tag:blogger.com,1999:blog-316822842024-03-16T07:08:01.585+00:00A Rural GP & Rural India: the ongoing love affairNo longer travelling with an anorexic wormArabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.comBlogger145125tag:blogger.com,1999:blog-31682284.post-63675146867938037662014-01-17T19:31:00.001+00:002014-01-17T19:31:57.247+00:00The broad reach of RUHSA<div>One of my main ambitions this time was to gain a better understanding of the areas I have been less aware of at RUHSA. I am very well acquainted with their social welfare programs which VRCT are involved in, but there is so much more going one here including other international collaborations. It is mind-boggling what a microcosm of a benign welfare state RUHSA is to the people and community of KV Kuppam block. They are a vocational college, Healthcare System, Social Services, Citizens Advice, University, Research Centre, Agricultural College, Community Support and much, much more all rolled into one. Just to illustrate the diversity of approach, the class I took today contained a wide variety of students: there were nurses, doctors, social workers, medical sociologists and health administrators all learning together. This fundamentally integrated approach to welfare delivery means that each person who comes into contact with RUHSA has a much broader perspective of what constitutes wellbeing. It would be amazing if universities in the UK had such a mixed syllabus approach for students instead of isolating everyone into their ivory tower subjects. </div><div><br></div><div><br></div><div>I was especially interested in learning of the other international collaborations for research projects. With the Bill & Melinda Gates foundation, RUHSA is a centre researching the aetiology of neonatal sepsis. They have recruited 1100 or so women, of which 750 have delivered and so far one baby instead of the expected 10% has developed sepsis.</div><div><br></div><div>In a long standing collaboration with University of Sydney, there has been a 7 year project looking at cervical screening of the local population. In rural India they are way away from the acceptance of having a 5 yearly smear and education about the need for women to be screened is slow work. You can just imagine the multitude of barriers in a country where no-one even kisses on screen in films, so to expect them to come freely and have an intrusive internal examination when they have no symptoms is a big ask, but even though the pilot project finished after 2y RUHSA has maintained the impetus, making it one of their core pieces of work to try & improve the health of the women in this block. The education about the causes of cervical screening is also fraught with problems because most of these village women have only slept with their husbands, but infidelity is a common occurrence and the women have little or no influence on the number & frequency of their husbands other partners. Husbands are welcome to attend the screening with their wives, but little or nothing is said to them about their role in the whole process. Cultural taboos make this difficult.</div><div><br></div><div>Aberdeen and RUHSA have started a new collaborative around nutrition in children for which they have opened a new nutrition centre, where they give cooking lessons to families in which there has been a child identified as being underweight. I did not have a chance to see the cooking lessons, but it would be lovely to see next time.</div><div><br></div><div>I also spent some time in the clinics. My god they are busy and apparently this is a lean time due to Pongal. It is like a noisy, bustling, exceptionally colourful conveyor belt. Forget about 10 minute appointments, no chance. People are even scattered all around the grounds as there are insufficient benches for everyone to sit on whilst waiting for the few moments with a harried Doctor squished into a short walled, open plan cubicle with an equally harried colleague an elbow poke away in the same space. There was not enough space for me to sit and observe, I had to lean over the partition from the entrance, whilst being bumped and squeezed past by the constant flow of patients, relatives, staff and children moving through the clinic like grains of rice sloshing around on a plate with too much rasam. The luxury of a spacious room to myself with a comfy lean-back chair - absolutely no possibility of leaning at all unless it is into the next cubicle to borrow a pencil - a large desk with computerised notes (yup the remaining spaces between people awash with thin Indian sheets of paper for various & all purposes) are but a few of the things I will be heartily thankful for on my return.</div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com9tag:blogger.com,1999:blog-31682284.post-10139282266884151192014-01-17T06:10:00.001+00:002014-01-17T06:10:16.864+00:00Keelalathur continues<div>One of the great privileges of being fairly independent is that I can arrive unannounced at the project sites and see for myself how they are really doing without anyone being warned in advance scrub up and look busy. Last Saturday I cycled to Keelalathur, the first and dearest project to me. It is where it all started and I always make a point to go there. To a certain extent it is a survival mechanism to have shameless favouritism in India. With over 1.2 billion people, some means of selection is essential or you would drown. There are now 5 elderly welfare centres and only 3 of there are funded by VRCT. Of course, I was deeply involved in the development of the principle of an elderly welfare centre and the rest evolved from then onwards, but this occured once I was back in the UK, consequently, I had much less personal input and connection with the members of the group. At Keelalathur, they actually feel like old friends. Pushpampal, who grudgingly attended at the beginning, always looking dissatisfied and complaining that whatever we were giving was not enough, is now one of the staunchest members. She is always gratifyingly pleased to see me and is very cheeky with her greetings. Last time she told me I looked like a boy since I had lost weight, this time, she pointed to her hair, to me & then to the greying paint on the wall. Nothing escapes peoples' notice over here and my increasingly greying hair was no exception to the beady eyes of Pushpamal.</div><div><br></div><div>In the back, the garden is a little more productive than before. Proudly, they presented me with some lemons from their tree. Beans hide between twisted vines and curry leaf plants glisten from their recent watering. Apparently they have a harvest for approximately 6m per year. Its not a huge amount, but the Elders enjoy tending the plants and they can reduce by a small amount their food costs. A few years ago, everyone was enthusiastic about the idea of a working garden, but when the monkeys used the net as a trampoline before snaffling the produce at Kovasampet, everyone became downhearted and I assumed the idea was dead in the water. Somehow, despite this, those little seeds of enthusiasm flourished despite an apparent lack of encouragementNow each centres with land attached. It is a metaphor we would do well to heed. In the UK we start projects and when they do not produce results exactly as expected in the proposal, they are often binned, but we rarely give them enough bedding in time. These projects have shown me that the pace of change is slow but steady instead of rapid and transformational. Perhaps we need to aim for smaller, tidier ambitions and apply them with greater patience, so after a few years, we do not have several failed initiatives to show, but a subtle shift in perspective and outcome. </div><div><br></div><div>Today, I promised them to come back so they could give me lunch. It is important not to always be the donor and create a permanent sense of gratitude, it is an ultimately destructive and disempowering dynamic, consequently, going to have lunch is an easy way of allowing them to give back. I look forward to it even though I will not really be able to understand the dinner table conversation! </div><div><br></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-62051043547483434802014-01-17T05:50:00.001+00:002014-01-17T05:50:15.089+00:00First RUHSA visit 2014<div>Owing to the beauty & brevity of twitter I have been able to annotate this year's progress at RUHSA without resorting to lengthy blog posts, for which I seem no longer to have the time. The seductive pleasures of intermittently tweeting have overtaken the homework-like feel of blogging. But there is so much going on that several times 140 characters cannot possibly be sufficient so I have forced myself to be a good girl and sit down to my long overdue prep on "What I did in my holidays at RUHSA".</div><div><br></div><div>The most momentous news is that Rita is a grandmother. She was delighted to welcome her newborn grandson to her family on 7th January 2014 - the second time in 2y I have been lucky enough to see a friend's unexpectedly early arrival. Last year, Victoria & Sudhir were delighted at Aadya's eager entry into the world which, had she been, on time, I would have missed. Rita's as yet unnamed grandson is very beautiful and clearly seems to have all his faculties intact as he blinks angrily at the bright lights when the blanket is lifted so admiring glances can be made and startles tremulously at the toxic air-horns on the passing trains. He too was early and is no doubt wondering why he bothered to rush as he is subject to the sensory overload India provides.</div><div><br></div><div>Of course, this week is Pongal, which has turned out to be a mixed blessing. As the organisation is Christian, the staff do not celebrate the Tamil Hindu Harvest Festival/New Year celebrations which exuberantly stretch across several days. However, the local community does, which means that the staff have an unexpectedly lean time, with fewer activities and therefore more time to sit down & talk to me about how things have been in the last 11 months. Of course it also means that a few staff are taking advantage & are on leave and also the projects might not be running exactly as usual, but being here fore 10d has helped ensure that I have seen pretty much everything I wanted to, which is great.</div><div><br></div><div>Everyone is well and happy to see me, as I am them. Most of us a little greyer, some faces new, some faces missing from the annual retirement cull but new faces also on the scene: despite her age and previous mid-life crisis, RUHSA is burgeoning new life and forging into the future with great purpose and intent. </div><div><br></div><div><br></div><div>Rather irritatingly, several people have correctly noticed that I am not as lean as I was when I first returned after my great loss. Although to a man (and woman) they are all saying they prefer me like this, still it is galling and has forced me to take stock. I am trying to think lean whilst here, but it is almost impossible. The Indian diet is a gigantic challenge for your average dieter. It is heavy in oil, the food is cooked till pulpy and the body needs expend no energy to digest it thereby increasing its glycaemic index & the quantities served, are ridiculous. The plates are the size of small tea trays. Not even small tea trays, come to think of it. Couple this with a natural desire for people here to force a constant stream of tidbits, heavily sugared tea and coffee, snacks, extra portions, large portions and other consumables, refusing all the while to allow "No" to mean anything other than a coy segue to a resounding "Yes", spells disaster for someone who is naturally greedy. On more than one occasion, an extra portion has been slipped underneath my outstretched hands vainly attempting to cover my plate, amidst lentil-showering, increasingly desperate protestations of impending food-induced explosion. I don't even want to think about how hard I am going to have to work on my return. I think the quest is on once more for a non-anorexic tape-worm.</div><div><br></div><div>However, the simplistic luxuries of my room have allowed me to have a couple of lean meals on my lovely induction ring which is so aesthetic it is a pleasure to use. In addition, a kettle provides me with the ability not only to have tea without sugar (my natural preference) but also a stirring glass of Booths Earl Grey, which I have successfully, if a little pointlessly, introduced to a couple of people here. They all agree it is delicious.</div><div><br></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-74685606351329479292013-03-11T22:31:00.001+00:002013-03-11T22:31:13.212+00:00Final thoughts on our 2013 visitIn February, 3 members of FOV spent a wonderful week in Vellore<br />
looking at all the amazing work that takes place there done by some<br />
incredible, inspirational, dedicated people and teams. One of those<br />
days was spent at RUHSA which is the extraordinary multi-disciplinary<br />
rural health & social welfare department about 30km outside CMC in KV<br />
Kuppam. Covering an area of 200,000 people, RUHSA works on a multitude<br />
of different projects to improve the local community from providing a<br />
small local hospital, outreach clinics, preventative medicine and<br />
educational programs, training local boys in auto maintenance, setting<br />
up & supporting self-help groups; and those are just the ones that FOV<br />
is not directly involved in!<br />
<br />
We in FOV are delighted to provide support for a range of diverse<br />
