Saturday, February 19, 2011

Graduation Day

Hello from Aranbol, in Goa. This is India for those who can’t really stomach “India”- -a far cry fro Jamkhed to be sure, but it’s nice and relaxing and quite easy travelling. I have a lovely Cliffside room overlooking the sea and I’m enjoying a few days of well-deserved rest before I hit the craziness of Mumbai and then the different kind of crazy that awaits in Melbourne. This is a hippie traveller town and with the shops selling glass pipes and the dreadlocked white kids wandering around, I’m just waiting for Jerry to show up!

Before I go any further, just a quick tutorial on how to post comments, as I’ve received many queries. Apparently, you can only do it from the main page of the blog, so I’ve sent you the link to that page this time. At the bottom of the post, there is a place that you can click on for comments. From here, you should be able to then post. So please do!

I know I’ve been out of touch. The last week of the course was busy with our group project and since then, I’ve been travelling, without my regular wireless connection. I’ll go back to our final day at Jamkhed and return, briefly, to our beautiful graduation ceremony. The biggest problem with this is that you are all very behind and frankly, you have not completed the work you need to do in order to fulfil the requirements of graduation. I am more than partially responsible for this- in my effort to complete my group project- which was a hypothetical project cycle incorporating the key principles and values in an Aboriginal Australian context- I did get a chance to share so many aspects of Jamkhed that put the “Comprehensive” in Rural Health Project.

For example, I didn’t tell you about our visit with the Farmer’s Club members, who explain how the first place CRHP starts in a new village is with a Farmer’s group, because you need to get the men engaged before you can get to the women. Unless you saw my photos, you didn’t learn about the amazing organic farm (where I milked a cow!) that uses wormiculture to create natural fertilizer and feeds 250 schoolchildren a day as well as all the visitors and staff at the compound and also provides work and housing for people living with HIV/ AIDS who have been ostracised from their communities. I didn’t go into much detail about the watershed projects that began in order to prevent soil erosion and create clean drinking water in the villages as water is the cornerstone of health. Nor did I delve into the Jaipur foot project, which provides low-cost prosthetics specifically designed for village life, allowing the user to return to work in the fields, allowing them to earn income and provide for their families.

The problem with Dr. Arole’s model is that it is so very comprehensive. One of the most powerful days of learning we had was when we did a village visit with the mobile health team alongside the village health worker. We saw the women’s self-help group (SHG) meeting, and they all gathered at the home of the VHW to have their blood pressure checked (if they were pregnant or over 40). The SHG is an income-generating scheme where each woman puts an agreed to amount. One of the women in the group was quite concerned as she was unable to pay back her loan on the due date. Her cow and calf had both died and her baby had been accidentally poisoned. In addition, she had suffered appendicitis. The combination of all of these hardships meant that she didn’t have the money. If she’d borrowed from a bank, her few, meagre possessions would have been taken from her, but the SHG understood her situation and gave her an interest-free extension, as well as emotional support. After this was decided, her blood pressure was checked, because the VHW was worried about the effect that all of these stressors were having on her mental health. This is just a quick glimpse of one of the most powerful days we had at Jamkhed, wandering around, seeing how the VHW was received into people’s homes. And the homes varied between the well-off and the very poor, but everyone was glad to see the VHW (who lived in a fairly modest home in comparison).

As the beach is calling, I’ll leave you, for now, with the words I spoke at our graduation ceremony. The ceremony was attended by our group as well as a group of 10 Nigerians who arrived our last week to learn about the project in the hopes of replicating it in their country. The VHWs were in attendance, as well as all of our teachers, translators, bus drivers…everyone at the compound who took part in our learning. Both the VHWs and the Nigerians performed a song (two different songs), giving the proceedings an international feel. Shoba, Dr. Arole’s daughter who did much of our teaching, spoke as did Shayla, another teacher. We sang as well, “We Are One, We Are Australia” at Shoba’s request and then a few of us spoke. Here’s what I said:

If I had to pick a moment- and there are many moments- that will stick with me as I return to life in Melbourne, it will be the stories of the Village Health Workers- your stories- especially the one who said this isn’t health education- this is love education.

