Friday, August 22, 2008

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!!

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