projects at RUHSA. We worked with them to set up their flagship<br />
elderly welfare centres which provide welcome havens of friendship &<br />
support, as well as a delicious meal made by local women who are keen<br />
to become involved & raise the issue of elderly care within their<br />
community. The FOV-supported occupational therapist has started income<br />
generation projects in all centres so the participants can raise small<br />
amounts of money for themselves by making paper bags which are then<br />
used in the college shop on Bagayam campus.<br />
<br />
The first centre opened in January 2007 and the fifth centre, funded<br />
by FOV Sweden has just opened in January 2013. RUHSA hope to<br />
proliferate these simple, but effective models throughout the area.<br />
This year we were told of one of the participants, a lady who has<br />
no-one and nothing in her life except a small bag she hangs from a<br />
tree under which she sleeps each night. Her time spent surrounded by<br />
other members of her community, chatting and being included gives her<br />
such pleasure, that every morning she is waiting at the door of the<br />
centre hours before it opens.<br />
<br />
Raising the profile of the elderly centres is always a priority for<br />
FOV as we are so aware of the increasing burden of ill health this<br />
sector of society bears and other work we support helps to improve<br />
family finances in the poorest groups so that they can afford to look<br />
after all their family members, but also some of the money generated<br />
can be recycled back in into the elderly welfare projects. This year<br />
we are supporting a pilot stall fed goat scheme. We are funding the<br />
building of a goat stall which can more intensively rear goats for<br />
better profit margins. We visited an organisation in the Javardi Hills<br />
who have a similar project & we were impressed with the set up. The<br />
stalls are airy & light, the goats are allowed to roam free for a<br />
couple of hours a day and they are fed well. RUHSA hopes that this<br />
will generate personal & project incomes as well as becoming an<br />
exportable model for other SHGs.<br />
<br />
This year, RUHSA made a further proposal looking at another difficult<br />
group, the local village youth, who often become rootless & aimless,<br />
reducing their future prospects. This year, they are looking to<br />
develop sports clubs in the local villages to encourage youngsters to<br />
take part, have fun & feel part of a community. With FOV support they<br />
will provide simple sports equipment for several villages and every<br />
year, there will be a sports tournament organised at RUHSA in order to<br />
give the lads something to work towards & achieve. Next year perhaps,<br />
some FOV members can present the first RUHSA trophy to the winners!<br />
<br />
It is always such a privilege to see first hand the work done out in<br />
India, the level of expertise & experience is extraordinary; their<br />
vision about their local community’s better future is inspirational<br />
and I hope this newsletter gives at least a flavour of what takes<br />
place. I would urge anyone to visit and see for themselves.Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-54310680659674784542013-02-25T12:25:00.001+00:002013-02-25T12:25:57.967+00:00ReflectionsAfter writing about all the things I have seen and done here since my arrival, I wondered what being here really meant to me. Its easy to write about hard luck stories, they are the literary equivalent of shooting fish in a barrel. But, in reality, what is the point in all of this?<br />
<br />
This thought occupied me greatly whilst padding around my room, for the first time in my 8 years of coming, able to enjoy the luxuries a single ringed induction cooker offered - the ability to boil vegetables and, with the wonderful sachets of spices here, cook a half decent curry. I had just finished watching Africa by David Attenborough the last episode of which I had downloaded before the trip out and which had moved me to tears. The sight of this brilliant, empassioned, octogenarian naturalist, who has spent his life bringing the wonders of the natural world right inside our homes, mewling softly on his hands and knees to engage with a blind baby rhinoceros, forcefully illustrated both how amazingly powerful and yet futile humans are. We are agents of devastation and awesome change, but at the same time, to think that this is so feels like an enormous arrogance. The horrors of climate change seem both inevitably and impossibly to be caused by humans. Humans whizz around doing 'stuff' - both good & bad and the world spins on - rocks shifting, waters rising and falling - our eventual destiny surely completely unknowable. Sometimes it seems we influence everything and other times, nothing. <br />
<br />
Given that rhinos do not reach their full maturity until they are about 10 years old, David Attenborough will be long gone by the time that baby has lived a full life & reached the potential hoped for by the wildlife team; he will never know whether he was a successful adult siring a whole new generation of black rhinos helping bring his species away from the edge of extinction. Watching someone towards the end of his life see, brutally, how much there is, will always be to do - no less than when he was hacking his way through the tropical forests with a black & white film crew makes me wonder whether there any point in doing anything at all, since the work is never done. <br />
<br />
Being here reinforces that sense of powerful futility. I spend half my time here feeling pleased at the effects the work is having on the local community, then I take a step back and see the drop-in-the-ocean-perspective which makes everything feel pointless. Finding a middle ground especially here, in India, a place of such extremes, is difficult; the human brain can find it hard to bridge these two spectrum-ending perspectives; we are binary by nature with our paired limbs and symmetrical bodies - on the one hand this, on the other that. We must either be useful or useless. Yet, reassuringly, a single grain of rice feeds no-one and no-one expects it to. It is not big institutions which make the differences, it is the accumulation of relationships. No-one has the "answer" there is no "answer", we are all simply part of an iterative process, some things we will do better and others we will do worse: influencing what we can, learning from mistakes, striving to improve and, crucially, enjoying ourselves. Meantime, the world turns until it stops. Then and only then do we need to search for progress no further. I guess at that point we simply say "Bugger" and accept our fate. Until then: Anything possible, Madam.Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com2tag:blogger.com,1999:blog-31682284.post-68017755850342094912013-02-22T18:29:00.001+00:002013-02-22T18:29:50.584+00:00The Palliative care teamYesterday morning we went out with the palliative care outreach team which was a window into a world of extraordinary suffering and reminds me anew how goddam lucky we are to live in a country which, whilst perhaps being less inventive, is better at looking after its most vulnerable. Yet, even amongst the ashes of despair and hopelessness there are extraordinary sparks of vitality. India is a country in which one never stops learning inventive and ingenious ways of doing things. The familiar is turned upside down to reveals its bloomers, probably made from recycled umbrellas.<br />
<br />
In this country chewing betel & paan is very common. For years men & women hold masticated toxic leaves in their mouth, with their delicate cheek tissues soaking up the carcinogenic chemicals. As a result of this, disfiguring, fungating, destructive tumours of the mouth are common. One of the patients the palliative care team visited had this type of cancer. She was 67 & the whole right side of her face resembled a mine field after someone has driven a tank through it. She was unable to drink because any liquid dribbled out of the hole in her face; that which made it to the back of her throat was misdirected by the tumourous growth into her windpipe causing her to hack and cough. The malodorous flesh passed close to her now exposed olfactory system. Her daughters tended to her as if she were a delicate flower, it was clear they did not want to lose their mother, yet they wanted her to pass peacefully with dignity and without suffering. They were quiet, calming and efficient, yet never forgot their instinct for hospitality, plying us with cold drinks, tea & biscuits as they intently watched the nurse showing them how to dress their mother's wound. <br />
<br />
The nurse used a sterile pack with cotton dressings, but these are expensive for the average indian family. So the nurse explained how to make a home made dressing pack. Firstly, place the cleaned steel equipment in a pressure cooker and cook for 10 minutes. The put 2 tsp of salt into a pan of boiling water & bring to the boil for 10 and allow to cool. For the dressings, cut a clean cotton sari into pieces and sterilised them in the idli maker. An idli maker is a steamer in which makes the breakfast rice patties are cooked. <br />
<br />
During this process, the lady was barely able to register our presence, she had her eyes downcast. The only sign of acknowledgement was as we arrived and saw her horrific plight, she raised her hands to the sky and looked at us - despairing, begging. It was our turn to have our eyes downcast. Who could deny the justification of her unspoken request? At the end of the visit, the christian chaplain, part of the multi-skilled palliative care team, stood with her, a muslim, embracing her faith and desire to be reunited with God by praying with her. Even I, a non believer, silently prayed that God might hear her.Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-55575229124922345082013-02-20T17:59:00.001+00:002013-02-20T17:59:04.104+00:00From Idea to MovementToday was the day I came out for. Three members of Friends of Vellore UK coming to RUHSA to hear about their projects and decide which could be supported. In past years, we have had to be fairly directive, often instrumental in the inception and development of the projects, but this year was different. Under the stewardship of Dr Rita, RUHSA has grown up. It is finally starting to realise its potential, which is very great. It is one of the most holistic organisations I know of, with its approach to community health and development. It pre-empts problems, finds problems, educates, trains, supports, heals, provides, empowers and all with generosity of spirit and kindness. Whether you are a woman who needs her blood pressure checking during her pregnancy, or you are a young man with learning difficulties who needs to learn simple activities of daily living, or you are an older person whose family has decided no longer to support you or you are a farmer who needs an interest free loan to buy a cow, RUHSA is able to facilitate you to a better state of being, whilst constantly on the search for new & innovative ways of improving the local wellbeing.<br />
<br />
We learnt of their recent successes, heard their new project proposals and listened to their ideas for the future. As so often in India, a circle of opportunity is starting to form, linking different spheres together. The newest proposal laid on the table, astonishingly & co-incidentally, was that of starting up a recreational youth club. The idea was born out of concern for the younger generation of lads who, not wishing to become agriculturalists, like their fathers, but with no additional skills to do anything different except yearn for easy money as apparently available to those on the public media, but lie just out of reach of their sparsely-educated, rural hands. There is a disenfranchised generation of young men who are ripe for the plucking for addiction, domestic violence, poverty & crime. RUHSA seeing this potential on the horizon wants to start a socially inclusive movement which nurtures skills, relationships and enthusiasms for these youths. They may not be a psychologically damaged as Celines lad, although undoubtedly there will be some who are, but the principle of need is the same. <br />
<br />
This starting point feels similar to where we were 6 years and 6 elderly centres ago, when we had no idea how we were going to do it, but we wanted to give the elderly people of poor communities a better and more dignified existence in their latter years. Now not only are villages coming to ask RUHSA to help them set up elderly welfare centres, but different countries are starting to sponsor the programs. Three were started by VRCT, the fourth was set up by the Bishopston link, the fifth by FOV Sweden and a sixth is earmarked by FOV Germany (we hope). Wherever we go to these centres, the story is the same, the elderly participants feel more highly valued & content than they have for years. They are enjoying the company, the attention the food and the small income generating programs. I wrote last year of a woman who has saved enough money to ensure she can have a proper funeral instead of the paupers funeral she had been destined for.<br />
<br />
