Menstrual Hygiene awareness in Gulbarga

Today (Sep 7, 2011) I spent time trying to assess the level of awareness on Menstrual Hygiene practises that adolescent girls and women in Gulbarga town have. This is one topic where you can’t distribute asurvey form and get data. You need to interact with them and make them come out of their shell and only then will they start talking. So I did 3 awareness sessions today – one with college going girls, another with high school girlsand finally, with married women from a slum. Some things that happened:

·        The college going girls were so amazingly enthusiastic and full of questions. Though I was supposed to take the sessionfor a class of 150 students, students kept peeping in and joining the session. By the end, at least 200 girls were sitting, standing, kneeling and absorbing all that I was telling them. And participating. Their doubts and questions were at the same level as those of girls in Bangalore's govt. colleges.

·        High school girls were also inquisitive and bold enough to ask questions and seek information though it was a much smaller group of about 20 students and a couple of teachers. Here too, the students can be compared to have knowledge levels same as Bangalore's govt. schools.

·        The women from slums in comparison were a big shock for me. Out of the 30 odd women present, at least 25 were married and NONE of them knew even basics. One lady, around 40 years of age asked “Is thereany relation between menstruation and child birth?!” And so I asked them “How do you think children are born?” Nobody knew. I asked a grandmother there who had 5 kids “Ajji, how do you think children are born?” She said “Gottilla amma" (I do not know). Then they bring a lady who is aged 30 years old and married forlast 10 years and ask me to advise her on what to do since she has no children.I asked her “Do you know how children are born?” And she said, Gottilla.

Those who do have children, have around 5-6 of them, oftenin an attempt to produce at least one boy baby. Ask them why and they say “Because women get married and go away, so at least boys would stay with us and lookafter us when we grow old. Plus, dowry is unaffordable”. While the young students I interacted with knew that having a boy or girl child is something that a male is responsible for (given that only men have the Y chromosome required to have a male child), the older married women were of the thinking that it is the women who has to be held responsible if the child born is not a boy. Clearly, we can see what education does because the married women were mostly uneducated.

I also interacted with someone from a women’s help NGO and they told me that child marriage is very common in these areas for many reasons, such as:

·        If the girl is married as a child, it is oftento a family member (uncle, cousin, etc) and therefore no dowry to be paid

·        If the girl is educated, a higher dowry has tobe paid to “get rid of her”

·        Once the girl attains puberty, it is dangerous to leave her unattended as she may talk to boys and get pregnant

·        Women are born only so that they can be married and sent away, and the sooner we do that (in the form of child marriage), thefaster our responsibility ends

For majority of the girls and women I interacted with today,I was the first person (including their mothers & teachers) who told them about what happens to their body during menstruation and what they need to doto be healthy & hygienic. Such a basic and natural process; yet nobody talks about it.

Chincholi

In Gulbarga now. Visited one of the taluks here called Chincholi which was recently in the news for selling girl children (much of which I am now told is untrue). Chincholi is a 3 hours tiring drive from Gulbarga on roads that are made bad with the rains turning everything to slush. Just when I thought the roads to Afzalpur are bad, Chincholi makes you feel like Afzalpur is really forward.

Chincholi

This place is quite cut off from the rest of Gulbarga and has a relatively large population of the Lambani group of tribals. Although an ex chief minister is from Chincholi, it has been around 2 years since any senior government official visited this place (except when the recent news flashed in the papers about selling of girl child). Surrounded by greenery,  mud roads and Lambani population, somehow, people seemed to have forgotten that Chincholi exists.

The situation at the Taluk Hospital

We first visited the Taluk hospital in Chincholi and one patient asked me where the doctor is. I told her that I am also wondering the same. We were taken to the doctors quarters which is quite a spacious & empty building. Slouching in one corner was a tired looking man - the doctor. He is one among the only two doctors in this hospital for the last 2 years. Although an Anaesthetist, he ends up attending to every type of case that comes there. A very well spoken doctor, but extremely overworked and exhausted. The only time I saw some light in his face was when we told him what we've done in Afzalpur and asked if such help is needed here. His reply was that any (even Ayurvedic) doctor will greatly reduce the burden here. He works day and night and sees 250 OPD cases a day. Even when he comes to his quarters to rest a bit, there are immediately patients queuing up outside his quarters.

