'Left Out' - a short film on denial of health rights in Karnataka

Over the past few years, I've helped organize meetings and consultations, produced reports and participated in research studies which documented various forms of denial of health rights in India, mainly Karnataka. Recently, while documenting cases for a planned public hearing with the National Human Rights Commission (which was later cancelled), I had the opportunity to collaborate in a project to video-document some testimonies. Thanks to Dipti Desai's persistence, these testimonies have been compiled into a short film 'Left out', which is available on YouTube here.
The stories are from across Karnataka and reveal how hard it continues to be to access health care and to pay for it...

The Universal Health Coverage Numbers Game

Some years ago, during a sojourn in Sitapur, we began discussing Rashtriya Swasthya Bima Yojana (RSBY), the National Health Insurance Scheme which provides 'cashless care' for hospitalisation at 'empanelled' private hospitals. The RSBY coverage limit is Rs. 30,000 per year for a family of five. I was already involved in the research of government-supported insurance schemes in Karnataka, and knew that while they gave poor families 'access' to private hospitals (there are denials as well), the devil was in the out-of-pocket expenditure that followed.

Here the tale was different:
"हमने उनको भगा दिया", "किन को ?”  "अरे, कार्ड छापने वालों को!"
which roughly translates to: “We chased them away”, “Who?”, “The card printers!”

Every year, the RSBY card has to be re-issued, so Third Party Administrators (TPAs) go to these villages to enrol people in the scheme at a cost of Rs. 30. But my friends in SKMS (Sangtin Kisan Mazdoor Sangathan) were fed up of getting a useless card - “We go to Sitapur city with this card to all the private hospitals, but no one gives us free treatment”. So they refused to get enrolled and asked the TPA to leave. One year, the District Collector got involved – he went to some villages and requested the villagers to cooperate! But as far as I know, some are still holdouts.

Addressing health inequities through community-led advocacy in Bangalore – experiences, successes and challenges

For some reason, I have not written much about my work in Bangalore. Maybe because it was 'paid' work and I spent so much time writing reports, updates etc. in the style that the organization and funders required. Well, now that the project has wound up, here goes... Below is a paper I submitted for the Medico Friends Circle (MFC) annual meet in February - I modified it slightly for this post. It is a long write-up (almost 2500 words) and a bit technical. But I think there are interesting stories in there...

The return of Mayawati...

After the Uttar Pradesh assembly elections in 2012, it seemed like the era of Mayawati was over. All the scams in her government, plus the massive statues in the parks she built - these are routinely tolerated from other leaders, but for a Dalit woman at the head of a Dalit party to do so! Her upper caste support evaporated...

Now her star is on the rise again. Which is good. As a health activist, I am dismayed at what happened to the National Rural Health Mission (NRHM) under her. Almost all the funds were siphoned off during her tenure - though some accused are behind bars and others committed suicide, crucial time and money were lost. Since the Samajvadi Party (SP) government took over, health services have improved slightly, as has rural transportation among other things.

But, at the heart of it, the SP is a Yadav party in a society that is relentlessly casteist. A few days after it came to power, a Yadav farmer in Pisawan block, Sitapur dt. fired at a neighbouring farmer (who happened to be Dalit) because apparently the latter's cow had entered the former's field. There may be a back-story to this, but the general feeling was that the Yadav farmer would not have dared to take up a gun when the BSP was in power. Later, Sangtin Kisan Mazdoor Sangathan (SKMS) activists were beaten up by police in Qutubnagar when they had just gone to the chowki to give their side of a village dispute. The policemen asked which caste they were before thrashing them. To get an FIR filed in this matter, SKMS had to agitate for more than a month.

I don't think I need to state what the BJP stands for in its 'karmabhoomi' UP.

Coming back to Mayawati, maybe most of what she did when in power was symbolic, but symbolism matters in a society that is so unjust and unequal. Security and respect are pre-conditions for any social improvements. So here's hoping that if BSP comes back to power in the 2017 elections (and there is now at least a chance for it), that they will not squander this opportunity. Because, like it or not, unless the challenges of our most populous state can be tackled, our nation's progress will always be incomplete.

Note: After I posted this on Facebook, my nephew (Vishesh) remarked that what remains of the Congress UP state unit could fit into a Nano! Strangely, I didn't even think about the Congress when writing this :)

Empathy begins at home

Another original post on Facebook, September 5th:
 
Teacher's Day has got me reminiscing...

My mother passed away 5 years ago this month. While she formally trained as a teacher (for kindergarten and then middle school Maths and Science) and worked for some time, she did not enjoy the test-driven, regimented curriculum of most traditional schools. For her, sharing the joy of learning was most important. She enjoyed babysitting and tutoring and, with patience, was able to help 'difficult' children improve their performance and enjoy learning. When I was unable to grasp some concepts, she would ask questions and lead me to clarity even though she was not familiar with the subject/topic herself.

And she taught me empathy. I don't remember specific incidents from my childhood, but I can clearly recall one from about 7 years ago. By then, she was already ill and increasingly turning inward. I was telling her about the deepening communal and religious divides in India and how the 'other' is being dehumanized. Generally, when I have talked to my relatives about such issues, they either say 'oh, how great that you work on this' (again making me the 'other') or ask me why I'm wasting my time and not working in IT.

My mother, instead, related to me her conversation with a maid who worked for us in the 80s: When this young woman came to meet my mother the first time, she set her terms and then said 'I should let you know, I am a Muslim. Please decide if you want me to work for you'. My mother said that it was fine and Saira went on to work for us for many years. Recounting this incident, my mother said, "I felt so very bad - why was it even necessary for her to have to say this, to anticipate rejection?"

My mother wasn't a scholar or a radical. She wasn't as brave as her dreams and aspirations needed her to be, and so was dissatisfied with her life. But she gave the best of herself to guide others, as any good teacher does. And today, in the midst of so much indifference to human suffering, I wish more people could have her basic decency...