This will be an interactive group discussion session led by N Devadasan with the support of Dorothy Lall. We shall identify key issues about NCDs in India from a health systems perspective (not a bio medical perspective). The purpose of the discussion shall be to evolve a position paper on NCDs in India by IPH. Participants (from within IPH or outside) can join together to work on a literature review of current health systems understanding of NCDs and work together on a position paper on NCDs from a systems perspective. The position paper shall also guide future activities of IPH’s work on research and action on NCDs.
Health workers—who are they, and can anybody become health worker? During this World Health Workers Week (April 2 – 8, 2017), Thriveni S. Beerenahally shares some of her experiences, training wonderful women to be community health workers.
Our work in Kadugondanahalli (KG Halli), Bengaluru started in 2009 with the census of the area. KG Halli is one of the 198 administrative units in the Bengaluru Municipal Corporation area, with a population of over 50,000 living in 0.7 sq. km. of area.
Six married women joined our Urban Health Action Research Project team for data collection. They came with no prior experience, but training helped to learn about data collection. They lacked confidence, and hardly spoke with the researchers in the team.
Later, we considered enrolling them to train as health workers with the project team. The education of the six women varied from Class VI to Class XII. They could speak and write in at least one language. Training these women was challenging, due to the multiple languages (Kannada, Hindi, Tamil) they understood. But the mutual co-operation between themselves helped with cross-translation, to make sure all of them understood what was taught. Training was structured with less classroom teaching and more hands-on training in the field.
Over the years, they got trained by health professionals to become community health workers (CHWs).
As the training progressed, and home visits with the team’s doctors increased, there was a sense of satisfaction for the CHWs on learning new things about health. More than that, there was a sense of pride that they were accompanying doctors during home visits, and were respected equally by the families.
Popular training topics for the CHWs included enhancing soft skills like team building, communication skills, and how to handle challenges while working in the community. There was constant effort during training to bring in the need of the community, and how to be sympathetic and empathetic while interacting with people throughout the training session. As the months progressed, it was evident that the confidence of the women was increasing.
It was visible that they were getting empowered even to tackle their own personal issues.
As the bonding between the CHWs and research team grew, they started sharing their personal problems. That’s when I realized that these women could relate very well with issues in the community, because they came from the same socio-economic background and had similar problems. More than half of the women had the burden of managing the house and kids while their husbands were either unemployed or non-supportive
I also realized some of them were the victims of domestic abuse, and had accepted it as a norm. No word of encouragement, information about their rights and law, or support from researchers helped empower these women to fight against domestic abuse. A famous saying commonly heard in the economically backward strata in India is “Husband is god”, which the victim also believed and thought it was her fate to bear with it.
Every time they reported domestic abuse, I used to get frustrated with a sense of helplessness and failure.
However, one incident brought the CHWs together to fight domestic abuse. One lady in the team was beaten up by her husband so badly that she risked losing her vision. That moment was a tipping point for all the women. They came together and stood with her and encouraged her to report to the police, as by then, many attempts by her family had failed to stop the abuse.
That lady’s decision was so courageous, because there was a chance that her family could have disowned her. But she had the confidence to lead life without her husband’s support, which came from her training and the financial stability of her job. This helped her take that step without worrying too much about the consequences of her decision. Sadly, for months, like many Indian women do, she felt guilty of taking her husband to the police station, a stigma in society.
But constant support from the team helped her face the consequences and fight domestic abuse.
When I look back at the journey of the CHWs over the last seven years, I see remarkable change in their personalities, the way they look at the world, and their capacity to deal with personal and professional problems independently. They have a sense of responsibility for the community, and are very sympathetic towards people without judging who they are. They are the last link in the chain reaching the end-users of all health policies. More than anything else, I sense pride, confidence, motivation to bring change, and self-respect in their conduct. This change did not happen overnight. It took many years, and the road was bumpy, but the result was fruitful.
As a researcher, it was great to understand that bringing in change, especially empowering women, is a long and tedious process, and requires dedication and belief. Girls always have a list of things to do or not to do, since their childhoods. According to me, notions like girls as a kid should only play with dolls, kitchen sets, etc., are an indication that when you grow up it’s your responsibility to raise children and manage the kitchen!
When boys play with a kitchen set in Indian families, one can often hear, “You don’t have to learn cooking, and when you grow up, your wife will cook for you!” It takes lot of energy and patience to change the way women look at life, themselves, and the way the community looks at them.
