by Kamala Paul 

hisanta2006@yahoo.com

My sister and I started attending a new school In Sri Lanka, (Ceylon)  when we were quite young. I was in grade 3 and my sister was just starting school when we were admitted to a convent Catholic school run by great nuns.

Unfortunately we did not have any transportation from the tea estate to the school. This walk through the estate, then through the tunnel and then through other tea estates took us about a whole hour. We would leave home around 7:00 AM, to be in school when it started at 8:00 AM. The scariest part was that we had to go through a long railway tunnel that had no lighting at all. It was about half a mile long and was calved under a hill called Singe Malay.  Since it curved in the middle, it was pitch dark most of the way.

At the beginning we had men helpers who had lighting with them, to take us to school. They would travel back to school to take us back home. So we managed the long distance without any serious problems. We had lighting with what my father constructed specially for us. We lit them with matches which we carried with us. Eventually we did manage to walk with other girls who were also attending the same school. They had long sticks just to feel where the iron rails were. If these were not available, one would walk on the rail while two others would hold onto them and walk beside them. There were about 13 of us altogether when we were returning from school. If we heard any footsteps coming from the opposite direction, we would say, “Aalay” to alert the person coming closer. Then we would step aside to let the others pass. This was all done in the darkness of the tunnel.  In the mornings we could not   walk together because we were from different families and started at different times. Eventually, I did got used to walking to school with my sister without any lighting.

Occasionally a train with coal engine would go through the tunnel. We managed to learn where there would be additional space on the sides where we could safely stand. Sometimes our white long-sleeved blouses would touch the sides filled with black soot. One welcome thing was that there were little streams of water flowing from a height on both ends of the tunnel. We usually drank this water to refresh ourselves.

https://www.youtube.com/watch?v=jPtP0QpAUnA A video of a recent ride in  a train through the same tunnel. Nothing much has changed!

One Saturday I had to attend an event or meeting where my sister was not participating. No helper was available to accompany me. When my parents asked me if I could manage it, I said, “Yes.” I was around 9 years old then. But I was very scared to go by myself. But I started walking through the tunnel. After a little while, I heard footsteps coming in the opposite direction. I called out ‘aalay’ and stopped to let the person pass. I heard a male voice and heard him stop near me. He asked me where I was going and I answered him. He immediately picked me up and started walking in the direction I had to go. It was opposite direction to where he was going. When he came close to the end of the tunnel where there was some sunlight, he gently put me down. I walked a few steps and then turned back to look at the person who had carried me. I should have seen him walk away. But I could not. He had vanished! I continued walking while I wondered how he went away so quickly.

Many years later I realized that it must have been an angel who came to help me when I was so afraid. GOD IS OUR HELP IN TROUBLE.

INTRODUCTION

HIV /AIDS is undoubtedly the most formidable public health problem confronting India today.     It has been estimated that around 75% of the transmission of HIV/AIDS occurs via the sexual route and over 90% of all infected cases belong to the sexually and economically active age group of between 15 and 49 years. The infection has begun to pass from individuals involved in high – risk behavioural activities to the general population, making the shift from urban to rural areas and so infecting more and more women.

HIV/AIDS poses a major challenge to all sectors of society. The Indian Government and NGOs are acting now to check the spread among vulnerable groups such as sex workers, truck drivers, women, and auto-drivers. However, there has been little or no concentration on the industrial workforce.

This workforce represents an enormous number of people who are potentially at risk of contracting HIV/AIDS. The practicalities involved in reaching this target group are made easier because of their already existing work groups. Despite the opportunity to reach large numbers as well as the easy accessibility, the industrial workforce has largely been ignored in HIV/AIDS prevention and education programmes. This paper describes the efforts by PREPARE to reach the industrial workforce in an appropriate manner, and in informing and educating its community about AIDS.

