Beyond lectures: new ways of learning

All of us who have gone through the institution of formal education know how easy it is to sit through a lecture, look attentive and not absorb anything! Even with a desire to learn, there is a limit to what can be absorbed and retained in the standard lecture format. In recent years, many innovative methods of learning have been experimented with and implemented in schools and non-formal learning centres, among village-level activists etc. During the orientation and mid-term review at CHC Bangalore, we experienced firsthand the benefits of such approaches.

During the 6+ weeks of sessions in June, July and September 2008, we sang, danced, acted, drew, presented and debated. For me, these interactive sessions often crystallized the content of lectures into valuable insights. One game, in particular, challenged our perceptions of the world we live in and ourselves. This was the monsoon game, led by Ravi Narayan, which we played on the 3^rd day of our orientation. It is a role-play which simulates life in a village. Most participants were divided into 8 upper caste, OBC and Dalit families with varying amounts of land. The huge landholders were all upper or the dominant caste, as is common, while the Dalits were marginal landholders. Other participants were moneylenders, government officials, journalists etc.

The game took us through 7 years of planning what to 'plant' and then 'reaping the harvest' in a good, average or bad monsoon. Those who did not have enough to eat 'starved' and a family that went through 3 years of starvation 'died'. While all this was going on, the moneylender was lending money at exorbitant rates; government officials were announcing relief schemes, very few of which the most needy were eligible for and the journalist was documenting the abuses. Finally, at the end of the game, 3 families were dead and the moneylender had acquired a lot of land!

In the post-game discussion, we realized how easily each of us had fallen into our roles, becoming complacent and often selfish as an upper-caste family and feeling powerless as a Dalit family. We appreciated the difficulty of mobilizing communities that are living a hand-to-mouth existance. We also realized that we had forgotten the activist part of our psyche! We hadn't protested, refused to obey the rules or 'organized'. The game was a powerful tool to make us appreciate the lives of the rural poor.

Dwiji and I traveled through the US in September-October visiting chapters of the Association for India's Development (AID), an organization both of us have volunteered with. While planning sessions on topics as varied as Sustainable Agriculture and Group Dynamics, the games and other activities at CHC provided plenty of inspiration and ideas. We wanted to have more discussions and debates and found that these methods were very effective in getting inputs from participants in these sessions.

While we did not have the time to play something as elaborate as the monsoon game, we tried to come up with a shorter role-play to illustrate group dynamics in the presence of an 'outsider'. The role-play is quite simple – most participants are villagers, while two are the 'change agents', representatives of an NGO. Each person is given a chit that assigns them their role and provides further information that they can choose to share or not share. The background is that the change agents are at the final stage of selecting the village as the site for a new high school which their NGO will manage, but they feel there is something the village is not sharing with them that could impact the success of the project. Their goal is to find out what this 'secret' is. On the other hand, the villagers are vested in seeing the school set up in their village and the resulting benefits. At the beginning, both the change agents and the villagers are allowed time by themselves to strategize – then comes the interaction between the two groups.

We played this game with the volunteers of two chapters and found it was even more successful in illustrating group dynamics and negotiations between groups than we had expected. Hierarchies were formed within the village group and the change agents in both chapters took different approaches – confrontational and friendly - while engaging with the village. We analyzed these interactions later and discussed their pros and cons, comparing them to modes of engagement in the field. Further, a number of issues were raised that were not covered in our initial briefing but are, in reality, important for a school's success. We discussed child and adult education, child labour, migration to cities, public land in a village, mid-day meal schemes and more.

Whether these interactive approaches are more effective than traditional methods remains to be seen. I think they are and we certainly enjoyed planning and participating in them! I hope to benefit from more such games and interactive sessions in the future, whether as just a participant or a co-ordinator and planner as well. In such an interactive process, we all learn and what could be better than that!

At the mercy of Mother Nature

August 2008

Growing up in Bombay, I thought I understood the downsides of monsoon well – the unceasing rain, the flooding, bus and train delays and cancellations... I prided myself on not just coping but also enjoying the season. Of course, things were much worse for the slum dwellers and people living in low-lying areas. But the rains would eventually stop and things would get back to normal, right? It took spending a few weeks in Sitapur in July-August to really appreciate the short-term and long-term impacts of the monsoon.

Most of the SKMS members are agricultural labourers or marginal landholders. They live in 'kuchha' mud houses with thatched roofs. This year, the monsoon was so fierce that it was, in the words of an SKMS supporter, 'Nature's terror'. All the fields were flooded through July and only the paddy seemed to be surviving. But further downpour through August and during the critical period of harvest damaged the paddy crop as well.

In the second week of August, it poured nonstop for 3 days. Houses, already unstable with the water-logging, began collapsing by the dozen – in some cases just one wall, in others the entire structure. These humble homes provided very basic shelter; with their collapse, people were all the more vulnerable to the elements. In one village, entire families spent days under plastic sheets hoisted next to a statue of Ambedkar, the one area in their 'basti' that was not waterlogged. Fevers, diarrhea etc. were rampant. The spring's wheat crop had been a bumper one and many families had stocked up on grain for the entire year. This grain was now wet, spoiled and mostly unusable.

While all this was playing out, we were hearing of the calamity in Bihar where the Kosi changed track and inundated entire districts. The suffering of the people in the affected districts was unprecedented. Even in Sitapur dt., certain blocks such as Rewsa were completely flooded and people were camped out on the roads and highways. Was the suffering of those people worse than that of the people here? After a point, can one quantify suffering?

We were ourselves staying in Surbala's house in the village of Satnapur. Surbala, through sheer determination and some financial strength, had constructed a concrete 2-room house. Unless there was severe waterlogging, her house was safe. But her husband was sick, one of the walls in her in-laws' house had collapsed and she was busy with personal and SKMS work. We were in a quandary – should we leave 10 days from now as we had planned or leave earlier? If we stayed, should we move to a hotel in Sitapur? Our utility to the sangathan was limited – we could help out with the applications for compensation for all those who had lost homes and property, but there were more experienced people already doing that. We could not work on long-term projects in this emergency situation. So we decided to leave early. It did not feel good to leave at such a time...

The rains have now stopped in Sitapur. It is likely that the damage to families' food stocks will have an effect in the coming months, though work through NREGA can mitigate that. It is to be seen how the winter will be. We will be back in Sitapur then and will hopefully contribute in a better manner than we could in the midst of the monsoon fury.

Becoming a 'jhola chhaap' doctor

'Jhola chhaap' is a colloquial term used to describe informal medical practitioners in some parts of India. These are usually people with some experience with medicines and health care – they may have worked as a compounder with a doctor somewhere or received some formal/informal training or just picked up medical knowledge along the way. But health services are so scanty in rural areas that these people can get elevated to doctor-like status. At CHC, we've had a few discussions about such practitioners – are they just quacks who should be discredited and banned? Or are they providing a valuable resource in the absence of trained professionals? Some groups have been working with such practitioners to improve their techniques – a powerful example is the trainings provided to traditional dais (midwives) to promote safe deliveries, prenatal and antenatal care etc.

The ease at which one can become a medical authority was brought home to me in Sitapur district this August. Malaria seems to be quite prevalent here – exact numbers are hard to come by. In Mishrikh block, only the town of Mishrikh has government and private labs that can test for malaria. The time and expense (including travel expenses and loss of daily wages) involved in the testing process discourage many people from going through with it. We were discussing this issue in the Sangtin Kisaan Mazdoor Sangathan's (SKMS) regional meeting at Qutubnagar and I asked what people did instead. One or two replied that they go to a 'doctor' in Qutubnagar who injects them with some medicine that makes them better.

Many situations have come up in Sitapur where people have taken decisions or acted in ways that I am sure are wrong for them. But I have often kept quiet due to the lack of alternative options for them and because I did not want to get into an indefinite 'lecturing' mode. Even with friends and family in one's socioeconomic strata, we choose to keep quiet during difficult discussions to keep the peace. But here, I decided to speak up and told the group that that was not the right way to treat malaria.

