Outline of all Projects 2: The Goat & Cow Schemes

The thorny issue of the Goat Scheme has always been tricky. It was first introduced as a passing on the gift scheme which benefited some individuals, but as has been mentioned several times, the second time we tried to introduce it in another village, the goats went missing presumed consumed. In the original village, Keelalathur, we are now on the 3rd or 4th generation and there are 11 kids to be redistributed. I think we should see whether the smaller group at Seeterampet look after the goat better than at Kovasampet.

After the passing on the gift scheme faltered, we introduced the idea of SHGs raising goats, but as mentioned in a previous posting, this produced only modest returns. Mathew and colleagues went to an NGO convention and saw a co-operative model which we are keen to introduce here at RUHSA run by an SHG as a coperative, so we have the benefits of a group deriving an income, but also being able to generate an income for the EWCs. The capital could be put up by VRCT, 50% returns come to RUHSA for the EWCs and 50% go to the group. The newly redesigned VRCT committee will await a full proposal from RUHSA about this project and hope to be able to approve it for the coming year.

The Farmers Club Milking Program is another co-operative model initiated by one of the RCOs to benefit poor village farmers. FOV raised funds for 15 cows, giving 5 to each of 3 co-operatives. This acts as an interest free loan. The farmers pay 2000rs (£28) back per month from the milk and dung income they receive. It is early days, but we went to see the projects on weds (see previous pictures) and it is looking promising. RUHSA have trained the farmers in cow management and dung collection and as milk prices are good, the returns are also good. Each cow can produce 10l per day of milk which can fetch 17rs per litre. After feed costs etc they can earn about 100rs per day from milk alone. RUHSA feels that the farmers’ wellbeing has increased and there may be a chance to explore the impact of schemes such as this on other dimensions of health such as domestic violence, alcoholism etc. We will await the evauation after a year is up to see what the impact has been.

Next to be continued: diabetic shoes made by disability SHG, community college revamping & fund raising officer

Outline of all Projects 1: The Elderly welfare centres.

As in August, there are 4 EWCs with 100 beneficiaries, who receive a midday meal for 5 days a week. 25 are in Keelalathur and Kovasampet, 40 in Ramapuram and 10 in Seetarampet with the children. In all the centres the beneficiaries are generating a small income from paper bag making. These bags are sold to the College Shop in Vellore for 75paise per bag (abut a penny). Richard was enchanted to hear that because he had, unknowingly, bought some stuff from the very same shop and had, without the penny dropping remarked to himself on the ingeniousness of Indians to recycle their newspaper so productively.

In Kovasampet, they are still struggling with the garden. They are so keen to grow some vegetables, but the blasted monkeys made a mockery of the netting we bought by using it as a trampoline, thereby getting some entertainment until it broke, then they could have a post exertion snack. There are a couple of burgeoning tomato plants which the monkeys are eyeing keenly, but so far they are unscathed. I suggested they used the net for individual plants rather than stringing it up across the whole area. We will see if this fares better, but the keenness to persevere is heartening. As I mentioned before, they are a really feisty bunch in Kovasampet and they clearly relish the companionship derived from the group and sit chatting and even arguing with empowered enthusiasm. They are also adorable about my diminished cheeks.

As you can see, the garden attempts are a little sad :-(

Seetarampet is a lovely model and is the baby of the Bishopston innitiative. Here is a link to an adorable video of the children not sleeping and to Sally Whittingham’s blog where there is more detail on the whole project. When I visited Keelalathur, the first centre, again they presented me with a shawl to say thank you which they bought from their own money. I feel bad taking from them when they have so little, but it is also important to be humble enough to receive and to respect their honouring of us.

Today I visited Ramapuram where the SHG is super keen and they are doing well. They are less skilled at the paper bag making and apparently the quality control is lacking so they made less money than at the other centres, but they are a newer and larger group so they may have a little further to go yet. Mathew & I went there today by bus, it is a much further distance from RUHSA than the others so it is visited less often, so they had lots to tell us. Mainly they were asking fi they coud go on an outing to a nearby forest. None of them have ever had the opportunity to visit the forest, much less the luxury of having a picnic, so I have asked Mathew to cost it out and see if we can raise the funds for it. I can't imagine it would be that expensive. It is a very remote village with no rickshaws, so once the rickshaw from Latteri had dropped us off, we were a bit stranded so two of the village boys gave us a lift back to the bus stop by on their motorbikes which excited some comment from the locals.

