The broad reach of RUHSA

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. 

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.

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.

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.

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.

Keelalathur continues

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.

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. 

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! 

First RUHSA visit 2014

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".

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.

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.

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. 

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.

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.