'Then what is the right way, didi?' asked someone. I mentioned chloroquine, the most commonly used drug for treatment or prevention of malaria. The group talked among themselves and more people joined the conversation. A little while later, another SKMS member came up to me and confirmed the name of the drug. By that evening, a number of people had bought chloroquine tablets to stock at home and had told their fellow villagers to come to them if they had 'jaada bukhaar' (cold and fever, the colloquial term for malaria)!

Was this the right thing to do? What if they used the wrong dosage? What if....? I was quite worried at this outcome and wondered if I should have instead pushed these folks to get tested and get proper medical advice from trained professionals. I called Sukanya at CHC Bangalore and the feedback she gave provided some comfort. She suggested that I talk to doctors in the area and the PHC and government staff to get an idea of the malaria situation in the area. Also, CHC would send me pamphlets on malaria, its diagnosis and treatment (written in Hindi) that I could distribute to the group and use for further discussions. 'You gave them the right information,' she added. 'The need for good health services in these communities is so acute that any good information they get can only be beneficial. So don't hesitate to share complete and accurate information – we all have a role to play.'

So this is how, for a short time, I became a 'jhola chhaap' doctor! I expect to fulfill that role again in the future and hope that I will be able to respond in a sensitive and useful manner. After all, when campaigning for 'Our health in our hands' (a message of the People's Health Movement), each of us have to step up to the challenge as best as we can.

In search of a doctor (and the system)

Again, it's been a long time since I posted - apologies! Also, considering the record length of my posts, I'll try to post shorter, more reflective pieces from now on!

August 2008

The orientation at CHC had given us a thorough introduction to Community Health. But in Sitapur, given that Sangtin Kisaan Mazdoor Sangathan's (SKMS) primary work was in mobilizing for NREGA, I did not plan on sharing my learnings at their meetings. My plan was to discuss these issues with a few people and then see what came through. However Mukesh, who serves in an advisory role with SKMS, suggested that I speak about health at the regional meetings using one or two talking points, thus starting the thought process in this important topic. Other SKMS members concurred, so I raised the issue at the Aug 10th and 11th meetings in Aant and Qutubnagar respectively. We discussed why it is easier, or rather more natural, to work on livelihoods, BPL etc. than on health – we only think about the health system when we are sick, knowledge and power are concentrated in the hands of medical professionals etc.


I asked the assembled people, about 100-150 in each meeting, to think about health-related issues and come up with one or two that they would want to work on. While everyone was mulling over this, a few people raised the issue of malaria. At this, others began speaking up about their own and their village's situation. From there, matters progressed very quickly, and before I knew it, plans were being made to prepare lists of people affected by malaria and to demand action at the block level.


I was not sure what to do with the information being collected, so contacted CHC. Armed with their advice, I went to meet Richa. She was quite concerned with the various illnesses prevalent in SKMS villages this monsoon. She felt that camps should be organized in a few central villages so that all the sick could easily access health services. We decided that I would meet the chief doctor in Mishrikh where a CHC (Community Health Centre) is based.


But first, a brief description of the area: the Mishrikh CHC serves most of Mishrikh block, with some villages as far as 20 km away. The average cost of travel one-way is Rs. 10. If the patient needs to be escorted, travel costs themselves could be as high as Rs. 40. Further, patients need to get to the CHC before noon to get a 'parcha' or token that would allow them to see the doctor, get medicines etc. Transportation in the form of tempos is not very reliable and if one is late, the entire day is wasted. In contrast, Qutubnagar, one of the big villages, is more accessible for the people in that area and has one MBBS doctor who charges ~Rs. 40 / diagnosis and a couple of 'Jhola chhaap' doctors who charge even less. But inspite of this, the Mishrikh CHC is well used as I discovered when I visited it on August 19th.


The chief doctor was not available – he was on leave till the 28th, the day after we were scheduled to leave Sitapur. Further, the situation was dire in many villages – just that morning, we had heard that the entire Dalit 'basti' in Kunwarapur was inundated with both lake and canal water. There and elsewhere, many houses had collapsed and people were exposed to the rains with nothing to protect them but plastic sheets. While I was in Mishrikh, Dwiji had gone to Kunwarapur and was wading through knee-deep water helping to document the damage.


On further enquiry, I found the junior-most doctor on service. He was swamped with patients. While watching him interrogate each patient briefly and jot down a prescription, I was reminded of Adithya recounting his health camp experiences at CHC Bangalore. In such a situation, the doctor can spend at most half a minute on diagnosis. It has got to be dehumanizing to treat patients as if they were parts on an assembly line. I managed to speak briefly to the doctor and ask him what planning the Health department did for malaria and other diseases in the monsoon. He looked at me like I was delirious – 'We are here treating patients – that's what we do!' I then asked what would warrant a personal visit by a team of doctors to a village. 'A serious outbreak of diarrhea or something equally contagious and life-threatening' was his reply before he was engulfed by patients again.


Given the lack of progress at Mishrikh, I went to the District Hospital in Sitapur the next day hoping to get more answers. Here, I was luckier – the additional CMO (Chief Medical Officer) and the Deputy CMO were both in the office and the latter was in a chatty mood. He talked about the staffing problems in the district – there was a shortage of at least 30 doctors. Government service and a rural lifestyle cannot compete with the salaries and career growth possible in urban settings. Currently, even C-sections had to performed in the District Hospital as there was no anesthesiologist at the CHC. They were under-equipped for normal times, let alone catastrophic situations. He then went off on a slight rant about how ignorant and lazy villagers were and how hard it was to treat them. These were comments similar to what I heard the past couple of days from private doctors in Qutubnagar – the path of least resistance in this thankless situation seems to be blaming the victims.


When pushed on health camps, the Deputy CMO said that a team would visit a village only in exceptional circumstances. Usually, there was a good reporting structure in place and news of outbreaks almost always reached them. In fact, in some situations, they had gone to villages and found that the situation there was not as dire as expected. Such visits were detrimental since the team could have spend their time better in the hospital treating the patients who arrived there.


After this discussion, I came to the conclusion that it would be very hard to get a medical team to visit any of the SKMS villages. Other areas in the district were in worse shape – in some blocks, villagers were practically living on the roads as all other areas were flooded. Nevertheless, I communicated this information to the SKMS team and they did try to get a team to visit Kunwarapur.


Two days later, we went to visit Reena and Shammu at Kunwarapur. No medical team had come to assess the situation. But we learnt that, in a nearby village, 7 children had died from diarrheal-related causes the previous day. So much for a good reporting structure...


But given the dire state of the Health system and the realities of rural life here in Sitapur and elsewhere, many such tragedies are in the making...

Potnal ooralli, part 3

June 27th, 2008

On Friday, the JMS team came up with a good way to give us even more exposure to the land and its people. They divided us into 3 groups and sent us off in different directions with different itineraries. Our task was to map the available resources – housing, access to water, health services etc. and thereby gain a better understanding of how communities become marginalized. Each group would also visit a PHC – the State Health Secretary had recently stated that all PHCs in Raichur dt. were open 24/7 and we were to ascertain whether that was the case.

Our group consisted of Devaputra, a JMS staff member, Obalesh, who is part of JAAK (JanArogya Andolana Karnataka), Ria, Jeyapaul and myself. Our first stop was the Dalit basti in Tornadini. Here, a Sangha and savings group had been formed recently. Like most Dalit parts of villages, this one had narrow streets, small huts and poor drainage. But it had a nice community hall, which now served as the Anganwadi. When we got there, some children were in the hall and their mothers soon joined them. Our discussion started off with a song and a round of introductions. We then asked the women to talk about their Sangha, on why they started a savings group (to save money, was the response) and whether there were any problems they wished to tackle together. They started off by saying they had no problems. But as we asked more and more specific questions, their circumstances began to emerge.

Firstly, their land holdings were meagre. Some were landless and none had more than an acre of land. Men could expect to receive Rs. 50-70 as daily wages during the season while women could earn Rs. 30-40. The minimum wage is Karnataka is Rs. 73 and this was being offered through some NREGA work. But when the lists of labourers were published, only women were listed. Their menfolk discouraged them from taking up the work and thus they could not avail of the better wages. There were also high rates of seasonal migration in the community.