This may be our new poster girl!

The plan now is to identify another area to open a further centre. We have roped in some more sponsors so the charitable income is increasing and the alignment of VRCT & FOV UK also now gives us direct fund-raising potential. I met the director of FOV Sweden who is also keen on supporting the elderly project and has a chair of Elderly Care Homes on his Swedish board who is looking to get some corporate sponsorship. He made the excellent suggestion of linking care homes with a single EWC in India to raise revenue. I had thought of Community to Community sponsorship, but this is even better. I may have to break my Staveley House fast and go there to do a presentation about the EWCs here. I will also approach the head of Risedale to see if they are interested. It’s a lovely idea to twin differing elderly populations. Perhaps they could start writing to each other as well. The letter might have to be translated, but it would be nice to have direct communication.

When Richard was here, we had a bit of a sticky moment about pensions. There is some suggestion that some of the elderly are unable to get pensions because they cannot afford to bribe the officials to get the forms completed. This may in fact not be the whole story, but Richard feels that this is a very easily surmountable problem and offered to pay this money to bypass the problem. I get very uppity about lining fat bureaucrats pockets in this way, not to mention the fact that as the new chairman of a charitable subcommittee I cannot be spending money in this way. In addition, as a fundamental principle, I object to sustaining a corrupt system. I would rather spend the time using clout to get it done properly, which would benefit more than the 12 or so people we know about. So there was not some insignificant friction and controversy. The upshot is that I think right will prevail. Next time I come, I am prepared to go with the elderly along with one of the RUHSA staff as their advocate and shame the officials to do it properly. Sadly, I do not have time to do it this visit. But who knows, perhaps wheels will have turned before then. If I were still teaching medical students, I could use this situation as an excellent example of the different between deontological and consequentialist ethical theory.

The Elderly, some naughty kids, more cows & paper bags and a chicken or two

A beautiful hibiscus flower

Piles of completed paper bags 

Naughty children on their afternoon nap, slightly distracted by the funny white woman making snoring noises to encourage them.

The beneficiaries of the Kindergarten & Elderly Centre at Seeterampet.

Some of the elderly at Keelalathur. The women have benefitted enormously from the goat scheme which worked very well in this centre. The lady on the left is saving all her earned 9000rs (£13) for her funeral expenses so she can go out with a bang.

RUHSA staff: Rural Community Officers, Training officers and Community Physicians, including Dr Rita.

A particularly beautiful cow donated by kind British people to start a milking & fertiliser scheme for very poor farmers who form a co-operative. The income from the first cows bought (5) will subsidise future investment in cows for the remaining farmers in the co-operative. The Farmers also pay back the money  to RUHSA, so it acts as an interest free loan, so more farmers clubs can be started.

The local RCO trying to catch another of the RUHSA purchased cows.

A sleeping calf

The third cow. Nice shadow.

Negotiations and picture opportunities with Richard and the cows.

Jungle fowl and little jungle fowlets

The fifth cow (fourth cow wasn't very photogenic)

Richard showing some more naughty children his photo of them.

Prabhu, the OT, assessing an elderly gentleman who had a stroke a month ago with R hemiparesis. He is going to show him & his family some basic activities of daily living, exercises and positioning to prevent contractures, reduce weakness and improve function. Behind are some informative posters.

Bullock cart in the sun.

You made not be able to see, but this lady is not sure of how jigsaw puzzles work, so she just puts the pieces together regardless of the picture.

We came across a huge festival on the way home one day. There was this crazy, enormous foil-covered construction being dragged through the streets, whilst people danced to loud drumming and generally made a lot of noise. Not sure what the reason was, but with 1000's of gods, any old excuse will do.

Chit-chatting at Kovasampet whilst making paper-bags. They have always been a fiery lot here and they had lots to tell us. 

One lady was all fingers and thumbs and kept getting herself stuck to the bags rather then the paper stuck to itself, so she needed help from a neighbour.

