphocytes
and Eosinophil cells in the blood drops off markedly.
Since the function of these cells is to seek out and
destroy foreign antigens, their reduction in numbers
24
Simontons combine standard medical procedures
with a programme of psychotherapy, meditation,
techniques of visual imagery and relaxation, designed
to counteract the stress resulting from the diagnosis of
malignancy.
This paper describes the work done by a VHAI and
Medical Mission Sisters team consisting of Carol
Huss, Mira Shiva, Penu Khanna and Celine P. with an
internal team of the Cancer Research Unit of Ruby
Hall Clinic, Pune, from Oct. 1980. The patients are
still being followed up. The work is the first of its kind
in India and is significant in that it was done in
Marathi and for poor patients receiving free Cobalt
therapy at the clinic. Several of these patients were
illiterate. The implications of the work in the manage
ment of other stress-related diseases such as TB,
leprosy, coronary disease, and asthma makes it an
important work for further extension and applications
of the technique.
during stress may increase vulnerability to cancer. The
work of George F. Solomon has contributed greatly to
the body of information connecting stress and cancer.
He has focused on the concept of immunological
balance as a key factor in the onset of both cancer and
arthritis. There is a complex relationship between hor
mone levels, psychological stress, and susceptibility
to cancer. If psycho-social stress factors, acting upon
the immune system, can induce cancer, then there is
the further possibility that this negative process can be
reversed and immunity stabilized. Dr. 0. Carl Simonton
teaches patients that they can mentally influence their
body's immune system and bring self-healing.
HEALTH FOR THE MILLIONS/AUGUST 1983
Modern cancer investigators believe that everyone
carries the cancer potential within him, that it is
simply a matter of whether you die of something else
before you die of cancer. This approach raises the
question of why the dormant pre-cancerous state
remains dormant in many, whereas in others it changes
early and rapidly. Predisposition to cancer and all
psychosomatic disorders is based upon a develop
mental process involving multiple psycho-social and
neurophysiological influences. This multiplicity of
interacting factors is in itself a convincing argument
that an integrated approch to cancer needs to be
adopted.
Management of Cancer Patients
The psychological model of cancer regression
shows the area of action by radiation, surgery and
chemotherapy. These act by decreasing the Malignant
Cells. Immunotherapy acts by improving the host
resistance by enhancing the immune mechanism.
Presence of positive attitudes and behaviours was
found to have remarkably good effect as shown by
studies conducted by Simontons in cancer manage
ment.
The Simontons have developed an entirely new
approach, using positive mental imagery, relaxation,
goal setting, managing pain, exercising and building
an 'emotional support system' which not only enhances
patient's chances for recovery but also substantially
improves the qualify of life and helps the family
handle the situation more easily. Simonton studied
2 5 per cent of patients with metastatic cancer who
had had unexpectedly good response to treatment to
see if he could find a common denominator which
might explain their recoveries.
The common single factor was one of attitude.
There was an extraordinarily high correlation between
this response to treatment and positive attitudes, both
to disease, and response to life in a more general
sense.
Prospects of changing patients' attitudes however
were not promising, especially .with people already
severely depressed and overwhelmed by the disease.
Simonton began experimenting with autogenics and
bio-feedback.
Dealing with stress altering behaviour by autogenic
training, and visualisation came to be the mainstay of
this psychological intervention. This has its effects
on the limbic system and helps in cancer regression by
effecting neural and endocrinal pathways.
••X
HEALTH FOR THE MILLIONs/aUGUST
i ••
1983
Meditative and visualisation techniques are noninvasive and have no side effects and are an important
part of a holistic approach to cancer treatment used in
adjunct to traditional treatment and not as a substitute.
See Appendix 1 for the Mental Imagery Exercise.
Mental imagery is a method for self-direction.
Autogenic training and relaxation
This involves simplified form of autogenic relaxa
tion with focus on breathing, and then psychological
relaxation. Visualisation involves
--Visualisation of a beautiful natural scene
—Visualisation of the illness
— Patient visualises his particular formal treatment
—Bullets as Chemotherapy
—Melting wax as Poisoning cancer cells
—Visualising army of WBC fighting and carrying
dead cancer cells
—Visualising Cancer as shrinking and responding
in a positive manner to treatment.
—Visualisation of pain in the same way, confront
ing it and focusing energy on its alleviation—just as a
magnifying glass can converge' sun's rays and burn a
piece of paper so too can psychic energy deal with
cancer if focused.
Through this approach, patients become profound
ly in touch with their entire psycho-physiology and
with the disease process itself and are thereby able to
exert some influence over it.
Applying stress alleviation techniques as an adjunct
to cancer therapy is one of the most outstanding
examples in current medicine of mobilizing the patients
volition in the healing process.
Looking for a Change
Young Doctor
A bright Catholic young doctor, M.B.B.S., D.C.H.,
having a strong character with specialisation in
paediatrics and experience of serving at Mission
Hospital, is seeking an attachment in some hospital.
Any organisation willing to offer him a chance please
correspond with the address given below, furnishing
full details, regarding pay, accomodation, allowances
and other facilities : Dr. Victor Salvator, M.B.B.S.,
C.H.,
D.
Christian Quarters, Church Road, West
Champaran, Bihar-845438.
15
How the Study Began
We had been reading a lot about the use of
Guided Imagery in the treatment of cancer. Over the
last 60 years research has been going on in the U.S.A.,
on this work and many books and articles are
available.
We wanted to try it somewhere in India and since
we are staying in Pune, we decided that would be
the best place. After visiting several hospitals and
either not finding them suitable or they not being
interested, we were finally referred to the Cancer
Research Unit at Ruby Hall Nursing Home. Here we
found the Psychiatrist and the head of the Cancer
Research Unit keenly interested and willing to co
operate with us in any way. We met Dr. Mrs Roshan
Mastersand Dr. Mrs. Mehta, in October, 1980 to
discuss our idea of a small group of poor cancer pati
ents with whom we could try out the Simontons'
method. They were quite interested and willing to
co operate. Dr Masters, who is the President of the
Indian Psychiatric Association, was somewhat skepti
cal of the outcome, but agreed to help by collecting
bio-psychological histories—looking at stresses in
childhood and five years prior to the onset of cancer
(see Appendix 2).
4. To see whether we could do it for illiterates and
in other languages.
5. To train and place persons in hospitals to carry
on the work.
6. To show that research can be done by others
who have very little resources.
The place we chose for the sessions was the
Doctors' conference room. On the first day we had
eleven patients and their attendants. They were very
apprehensive, intensely worried people suffering from
cancer of different parts of the body. Some of them
didn't have any relatives with them. The patients
formed a mixed group —men and women of different
religions and different ages. The oldest was 68 years
old, and the youngest was a 27-year old mother of
three small children whose husband had deserted her.
The majority of them belonged to an economically
weak strata of society. Hardly anyone knew English,
and some of them knew only Marathi. These patients
came, hoping that what we had to offer, might help
them fight their disease.
We began with an introduction of ourselves and
the programme. We explained that in these six weeks
Drs. Masters and Mehta were very helpful and we would help them to bring about a change in their
came with us to show us the places available in the attitude towards their disease; and help in building
hospital for our use. Next day we sent our criteria to supportive and helpful relationsh;ps in the group. In a
select patients: fluent in English, or fluent in Hindi
supportive atmosphere they would be able to talk
and could understand English, prefer younger patients about their worries and troubles and find new ways of
who are self-responsible, educated, open-minded, coping with stress. We stressed the point that this
flexible to try out new belief systems, able to explore programme would not necessarily result in the dis
problems, willing to look at death with a different appearance of their disease. We don't try to keep
outlook, willing, to participate in their cure, and willing people alive, we help them find the meaning of their
to come regularly for the sessions. Three days before illness, then they decide on whether to live or die We
we were supposed to start sessions, we received a then asked them to talk about themselves. They came
telephone call from Ruby Hall saying they can't find out with hesitation, most of them spoke in low voices.
even one patient with the above criteria. Then we told For many it was the first time sharing like this in a
them to choose those who are willing to come; with strange group. Their anxiety and worry was evident.
difficulty they recruited 12 patients for us. All had bad Some of them broke into tears when they faced the
surgery elsewhere and were getting Cobalt Therapy questions of 'attitude towards their disease'. 'What can
daily at Ruby Hall.
I hope for, I know what cancer does'. We listened
silently
with feeling. Though the sharing was painful,
Our objectives were :
they looked much relieved and less apprehensive, they
1. To see whether the Simontons'work is appli could say good-bye with smiles.
cable in India.
Before ending the first session we discussed their
2. To build up a caring community of patients and
commitment
to the programme. We asked them to
families.
bring a relative or friend with them so that the support
3. To encourage patients to take responsibility for and the continuity would be ensured at home, during
their own health and healing.
the week, and even after the six weeks.
26
HEALTH FOR THE MILLIONs/aUGUST
1983
We proceeded with the next session. The doctor
on our team, Mira Shiva, explained in simple Hindi,
how cancer is caused and how our immune system
can fight against it. It was a hard job to make them
understand, as they all were ignorant of any of these
terms, except one person, and she helped us to trans
late Hindi into Marathi. Using a number of attractively
sketched visual aids, Mira Shiva told them about
WBCs and RBCs and the immune system. She further
went on to explain how stress negatively affects this
protective mechanism of the body. The group was
keenly interested and thoroughly taken up by the
drawings.
They came out with moderate or high scores on
these tests.
Then, seeing the stressors in their lives we worked
with them on how to manage stress. We found that
many could take charge of their lives and solve their
problems. They saw they could meet their needs by
life-affirming behaviour. They set goals which were
achievable and gave meaning to their life. They also
learned how to forgive and let go of resentments.
Many of these hurts stem from childhood experiences
and through healing of memories they could forgive
and forget.
Review of Studies
After explaining this, we went on to do relaxation
exercises. Each one took up the savasana pose and
relaxed deeply and with soft music in the background.
We led them into an experience of guided imagery.
We told them to picture their WBCs as the guardians
of their body and to imagine the cancer cells as weak
cells, ineffective creatures. Then we asked them to
imagine that the WBCs are at war with the cancer cells
and are winning. The weak cancer cells were slowly
dying and decreasing in number. Slowly this realisation
dawned on them, that it is their mind that gives orders
to their army of WBCs, the guardians of their body.
The meaning of the exercise was now understood, and
they saw the relevance of positive imagery. They also
understood the need to avoid negative thoughts and
feeling of resentment, frustration, anger and sadness.
They just got in touch with their own power to heal.
We asked them to do this experience three times a day
at home and asked the person accompanying them to
lead the patients into it. In our subsequent meetings,
we introduced some-simple yoga exercise. They liked
it as a few of them were familiar with it and all of
them had heard of yoga.
