Over the last couple of days, I have had a glorious time, so busy that my feet have barely touched the ground. I have either been cycling to a village or bouncing along, my hair generating static electricity from rubbing against the velveteen roof of a hard-sprung Ambassador, or I have been revolving from office to office talking to different, different people in a heady combination of opportunistic interactions and tightly scheduled meetings. What a difference to my early days at RUHSA when I had to pretend not to be interested too much and setting up meetings gave me a sense of what it must have been like to organise Charlotte Grey’s schedule with informers in Occupied France.
As I mentioned, yesterday, was bittersweet, but I only described the sadness of Sukkupattu’s death, however, there were also many wonderful things to emerge from the visit. Most importantly, the elderly people still attend the centre. Every day for the last three years they have been turning up: coming to sit and chat, to read the newspaper, put together jigsaw puzzles, do some, admittedly, pretty pointless exercises (the kind someone does if they want to feel good about exercising without in any way exerting themselves – the kind my Dad would enjoy), to watch television or simply to get away from the worries at home. I must admit that last year I was disappointed that the function of the centre did not seem to have evolved; there was no sense of trying to generate sustainability and that made me feel that it had not been a success as a model. However, there have been a steady stream of people from the UK who having heard about it, have visited and their fresh-eyed impressions have been much different to mine. They have seen a gathering of chatty, happy-looking elderly people who gladly tell them how much they enjoy coming for all or some of the reasons above, who tell them how life is different now, how they feel valued, both by the attention from people such as them and also, by reflection, by their family. I have been told that it has the kind of atmosphere they would have liked to have been able to offer their aging parents, instead of some of the more sterile, soulless Day centres at home. That is an accolade indeed. For all its simplicity, the feel of the place is right. That is not to say that the model is perfect, it is not. I still feel that we have increased dependency and we did not take sufficient account fo their assets before we started. This means we are left in a dilemma - either we continue as is or stop funding, in which case the centre ceases to be. I would prefer to see a model that has some capacity to draw from local resources, not necessarily from the elderly themselves, but the wider community at least and this is what we are working on - taking the excellent components of Keelalthur but imbuing them with a greater sense of agency.
But there was a moment yesterday which corroborated the idea that success cannot necessarily be measured in financial output. Just as I am not supposed to have favourites, I am also not supposed to have anti-favourites, but I’m afraid I do. I can’t help it, she’s just really, really annoying. Always moaning and whining, not in a charming, chance-it kind of a way, but in a petulant, irritating, unrelenting kind of a way. Anyhow, it would appear that she doesn’t only evoke this reaction in me. Everyone metaphorically rolls their eyes when she starts talking. She sits a little apart from the others and scowls. Poor thing, I’m sure she’s a natural charmer to her family but I can’t see it. When Kalaimanai asked everyone at large what they thought of the centre, whether they felt they had benefitted or not, she started talking. Obviously I couldn’t understand more than a few words of the torrent of Tamil (ie sapad –food, kashtum- difficulty) but the tone was whiny and wheedling. The effect was instantaneous, everyone started up in fury, waving their hands at her, talking to Kalai and tutting in disapproval. It turned out she had said the centre was pointless except for food, she derived no other benefit from it and it was this which unleashed a flood of indignation. They were furious with her; they stridently contradicted her assertion that this was merely a place of feeding. It was lovely to see them so protective - she wasn't voicing the unvoiced, she was being unjust.
We also talked about whether the vacancies from participants’ deaths should be filled. Good old Minnie* moaned that we would not have enough food for her if we took on more people. Everyone else felt that more people should be invited, but they were concerned about finances from our point of view. They felt any incomers should have the same opportunities they have had in which case, they would be happy to have fewer meals per week if that helped. In fact, they said that if the project had to stop in order to benefit others, they have had a lovely time and would happily relinquish their turn for someone else. It emerged during the course of the conversation, that although the centre itself is not more sustainable, the individuals themselves have become so. Another adorable, deaf, bewhiskered old man called Duraisamy, who walks on swollen feet a mile each way in order to come to the centre, and who has a beaming smile as big as Sukkupattu’s, told us his story. 3 years ago, he tottered aimlessly around his village, sewing sacks together to swap for food. Some days he managed to get a small, small meal or snack and some days he got nothing. Now he gets a good meal every day, he feels better, he makes more sacks which, not having to swap for food, he able to make a little income from. I passed him whilst cycling home after lunch, he was walking briskly back to his village and gave me an Indianormous grin in response to my cheery wave. His life is definitely better. I am seriously having to re-evaluate my expectations about what outcome measures to use for the project. It would be wrong to expect him to use this little money he is gaining to pay for his food, it effectively puts him back in square one. Besides, he has already given us his goat’s kid back, how much more should we expect them to contribute? These are interesting philosophical problems between opposing positions between which I vacillate constantly.
The last thing to mention is the most personally moving. Rathinam is a small, neat man with a few words of English he polishes and shows me each visit. He is married to a woman with untreated schizophrenia with whom he had some children. Soon after marriage, it became apparent that she could not cope with caring for them or him, or sometimes, even herself. The solution was to also marry her sister, with whom he has some other children and who is the main carer for them and the household. He brings his schizophrenic wife to the centre every day where she sits softly blank, but in blessed calm. He told us how she enjoys coming, it has brought peace to her and she is has many fewer distressing episodes now. Every day she plays Pallankuzhi and he assembles the world map, pointing out India to his friends and Australia and UK to me, if I am there and then, being one of the few literate members, he reads the newspaper aloud to others. He told Kalaimanai how thankful he is for the centre and how his life has changed since coming here, a fact he attributes to me. I noticed him pointing to me a lot whilst he was talking and when Kalai translated, he told me that every day, when Rathinam says his prayers, he prays for me. It makes me ashamed to be so free and easy with life when I hear something like that.
* She's not really called Minnie, that would be ridiculous
Friday, January 22, 2010
Wednesday, January 20, 2010
Sukkupattu
Today was bittersweet. I went to Keelalathur today to say an enormous thank you to Kalaimanai, who has been instrumental in the development and continuation of the elderly welfare project, and who has retired after 30 years working at RUHSA. His meticulous and fair approach has ensured that any initiative started has been carried out in the best of ways. Unlike at Kovasambet, all the elderly people who wanted goats have not only received them, kept them and looked after them, but they have produced baby goats and, as per agreement with RUHSA, have handed the first kid back to donate to someone else and now have gone on to produce more kids. At Kovasambet, there have been several goats which have mysteriously “disappeared” (kid-napped?) and ended up garnishing someone else’s plate. But under Kalai’s stewardship, all of the Keelalathur goats have been a prolific success, giving increased freedom to the elderly, and in some cases, renewed respect for them within their family.