The downside of working with the elderly: Goodbye to Rathinam

On the spur of the moment and mainly to expend some chapati acquired energy I decided to cycle to Keelalathur Elderly Welfare Centre for an impromptu visit. Tomorrow there is an official visit for which Jamuna, the caretaker, will be forewarned, so everyone will be in their places, scrubbed, doing puzzles, playing games and generally showcasing the simple facilities at the centre, but I like arriving unexpectedly and seeing what is really going on, so today I cycled the 7km to Keelalathur and surprised them. I was heartened to see several piles of completed paper bags which some of the elderly had made. Each bag sells for 75 paise (1p) and so far they have made 738 bags in a month or so. It is hardly a project worthy of Dragon Den interest, but nonetheless sitting and chatting to friends whilst earning a few rupees instead of spending the whole day scouting around for hard labour which moment for moment has a much poorer rate, is a good use of their time.


When I arrived this time there were several new faces and only one of the men was there. Although a couple more arrived later, when I enquired, Jamuna told me that there had been 8 deaths since the start in 2006. I knew of a couple, including Sukkupattu who was a particular favourite, but I was extremely sad to hear that Rathinam had also passed away since August. Apparently he had been hospitalised for TB and had not survived. Rathinam was a relatively educated man who had married a lady with schizophrenia which was very difficult to manage, especially when she had children, so the family allowed him also to marry her younger sister. They all lived in the same house caring for each other and the children. Everyday Rathinam would bring his schizophrenic wife to the centre, and whilst she benignly sat and stared around, he would read the newspaper out loud to his friends. He was particularly fond of me and every time I visited, he would stand up and make a speech about how grateful he was for the centre, giving him peace and friendship in the last years of his life. If anyone complained about not being given saris or other things, he would get cross and tell them to be grateful for what they had. When we discussed the possibility of opening another centre after Keelalathur had been open for a year and, trying to stress the importance of sustainability, ie income generation, we had said that there was a limit to the funds available, he made one of his speeches. He stood up and said that they would always be grateful for what the centre had given them for a year and if it was the turn of other poor elderly to benefit from our generosity, they they would gladly give up coming to the centre so others might have a chance to receive what they had. It is almost inconceivable that someone with so little could be so generous. I am so glad that Rathinam derived such pleasure from the solace that the simplicity of the Keelalathur Elderly Welfare Centre provided him. His wife still comes and she is now surrounded by her friends; even though her mainstay has passed away, she has been incorporated by the group and they carry on her care and support.

Superstition and ear tagging

Last year one of the most exciting prospects was the idea of working with the SHG Federation, a community organisation formed by elected representatives from each SHG in one area. The Federation acts as an agent for each of the SHGs in applying for, managing & holding funds in order that they do not have to apply directly to the banks themselves. It has the advantage of being a peer represented group who due to economies of scale have greater power than a small village SHG. Peer pressure ensures that people behave with probity because everyone has a vested interest and of course these are elected members who can be stripped of powers if need be. At the time last year, when we raised this with the Federation, they were extremely keen. They helped us develop the model whereby  VRCT donated funds for some goats. The money would be handed over to the Federation who using their local knowledge were to identify a group of women who were keen and able to rear goats  and then organise the giving of goats to these women. When the goats were sold the capital would be returned and a proportion of the profits would be donated to another SHG to manage an elderly welfare program. The advantage of this model for RUHSA and VRCT was that the same money went much further empowering two SHG groups and an elderly group. The advantage for the federation was supposedly that their status & eligibility for government grants increased because you get extra points for social welfare work done. Everyone seemed keen, however, there was a slip twixt cup and lip between august and now and for some reason the Federation backed down.

As a result, RUHSA developed another model and bypassed the Federation by identifying two SHGs directly themselves and acting as goat agents. Interestingly, both groups behaved quite differently. One group have been highly difficult to work with, starting with being tricky about insurance. Apparently, insurance (which is essential, as we found when one group of elderly beneficiaries ate the goats rather than rearing them) requires the goats to have a tag on their ear. This particular village believe that this is bad luck and were cross about the tagged goats. As one might expect with superstitions, it was difficult to persuade them that there was no connection between ear-tagging and luck. Unfortunately, the goats themselves were not helpful and did not work with us on this. One jumped into a well and another one inconsiderately dropped dead. They even attributed the death of an entirely unconnected cow to the ear tagging, thus enabling the women to nod knowingly and smugly and demand the goats be sold immediately. Such was the pressure that the goats were sold prematurely and the profits realised were very small. However, even so, this represents the first formal community contribution to the Elderly Welfare Program.