We helped the patients f.ll up questionnaires on
stress. These stress questionnaires covered the follow
ing topics:
A.
Life-Change Index and Adaptation
B.
Frustration
C.
Overload: Psychosocial Causes of Stress.
D
Deprivation: Boredom and loneliness.
E. Patterns of Behaviour: Personality causes of
stress.
F.
Anxious Reactive Personality.
G.
Self Perception.
HEALTH FOR THE MILLIONs/aUGUST
1983
One of the first observations we came upon was
that the rate of heart disease and cancer have both
paralleled the degree of industrialisation in a society.
The incidences of heart disease and cancer have both
increased dramatically as life has become more
affluent, more sedentary (decreasing the amount of
physical exertion) and much more stressful.
In 1921 when I. Silvertsen and A.W. Dahlstrom
analysed the case histories of 86,000 deaths, they dis
covered that death rates from cancer were highest
among those having occupations involving the least
muscular effort and lowest among those having
oscupations involving the greatest muscular effort.
In 1938, Silvertsen found that the incidence of
cancer in a strain of cancer-prone mice was reduced
to 16 per cent by a programme of restricted caloric
intake and daily exercise. Mice in the control group,
which had unrestricted diets and little exercise, had a
cancer rate of 88 per cent.
In one ingenious study reported in 1960, S. Hoffman
and K. Paschkis took an extract from fatigued (exer
cised) muscle tissue of mice and injected it into mice
in which they had also transplanted cancerous cells.
They discovered that the muscle tissue extract led to
decreased tumour growth and, in a few cases, to dis
appearance of malignancy. An injection of extract
from non-fatigued muscle had no effect.
The work of Dr Hans Sclye and other stress resear
chers suggests that the correspondence between
exercise and reduced incidence of cancer may be
related to the appropriate channelling of stress.
These findings, coupled with the information from
other animal experiments that vigorous exercise tends
to stimulate the immune system, indicate that regular
physical exercise is one of the best tools for appro
priately channelling the physiological effects of stress.
27
and may also stimulate the body's natural defences to
do battle with malignancy.
Exercise has more than physical benefits; it can
produce significant psychological changes as well.
They tend to have an increased sense of self-sufficiency,
a strengthened self-concept, improved self-acceptance,
less tendency to blame others, and less depression.
Regular exercise contributes to postive persona
lity changes in other important ways. Setting aside
the time for regular exercise requires taking firm
control of your daily schedule. Taking charge of our
schedule will give you the feeling of being in charge
of your life. The assertive attitude helps create the
emotional climate conducive to recovering from your
disease.
big hen. We asked her why, she didn't say anything.
We were a bit anxious and then when we enquired
we found out that time she had some discharge from
the vagina (vaginitis) and was upset, thinking that
she is getting cancer again. We had them draw the
mental images three different times and each time
they were improving their perception of getting well
again. One of the patients wrote on his last drawing:
'Cancer has disappeared and I am well now,' and his
doctor confirmed it.
The group found value from doing Positive Mental
Imagery regularly 15 minutes three times a day. They
saw that what we taught them was true :
1.
The CA cells are weak and confused.
2.
The treatment is strong and powerful.
Finally, exercise teaches you to pay attention to
your body's needs. The feeling of vitality and health
that you get from regular exercise helps you see your
body as a friend, a source of pleasure, something
deserving of your care and attention. Asserting your
needs through a programme of regular exercise is a
way of saying that you are important.
3. The healthy cells have no difficulty in repairing
any slight damage the treatment might do.
Our Exercise Prescription
6. The dead CA cells are flushed from the body
normally and naturally.
We ask all patients to begin a programme consisting
of one hour of exercise three times a week. Please
note that the one-hour time frame is impoitant.
Studies suggest that shorter exercise periods do not
produce beneficial effects as consistently.
In the next session, one of the patients asked us
to start the session with a prayer. Everyone in the
group (we had a Muslim, seven Hindus and three
Christians) welcomed this. Henceforth a bhajan or a
prayer was an integral part of each meeting. They also
asked whether they could meet every day instead of
twice a week. We were happy to do it daily, we were
very happy to see their initiative and interest.
At the next meeting, we supplied them with
crayons and asked them to draw their perceptions of
their own WBCs. and cancer cells—some of the Ruby
Hall staff were skeptical about these illiterate people
drawing the images. We were thrilled to see their
drawings. It really gave a picture of their understand
ing, and to know where they are in their illness—how
positive they are. For example, one illiterate woman
who had probably never held a pen in her hand, drew
purple vultures which signified her WBCs. and small
chicks as her cancer cells. When she drew her imagery
a second time, we noticed there was a vulture and
28
4. The army of white blood cells is vast and
overwhelms the CA cells.
5. The WBC's are aggressive, eager for battle,
quick to seek out the CA cells and destroy them.
7. By the end of the imagery, you are healthy and
free of CA.
8. You see yourself reaching your goals in life,
fulfilling your life's purpose.
For a list of topics covered in the twelve occasion,
see Appendix 3.
Dreams and their Meaning
We had some profitable sessions on the meaning
of dreams. The group enjoyed sharing their dreams:
Some interesting things they learned are:
1. Dreams are more often about death. When
the pain level is high, they see themselves as helpless
and vulnerable.
2. Dreams are more often about personality
growth when the pain level is low, they tell you what
to focus on, deal with anger, need for comfort and
support, etc.
3. Dreams pay spacial attention to the emotional
content, especially what is suppressed.
4. Dreams can provide sources of identity, a new
part of the self.
HEALTH FOR THE MILLIONS/aUGUST
1983
(a)
How cancer is caused
(b)
Yoga
Dreams help people prepare for death.
(c)
Biogenic exercises
One of our patients dreamed that he was going for
a walk with his two small children. The youngest
was two years old and was very sick, so he was
carrying him. As he approaches a big bridge, he sees
his wife coming and he waves at her to come and
take the child to a doctor. Here the dream ends. As
he analysed the dream, the meaning became clear, he
was wanting to give over all the responsibilities of the
house and family to h:s wife and cross the bridge to
eternal life. He decided not to do this, but to fight his
disease and bring up his children himself. We then
prayed with him for an increase of his self-healing
powers, linked with God's power. He strengthened
his imagery and is presently frea of disease.
(d)
Mental imagery
(e)
Art imagery
5. Dreams offer information to make decisions
regarding treatment.
6.
By the twelfth session the group which had come
together on the first meeting were now a family. They
mutually helped and supported each other. They were
changed persons. We felt, the oneness very much. The
gloomy faces became bright and smiling. Susheela
who cried on the first day was a changed person. She
showed herself to be a woman of courage and hope.
She offered to be a resource person in any future
work with similar groups of cancer patients. Their
evaluation of our programme encouraged us very
much in this venture.
At the end of the 12 sessions the patients and
relatives answered the following questions.
Evaluation Questions
1.
What did I like about this course?
2.
What did I dislike about it ?
3.
Wnat did I learn from all that was spared?
4. What difference do I find in myself after this
course?
5.
What difference have others noted in me?
6. What more would I have liked, or what would
I like different?
7. Did I think this would be worthwhile for other
cancer patients too?
8.
What are my expectations from the team?
9. If I would like to meet again with the group?
When?
10.
Rating of the topics:
health for the millions/august
1983
(/) Strokes
(g) Ego strokes
(/?) Stress questionnaire
(/) Dream analysis
(/) Meditation, music, bhajans.
The results were tabulated and all were highly
positive about the benefits of the course. They wanted
all cancer patients to have this opportunity.
What the
team was:
patients appreciated
most about our
1. Our humanness, they kept remarking that love
and support are far more important than professional
knowledge.
2.
Our willingness to look at death.
3.
The deep personal level of sharing.
4.
That we were one with them.
5. We helped them
in life.
find
a
personal
meaning
We decided to meet them periodically according to
their request. We also ventured to take a second group
of cancer patients. This time also the type of patients
were the same.
In the second group, we couldn't meet daily as we
were only one regular person and two helpers—one
was a student and she couldn't spare more than two
sessions a week. This group we started on the 2nd
Jan. 1981. We had a guest speaker from the first
cancer group. He shared what it meant to him to
attend these sessions and how it has helped him. He
stressed the love and generosity of the team. The
group was very happy to know all the wonderful
things he was sharing. Our programme went on in the
same manner as for the first group. In this group the
drop outs were more, because of the long duration and
many other reasons. After they finished their cobalt
therapy, many left. Our drop out rate in both groups
was as high as in the Simontons' studies, but for
different reasons. Some are listed below:
1. Long distance to travel, tiring to wait just aftet
Cobalt treatment.
29
2. Room was cold (air conditioned), older patients
1. List the five or more most important benefits
had no warm clothes.
you received from a major illness in your life.
3.
Buses were hard to get, late coming.
4.
Too sick to attend.
2. Now review your list, consider what underlying
needs were met by your illness.
3. Next identify the rules or beliefs that limit
5. Language problem, only one member of our team
you
from meeting each of these needs when /ou are
was fluent in Marathi.
well.
In our evaluation, we considered three aspects :
4. See alternative ways of reviewing situations.
1. The reports from the doctors treating the
patients.
5. Educate yourself to recognise your needs and
2.
The patient's own assessment.
set up opportunities to satisfy them.
There were answers without hesitation such as: I
came closer to God, I noticed people, my family and
Our study confirmed the findings that cancer pati relations love me, my wife and children can run the
ents have the following personality characteristics:
house, I could see the town—could come out of the
house, otherwise, as a woman I couldn't, I could see
1. Tendency to hold resentments, and a marked
who really loved me, also noticed that people, when I
inability to forgive.
was thinking are my enemies, are not enemies, etc.
3.
The team’s assessment.
2.
A tendency to self-pity.
We had the 3rd follow-up programme on June 27,
3. A poor ability to develop and maintain meaning 1981. Before we met the group, we got the news of
the youngest patient who took her life away by hang
ful, long-term relationships.
ing herself. She had stopped coming to us after the
4. A poor self-image.
ninth session saying that she has no leave from the
nursing school. We shared our feelings with the group
5. Limited capacity to cope with life.
and it was an opportunity for us to talk about the five
6. Problems in sexual adjustment.
stages of accepting death, and how we can face it
well
or badly. We also had a meditation focusing
7. Often put everyone else's needs first.
attention on a picture and shared insights.
We found that a positive attitude toward life and
treatment is a better indicator and predictor of response
Patients who followed till this time are very happy
to treatment that is the severity of the disease.
and the medical check up showed no sign of cancer.