Happily, he looks like he is going to embrace and enjoy his retirement, but obviously, I am sad to say goodbye to him. He is a huge personality with a smile to match. He speaks a rolling, flamboyant English like a crowd of over-excited children running downhill; sometimes falling, sometimes running so fast it seems their feet will never catch up, laughing and jostling each other to get to the bottom first. In every word containing an R, he adds several more for good measure. In words without them, he adds them in for extra embellishment. His tongue moves rapidly and nimbly around his mouth, his accent so thick, that sometimes it is difficult to tell the point at which he swaps from Tamil to English or vice versa. He is a lovely man and I shall thoroughly miss him next time I go to the village and he is not there. He has been a ubiquitous presence, greeting me so warmly “Ahh, Drrrr Arrrrabella!”
We held a small celebration of thanks in the centre, with an exchange of presents and short speeches; the participants and self help group women smiling as broadly as only the Indians can. However, during the celebration I asked where my favourite was – Sukkupattu - as he had not turned up. I was told he had died on Monday.
I know you are not supposed to have favourites, but I couldn’t help it, he was adorable; a hugely tall, thin man with an elegant, lived-in face. His height gave him a slight stoop, the effect of which was enhanced by the presence of a lipoma the size of a melon nestling on his right shoulder like a shy, squat, monochrome parrot. His soft smile and warm, crinkly eyes always made a point of finding mine in order to express a greeting, knowing that words could not be exchanged. We wobbled at each other furiously every time I went to the centre, both of our faces lighting up with pleasure to see each other. It’s difficult to explain why one person moves us more than another. I think it is to do with the intensity of light in their eyes, the presence of an undeniable twinkle, a hint of gentle mischief. He never looked humble or ingratiating, he simply looked delighted to see me and who could resist that? He was very old for a rural villager, more than 80, and had a terrible cough. I have been dreading the time when I would go and learn of his death and finally, after three years, it came. I was devastated to have missed him by such a short time, but I am so glad that in the last few years of his life, he spent some time feeling less alone or abandoned by his family, being given some of his deserved dignity back and enjoying twinkling at a crazy English woman who turned up unexpectedly, usually sweaty and red-faced but who tried to return his heartfelt greetings with matched enthusiasm. I shall miss the wordless, graceful friendship.
Happily, he looks like he is going to embrace and enjoy his retirement, but obviously, I am sad to say goodbye to him. He is a huge personality with a smile to match. He speaks a rolling, flamboyant English like a crowd of over-excited children running downhill; sometimes falling, sometimes running so fast it seems their feet will never catch up, laughing and jostling each other to get to the bottom first. In every word containing an R, he adds several more for good measure. In words without them, he adds them in for extra embellishment. His tongue moves rapidly and nimbly around his mouth, his accent so thick, that sometimes it is difficult to tell the point at which he swaps from Tamil to English or vice versa. He is a lovely man and I shall thoroughly miss him next time I go to the village and he is not there. He has been a ubiquitous presence, greeting me so warmly “Ahh, Drrrr Arrrrabella!”
We held a small celebration of thanks in the centre, with an exchange of presents and short speeches; the participants and self help group women smiling as broadly as only the Indians can. However, during the celebration I asked where my favourite was – Sukkupattu - as he had not turned up. I was told he had died on Monday.
I know you are not supposed to have favourites, but I couldn’t help it, he was adorable; a hugely tall, thin man with an elegant, lived-in face. His height gave him a slight stoop, the effect of which was enhanced by the presence of a lipoma the size of a melon nestling on his right shoulder like a shy, squat, monochrome parrot. His soft smile and warm, crinkly eyes always made a point of finding mine in order to express a greeting, knowing that words could not be exchanged. We wobbled at each other furiously every time I went to the centre, both of our faces lighting up with pleasure to see each other. It’s difficult to explain why one person moves us more than another. I think it is to do with the intensity of light in their eyes, the presence of an undeniable twinkle, a hint of gentle mischief. He never looked humble or ingratiating, he simply looked delighted to see me and who could resist that? He was very old for a rural villager, more than 80, and had a terrible cough. I have been dreading the time when I would go and learn of his death and finally, after three years, it came. I was devastated to have missed him by such a short time, but I am so glad that in the last few years of his life, he spent some time feeling less alone or abandoned by his family, being given some of his deserved dignity back and enjoying twinkling at a crazy English woman who turned up unexpectedly, usually sweaty and red-faced but who tried to return his heartfelt greetings with matched enthusiasm. I shall miss the wordless, graceful friendship.
Tuesday, January 19, 2010
Rendu Dinner
Ruhsa canteen used to be run by a lovely woman called Vimala. She was always pleased to see me when I came back and we used to spend hours cahtting after eating. When my sister and her boyfriend came to stay at RUHSA, she showed them how to make vadai. When my mum and dad came to stay, she showed them how to make a chicken biryani. Last March, however, she lost the contract for the canteen, so when I came back this year she was gone.
Yesterday, a beaming boy on a moped whizzed past me, vanishing into the dust before I registered that it was Sammy, her son. A couple of judicious questions to Immanuel as part of my daily routine revealed that she was living in Vellore, yes, her husband still worked here and yes, it had been her son on the back of the moped as he came back often to see his friends. In reply to my questions about whether he still spoke to her he said he did, adding darkly that calling her was dangerous as she talked 23 hours a day. Always, always on the mobile phone: when cooking, eating, on the bus, in every situation. He phoned her then and there on the spot. She was busy. After a couple more tries we got through and had an ecstatic verbal reunion, rapidly arranging an actual reunion that night – arranging to go to her house for dinner.
Since being here in India, I have been attempting in my half-hearted way to continue my quest for effortless weight loss with nematode assistance. To no avail. I have been cycling furiously, sweating and panting my way through all the nearby villages, assisted by the breezes contained in their gales of hysterical laughter. Not much difference. In desperation, I added a new regime the other day, I would only have one cooked meal a day. For the other two, I would have home made muesli, which I love here. The dried fruit has barely less water than when it was plucked from the tree or vine and the fresh fruits, such as pomegranates, are plumptious, so home made muesli is a pleasure not a chore. I started in earnest the day before yesterday. Unfortunately, I was so pleased with myself after a massive hour long cycle ride, I ate 3 vadai, a coconut cup cake and 2 wicked sugary things, that I don’t even want to discuss. I had the muesli as well to pretend everything was above board. So yesterday was going to be a new day and all was going well until Vimala asked me to dinner. The invitation came after lunch so the opportunity for having 2 muesli meals today was already lost. Little did I realise that the opportunity was more than lost, it was murdered, dismembered and then buried in an unmarked grave in a remote part of the Gobi Desert which only scorpions and sidewinders visit.
I arrived at Vimala’s and the physical reunion was as joyous and noisy as the telephonic one. We chatted and chatted, in miniature breathes between sentences she rattled off orders to Sammy to buy, this and that and the other and more things for dinner.
“You want snacks? Biscuits, tea, coffee”
“No, no,” I replied, "I’m fine."
“Sure?”
