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.

Final thoughts on our 2013 visit

In February, 3 members of FOV spent a wonderful week in Vellore
looking at all the amazing work that takes place there done by some
incredible, inspirational, dedicated people and teams. One of those
days was spent at RUHSA which is the extraordinary multi-disciplinary
rural health & social welfare department about 30km outside CMC in KV
Kuppam. Covering an area of 200,000 people, RUHSA works on a multitude
of different projects to improve the local community from providing a
small local hospital, outreach clinics, preventative medicine and
educational programs, training local boys in auto maintenance, setting
up & supporting self-help groups; and those are just the ones that FOV
is not directly involved in!

We in FOV are delighted to provide support for a range of diverse
projects at RUHSA. We worked with them to set up their flagship
elderly welfare centres which provide welcome havens of friendship &
support, as well as a delicious meal made by local women who are keen
to become involved & raise the issue of elderly care within their
community. The FOV-supported occupational therapist has started income
generation projects in all centres so the participants can raise small
amounts of money for themselves by making paper bags which are then
used in the college shop on Bagayam campus.

The first centre opened in January 2007 and the fifth centre, funded
by FOV Sweden has just opened in January 2013. RUHSA hope to
proliferate these simple, but effective models throughout the area.
This year we were told of one of the participants, a lady who has
no-one and nothing in her life except a small bag she hangs from a
tree under which she sleeps each night. Her time spent surrounded by
other members of her community, chatting and being included gives her
such pleasure, that every morning she is waiting at the door of the
centre hours before it opens.

Raising the profile of the elderly centres is always a priority for
FOV as we are so aware of the increasing burden of ill health this
sector of society bears and other work we support helps to improve
family finances in the poorest groups so that they can afford to look
after all their family members, but also some of the money generated
can be recycled back in into the elderly welfare projects. This year
we are supporting a pilot stall fed goat scheme. We are funding the
building of a goat stall which can more intensively rear goats for
better profit margins. We visited an organisation in the Javardi Hills
who have a similar project & we were impressed with the set up. The
stalls are airy & light, the goats are allowed to roam free for a
couple of hours a day and they are fed well. RUHSA hopes that this
will generate personal & project incomes as well as becoming an
exportable model for other SHGs.

This year, RUHSA made a further proposal looking at another difficult
group, the local village youth, who often become rootless & aimless,
reducing their future prospects. This year, they are looking to
develop sports clubs in the local villages to encourage youngsters to
take part, have fun & feel part of a community. With FOV support they
will provide simple sports equipment for several villages and every
year, there will be a sports tournament organised at RUHSA in order to
give the lads something to work towards & achieve. Next year perhaps,
some FOV members can present the first RUHSA trophy to the winners!

It is always such a privilege to see first hand the work done out in
India, the level of expertise & experience is extraordinary; their
vision about their local community’s better future is inspirational
and I hope this newsletter gives at least a flavour of what takes
place. I would urge anyone to visit and see for themselves.

Reflections

After 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?

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.

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.

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.

The Palliative care team

Yesterday 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.

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.

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.

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.

From Idea to Movement

Today 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.

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.

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.

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.

RUHSA and the radical public health solution

There'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.

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.

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.

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.

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.

A 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.

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.

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.

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.

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.
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.

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.

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.

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.

Outline of all Projects 2: The Goat & Cow Schemes

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

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

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

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

Outline of all Projects 1: The Elderly welfare centres.

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

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

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

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

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

This may be our new poster girl!

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

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

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

A beautiful hibiscus flower

Piles of completed paper bags 

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

The beneficiaries of the Kindergarten & Elderly Centre at Seeterampet.

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

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

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

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

A sleeping calf

The third cow. Nice shadow.

Negotiations and picture opportunities with Richard and the cows.

Jungle fowl and little jungle fowlets

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

Richard showing some more naughty children his photo of them.

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

Bullock cart in the sun.

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

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

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

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

The downside of working with the elderly: Goodbye to Rathinam

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


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

Superstition and ear tagging

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

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

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

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

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

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

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

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

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

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

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

Last things crammed in

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.

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.

Here are some photos from the whole experience.

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.

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!

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.

A chameleon trying to be a stick.

Cramming the last few things in

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.

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.

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.

Final Wedding Photos

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.

Victoria & her sister by the pool

Victoria & me by the pool (still no blooming tan)

Sorry about the blurriness, but I wanted to show the whole & final outfit. This is Emma, Ebony & Caroline

Charlie mucking about with the kids (and a not-so-kid)

Victoria's family (minus Brian)

A lovely one of me with the bride & her new husband....

...until I revealed that he (inadvertently, apparently) had his hand on my arse.