The faithful followers, who missed no sessions are
Follow-up
only four. One day we went with the patients to visit
their homes. The visit to the houses helped us under
Our first follow-up meeting was held on Decem
stand their problems more clearly. One of the patients
ber 8, 1980. At this meeting, we did a stress question
was saying that he couldn't do meditation, Yoga,
naire and Colour Test of personality. The group enjoy
imagery, etc., at home. When we went, we realised—
ed being together again and sharing their progress.
he has only one small room—there are two cots and
The second follow-up was held on March 15 one side is the cooking, working area. It is in the
and 16, 1981, at Bibwewadi. We had the patients middle of the city. He has a grown-up son and
from both groups and they felt very much at home. daughter—now both are married. It was hard for him
When they come for follow-up, we had them report in that situation to do the exercises. But he told us
how far are they in their homework, what are the pro slowly he made his son and daughter do exercise with
blems they faced, etc. Then we let them do the exer him. The same patient was an encouragement for us
cises themselves, to see whether they are following all through our programme. When he came to us he
them correctly or not. Then we took up problems faced had hoarseness of voice and was upset because of the
by individuals. Our group problem-solving sessions death of his wife with cancer of the pharynx. Now he
helped them answer the following questions to find is able to speak normally, and has no sign of cancer.
the "Benefits' of their cancer :
This group will be followed up once more this year.
30
HEALTH FOR THE MILLIONs/aUGUST
1983
Results and Future Directions
10.
Kavetsky, R.E., Turkevich, N.M., and Balitsky, K.P. : 'On the
psychophysiological mechanism of the organism's resistance to tumor
The results of this study are encouraging. If it
works with Cancer, it can be applied to other stress
related diseases also. At present, studies are under
way in Leprosy and TB. We will have to await the
results before we can draw any conclusions. Ruby
Hall plans to apply for an ICMR grant to train person
nel to continue this work not only for cancer patients,
but for others as well.
growth.' Annals of the New York Academy
933-45.
11.
Klopfer,
B. :
'Psychological
of Sciences, 1966, 125,
variables
in
human cancer'.
Journal of Projective Techniques. 1957, 21, 331
*40.
12.
LaBarba, R.C. : 'Experimental and environmental factors in
cancer'. Psychosomatic Medicine, 1970, 32, 259.
13. LeShan, L.L. : 'A Psychosomatic hypothesis concerning the
etiology of Hodgkin's disease'. Psychologic Report,
1957, 3,
365-75.
Illness can be a very creative experience—a poten
tial source of regeneration and renewal. Our patients
found it so. They found that affirmative attitudes help
ed them deal with their pathology. They began to view
their illness not as a punishment for wrong doing or
wrong-being, but rather an opportunity to grow and
become more than they were, to open new vistas of
possibility. They became 'able to respond' right now,
in the present. So we offer this study as a small
experiment in helping people learn to live until
they die.
14,—: 'An Emotional life history pattern associated with neo
plastic disease'. Annals of the New York Academy of Sciences, 1966,
125, 780-93.
15. LeShan, L.L., and Bassman, M. : Some observations on psy
chotherapy with patients with neoplastic disease'. American Journal
of Psychotherapy, 1958, 12, 723-34.
16.
Luscher, May Dt. : Color Test, Pocket Books 1971.
17. Pendergras, E. : 'Host resistance and other intangibles in the
treatment of cancer'. American Journal of Roentgenology. 1961, 85,
891-96.
18. Pelletier, K.R. : Mind as
Delta, 1977.
healer, mind as slayer, New York:
19.—: Holistic Medicine : from
acorte Press, 1979).
Bibliography
Stress to Optimal Health. (Del-
1. Achterberg, J., Simonton, O.C., and Simonton, S. : Stress,
20. Prehn, R.T. : 'The relationship of immunology to carcino
Psychological Factors, and Cancer Fort Worth: New Medicine Press, genesis'. Annals of the New York Academy of Sciences, 1969, 164,
1676.
449-57.
2. Bacon, C.L., Renneker, R. and Cutler. M.: 'Psychosomatic
21. Schmale, A.H. : 'Hopelessness as a predictor of cervical
Survey of Cancer of the Breast', Psychosomatic Medicine, 1952, 6,
cancer.—Social Science and Medicine, 1871, 5, 95-100.
453-460 :
22. Simonton, Carl, and Simonton, Stephanie Mathews-Gett/n^
3. Barrios A. Alfred, Ph. D., and Kroger S. William, M.P.: Well Again, J.P. Tarcher Inc. Los Angeles, 1978.
Psychological Variables and
Immunological Response—a new
23.—: 'Belief systems and management of the emotional aspects
approach in the tteatment of Cancer'. Journal ot Holistic Health,
of malignancy'. Journal of Transpersonal Psychology, 1975,7 (1),
Vol. 2, 1978.
29-47.
4. Blumberg, E M. : 'Results of psychological testing of cancer
patients'. In J.A. Gengerelli and F.J. Kirkner (Eds.), Psychological
Variables in Human Cancer, Berkeley and Los Angeles: University of
California Press, 1954, 30-61.
5. Brown, B. : New mind new body. New York : Harper and Row,
1975. Brown, F.'The relationship between cancer and personality’,
Annals of the New York Academy of Sciences 1966, 125, 865-73.
6. Evans,
E. A. : Psychological
study of cancer. New York ;
Dodd, Mead and Company, 1926.
24.
Smart, A. : 'Conscious control of physical and mental states.'
Menninger Perspective, April-May 1970.
25- Shealy, C. Norman :
fornia 1976).
The Pain Game (Eklestian Arts, Cali
26.—: 90 Days to Self Help :
York.
Biogenics Dial Press, 1977, New
27. Solomon, G.F., and Amkraut, A. A. : Emotions, stress, and
immunity.—Frontiers of Radiation Therapy and Oncology. 1972, 7,
84-96.
7. Greene, W.A. : 'The psycho-social setting of the development
28. Thomas, C.B., and Duszynski, D.R. 'Closeness to parents and
of leukemia and lymphoma'. Annals of the New York Academy of
the family constellation in a prospective study of five disease states:
Sciences, 1966, 125, 794-801.
Suicide, mental illness, malignant tumor, hypertension, and coronary
heart
*.
disease
The Johns Hopkins Medical Journal, 1974, 134,
8. Holmes, T.H., and Masuda, M. : 'Life change and illness
susceptibility'. Paper presented as part of Symposium on Separation
251-70.
and Depression: Clinical and Research Aspects, Chicago, December
1970.
9.
Hutschnecker, A.A. : The Will
Crowell Company, 1953.
to
29. Virshup, Evelyn: Right Brain People in a Left Brain World,
Wheeler, J.I., Jr., and Caldwell, B. M. : Psychological evaluation of
live. New York: Thomas Y. women with cancer of the breast and of the cervix'. — Psychosomatic
Medicine 1955, 17 (4), 256-68.
HEALTH FOR THE MILLIONs/AUGUST 1983
31
Appendix /
The Mental Imagery Process
In this section, we will lead you through the relaxation/mental imagery process, repeating the pre
vious instructions for relaxation.
You may want to tape-record instructions, or have
a friend read them to you. If you are reading to some
one else, be sure to read slowly. Allow the other
person plenty of time of complete each step. Remem
ber that we encourage our patients to take ten to fifteen
minutes to complete the entire process and to practice
it three times a day.
Even if you do not have cancer, we ask you to
go through the cancer visualization once to give you
an emotional understanding of this process and insight
into how the cancer patient feels.
1. Go to a quiet room with soft lighting. Shut
the door, sit in a comfortable chair, feet flat on the
floor, eyes closed.
2.
Become aware of your breathing.
3. Take in a few deep breaths, and as you let out
each breath, mentally say the word, 'relax.'
4. Concentrate on your face and feel any tension in
the muscles of your face and around your eyes. Make
a mental picture ol this tension—it might be a rope tied
in a knot or a clenched fist—and then mentally picture
it relaxing and becoming comfortable, like a limp
rubber band.
5. Experience the muscles of your face and eyes
becoming relaxed. As they relax, feel a wave of
relaxation spreading through your body.
6. Tense the muscles of your face and around
your eyes, squeezing tightly, then relax them and feel
the relaxation spreading through your body.
7. Move slowly down your body, —jaw, neck,
shoulders, back, upper and lower arms, hands, chest,
abdomen, thighs, calves, ankles, feet—until every part
of your body is more relaxed. For each pait of the
body, mentally picture the tension, then picture the
tension melting away, allowing relaxation.
8. Now picture yourself in pleasant, natural
surroundings—wherever feels comfortable for you.
Mentally fill in the details of color, sound, texture.
9. Continue to picture yourself in a very relaxed
state in this natural place for two to three minutes.
32
10. Then mentally picture the cancer in either
realistic or symbolic terms Think of the cancer as
consisting of very weak, confused cells. Remember
that our bodies destroy cancerous cells thousands of
times during a normal lifetime. As you picture your
cancer, realize that your recovery requires that your
body's own defences return to a natural, healthy
state.
11. If you are now receiving treatment, picture
your treatment coming into your body in a way that
you understand. If you are receiving radiation treat
ment, picture it as a beam of millions of bullets of
energy litting any celis in its path. The normal cells
are able to repair any damage that is done, but the
cancerous cells cannot because they are weak. (This
is one of the basic facts upon which radiation therapy
is built.) If you are receiving chemotherapy, picture
that drug coming into your body and entering the
blood-stream. Picture the drug acting like a poison.
The normal cells a.-e intelligent ard strong and don'f
take up the poison so readily. But the cancer cell is
a weak cell so it takes very little to kill it. It absorbs
the po:son, dies, and is flushed out of your body.
12. Picture your body's own white blood cells
coming into the area where the cancer is, recognizing
the abnormal cells and destroying them. There is a
vast army of white blood cells. They are very strong
and aggressive. They are also very smart. There is
no contest between them and the cancer cells; they
will win the battle.
13. Picture the cancer shrinking. See the dead
cells being carried away by the white blood cells and
being flushed from your body through the liver and
kidneys and eliminated in the urine and stool.
* This is your expectancy of what you want to
happen.
* Continue to see the cancer shrinking, until it is
all gone.
* See yourself having more energy and a better
appetite and being able to feel comfortable and loved
in your family as the cancer shrinks and finally dis
appears.
14. If yo J are experiencing pein anywhere in your
body, picture the army of white blood cells flowing
into that area and soothing the pain. Whatever the
problem, give your body the command to heal itself.
Visualize your body becoming well.
HEALTH FOR THE MILLIONs/aUGUST 1983
15. Imagine yourself well, free of disease, full of
energy.
2.
Become aware of your breathing.
3. Take in a few deep breaths, and as you let out
16. Picture yourself reaching your goals in life. each breath, mentally say the word, 'relax'.
See your purpose in life being fulfilled, the members
4. Concentrate on your face and feel any tension
of your family doing well, your relationships with
in your face and eyes. Make a mental picture of this
people around you becoming more meaningful. Re
tension—it might be a rope tied in a knot or a clen
member that having strong reasons for being well will
ched fist—and then mentally picture it relaxing and
help you get well, so use this time to focus clearly on
becoming comfortable, like a limp rubber band.
your priorities in life.