“Sure, sure. I’m not really a fan of biscuits.”
“Ok, ok, me neither”
Of course she ignored me, but I managed to escape by eating only one of the egg puffs she brought, despite her looks of sadness that I refused the second one. My problem is that I have limited will power. Well, none actually.
As she started preparing the dinner, her teenaged son and daughter wafted languidly in and out of the kitchen either being helpful or disruptive depending on the presence of a Y chromosome.
In the miniscule hairs breadths between the miniature pauses, her mobile rang, which resulted in tens of minutes of one-handed cooking accompanied by yelled conversations at her various friends, family or acquaintance in that fabulously ululating language, interspersed with faintly recognisable English words, like “farinner” (foreigner – me presumably) and “dacktar” (me again, I would guess.)
I watched attentively to the cooking process which as you might imagine, without direct instruction, was somewhat obscure – pinch of this, dash of that, oops, what went in then, missed it. She was preparing ‘mashroom and baby corn soop’, capsicum fry, chicken fry, chicken with gravy, raitha and chapatti. Recipes on request.
In between the miniscule etc etc jingly feet padded in and out of the house from upstairs. Longing looks were cast at me, with much head wobbling and intimations to follow. Apparently, India, never short of events to celebrate or poojas to make had found another brilliant excuse for a party. Her neighbours' daughter had come of age and the whole building was celebrating. Struck by a sudden thought, I wondered how they measured this coming of age. Is it literally, an age, eg 13 or ……? Yup, you got it, once she starts her period the fact is announced to the world. Remembering the humiliation of mine which started unexpectedly in the school gym aged 12 ¾ this was one ceremony I’m glad we didn’t celebrate in West Clandon. The idea of bouffant women from the stockbroker belt all coming to ogle me knowing the shame of my transformation turned my blood cold. Then again, it’s all hideous anyway as a teenager, so perhaps one last bash as a child is not a bad idea.
Vimala promised that we would go upstairs and help celebrate. For reasons I still can’t fathom and which cause me cultural embarrassment, having a farriner at such events is highly desirable. I’ve said before and I’ll say it again, the honour is not reciprocated by White English in middle England to their Asian brothers and sisters. However, on this occasion my presence would be mutually satisfactory for everyone. I was dying to know what they did to the poor kid.
Meanwhile, Vimala continued cooking and cooking and cooking and cooking. When making chapattis I looked at the small pile of dough balls ready to be rolled out and thought it a bit strange that she was only cooking one each. Then she said,
“Four chapattis enough for you?”
Pardon? Was all this food for me?
“Yes, yes, special meal for a special friend”.
“But what are you going to eat?” I said, astonished and horrified.
“They will give us something something upstairs”.
Oh my God, not only did I have a gargantuan 5 dish meal being prepared for me downstainrs, but I was also going to have to eat dinner upstairs as well. It is impossible to refuse food in India, it is as bad as sleeping with a member of their family in public.
It didn’t matter how I tried to work it out, I was stuffed, figuratively and soon to be literally.
We went upstairs to celebrate the menstruation. A delightful and articulate young girl/ stood up from an appropriately blood red velvet covered throne with silver embellishment, dressed in a heavy brocade sari which rippled below her feet by several inches. Her hair was plaited and extended to her knees decorated with diamante buckles and jasmine flowers. Across her forehead lay a diamante chain coming from her parting and ending is a perfect drop. Henna decorated her hands and feet in elaborate patterns and rather charmingly she had her specs on.
“I am so very happy you could come to my celebration” she said to me and I responded in kind; she was adorable. Many photos, laughing and talking before the dreaded battle with dinner Number One started. A banana leaf with piles of rice, rasam, sambar, vegetable and lentils with a fried sweet snack thing and banana lay in front of me. I do not exude the impression of a picky eater so they looked at me expectantly. Knowing there were a further 5 dishes waiting for me downstairs put some brakes on my hunger. I looked at Vimala.
“Eat, eat” she said.
Traitor I thought. I managed the first wave of food, they had not been over generous which was lucky, but it did take an enormous surge of energy to stem the flow of further helpings.
“Rendu dinner" I said, pathetically -two dinners- looking at Vimala to back me up. She stepped in with a flood of Tamil and the efforts to fatten me up abated mildly until I got downstairs.
Vimala behaved as if she hadn’t just seen me eat. I did cope with a substantial serving of each dish, stuffing it down my increasingly rising gorge with sheer determination not to offend my friend whom I had watched slaving over a hot stove for an hour and a half. All three sat and watched.
“Please have some”, I pleaded.
“No, no”, they said as one. “We are too full.”
It was impossible, Vimala looked as if I had singled out her favourite relative to dance naked in front of when I refused to eat any more. I still had food in my mouth I couldn’t swallow, so talking was becoming increasingly difficult. It was torture. Torture to eat and torture to watch her face and torture to see all her efforts sitting sadly uneaten on the side.
I told her next time I was bringing my own dinner so I could have three meals with her. She did laugh. Today I am not eating a thing. Except I have been asked out for lunch and dinner. Oh God.
Yesterday, a beaming boy on a moped whizzed past me, vanishing into the dust before I registered that it was Sammy, her son. A couple of judicious questions to Immanuel as part of my daily routine revealed that she was living in Vellore, yes, her husband still worked here and yes, it had been her son on the back of the moped as he came back often to see his friends. In reply to my questions about whether he still spoke to her he said he did, adding darkly that calling her was dangerous as she talked 23 hours a day. Always, always on the mobile phone: when cooking, eating, on the bus, in every situation. He phoned her then and there on the spot. She was busy. After a couple more tries we got through and had an ecstatic verbal reunion, rapidly arranging an actual reunion that night – arranging to go to her house for dinner.
Since being here in India, I have been attempting in my half-hearted way to continue my quest for effortless weight loss with nematode assistance. To no avail. I have been cycling furiously, sweating and panting my way through all the nearby villages, assisted by the breezes contained in their gales of hysterical laughter. Not much difference. In desperation, I added a new regime the other day, I would only have one cooked meal a day. For the other two, I would have home made muesli, which I love here. The dried fruit has barely less water than when it was plucked from the tree or vine and the fresh fruits, such as pomegranates, are plumptious, so home made muesli is a pleasure not a chore. I started in earnest the day before yesterday. Unfortunately, I was so pleased with myself after a massive hour long cycle ride, I ate 3 vadai, a coconut cup cake and 2 wicked sugary things, that I don’t even want to discuss. I had the muesli as well to pretend everything was above board. So yesterday was going to be a new day and all was going well until Vimala asked me to dinner. The invitation came after lunch so the opportunity for having 2 muesli meals today was already lost. Little did I realise that the opportunity was more than lost, it was murdered, dismembered and then buried in an unmarked grave in a remote part of the Gobi Desert which only scorpions and sidewinders visit.