When discussing health services, or the lack thereof, the stories poured out. It seems that the ANM does not visit the Dalit colony for immunizations and does not touch the people here. When they are ill and go to the PHC, they are asked to pay money even though treatment is supposed to be free. If they do not have money, they are insulted and told to leave. In one case, a referral was made to a private clinic for a caesarian delivery, which ended up costing the family dearly. In another case, a woman mentioned that when her daughter-in-law gave birth, instead of receiving a cash payment under JSY, she was asked to pay the doctor Rs. 500!

We had plenty of ammunition for our PHC visit and decided to take the last-mentioned lady along with us. But before that, Obalesh exhorted the assembled group, which now included both women and men, to come together and work for the improvement of their community. He talked about how the Madiga communities in other districts in Karnataka had started in situations similar to these and yet had advanced in education and status. He mentioned that he also came from the same background as these people and remembered childhood deprivations and humiliations. But if he could overcome these handicaps, so could they. Listening to Obalesh speak, I was struck again by how important it is to both empathize with and challenge communities we work with. Of course, nothing beats such a personal and heartfelt testimony!

At the Tornadini PHC, we met with the Medical Officer. We asked him how the PHC was functioning and whether he felt the lack of anything. Like the villagers, he started off saying everything was fine, but under further questioning, admitted that the PHC and its subcentres were understaffed, no lab was sanctioned etc. etc. Of course, he did not admit that the staff (and he himself) were demanding money from the villagers. But he promised to process the payment to the daughter-in-law of the lady with us as soon as possible. He also promised to look into the matter of the ANM not visiting the Dalit colonies.

As we left, Obalesh again tried to convey the importance of standing up for their rights to the village women who had come along. But of course, these aren't lessons learnt in a day!

When we returned to the jeep, we found that our driver was missing. On further enquiry, we learnt that he had got into a fight into someone, and when that person left, got into an auto to chase him! Talk about combativeness!! Thankfully, the rental company had a spare key for the jeep and another driver a few kilometres away.

Our next stop was Donamaridi. The Dalit colony had a much neater appearance here – most of this community is Christian and apparently they have received some assistance to improve their homes and surroundings. But economically, they were worse off. Their land holdings were up to 2 acres but were not irrigated, so all they grew was jowar. Daily wages were as low as Rs. 15-20 for women. For me, the saddest part was listening to the girls who had gathered around me. None of them had ever attended school – their mothers had told them it was unnecessary. Instead, they worked either at home or in the fields. They stared with fascination at my notes. All I could think to do was write each of their names on a loose piece of paper for them – they insisted on me writing down mine as well.

As we were leaving, we saw a number of boys returning from school in their uniforms, bags on their backs...

Our next stop was the PHC in Bagwat. We were accompanied by a woman member of the village Panchayat who is also part of the group set up to perform community monitoring of the PHC. The Medical Officer here, Dr. Patil, is young and energetic, and once he realized we were there to listen, gave us plenty to mull over. He laid out in full detail the problems with this PHC and the area it served as well as with neighbouring ones. The staffing shortage, a common story everywhere, was reiterated here. They still managed to operate 24/7 by having someone on call at all times, but until a few months ago, there wasn't a staff nurse at the PHC, let alone the 3 required for 24 hour operation. He then started on his own plight. He was hired on a contract basis and joined because he was promised a PG seat. He was still waiting on that a few years later. The contract doctors, numbering 220 in Karnataka, were planning on approaching the government asking for permanent posting with accrued benefits for their years of service. If they did not get that, they would leave government service – he would then gladly start a private practice. His native village was close by and he owns 100 acres of farmland there – that was his only motivation for staying on.

He showed us around the PHC, pointing out items like curtains that he and his staff had personally paid for. Apparently, he had spent his own money repairing the quarters he was allotted as well. He had plenty to say about NRHM and its failures at the field level. And when Jeyapaul mentioned HIV/AIDS, one could hear the anger resonate in his voice while he talked about the shortage in disposable syringes and the risk doctors and nurses take in operating on patients and delivering babies without a good supply of gloves and sterile equipment. “Who knows what the rates of HIV/AIDS are here? For testing, one has to go to Raichur. How many people will go?”

Afterwards, we spoke to him about CHC, JAAK, the worldwide People's Health Movement (PHM) and how people needed to come together at all levels to fix the health system. Hopefully, some of that got across because he promised to get in touch with CHC when he was next in Bangalore.

Afterwards, the Panchayat member, Lakshmi, took us around Bagwat. We wanted to walk around the entire village to get a sense of how different communities lived. What a contrast! The Dalit basti here was much better than in the other villages – a number of small cement houses had been sanctioned through the Indira Awas Yojana and were being constructed. According to Devaputra, the community here was more mobilized as well, not in small part due to Lakshmi herself. A young widow, she had struggled to provide for her two sons for years. Now that they were grown up and married, she had taken on community issues, eventually elected to a Dalit seat in the Panchayat.

Rain disrupted our plans to meet with the sanghas in Bagwat, so we took shelter in Lakshmi's house and left for Potnal when the downpour subsided. These were the first rains of the season - a little late, but holding out hope that the monsoon would be normal...

Back at the JMS hut, we found that everyone had had as eventful a day as we did. Lakshmi and others had visited a PDS shop, a PHC in terrible shape and had witnessed a face-off between the village community and an ANM. Varsha's group had met some Panchayat members and seen how the women members got sidelined. They had also received a feast for lunch. The best 'tragic' moment of the day was when Sabyasachi, who was in Lakshmi's group, realized that Varsha and Savitri had got to have fresh grilled mutton and all he had for lunch was rice and sambhar!!

Potnal ooralli, part 2

Our first visit on Thursday was to a biothermal plant near Potnal. Premdas had never visited it, but had heard that they burn bio-waste to generate electricity. At any rate, we headed there to learn what we could. Like most plants, this was extremely noisy and dirty – a number of workers, their faces completely blackened, were exiting when we entered.

We visited the main control room, got a peek into the furnace and also saw the waste processing facility. Most of the engineers and technicians were Telugu-speaking, from the Hyderabad area. From them, we learnt that the plant generates 7.5 MW (it also receives 0.5 MW to power the magnet in its alternator). It requires 35 tonnes of fuel/hr and 3.5 tonnes of water/hr (the balance of its water needs are met by recycling). The main source of fuel was rice and other grains' husk according to the engineers - though we did hear later that when this bio-waste is not available, they burn wood. The impression we received from them is that they 'manage to get by' – one mentioned that the plant was shut down for a few months for repairs. But others in our group went to another level in the waste processing section heard that they were doubling the plant capacity soon – go figure!

On our return to Potnal, we split up into smaller groups and 'mingled' - the relaxed and familial atmosphere at JMS lured us in. I spent time with the terracota jewellery group – this is one of the income generating efforts launched during the drought years, when there was a need to do more than mobilization. Now 20 women from 2 SHGs work in this endeavour. The women maintain their own records and pay themselves, on average, Rs. 50/day. However, there is a huge backlog on payments because, though they have plenty of inventory, sales are not progressing at a good pace. Their biggest revenue grosser is the 'mela' in Delhi Haat. There are other fairs in Bangalore and other cities where they display their wares. But this is not enough. One possible handicap for the group is that they all speak only Kannada. Therefore they are not able to answer questions in Hindi and English. Premdas and Savitri had been thinking about getting some good posters done which would answer the most commonly asked questions and highlight the social aspects of the products. I offered to photograph the pieces with Dwiji's digital SLR and therefore found myself lugging around a lot of stuff for a weeklong trip. But it did prove worthwhile.

Savitri is one of the CHC fellows and this is her home turf – she grew up in Potnal and started working with the terracota group after completing her Std. X exams. Her elder sisters and even a younger one got married off before they turned 15. That Savitri managed to carve her own path (she has completed her BSW) is a testament to her determination.

After lunch, Premdas managed to herd us together for a discussion with the herbal medicine group – this is yet another income generation scheme with 14 women from different SHGs. When the program was first conceived, 4 women were sent to different places to get trained in health and herbal medicines. Later, more women were trained in Bangalore and local trainings continue on a regular basis. The health workers have combined the knowledge they acquired from their elders with what they learnt in Bangalore and other places and, in some cases, have developed their own cures. They shared some of their recipes with us along with the medicinal value of various plants. The tonics, hair oil etc. are bottled and sold in the melas, but their biggest sales are during their clinics held every Thursday and Sunday. These are market days in Potnal and people pour in from all the surrounding villages. Some of them make their way to the clinic. An amazing achievement of these health workers has been their ability to bridge the caste gap – high caste people will come to get treated by these Dalit women. It also shows how effective they have been and how renowned they have become.