These elderly project models are well established now and can be set up very easily. They include 10-40 members depending on the capacity of the villagers who provide the food and cost £126 a year per person for a daily meal 5 days a week. This money not only feeds an older person, but provides an income for women of the village. Today we went to the newest centre set up by FOV Sweden after seeing our flagship centre a couple of years ago. It was an unexpected visit because we had been due to see another one, so they were not awaiting our arrival. A wonderful sight greeted us: children playing in one of the rooms, wriggling around, running in and out of where the older persons were more sedately sitting playing games chalked out on the floor, batting the kids away as they knocked counters over whilst in the corner, the smell of spicy beetroot wafted across the newly cooked steaming rice. So much energy, laughing and chatting emanated from all and wrapped us in their pleasure at being there. The women of Panamadangi village wanted to start this centre; they were instrumental in helping identify the most needy villagers and donated their own building and money to ensure the centre had appropriate facilities (loo). I felt humbled & not some little pride at how our early efforts have become a movement of its own. I hope that, in 6 years time, we are experiencing the same sense of pride and awe looking back at the inception of the youth project. <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwUgDld_RSdDSF91bjvUcgb0fYTfqB0DYJJaJFPoP1-sQwe0SmVJOYqyfSHFkU9Ac1afVl_9p7a1KnQi7qZwbPhl3yyKu-hkUzmhZ1fT5JsUiS-bzRfwkyOZr7JQUYnlueqZK7rg/s640/blogger-image--474922223.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwUgDld_RSdDSF91bjvUcgb0fYTfqB0DYJJaJFPoP1-sQwe0SmVJOYqyfSHFkU9Ac1afVl_9p7a1KnQi7qZwbPhl3yyKu-hkUzmhZ1fT5JsUiS-bzRfwkyOZr7JQUYnlueqZK7rg/s640/blogger-image--474922223.jpg" /></a></div> <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9bfT1lt-BB51oZovoN_fQVo-I-rIg0rmWvSyWKHv-U8qfSwWAcy2DRhrzcQqkuTCMwEokHJe_RAnLbN7n4LEx-VAD63-E_c-BEB6R8D-fxZPYrCBYuJ5UEVrRg8C43A1TleseLQ/s640/blogger-image--974805161.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9bfT1lt-BB51oZovoN_fQVo-I-rIg0rmWvSyWKHv-U8qfSwWAcy2DRhrzcQqkuTCMwEokHJe_RAnLbN7n4LEx-VAD63-E_c-BEB6R8D-fxZPYrCBYuJ5UEVrRg8C43A1TleseLQ/s640/blogger-image--974805161.jpg" /></a></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-19947192171183802682013-02-19T17:53:00.001+00:002013-02-20T03:30:41.403+00:00RUHSA and the radical public health solutionThere's a new state in central India which has more consonants in its name than most people might expect except perhaps a Welshman. Chhattisgarh. Their health outcomes are very poor and doctors trained in their medical schools do not work where they are most needed - the remote rural villages. The shortfall is high throughout the state and dire in the most needy places. There are plenty of health sub-centres, but almost 1/3 do not have even a nurse practitioner, let alone a doctor. This is a problem all over India, but especially acute in this new state, which has the added disadvantage of having acquired none of the medical schools subsequent to its bifurcation from Madyar Pradesh from whence it was carved. There was another problem to be countered as well. In the health professional void of rural Chhattisgarh “jhola chaap” doctors, a derisive term for unqualified practitioners, were mushrooming in the villages, making matters worse with their nefarious practices.<br />
<br />
The obviously passionately enthused state government therefore came up with a radical & contentious public health solution. They tinkered with the medical school degree, shortening it & targeting more local, less affluent students to train them to deliver community health care. These 3-year diplomas of medicine were government endorsed & privately funded with 50% free places and the remaining at least partly subsidised. The trade off for the graduates attaining a level of skill and employment opportunity they might not have been otherwise able to afford was that they were encouraged to practice in the less attractive rural areas normal graduates would shun, thereby generating expertise and a willing workforce right where it is needed. <br />
<br />
One of the proponents of this model was an erstwhile RUHSA graduate and, knowing how broad RUHSA's expertise is in rural healthcare and economic development, he suggested part of the training took place at here, so every one of the 1000 trainees will pass through RUHSA's wise portals. As a result, RUHSA has developed and is delivering part of the syllabus for these Rural Medical Assistants - a cadre of trainees specially designed to improve the welfare of very disadvantaged populations right at the core of where it is needed, the local community. <br />
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Unfortunately, as one might imagine the Medical Council of India was dubious and rejected the proposals out of hand before the course started but it had been designed so their approval was not in principal needed. However, the Indian Medical Association, equally threatened by this erosion of their "standards" jumped on the bandwagon and mounted a legal challenge almost immediately after the program started, causing a war of attrition with the state government whose energies became subsumed by the need to find ways and means of fighting the challenge, so withdrew their endorsement. After quite some in-fighting, this training program ceased recruiting after 3 years so there are no new trainees coming through at the moment. One can understand the arguments against embedding a two tiered system instead of increasing the value of working at a local level. It is a well recognised problem with no easy solution; Indian Health Policy (2002) describes it well. Becoming a doctor is a highly desirable career path, the opportunities to make significant amounts of money & maintain a certain lifestyle are legion. You have to be rich to be a doctor, unless you are exceptional, and coming from a certain sector of society is not going to make it likely you want to hide yourself away earning a pittance delivering basic healthcare needs to a highly disadvantaged community. However, there is also an argument that filling that need from an alternative path and gradually increasing its value over time, might have enabled the two perspectives to meet in the middle. <br />
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It is sad that this innovative program seems to have ground to a halt, but a recent review http://cghealth.nic.in/ehealth/studyreports/chhattisgarh%20experience%20with%203-year.pdf suggests that there is still an impetus behind the program. There has been an iterative approach to finding a solution and there is life in this model yet. Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-13569031737389432762013-02-19T02:54:00.000+00:002013-02-19T11:00:58.870+00:00A constant reminder of how lucky we are.Celine was waiting for me, sitting calmly in her still-crisp sari stiff to the floor like the flights of a shuttlecock. She had been there for four hours having arrived from Mumbai earlier in the evening and in her typical generous way had offered to wait for me to drive back to her house for the day. The precise timings of what was needed to effect this transaction had been overlooked in our mutual enthusiasm at our impending re-union. It was only as the plane taxied to its stop that I realised how truly saintly her offer was. I hadn't even told her which flight I was coming in on, so she had been searching for flights from Heathrow arriving at 2.55. There were none, they were all coming in well after 4am. Still she waited, not knowing to check the arrival of flights from Doha. Her usual telephonic response to my slightly guilty call, as the plane wheels skidded to a halt, of "Where are you?" was never more appropriate.<br />
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In contrast to her crispness, I was crumpled, tousled, ruffled & dusty, but no less delighted to see her. We spent the day driving around and chatting. Firstly we visited my friend Victoria, who, with perfect timing, had delivered a delicious little girl two days previously, then, in a extension of her saintliness, she accompanied me to RUHSA (four hours there and four hours back). In between my brief but deep trips to unconsciousness whenever the hum of background India lured my grateful brain to sleep we caught up on all the news of the year since we had last seen each other.<br />
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Karuna Niwas continues its work. Recently a new lady has come to stay. She was a victim of domestic violence whose husband beat her because she produced only girls. Clearly, he was not up to date with biological fact. She ran away on many occasions, but he would drag her back for more beatings. Eventually he left her, destitute and degraded, with her three daughters to find a younger woman to give him boys. She has a lovely face, sweet and earnest, with soft brown eyes and a kind smile. She looks happier now. Celine has ensured the oldest two children are in an English Medium school, which she could never have afforded before. Hopefully it will give her girls a better future than they had looked forwards to before. The youngest will benefit from the gift of a teddy bear that one of my lovely patients gave me to bring out for someone. Celine is now helping the mother to find a job. Her prospects are good but even if she cannot find any work, then she could do one of the several training courses available at Karuna Niwas - beautician training, spoken english, tailoring, computing to name a few.<br />
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However, the story that troubled me the most this time was that of the newly teenaged young lad & his sister who have been under Celine's care for over 7 years. Their mother too was a victim of domestic violence which they witnessed in brutal detail. When the girl was 4 & the boy, 6, the father beat the mother to death & set fire to her. She had been holding her daughter who suffered extensive, disfiguring burns over her limbs & torso. Her scars are visible. Tangible and easy to identify. A constant reminder of her need for empathy & love. Luckily, she does not consciously remember the incident, although she does get nightmares. The boy, however, witnessed the entire incident and remembers clearly & consciously. His scars are more penetrating and eviscerating. Celine is the only family they have, but she is not a family. She is alone and a loner - part of the reason for her success in the work she does, but this makes it difficult for her to provide the unquestioning presence & constancy children who have suffered such as they need. They love her and she them, but the young boy is reaching difficult teenage years which is a different country at the best of times, without starting from such a desperately traumatised position. He does not understand anything except loss and anger. Celine is despairing because he has become so destructive. He makes no friends, he trusts no-one, he cherishes nothing. He has no idea how to invest in his future, he simply perpetuates the familiar cycle of loss, bereavement & rejection.<br />
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We talked at length about him. Two spinsters without children exchanging theories on what to do. In some ways, however, the cultural context of the UK, which attempts to be children-centric would be a kinder place than India, where expectations of good behaviour are high and deviations from the norm are treated as wilful intent to upset. This results in the poor boy constantly being told off, giving perpetual momentum to his dysfunctional behavioural cycle.<br />
Celine is trying to teach him to be independent and look after himself, but thinking about it, that is exactly what he has had to do all his life. No-one has looked after or even nurtured him so the only person he trusts is himself and even that is fragile.<br />
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This middle group of children - not privileged and not destitute - are a forgotten segment of India's future. There are so many people to rescue in India, that those who appear not to be wanting in the most basic of Maslow's hierarchy of need are left to work it out for themselves. I have no idea what the state of child psychology is here, but judging how less than perfect it is in the UK, cannot imagine that is going to be more sophisticated. There are so many things he needs, but no-one has any idea how he might access them. I mean, that I can also say about some who come to see me at home. If the means of getting help for troubled children is obscure in Dalton, imagine how much more challenging it is here. Apparently, he did go to see a child psychiatrist once, who, on seeing his easy completion of age-appropriate motor tasks, concluded that he had no need for input because his development was normal.<br />
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In the absence of good child & adolescent mental health services, he might benefit from activity clubs where he could go to do things he enjoyed. For example, he loves cycling. Perhaps joining a club where he could meet people doing activities along side each other, learning gradually to get to know and like them through shared interests, would give him some confidence. However there are no such places like that in Bangalore, Celine says. I confirmed this on google.<br />