I arrived at Vimala’s and the physical reunion was as joyous and noisy as the telephonic one. We chatted and chatted, in miniature breathes between sentences she rattled off orders to Sammy to buy, this and that and the other and more things for dinner.
“You want snacks? Biscuits, tea, coffee”
“No, no,” I replied, "I’m fine."
“Sure?”
“Sure, sure. I’m not really a fan of biscuits.”
“Ok, ok, me neither”
Of course she ignored me, but I managed to escape by eating only one of the egg puffs she brought, despite her looks of sadness that I refused the second one. My problem is that I have limited will power. Well, none actually.
As she started preparing the dinner, her teenaged son and daughter wafted languidly in and out of the kitchen either being helpful or disruptive depending on the presence of a Y chromosome.
In the miniscule hairs breadths between the miniature pauses, her mobile rang, which resulted in tens of minutes of one-handed cooking accompanied by yelled conversations at her various friends, family or acquaintance in that fabulously ululating language, interspersed with faintly recognisable English words, like “farinner” (foreigner – me presumably) and “dacktar” (me again, I would guess.)
I watched attentively to the cooking process which as you might imagine, without direct instruction, was somewhat obscure – pinch of this, dash of that, oops, what went in then, missed it. She was preparing ‘mashroom and baby corn soop’, capsicum fry, chicken fry, chicken with gravy, raitha and chapatti. Recipes on request.
In between the miniscule etc etc jingly feet padded in and out of the house from upstairs. Longing looks were cast at me, with much head wobbling and intimations to follow. Apparently, India, never short of events to celebrate or poojas to make had found another brilliant excuse for a party. Her neighbours' daughter had come of age and the whole building was celebrating. Struck by a sudden thought, I wondered how they measured this coming of age. Is it literally, an age, eg 13 or ……? Yup, you got it, once she starts her period the fact is announced to the world. Remembering the humiliation of mine which started unexpectedly in the school gym aged 12 ¾ this was one ceremony I’m glad we didn’t celebrate in West Clandon. The idea of bouffant women from the stockbroker belt all coming to ogle me knowing the shame of my transformation turned my blood cold. Then again, it’s all hideous anyway as a teenager, so perhaps one last bash as a child is not a bad idea.
Vimala promised that we would go upstairs and help celebrate. For reasons I still can’t fathom and which cause me cultural embarrassment, having a farriner at such events is highly desirable. I’ve said before and I’ll say it again, the honour is not reciprocated by White English in middle England to their Asian brothers and sisters. However, on this occasion my presence would be mutually satisfactory for everyone. I was dying to know what they did to the poor kid.
Meanwhile, Vimala continued cooking and cooking and cooking and cooking. When making chapattis I looked at the small pile of dough balls ready to be rolled out and thought it a bit strange that she was only cooking one each. Then she said,
“Four chapattis enough for you?”
Pardon? Was all this food for me?
“Yes, yes, special meal for a special friend”.
“But what are you going to eat?” I said, astonished and horrified.
“They will give us something something upstairs”.
Oh my God, not only did I have a gargantuan 5 dish meal being prepared for me downstainrs, but I was also going to have to eat dinner upstairs as well. It is impossible to refuse food in India, it is as bad as sleeping with a member of their family in public.
It didn’t matter how I tried to work it out, I was stuffed, figuratively and soon to be literally.
We went upstairs to celebrate the menstruation. A delightful and articulate young girl/ stood up from an appropriately blood red velvet covered throne with silver embellishment, dressed in a heavy brocade sari which rippled below her feet by several inches. Her hair was plaited and extended to her knees decorated with diamante buckles and jasmine flowers. Across her forehead lay a diamante chain coming from her parting and ending is a perfect drop. Henna decorated her hands and feet in elaborate patterns and rather charmingly she had her specs on.
“I am so very happy you could come to my celebration” she said to me and I responded in kind; she was adorable. Many photos, laughing and talking before the dreaded battle with dinner Number One started. A banana leaf with piles of rice, rasam, sambar, vegetable and lentils with a fried sweet snack thing and banana lay in front of me. I do not exude the impression of a picky eater so they looked at me expectantly. Knowing there were a further 5 dishes waiting for me downstairs put some brakes on my hunger. I looked at Vimala.
“Eat, eat” she said.
Traitor I thought. I managed the first wave of food, they had not been over generous which was lucky, but it did take an enormous surge of energy to stem the flow of further helpings.
“Rendu dinner" I said, pathetically -two dinners- looking at Vimala to back me up. She stepped in with a flood of Tamil and the efforts to fatten me up abated mildly until I got downstairs.
Vimala behaved as if she hadn’t just seen me eat. I did cope with a substantial serving of each dish, stuffing it down my increasingly rising gorge with sheer determination not to offend my friend whom I had watched slaving over a hot stove for an hour and a half. All three sat and watched.
“Please have some”, I pleaded.
“No, no”, they said as one. “We are too full.”
It was impossible, Vimala looked as if I had singled out her favourite relative to dance naked in front of when I refused to eat any more. I still had food in my mouth I couldn’t swallow, so talking was becoming increasingly difficult. It was torture. Torture to eat and torture to watch her face and torture to see all her efforts sitting sadly uneaten on the side.
I told her next time I was bringing my own dinner so I could have three meals with her. She did laugh. Today I am not eating a thing. Except I have been asked out for lunch and dinner. Oh God.
Friday, January 15, 2010
Evolution
The plan is evolving. Today the adult psychiatrist, Dr Anna Tharyan, who is an adult psychiatrist working in community rehabilitation, came to RUHSA to discuss the germ with us and the plan is unfolding, forming definite shapes and vistas. As expected there is no capacity in the Psychiatry department to spare an OT who can come and train the village carers on a regular basis, which means that VRCT is in an ideal position to consider funding an OT post for RUHSA. Of course being an OT of children with learning difficulties and an OT of adults with severe and enduring mental illness are two distant branches of a great tree connected only via the trunk of undergraduate learning. Once beyond university training, decisions as to which branch to follow come immediately and decisively. This means one of three possibilities: either the OT who is appointed must have little ambition of personal academic development down the specialist route – which in India, where continued professional achievement is paramount, is going to be difficult to find; or RUHSA needs 2 OTs, which would be prohibitively expensive and also misses the point that these branches are arbitrarily determined by medics not communities and in practical terms the needs of the carers of these two groups of patients are remarkably similar and it is the carers we are wanting to train not the patients; thirdly, RUHSA uses this as an opportunity to look at developing this concept as a subspecialty in it’s own right. In other words, becoming an OT in the subtleties of training community members in management of dependent family members of all types is a validly different and separate skill set than being an OT for children with learning difficulties or an OT of adults with mental health problems. Needless to say, I favour the latter option. It validates this entire approach rather than making it seem a makeshift alternative to proper services, which indeed it is not, it just happens to be a cheaper option.