INDUSTRY and AIDS PREVENTION

Much of the fear and panic about HIV/AIDS is the result of misinformation. People believe that AIDS spreads through touch and blood donation. They believe that people with AIDS should be isolated and that women are the cause of the spread of AIDS. They believe also that STDs always result in AIDS.  The only way to deal rationally with the problem and to prevent the further spread of fear is for employers and employees to be adequately informed about the infection.   For employees who are not infected, there is  the concern about the safety of working with people who are infected. For those with the infection, there are fears of discrimination and of losing employment, benefits and friendships.  Employers are concerned about how to manage the problem in general and the specific HIV/AIDS issues in particular.  Management and workers both have equal vested interests in ensuring that the disease has the least possible impact in the workplace.

Attitudes towards AIDS and policies developed in the workplace will have a profound impact on the eventual social and economic outcome of the epidemic.   Managers of large and small enterprises, in cities and smaller towns, and in all sectors of industry and commerce, as well as union leaders and organisers will need to have a basic understanding of this disease in order to adopt attitudes and develop policies that are both informed and rational.

The epidemiology of HIV/AIDS in India clearly indicates that about 89% of all reported cases belong to the sexually active and economically productive age group.   It is commonly understood that the above group is found mostly in self-employed sectors, business establishments and private sector companies, besides government employment.  In addition to this number are the millions of people in this age group spread out in the agricultural and unemployed sectors.

The incidence of HIV/AIDS in the workforce and in the surrounding community directly affects industry. There is a rise in employee absenteeism when a sick member of the family needs to be cared for and an increase in employee turnover due to the disabling effect of associated illnesses, the need for persons to stay at home to look after the ill and deaths. Inevitable are the higher insurance premiums and government health expenditures, the difficulty in replacing skilled personnel and decrease in net earnings as more money goes towards cost of AIDS management.

To counter this problem, industry must work to build employee morale by  providing supportive work environment for people who are infected and for their families. For companies that want to project a socially conscious profile, the demonstration of such concern is a particularly urgent task. 

ABOUT PREPARE

PREPARE is a non governmental   organisation formed in 1983   towards  social and economic and political justice, and focusing on democratic development, environmental  protection, food security, gender equity and human rights.

Initiating with disaster preparedness, PREPARE has diversified to  deal with basic injustice affecting dalits tribals and fisherfolk  catering to related  intervention groups.  PREPARE felt the spread of HIV/AIDS as a socio – economic threat to the poor and thus included HIV/AIDS action to its existing healthcare and development initiatives.   Now PREPARE has three main focus areas within a broad HIV / AIDS work,  Commercial Sex Workers in Chilkalurpet in A.P., Truckers and highway prostitution stake holders  in Gudur – Guntur in A.P. and Slum dwellers and street children in  Chennai .  Having its office in close vicinity to industries in Ambattur, PREPARE naturally chose concentrates on the industrial  workforce, even as we stepped into this area of HIV/AIDS prevention.

Workplace intervention in AMBATHUR INDUSTRIAL ESTATE

The office of PREPARE is located in the heart of the Ambattur Industrial Estate in west Chennai, Tamil Nadu, India and therefore has easy access to this Industrial area.    Ambattur Industrial Estate is South East Asia’s second largest industrial unit. There are now between 2000 official and 1,000 unofficial industrial units in the Ambattur/Padi area and about 200, 000 to 300, 000 people.   Of these, 40 percent are women, because of the large number of garment industries in the area. The availability of  such a large sexually active population coupled with the fact that many of them are migrants living alone away from families and therefore exposed to casual sex and associated high risk situations,  prompted us to choose this population.  Additional consideration leading to this choice of target group  were of a mission amended nature; behavioural change , if brought about,  could have considerable impact in terms of lives saved, and    economic productivity  and this was the.

THE FIRST PHASE

FRAMING THE ISSUE

The project started in September 1996.   An initial analysis of the situation showed that employees were at risk for HIV / AIDS for several reasons.

