Trust for Reaching the Unreached - Site Visit Report Vinay Bhat, December 2011 As I departed from Mumbai towards Vadodara, I wasn’t quite sure what to expect from the visit other than the opportunity to learn. My participation with AID over the last couple of years has been through remote support of campaigns, particularly in conflict affected areas. One often reads and sees images of severe malnourishment, and at least I had a pretty narrow view of how poverty manifests itself. However, while Shivrajpur did not display such acute symptoms, I was educated on how poverty manifests itself in different ways. Trust for Reaching the Unreached (TRU) is primarily a health service NGO operating in the Panchmahals for more than two decades, and founded by two Gandhians - Dr. Ashvinbhai Patel and Nimittaben Bhatt. Both are highly seasoned in development work and pioneers in community health, the organization demonstrated mature professional operations with a deep connection to the people and their issues. Shivrajpur is a ninety minute drive from Vadodara, and the four lane highway is apparently responsible for this short timeline as compared to the four hours it took even up until seven years ago. Shivrajpur lies in the Panchmahals district of Gujarat, which in 2006 was named amongst the 20 most backward districts out of the 640 districts in India. This was not immediately apparent to me, primarily because of my own lack of understanding and secondly because the duration of my visit was short not allowing me to ask the residents more probing questions. The general population in the area is predominantly – tribal (Rathvas and Nayaks) and a backward caste (Baria). Nayaks are predominantly landless and the most backward. Barias are at the top of the social ladder here. General economy is agriculture based and migration for urban labor. Crops grown are cotton, corn and daangar (a less water intensive grain of rice). Poverty out here is a little more deep rooted, as most of the people rely on subsistence farming with little balance income left out for education or healthcare. Most people then turn back on migrating as urban labor to supplement their income. This again has an adverse effect on the households. In the words of Nimittaben, “It is important to remember here that those who are migrating are a large population who is at stress and so those who are left behind in the villages are also at stress. This is evident from the fact that the boys are unable to study more than 10th or 12th std in life. This is not only because the school education is difficult, but it is due to the fact that they have to earn livelihood for the family. All of them add to the labour market of the urban places.”
My visit covered three aspects of TRU - 1) General Health Program 2) Girl Education Program 3) Mental Health Program General Health Program I began my tour of the villages to view the general health program visits onn the morning after I reached Shivrajpur. The plan was to visit several village houses with Ashvinbhai and other health workers -
Vikrambhai and Samjuben. The visits would cater to th monitorng of the health of children under the age of three. We first visited the dispensary in Bakrol. The dispensary had a waiting area, a consultation area and room for meetings / trainings. I was also shown the child health monitoring tool. This is a chart that marks the progress of a child’ height, weight and age along with a list of immunizations administered. These charts are left with the mothers, and the health workers visually explain if the child is tracking well or is at risk of being malnourished. We then visited 10 houses in total, and in each house the child was weighed in a scale, readings recorded and the mothers were advised whether the child was on the right trajectory or not. It was particularly amusing that all children without fail began to cry as they were placed on the swing-type scale. Generally through the small sample, I did not observe anything extremely alarming. But again, my understanding when conducting these visits was pretty limited. TRU itself has collected a lot of data. To summarize this data – 65% of the children at the age of two and 52% of adults are undernourished. Where the children were not tracking well, the mothers were advised to feed the children rotla and dal. One could also not escape the sight of the invasion of market forces in the area. There were many stray chips packets and other packaged food casings lying on the streets and fields. In fact in one of the houses, baby Sultan was slightly undernourished, and when his mother was asked if he started taking solid food, “Yes, we give him Parle G” - came the answer. This of course is better than packets of chips. Women in this area are highly anemic, and it was pretty interesting to see how the community health workers figure out if pregnant women are taking their iron tablets. “What was the color of your stool?”, asked Samjuben. Yellow color would indicate that the woman was not taking her iron tablets. It was generally refreshing seeing the amount of diligence and intimacy with which the health workers understood the problems in each house. It was also encouraging someone like Samjuben - possibly in her early twenties displaying a great deal of confidence in how she conducted her consultations. Girl Education Program: This program caters to girls from neighboring villages. It is a residential program for girls from class 8 to 12 providing lodging, boarding and supplementary tuition to the girls. The government school is right next door to the TRU campus, and provides a safe haven for girls who would have otherwise have to walk for miles through the jungles to go to school. This is also one of the primary reasons girls are denied an education from their families. Families also feel like the girls are required at home to help with household work. This mentality is slowly changing. Girls looked extremely happy with their stay. There are almost 120 girls and the thing to note here was the great camaraderie they shared. Another aspect was that they were an extremely shy bunch, and my urban upper middle class upbringing had to unlearn a lot of things to interact appropriately with them. After returning from school the girls divide into different groups to carry out chores. Some work on the kitchen garden, some on preparation of food and some on cleaning activities. They later assemble for prayer and studies. One of the songs that they sing is an anthem composed by Nimittaben – which goes