Our next meeting was with the teachers and students of Chilipili. Earlier this school was operated as a day school, moving to a different village each year. But a few years ago, SSA and NCLP provided funding and mandates for residential schools for ex-child labourers. Then, Chilipili found a home in the JMS hut. Just like the school in Prakashpalya, children are taught for 1-2 years in a bridge school setting. Some of the funding Chilipili receives from NCLP was elaborated on. Rs. 11 is provided for food/day/child. This does not allow for much fruits and vegetables, though the JMS cooks do provide some vegetables every day. I found it ironic and sad that none of the employees – teachers, accountant, ayah or cook – is provided a minimum wage. The maximum paid is Rs. 2000 p.m. to the teachers. Navnirman Trust, the trust supporting JMS, does supplement this salary, but how conveniently the government ignores its own laws by cloaking it in terms like 'honorarium' and 'contract work'!

Chilipili refers to the sound birds make and the goals of everyone involved in the school is to make the children as cheerful as birds. And I think they have succeeded. The kids have all also learnt such beautiful songs – many of them original and some that teach them about the country etc. Some of us, especially the crooners in the group, began to feel a little sheepish that most of the songs we knew were timepass Hindi film numbers!

Later, we headed to the market which spilled over throughout the village - the main street, the side streets and an empty space in front of a temple. We managed to get our fix of junk food and also some local mangoes.

The final trip of the day, which in hindsight should have been avoided, was to meet with the women of the neem fertilizer group, the third and last income generating venture of JMS. We sat in the trailor of the JMS tractor and were driven a few kilometres to the village of Muddanagudi. By the time we went around the village once (and were invited into numerous households), it was quite late. The women had spent the entire day collecting and drying neem seeds and were too tired to have a meaningful discussion. We did learn that this venture is reasonably successful and that it is the most local of all the 3 ventures – nearby farmers purchase the fertilizer. It was a tired lot that returned to the JMS hut and turned in for the night.

Potnal ooralli (in the village of Potnal)

June 25^th, 2008

We reached the JMS (Jagruta Mahila Sangathana) premises in Potnal, Raichur dt. on Tuesday night and woke up to the sound of children busy at their morning tasks. A child labour school is run in JMS and the room we were sleeping in was usually used by the boys who had slept in the hall instead.

After our breakfast, we were introducted to the JMS staff. The organization was formed by 8 people in 1999 – 4 from within the area and 4 from outside. Today the locals run the organization with a little help from the outsiders, including Premdas who is now with CHC. There are 6 Sanchalakis – convenors of the village sanghas, plus 3 teachers in charge of the school and a cook with 2 assistants. JMS started its work in 4 villages and now operates in 20 villages with 40 sanghas and a membership of about 800.

The challenges of working with Dalit women in Raichur dt., one of the most underdeveloped areas of Karnataka, was elaborated on through numbers and anecdotes. The literacy rate is about 1% among these women, most are landless or have less than 2 acres of unirrigated land and they face discrimination and even violence from upper castes. Further, being women, they face violence at home and get less than half the daily wage that men receive. A 3-year drought in recent history led to large-scale migration from the area. However, since forming Sanghas, the women have been able to unite and mobilize against injustice. In one incident, a woman was paraded naked in her village as a 'punishment'. The JMS women protested for action against the offenders and even managed to shut down Potnal, a big-sized village with plenty of shops, for a day. Legal action was taken and the woman received compensation. Another time, JMS organized a habba (festival) that was attended by the local MLA. The women demanded that he sanction funds for a road and he agreed. Their menfolk were unhappy with their actions and refused to cooperate, so the women began digging the road themselves. Their most notable achievement, in my opinion, was their action against harvesters - these machines were taking away the livelihoods of families already under distress. Their mobilization led to harvesters being banned throughout Raichur dt., a first in the country.

Later in the day, we met with John, a post-doctoral fellow from the University of London. He has been visiting Karnataka for the last 3-4 years, studying the impact of post-Washington consensus on PRIs and government programs at the village level. In brief, his conclusions are that the withdrawal of the state, which has been cloaked in 'governance at the village level', manifests itself through the poor technical support given to projects, understaffing, systemic corruption and the transformation of NGOs into contractors. He talked about how civil society is being depoliticized and neoliberalized. He also analysed the performance of NREGA and NRHM. I felt that the work and analysis he was doing needed to be shared in wider platforms than just academia and he replied that he was doing that to a certain extent and looking to disseminate his findings more widely.

Afterwards, Premdas led a session on Hyderabad Karnataka. The districts of Bidar, Gulbarga, Raichur, Koppal and Bellary were all under the Hyderabad Nizam's rule. In fact, they received independence on September 17^th, 1948, more than a year after the rest of India. The Nizam retained the feudal system and the effects of this can still be seen today in terms of the huge inequities in land holdings. For example, a sitting MP, Rajarajeshwari, owned more than 10,000 acres. After 4 years of protest, she distributed just 100 acres of her land, that too of poor quality. In contrast, in coastal Karnataka, tillers in the lands of absentee landlords wrested control of the land after the Land Reforms Act was passed by the Indira Gandhi government. In Raichur, after the TB dam was built, land values further increased and there was even more encroachment by the landlords. In the earlier session, one Sanchalaki had talked about some rudimentary toilets the women had built, more to give themselves privacy than for hygiene purposes. This is directly attributable to the overuse of land.

We also spent some time going over statistics on health, education etc. in various districts in Karnataka. The districts of Hyderabad Karnataka were almost always at the bottom of the list. A lot of money has been pumped into these districts but has had little impact in the light of the strong structural inequities in place. However, the work done by JMS and other organizations in the district have shown that even in such situations, some change can be brought about through collective action.

As the day drew to an end, the shouts and laughter from the children drew us outside into the yard. As is common throughout India wherever there is a little place to be had, a cricket game was in progress. Jeyapaul, Sabyasachi and Lakshmi jumped into the game almost instantly with full enthusiasm. I stood around watching for a while until I noticed that only boys were playing and a group of girls were watching them. This wouldn't do! I went up to them and suggested they also play, at which they turned around and asked me to teach them a game! I was stumped for a minute, then remembered wishing I could play 'lagori' recently. Varsha joined in as did one of the schoolteachers, Sakeena. The game was played furiously – Varsha is as competitive as an eight year old – and I had an amazing time.

Later that night, when the children were saying their nightly prayers, Jeyapaul taught them a song that goes:
'Every single cell in my body is happy
Every single cell in my body is well
I thank you God, I feel so good
Every single cell in my body feels well'
complete with action and repetition at different speeds. What a fun little prayer it was!

Mining wealth and poverty

23^rd - 24^th June 2008

Week 4 of our orientation was a field trip to Bellary and Raichur districts. We spent the first 2 days in Hospet in Bellary district. Our guide for the first day was Bhagya, a coordinator with SAKHI, an organization working with SC/ST women in Koppal and Bellary districts. In some areas here, the literacy rate of Dalit women is less than 10%! There are also high rates of child labour and child marriage and the Devadasi system still hasn't lost its stronghold here. SAKHI is trying to counter all this with counselling, dialogue, meeting young girls in hostels and working with them to improve the facilities etc. They've had success stories of girls going on for postgraduation and some getting government jobs etc. SAKHI has also been handling rape and abuses cases both legally and socially.

We then began discussing an issue very close to Bhagya's heart – mining. In the past 8-10 years, Bellary dt. has been transformed by the proliferation of mining operations. There are now atleast 138 open-cast mines in the district. It is very hard to campaign against them – in 2003, there were some farmers' protests. But 2 years of drought followed, so though these farmers realized the ill-effects of mining, they often ended up leasing their land for this purpose. For local organizations to work on this issue would be tantamount to suicide – already SAKHI's quarters have been raided because they had filmed some of these operations. Now, after the most recent state elections, the situation is even more intractable. One of the big mine owners in the area was elected as an MP and is now the Health Minister!