I’m a bit of a stereotypical New Yorker, jaded and cynical at times. At the same time, I have a belief in the human spirit and trust that ultimately there is good and justice in the world—I just sometimes get distracted by the negatives and lose sight of these deeply held beliefs. I get blinders on. Coming here has stripped away those blinders. The Aroles have shown that two people can make an untold amount of difference by empowering communities and teaching others that THEY can make a difference in their own lives.

Over the next few hours, we will be thanking all of our teachers for sharing their knowledge and experience with us, and this gratitude is heartfelt and sincere. And I have no doubt, with the varied talents of this cohort, we will each take what we’ve learned and apply it in various, meaningful ways to our current and future paths.

But just imagine, for a minute, if each of us were able to share with ten people the idea that they can change the world by empowering others to change their world. And then those ten people did the same thing, spreading this message. Now I don’t mean everyone will be setting up Farmer’s clubs and creating watersheds and starting organic farms with wormiculture and empowering women by training them as VHWs. I mean on a small scale, just spreading this simple message that each of us could teach those with less power and less agency to start to take back their world -this could have an untold effect.

I know that one person alone can’t change the whole world. But CRHP and the Aroles have shown me that they can change the way the whole world changes.

Thank you.

The VHW checks a woman's blood pressure. This is outside the VHW's home, as that is where the SHG meets.

The woman who had suffered such hardship and was late paying back her loan stands outside her modest house. You can tell she is much relieved after the SHG meeting where she was given an extension.

The picture of health in the village- the new VHW, who has been so for 4 years, the former VHW, who served for almost 30 years, and the nurse from the mobile health team who comes once each month.

Shae and I await the festivities

The Nigerians singing and dancing for us!

The women who bought Saris pose in their finery.

Our graduation goodies: the garland smells delicious(and meant something too but I forget what), the candle holder demonstrates that our knowledge enables us to be a source of light, the scraf (everything else is on top of it) is something all teachers are given, and the certificate is well, a certificate.

Sunday, February 6, 2011

Village Health Workers

Wow, have we fallen behind on things! We went away for a couple of days to Aurangabad on “holidays” and even more things happened, not to mention we actually have school-work to do, so I’ve been remiss in keeping you up to date.

Looking back, the next thing we learned about—well, experienced- were the Village Health Workers (VHWs). For those who missed it, VHWs are women chosen by their community to come to Jamkhed to train. Initially they came for a few months of intensive training, although now that the project is so established they just go “intern” at another village with another VHW and get on the job training. But I’ll tell about the original model, which is how the women we met were all trained. Since many of these women have little or no schooling, the training is not typical classroom training with textbooks and notepads but rather involves songs, story-telling and experiential learning, especially lots and lots of role-play. My favourite kind of medical education!! They are taught everything from nutrition and hygiene to how to identify leprosy, information about good nutrition for pregnant women and how to take blood pressure readings to how to deliver babies and understand signs of foetal distress. We’re not just talking about band-aids and temperature here, we’re talking about real medical care and real skill building and these women were given the tools and the knowledge to provide this health care in their village.

In a Western, litigious society, we think about all the what-ifs and reasons why this can’t and shouldn’t work. But this is in a rural setting with no clinic nearby and hospital services far away with access on dirt roads impossible for some with no vehicles and expensive upon arrival. This health care was the alternative to none-at all and it has proven to be an excellent alternative. Maybe better than some Western options, as you’ll see when I share some of their stories.It's interesting that as the VHWs are established in their villages, they eradicate infectious diseases like TB (virtually gone from the villages CRHP works in and yet rampant in other parts of India) and leprosy. However, heart disease and diabetes are rapidly on the rise in all of India as more people spend time behind desks and start eating processed foods and the VHWs are learning to screen for this and educate people about these issues as well. They are also quite well-versed in mental health issues and in many villages, depression is less stigmatised than it is in Australia!