Travel to the work site from distant places, leads to less time  with families and the tendency to seek sexual satisfaction near the workplace. There is also  the opportunity to have unprotected homosexual encounters even    while travelling in the electric train.  Those residing in small groups in local areas closer to the work site and away from their homes for long, have a greater tendency to  turn to FSWs.  There is pressure on the migrant girls to make money through sexual services to meet living costs and to support families back home in small towns and villages.  Influence of alcohol and drugs leads people to ignore safer sex , to seek casual relationships and also to involve in commercial sex. 

Economic and sexual exploitation of women at the workplace by the male supervisors whom they have to please in order to save themselves from being retrenched during this economic recession, is another contributing factor to a high risk situation.

Migrant girls in the industries come from towns and cities as near as 70-80 km. as well as Villages as for as 1000-15000 Km. away.  Some are run away girls white some have come with the consent of the families.  They earn for their existence and stay either in groups renting a house or   in hostels.  As sexuality goes, many try and stay away from relationships till their families get them married.  Some strike up acquaintances/friendships with men whom they come in contact with and may or may not marry them. 

In the context of the industry, the women  have male supervisors who have to certify the produces (made by these girls) them for payment and tend to sexually harass them in return for this favour.  The girls are made to sleep with them in a convenient place  elsewhere.  This harassment is common although not an organised one.  We came to know of this, in our counselling sessions and this is one of the reasons  why we developed Health Education messages on sexual exploitation and gender concerns.  We find that these charts help us to establish an immediate rapport with such girls whereas the conservative housewives consider that these stimulate casual sex among unmarried girls and are therefore irrelevant and unnecessary,

 The objectives of the project   are   thus came to be formulated as follows :

1. To sensitise the workforce to a basic understanding of STD/HIV/AIDS and issues related to alcohol, drugs, sexuality, power and gender relations.
2. To enhance STD/HIV/AIDS prevention by promoting the use of condoms and providing information about its proper use in STD/RTI care.
3. To develop an AIDS policy in the workplace that opposed discrimination in the   workplace in line with the guidelines laid out by the ILO/WHO.

IMPLEMENTATION METHOD

The team gathered some preliminary understanding about the local Industrial sector, its priorities, and its pattern of functioning : the management their professional  associations, their relationship with employees, their recruitment patterns, and the facilities and benefits offered to employees.  The area was mapped and the units classified according to size (i.e. No of employees).

We then went about developing  health education material for our use among  the employees. Most of the materials available in India were Western oriented, and hence carried assumptions and values totally alien to our culture. In order to develop health education materials which would be relevant to this intervention group,  with a sample size of 50 women and 199 men employees.  Our main findings of prevalent attitudes were

• AIDS is a killer disease and HIV infected should be shunned;
• AIDS was curable if detected early;
• STDs   are a symptom of AIDS;
• Women were the prime cause for the spread of AIDS;
• AIDS can be spread by  social contacts like sharing toilets & food;
• A person affected by HIV can be easily recognised by their external appearance.

In general, employees were negative toward HIV/AIDS. There was refusal to work among HIV+ co-workers or claim for rights to a disease-free environment, discriminatory attitude towards HIV+, and  fear & stigma regarding STD & AIDS.

The next step was to create awareness among the management about the need for an AIDS prevention programme in the workplace. We met company heads on an individual basis and discussed our mission in order to convince them to give us an opportunity to provide health education to their employees.  We stressed the socio-economic impact that AIDS would have on companies  if they did not take preventive efforts now- the loss of trained  human resource, number of days of lost due to  sick leave,  the reduction in productivity, the cost of retraining new teams,  medical costs, insurance costs, cost of litigation if the management demands resignation of infected persons, the animosity of un- informed /mis-informed colleagues who would  demand discrimination against the infected,  the loss of morale among the working community when loved ones pass away. and discrimination against working women. 