The SAKHI members talked about the health effects of mining. Deep shaft mining contains the dust generated to some extent, but open-cast mining is at the surface and does not allow for any protections for nearby areas. Rates of respiratory disease are on the rise, especially TB. Historically, this area was under the Nizam rule and has poorer health facilities than the rest of Karnataka. So the people face a double burden, unable to access good government health services – even the TB hospital in the area was closed recently. And then there is the psychological toll that the sudden influx of cash into a few hands has created in Hospet and other towns...

After the discussion with SAKHI, we headed out to visit a mining operation. As we discovered, open-cast mining can be done with very little machinery – in its simplest form, a JCB unearths a heap of soil and then workers sift through these to collect stones that might have iron ore. The stones are later sorted by weight – the heavier ones more likely to contain ore – and sent to a refinery. A little more equipment is required on hills – we saw hills in the process of being razed to the ground bit by bit.

The landscape in these areas is coated by red dust – whatever trees and shrubs still survive are struggling. And in these conditions, men, women and children slog on for indeterminate periods of time because they are paid for the amount of stones they can sift out. We chatted with a few people who were working at one operation – they said they got Rs. 10 for a small bag of stones. They can collect anywhere from 10 to 20 bags a day. They said that these were better wages than they were getting in their villages – a lot of them were from neighouring districts, some in Andhra. But there were also people from Tamilnadu, Maharashtra and beyond. Almost all the groups working in this mine were entire families, with children of all ages at the mine site and those old enough to lend a hand working. While we could clearly see children as young as 8 working, they told us that they were 16 years old...

While meeting these people was insightful for us, I felt very uncomfortable. Here we were - a huge group of well dressed people, clicking away, taking photographs without asking permission or even thinking it was necessary and intruding into others' lives. And while we saw these people as victims of a system that neglected their needs and then forced them to work in such conditions, was it fair of us to objectify them? A number of them had made a rational decision to work there. As they said, there was very little work in their native towns and villages, so by working here for a few months, they would make a good amount of money. Later Sabyasachi, who has lived in Jharkhand, made a strong case about tribals making an economic decision to work in mines even though they may be doing reasonably well in their native villages. Though I didn't fully agree with his analysis – this could be a forced choice – I feel we have to deal with more sensitivity in such situations. Otherwise, we will also be guilty of having engaged in social tourism...

In the afternoon, in a study of contrasts, we went to visit the Tungabhadra dam. Or as it referred to locally, the TB dam. Thanks to earlier politicization and AID discussion, I had been sensitized to the folly of big dams. But many of my co-fellows had developed a change of perspective. Now, the number of displaced villages and the area of land submerged took on a new meaning. Now all the proclamations about the importance of this water for irrigation seemed hollow – more and more of this water is being diverted for mining operations and urban use. We sat at the dam site, discussed what we had seen, sang songs and hopefully put in some good karma at a place of short-sighted plans and massive folly.

The next morning, we visited various interventions of the Punyakoti Trust. This trust was set up by a psychiatrist, Dr. Ravi, and has been working on alcohol and tobacco de-addiction, community psychiatry etc. In their alcohol and tobacco de-addiction programs, they make sure to involve the entire family and try to find jobs for rehabilitated individuals. Their new intervention is very interesting – they have contacted all private GPs in Hospet and now a social worker will be present once a week in most clinics. The job of this social worker is to be present during diagnosis and assess if the patient has a mental illness. A lot of studies are claiming that up to 50% of the general population suffers from some kind of psychological disorder at some point in their life. This effort could be clubbed as one to weed out the psychological from the physical and treat the patient accordingly.

Later, we visited Manochetana, a school for mentally retarded children run by Punyakoti. Here, about 20 children are looked after by staff and volunteers fro half a day while other children are brought in for therapy. The center has been running throgh community support and with a percentage of Dr. Ravi's earnings. The school is very thoughtfully built, with a lot of green and yellow, supposed to be visually soothing and plenty of uneven structures to provide mental and physical stimulation.

Dr. Ravi joined us later to discuss this and other efforts he has been involved in. According to him, in all of Northern Karnataka, with a population of about 1.2 crores, there are just 12-15 psychiatrists (most of them in the Hubli-Dharwad region) and ~30 beds for psychiatric care. This is woefully inadequate. But given that most psychological disorders can be alleviated by counselling and 45% of these disorders can be treated by people receiving paramedical training, there is a lot that can be done in the community. Therefore, people have been trained to identify mental disorders – people with physical disabilities have proven to be particularly adept at this – and ANMs, anganwadi workers, BSW graduates etc. have been trained to provide counselling or referrals. Punyakoti has even worked with women suffering from domestic violence, providing counselling if alcoholism is the problem, referring the family to legal services if mediation is possible and referring them to court if not.

We asked Dr. Ravi about the effects of increased mining on mental health and mental retardation. While the former can be easily linked – migration, a sudden influx of cash and environmental degradation can all lead to stress and mental disorders – the latter is less clear. The mining boom is very recent and it might take some time for it to show up in birth defects. Ravi did mention that a rough survey of Hospet indicated ~330 mentally retarded children in a population of 1.5 lakhs, which is slightly higher than normal.

All in all, an impressive array of work in a field and region that is grossly underserved...

After our time with Punyakoti, we had a few free hours that we decided to spend visiting Hampi, which is just about 15 km from Hospet. The capital of the once-mighty empire of Vijayanagar was a sight to behold. For ruins of this magnificence (it is designated as a UNESCO world heritage site), there were few visitors. Fields of sugarcane and banana dot the landscape as do huge rocks. In a few cases, a little exploration showed us yet another temple hidden from the casual eye. I was left wondering how this empire settled on a capital that was in such a dry region. Yes, there was the Tungabhadra, but these ruins were some distance away from the river. But then discussion revealed that this kingdom traded extensively in gold mined from the Kolar gold fields. Yet another rags-to-riches story based on mining? I'll have to revisit Indian history books!

Bettasivanna and Kaveri

16th - 17th June 2008

We were to head to a village called Prakashpalya for lunch in the afternoon. This is where Holy Cross operates a school for former child labourers. It was nearly 1 pm when we reached the school and as we were approaching, we could see all the children lined up outside in the afternoon heat. Some of them started playing band instruments as we approach, with the drummers being extra enthusiastic. The children escorted us inside the school and assembled in a room to give us a little welcome program. They performed very well and we enjoyed ourselves thoroughly. Later we had a round of introductions of the visitors, the teachers and the children. We had asked the kids to tell us where they came from and what they wanted to do when they grew up. For the boys, the most common answer was 'police' and 'military', though some did say 'master' and one or two wanted to be lawyers. For the girls, it was either 'sister', 'teacher' or 'housewife' – a few said 'doctor' and one surprised everybody by saying she wanted to be a bus conductor! There were some older girls in the age group 14-18 years. They were being provided vocational training in tailoring, baking etc. Even this training is covered through NCLP.

The headmaster, Mr. Ravi, talked about the school mission, activities and the children. It seems they hold a parent-teacher meeting every few months and in general they do not encourage the parents to visit often. The most frequent a parent visits is twice a month – most are less frequent. We asked about that and he cited financial difficulties on the parents' side also being a factor. He said that most parents were happy with the facilities their children were getting and grateful for the opportunity of an education. The children stay in this school for upto 2 years – this is geared to be a bridge school – and afterwards are mainstreamed in residential schools. The teachers do follow up with children who have left, meeting with them and helping out in personal and educational difficulties.

Soon it was time for lunch and we left for a delicious meal. Though the children had fewer items than us, they still got more variety than I have seen in many a rural setting. One of the kids' activities is square metre gardening – they grow a good share of the vegetables they consume. The school also has a papaya grove and the children get to eat the fruit a few times a week. Overall the facilities were well-maintained and cheerful and the children did seem to be happy there. However, there are runaways – just the previous day, a child had vanished. The school does try to check whenever possible if the child has returned to his or her parents, but then do not force the child to come back.