Unlearning what they have heard from childhood is a difficult task.
It’s a proud moment for us to say that now, these women can “empower” other women in the community. Personal experience is always rich and enriching for researchers, and witnessing their journey was great learning for the whole team. Proper training, support, encouragement, and economic independence helped bring in change in these women’s lives. This World Health Worker’s Week, let us celebrate such inspiring people who are an integral part of the healthcare system, and whose efforts often go unnoticed and unappreciated, yet without whom, there would be a large gap between communities and the healthcare system.
This paper briefly discussed the challenges before the Indian efforts to train more public health professionals. The paper attempted to argue that the future relevance and sustainability of public health programmes depend on its ability to focus on capacity development for public health practice at the local level. Much to be learned from the experience of African schools which shows that despite being offered as distance learning courses, their MPH programmes have achieved reasonably high course completion rates Years of experience in training public health professionals through distant learning mode has helped them accrue invaluable knowledge to orient their courses to the personal and professional priorities of the working professionals. If India’s current reformation in public health education has to contribute to its larger goal, it is important that the progress thus far ought to be reviewed and necessary path corrections are made at the earliest.
TBI Blogs: This Small-Scale Farmer Bravely Fought Cancer and Is Now Helping Others Fight Tobacco Addiction
Meet Durgaiah, a farmer and a cancer survivor who not only won the battle against throat cancer, but is now using his second chance at life to train, counsel, and inspire. Dr. Pragati Hebbar explores further.
Settled in a quaint village called Hunsemaradoddi off Kanakpura in Karnataka resides Durgaiah, a small-scale farmer who used to grow ragi, a millet. Very early in life, he got hooked to tobacco use in the form of beedi. Exposed to the habit in his school days, he recalls how common it was for young boys to experiment with tobacco products. The first puff soon turned to a couple of beedis a day, to almost two bundles – with roughly 20-24 beedis in each bundle – a day.
By the time he was in his early forties, Durgaiah’s lungs could no longer take the burden of this excessive addiction, and he was advised by his doctors to give up the habit. This prompted him to reduce, but he couldn’t give it up entirely, and in fact started using chewing tobacco to distract himself from smoking beedis, assuming it was a safer alternative.
The long-standing exposure to such carcinogenic products finally showed their effect around six years ago, when he observed a change in his voice texture, which sounded hoarse. Over the span of a few months, he could barely speak, and finally found it difficult to breathe. This is when he panicked and rushed to Bangalore to understand what was causing this difficulty.
He was referred from one hospital to another, and finally met an oncosurgeon who broke the news to him about voice-box cancer, but at the same time gave him hope that he would be able to speak again.
Durgaiah underwent the surgery and radiotherapy, and was cured of the cancer. He loved to speak and was engaged in local theater and drama, and had never felt as handicapped as he did when he lost his voice. Additionally, he’d have to pay an additional ₹30,000 for a prosthesis, to get his voice back.
An elderly gentleman in the same hospital was suffering from a similar condition, and had ordered for an imported prosthesis which had arrived, but unfortunately he didn’t survive the surgery. His spouse graciously offered to donate the voice prosthesis to Durgaiah.
After the surgery, the day he received the voice prosthesis, Durgaiah spoke the whole day, as excited as a young infant who had spoken his first word. He vowed to spread the word on cancer and prevent other people undergoing the suffering and hardship he did.
He laments how an innocent-seeming habit nearly cost him his life and wiped out his hard-earned savings.
Tobacco use claims a million lives each year in India. Durgaiah shudders at the fact that he could have been part of this statistic if he hadn’t received timely intervention. In his neighborhood, he leaves no stone unturned to convince people—especially the youth—addicted to tobacco to give up. He has volunteered to speak at various fora with the Institute of Public Health. There, he sensitizes children, law enforcers, policy makers, and anyone else who doesn’t realize the hazards of tobacco use.
Taking his own example, he strongly believes that awareness on the dangerous and addictive nature of these products is lacking. For example, he strongly believes that the previous warnings of the tobacco packets barely conveyed any message. He is an avid supporter of the large new tobacco package warnings containing photographs of actual cancer patients.
He greatly appreciates this step which makes India one of the leaders globally in this preventive tobacco control measure.
What doesn’t kill you makes you stronger. This phrase perfectly defines Durgaiah’s journey from a small-scale farmer, to a forceful health advocate-cum-motivational speaker.