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In a pathetic attempt to show him that there are some people who, even if they don't know him, might care about him, I will ask my two to become pen-pals to him & his sister. I am sure they will consider it an arduous task, but it would be good to encourage them to do something for someone else's benefit entirely. Perhaps a small kindness from strangers prolonged over time may in a tiny way challenge some of his self-destructive beliefs. Of course it fixes nothing really; no doubt this is a response to being overwhelmed by the obvious contrasts between my easy life & theirs. Nonetheless, one day, I hope to bring the kids to India. If they have shared correspondence for a while perhaps it would also give them an interest to meet up.Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-57190835189794291792012-02-24T12:23:00.003+00:002012-02-24T12:26:59.883+00:00Outline of all Projects 2: The Goat & Cow Schemes<div dir="ltr" style="text-align: left;" trbidi="on">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. <br />
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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. <br />
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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.<br />
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Next to be continued: diabetic shoes made by disability SHG, community college revamping & fund raising officer</div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com3tag:blogger.com,1999:blog-31682284.post-64932089816874006882012-02-24T08:34:00.002+00:002012-02-24T11:42:06.083+00:00Outline of all Projects 1: The Elderly welfare centres.<div dir="ltr" style="text-align: left;" trbidi="on">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. <br />
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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.<br />
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<div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGzcjgw-9cUVSIW_tlarpv-ciOW0TYyUtbhNJPqEt_bHDk6ycB77rS-Psu2UEQ96KM8KV3hKgl-LRxmYwFwp9WvuLOpMlhy19dsKLo7X6oWb2yAVEPD7omrWWot9fidepD5N8UFQ/s1600/P2221619.JPG"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiGzcjgw-9cUVSIW_tlarpv-ciOW0TYyUtbhNJPqEt_bHDk6ycB77rS-Psu2UEQ96KM8KV3hKgl-LRxmYwFwp9WvuLOpMlhy19dsKLo7X6oWb2yAVEPD7omrWWot9fidepD5N8UFQ/s320/P2221619.JPG" /></a></div><br />
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<div style="text-align: center;">As you can see, the garden attempts are a little sad :-(</div><br />
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. <br />
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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.<br />
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<div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuGcEQkAfh5muaTOG7OIu7-xGTNfLblIMxQTEHKZL8ZIw9cagQARfvNNc9HYCQzz1j5aiL-AHO8AUdE8ldiLsruP0ujWjQeEvJzx6oRd5jL88WAC2P_6yra3pKe6wdk4CFmNndtQ/s1600/P2241708.JPG"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuGcEQkAfh5muaTOG7OIu7-xGTNfLblIMxQTEHKZL8ZIw9cagQARfvNNc9HYCQzz1j5aiL-AHO8AUdE8ldiLsruP0ujWjQeEvJzx6oRd5jL88WAC2P_6yra3pKe6wdk4CFmNndtQ/s320/P2241708.JPG" /></a></div><br />
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<div style="text-align: center;">This may be our new poster girl!</div><br />
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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.<br />
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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.<br />
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<div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span style="letter-spacing: 0px;"></span></div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-78095600283591261592012-02-23T11:02:00.003+00:002012-02-23T11:58:01.326+00:00The Elderly, some naughty kids, more cows & paper bags and a chicken or two<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><br />
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</div><div class="separator" style="clear: both; text-align: center;">A beautiful hibiscus flower</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">Piles of completed paper bags </div><br />
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</div><div class="separator" style="clear: both; text-align: center;">Naughty children on their afternoon nap, slightly distracted by the funny white woman making snoring noises to encourage them.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">The beneficiaries of the Kindergarten & Elderly Centre at Seeterampet.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">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.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">RUHSA staff: Rural Community Officers, Training officers and Community Physicians, including Dr Rita.</div><br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_LbbORoS7Esho1dyy-JlbyVoCRlXqvhMHee2EPAGEOhkbUr1UA3X5gn0ySXxYH820kbTJ-KeoNtpv0TcETSJ7ryvRJtRvWM0VgKecaAv9RCndBlEGsc0zEzWeeQW1cuTHTLT7fQ/s1600/P2221653.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_LbbORoS7Esho1dyy-JlbyVoCRlXqvhMHee2EPAGEOhkbUr1UA3X5gn0ySXxYH820kbTJ-KeoNtpv0TcETSJ7ryvRJtRvWM0VgKecaAv9RCndBlEGsc0zEzWeeQW1cuTHTLT7fQ/s320/P2221653.JPG" width="240" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;">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.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">The local RCO trying to catch another of the RUHSA purchased cows.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">A sleeping calf</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">The third cow. Nice shadow.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">Negotiations and picture opportunities with Richard and the cows.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">Jungle fowl and little jungle fowlets</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">The fifth cow (fourth cow wasn't very photogenic)</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">Richard showing some more naughty children his photo of them.</div><div class="separator" style="clear: both; text-align: center;"><br />
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</div><div class="separator" style="clear: both; text-align: center;">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.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">Bullock cart in the sun.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">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.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">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.</div><br />
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</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTTVqfJS-AevdEk4CGs30cq-P05NSB8-lHdCQUhGOEED35xC-yW78QYSKTBgbbBrMPN-jHtd8oV4XdU8CrruN74Bh1r4_qn8YQyFz6bJcmRr5CLk6hpNo8Z2XKdTC0kFgqVIXIdw/s1600/P2221622.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTTVqfJS-AevdEk4CGs30cq-P05NSB8-lHdCQUhGOEED35xC-yW78QYSKTBgbbBrMPN-jHtd8oV4XdU8CrruN74Bh1r4_qn8YQyFz6bJcmRr5CLk6hpNo8Z2XKdTC0kFgqVIXIdw/s320/P2221622.JPG" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br />
</div><div class="separator" style="clear: both; text-align: center;">Chit-chatting at Kovasampet whilst making paper-bags. They have always been a fiery lot here and they had lots to tell us. </div><br />
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</div><div class="separator" style="clear: both; text-align: center;">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.</div><br />
</div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-21429899279019557132012-02-21T19:00:00.004+00:002012-02-23T09:10:50.168+00:00The downside of working with the elderly: Goodbye to Rathinam<div dir="ltr" style="text-align: left;" trbidi="on">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. <br />
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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. </div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-52781441314198969302012-02-21T10:48:00.000+00:002012-02-21T10:48:23.944+00:00Superstition and ear tagging<div dir="ltr" style="text-align: left;" trbidi="on">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. <br />
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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.<br />
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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.<br />
<br />
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.<br />
<br />
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.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvumiJFnJzV75wJaG5mFSuDX8_iYove5C9wCu7Aiu9ZC9et1D9Db499A4xFu5BLJCBfPtnntzeDr4AuieT7zwXLw7kAIXSgwjtJ0S1NQ_GSjJhL6HCMdy2Ke3oXPBLwq4YXaoTiA/s1600/P2211579.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvumiJFnJzV75wJaG5mFSuDX8_iYove5C9wCu7Aiu9ZC9et1D9Db499A4xFu5BLJCBfPtnntzeDr4AuieT7zwXLw7kAIXSgwjtJ0S1NQ_GSjJhL6HCMdy2Ke3oXPBLwq4YXaoTiA/s320/P2211579.JPG" width="240" /></a></div><br />
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.<br />
<br />
(*Note to self. Mustn't let the power go to my head.)<br />
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</div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-69881343899663240562012-02-20T11:38:00.005+00:002012-02-20T13:27:46.401+00:002012 visit: Brief recap on why I come out to India.<div dir="ltr" style="text-align: left;" trbidi="on">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.<br />
<br />
My arrival last night coincided with director of <a href="http://fovuk.tripod.com/home.html">Friends of Vellore</a>, 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 <a href="http://afpionline.com/default.aspx">Associated Family Practitioners of India (AFPI)</a> which has now been awarded <a href="http://www.globalfamilydoctor.com/">WONCA</a> 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.<br />
<br />
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.</div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-30440354820918508152011-08-06T18:27:00.006+00:002011-08-07T08:03:41.928+00:00Last things crammed in<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;"><span class="Apple-style-span" style="font-family: Helvetica;">Last night, I spent a long time dividing my now vastly expanded luggage into two equal piles. 15 shirts in the left pile, 15 in the right, 2 saucepans in the left pile, 2 in the right and 2 in the hand luggage pile. 1, 1 beaded salwar kameeez, 10, 10 packs of spices, 2, 2 novels, 2, w2 tiffin tins etc etc. At the end of the process there were 2 bulging piles, looking not unlike the checkout counter at Shoppers Stop in Bangalore. Bearing in mind that I came over with 16kg, it was difficult to gauge now how much more luggage I had acquired. It looked enormously more. My allowance was an astonishing 46kg excluding hand baggage. I have never had so much, note to self - fly Air India again if needing to do some new wardrobe shopping. Of course, I saved up my mental shopping credits for this trip, bearing in mind that none of the clothes I had before fit me at all, having lost almost as much as my baggage allowance. Looking at the two stuffed suitcases, I imagined them attached to me and realised quite how much smaller I must be now. It’s always difficult to feel different because always you feel like you and the change is gradual, but when faced with almost the amount of kilos of lard lost repackaged as shirts, saucepans and chilli powder, the reality hits home. It was with astonishment and not some little dismay, therefore that I discovered that my total kiloage was only 31kg - not only far short of my allowance, but also actually less than I have lost. I would have to imagine an extra couple of tawa pans strapped to my bum. Of course, the fat was distributed everywhere , having more or less run out of places to go, and my sister has since mourned the demise of my Poggibonsi (fathead). The good news is that there was a Shoppers Stop at Bangalore airport, but I didn’t get 15kg of extra presents just because I could.</span></div><div class="separator" style="clear: both; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;"></div><div style="font: normal normal normal 12px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; min-height: 14px;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div></div></div><div style="font: normal normal normal 12px/normal Helvetica; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">This trip has been a fine one, but there have been moments of great sadness. Not because of what has happened here, because everything has been immensely positive and proactive, but because I have so often thought of Dad. One of the reasons I love India so much is because of her exceptional spirit of possibility and the very high amusement index. Although India is also oppressive, very oppressive, to many, there is, underlying everything, such an astonishing sense of potential. Despite how difficult life can be for so many of the population, there is amazing hope. It seems strange that a culture which seems so fatalistic, can so palpably take its destiny into it’s own hands. Wherever you go there is evidence of this. Someone reminded me of the man sitting on the side of the road selling shoes. But he only had 2 pairs. His belief that a customer who happened to want a size 7 black moccasin should walk past his “shoe stall” keeps him going there every day. And, judging by the things that people buy on the trains and at traffic jams, sold by members of apparent consortia, usually of blind people, perhaps blinded in order to gain entry to the employment program and evidence of India’s cruelty to her people, it may be that he gets daily customers who know where to get a fine, and cheap, pair of size 7 black moccasins. This spirit of India is identical to that possessed by Dad and so much in evidence during his last few months. Despite the cruelty of the cancer and the disintegration of his physical health, his suppleness of spirit (beautifully described by my cousin), courage, hope and positivity was manifest for all to experience and wonder at. He was selling his own two pairs of shoes and it is a cruelty that in the end, despite his hope, it was not enough. India, for this reason, and also for her history in which he was so fascinated, her abundant humour - so many stories I could have told him on my return - and the changes in all the work I have been doing - he would have been so interested to hear how the projects have progressed - all these embody Dad. It feels as if I have been on a pilgrimage to his soul and it has been sad, but beautiful.</span></span></div></div></div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;"><br />