5. Experience your face and eyes becoming relax
17. Give yourself a mental pat on the back for
ed.
As they relax, feel a wave of relaxation spreading
participating in your recovery. See yourself doing this
through
body.
mental imagery exercise three times a day, staying
6. Tense your eyes and face, squeezing tighly,
awake and alert as you do it.
18. Then let the muscles in your eyelids tighten then relax them and feel the relaxation spreading
up, become ready to open your eyes, and become throughout your body.
aware of the room.
7. Apply the previous instructions to other parts of
19. Now let your eyes open, and you are ready to your body. Move slowly down your body—jaw, neck,
shoulders, back upper and lower arms, hands, chest;
resume your usual activities.
abdomen, thighs, calves, ankles, feet, toes—until every
If you have not done so already, please take the part of your body is relaxed. For each part of the body,
time now to go through this mental imagery process.
mentally picture the tension, then picture the tension
When you have completed the entire exercise, draw a
melting away; tense the area, then relax it.
picture illustrating the images you created, so that you
8. When you have relaxed each part of the body
can analyse your imagery in more detail.
rest quietly in this comfortable state for two to five
The Relaxation Technique
minutes.
The relaxation techniques we developed while
9. Then let the muscles in your eyelids lighten up,
working with our patients is taken largely from a pro become ready to open your eyes, and become aware
gram devised by Dr Edmond Jacobson, who calls his of the room.
technique 'progressive relaxation.' In practice, we com
10. Now let your eyes open, and you are ready to
bine this technique with the mental imagery process
go on with your usual activities.
we describe later in this article. However, we have
detailed the relaxation process separately here so that
you will see its value for use anytime. We recommend Appendix 2
to our patients that they complete the combined relaDr. Masters interviewed the patients for stress
xation/mental imagery activity three times a day for levels in childhood and up to five years before the
ten to fifteen minutes each time. Most people feel onset of the cancer.
relaxed the first time they use this technique. But
Her interviews determined:
since relaxation is something that can be learned and
improved upon, you will find that you'll enter into
A. Stress in childhood and now, any significant
emotional loss in the last 5 years.
increasingly relaxed states as the process is repeated.
To make the relaxation/mental imagery process
easier to learn, we provide our patients with a cassette
tape of instructions. You may also find it helpful to
have a friend read the following instructions to you or
to make a tape recording of them. Allow plenty of
time for completing each step in a comfortable, relaxed
manner.
B.
What is their self-image ?
C. Can they develop and maintain meaningful,
long-term relationships ?
D. Anxiety level : any feelings of helplessness,
hopelessness or despair.
Copies of her psychological history were given to
1. Go to a quiet room with soft lighting. Shut the us and these confirmed the fact that the same stressors
door and sit in a comfortable chair feet flat on the were found in our patients, as were found in those
floor, eyes closed.
studied in the U.S.A.
HEALTH FOR THE MILLIONs/AUGUST 1983
33
In childhood, stressors included :
Appendix 3
Tension over ^relationship with one or both Educational Topics Covered in the 12 Sessions
parents, friction.
How to deal with Stress, for patients and their
2. Breakup in the family, loss of a parent.
families ?
3. Inability to express anger.
Life-Planning living together in marriage
4. Poor emotional outlets.
Experiencing loss.
5. Child experienced anxiety, rejection, and lone
Immune System and how it functions.
liness.
1.
6.
No close relationships with parents.
Meditation/Yoga.
7.
More frequent negative fantasy.
Visualization-Guided Imagery.
1.
Significant emotional loss.
Psychosomatic aspects of cancer and other stress
related diseases involving attitudes and Immune
responses.
2.
Marital difficulties.
Dream processing
3.
Adverse events related
stress.
Upto five years before cancer began :
to work,
economic
Biogenics exercises
Transactional analysis
4.
A cluster of stressful life events.
Art therapy
5.
A problem with which the person does not
know how to deal.
Family and financial planning.
RURAL DEVELOPMENT COURSE
RUHSA—offers a 17-week Post-Graduate Certi
ficate Course in Integrated Rural Development (CIRD).
The third session commenced on 16 August 1983.
This is a job oriented residential course.
Music therapy
The candidates must be interested in social wel
fare. Salaries according to qualification and experience.
Application with
complete bio-data and photo
graphs must be sent as soon as possible to ANKURAN,
Gudri Mahalla, Chatra 825401 (Bihar).
Wanted
Looking for a Change
ANKURAN, Self Reliant Health Project in Hazaribagh District (Bihar), would like to complete its staff
members and requires for this :
Social Worker
— One Medical Officer (G.A.M.S.) or B.A.M.S. with
good experience, dynamics, motivated to work in
rural area and interested in traditional medicine.
— One Pharmacist (B. Pharm or M. Pharm) to start
and to run one small-scale pharmaceutical industry
which will produce low-cost drugs from medicinal
herbs and from chemicals in generic name.
34
Mick Small (30) Social Worker for mentally
handicapped and Susan Oates (29) Librarian Coventry
Social Services Department U.K. are seeking a years
meaningful exposure to a field project in India. Both
have practical abilities for creative work etc. painting,
horticultural skills, atheletics, cooking and photo
graphy. Active in human rights movement. Those
interested may write to them at 37, Highland Road,
Earlsdam 1, Covenry United Kingdom.
HEALTH FOR THE MILLIONS/AUGUST 1983
JEAN GIONE
The Man Who Planted Trees
Meaning is not out there. It is within one's self. The following article is a beautiful real story of a person
who found his own meaning—by planting trees. A barren land was changed by the singular vision of
this man—not by fighting his way through, but by his own reticent crusade, the work its own reward.
For a human character to reveal truly exceptional
qualities, one must have the good fortune to be able
to observe its performance over many years. If this
performance is devoid of all egoism, if its guiding
motive is unparalleled generosity, if it is absolutely
certain that there is no thought of recompense and that,
in addition, it has left its visible mark upon the earth,
then there can be no mistake.
About 40 years ago I was taking a long trip on
foot over mountain heights quite unknown to tourists
in that ancient region where the Alps thrust down
into Provence. All this, at the time I embarked upon
my long walk through those deseited regions, was
barren and colourless land. Nothing grew there but
wild lavender.
I was crossing the area at its widest point, and
after three days' walking found myself in the midst
of unparalled desolation. I camped near the vestiges
of an abandoned village. I had run out of water the
day before and had to find some. These clustered
houses, although in ruins, like an old wasps' nest,
suggested that there must once have baen a spring
or well here. There was, indeed, a spring, but it was
dry. The five or six houses, roofless, gnawed by wind
and rain, the tiny chapel with its crumbling steeple,
stood about like the houses and chapels in living
villages, but all life had vanished.
HEALTH FOR THE MILLIONS/aUGUST 1983
It was a fine June day, brilliant with sunlight, but
over this unsheltered land, high in the sky, the wind
blew with unendurable ferocity. It growled over the
carcasses of the houses like a lion disturbed at its
meal. I had to move my camp.
After five hours' walking I had still not found
water and there was nothing to give me any hope of
finding any. All about me was the same dryness, the
same coarse grasses. I thought I glimpsed in the
distance a small black silhouette, upright, and took it
for the trunk of a solitary tree. In any case I started
towards it. It was a shepherd. Thirty sheep were lying
about him on the baking earth.
He gave me a drink from his water-gourd and, a
little later, took me to his cottage in a fold of the
plain. He drew his water-excellent water-from a very
deep natural well above which he had constructed a
primitive winch.
The man spoke little. This is the way of those who
live alone, but one felt that he was sure of himself and
confident in his assurance. That was unexpected in
his assurance. That was unexpected in this barren
country. He lived, not in a cabin, but in a real house
built of stone that bore plain evidence of how his
own efforts had reclaimed the ruin he had found there
on his arrival. His roof was strong and sound. The
wind on its tiles made the sound of the sea upon its
shores.
35
The place was in order, the dishes washed, the
floor swept, his rifle oiled; his soup was boiling over
the fire. I noticed then that he was cleanly shaved,
that all his buttons were firmly sewed on, that his
clothing had been mended with the meticulous care
that makes the mending invisible. He shared his soup
with me and afterwards, when I offered my tobacco
pouch, he told me that he did not smoke. His dog, as
silent as himself, was friendly without being servile.
It was understood from the first that I should
spend the night there; the nearest village was still
more than a day and a half away. And besides I was
perfectly familiar with the nature of the rare villages
in that region. There were four or five of them
scattered well apart from each other on these moun
tain slopes, among white oak thickets, at the extreme
end of the wagon roads. They were inhabited by
charcoal-burners and the living was bad Families,
crowded together in a climate that is excessively harsh
both in winter and in summer found no escape from
the unceasing conflict of personalities. Irrational
ambition reached inordinate proportions in the conti
nual desire for escape. The men took their wagon
loads of charcoal to the town, then returned. The
soundest characters broke under the perpetual grind.
The women nursed their greivances. There was
rivalry in everything, over the price of charcoal as over
a pew in the church. And over all there was the wind,
also ceaseless to rasp upon the nerves. There were
epidemics of suicide and frequent cases of insanity,
usually homicidal.
The shepherd went to fetch a small sack and
poured out a heap of acorns on the table. He began to
inspect them one by one, with great concentration,
separating the good from the bad. I smoked my pipe.
I did offer to help him. He told me that it was his job.
And in fact, seeing the care he devoted to the task, I
did not insist. That was the whole of our conversa
tion. When he had set aside a large enough pile of
good acorns he counted them out by tens, meanwhile
eliminating the small ones or those which were
slightly cracked, for now he examined them more
closely. When he had thus selected one hundred per
fect acorns he stopped and he went to bed.
There was peace in being with this man. The next
day I asked if I might rest here for a day. He found it
quite natural—or to be more exact, he gave me the
impression that nothing could startle him. The rest
was not absolutely necessary, but I was interested and
wished to know more about him. He opened the pen
and led his flocks to pasture. Before leaving, he plung
ed his sack of carefully selected and counted acorns
into a pail of water.
I noticed that he carried for a stick and iron rod as
thick as my thumb and about a yard and a half long.
Resting myself by walking, I followed a path parallel
to his. His pasture was in valley. He left the little
flock incharge of the dog and climbed towards where
I stood. I was afraid that he was about to rebuke me
for my indiscretion, but it was not that at all; this was
the way he was going and he invited me to go
along if I had nothing better to do. He climbed to the
top of the ridge about a hundred yards away.
There he began thrusting his iron rod into the earth,
making a hole in which he planted an acorn; then he
refilled the hole. He was planting an oak tree. I asked
him if the land belonged to him. He answered no.