Since travelling to this place back and forth from Gulbarga might not be an option given the distance and bad roads, I asked him if any accommodation could be arranged for me if I decided to work there. He said "consider this your house. I will move out if you wish to stay here". I can't help but admire this doctor's will to stay back in this isolated place when he definitely can get many other options for a job. Hats off to him.

Women's health and hygiene

I don't know where to begin when it comes to this. I interacted with some Lambani women, an anganwadi lady and someone from an NGO working in these areas and the answers have been sad. Women here keep reproducing like a machine unless they have a boy child. If not, their husband will leave them and marry elsewhere. Girls are a burden because you have to pay Rs. 3 lac as dowry to get them married. Needless to say that such attitude towards girls means that they do not care much for their education or well-being and without the constant push of the NGO there, they would not bother sending them to school either. A senior person said to me "Obviously they want a boy. If I had 4 girls, then even I would want a boy...who wouldn't? And what use are girls anyway?" Yes, girls are probably sold here and it is likely that they are killed too (since the concept of abortion in the womb hasn't reached them yet), but it is apparently no big deal since it is only around 4% of the population which does that. That is what I was told.

Then I heard how someone tried to build a toilet for a Lambani family, and they pulled it apart completely, broke the water pipes, even the bucket was destroyed. For them, it is unthinkable to do something so dirty near your house (having a toilet inside your house is unmentionable). I'll skip mentioning their practises related to menstrual hygiene.

NGOs, government and other groups have conducted awareness sessions and after the recent news in the papers, some lawyers were also called to explain that killing the girl child is illegal. The NGOs even had some women come & talk who have done well in life despite coming from a similar background, hoping that these women can be role models for the Lambanis. The tribals are aware of all the facts and the law and will listen to all that is told to them. Yet it does nothing to change their attitude. And here too, men spend more than half the income(mostly earned by women working as coolies) on alcohol, and if they run out of money, they borrow money just to buy alcohol. I sensed that even the NGOs are slowly giving up.

No amount of money spent by the government or others will necessarily help in this case - either to bring doctors to the Taluk hospital or to change the attitudes of the Lambani tribes.

What do you think should be done in such a scenario?

The Afzalpur project: Micro-volunteering by doctors

The Afzalpur Taluk hospital has no appointed Gynaecologist or Paediatrician. Travelling to the nearest town of Gulbarga is possible for some pregnant women despite the bad roads and 60 km distance to be covered in a crowded bus during pregnancy. Other women, who cannot afford the travel, resign themselves to fate. The locals do not find it odd since it has been this way since the last 15 years. Maybe longer…

When the DFS team first decided to pick Afzalpur Taluk of Gulbarga to try the concept of micro volunteering through doctors, we did not fully realise what we were attempting to change.

“Why Afzalpur of all places? When the government, despite offering Rs.70,000 a month has failed to bring in specialists, how can you even imagine that you will get the same doctors to volunteer in a place like Afzalpur?”

Need assessment in Gulbarga by DFS volunteers (Nov 2011)

These questions have been asked many times since we first decided to start work in Afzalpur Taluk of Gulbarga district. Our rather simple answer of “Afzalpur has zero specialist doctors and hence is one of the neediest places which can benefit by doctors volunteering regularly” didn’t seem to impress many who saw it as an idea that would never succeed. Terrible connecting roads, lack of motivation among doctors to volunteer, several failed attempts by the government and the fact that this is a never-before-tried idea, were challenges assumed by many.

