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Initiatives: Healthcare and Nutrition

Sunday, May 17th, 2009

an excerpt from our upcoming website
written by Sriram Ramgopal

Healthcare: Problem Statement
Healthcare – and the lack of easy access to it – prevents people from upward social and economic growth in India. The lack of healthcare stems from two important issues:

The first issue is a lack of access. Healthcare facilities in India are difficult to access. Government hospitals, though technically free, are so burdened by a massive population of patients and a deficiency of qualified medical staff that they simply cannot cope with the load. They have a perpetual shortage of essential medicines and are simply unable to do essential diagnostic and therapeutic procedures. Corruption in such hospitals also plays its role in limiting access to ordinary people. Thus, people are unable to utilize these hospitals in their time of need. “Experts and the general public perceive public hospitals as inefficient, dirty, unhygienic and their staff as rude, negligent and callous,” writes Ratna Magotra, for the Indian Journal of Medical Ethics1. However, while ‘free’ government hospitals are unusable, impoverished people in India simply cannot afford to go to more expensive private hospitals, where the costs of treatment are exponentially higher than what they might earn in a year – or even in several years. The long-term costs of treating chronic ailments such as diabetes and hypertension put a heavy, often unbearable burden on people with a limited income.

The second issue preventing access to healthcare is a lack of knowledge, awareness, and initiative and an ignorance about the importance of health. Such a statement is not intended to allocate blame to these people. However, they are unaware that treatment is available for many conditions, that it is affordable and easy to obtain. They do not know that many diseases – such as debilitating complications of diabetes – can be prevented by simple and inexpensive means. Perhaps more ominously, we have found in our short work here at Ramavaram that patients are unwilling to receive treatment, even treatment that they perceive as necessary and that our group has been willing to sponsor. This can be attributed to a cynical attitude towards the healthcare system and the importance of good health in their lives.

The economic and social toll that lack of proper healthcare takes in such urban communities cannot be calculated in any straightforward way. Children suffer in school because of undiagnosed refractive problems. Adults suffer from bone aches due to osteoarthritis. Acute trauma such as fractures from road traffic accidents, when improperly treated, prevents adults from being economically productive in the future. Death tolls in children due to untreated diarrheal and respiratory diseases are also distressingly high. The tragedy is that many of these people suffer from conditions that can be treated easily – and often inexpensively.

The Importance of Healthcare in Community Rehabilitation
We have chosen to work on heath care for several reasons. Most of our members, being students and workers in the healthcare field, grasp the vital importance of health in the chain of human suffering and poverty; we share a keen sense of empathy for their pain. Our belief is that ethically, the choice of providing health care when we have the power to do so is a matter that requires little deliberation. We see it as a clear responsibility with few shades of gray to complicate the issue. Helping those who are sick serves additional advantages as well. It allows people to get to work and to school and to become productive – thus breaking a chain in the disease-poverty-disease cycle. Socially, it shows our solidarity with those who need help and creates a strong bond with them based on our concern for their welfare. This leads to trust, and over time, it allows us to work with these people in other arenas as well, such as education and vocational training.

Our philosophy of health care is that of ’self care.’ When someone is sick, we believe that the immediate course of action is to help them get better. However, this is not the end-all of health care as it does not provide a long term solution for health problems that are an inevitable part of life. People from impoverished backgrounds lack access to healthcare for a number of reasons. But armed with information and support, they can make the right healthcare choices and play a positive, active role in their health.

Our Approach to Health Care
Our approach to health care has a number of facets. As the axiom says, “An ounce of prevention is better than a pound of cure,” and this certainly applies to underprivileged communities. Health education is an important part of this process. Teaching children and adults alike the importance of basic hygiene and sanitation is critical to combating common infectious diseases. Preventing children from using drugs forestalls long term, chronic health problems ranging from alcoholism to lung cancer. Informing women about contraception and its importance decreases complications associated with excessive and frequent childbirths. Thus, health education is the cornerstone to our approach in underdeveloped communities. It is the cheapest and the most effective way to avert disease and debility.