Did he know whose it was ? He did not. He supposed
it was community property, or perhaps belonged to
people who cared nothing about it. He was not inter
ested in finding out whose it was. He planted his
hundred acrons with the greatest care. After the mid
day meal he resumed his planting. I suppose I must
have been fairly insistent in my questioning, for he
answered me. For three years he had been planting
trees in this wilderness. He had planted 100,000. Of
these, 20,000 had sprouted. Of the 20,000 he still
expected to lose about half to rodents or to the un
predictable designs of Providence. There remained
10,000 oak trees to grow where nothing had grown
before.
That was when I began to wonder about the age
of this man. He was obviously over 50. Fifty-five, he
told me. His name was Elzeard Bouffier. He once
had a farm in the lowlands. There he had had his life.
He had lost his only son, then his wife. He had with
drawn into this solitude, where his pleasure was to
live leisurely with his limbs, and his dog. it was his
opinion that this land was dying for want of trees. He
added that, having no very pressing business of his
own, he had resolved to remedy this state of affairs.
Since I was at that time, in spite of my youth,
leading a solitary life, I understood how to deal gently
with solitary spirits. But my very youth forced me to
consider the future in relation to myself and to a
certain quest for happiness. I told him that in 30 years
his 10,000 oaks would be magnificent. He answered
quite simply that if God granted him life, in 30 years
HEALTH FOR THE MILLIONs/aUGUST 1983
he would have planted so many more that these
10,000 would be like a drop of water in the ocean.
10.000 oaks and more
Besides, he was now studying the reproduction of
beech trees and had a nursery of seedlings grown from
beech-nuts near his cottage. The seedlings which he
protected from his sheep with a wire fence, were very
beautiful. He was also considering birches for the
valleys where, he told me, there was a certain amount
of moisture a few yards below the surface of the
soil
The next day we parted.
The following year came the war ot 1914, in which
I was involved for the next five years. An infantryman
hardly had time for reflecting upon trees. To tell the
truth the thing itself had made no impression upon me;
I had considered it as a hobby, a stamp collection, and
forgotten it.
The war over, I found myself possessed of a tiny
demobilisation bonus and a huge desire to breathe
fresh air for a while. It was with no other objective
that I again took the road to the barren lands.
The countryside had not changed. However, be
yond the deserted village I glimpsed in the distance a
sort of greyish bush that covered the mountaintops
like a carpet. Since the day before, I had begun to
think again of the shepherd tree-planter. "Ten thou
sand oaks," I reflected, "really take up quite a bit of
space." I had seen too many men die during those five
years not to imagine easily that Elzeard Bouffier was
dead, especially since, at 20, one regards men of 50
as old men with nothing left to do but die. He was
not dead. As a matter of fact he was extremely spry.
He had changed jobs. Now he had only four sheep
but, instead, 100 beehives. He had got rid of the sheep
because they threatened his young trees. For, he told
me (and I saw for myself), the war had disturbed him
not at all. He had imperturbably continued to plant.
The oaks of 1970 were then 10 years old and taller
than either of us, it was an impressive spectacle. I
was literally speechless and, as he did not talk, we
spent the whole day walking in silence through his
forest. In three sections, it measured 11 kilometres in
length and three kilometres at its greatest width.
When you remembered that all this had sprung from the
hands and the soul if this one man, without technical
resources, you understand that men could be as
effectual as God in realms other than that of
destruction.
37
He had pursued his plan and beech trees as high
as my shoulder, spreading out as far as the eye could
reach, confirmed it. He showed me handsome clumps
of beech planted five years before-that is, in 1915,
when I had been fighting at Verdun. He hed set them
out in all the velleys where he had guessed—and
rightly—that there was moisture almost at the surface
of the ground. They were as delicate as young girls
and very well established.
Creation seemed to come about in a sort of chain
reaction. He did not worry about it; he was deter
minedly pursuing his task in all its simplicity; but as
we went back towards the village I saw water flowing
in brooks that had been dry since the memory of
man. This was the most impressive result of chain
reaction that I had seen. These dry streams had once,
long ago, run with water. Some of the dreary villages
I mentioned before had been built on the sites of
ancient Roman settlements, traces of which still re
mained; and archaeologists, exploring there, had found
fishhooks where, in the 20th century, cisterns were
needed to assure a small supply of water.
The wind, too, scattered seeds. As the water re
appeared, so there reappeared willows, rushes, mea
dows, gardens, flowers and a certain purpose in being
alive. But the transformation took place so gradually
that it became part of the pattern without causing any
astonishment. Hunters, climbing into the wilderness
in pursuit of hares or wild boar, had a course noticed
the sudden growth or little trees, but had attributed
it to some caprice of the earth. That is why no one
meddled with Elzeard Bouffier's work. If he had been
detected he would have had opposition. He was
undetectable. Who in the village or in the administra
tion could have dreamed of such perseverance in a
magnificent generosity?
plant beeches at a spot some 12 kilometres from his
cottage. In order to avoid travelling back and forth for
he was then 75—he planned to build a stone cabin
right at the plantation. The next year he did so.
In 1 935 a whole delegation came from the Govern
ment to examine the "natural forest”. There was a high
official from the forest service, a deputy, technicians.
There was a great deal of ineffectual talk. It was
decided that something must be done and, fortunately,
nothing was done except the only helpul thing: the
whole forest was placed under the protection of the
State and charcoal burning prohibited. For it was
impossible not to be captivated by the beauty of those
young trees in the fullness of health, and they cast
their spell over the deputy himself.
A friend of mine was among the forestry officers
of the delegation. To him I explained the mystery.
One day the following week we went together to
see Elzeard Bouffier. We found him hard at work,
some 10 ki’ometres from the spot where the inspec
tion had taken place.
This forest was not my friend for nothing. He was
aware of values. He knew how to keep silent. I
delivered the eggs I had brought as a present. We
shared our lunch among the three of us and spent
several hours in wordless contemplation of the
countryside.
The fullness of health
In the direction from which we had come the
slopes were covered with trees 20 to 25 feet all. I
remembered how the land had looked in 1913: a
desert . . . peaceful, regular toil, the vigorous moun
tain air, frugality and above all, serenity in the spirit
had endowed this old man with awe-inspiring health.
He was one of God's athletes. I wondered how many
more acres he was going to cover with trees.
Before leaving my friend simply made a brief
suggestion about certain species of trees that the soil
here seemed particularly suited for. He did not force
the point "for the very good reason,” he told me
later, "that Bouffier knows more about it than I do."
At the end of an hour's walking having turned it over
in his mind—he added, "He knows a lot more about
it than anybody. He's discovered a wonderful way to
be happy!”
In 1933 he received a visit from a forest ranger
who notified him of an order against lighting fires out
of doors for fear of endangering the growth of this
natural forest. It was the first time, the man told him
naively, that he had ever heard of a forest growing of
its own accord. At that time Bouffier was about to
It was thanks to this officer that not only the
forest but also the happiness of the man was pro
tected. He delegated three rangers to the task and so
terrorised them that they remained proof against all
the bottles of wine the charcoal-burners could
offer.
To have anything like a precise idea of this excep
tional character, one must not forget that he worked in
total solitude; so total that, towards the end of his
life, he lost the habit of speech. Or perhaps it was
that he saw no need for it.
38
HEALTH FOR THE MILLIONS/AUGUST 1983
The only serious clanger to the work occurred
during the War of 1939. As cars were being run on
gazogenes (wood-burning generators), there was
never enough wood. Cutting was started among the
oaks of 1910, but the area was so far from any rail
way that the enterprise turned out to be financially
unsound. It was abandoned. The shepherd had seen
nothing of it. He was 30 kilometres away, continuing
his work, ignoring the war of 1939 as he had ignored
that of 1914.
I saw Elzeard Bouffier for the last time in June of
1945. He was then 87. I had started back along the
route through the wastelands; but now, in spite of the
disorder in which the war had left the country, there
was a bus running between the Durance Valley and
the mountain. I attributed the fact that I no longer
recognised the scenes of my earlier journeys to this
relatively speedy transportation. It took the name of a
village to convince me that I was actually in that
region that had been all ruins and desolation.
Condition beyond hope
The bus put me down at Vergons. In 1913 this
hamlet of 10 or 12 houses had three inhabitants. They
had been savage creatures, hating one another, living
by trapping game, little removed, physically# and
morally, from the conditions of prehistoric man. All
about them nettles were feeding upon the remains of
abandoned houses. Their condition had been beyond
hope. For them, nothing but to await death a situation
which rarely predisposes to virtue.
Everything was changed. Even the air. Instead of
the harsh dry winds that used to attack me, a gentle
breeze was blowing, laden with scents. A sound like
water came from the mountains; it was the wind in
HEALTH FOR THE MILLIONS/aUGUST 1983
Contraceptive Vaccine
In ten years the contraceptive vaccine will be
available for man use. ICMR is the modal coordinat
ing agency for the "Immunological approaches to
fertility control" project. The other groups who are
working in this line are AllMS, New Delhi, Drug
Research Institute in Lucknow, Institute of Science,
Bangalore, NIHFW, New Delhi; Institute for Research
in Reproduction, Bombay, and WHO.
— Ti'mes of India 15-7- '83
the forest; most amazing of all, I heard the actual
sound of water falling into a pool. I saw that a foun
tain had been built, that it flowed freely and-what
touched me most-that someone had planted a linden
beside it, a linden that must have been four years old,
already in full leaf, the incontestable symbol of resur
rection.
Besides, Vergons bore evidence of labour at the
sort of undertaking for which hope is required. Hope,
then, had returned. Ruins had been cleared away,
dilapidated walls turn down and five houses restored.
Now there were 28 inhabitants, four of them young
married couples. The new houses, freshly plastered,
were surrounded by gardens where vegetables and
flowers grew in orderly confusion, cabbages and
roses, leeks and snapdragons, celery and anemones. It
was now a village where one would like to live. From
that point I went on foot. The war just finished had
not allowed the full blooming of life, but Lazarus was
out of the tomb. On the lower slopes of the mountain
I saw little fields of barley and rye; deep in that
narrow valley the meadows were turning green
peacefully.
39
Youth and motion
It has taken only the eight years since then for the
whole countryside to glow with health and prosperity.
On the site of the ruins I had seen in 1 91 3 now stand
neat farms, cleanly plastered, testifying to a happy and
comfortable life. The old streams, fed by the rains and
snows that the forest conserves, are flowing again.
Their waters have been channeled. On each farm, in
groves of maples, fountain pools overflow on to car
pets of fresh mint. Little by little the villages have
been rebuilt. People from the plains, where land is
costly, have settled here, bringing youth, motion, the
spirit of adventure. Along the roads you meet hearty
men and women, boys and girls who understand
laughter and have recovered a taste for picnics. Coun
ting the former population, unrecognisable now that
they live in comfort, more than 10,000 people owe
their happiness to Elzeard Bouffier.
