The Project Continues

In between having an amazing time at Mysore and selling the services of a mattress cleaning agency (you'll have to wait for that episode), the project has been quietly gathering pace. It started out, sometime in July with a 42 page document detailing grandiose plans to "help the most vulnerable" members in all the local villages, incuding mentally/physically impaired/elderly/widows/destitute and the poorest of the poor. Clearly the scope for this was too broad and it was impossible to make any headway into the project as it was. Consequently, the project team, which consists of RUHSA staff - experts in delivery and development of rural programs, as well as a couple of doctors and of course, myself, decided to do a pilot rehabilitation project in one of the villages. We started out with plans to gather relatively hard data about the physical presence of need, ie numbers of elderly, physically handicapped etc, and also, if possible, about mental illness, which as mentioned before is very difficult, as there are no "hard" signs/symptoms which can be used as identifiers. The RUHSA staff were sure that the villagers would know the difference between mental retardation (a word which sits uncomfortably with me, but is still in full use here) and mental illness, but that there just wasn't any mental illness in the villages. Well, clearly that's bollocks and when I asked the staff to ask the villagers what they understood to be the difference, the only thing they could come up with was that those with mental impairment drooled more. It has therefore become clear that both staff and villagers need education into mental illness before the community centre can provide a meaningful service addressing it.

As far as the data collection is concerned, it is interesting how it has evolved. Quantitative data collection methodology is set out before the data collection begins, and regardless of any flaws which come to light, is usually adhered to. Qualitative data collection is a very different beast altogether. You might remember that we started with the PRA and were going on to interview key village members, ie those identified as being most vulnerable, in order to assess the nature of their needs. However, it was clear that the PRA was too lengthy and yielded too much quantitative data and not enough qualitative data. Also it was clear that interviewing to assess need would be far too cumbersome a process because there was so much need in the village that we might end up interviewing almost all the households. Consequently, we decided to hold a "Rapid Rural Appraisal" which is essentially a village meeting, whereby the project team stated their intent to set up a community centre and asked the villagers to discuss what they think it should be used for and how they would keep it running - ie sustainable.

It was extraordinary that the overwhelming concern was for the elderly in the village who were not being takn care of by their families, through poverty. They felt that the best possible use for the community centre was to provide these vulnerable older members of the village with one meal a day, because some of them weren't even getting that. As far as the rehabilitation services were concerned, they were interested, but it fell very far down their list of priorities.

Our plan now, therefore, is to set up an elderly day care centre where they can come and get a meal, with volunteers taking food to those who can't make it to the centre. Once the centre has a relatively fixed population, we can start bringing in other services for both those who use it and their carers. So for example, physiotherapy for the elderly and training in physiotherapy for the carers; nutrition advice esp with regard to diabetes which is increasing in significance, even in the villages, with their absolute distance from a Western lifestyle. Other issues of interest which were raised included a woman who mentioned that her husband was, currently independent, but would gradually become more dependent on her and she was concerned about this as a future burden. This is a very exciting avenue, because it opens up the discussion about preventative medicine, screening, monitoring and lifestyle education in order to minimise future health risks, something which has traditionally been very hard to focus on in a society which lives a hand to mouth existence.

One idea for funding which we have been discussing in the meeting is to try and develop some "Community-to-Community" programs along the lines of person to person funding (like sponsoring a child, or paying for an individual's hospital care), where a community abroad is linked (like twinning) to a village and holds a few charity events, raises some money and then sees exactly how the community spends it. The funding needs for programs like these centres would be minimal. The cost of feeding one elerly person a day is estimated at about 20p. As our plan is to set up community centres in every one of the 100 or so villages in the KV Kuppam Block (similar to district) there would be lots of scope for this. I would be interested to know if anyone had any thoughts regarding this idea. I chucked that question in to check and see if anyone has read it to the end!