</div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">Here are some photos from the whole experience.</div><div class="separator" style="clear: both; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: center;"><br />
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</div><div class="separator" style="clear: both; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: center;">The beautiful countryside around RUHSA. Cycling up the hill to the Temple offers a stunning view of the plains. Coconut plantations and fields as far as the eye can see.</div><div class="separator" style="clear: both; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: center;"><br />
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</div><div style="text-align: center;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">The elderly centre run at Ramapuram. This is owned by the local village,established and run by two SHGs for twice as many people as the ones that RUHSA runs. They even managed to persuade the local politicians to spruce up their building, shich they did an excellent job of!</div></div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
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</div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibapKMKhK8Bjt5hY0uNQ36KFDD8pnl3C89uYNIHbiev9OidpDRmuIHfRCaS1rC-hAzCCSkUmM3ffB7SfS0z3JcZy6eHDZjrESzxi3R7oOaPcArFJSpFYx6dc-xS0Rfvd5Vtm9DaA/s1600/P7293191.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibapKMKhK8Bjt5hY0uNQ36KFDD8pnl3C89uYNIHbiev9OidpDRmuIHfRCaS1rC-hAzCCSkUmM3ffB7SfS0z3JcZy6eHDZjrESzxi3R7oOaPcArFJSpFYx6dc-xS0Rfvd5Vtm9DaA/s640/P7293191.JPG" style="cursor: move;" width="640" /></a></div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div><div style="text-align: center;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">A little girl at the Pachaikilli Play Centre and Elderly welfare centre run by Bishopston, in Bristol, who started the Play centre and were moved to combine it with an elderly centre when they saw the one at Keelalathur.</div></div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
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</div><div class="separator" style="clear: both; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: center;">A chameleon trying to be a stick.</div><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;"><br />
</div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-32826934267165860592011-08-05T06:16:00.003+00:002011-08-05T16:27:32.007+00:00Cramming the last few things in<div dir="ltr" style="text-align: left;" trbidi="on">It has been one of the busiest visits I have had at RUHSA even counting the time I successfully managed to squeeze a 5000km road trip to the Himalayas in between village visits. RUHSA is such a busy, active and productive place nowadays that there is so much to see and do. In addition, my time at Celine's was also busy, although I was no longer doing the Karuna Niwas website, which appears to be down. Grrr. A good example of paternalism not working, I feel. Quite annoyed by that, but will choose a time apart from his wedding to discuss it with Sudhir. Anyway, there are a few interesting things going on with Celine too, namely that she wants to develop the Spoken English language classes which are apparently successful and so it was timely that I should be spending time with current & retired teachers, which is what Victoria's family seems to consist of mainly. I am hoping that Caroline, who was absolutely lovely and enthusiastic, will be able to liaise with Celine and develop a link with her school from which both will benefit. Hopefully, students wanting a year off can spend 3 months with Celine teaching all kinds of people spoken English. It will be even better if I don't have to organise it because I am at capacity and I don't have any direct links myself anyway. So fingers crossed that will work.<br />
<br />
At RUHSA over the last few days I have been cycling around like a loony (and receiving a response in kind from the villagers as I whizz by) going on field visits with the OT and visiting the increasing numbers of elderly centres as well as meeting the women of the PLF and SHGs who are very very interested in developing social welfare projects in their areas as discussed previously, with capital input (as opposed to income stream) from the UK charity. In addition I heard about a farmer's club which is being started using an interest free-loan from another UK charity to buy cows, which the farmers club members will pay back and the money will also be used to fund social welfare programs as well. The OTs field visits are part of the community based rehabilitation program which is trying to tackle the overwhelming problem of adults and children with mental health needs. The most visible part of the iceberg of this particular problem are children with learning difficulties and psychotic adults, but of course, mental health needs go much deeper and farther than that, not least extending to the care-givers of this very disabled & dysfunctional group of people who tend to require 24/7 & difficult input. It's early days and the problem seems to be beyond the scope of what is set up now, but little by little we can develop and evolve it into something which provides a wider benefit than it can possibly do so at the moment.<br />
<br />
So we have some clear plans in place and expectations to be delivered in January when I or Richard, or indeed both revisit with a view to setting up the funding for the next years donations. For the first time there is a real sense of iterative progress rather than serendipitous change and it's good.</div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-6106214132287623122011-08-05T06:04:00.001+00:002011-08-05T06:11:21.542+00:00Final Wedding Photos<div dir="ltr" style="text-align: left;" trbidi="on">After the main ceremony, Victoria's friends and family had a lovely few hours to lounge by the pool and cloud-bathe whilst waiting for the evening do. Victoria's family are lovely. Her mum & Dad came, whom I had met in Jaipur all those years ago, but also her sister about whom I had heard a lot and who was as lovely as expected, her partner, Brian and her foster daughter, Ebony (of henna fame), as well as her fun cousin Caroline and Caroline's extremely popular nephew, Charlie, whom everyone adored, especially the young children, mainly because he horseplayed around with them endlessly, swinging them above his head, carrying them on piggy back and generally mucking about. I spent a wonderful afternoon chatting to them all, making new connections and I hope to be able to see them again at Victoria's English wedding when I return. Meantime, here are the last of the photos.<br />
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</div><div class="separator" style="clear: both; text-align: center;">Victoria & her sister by the pool</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">Victoria & me by the pool (still no blooming tan)</div><div class="separator" style="clear: both; text-align: center;"><br />
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<div style="text-align: center;">Sorry about the blurriness, but I wanted to show the whole & final outfit. This is Emma, Ebony & Caroline</div><br />
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</div><div class="separator" style="clear: both; text-align: center;">Charlie mucking about with the kids (and a not-so-kid)</div><div class="separator" style="clear: both; text-align: center;"><br />
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<div style="text-align: center;">Victoria's family (minus Brian)</div><br />
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</div><div style="text-align: center;">A lovely one of me with the bride & her new husband....</div><div><br />
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</div></div><div style="text-align: center;">...until I revealed that he (inadvertently, apparently) had his hand on my arse.</div><div><br />
</div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-54882686224523083122011-08-02T13:20:00.005+00:002011-08-10T13:50:39.161+00:00Wedding Weekend<div dir="ltr" style="text-align: left;" trbidi="on">Back in the tranquility of RUSHA after a frenetic weekend in Bangalore, dashing hither and thither for the various wedding related activities during which Sudhir & Victoria tied the knot, and in a hindu ceremony there really is a knot tying moment. Victoria & I met in a Haveli in Jaipur in January 2007 where she & I were both taking our parents, who were visiting their relocated daughters, around the golden triangle in the North of India. The Haveli, which is a hotel converted from an old Persian Town House, was a lovely building with islamic architectural features, including a courtyard and decorative stonework and was run as if it still were an old Persian townhouse. We were treated like house guests, all those staying dining with the family at night in the communal dining room. Victoria & I discovered that despite being 1000km from where we lived, we were in fact practically neighbours in the South of India, her being in Bangalore and I, in Vellore a mere 4 hour train ride away, which is nothing when considering distance in India. We also discovered that we had many other things in common, although a Brahmin fiance was not one of them - only Victoria had one of those - so we became and have stayed good friends, spending much time together in Bangalore, Kerala and even on one occasion, Cumbria, where she visited on one of her trips home. After 7 years together, Victoria & Sudhir have finally overcome almost all the obstacles which culture, family, religion and India can throw at a transcontinental couple who fall in love and celebrated their wedding over the weekend. It is a small matter of detail that India still has a teeny trump card in that the bureaucracy of getting legal recognition of such a marriage whilst on a tourist visa (the only one Victoria is eligible for) without indulging in huge or indeed any amounts of baksheesh, was overwhelming and truthfully was not resolved before the ceremony, but if ever a public declaration of intent were made, Sudhir & Victoria after three days and four wedding events are more married than most people. It is only a matter of time and because Victoria quite rightly wants to make sure that it is legit in EVERY sense, so no illicit channels are being used, much to the disappointment of the cogs in the bureaucratic wheels.<br />
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The events kicked off on Saturday with a warm up party. Sudhir's family being Brahmin, neither eat meat nor drink alcohol. So the actual wedding itself would be a dry, vegetarian occasion, with potentially no music. Victoria was worried about the ability of people to mingle cross-culturally for the first time with only tender coconut juice as lubrication to the default Indian melodic background sound of frogs informing the world as to their mating intents, so they decided to have a warm up ceremony with booze and music to get the party started, which indeed it did. It was a light-hearted fun evening, with Sudhir's friends enthusiastically teaching the English visitors how to screw in the lightbulb to a loud, pulsing Indian beat. I am delighted to introduce outfit number one (for me, of course), a pale, powder blue chudidhar & pant suit, with silver highlights and beaded detail. Victoria looked lovely too.<br />