When I reflect that one man armed only with his
own physical and moral resources, was able to cause
this land of Canaan to spring from the wasteland. I am
convinced that, in spite of everything, humanity is
admirable. But when I compute the unfailing great
ness of spirit and the tenacity of benevolence that it
must have taken to achieve this result, I am taken with
an immense respect for that old and unlearned peasant
who was able to complete a work worth of God.
Elzeard Bouffier died peacefully in 1947 at the
hospice in Banon.
Courtesy: Development Forum.
Community Health Programme
Apex Committees to fulfil water and sanitation
targets
10-week courses are available in Community
Health and Development for medicals and paramedical
The rural water supply programme has been sanc
tioned another Rs. 600 crores under the centrally
sponsored Accelerated Rural Water Supply Programme.
It is hoped that atleast one source of safe and assured
drinking water supply to problem villages numbering,
2,31,000 will be ensursd by the end of sixth plan
terminating in 1985. The states have been directed to
set up apex committees.
A recent survery has shown that only a fourth of
the urban population is taken care of in sanitation
drives. While in rural areas it is completely neglected.
The apex committees are to work towards fulfilling
the targets in respect of urban and rural sanitation.
Sleeping in the open not only strengthens the
central nervous system but also restores normal activity
of lungs by steadily increasing oxygen assimlliat on.
For city office-goers sleeping at night in a balcony
or verandah serves as a tonic.
However Soviet doctors caution that people in
clined to get kidney trouble and throat infection must
get themselves medically examined before enjoying
this non-expensive health stimulant.
workers involved in community health and interested
in training community/village health workers.
Courses begin : January 16th 1984, (Applications
due October 30, 1983), July 17, 1984 (applications
due April 10, 1984); Contact Programme Director
INSA/INDIA Rural Health and Development Pro
gramme, 2, Benson Road, Benson Town, Bangalore
560046.
Goitre Control
“If there is one disease more than any other, wh:ch
leads itself easily to total eradication, within the next
two decades, it is goitre". About 120 million Indians
are exposed to endemic goitre. The technology for
goitre control is well within Indian's competence and
the financial inputs are insignificant, according to a
report of the Nutrition Foundation of India.
Health Policy Seminar Report
The printed report of the VHAI-AIWC and CCM Seminar on the National Health Policy
held in New Delhi on April 23, 1983 is ava;lable on sale at VHAI. Copies may be ordered at
Rs. 6.50 (including postage)
40
HEALTH FOR THE MILLIONs/aUGUST 1983
Book Review
A Profile in Courage
'A Rankling No More'
by Thomas Moon,
Pubished by Mitson Publishers, New Delhi, 1981. Rs30jSeveral people have written about how having
something to live for gives the dying a new lease for
their lives. Hutschhecker talks of'will to live', Victor
Frankl talks of 'logos' or the meaning of life. Many of
us have experienced the struggle between death and
the will to live in our own lives and in the lives of
loved ones.
A RANKLING
NO MORE
THOMAS MOON
'A Rankling no more' is a book dealing with the
same theme. It is a story of a 16-year old boy, Tim.
Tim is an acknowledged State and Western Regional
Junior Tennis Champion. He gets a great thrill out of
running and playing tennis, but his real goal in life is
to be a symphony trumpet player in one of the world's
finest symphonies. He is competent and his victories
are well deserved. He looks forward to playing the
trumpet at the approaching Edinburgh festival...when
polio strikes, 'A Rankling no more' is touching tale
of Tim's battle with polio.
His days in the hospital and his excruciatingly slow
and painful progress are well-depicted by the author.
One of the many incidents which leave a deep im
pression on the reader's mind describes Tim's first
encounter with the physiotherapist. At the end of the
hot baths and hot blankets and the gruelling exer
cises, the physiotherapist tells him 'If you ever walk
again, its going to be because you got enough
courage together to work hard despite the agony. And
because you had guts enough to let me work you
over a few times each day.'
Tim's is not just a physical battle. He overcomes
this battle with a steely strength------ in the process he
becomes cold, abrasive and bitter. Gone is warm
spontaneous, joyful young boy. Through the grimmer
psychological and spiritual battle, his father, a staunch
Mormon helps him. In so many words, he says,
'McClellans aren't, quitters !' ... and 'McClellans are
not bitter types. Bitterness is for those who let their
minds go vacant and can't find the gumption to
occupy their thoughts with other more important
matters than how life has cheated them from this or
that.'
Many readers may find the background against
which the story is set too alien to identify with. But
the unifying feature are the relationships. The relation
ship between Tim and his parents and his brother
are warm, close and very real. They feel all his
suffering with him. At times they leave him alone to
HEALTH FOR THE MILLIONs/aUGUST 1983
41
sort things out for himself, at times, they step in
actively support him. There are also times when they
do not hesitate to tick him off. And then there is the
incident when almost the entire junior school arrive at
his doorstep to pay him a 'get-well' visit 1 And the
pride that the conductor of the symphony orchestra
has when he thinks of Him I
The way Tim's character is portrayed can be a source
of envy and inspiration in many of us. Envy, at seeing
his zest for life, inspiration at witnessing his determi
nation and seeing the way in which he forces himself
News form Abroad
Kenya
REGIONAL HOSPITALS MEET
Kenya will be hosting the 14th Regional Con
ference of the International Hospital Federation (126,
Albert St., London, NW1 7NX, UK).
In the sessions on Role of hospitals in Primary
health care, appropriate design and technology for
rural hospital and health care facilities, strengthening
health services management, essential drugs for health
care and health insurance. The emphasis will be on
innovations and developments in the role of the
hospital in promoting, supporting or providing Primary
health care in its widest sense.
Anyone interested in presenting a paper at the con
ference may write to : Dr. F. Mueke, Deputy Director
of Medical Services, Ministry of Health, Post Box
30016, Nairobi, Kenya.
Indonesia
ASIAN COMMUNITY HEALTH ACTION
NETWORK
(ACHAN) held a ten-day workshop on Training
Methodologies in medical education for Primary
Health Care in Jakarta, Indonesia from July 20-30,
1983.
Bangla Desh
PEOPLE AND HEALTH
Drs. Aswin Patel, C. Satyamala, Mira Shiva, Abhay
Bang, Dhruv Mankad and two young journalists from
42
step-by-step over all the painful hurdles. For him, only
the goal of playing at the momentous festival exists.
This simple novel is written by a man who had
a personal encounter with polio as a teenager. This
experience, as well as his years as an amateur and
professional trumpet player prompted his writing the
novel. Probably because of his personal involvement
in the character of Tim, he has been able to write this
story so feelingly. Many disabled youngsters (and, of
course many others) would find this book inspiring.
Available from VHAI at Rs. 30 only.
India participated in a Seminar on "People and
Health" organised by Jahangirnagar University and
Gonoshasthaya Kendra at Savar-Dhaka from March
18-22. The participants discussed "curriculum plann
ing for an alternative Medical School". They visited
some of the Medical institutions in the country.
Nuclear Hazards
The use of even a fraction of the estimated 60,000
nuclear weapons now in existence would result in the
immediate death of 750 million people with another
340 million seriously injured according to the findings
of a study on nuclear war effects by the Royal
Swedish Academy of Sciences.
—Patriat 4-7-'83
Radiation Hazards
Diagnostic X-ray units are the major man made
sources of hazardous ionizing radiation exposure to
public experts in the division of radiological protection
(DRP) of Bhaba Atomic Research Centre, Bombay have
reported. The hazards, irrespective of the dose received
are somatic effects namely decreased life span, en
hanced chances of developing blood and other organ
cancers especially of the susceptible organs such as
breast and lungs. Genetic effects namely infertility
and congenital defects are also seen
—Patriot 19-6-‘83
State Secretaries Meet
Voluntary Health Association of Karnataka had
the meeting of Organising Secretaries of State
VHAs from August 22—24, 1983 at the St. John's
Medical College. With the induction of Sr. Lilly
Chunkapura on its staff, VHAK hopes to get a fillip to
its activities.
HEALTH FOR THE MILL10NS/aUG(\ I’ 1983
Book Review
RENU KHANNA
To Work for What
Good Work
by E.F. Schumacher, Johnathan Cape Ltd,
1979, London : Price Rs. 35 (approx)
Many of us many a time question our fives. We
seek and search for a unique reason to live, for a
unique purpose to fulfill, we often wonder what our
special contribution to this earth is meant to be. Many
of Viktor Frankl's writings provide some solace to
such seekers. In his beautifully simple style, he states
that life will not tell us its meaning. Rather, it is upto
each one of us to ascribe meaning to it. According to
Frankl, a human being is the 'highest and the mostdeveloped' species of living beings, this claim carries
with it corresponding burdens—it means that only
human beings have the responsibiitiy to choose. This
can be a little frightening—the fact that we are ulti
mately responsible to make our own choices and our
own decisions means we cannot blame conditions out
side of us. And that we cannot wait passively for
things to happen to us. On the other hand, this
thought can also be a source of tremendous consola
tion and strength. We can choose our own inter
pretation I
Frankl says that 'meaning of life' changes with
time. Different situations place different challenges
upon us and demand different responses. The mean
ing of life rests in the realisation of three different
kinds of values—'experimental' values, 'attitudinal'
values and 'creative' values. We can find the meaning
of our life in letting ourselves experience its poignancy
—through the experience of a perfect sunset. Or when
we hear a beautiful piece of music. Or when we ex
perience the touching love and beauty of a child.
Opening ourselves to all the experiences that life has
to offer, aspiring to increase our sensitivity, letting
ourselves be touched—by the harsh as well as the
beautiful—can be the aim of our lives.
HEALTH FOR THE MILLIONS/ AUGUST 1983
The second category of values that Frank! has speci
fied is 'attitudinal'—the values that help us to find
some good in the most horrible suffering. In our lives
we come across individuals who are invincible in the
face of the most severe afflictions. I am reminded of
an instance narrated by a friend. On her visit to a
Cheshire home in Trivandrum, she met an inmate who
was born crippled. His body was stunted, he was the
size of an one-year old, but his mind was well-deve
loped. He was welcoming and seemed to be vitally
interested in a range of subjects. He could move
around only on a wheel chair. On meeting her he led
her eagerly to his bed. This was next to the window
and on the widow still was a remarkable collection of
books. The books set them talking I My friend was
impressed by the aliveness of the man—he was warm.
This is a perfect illustration of Frankl's 'meaning of
life through realisation of attitudinal values'. It is easy
to blame fate for one's incapacities —it requires tre
mendous strength fo find the silver lining and carry
on through the clouds.