Dr. Arole’s model is to get women of various castes from different villages all learning together so they can start to break down some of the class (and caste) divisions among themselves so when they go back to their communities, they know it can be done. It is hard for low caste women to go to their communities and convince the high caste women to let them treat their babies, but once they see that the low caste babies are thriving, they generally come around. Over and over again we’ve heard that it takes action not words for communities to believe in the ability of the VHW. The Health workers are fighting against traditional beliefs- for example, it is common practice not to breast-feed babies for the first 3 days after birth when there is lots of nutrients in the milk. Another common practice is to keep feverish babies very warm, rather than putting cool water on them. Sometimes, pregnant women are taught to avoid certain foods. All of these traditional practices need to be re-taught by the VHW who is going against generation after generation of belief and practice. Having her, a member of the community, to start to break down these myths is far more effective than having a western health workers come in and do so, but it still takes time.

We were in a classroom and 6 VHWs came in, along with Shayla, one of our teachers who served as translator. One by one the women shared their stories (I won’t tell them all here). There was Sambi, who has been a VHW for 26 years, yet can’t be older than me. She told us how she was the fourth of 4 girls in her family, but her sisters were all married off so young she never knew them. She was married at 12 (the same time I was studying my Bat Mitzvah portion and reading Judy Blume books) and her husband did not ask her father for a dowry (a tradition here in India is for the Bride’s father to pay a hefty sum to the groom to take his daughter off his hands). What the family didn’t know is that this man was already married. Sambi delivered her first baby, a girl, when she was 14-years-old.

On a side note, a girl baby is always a cause for disappointment and is an excuse for the mother-in-law and husband to punish the wife, often violently (one particularly horrifying statistic we learned in our seminar on the status of Women in India is that 55% of Indian women TODAY believe it is normal and acceptable to be physically abused in their marriage and many women feel something is missing from their marriage if their husbands DON’T beat them.) It is one of the many ironies of India that when a woman bears a daughter it is her fault and she is blamed but when she has a son, the husband is praised and given the credit.

In any case, Sambi’s daughter was one of twins, but the other baby died. She had gone to her parents’ house to have the baby and her husband came to visit but his other wife was suing him for divorce. She went back to Pune with her husband but eventually left him because he as violent and had debts to pay to the other woman, and went back to her village at 16, with her daughter in tow. Her parents couldn’t really take care of her though and she was scared and alone with no brother and no son…she didn’t know what she would do and she became depressed. A woman in the village talked to her and told her she could sit tall and stand on her own feet and told her about being a VHW. She slowly, slowly learned and got people to listen to her and eventually, she helped the people in her village and then, got a loan from Dr. Arole and bought two embroidery machines and started sewing and now she owns a 4 BR house. Her daughter is 12 years old and her husband came back to her. Before she took him back, she made him take an HIV test. Now, she is strong and feels happy and secure.

There was also Rekha who has been a VHW for only 10 years. I’ll tell her story in the first-person: “I was low-caste. When I was training at the compound, Dr. Arole had me make some bread for everyone and I said no one would eat bread from my hand but the others took it from me and it made me feel so happy for the first time in my life people took something from my hand. I thought to myself, this isn’t health education- this is love education. We (the VHWs) all have the same brain as we had before but it was locked and Dr. Arole had the key and opened it up. “ Rekha uses songs in her community to educate people about nutrition and sanitation and started a community group with others. Her singing has been featured on National radio and she even got to go (in an airplane) to Calcutta to sing.

A third VHW we spoke with has been in the role for over 30 years and she told how she was married at the age of 2. Yes, 2. TWO. Her husband was much older than her and she was widowed with young children and had nothing; being a VHW saved her life.

VHWs don’t get paid for their work, but they are privy to learning about government schemes and they also get involved in Women Self Help groups which are income generating groups—which I’ll talk more about in another blog.

