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!