Meet Nalini Satyanarayan, a 70-year-old cancer survivor who is now championing the cause of cancer prevention.
Diagnosed with vocal chord cancer in early 2010, Nalini Satyanarayan underwent a surgery successfully in April 2010 and took radiation therapy subsequently. But due to the location of the cancer, they had to remove her voice box, and she was fitted with a provox prosthesis during surgery. The prosthesis is a valve between the food pipe and the wind pipe. It helps one to speak by modulation of air. The international varieties of the prosthesis cost anywhere between ₹20,000 – 30,000. Currently Nalini uses the AUM prosthesis developed by an Indian oncologist, costing only ₹50.
Nalini’s husband was a heavy smoker (making her an inadvertent passive smoker) who passed away due to cardiac ailments before her cancer was diagnosed. Despite the harrowing experience of conquering cancer, she very soon bounced back to a new normal life with confidence and determination.
Fortunately enough, her son, daughter, and grandchildren stood by her in this difficult time and are supportive till date, encouraging her each step of the way.
Tobacco use kills around 6 million people globally each year, of which almost 1 million people are from our country alone. In India, the economic burden of tobacco-related diseases was ₹1,40,500 crore for the year 2011-12, which is about 1.16 % of our GDP, and 12 % more than the combined State and Central Government expenditure on health in the same year.
It is unfortunate that innocent family members are subjected to the harms of tobacco apart from the user, who might or might not make an informed choice. Second-hand smoke is the combined mix of the smoke that comes from burning tobacco products such as cigarettes, beedis, cigars etc., and the smoke exhaled by the smoker. Studies have found this second-hand to contain more than 7,000 chemicals, of which 250 are harmful, and at least 69 are carcinogenic. Globally, about 6,00,000 deaths are due to exposure to second-hand smoke.
This smoke leads to a variety of ailments including cancers, heart and respiratory diseases, strokes, etc.
The above statistics do not convey the emotional suffering caused by tobacco use. Apart from the economic and financial impacts, tobacco cultivation also has significant environmental impacts, leading to large amounts of deforestation. Curing a kilogram of tobacco leaves requires 7-8 kg. of wood, and causes nutrient depletion in the soil.
Since her recovery, Nalini has reached out to as many individuals as possible, spreading the word on cancer prevention. She volunteers for trainings conducted on tobacco control for children, law enforcers, and other relevant audiences. She also counsels patients recovering from surgeries similar to hers who have lost voices and are learning to speak again.
Nalini helps them navigate this crucial time by instilling confidence in them and being a true role model.
Nalini is a proud member of the Voice of Tobacco Victims, and the Pink Hope Support Group in HCG Global. Able to reach out to fellow survivors, she helps cancer patients lead a life of hope after the treatment. She is also a member of the University Women’s Association. She runs two hostels for girls and women from rural areas who come to the city to study or work.
Very few victims of tobacco-related illnesses come back to mainstream society after undergoing disfiguring surgeries. Life has given Nalini a second chance, and she has grabbed it with both hands, becoming an inspiration for many. The Institute of Public Health is proud to associate with volunteers like her. These volunteers lend themselves to the cause of cancer prevention, protecting lakhs of young productive lives from this deadly addiction.
Cooking, cleaning, gardening, using public transport, inspiring children, sensitizing officials, or addressing the media—Nalini does it all with flair. She truly lives up to her motto, “Learn from yesterday, live for today, and hope for tomorrow!”
Manoj Kumar, staff at IPH published an article in International Health Policies
I write this blog based on reflections from a global health conference I attended recently, but the issue of gender (in)equality has also been weighing on my mind for some time now.
Gender equality and equity – we refer you to some literature for the intricacies of the terms – can enable us to create a society wherein each individual enjoys equal opportunities, rights and obligations. And early on in this blog, I would like to clarify that for the sake of this blog post I am referring to gender within the binaries of male and female.
Gender equality is intrinsically linked to sustainable development and vital to the realization of human rights for all. Gender inequities, as one report tells us, can for example damage the physical and mental health of girls and women. Many of us working in global health and social development are familiar with the literature and discourse on gender and its role in the wellbeing of entire populations. And yet, attending some sessions on gender at the Fourth Global Symposium on Health Systems Research in Vancouver (HSR 2016) got me [as a male participant] thinking – where are the men?
Meet Nalini Satyanarayan, a 70-year-old cancer survivor who is now championing the cause of cancer prevention.