Prevention, though better than a cure, by no means replaces it. It is also important to develop ways to treat patients who are in need of curative therapy. We plan on increasing access to health care by two means – bringing health care to those afflicted with minor conditions, and for more serious conditions, taking them to centers for definitive treatment. Bringing health care to the community involves running health camps and bringing qualified medical professionals to help the residents deal with their medical complaints. By eliminating the cost of treatment and bringing doctors to their own neighborhoods, we can surpass many of the barriers that they face in getting treatment. By individually assisting the patients, we help them overcome their fear of what seems to them as a complicated and menacing system and get them the treatment they deserve as human beings.

To finish the rest of this article, check back on our upcoming website, releasing June 2009.

  1. Magotra, Ratna. “Revitalising public health care.” Indian Journal of Medical Ethics. 1995. Forum for Medical Ethics Society. 14 May 2009 <http://www.ijme.in/034ed068.html>.

Posted by The Sangam India Team in Healthcare, article, initiative | 1 Comment »

Perspective: Making a Difference

Monday, May 11th, 2009

ARTICLE BY SRIRAM RAMGOPAL

We have been going to the Ramavaram slum for over a year now, and our goals and objectives for the community are maturing in many ways as we learn more about the people there as well as about ourselves. The educational programme that we started from March of this year has been working well, but perhaps not in the ways that we expected it to. We worked hard to elucidate the goals of what our program were going to be; and we decided on a number of objectives. These were based on the information that we had about the children from numerous visits, from their parents, and from a visit to their school that some of our members made earlier this year. As Bhavya described, these were health education, teamwork and trust, values, etiquette, citizenship and creativity. These goals were selected because we thought they would help these children become responsible, hardworking adults, who had careers and a bright future ahead of them.

It remains too early to know whether or not we achieved our objectives. We have tried hard to develop and carry out activities teaching these values, but whether or not they learn something from it is not so clear. It is difficult to change the way people are. It’s hard to make people, especially a group of children, realize the importance of things like handwashing and hygiene when their parents and surroundings tell them otherwise. Likewise, it’s hard to convince children that with hard work and with a positive mindset that they can indeed be doctors, cricket players and policemen, when everyone and everything around them seems to contradict that notion. The effects of health education, etiquette, citizenship and creativity are hard to impart to a group of children who have been taught that such things are meaningless. Thus, though we have tried very hard and will continue to do so, we may or may not reach our objectives. Nonetheless, we will do our best to reach them because we strongly feel that these things have value and are important.

However, I have realized over the last several visits to Ramavaram, that we are making a difference here, though in an unexpected way. Though we may or may not be successful in reaching arbitrarily stated objectives, something is changing, though slowly and subtly, in this group of children. Every time we go to the slum, the children rush out and are excited to see us. They are excited when we sit them down in groups, and though they quickly grow tired of being lectured, they are immensely excited by the prospect that young adults, coming from entirely different walks of life, take time, every week, to go and see them.

For a group of children who receive little attention from their parents, the adults in the community, or from their teachers, the fact that we come there for the sole purpose of spending time with them carries great meaning for them. We sit down with them in small groups, and they take great pleasure in sitting next to us. Many of our members speak little or no Tamil but despite this, the children love to talk to us about everything they can possibly think of. They love the thrill of communicating with somebody who cares about them. Some of our members are especially successful at talking to the kids there and finding out what their problems are, and by listening to their problems with a sympathetic ear, we can connect with these kids on an emotional level and produce more positive change than we could by merely following orders on a checklist.

On Saturday evenings, as we come home from another day at Ramavaram, we wonder whether or not we were able to teach anything to the kids, and whether anything will change there as a result of it. No doubt that progress comes slowly and it is too early to expect dramatic changes. No doubt that the things we are teaching the children there will slowly but surely change their behavior, as long as we are consistent and clear with them. Of course, we will continue to refine our lessons and our plans in the community as we gain more and more experience with the people and from other organizations. I strongly believe that we can make a difference here and break the cycle of poverty and hopelessness for at least a few families here at the Ramavaram slum. However, after spending time with these kids and showing them that we care about them, I’ve come to realize that there is more than one way to define success. By sharing happiness, compassion and goodwill in these children, I believe we can give them something more meaningful but less measurable: hope. And for this reason we will keep trying to make a difference here despite the odds we face.