And finally, according to Frankl, we can find mean
ing in life through the expression of our creative
potential. In each of us there is this creative urge that
seeks fruition and if we can give it some form, we feel
fulfilled. The creative urge is expressed in different
ways—some persons find fulfilment in creating music
or other works of art, some in writing, while some
others incorporate creativity in their daily work—a
nurse discovers her own unique and creative way of
providing comfort to her patients, a teacher discovers
innovative teaching methods. And it is the realisation
of these creative values that has a primary place in
most of our lives. We aspire to be creative, to be
original to leave behind something that bears the mark
of our uniqueness. We wish to be involved in work
which is meaningful through which we can express our
creative instinct. Most of us are more concerned about
the 'doing' part of our existence than the 'being' part.
43
In our chase for work by which we can leave our
mark on this world (so it is seldom free of egocentricity) we often forget the values of 'being' and 'living',
we forget the experiential and attitudinal values as
designated by Frankl. The message of Frankl, that
meaning of life is obtained by realisation of all three
categories of values (and not just the creative values
as some of us mistakenly believe) is echoed in E.P.
Schumacher's book titled 'Good Work'.
To What Purpose
In 'Good Work', Schumacher addresses a question
which is central to most people : What is the purpose
of our work ? (For many of us this question is synony
mous with : What is the meaning of my life ?),
Schumacher gives three answers to this question : to
produce necessary, useful goods and services; to
enable us to use and perfect our skills; and to serve
and collaborate with other people in order to liberate
ourselves from our inborn egocentricity. Schumacher
writes, 'This threefold function makes work so central
to human life that it is truly impossible to conceive of
life at the human level without work'. He quotes
Albert Camus—'without work, all life goes rotten,
but when work is soulless, life stifles and dies'.
'Good Work', the contents directly pertaining to 'Good
Work' are about 1/5 of the total contents. The reader
tends to wonder when the discussion on good work'
will begin. The chapters contain a variety of ideas
sometimes not too well linked together. However the
book is enjoyable because it is not 'written'—Schuma
cher talks to us through the pages. He draws freely
upon his personal experiences from his work in the
National Coal Board, with Intermediate Technology
Development Group (ITDG), with Soil Association in
India, and other developing countries. The book is
alive, revealing his personality with all his creativity
and dynamism.
Pre-scientific Questions
The author begins his discussion on "good work'
by asking some (as he calls them) 'pre-scientific'
questions : What is man ? Where does he come from ?
What is the purpose of his life ? His analysis brings
him to the following conclusions •
— Man is a divine being. He needs to act as a
spiritual being, that is to say, to act in accord
ance with his moral impulses.
— Man is a social being. He needs to act as a
neighbour, to render service to his fellows.
— Men himself and herself. People need to act
as persons, as autonomous centres of power
and responsibility, that is, to be creatively
engaged, using and developing gifts that we
have been blessed with.
'Good Work,' is compiled mainly from a series of
lectures that Schumacher gave in the USA during the
mid-70s. Three chapters are based on earlier written
essays. They have been included for their relevance to
the subject of good work. This book comes after
'Small is Beautiful', in which Schumacher launched a
powerful attack on conventional economics and
technology and the value system underlying both.
He also suggested his alternative route to living. In
'Guide for the Perplexed' he dealt with the individual's
philosophy. 'Good Work' is an extension of both
books—the author has suggested a framework for a
society in which the individual’can find and retain his
soul. He has integrated the micro with the macro
in his discussion of nature of man with the characteri
stics of a suitable society. Although the book is titled
44
These precepts seem to be the core of the philo
sophy which has directed Schumacher's own life and
work. The beautiful blend of the micro with the
macro is a remarkable feature of his life's work; his
convictions about the nature of man and his concern
for mankind are reflected in his efforts to spread the
gospel of 'intermediate' or 'appropriate' technology.
He is the founder and father of the concept of
'intermediate' technology.
In this book as in 'Small is Beautiful' Schumacher
disagrees very eloquently with the philosophy and
functioning of modern industrial society that is the
result of 'technological progress'. Modern industrial
society according to the author has four main charac
teristics :
— its vastly complicated nature
— its continuous stimulation of and reliance on
the deadly sins of greed, envy and avarice
HEALTH FOR THE MILLIONS/AUGUST 1983
— its destruction of the content and dignity of
most forms of work
— its authoritarian character, owing to organisa
tion in excessively large units.
Violent Technology
He is opposed to 'technological progress' and
modern industrial society because of their effects on
man. ‘. . Mechanial, artificial, divorced from nature,
utilising only the smallest part of man's potential capa
bilities, it (modern industrial society) sentences the great
majority ot workers to spending their working lives in a
way which contains no worthy challenge, no stimulus
to self-perfection, no chance of development, no
element of beauty, truth or goodness'. The concept of
intermediate technology is in harmony with man and
with nature—it is not technology imposed on man or
violently exploiting nature. Intermediate technology
means technologies appropriate to the needs and
resources of poor people in poor countries; tools and
equipment deliberately designed to be relatively
small, simple, capital-saving and environmentally non
violent. Experience shows that whenever you can
achieve smallness, simplicity, capital cheapness,
and nonviolence, or indeed, any of these objec
tives, new possibilities are created for people, singly
or collectively, to help themselves. The patterns that
result from such technologies are more humane, more
ecological less dependent on fossil fuels and closer
to real human needs than the patterns (or life
styles) created by technologies that go for giantism,
complexity, capital intensity, and violence. It is incum
bent on those who reject these criteria or guidelines
to come forward with another set; because as long
as there are no guidelines the search for alternatives
cannot even begin. In one of the lectures he des
cribes how he implemented these ideas. Schumacher
and a few of his friends started the Intermediate
Technology Development Group (ITDG) in London.
Initially their work was restricted to helping groups in
the third world countries in the developing techno
logies suited to their conditions. The organisation's
administrative structure is based on the very principles
that the author believes in—small is beautiful—
decentralisation. As more and more demands were
made upon ITDG, their diversified and decentralised; in
time Intermediate Technology Publications Ltd was set
up, this was followed by Intermediate Technology In
dustrial Services and lnte
*m
?d ate Technology Services
HEALTH FOR THE MILLIONs/jUNE 1983
Ltd. An example of Schmacher's style is given below
—he pictures 'decentralised structures' as a chap at
a fun fair, who in one hand holds hundreds of strings,
and at the end of the string a balloon. 'Each balloon
has its own buoyancy, a nice round thing. That is the
ideal; structure in a large organisation. Of course you
need someone to hold it all together, but it is not a
star at the top, it is a man underneath and each
balloon has its own buoyancy. Each balloon is
somehow a limited thing, and thus, in a manner of
speaking, the moro the merrier.'
So all through this book Schumacher discusses the
evils of modern industrial society and puts forward
his alternatives in terms of intermediate technology,
decentralisation—structures and systems in which
man does not feel alienated and desouled; in which
man can discover himself and bloom.
Scott Bader Co.
The Scott Bader Co. in England is an illustration of
where this became possible. The founder of this plas
tics company gave the ownership to a commonwealth
consisting of everybody who worked in the company
for a certain length of time. And then they started
practising participative management. It was only after
12 years of efforts that this situation of coworkers and
coowners came about. The interesting feature of
Scott Bader is the 'self-denying ordinances' that they
imposed on themselves : (a) they would not sell any
product for use in armaments (b) a parliament of
workers would be the sovereign body and not the
board of directors (c) the maximum spread between
highest and lowest paid member would be one to
seven (d) they would not grow beyond 400 members
(e) a maximum of 40% of profits would be distributed
amongst members and half for some noble purpose
outside.
Schumacher says, 'Scott Bader is more than an
experience its a life-style.' They moved beyond the
humanisation of the work process into community
development—community motor car repair shop,
gardening machine pool, furniture-making shop. At
the time of writing, this experiment had been going
on for 27 years and as he says 'going from strength
to strength'.
The second but last chapter titled 'Education for
Good Work' is the most beautiful and thought pro
voking. It is deeply spiritual in its approach. If the
educational systems all over the world could adopt
these basic guidelines, the coming generations would
(Contd on page 48)
45
Further Reading on the Meaning of Life
The literature on rhe issues discussed in this issue is vast. Given below are some references
dealing with the questions of meaning, how to deal with individual meaninglessness; and the
related issues of psychological treatment and cure as related to traditional medicine and science.
(1) Assagioli, R : Psychosynthesis. Penguin,
New York (1979). Pioneering work showing
how the various subpersonalities in man, the’.r
integration and the will to live gives a meaning
to one's life.
(2) Dossey, Larry : Space, Time and Medicine.
Shambhala, Boulder and London (1982).
The author points what is wrong with medi
cine's perception of time and space and how
it distorts the patient’s meaning and what
need to be done.
(3) Faraday, Ann : Dream Power. Berkeley
Medallion Books, New York, 1973.
Very good survey of Post-Freudian thinking
on dreams.
(4) Frank!, Viktor E. : The Doctor and the Soul.
Bantam, New York (1971).
(5) Frankl, Viktor E. : Psychotherapy and Exis
tentialism. Penguin, England 0967).
(6) Frankl, Viktor E. : Man's Search for Mean
ing. D.B. Taraporewala and Sons, Bombay
(19
).
(7) Hall, Calvin S. : The Meaning of Dreams,
McGraw-Hil1, New York, 1966.
Reflects mainly Freudian thinking on dreams.
(8) Hofstadter, Douglas R. and Daniel C. Dennett
(ad) : The Mind's I—Fantasies and Reflec
tions on Self and Soul. Penguin (1981) A
selection of strange thought-experiments,
mind-stretching fantasies and humorous dia
logues, designed to shake both hard-nosed
scientists and religious priests our of their
complacency. Gives a new twist to problems
of meaning.
46
(10) Karl, Frederick, R. and Leo Hamalian (Ed):
The Existential Imagination. Picador, Pan
Books (1973).
A bird’s eye-view of existentialist literature
from de Sade to Sartre.
(11) Koothothil, Abraham
(Ed.) : Jeevadhara.
(Vol. XII, 67) Jan.-Feb. '82 issue. Theology
Centre, Kottayam, Kerala—686 017.
This issue of this bimonthly examines the
traditional Indian meaning and goals of life
usually enumerated as dharma, artha, kama
and moksha. They are not seen as mutually
exclusive but as harmonising day to day living
by their holistic and positive approach to all
aspects of life.
(12) Progoff, Ira : Depth
Psychology and
Modern Man, Megraw and Hill, New York
(1959).
(13) Progoff, Ira : The Symbolic and the Real.
Mcgraw-Hill. New York (1973).
The above two books are a basic introduction
to the new depth psychology and the thinking
of Progoff.
(14) Sahi, Jyoti : The Serpent and the Child.