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On sunday, there was the Mendhi Event. This is the Hindu tradition of covering the bride's arms and legs with intricately patterned henna, a stains which lasts for for weeks. It is an occasion for women only, although a couple of men did sneak in, and it starts with the women in the bridegrooms family conducting a pooja (blessing) for the bride. This entails lots of turmeric & red sandal paste being rubbed into the hair parting, forehead, cheeks, feet and various other places, with yellow dyed rice being chucked here about the place, jasmine flowers placed in the hair and lots of walking around either chanting, or, because this is modern India, answering the many, many calls which came through any one of the dozens of mobile phones attending with their owners. Once the pooja is over, the bride settles down for the henna paste artistry. This takes four hours. Luckily Victoria is big into yoga and meditation, so sitting still for so long for her was not too arduous; she managed it all with great dignity, dressed in her sari and still with rice and cumin seeds (not, as I erroneously heard, human seeds) in her hair and without smudging the henna paste before it dried.<br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiswl5KsvS5C2ehSNa6bgZ3XOaPBwITiGTnB6Lp770NhLkGCp2afmev0dVR0FixYYO2gt3-_siFesI_OA2BmaLiX_HUB5KpYVevIkz_WWyVzMJftJ41gpz4ahwxfb9ACdzLH89rww/s1600/P7313252.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiswl5KsvS5C2ehSNa6bgZ3XOaPBwITiGTnB6Lp770NhLkGCp2afmev0dVR0FixYYO2gt3-_siFesI_OA2BmaLiX_HUB5KpYVevIkz_WWyVzMJftJ41gpz4ahwxfb9ACdzLH89rww/s640/P7313252.JPG" width="640" /><span class="Apple-style-span" style="color: black;"> </span><span class="Apple-style-span" style="color: black;"></span></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmStiWTnyjhWYm3UHAy6ZbmBY6y2kTRm8zl7HFLH9IzXcbpv1BsQO_yBD1BDiXsCWZV-j-20fD37KABb8XeQicYjSCGnKB-9SRrKZFbHomFkTDD9bMxBXvbFsw3YzwFjgWobsVTA/s1600/P7313258.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmStiWTnyjhWYm3UHAy6ZbmBY6y2kTRm8zl7HFLH9IzXcbpv1BsQO_yBD1BDiXsCWZV-j-20fD37KABb8XeQicYjSCGnKB-9SRrKZFbHomFkTDD9bMxBXvbFsw3YzwFjgWobsVTA/s640/P7313258.JPG" width="640" /></a></div>The house was full of bustling people, some of whom were also having much less extensive henna applied, there was food and tea and juice, all of which had to be hand fed to Victoria because she was unable to use any of her limbs. There was a lovely atmosphere and it allowed more mingling between the women. The two girls doing the henna were somewhat overwhelmed by the numbers and so there was not time for them to do my hands, but Victoria's sister's foster daughter was keen to have a bash and she did a great job on me.<br />
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</div><div class="separator" style="clear: both; text-align: left;">On monday morning, the wedding ceremony took place in the garden of a beautiful resort, under a traditional Mandap, decorated with jasmine flowers, marigolds, banana leaves and roses, which completely covered every inch including the roof. There was a lovely Indian lady official (can't remember what it is called) who conducted the service in Sanskrit and translating & explaining the significance of it for the guests, and a priest chanted the vows which are beautiful. In a traditional Hindu wedding, a knot is tied between the brides sari shawl & the husbands kurta or dhoti, they perform the Saptapadi - seven steps around the Holy Fire, Agni, the deity who is the chief witness to the marriage. These seven steps, starting with the right foot, correspond to seven vows the couple take. The seven vows vary from state to state, but they incorporate the ideas of being blessed with strength in their relationship, a happy family life, riches in all ways, happiness, honesty & integrity, honour each other and above all be good friends. It was wonderful having the translation of not only the vows but also of the symbolic actions. I am sure Victoria was glad to discover that the reason she had honey & curd smeared all over her face was to represent the ability to sweeten any sour notes within their marriage. Victoria's mother symbolically placed her daughters foot on a rock to symbolise that she was giving her to her husband and showing her the strength of their future partnership.</div><div class="separator" style="clear: both; text-align: left;"><br />
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</div><div class="separator" style="clear: both; text-align: left;">My outfit? A black & gold number with diamante sandals (same ones as from saturday to be truthful...)</div><div class="separator" style="clear: both; text-align: left;"><br />
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</div><div class="separator" style="clear: both; text-align: left;">(Me & Celine)</div><div class="separator" style="clear: both; text-align: left;"><br />
</div><div class="separator" style="clear: both; text-align: left;">Still one event to go, more later....</div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-39425930901185141872011-07-30T18:57:00.065+00:002011-07-31T18:49:06.062+00:00I think we've cracked it.<div dir="ltr" style="text-align: left;" trbidi="on">Ever since we started the Elderly Welfare projects at RUHSA we have struggled to find a way of making them sustainable. There has always been a sense that unless the centre itself can be self-sufficient or community are able to support it, then it is just another example of an paternalistic imposition, ultimately creating dependency not independency and as a model is not one which can be applied to beyond how it is being used now. Certainly, the initial centre in Keelalathur was a victim of this. Our attempts to get some income generation program or garden grown to generate some funds for the running of the project were not successful in the way in which we wanted it to be. Income generating programs did not generate income, Richard Smith's funding for goats given to the elderly gave some elderly some small income and passed on a goat to another person in the village, but it felt like a separate program as it generated no funds for the centre, however, it was the closest thing to sustainability we managed. The next group of elderly who were given goats ate them, so that did not work. Again the garden there, despite the participants being keen and asking to run it, was also not a success. The monkey nets to protect the fruit & veg were simply used as giant trampolines by the monkeys until the nets caved in and gave them access to snacking after their vigourous gymnastic routines.<br />
<div><br />
</div><div>A glimmer of possibility was seen shimmering when a self help group came to ask whether they could start an elderly centre. This was a new development. Raising the profile of the elderly in the area was giving them a hitherto unheard of status and local women's groups keen to provide a social service to their community wanted to run an elderly centre. In fact 2 groups wanted to and they share the work, providing meals for 40, which is almost twice as many as the RUHSA-run centres. So now there is a desire in the communities to run the centres and the money is being used to benefit two groups. The charity pays the self help group to run the centre and the more efficiently they do it the more profit they make. It is starting to feel as if this is a model which, whilst not sustainable, is at least supporting a community welfare system. The goat scheme, meanwhile had captured the imagination of donors in the UK and money has come in for 20 more goats. Reluctant to give goats to people who are too hungry, RUHSA decided to give the goats to a self-help group using a different model. Previously, the goat owners would give the first kid back to RUHSA to pass on and then every kid after that belonged to the new owner, but now their scheme is slightly different. RUHSA & the SHG are business partners. RUHSA retains ownership of the goat, but all profits from selling the goat are halved, RUHSA's half being used to contribute to the elderly fund. Now we have a potential income stream for the elderly program. but it was still having to be financially managed by RUHSA and therefore incurring the added expense of RUHSA staff working on it, which does not cost the charity any more, but does use up resources and limits the amount of programs which can be started.<br />
<br />
So. The final piece in the jigsaw evolved during the course of our first meeting. But first, a little background to set the scene. SHGs (self help groups) were set up in Bangladesh as part of the micro-finance model, which is a grass roots financial lending initiative, enabling women to form co-operatives and develop or start small businesses with small amounts of capital. It has been deemed successful and the guy who developed it in Bangladesh, Muhammed Yunus won the Nobel Peace prize in 2006. His micro-credit organisation, Grameen Bank, has 7 million of the poorest women in Bangladesh as it's customers. These women are in SHGs. India has adopted the concept of SHG development and nowhere is this more evident than in South India. All the four S Indian states - Tamil Nadu, Kerala, Andra Pradesh & Karnataka - are effectively committed to the empowerment of women & other of the poorest members within communities and there are many government schemes supporting these principles. In Tamil Nadu in particular, the government has gone a step further. The Bangladeshi model is only an economic model, but in TN, the government has incentivised social development as well. Each SHG is graded and on the basis of their grading, may be eligible for microfinancial assistance or micro-credit. They will get extra points if they contribute to the social welfare of their community, which helps to explain why the women have been interested in starting up elderly centres within their communities. Not only is there a social drive, but also there is financial benefit, because it improves their credit rating.<br />
<br />
One more piece of background. Clearly the effectiveness of any micro-finance scheme depends on the loan repayments and of course one of the difficulties of keeping track of what's going on is the sheer number of borrowers. A system like this run from a bank is open to abuse, either by the borrowers who default because there is no incentive to pay back (there is no means of legally recouping small amounts of money from very poor people in India) and secondly from corrupt lenders or their minions who say a rupee for the bank and a rupee for me. In Tamil Nadu (and perhaps elsewhere) they have developed a system of local corporations called a PLF - Panchayat level federation, I think (panchayat meaning district) - to which the SHGs must belong. The executive members are elected from the full membership of women in the SHGs. The PLF is then responsible for the financial interactions. They collect the money from the SHGs, they pay the loans out, they administer funds, they ensure financial probity within the groups and because everybody either benefits or loses out depending on how effective the PLF is at managing funds, there is is strong collective peer pressure to run things smoothly. It is a very clever system which uses big business principles at a local level where there are still direct relationships between social equals, which makes the peer pressure more meaningful.<br />
<br />
So...the plan as it unfolds is this. The PLF are given goats to distribute to those members who wish to rear them for profit. It's quite a hard job, so not everyone is keen. Each goat costs, say 2000 rs (roughly 30 quid). The goat can be reared and then sold at peak, goat-eating season (often Islamic festivals) for 5000 rs. That means there is 2000rs available to invest in another goat (in the non-eating season) and 3000rs to share. The goat owner will get 1500rs and another goat and the PLF will get the remaining profit, which they will hold in a new bank account specifically for Social Development (elderly welfare). It can then be used to pay another SHG, of which there are several, who wish to start an elderly welfare centre in their village. RUHSA will calculate how many goats are needed to pay for each centre over the course of a year and can raise funds as a one off payment (seed funding). As we have already given goats to an SHG, in 6 months time we will know what the actual earnings are and develop a business model for future goat schemes. So now, we have an model whereby the elderly get fed, women in the community earn money from goat rearing, another SHG can earn money by running an elderly welfare centre AND improve their credit ratings for future projects (and improve the PLFs rating too) and the very poor elderly in more villages are given an increased status and lunch 5 times a week. All RUHSA has to do is keep an eye on the overall equation: Number of goats = so many elderly meals. Call me old-fashioned, but I think it's brilliant and seems run along everyone's incentive lines smoothly. Everyone at RUHSA is very excited and thinks it will facilitate many more elderly centres being started. In addition, it is JUST the kind of thing people like to put their hands in their pockets for and has already proven extremely attractive. Genius.</div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-45079597675770489552011-07-29T16:47:00.001+00:002011-08-03T04:00:19.916+00:00What’s your secret?<div dir="ltr" style="text-align: left;" trbidi="on"><br />