Posted by sriram in article, education, perspectives | No Comments »

“Everybody Loves a Good Drought”

Saturday, November 22nd, 2008

ARTICLE BY NIVEDITA GUNTURI

Since I moved to India, I’ve found that public awareness of true social conditions is sorely lacking, in the non-humanitarian circles at least. Thorough journalism and a global commitment to turning awareness into a social epidemic might do something to move us in the correct direction.

I came across a book in which the author attempts to do just this, getting the word out to as many people as possible. P. Sainath, a journalist, received a grant from The Times of India to travel across the country, revealing the hidden injustices that the poorest of the poor suffer in India. He did a phenomenal job, creating a volume that anyone with any vested interest in social work in India must read. His work is investigative journalism at its best, filled with everything from statistics to case studies to thorough, incisive interviews.

The author covers a host of topics, which I’ll list here so that readers can have a better idea of what the book actually contains:

Health Care
Sainath talks about the state of rural health care and the shortage of doctors for the poor. He asks biting questions about why a poor child does not deserve the same care that a better-off child gets. Important reading for any one wanting to go into public health anywhere in the world, and especially in South Asia.

Education
The dismal state of education in India is covered here. This chapter left me feeling that a proper education is vital to the improvement of the state of affairs here in India.

Displacement
It is particularly heartbreaking to read of how adivasis (tribals) are being summarily thrown out of their homes with little to no promise of compensation. The truly dismal part of this is that their homes and villages are being used for weapon testing and target practice by the military. It is shameful and despicable that a nation can treat its own citizens like this. Of course this is not the only place in the world that this has happened, but that does not make it acceptable.

Survival Strategies
This chapter is at once uplifting and tragic, as we see what the poor of India have been doing to improve their lot in life.

Crime
This part of the book looks at what kinds of crimes have been committed against the poor and the utter, shocking, lack of response from the Indian justice system.

Water
This chapter describes the lengths many in India have to go to to find water for daily use and how dependent they are on others for their water supply.

Media
This is a particularly important and especially impressive part of the book, I feel, because Sainath takes a moment to cast a critical eye on the media and journalists, of whom he is one. He talks about how journalism takes a view that is either sympathetic to the government or speaks highly of NGO’s. He argues that neither is helping the poor. He also reveals the sheer number of NGO’s which have been accused of corruption and have embezzled funds donated to the poor.

Overall, Everybody Loves a Good Drought is a true eye-opener, in many senses, and should be required reading for anyone wanting to work for India’s poor or India’s children. Although it is now twelve years old, I think the examples and causes delineated in the book are still 100% valid.

I’ve given an excerpt here from the chapter on health and health care, because it particularly hit home with me. I hope that it gives you a good idea of the tone and feel of Sainath’s book.

“Tuberculosis claims over 450,000 Indian lives each year. It would be lucky to get a couple of columns in the newspapers yearly. If it does, it’s when the country’s distinguished chest physicians, some of whom treat newspaper proprietors, hold their annual congress.

Diarrhoea claims close to 1.5 million infants each year in this country, one every three minutes. The best it can get by way of space is when UNICEF’s annual “State of The World Children’s Report” is released. Then it makes an occasional bow on the centre page. Or, in one of those anguished editorials (hastily written because the one on the Stock Exchange didn’t turn up) asking: “Where Have We Gone Wrong?” After which, it can be packed away to be used in identical form the following year. If no Indian has won a beauty contest that season, it could even make the front page. This establishes that the newspaper has a caring editor, who will soon address the Rotary Club on What Can Be Done For Our Children.

Every fourteen days, over 7.5 million children below the age of five in India suffer from diarrhoea. Close to nineteen million contract acute respiratory infections including pneumonia, in the same 336 hours. Quite a lot can be done for them, but it isn’t.