RKP, London, 1982.
A rambling but interesting work, laced with
original reflections of an Indian artist in search
of meaning in traditional Hindu Symbols,
myths and legends.
(15) Tournier, Paul : The Whole Person in a
Broken World. Harper and Row, Publisher
(1947).
(9) Jung, Carl (Ed.) : Man and His Symbols.
Pan Books Ltd., Picador (1964).
(16) Tournier, Paul : The Healing of Persons.
Harper and Row Publishers, New York
(1965).
A brilliant book reflecting the insights of the
Jungian School, and their contributions to
questions of meaning.
The above two books reflect the theme of this
issue of 'Health for the Millions' from a Chris
tian physician's point of view.
HEALTH FOR THE MILLIONs/aUGUST 1983
JOAN NABERT
Development Marketing—
Where is it? Where should it go?
(A persona! Viewpoint)
Food is the basic requirement for health. This state
ment, I think will warrant little argument. Many
organisations in the voluntary sector are working
among women, rural craftsmen, handicapped persons
and their primary aim is to raise the income level and
the purchasing power of the poor. These income
generating activities are especially relevant in rural
programmes.
Why VHAI ? Because insufficient purchasing power
means insufficient food. Without enough food for all,
can there be health for all by the year 2000 ?
VHAf's interest in development marketing dates
back to January 1976 when Sister Carol Huss initiated
a discussion on the marketing of handcrafts. The sub
ject was raised again in 1977 : "We have been asked
to investigate the possibility of helping to market craft
products. We have neglected this for lack of time." In
1982, special funding was received and a project in
development marketing was begun. The proposed
goals of the project were :
(1) The production of a catalogue of development
products
(2) A domestic market survey
Step No. 1
With the first of the above goals in mind, question
naires were sent to thirty-two voluntary projects in the
various states in India. The questionnaires covered
general information on the project, number of workers,
product information, prices. We requested samples or
pictures which might be used in the production of a
catalogue. The number of questionnaries which were
returned was less than satisfactory, and therefore the
questionnaire approach was ruled out.
Step No. 2
As a second step, we (Joan Nebert and Arun
Goya|’ a marketing consultant working on the project)
visited several projects in Rajasthan, Poona, Bombay
and Ahmedabad. It was our intention to visit projects
health for the millions/august 1983
in othar states, but we felt we should stop the survey
temporarily in order to begin, with the information in
hand, a limited test market in Delhi.
Step No. 3
This entailed a survey of the domestic market in
New Delhi. Arun Goyal visited small retailers, craft
shops, drapery marchants and others in various
markets throughout the city. We deliberately avoided
the usual handicraft channels like Cottage Industries
a” State Emporiums which are already used by most
organizations. The small retailers indicated a willing
ness to try various craft items on a small scale: how
ever, the general feeling was that a catalogue was not
the answer to the retailer's needs. Tney prefer to buy
from salesman who can supply their products in small
lots, on a regular basis.
At the same time, the survey of the producers in
Step No. 2, indicated that many or the voluntary
organisations have not yet reached the point where
the production, quality and quantity wise, is up to the
large orders that might be generated by a development
marketing catalogue, especially if the catalogue was
targeted at Alternative Markets abroad. Some pro
ducers feel that the damands of the export market are
too high. Those that do use the Alternative Markets
for some of their products, have already published their
own individual catalogues—many of which are colour
ful, well designed, and attractive. For these reasons,
we have ruled out our first goal, and will not publish
a development marketing catalogue at this time. The
catelogue has not been ruled out—it has been post
poned.
Step No. 4
In the month of June, 1983, we began a test
of the Delhi retail market. We have selected ten
different products from the various centres which
we visited and shall try to market them to small
retailers in the different market areas of New Delhi.
We have set up a temporary showroom at 14 Birbal
Road, Jungpura Extension, New Delhi (Tel: 69-3113).
Arun Goyal, along with a volunteer salesman, will
47
personally take the samples to the retailers. They will
try to get orders which will be relayed to the crafts
men. We have set the limit of the orders for each
item during this month to fifty pieces. For this initial
test market, we plan to take delivery of the goods
deliver to the retailers, and take resposibility for collect
ing payment. This is a test market only, and will not
be continued by VHAI, as a project. If the test market
proves successful, we hope that there will be some way
in which a general service agency might be formed
which might bring all the crafts of voluntary agencies
into regular contact with the retailers in New Delhi and
other large cities, as well as to the attention of the
Alternative Markets abroad.
For this operation in June we have taken the name
of People's Action League for Marketing (PALM)
Our survey showed that one of the ways of market
ing crafts has been through Exhibitions-cum-Sales at
various large centres. These have been relatively
successful, particularly to the extent that the village
craftsmen are brought into contact with the city con
sumer—the craftsmen are beginning to understand the
needs and demands of the city buyer and there is a
growing awareness of the importance of colour,
design, and quality control. The present test market
in Delhi is seen as a possible addition to the present
system of Exhibition-cum Sales, and not as a replace
ment. Exhibition-cum-sales are presently supported by
the Handicrafts Board—will this kind of support be
continued indefinitely ?
This is where we are ? Where should we go from
here ?
Problems Related to Craft Marketing
Quality Control: From my own personal experience
marketing for leprosy rehabilitation projects around
New Delhi, and from other centres in other states, I
submit that nothing is more important than quality
control. I feel that this/s not only true of the export
market. The local Indian buyer is just as concerned
about quality. Where the export market will reject a
poor quality item totally, the local buyer often looks
for a flaw to increase his or her bargaining power.
Raw Materials : A constant source of quality raw
material is often a major problem. This is particularly
true in the leather industry, where monopoly buyers
snap up the prime skins. It is possible that a broader
organisation and collective buying might strengthen
the purchasing power of the craftsmen.
Pricing : This is very important, of course. It
should include full labour costs, full cost of material,
incidental costs of measuring, checking, quality control,
transport costs to the market place, markup for loss or
breakage, and, hopefully, a margin of profit so the
group can build up some kind of working capital.
Design : Constantly changing design are as much
a part of the Indian consumer demand as that of
foreign markets. Consumer needs and wants vary from
village to small town markets, from city to city, from
state to state, from person to person. Flexibility in
design becomes increasingly important. In the hand
loom industry where the market is glutted with bed
sheets and bedcovers, all markedly similar and there
fore available at a very low price, there is scope for
flexibility and variety. The survey of the Delhi market
showed that small retailers are open to new designs
and textures—handloom has the advantage over the
mills in that it can experiment with new designs where
a specific order can be produced in small quantities—
200 meters, as against 25,000 meters.
Proposed Step No. 5
The next step in this project anticipates the publi
cation of a manual that will provide useful information
to producers on loan, credit, training and other govern
ment schemes for small scale producers. We hope to
touch on costing, packaging, shipping, export proce
dures and other related matters. Dastkar will be colla
borating in the collection of information for this Pro
ducer's Manual.
Once again, this is where we are 1 Where should
we go ? We invite your suggestions, comments, any
ideas on development marketing. Please direct your
letters to the Development Marketing Project, VHAI.
TO WORK FOR WHAT (Contd. from page 45)
consist of liberated human beings liberated in the
sense that they will not strive to be who or what they
are not meant to be ; liberated because they will not
be themselves in the tangles of futile competition.
Each new man would aspire to live his life in a way
that he unfolds his unique potential as he goes along.
He will get satisfaction not from the fruit of h s
'Karma' but from the process of performing his
mission. These educational principles would lead man
to fulfill his unique potential, do creative work, be free
from egocentricity, and reach out to other men.
If these basic guidelines of Education for Good
Work' were followed, we could hope for greater har
mony and peace in the generation to come. Maybe
we'd be better able to cope with questions which
baffle us now, questions like 'What is the meaning
of life ? What am I to contribute to Mother Earth ?'□
48
health for THE millions/august 1983
Maintenance Help Available
\/HAr
Tra,ned maintenance help is available from July 1983 when eight participants of
s health equipment maintenance programme (HEMAT) have graduated. They have com
pleted a 2 + 1 years of training in electrical work, refrigeration, air conditioning, carpentry,
plumbing, simple hospital equipment, building latrines, how to tap alternate sources of energy and
simple medical electronics.
For details of graduates’ biodata and other details, write to
S. Srinivasan, programme coordinator, VHAI.
Helping Health Workers Learn
Dear friends,
We have great pleasure in announcing the release of Helping Health Workers Learn—a
book of methods, aids and ideas for instructors at the village level. This new book by David Werner
(author of Where There is no Doctor) and Bill Bower explores activities in the three main places
of learning in a training course: the class room, the community and the health centre.
It is an idea book for trainers who are looking for exciting and proven alternatives.
The international edition of the book is priced at S7 (Rs. 70/-). VHAI true to its tradition,
sells it at Rs. 55/- a copy. As a special pre-publication offer, this book will now be available to
the first 5,000 orders at Rs. 39/- a copy.
This special offer is valid only for orders sent with payment.
Please add Rs. 8/- for postage per copy.
Publications Department
VOLUNTARY HEALTH ASSOCIATION OF INDIA
C-14 Community Centre
Safdarjung Development Area
New Delhi-110016 INDIA
Your sincerely,
Augustine J. Veliath (sd/-)
Publications Officer
P S.
. -
'
’
Please bring this offer to the notice of your friends.
If you would like us to write to more people, please send us the addresses.
Workshop on Solar Equipment
VHAI in collaboration with Institute of Engineering and Rural Technology/Allahabad U.P.
is organising a training workshop on Solar Equipment Fabrication and Maintenance in November
1983. This will be a month long workshop enabling the trainees to fabricate solar equipment
such as solar cookers, ovens, water heaters and distillation plants. The fee per trainee will be
Rs 1 200/- inclusive of board and lodge. For further information write to : Workshop Coordinator,
Solar Equipment Maintenance & Fabrication, Voluntary Health Association of India, C-14 Community Centre, SDA, New Delhi-110 016
SB®.
From The Wilderness
- -
He who was a river into the wilderness
'J-
Is now come back from misery to bless
The hounding spirit.
He who was rich and now so seeming poor
Owns an inheritance which was not his before
Even his self.
This was the gift from the dark hour which thrust
Him forth to solitude;
Which laid him in a grave while yet the dust
Was under him; while yet the blood
Water'd the withering march 'twixt sense and sand.
A
3
&
He knew the hour of nothingness when the hand
Is empty, and empty is the heart;
And the intelligence, with its keen dart
Of reasonable speech, slays its own pride.
'Twas thus he died;
Suffering his solitary hour beyond the world of men;
And it was thus, alone, he found the flower
Of his own self;
Which yet had been only a flower of stone
Had he not brought it back into the world again.
William Soutar, 1898-1943, Scottish Poet
is
For Private Circulation Only
$
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