The second village were more amenable and relaxed about the whole ear tagging business - I think it was helped by their goats avoiding wells and death successfully - but they have been rearing their goats for longer and those who have sold realised 33% net profit, which is a good return. There are still a few women who have not sold yet, who will scoop even more profit. At the moment it is generating small amounts of money only, but it is a start and also it is an attractive fund raising opportunity for FOV, as not only are you enriching the life of the person who owns the goat but also you are providing some social benefits by subsidising elderly programs. Of course the goat does not benefit much, but there's always got to be an underdog.

Overall, the scheme has some promise, but as it is, the returns are too small and the workload for RUHSA staff in galvanising and motivating the SHG women, not to mention the time taken arguing about the relative likelihood of their goat having Kamikazi tendencies because of the presence of an ear tag, has been somewhat arduous and therefore not sustainable. As a result the team have been looking into other options and there is some interest in a goat shed project where there are a group of goats raised by an SHG in a shed. The advantage being that more goats can be reared at anyone time, there is no need for grazing and income is generated not only by the sale of the goats but also by sale of manure which collects below the slatted floor of the raised shed. RUHSA has a space it can construct a shed and an SHG group who can be in charge of it and the income generated can be shared by RUHSA & the SHG.

In addition to the income generated for the projects as a whole, there has been some movement on opportunities for individual income generation. Prabhu, the OT, has initiated some paper bag making in all the EWCs. The materials are free apart from the glue, which is very cheap, the staff are donating old newspapers and the elderly slowly, but efficiently transform them into paper bags, the demand for which is apparently high. For a couple of hours work, when they come to the centre, whilst sitting and chatting to their friends, they can make some paper bags and earns a few supplementary rupees. Below is one of the men using a stick to spread the glue as he wraps the newspaper around a sari box to make consistent, uniform sized bags.

It has only taken 5 years to develop these income generating projects and we are a long way from self-sustainability, but there are even more ambitious plans in the ofing and now I am chairman of VRCT I have at least some say in what we can do. Which is very exciting.

(*Note to self. Mustn't let the power go to my head.)

2012 visit: Brief recap on why I come out to India.

Once more I find myself sneaking into RUHSA late at night and being shown to my dear little room which had been vigorously cleaned for my arrival, resulting in a not-so-faint odour of Jeyes fluid. None the less, I slithered into bed, warmed by the balmy air and a light coverlet, not missing the nip and pull of freezing mountain temperatures, and slept like a log until the familiar early morning crow conversations woke me up refreshed and raring to get going.

My arrival last night coincided with director of Friends of Vellore, Richard Smith's drive to Vellore, so he very kindly picked me up from the airport, giving us a great opportunity to plan our strategy for project fundings for 2012. Friends of Vellore is the umbrella organisation responsible for fundraising for projects in the main hospital; VRCT - Vellore Rural Community Trust - has always been an affiliated, linked trust fund separate to FOV, but last year we merged and I have been made chairman of the VRCT subcommittee which remains responsible for supporting rural healthcare projects and focuses on the work done at RUHSA. RUHSA is the Rural Unit for Health and Social Affairs, a rurally situated health and welfare department with a small hospital and training centre, 30km from the centre of town. It is responsible for a population of around 200,000, in a district comprising roughly 30 panchayats (village municipal units) and has a wide network of local activities and has done for 30 years. The beauty of being involved with RUHSA is their vast network of well-developed relationships, local knowledge and experience in grassroots working. The main hospital is a huge monolith with impressive technological expertise comparable to a western tertiary centre. The work they do there is incredible, but it is very high tech and therefore, like all tertiary centres, focusses on those who are already sick and not on keeping people healthy or dealing with the early, primary care stages of illness. Primary care in India is still in its organisational infancy, but is gaining intellectual credibility due to the work of dedicated family practitioners, such as Dr Raman Kumar, who has set up and is running the increasingly high profile Associated Family Practitioners of India (AFPI) which has now been awarded WONCA status, but in the meantime, places such as RUHSA provide much a much needed bridge between health and devastating illness. RUHSA not only deals with minor and early ill health, but also runs community development projects such as the SHG (self-help group) co-ordination, waste management schemes, 2-wheeler mechanics apprentice programs, cow-rearing projects and of course our elderly welfare and goat schemes.

This time, for the first time therefore, I arrive with clout and the capacity to made decisions about how our charitable moneys are spent, rather than merely being a reporter to the committee on what is going on. It is a very exciting opportunity to really encourage RUHSA to become even more ambitious and wide-reaching.