<div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span class="Apple-style-span" style="font-size: small;">I arrived back at RUHSA in the dead of night, without anyone much seeing me, because firstly it was dark and secondly, most people had gone home by the time I rocked up, so the next morning there was a big (or smaller) unveiling and I have to say, it has created quite a stir. I guess 12 months and 39 kilos is quite some time ago. Vartsala, the lovely secretary with a predilection for peach saris, was cross. Her first words, after screwing up her nose in disapproval were “I loved that round face, now it is soooo long. I miss that face”, but then I caught her sneakily peeking at my less-existent belly. At one point she pinched my arm to see what less fat felt like. Then she confessed that she wanted to reduce too, but was secretly glad to discover that although I don’t have a chicken neck, there was evidence elsewhere of imperfect re-elastication of skin. </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">Every conversation and greeting has started with, </span></span><span class="Apple-style-span" style="font-size: small;">“Ooohh-hooo, so much reduced!” followed by furious head-wobbling and grinning. </span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">Rita was trying to explain to some nearby interns whom I had not met and who, incidentally, could not have been less interested, unsurprisingly, in the whole conversation, what a transformation there had been. </span></span><span class="Apple-style-span" style="font-size: small;">“Before, you couldn’t believe how fat she was. Sooooo broad” (Coupled with actions to recreate general girth & enormity of body). The interns looked a little shocked at that, I have to say.</span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">I had been due to meet Mathew at 8 o’clock sharp - my own arrangement on which I reneged owing, I think, to ongoing jet lag and a missed alarm clock - so he came down to find me at the entrance where he heard I was hanging around about 50 minutes late. I hadn’t been able to get very far owing to everyone wanting to know my secret. He guffawed when he saw me. “Oh my God, when I knew you were coming, I specially opened both doors to my office because I thought it is more comfortable for you to get through!” It just goes to show that however hidden we think we are and however private we feel how we look, nowhere more so than India reminds you what public property we are.</span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">Stalin, the media guru at RUHSA, came up and said to me, “you must give me tips for my wife” Small and petite himself and less like his more famous namesake would be hard to find, except for the presence of a beard, his wife is certainly no taller, but has expanded horizontally according to him. He looked a bit wistful when he told me she was “now 82kg” I am sure his wife would be delighted to know how he’s bandying her weight around so freely. He asked the question that everyone has asked. It is clear that they believe there is some magic answer accessible to reduced rich white English doctors. “Any English medicine?”</span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">I asked him how his wife ended up being 82kg, he said she eats too much, I replied well there you go.</span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">So many people have sidled up to me asking to know my secret, hoping against hope that there is a magic answer and all I did, for example, was put a half ripe mango under my pillow one night and woke up transformed, or that taking a diet pill every day caused the fat to slip away. The disappointment is palpable when I tell them no magic bullets, only hard work and dedication. I missed a trick there. I could have had such fun thinking up weird and wonderful ways in which it could have happened.</span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;"><br />
</span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">Going to the tailors, those of Innerwear fame, was the final hurdle. At the tailors are two girls who have been working there for the whole time I have been coming to Vellore and who inexplicably find me HILARIOUS without any effort on my behalf. I have never needed to do anything more amusing than order a pair of trouser made of underpant material or buy a rickshaw horn for my bicycle and now even the very sight of me makes them fall about with laughter, continuously. And loudly. Today, the laughter stopped briefly in amazement, so that was a good thing and then it redoubled and they called everyone who might have been interested and quite a few who clearly weren't, to come and see the new freak show - The Magical Disappearing Woman. Any new customer who came in whilst I was there was forced to listen to the tale whilst trying to mind their own business and buy saris or innerwear material. I could tell from the few interspersed English words like Doctor, UK, exercise, eating, accompanied by </span></span><span class="Apple-style-span" style="font-size: small;">the universally understood Indian gesture for fat, which approximates to clenched fists facing each other at chest height with elbows out with a pumping in & out action, culminating in not-so-subtle pointing at the "new me". Of course, its really touching how much interest people have taken, I think, despite the sometimes clumsily made comments, it indicates a genuine fondness for me which I both reciprocate and appreciate</span></div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-5464997012864328322011-07-29T02:30:00.004+00:002011-07-29T04:05:19.570+00:00The RUHSA effect<div dir="ltr" style="text-align: left;" trbidi="on"><span class="Apple-style-span" style="font-family: Helvetica;">It is so lovely to be back. RUHSA is the equivalent of a little place in the country for me. Unfortunately, its a little place in another country so its not possible to nip here for the odd weekend, but whenever I imagine solitude and peace to achieve clear thinking away from the hustle & bustle of normality, I imagine sitting in this dear, bare room, with the throaty bird calls and constant chattering of insects embalming my ears. Ironically, it is less quiet than the equally gorgeous place I live normally, but of course there is only one room to manage, no washing up and no daily minutiae to interrupt continuity of thought.</span><br />
<div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">Arriving late wednesday evening after a brief and monsoony visit to the swimming pool, Immanuel’s replacement, Vinodh, greeted me. Immanuel, sadly & unexpectedly died last September. Unexpectedly, because although he was almost moribund from obesity, he did not have any obvious, pressing health issues, but from all accounts, a minor illness became overwhelmingly difficult for his poor beleaguered body to deal with and his heart gave out. His death left a huge hole in RUHSA’s fabric, both literally and figuratively. He had been here since the very beginning and knew each contour of the warp & weft of RUHSA. He was the oil that greased the machinery. We had our problems, there’s no doubt. Having spent so much time here on my first visit, my deferential guest status transformed into something more meaningful and I think he found me intrusive and tricky & I found him to be controlling and sometimes obstructive. I had several run ins with his henchmen who could make my life quite difficult, but Immanuel was essentially a good and kind man, who’s entire life was RUHSA and he served RUHSA with his whole heart and he was loved my many. His passing was a sad, sad time for RUHSA.</span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">His replacement was only appointed 3 weeks ago and has the look of someone who is not quite sure of the magnitude of the mouthful he has bitten off, but he is very pleasant and seems to have a quiet certainty about him, which will serve him well in his new role. His wife & daughter are an unusual accessory in this post, but charming non the less. He is very young and as Rita said, will grow in the job. Personally, I think it is an incredibly exciting position to have, RUHSA is in a new ascendancy and has the potential to become an extraordinary place once again after its years in the wilderness.</span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">Yesterday, in between the frequent conversations about how I managed to reduce so so much (UK medicine? Special diet? - more of those conversations later, they deserve a chapter of their own) there was much to take in since my last visit. Already conversations about how to further develop the elderly welfare centres have been animated and voluble. At the moment there are 100 beneficiaries, in four different centres all of which have slightly different models, having evolved each time a new one was set up. I thought there were going to be two in one village but in fact they have merged and there is one centre with 40 participants instead of the more usual 25. Similarly, there is a joint centre with Bishopstown kindergarten to which 10 attend. By the way THE WELL HAS BEEN DUG (only last week, but borewell in place nonetheless. Water was reached at 265m) Last year the monsoon was a good one after 4 years of drought so no water had to be bought for the whole of last year, and hopefully, this year the monsoon will keep the water table topped up, easing up the pressures of increasing global food prices for the local villagers. </span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px; min-height: 14.0px;"><span class="Apple-style-span" style="font-size: small;"><span style="letter-spacing: 0px;"></span></span></div><div style="font: 12.0px Helvetica; margin: 0.0px 0.0px 0.0px 0.0px;"><span style="letter-spacing: 0px;"><span class="Apple-style-span" style="font-size: small;">It looks like we are in the process of developing a fully sustainable elderly care model, which, after 5 years, is thrilling. I learnt some fascinating local politics yesterday. It seems that there is no means of recouping money lost to the poor. Local law states that if a poor person owes money from a government or NGO loan, there is no legal method of getting the money back. Which is great for those with so little, but of course, makes creating a dialogue with trustworthy partners a little harder if there are only carrots & no sticks on the table. However, RUHSAs reputation & relationship with the local community is so highly valued that engagement with schemes is high and honesty - in some form - prevails. The clearest example being when the goats went missing presumed consumed at the second elderly centre, Rita felt strongly that they ought to have some responsibility for this “stealing” although one can see that if you are so deprived a free goat is manna from heaven, but of course it comes attached to a longer term benefit. Since she said that they ought to pay for the goats, money in small amounts to recoup that loss has come steadily trickling in from every single person. Not a huge flood, but a clear intent to redress the balance. One can argue that when people have so little, asking for repayment is unfair, however, I agree with Rita, that the most important commodity for both the present and the future, which is more than a single goat can offer, is a trusting relationship and this needs to be preciously guarded. It naturally fits right in with my fundamental philosophy which is that anything is possible, just don’t take the piss. This has implications for setting up any project, because it implies that the most important fundamental is the relationship, but how can you start with a relationship, something which takes the longest time to develop. It completely undermines any attempts to develop system introduction of projects, because the foundation of those projects, if not evolved from existing relationships, will be based on sand not rock. Of course, the one person I would love to discuss this with is dad. He’d find it so interesting.</span></span></div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-85016978476928144682011-07-28T06:07:00.003+00:002011-07-28T11:04:42.255+00:00Mobility India<div dir="ltr" style="text-align: left;" trbidi="on">On my second day in India a very exciting thing happened. I saw my name in print for a chapter on Primary Health Care I had written on the basis of a chance encounter in the Indian Embassy in Sri Lanka in January 2007.<br />
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</div><div>Whilst waiting for my visa I went into a waiting room with one other person who happened to be a charming physiotherapist from England who was working on for an NGO dealing with prostheses (false limbs etc) and orthoses (walking aids, braces, supports etc) for people with physical disabilities, amputations, cerebral palsy and the like. We got chatting because her work sounded so interesting and of course being out here doing stuff too we realised quickly that we had a similar philosophy of enablement. Sadly she was not coming back to India for long so I never had a chance to meet her again in Bangalore, but we kept in email contact over the years and at some point she asked me if I could write a chapter on primary health care for the training manual designed for the rehabilitation therapy assistants at the <a href="http://www.mobility-india.org/Index.htm">Mobility India Centre</a>, in Bangalore, who are less skilled than physios or occupational therapists, but who are very practical and needed a practical & philosophical overview of primary care. Absolutely not, I said, I was really sorry but I had so much on I couldn't possibly. Ok, we won't re-write it, but could you proof read and revise the existing chapter. I felt capable of that and agreed to do that. You might imagine what ended up happening. It was so paternalistic & impractical that I ended up re-writing the whole thing. The whole project was very interesting and made me think about primary care in a more cohesive way in order to try and convey the principles to non-medics, whilst giving them some simple skills to deal with potentially complex situations and on Tuesday, I got to see it published. Very, very exciting. There is now a textbook in which I am a credited contributor. The whole manual and indeed the whole centre in Bangalore was fascinating. Truthfully, I think my chapter is probably the driest and least interesting, because the rest of the textbook deals with the very practical issues of managing and coping with persons with disability. Or as they call them over here PWDs - not sure what I think of that.<br />