Initially we thought that the data on HIV/AIDS prevalence and epidemiology would be sufficient to persuade companies to adopt a prevention programme but, we were wrong. The management did not believe that HIV/AIDS had reached the of their factory gates. They believed that the  employees know enough about HIV/ AIDS as there was plenty of publicity in the television, papers news and radio. Even if  their work force was infected the number will be small enough for them to manage, They could  prevent AIDS through pre – employment screening of their employees.

The employers were reluctant to give us time for our educational programme during working hours, since this would slow down production. However, most company heads agreed to allow us atleast about half-an-hour during the lunch break and after factory working hours to meet the employees.

TRAINING CONTENT

Apart from a half hour to hour long talk about STDs and HIV/ AIDS setting out the basic facts, the course designed by PREPARE is divided into   eight modules , of one hour each catering to 30 to 40 participants at a time. The modules offer comprehensive information about STDs, HIV &   AIDS in relation to developmental, social economical, cultural and gender aspects.  

The curriculum covers basic facts on HIV/AIDS; STDs in relation to HIV; safer sex methods; understanding AIDS as a community / individual responsibility; developing positive attitudes & responsible behaviour towards those infected; counselling & testing aspects & ethics; legal aspects of HIV in the   Indian context and gender & promotion of basic human rights.

We pilot tested the tools and methodology of awareness creation and modified our approach according to the culture of the local population. The educational tools & aids used were :

• slide & OHP projector to understand basics of HIV;
• video show to promote understanding beyond basics;
• flash cards and flip charts to promote knowledge on STD/HIV/AIDS, gender inequalities and RTI cases;
• condom demonstrations using a phallus/banana/candle to promote  regular and proper use;
• case studies, and sharing by HIV+ volunteers to remove unfounded fears ;
• to focus on community / individual responsibility,  and encourage non-judgmental attitudes;
• games & exercises to personalise the issue of AIDS.

Among the above health education tools, the most successful were the  slides and  video followed by  open discussions. Case studies helped in emotional involvement. Success was less forth coming in gender mixed groups or in groups where  individuals of vastly differing age groups participated or in groups of individual of mixed marital status.  Sexuality could not be openly discussed in the first two kinds of groups, which in the last, openness was less and with the married individuals,  trying to be more  closed and judgmental than the unmarried.

Further sessions held at the end of the day were more relaxed and open than those held  in-between working hours.  Younger team members and younger health workers  were able to have a more frank discussion on sexuality than the others, as they were able to identify with each other.

It is interesting to look at the concerns, questions, myths and fears voiced by different groups. With the 16-20 age group, the questions are diffidently asked – they are worried about vaginal infections, menstrual problems, pregnancy, sexuality, gender concerns, escaping from high risk situations and symptoms and signs of HIV and about cure.   With the married women, the questions are on STD, risk of multipartner sex, condom usage, HIV/AIDS symptoms, communicability, complications, breast-feeding by HIV positive women and cure.  They were in general not open about their own sexuality.  While we found that Health Education materials could not be formulated to cater to each such group, we learnt how to use the same material differently with each different group and how to steer the discussions as per their  need.  Case studies were a tremendous help – taking up for discussions ways and means of preventing high risk situations commonly encountered, evoked a more frank exchange.

About 5 to 10 minutes spent on breaking the ice was definitely helpful in eliciting participation. The presence of management representatives was an inhibiting factor to free interaction dissuaded.

The videos we use only help to initiate the awareness process.  It would be a good idea to enact high risk situation or present them through videos to bring out the hidden concerns to the open, atleast in small groups.  We found from our experience that even among close friends, sexuality was not discussed at all.  Our interventions act as a catalyst to further the desired openness, which would help them to prevent  gender exploitation and STDs.

The participants were followed up with discussions on a one-to-one basis or one-to- group basis as well as with informal counselling sessions, either in the company premises if permitted,  at the gates or near the bus stops. 