Our long day was far from over – we left to go to visit one of the Health Promoting Schools that the Hannur Program is working with. The school building seemed quite new and there was also a hostel nearby. There seemed to be just one teacher for 3-4 classes and he assembled all the children from Std. 1 to 3 in one room. The body language of these children could not have been more different from the children in Prakashpalya. Where those kids seemed curious, confident and noisy, these were eerily quiet and looked terrified of all the strangers in the room. Karibasappa, one of the CHC fellows, tried to engage them in various activities for a while (he used to be a teacher) and they followed and even seemed to enjoy them. But once done, they returned to their silence and didn't answer any questions about the health and nutrition related activities they had participated in last year. Their master did seem quite intimidating, walking around outside with his stick tap-tap-tapping on the ground. We all left the room feeling a little depressed.

Our next meeting was in another room in the school with the local farmers' group. This group was set up to facilitate various activities that farmers need help with, whether it be bank accounts or applications with the district officials etc. We had earlier seen teacher Karibasappa in action and now we got to see leader Kari in full force. He exhorted the farmers to think about why they had come together and what they could achieve as a sangha. One of the members of the group, a CHW, had told us about the problems they faced with health issues and he talked about what they were entitled to receive from the government. The road connecting their village to the nearest town was in bad shape – they should take up that issue together and demand improvements. Further, most of them were Adivasis – a lot of government schemes had been devised for them, at least on paper, and it was up to the people to use them for their benefit. His speech breathed energy into a muted lacklustre meeting – I for one had been dozing off earlier, but what's new about that?!

Our last visit in a very long day was to Rajappajinagar to meet a lantana furniture maker and his sister who helps him and also works as a CHW. Lantana furniture making was conceptualized in this region by ATREE with the goal of protecting bamboo, which is endangered, and keeping lantana, an invasive species, under control. Lantana furniture seems less sturdy than bamboo – the stems are more slender – but they are still quite elegant and definitely affordable in an urban market. But that in itsef is a problem – accessibility to markets. Bangalore is far away and such a sophisticated market requires more consistency and perfection than this furniture maker can manage currently. Currently, this furniture maker is selling his goods in smaller markets which are more forgiving, but that is not enough to earn him a good livelihood. But he manages...

Then the sister, Jedemadhamma, began talking about her health work and this was easily the highlight of the day. She recounted learning about herbal medicines and treating the village folk inspite of their initial scepticism. She was married in childhood and doesn't remember her husband – she only knows that he died young, after which she returned to her native village. Become a CHW has given her unparalleled respect, given her socioeconomic status. For her work treating illnesses and assisting in childbirths, she might receive a blouse piece or some few handfuls of ragi. But the satisfaction she receives doing this work is clearly visible.

This is a remote place, less than a kilometre from the forest that forms the border of Karnataka and Tamilnadu through which the Kaveri flows. The Soliga tribespeople lead a hard life – she told us how pregnant women go into the forest to collect timber and produce and sometimes return with their baby in tow! So Bettasivanna might be so named because he was born on a hill and Kaveri might have been born on the river's banks. We left Jedemadhamma's house long after darkness had set in, stumbling a little and marvelling at the lives of these hardy people.

Our tour of the Hannur area didn't end there – early the next morning, we went to visit a village where the watershed program was being implemented. This area is slightly hilly and has experienced massive deforestation in the last few decades. In more recent times, these forests were the hideout of the infamous Veerappan and ironically were better protected because fear of the bandit kept people and logging companies away.

The major work of the program has been to construct bunds, gully checks etc. that would make the water 'walk, not run'. This has been quite successful – farmers contributed their labour and materials and though they preferred straight rather than contour bunding, the bunds have been successful in increasing soil accumulation on the fields. Some farmers have even been able to plant crops where earlier there was not an inch of soil to support them. The next part of the program has been less successful. With trees donated by the Forest Department, MYRADA launches a massive tree planting programme each year. And each year for the past 3 year, the trees have dried up in the dry season and died. Why has this program not worked, I asked, and had work hard on getting an answer. It seems that the root of the problem is that most adults in the village migrate for work in the dry months leaving only their elders and cattle (and sometimes children) back home. So there is no one to take care of the saplings. Animals eat or trample them and that's that. Seems like a problem that can be addressed if the NGO puts some effort into it and the community is vested enough...

We went to visit the village later – it was a stark example of a water-deprived community. They get piped water for half an hour each day and in that time all 80 or so families have to fill up enough water for their daily needs. In this season, before the rains, there aren't any other sources of water. Everyone seemed to be waiting for the rains to come.

We had similar discussions here as in previous meetings, about health, work, government services and migration. These past few days have made me think more about seasonal migration and how it impacts communities' native villages. How hard it is to implement any kind of developmental initiative with this kind of instability!

Our last visit during the Hannur trip was to a day bridge school set up for former child labourers. A lot of these children were from the Muslim community and Urdu speaking, so I could finally chat freely. During our introductions, I ended up saying, as has become usual, that I do not have any one place to call home. This led to an impromptu geography discussion with the kids. The nice thing about this school, like the one in Prakashpalya, was the amount of information displayed on charts and the words written on flash cards and hanging from the ceiling across the room – plenty of visual stimulation. Among the charts was a map of India that was useful in our discussion. There were about 20 kids of all ages in the school and it was interesting to see how they were all learning different things in the same room.

We returned to the Hannur program centre to thank the sisters for their hospitality – the food and fruits they provided were a feast – and pick up our bags to leave. It had been a whirlwind tour but, like with everything else at CHC, had provided plenty of food for thought...

Callings and financial incentives - the motivations for community work

15th - 16th June

Our first field visit as CHLP fellows was to Hannur, a town in Kollegal taluk in Chamarajanagara, a district in Karnataka that borders Tamilnadu. We left early Sunday morning and arrived there in the afternoon. We had briefly discussed the plight of border districts – they tend to be neglected and usually have lower developmental indicators than the rest of the state. Chamarajanagara continues in this trend, with indicators more like northern rather than southern Karnataka.

In Hannur, a group of sisters of the Holy Cross Congregation run a community health intervention. It was initiated by Sr. Aquinas, a doctor who worked in a nearby Order-run hospital. She noticed the poor rate of retention of TB patients on DOTS (Directly Observed Treatment, Short-course). Patients who stop the treatment mid-course are more likely to develop drug-resistant TB, which can then spread in the community. She decided to train community health workers to provide follow-up for TB patients. As she and other sisters began their work, they realized that TB was the least of the problems that plagued these rural, mainly Adivasi communities.

Since then, the Holy Cross Comprehensive Rural Health Program at Hannur has trained a number of women in basic healthcare, safer deliveries and herbal medicines. Sister Teena gave us a brief presentation of their work. Beyond training CHWs, the Hannur Program has also organized health camps with GPs or specialists such as opthalmologists and has conducted sessions on health and nutrition in government schools that are designated as Health Promoting Schools. With help from Vellore Medical College (VMC) and CHC, they have developed a Health Information System that collects health data, analyzes the outcomes of specific interventions and makes the case for new ones.

The Program has partnered with a local NGO, MYRADA, to work on watershed development and some income generation activities. It is now actively involved in preventing child labour in the region. Child labour rates are very high in the district and in recent years, NCLP (National Child Labour Project) has focused efforts here. The Hannur Program works to identify children who have begun to work or who are at risk and places these children in a residential school.

This aspect of the Hannur program's work is controversial and Sister Teena was quite open and frank about it. Before NCLP got involved, the sisters would themselves go to meet the child, get the parents' approval for their child's placement through persuasion or with the threat of reporting their illegal action. In some cases, they have paid off bond money if the child was bonded to some landowner, factory owner etc. Now, with NCLP conducting raids and follow-up, their direct intervention is usually not necessary. But problems remain. Sometimes raids net children who are going to school and working evenings or weekends to pay school fees or buy books. The problem is: according to the law, children should not be working at all. Another aspect some of us found troubling was that children are effectively removed from their parental home and have very little contact with their parents afterwards. Sister Teena said that organizations working on the issue have found this to be the best approach.

The patience, strength and conviction exhibited by the sisters and staff when talking about their work was quite impressive. There is limited support within the church, as with most big institutions, for this kind of work that involves learning from the community and adapting to fit its needs. Yet these women soldier on and take satisfaction in every achievement, big or small.