So, how to start the project running? How to establish trust in the community that meaningful services are going to be provided before we appoint a full time OT, which may take 2m or, more likely, 6m? Selvakumar, in a blinding flash of brilliance, volunteered his son, who is just about to finish his exams, but then has 2m to wait before finding out the results to volunteer during the waiting period. Eyes gleamed at this. He is known to be local, dedicated, bright, enthusiastic, innovative and most of all, currently working in the community rehabilitation department.
Dr Tharyan mentioned that training for women in caring for special needs children already takes place. It is a 3m course and takes place the other side of Vellore 35km aware, so in principle this would be difficult for the mothers in the local villages here. Another role for VRCT? Perhaps, sponsorship of these mothers with regard to travel and living expenses. It is a daily interactive course which the children attend too. Interestingly, an unexpected side effect (from the perspective of the psychiatry department) is that 2 mothers have started day centres in their own homes for 5-6 children. Hallelujah. This is not to be an unintended consequence for this project, but the overarching aim. Dr Annie and I will try and visit these mothers next week to hear their stories and hopefully, ask them to come deliver some of the early introductory training sessions at RUHSA to inspire mothers here.
So, now we have an interim OT, with the promise of cover for a couple of months if there is a hiatus between the end of the appropriately named Trinity Selvakumar’s voluntary period and the full time appointment. We have training opportunities for keen mothers in both intensive out of campus established training programs and introductory training sessions at RUHSA for staff, mothers other carers and SHGs. I suggested to Dr Tharyan that her department and RUHSA could start to develop and formalise training sessions for caring for adults with mental illness. It takes place but ad hoc. She made an interesting point which is that in adult psychiatry, the single most important intervention is affordable and effective medication regimes. The only problem is that often villagers have no sense of conventional time. Next Tuesday means nothing at all to them. Again, an effective community lead co-ordinating timetabling of medication regimes would be incredibly empowering for the community. It begins to unfold some of the unmanageability of sever and enduring mental illness. Formalising the caring role is another future potential of this project in terms of academic validation and transferrable usefullness for other health centres; not to mention the benefit to the community. People can start being untied from their beds.
So, how to start the project running? How to establish trust in the community that meaningful services are going to be provided before we appoint a full time OT, which may take 2m or, more likely, 6m? Selvakumar, in a blinding flash of brilliance, volunteered his son, who is just about to finish his exams, but then has 2m to wait before finding out the results to volunteer during the waiting period. Eyes gleamed at this. He is known to be local, dedicated, bright, enthusiastic, innovative and most of all, currently working in the community rehabilitation department.
Dr Tharyan mentioned that training for women in caring for special needs children already takes place. It is a 3m course and takes place the other side of Vellore 35km aware, so in principle this would be difficult for the mothers in the local villages here. Another role for VRCT? Perhaps, sponsorship of these mothers with regard to travel and living expenses. It is a daily interactive course which the children attend too. Interestingly, an unexpected side effect (from the perspective of the psychiatry department) is that 2 mothers have started day centres in their own homes for 5-6 children. Hallelujah. This is not to be an unintended consequence for this project, but the overarching aim. Dr Annie and I will try and visit these mothers next week to hear their stories and hopefully, ask them to come deliver some of the early introductory training sessions at RUHSA to inspire mothers here.
So, now we have an interim OT, with the promise of cover for a couple of months if there is a hiatus between the end of the appropriately named Trinity Selvakumar’s voluntary period and the full time appointment. We have training opportunities for keen mothers in both intensive out of campus established training programs and introductory training sessions at RUHSA for staff, mothers other carers and SHGs. I suggested to Dr Tharyan that her department and RUHSA could start to develop and formalise training sessions for caring for adults with mental illness. It takes place but ad hoc. She made an interesting point which is that in adult psychiatry, the single most important intervention is affordable and effective medication regimes. The only problem is that often villagers have no sense of conventional time. Next Tuesday means nothing at all to them. Again, an effective community lead co-ordinating timetabling of medication regimes would be incredibly empowering for the community. It begins to unfold some of the unmanageability of sever and enduring mental illness. Formalising the caring role is another future potential of this project in terms of academic validation and transferrable usefullness for other health centres; not to mention the benefit to the community. People can start being untied from their beds.
Thursday, January 14, 2010
The Germ of an idea: microhealth
At a meeting today with Dr Rita and Dr Annie, the first germs of an entirely new, community centred, asset based approach to mental care have been cast into fertile soil. I am repressing any premature excitement, but perhaps you can tell by the way I am typing how enthusiastic I am.
The problem: debilitating mental illness and mental impairment is a huge burden in rural India. Let's face it, it's no picnic in the UK, but in India it is catastrophic. According to the WHO only 1% of India's health budget is spent on mental health. There are a puny 3500 psychiatrists in India. By that I am not passing judgement on their stature or relative musculature. Considering there is a lifetime prevalence of 22% of mental illness in a country of 1 billion, 3500 psychiatrists does not go very far. Of course most of those doctors will be in the cities and as already mentioned earlier in the blog, 70% of the country’s population is rural. Mental health in the villages is in a dismal situation: there is quite simply no help.
So starting any mental health program is a gargantuan task. The need is enormous and the resources microscopic. When Dr Rita, Dr Annie and I first spoke about this last year, fresh from the introduction to asset mapping as opposed to needs assessment, we explored the new concept of figuring out how, given that they have absolutely nothing, these people are managing; because somehow, however crappily, they are; like the elderly at Keelalathur before we came along to offer food, who were also somehow managing. They had a life. It probably was not great, but we did not account for any of it and as a result we simply increased dependence.
Dependence in mental health is ruinous for two reasons, firstly it impedes recovery and welfare, secondly, it unleashes the untameable beast of unmeetable need. No health care service can solve the problem of mental illness; it's not like removing footprints from a polished floor. Mental illness is messy, complicated, intrusive, pervasive and, most of all, endemic. In fact, most of all, it is embedded within the lives of individuals and their community. Solutions therefore must necessarily mostly be born from within those communities. Any health care professional who fails to acknowledge that from the start is starting a long journey across a hot desert in a thermal snowsuit with lead weights in his boots. Without water. Or a phone. In other words, it is madness. The astounding thing is that the madness of mental illness is indeed in those very professionals for the idea of actually asking people how they cope is not only incredibly new, but it is not done well: "Ask a mad person how to manage their mental illness? Are you mad? That would be like asking a heart translant patient if they had any hot, new suturing tips." It would appear then, that the idea of starting a project with this concept is new. I’ve researched it and I cannot find anything along these lines. If anyone knows of anything similar I would love to hear of it.