The concept of micro-volunteering by a team of local doctors reduces the burden on any one doctor, and yet ensures that people have regular access to a doctor. By roping in 15 specialists (gynaecologists and paediatricians) to take turns, with each doctor volunteering only once a month, we found a solution to an age old problem of finding specialists to work in remote locations. We realised that attending to simple issues like having a local coordinator as the link between the patients and changing doctors, providing transportation & basic hospitality for the volunteering doctors and by facilitating communication between private practitioners and the government hospital staff, most problems get resolved. Using the existing 100 bedded Taluk hospital premises was another reason why we were able to initiate the process so quickly and with relative ease as compared to having our own set up. The main idea that the volunteering doctors will be from the nearest town of Gulbarga (and not Bangalore just because we have a team here) has been the key to ensuring continuity of the process and ownership by locals.

It is interesting to note that there are so many genuine doctors in Gulbarga who wish to do their bit (and we are certain it’s the same in most other small towns as well). Providing them a platform was all it took to get them to volunteer. When Dr. Vipul Shah & Dr. Ravi More, both Paediatricians, offered to get their own vehicles to Afzalpur to reduce our costs; when Dr. Greeshma, a Gynecologist, despite having a young child makes it a point to visit Afzalpur during her turn each month; when Dr. Rasalkar and Dr. Desai, who are over 65 years of age do not complain about the terrible roads to Afzalpur; when Dr. Milind, a Pediatircian, humbly says his job is done even if it is just one child who he helped during his visit to Afzalpur; we know that we’ve got a team of sincere and dedicated people who are more than just certified medical practitioners.

Dr. Rasalkar with Dr. Dayaprasad and coordinator Latha (Apr 2012)

Without any publicity, the number of patients visiting the Taluk Hospital in Afzalpur has steadily increased in 3 months from just around 5 to 74 patients in July on a single day. With the consistency of volunteering doctors, the government too has been very supportive in offering to take care of the transportation, hospitality of volunteering doctors and providing any additional medicines or equipment as requested by the DFS members.

Yes, there have been challenges, be it in getting the two medical colleges to volunteer; in finding local coordinators; in finding private practitioners willing to close their clinic one day in a month; in ensuring enough patients turn up to keep the motivation going; and in starting from scratch in a completely new place. However, with strong belief in the concept of volunteering and the spirit of never giving up, we have so far managed to address challenges that have come our way.

8 months since our first visit to Gulbarga in November 2011 and 3 months since April 2012 when we started bringing 20 specialists to volunteer in Afzalpur, benefitting 297 patients, we are glad we took up this initiative despite all odds.

Doctor-at-School begins

What happens when the wisdom of a retired senior bank manager, the enthusiasm of a teenage volunteer, the skills of a voluntary doctor, a supportive school staff and a needy set of children come together? A perfect model of Doctor-at-School 

Today, Namita and I did the introductory session at Chunchunghatta Government School (Konanakunte). The team we have at this school is ideal and going forward, I am certain it will be a good example of how this program is meant to run. The team members are:

Weekday volunteer: Mr. Venkatesh Murthy, retired senior bank manager

Weekend volunteer: Sameer, just passed 10^th std

Doctor at School: Dr. Harsha, General Practitioner who runs a clinic very close to the school

DFS Cluster Coordinator: Namita

Screening at this school will take place every Friday afternoon, and both volunteers have agreed to accompany and assist the doctor. While the doctor offered to see children any time at his clinic(in addition to school screening), volunteer Mr. Murthy offered to donate his weighing scale since the school didn’t have one, and an interesting offer was made by volunteer Sameer saying “I finish college early on Fridays, and instead of playing in the ground, I’ll come and volunteer at the school” 

This school has 300 students and a very cooperative school staff. Quoting the HM “We teachers, many a time, play doctors, police, parents and various other roles which are outside of our given responsibility”. She was referring to the case of a young child whose mother left her, whose father is an alcoholic and whose grandmother couldn’t care less about basic things like feeding this child. In such situations, it is the teachers who step in and help the child.

It struck me that the doctor’s clinic was so close to the school and such a mapping should have happened long ago. Not to forget these sincere volunteers who are so ready to help out should have been part of the school much before. However, it is good to know that at least we now have a platform to bring these people together and truly make a difference.

As we go forward, each of you can play a very important role in the schools where you decide to volunteer. Come forward, and let us know when you wish to get started and we’ll map you to a school closest to your area of preference.