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Physical disabilities can for simplification broadly be divided into amputations and cerebral palsy. As might be imagined, the pathology in India is profound, so children, or indeed adults with CP rarely have simple or exclusively motor disabilities, they more usually have profound learning needs as well, so the isolation of physical disability from mental disability is difficult in terms of management. <a href="http://www.mobility-india.org/Index.htm">Mobility India</a> or other agencies dealing with physical enablement, must also train their rehab assistants to manage these physical disabilities within the context of learning difficulties. New to this book is also a chapter on mental health both the effects on the carers and the effects on the individuals with disabilities. It has been interesting working with them on that too, because although the idea that a carer has any needs at all is new, the "fixing" culture still very much prevails, ie we need to get them back to functioning as carers again otherwise the whole family suffers, rather than creating a supportive environment for the whole family to prevent mental health crises from happening in the first place. But these are easy philosophies to set into motion, because as soon as you explain it, it is obvious how important that approach is. Putting it in a text book to create a new learning culture encompassing this philosophy is very exciting.<br />
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<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">As well as the problems with CP, there is also a lot of fieldwork and RTA injury leading to amputation, so there is a large demand for prosthetic limbs and one of the most interesting aspects of the visit to <a href="http://www.mobility-india.org/">Mobility India</a> was seeing the <a href="http://www.jaipurfoot.org/">Jaipur Foot</a> being made. It is a very cheap, lightweight, prosthetic foot, moulded for some realism, originally made of tyre rubber, but now it is alsodeveloped in polyurethane, which does increase the cost slightly, but is longer wearing. . It was co-invented (in Jaipur) by and orthopaedic surgeon, PK Sethi and Ram Chandra Sharma (not related to Simon) who thought of the idea, allegedly, when his bicycle had a puncture. It was developed in 1969 and it's 2 USPs are that it is incredibly cheap to make (480 rs, about £7) and it is flexible, allowing walking without aids on a prosthetic limb. Although it has no articulation, being made of rubber it flexes with gait and even on uneven surfaces which fixed rigid limbs cannot do. It has enabled millions of people, including those with limbs blown off in Afghanistan to walk again. At MI, they have lots of different options, and they showed me another foot which looked similar but was made of a polyurethane shell which could be changed without the need for whole new leg, but the cost was 100 times more.</div><br />
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<a href="http://www.mobility-india.org/">Mobility India</a> as an organisation is one of many, many individual NGOs working with physical disability. It is fascinating to learn of how poorly such organisations collaborate and co-operate with each other. They are doing such amazing stuff individually, but on the face of it there is no network to share ideas or resources. Of course in the UK, there is a social welfare system that provides some kind of baseline collaborative and universal access. Of course the funding is largely centrally determined, whereas NGOs are essentially competing for the same pot, which means that they are more likely to need to be independent, but of course, the result is that the service provided to the people of India is very patchy. If we feel hard done by in the UK, by the postcode lottery, the problem is magnified a million times in India. Those who benefit work such as MI are lucky and few, relatively speaking, and it is not just the individuals who get to take home another leg who benefit, because almost 50% of their workforce have a physical disability, which is a claim few places in the UK can make. Thus, not only is MI enabling individuals to be physically more functional, but they are also offering employment opportunities and providing a visible, functional, integrated front to the rest of the community reducing exclusion and stigma.<br />
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</div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com0tag:blogger.com,1999:blog-31682284.post-90999893305663411102011-07-25T17:30:00.003+00:002011-07-25T17:44:42.664+00:00Never shop when jet-lagged<div dir="ltr" style="text-align: left;" trbidi="on"><div closure_uid_o8lscs="120"><div closure_uid_pza2sr="105"><div closure_uid_ddwei="105">Celine's eyes looked past the woman walking purposefully towards her, searching the airport crowd for a familiar face, but the unfamiliar one kept on going, fixing her with a beady stare and knowing grin until she locked eyes and recognised me. Very satisfactory moment filled with exclamations and standing back looking me up and down, saying "I can't believe it" and "what's your secret" etc etc. She was most gratifyingly impressed with my transformation. Funnily enough, I have been slightly nervous of how my friends here would react because change is always a little difficult to accept. When you get to know someone, their characteristics and character become enmeshed, so when one aspect changes almost beyond recognition, it might fundamentally shift the sands of the relationship. However, Celine is honest and direct, so it would be clear what her reaction would be from the outset and it was wholly positive. In fact, she was so positive, that we have spent the entire day redesigning my wardrobe and modelling the contents already. Bliss. I have been waiting for months to shop in Bangalore for beautiful Indian tops THAT FIT. I have held off buying too many new things in the UK, despite the fact that I have had to have all new clothes, not once, but twice, especially in anticipation of this moment. Even my interim wardrobe is now too big. So when we passed the road on which my favourite mall is, I asked whether we could stop off there. Big mistake. Being jet-lagged and excited about being able to fit into clothes for the first time ever in your favourite shop in the world is a staggeringly bad combination for the wallet. I fully expected a phone call from visa at some point asking "Are you SURE about this?" Of course, although these are not dirt cheap clothes because it is a proper shop, they are still beautifully made for significantly less than in the UK and also in ranges of colours, trims, decoration and styles that are not readily available in Barrow-in-Furness.</div></div></div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120"><div closure_uid_pza2sr="107">The adrenalin surge of excitement filled my almost empty jet-lagged body and shunted it rapidly into high gear. I became ultra-decisive but minimally restrained. Everything was so tempting. Turquioses, golds, reds, oranges, pinks, greens, blues, sequins, embroidery, beads. They were delicious. For some time, simply stroking the clothes was enough, and then the basket started to fill up. One of the many, many serving ladies employed by shops to look busy and help the customers part with their hard earned cash, kept following me, then sidling up to me as I rattled through the racks, stroking or picking items up apparently without discrimination. </div></div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120"><div closure_uid_pza2sr="108">She made the mistake of saying softly, "Too small madam, you need big size." Well. Deceptively calmly, I asked what size she thought I needed. Of course, the Indian frame is much smaller than the European one and she was the height of my shoulder, so I expect I looked enormous to her, but, hey, she should have been around a year ago. </div></div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120">"You need XL madam" </div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120">Quieter still, I asked "What size is XL?" </div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120">"44 madam" </div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120">"44 centimetres, I hope?"</div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120">"Yes madam." Puzzled look. "Um, no Madam, 44 inches"</div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120"><div closure_uid_pza2sr="109">Outraged, the volume escalated without intent. "THESE" I yelped, pointing to my boobs, "Are NOT 44 inches" To her teeny weeny, slight, petite, delicate eyes, which were basically on the level with them, they probably looked 54 inches, but I was completely indignant. These babies have been measured on a regular basis over the last year and I know EXACTLY how big they were and they were not 44 inches. </div></div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120">We had a stand-off. </div><div closure_uid_o8lscs="120"><br />
</div><div closure_uid_o8lscs="120"><div closure_uid_pza2sr="111"><div closure_uid_h9c0u="96">The only way of resolving the issue was by scientific means. I made her get her tape measure out and measure them then and there on the shop floor. I was right. They weren't. Not even close. I celebrated my triumph by buying her beautiful clothes. It so much FUN when you can fit into things! Of course, once we left the shop, adrenalin surge over, clutching our many, many purchases, my poor jet-lagged body, depleted of any remaining energy, was a mere husk. Once home, I collapsed on the bed, hugging my new finery and fell into a deep and lengthy sleep.</div></div></div></div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com1tag:blogger.com,1999:blog-31682284.post-78913415339742615852011-07-24T20:17:00.002+00:002011-07-24T23:44:39.291+00:00Back at last<div dir="ltr" style="text-align: left;" trbidi="on">Aaaah. It's so familiar and lovely. Although, it has to be said that sitting in Chhatrapati (yes there really are two 'h's) Shivaji International Airport, Mumbai, waiting for the bus to the Domestic Terminal is admittedly not the most romantic start for what feels like a home coming after a year away. It ought to be a more dramatic return with vibrant colours and swirling activity, instead it's a bit grey and soulless, but a quick jingle on the anklets and a waft of coconut oil is enough to transport me to more spiritual imaginings. Having been spectacularly disorganised, I think I surpassed any previous PB for inefficiency, I only really started to get excited on Friday, just after I bought my ticket for Sunday. Since then, I have been in a steady state of joy at the thought of coming back, relaxing, seeing friends, seeing India (who feels like an illicit lover) smelling India, feeling India. I have no idea what I am going to do, clearly everyone can get on very well without me, so my presence is superfluous, but I am going to barge my nose in and make my presence felt anyway. And who knows, they may forget how unnecessary I am and include me all over again. I shan't take no for an answer.<br />
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I am excited about seeing how things have developed at RUHSA since my last visit, most particularly, the mental health project which was just incipient a year ago, but is a whole year down the line. My only sadness is that my year out co-incided with a year of Dr Rita's directorship. Out of five years, one year is a big proportion and I am sorry not to have spent time working more closely with her. Hey ho, what to do?<br />
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The flight over was brilliant. So much blooming bum space now. I guess previously, it was like sharing a seat with a whole other person. No wonder it was squished. I flew Air India, which was very comfortable and quiet. I have been on previous Air India flights, where it was so full and noisy that it seemed as if everyone was sharing a seat with another person. This time, however, it was lovely. At the beginning, there was the usual perfunctory health & safety announcement telling us briefly about what to do if we crashed, how to get out of the plane, what kind of equipment our lifejackets would be adorned with - whistle, light (all of which look rather like they might have come out of a cheap cracker) etc etc. Then there was an extremely detailed announcement about how to use the lavatories aboard. Seriously, she went on and on about flushing, not putting anything down the loo - listing exhaustively all the kinds of things one might have on board which could end up down the loo and then went on sternly to tell us in a school marmy kind of way how "deeply inconvenienced" fellow passengers would be were some foolish traveller inconsiderately to use the toilet in an inaccurate and frankly irresponsible way. I guess the amount of time she spent talking about the relative dangers of flying on Air India reflected the likelihood of them actually happening and I am glad it was that way round. In the event, when I did nervously make my way to the loo, expecting it to be chock-a-block with diapers, napkins, tampons, combs, razors or small children, it was cleaner than a budget whistle on a life jacket and surprisingly fragrant. The Bad Cop routine obviously works.</div>Arabella Onslowhttp://www.blogger.com/profile/03865166253262360284noreply@blogger.com3