The next morning, we went to visit the MYRADA office in Hannur. This centre coordinates the watershed development efforts in the area and conducts vocational training for TV repair, basic computer maintenance etc. They also provide operational support for a number of Community Based Organizations (CBOs). Most recently, they have started working with Panchayats on Participatory Planning activities.

From their talk, I received the impression that this is a typical NGO, which gets money to implement programs and therefore does them. One thing stood out – the charges for the vocational training. For training in driving, the NGO charges Rs. 2000. This seemed comparable to and maybe more expensive than commercial driving schools. I asked about job opportunities for this and other trainees and learnt that they mostly move out of the area to Kollegal, Mysore, Bangalore etc. and remit money home. How does this benefit the local community? Sure, more money flows into households, but is an NGO necessary for this kind of improvement?

Our next stop was the Hannur Primary Health Centre (PHC). At CHC, we have been learning about the basic amenities that government health services must provide and received a questionnaire that is being used by groups involved in community monitoring. We started our visit with the PHC Medical Officer (MO). This person was quite uninterested in us until he realized that Sukanya, who was coordinating this trip, is a doctor. Then he wanted her to be seated and have a cup of tea, which she very politely refused! He gave us some details of the PHC's operation and gave us permission to tour the facilities. All through our discussion, he continued treating patients, which was quite an education for us...

This PHC used to conduct minor operations but now is only restricted to deliveries. As with most other PHCs, it is understaffed – the lab technician and pharmacists alternate their time between this and another PHC. However, it had a functioning lab where we observed a simple haemoglobin test. They also conduct tests for various infectious diseases including TB. The pharmacist showed us their ice box which is used to store vaccines. It is able to maintain the correct low temperature for up to 24 hours without electricity. There are smaller ice boxes that the ANMs take with them on immunization days.

Later, the Block Health Officer (BHO) talked to us about his tasks. He is responsible for checking water sources to make sure they are fit for drinking, monitoring for malaria and other outbreaks, working with Village Health and Sanitation Committees (VHSCs) and more. He elaborated on the staff shortage – 4 of the ANM positions and 6 of the Male Health Worker (MHW) positions have not been filled. Each ANM is responsible for running a subcentre – if there is a shortage, many are responsible for 2, which means that many subcentres cannot open every day. The technician, pharmacist etc. shortages are rampant. Even this BHO is responsible for 2 blocks. With conservative thought dominant in India and throughout the world about the 'inefficiency of government' (paradoxically, alongside huge government programs), there is a deep reluctance to hire staff. This then leads to failures in the Health system, overworked employees and low morale. However, the BHO was still quite upbeat and positive about his work – kudos to him.

Finally, we went to see the delivery room with the staff nurse. There had been a delivery just that morning and the room still had a strange smell to it. A sterile delivery kit had been used and the room in which the new mother and her baby lay was in reasonably good condition. There has been a large drive nationwide to encourage institutional rather than home delivery. Families receive a cash allowance on the birth of a child, which is higher if the delivery is in the presence of a trained physician and also higher if they are Below Poverty Line (BPL). This scheme is called the Janani Suraksha Yojana (JSY).

In Karnataka, the new mother also receives a kit with a blanket, some clothes for the child etc. under a scheme called Madilu. We looked at a few of these kits. Finally, we talked briefly with a few ANMs. They looked so young, barely out of girlhood! Later, we learnt a snippet of history from Ravi (Narayan) that helped put this in perspective. After independence, one of the first needs of the young nation was to establish medical and nursing colleges. Rajkumari Amrit Kaur, the first health minister, pushed for training older married women as nurses. The dai tradition was strong and continues to be strong in India. As a rule, dais have experienced childbirth themselves. This helps them to be more empathetic to the to-be mother's pain. Further, by their age and experience, they have some respect and following within rural communities. How could young girls, fresh out of school, be expected to talk about family planning, child rearing techniques and more in rural India? But Nehru, in his continuing fascination with the West, vetoed this idea and the tradition of training girls right out of school was established. What a pity!

Everything is connected to health...

June 2nd – July 5th 2008

In the second half of May, we went on a family vacation to Kerala with Dwiji's parents, brother, sister-in-law, sister and nephew. It was good fun and the longest purely touristy vacation that I've taken in India. The sociopolitical part of my mind was on partial hibernate, though it was active enough to think about the negative aspects of tea estates around Munnar. The spice gardens of Thekkady seemed better, especially because of the number of small landholders. And the backwaters of Allapuzha brought forth all kinds of thoughts about land reclamation, intensive cultivation and the instability of such places in light of global warming...

I had been selected as a fellow at Community Health Cell (CHC) and started the orientation on June 2nd. I learnt a lot in the following 5 weeks and will not document it all here. Instead, following is a brief report I submitted at the end of the orientation. I will also post detailed reports of the field trips we made to Hannur, Hospet and Potnal.


CHC Orientation

Having only a vague idea about CHC, I started CHLP with very few expectations beyond getting a grounding in community health. Ravi (Narayan) mentioned in one of his sessions that he thought of CHC as a 'sarai' that provided some space and time to fellow travellers. That is perhaps the best way to explain my viewpoint when I started the program. However, the orientation turned out to be much more than that.

Starting off, the CHLP fellows of 2008-09 couldn't have been better chosen. The diversity in ages, backgrounds and interests of the fellows was impressive, to say the least. There is a lot we can learn from each other and I hope we can manage that during the course of the fellowship. The 'group lab' session and the group assignments helped build connections and the time spent together during the field trips also allowed us to interact to a greater extent. We have learnt much more as a group than we would have individually, I believe, and that has underlined the importance of 'community' in community health.

The sessions that made up the orientation program could be broadly divided into the following categories:

1. Overviews of concepts such as Primary Health Care, globalization and the public health approaches to disease.
2. Specific topics of interest, for e.g. tobacco, non-communicable diseases, immunization.
3. Analysis of existing structures or approaches, for e.g. understanding social movements, the lacunae in public health approaches to disease.
4. Personal journeys such as Sunil Kaul's experiences with the ant and Lalitha's description of Tribal Health Initiative's (THI) work.
5. Field trips to organizations in and near Hannur, Hospet and Potnal.

There were overlaps, of course, and interwoven with most sessions were stories that breathed life into dry concepts and definitions. The breadth of topics and the varying styles of the facilitators kept us on our toes and motivated. I could not have imagined further reading after a long day of classes and yet that is what I often found myself doing!

At the end of the orientation, I have gained a much better understanding of community health as a concept, a philosophy and a uniting issue for mobilization. The ideas that I had about livelihoods, education etc. being connected to health have been solidified with data and examples. The sessions covering the history of community health have provided a foundation, those that were about specific issues have provided detail and the analyses have provided perspective.

The field trips were invaluable for understanding how the issues we talked about manifested themselves practically. At the same time, our field interactions with health and development workers, medical professionals and the community were enhanced by our in-class learning. We understood how to apply the lens of caste, class and patriarchy to various aspects of community work. Due to the presence of experienced activists during our field visits, we also got to see some approaches of interacting with and motivating the community. I realized that even in initial interactions where the focus is on our learning from the community, it does not hurt to share some useful information and to speak from the heart.

Finally, the positive and can-do attitude of everyone we interacted with is heartening. The road to good community health is littered with failures, unavoidable detours and roadblacks. Yet those who are working on these issues have not lost their enthusiasm for it and are motivating entrants into the field. The orientation session has left me brimming with ideas and enthusiasm. My thanks to the CHC team for their untiring efforts!

End of a chapter

9th - 13th May 2008

As I'd mentioned earlier, Richa had asked me to present my writeup of the organization and the project proposal to the SKMS core committee. The committee members are Richa, Surbala, Reena, Kamala, Shammu, Rambeti, Sunita and Maya with Richa Nagar and Mukesh as advisory members. While Richa, Surbala and Reena are actively involved in all aspects of the organization, the others are newer and have varying levels of involvement in and understanding of the organization. Also, with the varying levels of literacy in the group, most ideas would have to be communicated orally. However, the enthusiasm and motivation of these women and men is very high, so I'm sure they will be equal to the challenge ahead of them.