So, the plan: at RUHSA there is an occupational therapy clinic for children with mental impairment. There are some extremely keen mothers who come every week and have already noticed a difference. These mothers have to look after their children 24/7 so there is no time to do any income generating activities. The double whammy of illness and poverty. So the plan is to tap into this keenness and have a training session for these women. Firstly, learn how they manage – effective techniques can be disseminated to others. Secondly, equip them with generic skills for caring such as hygiene, nutrition etc. Add in specific skills for children with learning difficulties and adults with severe and enduring mental health needs. Then, and here is the genius bit, train them to look after more than person. Now send them back to the village with back up from the community staff already in place, such as RUHSA’s Rural Community Officers, family care volunteers, health aids who have been working for the medical care team for the last 30 years, who will now be additionally trained to recognise and destigmatise mental illness in order to identify other families in the village in need. Let the women in their own community persuade other families of the benefit of OT work and then encourage them come for training and then to form co-operatives so that the care burden can be shared. This will allow some women to be relieved of their 24/7 caregiving role to enable them to generate an income which can be shared. As more people benefit, the training programs can become more specialist and directive according to need. It seems to be a win win situation. Serious problems are more likely to be delflected with better care or recognised with increased experience and then can be directed as appropriate to the medical team.
This idea is so simple, I like to call it microhealth because, like microfinance, it draws on the big ideas, but brings them to a simple, manageable practical solution for the individual and leaves the medics to deal with cases which cannot be managed except by medication. The outlay of the mental health system then becomes training plus appropriate, hardcore management rather than getting bogged down by taking on problems indiscriminately; the momentum and power is generated by the community, for itself.
I think you’ll agree, it’s genius in its simplicity, but as I mentioned before, this is just the beginning and the road to make this idea a reality will be long and hard. It will need passion and dedication and effective leadership to make it work: Dr Rita & Dr Annie embody these values.
The problem: debilitating mental illness and mental impairment is a huge burden in rural India. Let's face it, it's no picnic in the UK, but in India it is catastrophic. According to the WHO only 1% of India's health budget is spent on mental health. There are a puny 3500 psychiatrists in India. By that I am not passing judgement on their stature or relative musculature. Considering there is a lifetime prevalence of 22% of mental illness in a country of 1 billion, 3500 psychiatrists does not go very far. Of course most of those doctors will be in the cities and as already mentioned earlier in the blog, 70% of the country’s population is rural. Mental health in the villages is in a dismal situation: there is quite simply no help.
So starting any mental health program is a gargantuan task. The need is enormous and the resources microscopic. When Dr Rita, Dr Annie and I first spoke about this last year, fresh from the introduction to asset mapping as opposed to needs assessment, we explored the new concept of figuring out how, given that they have absolutely nothing, these people are managing; because somehow, however crappily, they are; like the elderly at Keelalathur before we came along to offer food, who were also somehow managing. They had a life. It probably was not great, but we did not account for any of it and as a result we simply increased dependence.
Dependence in mental health is ruinous for two reasons, firstly it impedes recovery and welfare, secondly, it unleashes the untameable beast of unmeetable need. No health care service can solve the problem of mental illness; it's not like removing footprints from a polished floor. Mental illness is messy, complicated, intrusive, pervasive and, most of all, endemic. In fact, most of all, it is embedded within the lives of individuals and their community. Solutions therefore must necessarily mostly be born from within those communities. Any health care professional who fails to acknowledge that from the start is starting a long journey across a hot desert in a thermal snowsuit with lead weights in his boots. Without water. Or a phone. In other words, it is madness. The astounding thing is that the madness of mental illness is indeed in those very professionals for the idea of actually asking people how they cope is not only incredibly new, but it is not done well: "Ask a mad person how to manage their mental illness? Are you mad? That would be like asking a heart translant patient if they had any hot, new suturing tips." It would appear then, that the idea of starting a project with this concept is new. I’ve researched it and I cannot find anything along these lines. If anyone knows of anything similar I would love to hear of it.
So, the plan: at RUHSA there is an occupational therapy clinic for children with mental impairment. There are some extremely keen mothers who come every week and have already noticed a difference. These mothers have to look after their children 24/7 so there is no time to do any income generating activities. The double whammy of illness and poverty. So the plan is to tap into this keenness and have a training session for these women. Firstly, learn how they manage – effective techniques can be disseminated to others. Secondly, equip them with generic skills for caring such as hygiene, nutrition etc. Add in specific skills for children with learning difficulties and adults with severe and enduring mental health needs. Then, and here is the genius bit, train them to look after more than person. Now send them back to the village with back up from the community staff already in place, such as RUHSA’s Rural Community Officers, family care volunteers, health aids who have been working for the medical care team for the last 30 years, who will now be additionally trained to recognise and destigmatise mental illness in order to identify other families in the village in need. Let the women in their own community persuade other families of the benefit of OT work and then encourage them come for training and then to form co-operatives so that the care burden can be shared. This will allow some women to be relieved of their 24/7 caregiving role to enable them to generate an income which can be shared. As more people benefit, the training programs can become more specialist and directive according to need. It seems to be a win win situation. Serious problems are more likely to be delflected with better care or recognised with increased experience and then can be directed as appropriate to the medical team.
This idea is so simple, I like to call it microhealth because, like microfinance, it draws on the big ideas, but brings them to a simple, manageable practical solution for the individual and leaves the medics to deal with cases which cannot be managed except by medication. The outlay of the mental health system then becomes training plus appropriate, hardcore management rather than getting bogged down by taking on problems indiscriminately; the momentum and power is generated by the community, for itself.
I think you’ll agree, it’s genius in its simplicity, but as I mentioned before, this is just the beginning and the road to make this idea a reality will be long and hard. It will need passion and dedication and effective leadership to make it work: Dr Rita & Dr Annie embody these values.
Wednesday, January 13, 2010
Waffle vs Ryvita
The most exciting piece of news, which I forgot to mention in the first posting is that after three years of coming and having to sleep on a twice baked ryvita mattress (the dimply side) I have been awarded the honour of being given a proper, no coir, foamy, spongy, bouncy, thick, cosy, deep, enveloping, DELICIOUS new mattress. It is impossible to describe the joy I felt when I sat down on the bed, expecting to go "crunch" and instead going "squish". My brain could barely compute the significance of the signals coming from my bum. No longer do I have to put the two mattresses together to give a semblance of substance beyond tungsten carbide to my sleep. Despite the addition of a slightly thicker coir mattress last time - which sandwiched between the other two wafers, created a marginally less horrific night's sleep, I still developed pressure sores albeit to a lesser depth than without the coir mattress, but now! NOW! Now, I sink into blissful slumber as soon as my head hits the brick. (A comfy pillow is a step too far). Anyway, thank you to the Gods of Nighttime Torture, that they have taken pity on me and facilitated this new look RUHSA room.
As if a new mattress were not enough, however, when I walked into the bathroom, I saw to my absolute delight a newly fitted electric hot water cylinder. Oh. My. GOD! I am going to be able to have an appropriately temperature-regulated shower. No more freezing ones in the morning (when it's cold) or tepid ones in the afternoon (when it's boiling). With shining eyes and clapping hands I turned excitedly towards one of the Henchmen. My smile dropped. An imperceptible head wobble did not bode well. Wafting his hand towards the gleaming new apparatus I heard the devastating words, "not working", crushing my new found hope. It's true, not only is it not plugged in (and the socket too far from the cylinder) but it is not attached to a water source. As such it is merely decorative and very beautiful it looks too. Still, one step at a time. How things have changed even since I first came here three years ago. I have high hopes that next visit I will have a sit-down loo, a comfy mattress AND hot water. Woohoo.
