Friday, January 15, 2010


The plan is evolving. Today the adult psychiatrist, Dr Anna Tharyan, who is an adult psychiatrist working in community rehabilitation, came to RUHSA to discuss the germ with us and the plan is unfolding, forming definite shapes and vistas. As expected there is no capacity in the Psychiatry department to spare an OT who can come and train the village carers on a regular basis, which means that VRCT is in an ideal position to consider funding an OT post for RUHSA. Of course being an OT of children with learning difficulties and an OT of adults with severe and enduring mental illness are two distant branches of a great tree connected only via the trunk of undergraduate learning. Once beyond university training, decisions as to which branch to follow come immediately and decisively. This means one of three possibilities: either the OT who is appointed must have little ambition of personal academic development down the specialist route – which in India, where continued professional achievement is paramount, is going to be difficult to find; or RUHSA needs 2 OTs, which would be prohibitively expensive and also misses the point that these branches are arbitrarily determined by medics not communities and in practical terms the needs of the carers of these two groups of patients are remarkably similar and it is the carers we are wanting to train not the patients; thirdly, RUHSA uses this as an opportunity to look at developing this concept as a subspecialty in it’s own right. In other words, becoming an OT in the subtleties of training community members in management of dependent family members of all types is a validly different and separate skill set than being an OT for children with learning difficulties or an OT of adults with mental health problems. Needless to say, I favour the latter option. It validates this entire approach rather than making it seem a makeshift alternative to proper services, which indeed it is not, it just happens to be a cheaper option.

So, how to start the project running? How to establish trust in the community that meaningful services are going to be provided before we appoint a full time OT, which may take 2m or, more likely, 6m? Selvakumar, in a blinding flash of brilliance, volunteered his son, who is just about to finish his exams, but then has 2m to wait before finding out the results to volunteer during the waiting period. Eyes gleamed at this. He is known to be local, dedicated, bright, enthusiastic, innovative and most of all, currently working in the community rehabilitation department.

Dr Tharyan mentioned that training for women in caring for special needs children already takes place. It is a 3m course and takes place the other side of Vellore 35km aware, so in principle this would be difficult for the mothers in the local villages here. Another role for VRCT? Perhaps, sponsorship of these mothers with regard to travel and living expenses. It is a daily interactive course which the children attend too. Interestingly, an unexpected side effect (from the perspective of the psychiatry department) is that 2 mothers have started day centres in their own homes for 5-6 children. Hallelujah. This is not to be an unintended consequence for this project, but the overarching aim. Dr Annie and I will try and visit these mothers next week to hear their stories and hopefully, ask them to come deliver some of the early introductory training sessions at RUHSA to inspire mothers here.

So, now we have an interim OT, with the promise of cover for a couple of months if there is a hiatus between the end of the appropriately named Trinity Selvakumar’s voluntary period and the full time appointment. We have training opportunities for keen mothers in both intensive out of campus established training programs and introductory training sessions at RUHSA for staff, mothers other carers and SHGs. I suggested to Dr Tharyan that her department and RUHSA could start to develop and formalise training sessions for caring for adults with mental illness. It takes place but ad hoc. She made an interesting point which is that in adult psychiatry, the single most important intervention is affordable and effective medication regimes. The only problem is that often villagers have no sense of conventional time. Next Tuesday means nothing at all to them. Again, an effective community lead co-ordinating timetabling of medication regimes would be incredibly empowering for the community. It begins to unfold some of the unmanageability of sever and enduring mental illness. Formalising the caring role is another future potential of this project in terms of academic validation and transferrable usefullness for other health centres; not to mention the benefit to the community. People can start being untied from their beds.

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