In 1992, USAID gave India Rs. 12.6 billion to be spent solely on population control in the northern state of Uttar Pradesh. This program has serious implications. One is that hazardous contraceptives like Norplant will be pushed onto very poor rural women who have little or no access to proper health care. The same contraceptives are not in general use in any Western country.

Funds are much harder to come by for, say, water-borne diseases which account for nearly 80 percent of India’s public health problems and claim millions of lives yearly. These include diarrhoea, dysentery, typhoid, cholera, and infectious hepatitis. Water-related diseases, including malaria, take their toll in tens of thousands of human lives annually.

Yet every third human being in the world without safe and adequate water supply is an Indian. Every fourth child in the globe who dies of diarrheal disease is an Indian. Every third person in the world with leprosy is an Indian. Every fourth being in the planet dying of water-borne or water-related diseases is an Indian. Of the over sixteen million cases of tuberculosis that exist at any time worldwide, 12.7 million are Indian. Tens of millions of Indians suffer from malnutrition. Yet, official expenditure on nutrition is less than one percent of GNP.”

One point that particularly struck me were that only 20% of hospital beds are in rural areas, where 80% of the population lives. I have heard varying versions of this statistic, but it’s always been just as drastically disproportionate as this version makes it out to be.

One particularly biting statement Sainath makes is that the Indian government is trying the ‘trickle down theory – take away from the poor, give to the rich, see how much trickles down to the poor.’ He remarks that the result is that ‘money trickles up, malaria trickles down.’

From my blog, Informed Activism in Ind
ia.

Posted by nivedita in article, perspectives | 2 Comments »

“Social Consciousness and Vogue India’s gross miscalculation”

Sunday, September 28th, 2008

ARTICLE BY NIVEDITA GUNTURI

There’s something about this notion of globalization that makes people seem to think that we are not all responsible, as citizens of a nation and of the world, for being socially conscious and aware. Many seem to be blindsided by the rapid progression and economic boom hitting the world, and India in particular, to the point of truly becoming blind to what is appropriate and what is utterly unacceptable.

A friend in London brought this to my attention, and frankly I thought it was a joke.

For those of you who haven’t seen this particular issue of Vogue, take a look at the NYT article linked to in the previous paragraph. When challenged by the NYT, Vogue India editor Priya Tanna told folks to lighten up. She states herself that fashion magazines are not where one should look for social consciousness and “saving the world.” Amen, sister. But here’s the thing. Where do we draw the line? Whom are we allowed to exploit? Who is allowed to do the exploiting? The men and women depicted in the shoot are not referred to by name, merely as “lady” or “man”. I appreciate the egalitarianism, but is there anyone who truly believes that given the choice, if woman is living in a leaky hut with her husband who earns barely enough money to feed her 4 children and not enough to send them to school so only the boys go to school and they eat meat once in two weeks, after saving up, and they all share one 3 rupee cup of tea because they can’t afford milk for the children, she is going to save up for maybe 4 years and buy a Prada handbag? If you’re out there, you lofty dreamer, get in touch with me because I’d love to pick your brain.

I understand the thematic approach: anyone can be pretty, you can aspire to these great heights if you really want to, blah di blah, et cetera, et cetera. But do you mean to tell me that these people that are in these pictures have heard of Gucci? That the children write to St. Nick asking for a Versace backpack for Christmas? I don’t think anyone can be so deluded as to think that the ‘lady’ and ‘man’ and ‘boy’ depicted in the shoot know anything about haute couture. And if they don’t, then why are they the subject of the pictures?

Frankly, I am personally appalled that an Indian can subscribe so shamelessly to a neo-colonial mindset. So now that we don’t have foreign invaders in our country anymore (well we do, but more on that in a moment), it’s time for us to behave imperially towards fellow citizens? Beautiful, Priya Tanna. Bravo. Maybe next time we can show an auto-walla driving a Jag. If Louis Vuitton and Hermes are no longer a rich man’s privilege, maybe Bentley and Ferrari aren’t either. Maybe those of us who still believe that poverty may be holding some people back are living in the history books. Maybe we should open our eyes and look around.