something like “We the girls of Abhinav Chattralaya – play together, sing together, eat together. We will hold our heads high and not be afraid.” I did spend an entire evening interacting with the girls. It was a little unnerving primarily because no one would start talking and everyone would expect me to talk. While I faced everyone to begin the interaction, there was dead silence for a good ten seconds. I was interested in listening to them, and they to me I guess. It made me realize how in our daily urban lives we take interaction and being outspoken for granted. Culturally it must be very hard for these girls to open up to an outsider and interact freely. I tried to ask them what they liked and didn’t like about the place. “The school offers only arts,” said Alkaben Nayak, who after Sheetalben was the only other one to have spoken out aloud. “Do you know what opportunities you have after studying arts?” I asked. After which I provided them with some general counsel on what they could study and what career opportunities existed. I was more interested in what they had to say, but alas it ended up that they had more questions for me. I guess it takes more than three days to have a conversation where you can be one of them. Things that opened up their interest was when I described the US and Mumbai to them. Having viewed these places only on television, it was a great surprise when I said that Mumbai perhaps has one of the most polluted airs in the world and that they are lucky to still have fresh air to breathe. They were amused and bewildered. “We would like to travel and see all these places for ourselves,” said Alkaben. The girls spent Sunday mornings studying and attending to other chores. They would just come out and study in the open, a very conducive environment to studying and reading. On Sunday mornings Meena, a software professional comes from Vadodara to teach them basic computer usage. It was a lot of fun seeing their enthusiasm for learning how to right-click, double-click, open documents – things that we take for granted. And I realized there is a great vacuum for vernacular words to describe computer lingo. Any case Meena promises me that they are picking things very fast. Mental Health Program: As we reached the Shivrajpur campus on the first day, we met five mental health workers to learn about the program, the challenges and their perception of the impact the program has had. This work was formerly being funded by the Government, after a survey was conducted and it was discovered that there were almost 800 mental health problems in 238 villages out of a population of 200,000 people. In fact there were 45 suicides discovered within this population which is an abnormally high number. The Government has now decided to stop funding this initiative since mental health is not covered under the ambit of the National Rural Health Mission (NRHM) program. Having already completed a lot of the campaign and educational work, TRU is now strapped for funds and has not even received the
previously committed funds. However, the workers displayed commitment to continue the work in hope that funds would come in through some other avenues.
Interesting parts of this meeting was again a deeper understanding of the workers around mental health issues, the connection they could draw with the local population and adapt techniques that suit them. An instance of this was the anecdote where they engaged with local faith healers who used to be the the “go-to-people” in case someone in the family were going through a mental health crisis. The health workers did not fight against these healers, but in fact played to their sense of pride and only encouraged them to send people to the organization as supplementary treatment. “What use is it if we don’t instill trust in people”, said Sureshbhai Parmar, the youngest mental health worker. “This makes people less resistant to treatment.” Another achievement has been to raise the awareness among the population that mental health problems are like any other illness and treating this illness is possible.TRU has been successful in creating a community model to address mental health issues, and has even created its own assessment tools. Also on the 1st and 3rd Sundays of the month, a professional psychiatrist visits from Vadodara to provide consultations. As a separate round of village houses, I accompanied Keshubhai - a mental health and general health worker visiting mental health patients. Having visited 8 houses in six villages, it was heartening to know that patients are generally coping well with their conditions. Some of the recovering patients were even now aware of their condition and were particular in sticking to their treatment regimen. One of the recovering patients was a twenty four year old tailor Kiranbhai. “I am now able to work properly, and without the treatment I would often be found in the streets staring into space”, is what he said with a straight face and sense of new attained self-assurance. The greatest challenge for the mental health program right now is the lack of funding and with medication being so expensive, a good plan for funding this program will be of tremendous benefit. On the other hand there is also opportunity for advocacy work in campaigning that mental health be included as part of the NRHM. As market pressures grow, the marginalized will face increased mental heat, and it will become necessary for the overall health of the community. While the general population now understands mental illnesses are just like any other illness albeit complex, the State needs to understand this aspect now.