This is getting lengthy, so I’ll just list a few of the successes these women cited in their villages as they proudest accomplishments

  • We worked together to build a road (this may not seem health related but improved access means quicker ability to get to the hospital when needed as well as better access for government trucks to deliver rations and better opportunities for income generation. Lack of isolation =improved health.
  • No child under 5 years old has died in my village for over 6 years now
  • When I started as a VHW, there were 20 leprosy patients living outside of houses, (stigmatised)…now, they have been given medication and most escaped permanent deformity and all of them are back with their families in their homes because the stigma is gone.
  • I have taught my village that cleanliness is very important. Before, children were defecating everywhere. The Women’s group and the Men’s group (farmer’s club- tune in next blog!) worked together to teach about hygiene and now no one defecates near the water we drink.
  • Everyone has healthy pregnancy and knows what to eat.
  • In my village we try to make sure the adolescent girls don’ t marry before 18 so she can have a healthy baby.
  • We teach about immunisation

A few interesting comments in contrast to western medicine:

1) The VHW who married at 2 has delivered over 300 babies and only 6- SIX!!! of them were Ceasarean (performed at the closest hospital-- as I said, the VHWs are taught to recognise signs of foetal distress, breech positioning, etc. and when necessary, do send women to hospital- often by motorcycle!!) So perhaps it is possible that at least some of our c-sections are unnecessary?!

2) One really interesting comment is that when asked what they do with a woman who can’t produce enough breast milk for her baby is that among all of them- with over 100 years of combined years of VHW experience and countless births, there was only ONE incidence of a woman not being able to breast feed.

It got us all talking about whether there could be environmental factors or a different level of patience in terms of how long we try before we allow a mother to decide she “can’t” do it…not trying to start a la leche war here, just thought it was interesting.

In any case, I don’t mean to gush- I’m not really a gusher- and I’m not easily impressed, but the stories of these women- and how Dr. Arole has transformed their villages and their lives- is truly amazing.

Next up- the Farmer’s Clubs...these are the men’s groups…where it all really begins!

Here is a few shot of these great women: (Shayla, our teacher, is the 3rd from left)

Wednesday, February 2, 2011

India Republic Day...and Australia Day

Wednesday, 26 January was both India Republic Day, which commemorates the birth if the Indian Constitution after getting rid of the British and gaining independence and Australia day, which commemorates the European invasion of Australia. In our honour, Jamkhed celebrated both, though thankfully more emphasis was put on the former. Dr. Arole told us that they purposefully don’t invite government officials or powerful businessmen to their India celebration but prefer to have HIV positive patients or Leprosy patients, to demonstrate that those people are as much a part of the fabric of India as the “important” people.

The celebration included a performance by the children from the Jamkhed compound preschool, which services the slum across the road. The school was started by Jamkhed to help the immediate community and while its been operational for a number of years, ahs only been in a formalised setting for one year. There was also a poem and a group of our students sang the Australian National Anthem (I did not). Then, we all helped out giving out snacks of grain and bananas to the children. I can’t imagine Western kids getting this excited over a banana. At the end, the kids asked for “just one photo”. They see westerners all the time at the institute but still want “just one photo.”

Our class-time was much more like regular class, with lectures and PowerPoint’s by both Dr. Arole and others on various issues, such as the Caste system in India, Tribal Groups in India and Social Factors (aka determinants) in health. It was good to hear this and put it in context. The Caste lecture was especially enlightening and interesting to hear how the Jamkhed model worked to deal with Casteism. For example, when they were deciding where to dig a well, they would put it in the Dalit or “untouchable” area, to ensure that these marginalised people would have access to the water and force the higher castes to come to that area and mix with them. They also sought out low-caste women to become Village Health Workers…but I’ll save that for the VHW story, which is coming up next!

Here are just a few photos from the celebration:

The whole pre-school sings

A few girls had a solo

These women recite a poem (in Marathi so I don't know what about...)

"one photo, one photo"