The sad truth is, however, that enough of us are NOT looking at our surroundings with as close an eye as we should. The human beings around us have become part of the landscape. We see them but we do not notice them. They have become important to us purely in a utilitarian manner. I wonder many things about the people chosen to become models for this shoot. How were they compensated? Did anyone really learn their names? Were they treated like other models? Or no because they were amateurs? Or even – maybe – because they were poor? (gasp!)

I think it’s important that we as the residents and citizens of India – nay, the world – owe it to ourselves and our fellow citizens to pay attention to what’s going on. And even more importantly, the media has a strong role to play in this. The first thought I had when I saw the NYT article (after my Britain-dwelling friend sent it to me) was ‘why haven’t I already heard of this, living in India?’ And that is the first thing that is wrong with the Indian social consciousness. If you pick up any well-regarded Indian newspaper, you will see one page devoted to local news, one page for national news, and one page for international news. There’s maybe one page for general human interest stories, one page for business, and approximately 10 pages for celeb gossip and of course there’s the supplement with the society pages and full body shots of hot, famous women. I happen to glance at the papers almost everyday, and I’m online quite a bit. But neither me, nor any of my friends and colleagues who do read the newspaper everyday, had heard anything about it. Why? Because the media believes – rightly – that not enough people care to make it worthwhile news.

It’s time for us to make these things worthwhile. We should know, we should make it our duty to know, what’s going on around us. If we really want to turn a blind eye to the state of affairs, then we are doomed to a very difficult life. The cotton, dye, stitching, and embroidery for the clothing we wear, the raising, growing, harvesting and transporting of the food we eat, and every other kind of handiwork we take for granted, is done by the poverty-stricken people that we so blithely dismiss. Priya Tanna and her cohorts have committed a true travesty by allowing this to happen.

Here’s what I read in The Independent:

“Leading Indian fashion designer David Abraham jumped to the magazine’s defence.

“This kind of juxtaposition is always there in India – the servant who serves a glass of wine which costs more than his monthly salary,” he said.”

True, it’s always there. And I believe we should all be doing whatever we can to narrow the gap. But fine, even if you don’t agree with my brand of egalitarianism, I don’t see the legitimacy of propagating and highlighting such juxtaposition. The tragedy of seeing a homeless man lie, sick and hungry, in front of a glamor-ridden, blindingly minimalist Marks and Spencer store never escapes me. Photographing that image highlights the juxtaposition enough for me. Capture that image, and as an artist, display the dichotomies in our society. I would gladly support that. But what is the need for creating such inequalities and then publishing them for the world to see?

It seems to be an inherent problem in the way we think. The interesting point here is that I don’t think Tanna or her colleagues ever intended to hurt, offend or harm anyone. But as individuals who have the power to reach out with a message to so many people, I think that whether or not they accept it, members of media outlets do have a social responsibility, to be at least minimally aware of injustices and ignorance that are present around them. To me it truly seems reminiscent of old-timey Indian exoticism as “captured” by the British. We should not allow ourselves to be colonialized and imperialistic within our own society. By forcing so-called signs of prosperity onto people who cannot dream of ever being in such a position, I do not think we do ourselves a favor. I do not think it is acceptable for women like Editor Priya Tanna, who should be a beautiful example of the success of the Indian woman, to
degrade and exploit her fellow Indian in such a way.

Instead of declaring that fashion is no longer a rich man’s privilege, why not we take the opportunity to share with the public that education is no longer the rich man’s privilege? That is actually something to spread the message about. When India has reached a point where we can say that every person has the bare necessities, food, water, a means of sustenance, a place to live, and if they’re lucky, the chance for an education, then we can move on to bringing high fashion to the masses. Until then, let’s try and keep our priorities straight. When the last little girl has two pieces of clean, whole clothing that she can wear proudly, then let’s start thinking about teaching her fashion and style.

The hierarchical, classist ignorance shown by Vogue India and its supporters is disdainful. I urge everyone to make their views known to the editorial staff so that they think twice before making a similar gaffe in the future.


From my blog, Informed Activism in India.

Posted by nivedita in article, perspectives | No Comments »

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