You can write to info@doctorsforseva.org to get started.

The Government and Us

                The public consultation on Healthcare in Urban Bangalore- Mar 09, 2012

Most of us have been accustomed to hear people speak of the government and its duties towards common man with such conviction and surety, that we’ve probably forgotten how we too have a role to play to make things work.

The event (Public Consultation on Healthcare in Bangalore) on Mar 09 was such a surprise as none of us really anticipated what we heard. The honesty to point a finger at itself, the openness to hear new ideas, and the fact that the BBMP called the public for such a discussion is truly praise worthy.

The event organized by the BBMP started with a presentation on the current status of healthcare in urban Bangalore. Around a 100 participants from the BBMP, Government, NGOs and others who were into healthcare were present. The BBMP Commissioner M.K. Shankar Linge Gowda & Mr. B.S. Ramaprasad, Commissioner of Health & Family Welfare were among those on the dais.

Introductory talk

The introductory talk straightaway dove into how despite several healthcare programs, healthcare institutions and charities, we still do not have a comprehensive plan covering the whole of Bangalore. For ex: Ward nos. 29, 38 and 27 are completely untouched by all healthcare programs. It was also said that there is an absolute lack of coordination within the various departments of the government. The purpose of this event was therefore to seek ideas and inputs on how the healthcare programs in urban Bangalore can be improved.

The introduction was followed by a very engaging talk by Mr. Shankar Linge Gowda. He spoke of Bangalore having 7000 General Physicians for its 8.5 million population, and yet so few in government service. He spoke of why it is important for every Specialist to sit in OPD to understand basic ailments, and how specialization in medicine is ending the important concept of a family physician. And, he openly welcomed NGOs to work with the government on solving healthcare issues.

Corruption!

Following this, other presentations were made which were startling in their revelation of cases of corruption seen in government hospitals where several services are supposed to be free of cost. Some points:
·         Normal deliveries are charged between Rs. 2000 – Rs. 3000 and Caesareans cost Rs. 5000
·         People are asked to pay Rs. 300 to see a female child and Rs. 500 to see a male child!
·         Pregnant women from economically challenged sections are at times not touched by the practising doctors because the doctor feels that the patient is unclean
·         There is no bread or milk available for in patients
·         Iron, Folic acid and Calcium tablets are often unavailable
·         There are either no doctors in the government hospitals or the ones who are present are insensitive to patients from slums
·         Many women do not get the available free schemes even if they are eligible. There is also no information available on the schemes.

(For whatever reason, it seemed to me that the government health services in Gulbarga were far better. This is something I’ve been told before as well – that urban government centres are much worse when compared to rural centres. )

Audience speaks

The session then opened up to the audience and 5-6 people came forward to share their experience and knowledge. The one that stayed in my mind was of a very energetic nurse named Shani who questioned why nurses are not given more roles or better payment in the government set-ups . She spoke of how nurses pretty much run PHCs in cases where there are no doctors available (I’ve seen this in Gulbarga) and can actually give doctors a run for their money if allowed in the system. She spoke of how nurses can fill in many of the gaps in delivering quality healthcare, but for some reason the government only seems to think about doctors, and nurses are almost completely excluded from their plans.

While some people kept blaming the government for the things they were not doing right and suggested new schemes and plans, Mrs. Swarupa (from Mahati Trust) spoke about how tightening the existing system might suffice rather than introducing new plans, much to the relief and applause from the government representatives .
Future of Healthcare

Some interesting aspects about the possibilities in the coming years about changes in healthcare:
·         Universal healthcare for all in India, regardless of income. This means, all of us can walk in to government hospitals and certain private hospitals for free basic healthcare
·         Should government regulate costs in private hospitals? This was being thought of so that the huge cost difference in government and private facilities are reduced, enabling common man to afford health facilities even in private hospitals
·         Introduce labs in more government centres (what costs Rs. 300 in a private lab will cost Rs. 30 in a government lab)

My take home

·         7000 General Physicians in Bangalore! Imagine if we reached out to even half of them to volunteer as part of DFS in Bangalore, we could happily cover all the 2000 odd schools, 325 notified slums, and still have room for more.
·         The government is looking for and willing to work with NGOs – an opportunity we should make the most of
·         One of the government representatives mentioned how they’ve tried just about everything to get doctors to work for them; they even approached 50 retired doctors, but only 12 had agreed to work for the government. This made me think that we must be doing something right to have 67 doctors and 31 hospitals volunteering with us!