On the 9th, we gathered in the usual meeting place, the Dak Bungalow in Mishrikh. We started off by discussing what SKMS does and moved on to what it should be doing and how those goals could be achieved. There were a few issues that I needed clarification on and the group did not disappoint. We have often heard that our way of analyzing situations is framed by our socio-economical background, education etc. and therefore we must be very careful not to apply our value system to someone else's life. This meeting gave me a valuable glimpse into this. It allowed me to put a lot of the principles I had reflected upon in a theoretical manner into practice.

The meeting adjourned at 4:30 pm because Rambeti and Maya had to head back to Pisawa before the last jeeps and tempos left. Mukesh, Dwiji and I headed back to Sitapur to brief Richa about it – she had been at another meeting. She had also not planned to attend this meeting to give space for the other committee members to speak.

On another front, a number of stamp papers had been issued in Sitapur dt., presumably to get more false affadavits signed. It was decided that a pre-emptive approach was necessary to stem this. A list of villages where SKMS was vulnerable was drawn up and plans were made for a 'pukka saathi', a seasoned SKMS member, to visit the village in the next few days in order to shore up the confidence of the SKMS members there. A set of 'difficult' villages was given to Richa to handle.

While all this was going on, our current stint in Sitapur was drawing to a close. I had applied for a fellowship at the Community Health Cell and the first 5 weeks of the program would be in Bangalore. Before that, we planned to go on a family vacation with Dwiji's parents and siblings. We found that we could all take time out in the second half of May and plans were made to go to Kerala. Therefore Dwiji and I were leaving on the 13th for Bangalore.

It was hard to believe that only six weeks had passed since we came to Sitapur. We had learnt and experienced so much. We had gained a solid appreciation for the ground realities in Sitapur. The experience also left us brimming with ideas and enthusiasm. This will definitely be the first of many stints with SKMS...

A bend in the road

7th - 8th May 2008

Our plans for another village meeting the following day were cut short because of a new development. In a number of villages, Pradhan and district officials were pressuring people to sign affadavits saying that they had falsely applied for NREGA unemployment allowance. In a village close to Aant, some villagers had already signed affadavits. So on the evening of the 6th itself, we headed to that village.

Richa and Sharmaji met us there. This was yet another kind of meeting that we got to see, one where the village group was under pressure. There were quite a few arguments among the villagers – a father shouting at his son for signing in his name and another villager asking how on earth they could say no when the Pradhan appears at their doorstep along with other powerful men in their community. There are no easy answers in these circumstances, but Richa did an amazing job exhorting, chiding, reasoning with and inspiring the assembled crowd. Finally, after all the discussion, a plan was made to submit a complaint to the SDM the next day.

We left the next morning for Mishrikh and a group of villagers met the SDM and submitted their complaint. Later, Dwiji and I returned to Sitapur. Richa and Sharmaji were discussing the ramifications of this development. Since all these people had already given sworn statements to the investigation committee about their eligibility for unemployment allowance, it was unlikely that these affadavits would make a difference in the official process. But perhaps the Pradhans were planning to go to court. At this point, everything was speculation and conjecture.

Richa, Dwiji and I discussed the Kunwarapur meeting. She recommended that we meet with all the core committee members and discuss the project proposal. Some of the members were new, most of them were barely literate, so I would have to come up with ways of communicating what I had written down about the group and its planned activities.

Later in the night, Richa got a call from an SKMS member in a panic. He had been out in his orchard when a group of people close to the Pradhan came and started yelling at and threatening him. He had run away from that spot and into the village where his friends and family were. At the same time, another villager there who is part of SKMS had been arrested on trumped up robbery charges. Things were heating up, indeed...

It was decided that Richa, Sharmaji and Dwiji would go to the village and Reena would meet them there. I stayed back to keep the numbers down and get my other tasks done.

The arrested villager was released very soon – it was quite apparent to the SI (Sub Inspector) that the charges were trumped up. Richa and the others then proceeded to the village where they had a long discussion with both parties in the previous night's conflict. What seems to have been happening as SKMS's work progresses is a realignment of the power structures within villages, which upsets those that prefer the status quo. In some places, SKMS members are more sensitive to the situation and are able to defuse situations before they erupt into conflicts. In other places, SKMS members are either less sensitive or more hot-headed! Well, all part of growing pangs of an organization or increasing self-assertion of the oppressed, depending on one's point of view...

On the road to participatory planning

5th - 6th May 2008

Richa and I returned to Sitapur on May 1st while Dwiji arrived 2 days later. Reena had made plans for us to spend some more time in the villages and so we set off for her house on the 4th. I had been working on a project proposal for the group and wanted to talk to the dairy cooperative to get their inputs on it. There were plans to organize village meetings as well.


On the 5th, we sent out to Vaikunthapur, a village about 8 km from Reena's house. Shammu joined us and the plan was to go by bicycle. Problem was, there were only two cycles available. Now Reena had no problems sitting on the carrier, but I was sure it was going to be uncomfortable. And sure enough, sitting behind Dwiji meant a joyride with no joy in it whatsoever. So we switched and Dwiji and Reena went on ahead. Shammu and I walked for some time, I sat on the carrier wincing occasionally for some time and I rode the cycle while Shammu ran alongside for some time – poor Shammu!

Vaikunthapur is part of a cluster of villages which includes Gopalapur where there are strong SKMS supporters. The group in Gopalapur even brought along a portable sound system and set it up at the meeting place. Groups from the villages of Ramnagar Tevti and Sibiliya attended and the sound system ensured a bumper turnout, so the atmosphere was much more vibrant than at previous meetings. Reena was conducting the meeting singlehandedly so the sound system really helped.

The proceedings did get interesting at some point as the Pradhan's son was in attendance and strongly objected to some of Reena's statements. A fight would have broken out if calmer heads hadn't prevailed. All in all, an interesting time...

While heading back to Kunwarapur, we stopped by in Sundar, an active SKMS member's house. During the conversation, we found that they had harvested a quintal of oats. During our earlier stay in Reena's house, we had eaten powdered oats with jaggery and mango chutney that was delicious. So we asked for 5 kg. of roasted oats. Initially, Sundar's family refused to take any payment from us. We then got into a discussion of how well-off we were, how it wasn't fair that they would charge their neighbours but not charge us etc. They finally accepted our cash and I think we didn't browbeat them into it!

We returned to Kunwarapur to wash up, cook and eat and plan the next day's activities. I haven't talked about bathing in the villages yet, have I? Not having a toilet is something I can get used to, I think – there are plenty of fields and trees in this part of the country. But bathing is an open-air activity in front of the hand pump. Richa advised me to be bold and ask the menfolk to leave the courtyard when I wanted to bathe, but most women can't do that and pretty much have incomplete baths partially clothed. Incidentally, Dwiji chose to bathe one evening at the handpump near the dairy and soon found himself gawked at by half the neighbourhood!

The next day, Reena called a meeting of the dairy cooperative. The dairy was set up in 2004, got funds to construct a two-room building and even got a road to the dairy sanctioned. However, it has not been smooth sailing where the functioning is concerned. Parag dairy in Sitapur is the main buyer of the milk and the relationship with them has had its ups and downs. A big problem has been the transportation of milk. It takes an hour to get to Sitapur and in the event of extremely hot weather or road delays, the milk is spoiled when it reaches the dairy. The cooperative is planning to buy a pasteurizer/cooler but is not sure how to get financing for it. Parag would give them one but would then want to be the exclusive buyer of milk. Getting funding from non-profits is not easy and none of them have the collateral to take on this kind of a loan. Further, they are thinking of value addition in terms of making khoya (condensed milk), ghee etc. They have also been considering composting, given the increased amounts of manure in the village, and sustainable farming.


We sat in Reena's cowshed and talked about this and other issues for hours. I was really interested in finding out how the cooperative helped empower these women. Two or three of them in particular did seem to have found their voice in the past few years. One woman talked about how shocked Parag officials were when they flatly refused to take a pasteurizer from them. Another talked about caste divisions within the village. A question about why I didn't wear a mangalsutra led to talk about the treatment of widows. Finally, we talked about the funding proposal I was writing up and the possibility of an exposure trip for these women to groups that are working on sustainable agriculture. This is the first time I have interacted so closely with people on whose behalf I was writing a funding proposal. In fact, I felt that with a few more discussions and planning meetings, I could just serve in the role of facilitator and translator for this proposal. As it should be.