This year's projects

I have yet to see the elderly welfare centres as it is Pongal - Tamil New Year - when people are too busy celebrating and painting cows to come to the centre, so I plan to go next week. In actual fact there are only 2 centres open at present. Keelalathur, the pilot centre and a second centre opened in Kovasambet. The second centre is a slightly different model, they get only snacks - tea and biscuits - which tends to discourage all but the poorest of the poor. They still come every day, but the on dit is that it is a more dynamic centre than the original. This is partly due I beleive to the caretaker who is more proactive and ensures that they do exercises and other activities every day. This highlights an interesting point that, above all, projects need good leadership; with the best will in the world, nothing will happen if there is no good, strong, clera co-ordinating force.

The other exciting development is the embryonic mental health project. In line with the global trend there is an increased focus on mental health in India and the director of mentla health services has commissined RUHSA to carry out a project to tackle this issue in rural areas. only remit is to develop a service which relies less on secondary and tertiaty care. Currently there is little input for all but the most florid and there is no active programs seeking out and assessing the mental health status of the local population, porbably because they know that it is a potential pandora's box with a tardis-like interior.

Rita and I discussed what strategies could be used. We talked about needs assessment and categorising the mental health issues in the region, but with the white elephant in the room of finite diminishing resources. We have therefore come up with a strategy which starts with asset mapping in a single village. At present, as physicians we know there is unmet mental health need in the community, however, there must also be met mental health need - essentially there is some way of coping, even if it is not perfect. It is therefore important to establish the resources available in the community. Once this has been done, there can then be a further assessment of where there is need shortfall. The first aspect of improving mental health care will therefore concentrate on bolstering and enhancing the existing resources. This process will culminate in building a resource pyramid, starting as locally as possible with self & family and only when all the resources fail will medical care be needed.

One conundrum is how to access the information about existing resources, it is difficult to enumerate or categorise as nothing like this has been done before. We are therefore toying with the idea of using narratives and traditonal story telling to elicit coping stories wich with hopefully reveal indirectly the resources people draw on to manage mental health problems.

Astonishingly, once again, India has managed to mirror and crystallise my work - both MSc and professional -into a single nugget, helping me clarify my thoughts and refocus. Amazing.