To conclude

The government is another entity – trying, succeeding at times, failing at others. While we are quick to criticize all the wrongs that the government does, do we ever appreciate the good they do? And do we even attempt to join hands with them in the struggles and failures? After all, why should the government do so much for our families, while we do nothing much to even assist? Yes, we pay taxes, but money doesn't solve all issues. Citizen participation is very essential. 

I remember once when I was interacting with a group of children in a special home, they asked me “Akka, why have you chosen to do this work?” It is very tricky when you have to answer children; no amount of smart adult thinking can come to your rescue! So I thought of the first thing that comes to my mind when I see something that bothers me, and said to them “I do it because I feel it is my responsibility.”

Doctors for Seva arrives in Gulbarga

If you happen to pass by Korali, in Aland taluk of Gulbarga district, you will come across a seemingly happy and loud set of lambani(tribal) women and their many children who call themselves the NN Thanda. Their clothes have just about every color of the rainbow and their sunny smiles spread more warmth than the sun’s rays on a winter day. The chirpy voices of their young and many children may seem a happy sight at first, but look closer, and you might realize that all is not well in this tiny hamlet.

The young women are lean and tired looking from bearing so many children. And at least one child seemed to be mentally challenged. Ask them if they visit the nearby government hospital during delivery, and the answer is a hesitant no. They complain that no specialist ever visits the hospital and the regular doctor asks them to go to Gulbarga for cases which may have complications. Travelling to Gulbarga is something they quietly rule out since having to take loans for the travel and the distance to be covered in their pregnant state is not a very encouraging thought. Perhaps, it was one such chance they took which led to the child being born with what looked to be cerebral palsy.

Similar stories are repeated across several villages of Gulbarga district which have little or no access to specialists at the PHCs and Taluk Hospitals. While primary healthcare is being covered well by the government initiatives, presence of specialists and even simple facilities like scanning remains a far cry in the villages of Gulbarga.

It is in the backdrop of these circumstances, that Doctors for Seva, a project run by a trust named Youth for Seva, has arrived in Gulbarga. Doctors for Seva, has its main operations in Bangalore and comprises of a network of doctors and hospitals which provide voluntary services for the economically challenged. At present, this network has 53 individual doctors and 27 hospitals who volunteer their skills and services for the under-served in Bangalore’s slums.

While it is ideal to have doctors enter a contract with the government and offer their services on a long term basis, it has been something that has not been easy in coming. The living conditions in villages coupled with the barriers that language and culture creates between doctors and patients, it remains challenging to retain doctors in Taluk hospitals. Therefore, Doctors for Seva, is attempting to motivate a team of doctors to volunteer their services on rotation at Taluk hospitals, so that no single doctor is burdened in shouldering the entire responsibility. Doctors will have the freedom to decide how often in a month they would like to volunteer at the Taluk Hospitals. In addition, a local coordinator will be present to act as a link between doctor and patient to enable easy communication; to assist the doctor with basic logistical needs, and for coordination with the hospital where the doctor will be consulting.

We invite doctors, especially Gynecologists, Obstetricians, Pediatricians, Dentists, Ophthalmologists, Surgeons, Anesthetists and other medical professionals to join Doctors for Seva and render your services for the needy in Gulbarga. To join, please write to info@doctorsforseva.org. For more details, please visit www.doctorsforseva.org

Going beyond the first step

How it began: Sometime in November, while I was doing an awareness talk at a government school, I noticed a young girl, about 12 years, with a shaved head and drooping eyes. She hovered around me after the talk and seemed keen to approach me. All I had to do was smile at her, and she told me her story. Let’s call her Annu.