Monday, January 11, 2010
A New Year, a New Visit, a New Director and a New Start
Firstly, I must thank & congratulate Dr John, the erstwhile director of RUHSA, who has been made director of CHAD, which has long been his personal vision. Although we have had a stormy relationship, he has welcomed me and allowed me to visit RUHSA; working and learning here for the last 3 and a half years. It is impossible to quantify how much I have gained from my time here. Much of it has has formed the philosophical scaffolding of my MSc and continues to inform my practice in the UK. Therefore, I wish him the very best for his last few months at CMC before final retirement.
Our meeting in January 1989 over 20 years ago was inspirational for me then; there was a propitious sense then, but I was not to know how influential in many ways that first meeting would be. I remember so clearly our trip to the tribal village by jeep aged 18. As we crossed a dried river bed, bouncing against the hard springs, we passed a woman being carried in a makeshift sling by two men. She was still and cachectic. With her huge bulging stomach, a visible ovarian tumour beneath the paperleaf skin, she looked like a child's badly made doll. Dr John stopped to talk to the men. The woman was incapable of doing anything more exhausting than breathing. She was being brought home to die. The faintly glowing embers of interest in medicine in me were fanned. Many years, and several arguments later, despite our often fractious interactions, I am very grateful to him and all he has done for me.
Dr John's leaving, however, means that a good friend and excellent person is now director of RUHSA and I am delighted not only at her achievements, but also at her keenness to continue my association here, working on nothing less than my main interest - mental health. I wish Dr Rita Isaac best wishes for her and RUHSA's furture success. I have every confidence in her.
So far 2010 has had a great start and I can't wait to get stuck in. Early plans suggest that she is keen for me to start looking at community resources for mental health. Mental illness has a huge impact on poor families in rural India - family members are sacrificed to look after the ill person and therefore not only is there a loss of income to medical care but also because of loss of working capacity. This results in mental ill children growing up neglected, tied to cots, restrained, being mistreated and reaching very much less than their full capacity in the strive for families to manage. It is extremely tough. However, mental institutions can neither cope nor provide the answer necessarily. The starting point for sustainable mental care is to look at what communities already do and try to help them to do it better in conjunction with delivering appropriate medical care. A cluster of families with mentally ill relatives have been identified and we are going to explore the idea of developing co-operatives between them. Anything like this whichde velops within the community must evolve through community potential and not be imposed, so I expect the road to the right solution will be long and occasionally disheartening, but I have no doubts that it is the correct path to be taking.
Our meeting in January 1989 over 20 years ago was inspirational for me then; there was a propitious sense then, but I was not to know how influential in many ways that first meeting would be. I remember so clearly our trip to the tribal village by jeep aged 18. As we crossed a dried river bed, bouncing against the hard springs, we passed a woman being carried in a makeshift sling by two men. She was still and cachectic. With her huge bulging stomach, a visible ovarian tumour beneath the paperleaf skin, she looked like a child's badly made doll. Dr John stopped to talk to the men. The woman was incapable of doing anything more exhausting than breathing. She was being brought home to die. The faintly glowing embers of interest in medicine in me were fanned. Many years, and several arguments later, despite our often fractious interactions, I am very grateful to him and all he has done for me.
Dr John's leaving, however, means that a good friend and excellent person is now director of RUHSA and I am delighted not only at her achievements, but also at her keenness to continue my association here, working on nothing less than my main interest - mental health. I wish Dr Rita Isaac best wishes for her and RUHSA's furture success. I have every confidence in her.
So far 2010 has had a great start and I can't wait to get stuck in. Early plans suggest that she is keen for me to start looking at community resources for mental health. Mental illness has a huge impact on poor families in rural India - family members are sacrificed to look after the ill person and therefore not only is there a loss of income to medical care but also because of loss of working capacity. This results in mental ill children growing up neglected, tied to cots, restrained, being mistreated and reaching very much less than their full capacity in the strive for families to manage. It is extremely tough. However, mental institutions can neither cope nor provide the answer necessarily. The starting point for sustainable mental care is to look at what communities already do and try to help them to do it better in conjunction with delivering appropriate medical care. A cluster of families with mentally ill relatives have been identified and we are going to explore the idea of developing co-operatives between them. Anything like this whichde velops within the community must evolve through community potential and not be imposed, so I expect the road to the right solution will be long and occasionally disheartening, but I have no doubts that it is the correct path to be taking.
Sunday, July 19, 2009
Belated update
I feel chastened. I was too busy having a great time in India to keep the blog updated and although I did go out there for a holiday (driving from Vellore, Tamil Nadu to Chamba, Himachal Pradesh) I also did some work so I stand corrected about my neglect.
Ostensibly, I went out as part of my cunning plan to "encourage" RUHSA to finish the building works on the CHEW (Community health education and welfare) buildings in which we were planning to start two other elderly welfare centres. Ie, the cunning plan was to announce a Grand Opening (with photo opportunities) in order to create a deadline to be met, rather than an open-ended timeframe. Oringially the Grand Opening was planned for August, then it was moved forwards to July and finally, much to the distress of those whose responisbility it was to actually deliver the goods before the deadline (ie not the person who was swayed by the thought of the photo opportunities) it was brought forwards to June. So the date was set that two trustees, Dr William Cutting and myself, would come out to open the CHEW buildings at Kovasambet and Sholamur respectively on Monday 22nd June. William would then go on to other meeting whilst I went on to other fun.
Prior to going to RUHSA, I met Celine, who has the women's refuge centre/Home of Compassion in Bangalore. We are trying to set up a website for her so people can donate money to her work. Her aim is to establish a core capital fund, from which there would be interest and income generated to enable her pay for any children's schooling, so no-one remains disadvantaged by circumstances. So far she is already paying (with some sponsorship) for about 7 children's schooling. And she is fussy, the cheapest school will not do, she wants the best. This still only costs about £300 a year, but that is a substantial amount to find if there is no income. She also thinks it is important for women to have some possessions of their own to take into a future marriage with them, even if this happens many years after they leave her care. As these women usually arrive with nothing, the only person who can provide these - usually it comes from the brides family - is Celine, who becomes their new family, often. As soon as the website is up and running I will post it. It is looking good so far.
RUHSA had planned a full and interesting day for William and myself.
In the morning, there were the ceremonial openings, Willam opened the building at Kovasambet and I opened the Sholamur building. I even have a plaque which was revealed by pulling on a little curtain! After I opened the curtain I had to cut the ribbon into the building.