Annu’s father died an alcoholic, and her mother is a chronic alcoholic too. Her mother is rarely in her senses to take care of Annu, so she ends up roaming the streets and doing whatever comes to her mind. She visits school once in few months, especially when they distribute uniforms or books. Her speech seemed slurred and her strange eyes had me thinking if she herself is under substance abuse. Before I could complete that thought, Annu told me how her mother gives her alcohol occasionally as a “medicine” for her aches and pains, and later the teacher told me how some students had seen her unsteadily walk along the streets, sniffing some white powder. And she is just 12 years old!

Strange and painful as it may sound, she isn’t the only such child in that school. Out of a strength of around 100 children, that school has nearly 20 children who are regular absentees. Where do they disappear? What happens to them? Can’t we talk to their parents? Haven’t the teachers tried to intervene? Every time I asked these questions, the teachers told me that they’ve tried it all and nothing works. The parents are not receptive and the children have been advised, counseled, punished and what not…..and it has been of no use so far.

Home visits: Today, I decided to find out for myself what really happens, and walked into that school in the morning. And what greets me? A 13 yr old being beaten by the teacher for coming late. That poor weeping child kept mumbling something to avoid being beaten, only to be beaten further. The reason given by the teacher was that this child always lies and comes late and requires counseling. Being a trained lay counselor, I sat down with that child in a separate room. Let’s call her Spandana.

Spandana wakes up at 6 am every day, collects water from a nearby tap for the household needs, then walks around 2 kms to collect timber for heating water, then prepares tea for her family, cooks the food, washes the utensils, and then if nobody beats her that day, she rushes to school. A similar story follows at night. He hands and legs have marks of dried and fresh wounds from being beaten by family members for not doing enough work! Her family consists of a father, a mother, grandparents, an older sister and a younger brother. So why does she have to do all this work? She is an adopted child. Her mother died when she was young, and she is looked after by relatives. Spandana requested me to help her move to a hostel so that she can focus on her studies. Ask her what she wants to become in life, and pat comes the reply - a Doctor.

I also visited homes of 3 other children from nearby slums. I was accompanied by 2 little girls from the school, sent by the teachers.

The first house was that of Annu’s, but she wasn’t there. So I asked her Aunt (mother stays elsewhere) to bring her to school tomorrow. I plan to take her to a Pediatrician for a complete checkup, before I decide a further course of action. Here again, her Aunt requested me to enroll Annu in a hostel.

The second visit was to meet a boy who has been absent for months. Let us call him Vinay. After an accident which badly burnt his feet, Vinay has not been coming to school. After some talking, laughing and attempts at convincing, Vinay was asked to come to school tomorrow. He smiled, and whispered something in his relative’s ear. Worried that he was expressing his intention of not going to school, I asked the relative what he whispered. Apparently, Vinay was worried about his uniform that needed to be collected from the tailor since he had to go to school the next day! Let’s hope…

The third visit was to meet Soniya, 8 years old and suffering from a condition since birth that will leave her visually impaired in a few months. Her parents were supposed to take her to Sankara Eye Hospital, but being new to Bangalore, and generally afraid of the world out there, they just stayed at home. Her mother, though wary of us in the beginning, ended up sharing the child’s medical reports and requesting us to help with admitting the child to a school for visually impaired children.

A bit about visiting slums – Contrary to what we may hear about it being unsafe for women, or that slums are full of rowdies, uncouth people, and what not, I saw that when you request people for ten minutes of their time to talk about helping their child, they are quite welcoming. And in case they do not wish to talk to you, you can just apologize for intruding and walk away.

As volunteers, most of us prefer to play with children, make them smile for that moment, have a good time, and come back happy. While this is a good first step, why do we hesitate to go beyond? Possibly, because it disturbs us to see a child in pain; it scares us to even think what a young homeless girl might be put through on the streets; it frustrates us that we might put in so much effort, and see so little result.  

But, for one moment if we stopped thinking so much about “us”……..and spared a thought for that child who is in fact going through the things we can’t even begin to imagine…

One day a week, one child at a time. It is worth a shot, even if you fail.

I have gone beyond the first step to preserve a childhood. I hope you will too.