Ostensibly, I went out as part of my cunning plan to "encourage" RUHSA to finish the building works on the CHEW (Community health education and welfare) buildings in which we were planning to start two other elderly welfare centres. Ie, the cunning plan was to announce a Grand Opening (with photo opportunities) in order to create a deadline to be met, rather than an open-ended timeframe. Oringially the Grand Opening was planned for August, then it was moved forwards to July and finally, much to the distress of those whose responisbility it was to actually deliver the goods before the deadline (ie not the person who was swayed by the thought of the photo opportunities) it was brought forwards to June. So the date was set that two trustees, Dr William Cutting and myself, would come out to open the CHEW buildings at Kovasambet and Sholamur respectively on Monday 22nd June. William would then go on to other meeting whilst I went on to other fun.
Prior to going to RUHSA, I met Celine, who has the women's refuge centre/Home of Compassion in Bangalore. We are trying to set up a website for her so people can donate money to her work. Her aim is to establish a core capital fund, from which there would be interest and income generated to enable her pay for any children's schooling, so no-one remains disadvantaged by circumstances. So far she is already paying (with some sponsorship) for about 7 children's schooling. And she is fussy, the cheapest school will not do, she wants the best. This still only costs about £300 a year, but that is a substantial amount to find if there is no income. She also thinks it is important for women to have some possessions of their own to take into a future marriage with them, even if this happens many years after they leave her care. As these women usually arrive with nothing, the only person who can provide these - usually it comes from the brides family - is Celine, who becomes their new family, often. As soon as the website is up and running I will post it. It is looking good so far.
RUHSA had planned a full and interesting day for William and myself.
In the morning, there were the ceremonial openings, Willam opened the building at Kovasambet and I opened the Sholamur building. I even have a plaque which was revealed by pulling on a little curtain! After I opened the curtain I had to cut the ribbon into the building.
We also visited the original health centre where the elderly are enjoying the fruits of the goat scheme. Several goats have had two kids, enabling the owners to give one back to RUHSA as part of the pass it on scheme but also sell one to make money. I was a bit concerned that we might simply have generated a means of causing several fractured neck of femurs, as the goats yanked their frail owners towards something tasty looking (see left), but apparently they all know when to let go of the rope. The picture on the right shows a couple of generations of goat owners.
After the Grand Openings, William and I had a series of very interesting meetings with Dr John, Dr Rita and the RUHSA team. There are several very exciting new projects on the horizon, the two most gripping for me are the mental health developments and the microfinance project. Mental health has been a significantly under-resources aspect of health (sound familiar) and of course there is some serious pathology out there. I heard about two twin sons who have developmental delay and mental health problems and who are now physcially grown men. the only way thei family can manage them is by tying them up every day to prevent injury to themselves and to others. The first phase of the mental health project is to identify the most serious, behavioural pathology and treat what is possible. This is already starting, but there is a great need to harness community support, because medical treatment is not the complete answer. So Annie, who is one of the Community Health Physicians, is trying to develop programs to utilise community resources to increase the management options for people with mental health issues. I look forward to getting involved with that in January.
The microfinance project is also very exciting. It capitalises on the uniquely uncorrupt reputation of RUHSA and the relationship of trust between RUHSA and the local community. The plan is to create a Federation from a few of the most successful self help groups and using funds from the VRCT Trust, enable them to loan small amounts of money to local groups who want to set up their own SHG. RUHSA would not be in charge of the money, nor indeed be giving the money, but passing the donation on according to the small business proposals. The Federation would then be responsible for collecting the repayments. Part of the agreement would be that they would have to contribute some of the money recouped for local charity projects, thereby reinvesting the moeny into the community - eg keeping the elderly welfare centres running, but would then be able to keep the profits, whilst not losing the capital. It is a brilliant idea and only one which can work because of RUHSA's long history in working for the local area. By january, I think there may be some real development on this.
As for my holiday. I won't bore you, but I had a great time. The middle of India was very hot (52 degrees C) and the top of India was very beautiful. It was too short, but not long before I go back again. I think I'm addicted.
Saturday, February 21, 2009
Thursday, February 05, 2009
From balmy PK Puram to Snowy London*
Am back in the UK now, after a blissful week travelling around the western ghats and Indian Ocean coastline relaxing and trying to get a tan. I have managed to get a good hand tan, but my face just looks dirty. I am slightly concerned that it will in fact all wash off in the bath, which makes me reluctant to have one. Think it's getting to the point I need both metaphorically and literally to take the plunge. All in all this trip was much more of a success than I ever expected. I was quite pessimistic about what I would find, how I would be greeted and what I would do, but in fact it has surpassed expectation. Of course, there was the minor hiccup of no-one knowing I was coming, but I was half expecting that, given previous form. However, unlike last year, they did seem more pleased to see me! Once the initial hurdle of getting my room ready, everything was fine. In fact there were some advantages to coming unexpectedly because no-one polished things up to present to me, I saw it all in it's unprepared state and the elderly centres really have a life of their own now and look like being an easily replicatable model. The group from Bishopston in Bristol, who are setting up a play and teaching resource centre want to use one of the spare rooms for a similar elderly welfare . The exciting potential consequence for this is that there will be a juxtaposition of the elderly and very young. One of the ideas about the sustainability of the first centre was to use the physical presence of the elderly as a kind of baby sitting/creche service. This did not seem very culturally acceptable at the time, but the propinquity in the Bishopston centre may result in a natural evolution of this, making it much more acceptable and therefore, potentially be used in other areas. So another really exciting avenue is opened and we will see how it develops. In addition to this, building works have actually started in the new centres, there will be a "Grand Opening" in August (ploy to accelerate the building works), which will give me an exucse to come out again (hurrah), although for a shorter time (boo). Here are some pictures to show works in progress.
Of course the other interesting development is the mental health project proposal. During my last couple of days there I attended a couple of lectures on mental health in the community which were fascinating. Suicide is a huge problem in India, although studies suggest that unlike in the UK, the proportion which are due to mental illness is only about 1/3, meaning 2/3 probably commit suicide for socioeconomical reasons. In addition, unlike the developing world, more women than men commit suicide and of those there are 2 peaks, the first, horrifyingly, is in the 15-25 age range and the second in the >65y olds. This is such a waste of life. Most people who commit suicide do so through quite definitive and likely to be successful means - poisoning, eg organophosphate poisoning, drowning, hanging. The implications of all this are that there need to be significant population based approaches to prevention, for example more sociostructural support, outlawing of poisonous substances etc, rather than simply measures targeting mental health, because these measures would only capture a small proportion of people who commit suicide.Interestingly, the lecturer mentioned, as an important strategy, the need to map community assets. Very excited I went up to him afterwards and asked what research had been done in this area. None, he said. Ah, well, that is both disappointing and thrilling. I look forward to cutting a wave (or falling flat on my face!)
*attr. Lot Onslow in sms circa 2007
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