CHALLENGES AND CONSTRAINTS

Apathy of the management and their lack of commitment to the cause was the main challenge faced by us. Frustrated, and to overcome  this we took the message to the trade unions, focusing on the rights of the employee and how these rights would be violated when HIV / AIDS enters the industry sector in a significant way.  We  focused on the rights to information, to choose whether to be screened or not for STDs and HIV, to confidentiality.  We stressed the need to look at HIV/ AIDS as any other chronic disease, the issue of medical treatment costs to be met by industry, insurance, availability of universal protection methods in the accident prevention or treatment centres, availability of condoms, the issue of discrimination and retrenchment of those infected, etc. This created a stir among trade union members and there also arose the demand for health education and counselling for behaviour change.  The Personnel management then called us for a discussion and gave us time to mount a brief intervention with a view  to test us out.   In fact, they were  hesitant to allow discussion of anything related to sex within their professional premises. They also fought shy of the easy familiarity that might emerge if such discussions took place in their presence and resented our growing closeness to the trade unions arising out of our discussions on workers ‘ rights as spelt out by the ILO.  But once the health education sessions commenced,  and they were able to see the ease with which the whole aspect of sexuality was handled, they started to be more helpful in giving us time and space for our intervention.

Problems and constraints in dealing with the workers on HIV prevention.

Most of the workers do not live near the industrial estate and are anxious to get back  to their home/hostels early.  Some of them have to travel 1-11/2 hours daily by train to do so.  It is not easy to get them to stay for discussions or counselling after factory hours.  We are able to meet only about 2-5 persons a day for such discussions.

This makes it difficult for  us to assess the impact of our Health education on their sexual behaviour.  This is especially so in the case of women.  When conducting awareness sessions in the factory premises, within the constraints of time and space, we are not able to segregate the younger from the older workers. The younger respond easily if they find that we are non-judgmental, familiar with their jargons, and able to laugh with them and wink at their jokes .  The older are more judgmental, even among men, and it sometimes is not a comfortable situation.  The questions also differ.  The older ones do not want to look at the pictures of STD with ease when the younger ones are around and vice versa. 

An open discussion an sexuality becomes difficult in such circumstances we try to overcome this by meeting the younger ones at the gates after work, and speak to them giving them an opportunity to open up.

While STD is a reality, often experienced by atleast some of them, AIDS is still an unfamiliar phenomenon.  They have not yet seen deaths due to AIDS.  Connecting the threat to sex becomes a problems to many of them.  Our culture is blessed with many kinds of traditional healthcare systems.  No one , not even the so-called learned is able to negate or swear by the effectiveness of these .  Therefore it is difficult for us to convince the workers that there is no cure for AIDS.  This is especially so, because of the publication every now and then, of the various trials being carried out by  the alternate health care systems, added to the unethical claims of may quacks in the news magazines commonly read by the workers.  Western medical information is not always accepted as truth and statistics do not always help to prove that most HIV positive persons suffer and die eventually. We have to patiently deal with this.

Although  the rationale of condom usage is accepted we are unable to ensure whether there is universal usage at all high risk sexual encounters. women feel that they are still not in control of the situation as men are often more powerful in their relationship and that they do not have the bargaining power especially within  marriage. Discussions on gender are not easy for want of time.

Despite this, our experiences in the pilot project were frustrating, because although in quantitative terms we seemed to have done a lot in qualitative terms, there was hardly any indication of behaviour change, nor of internalisation of the issue by the industry. We realised that for the programme to be successful, it had to become flexible and innovative, and adapt to the companies’ schedules. Therefore, we changed our approach in Phase Two.

PHASE 2  

CHANGING THE APPROACH

The advisory committee consisting of NGOs. Lawyers, trade unions, management, health personnel, and Communication and counselling specialists with whom our performance is discussed in a detailed manner. This has greatly helped us to steer the program in a fresh direction.

What we sought to do in this phase was to make our interventions more acceptable and sought after by both the management and the employees.  Thus the focus was on two areas – to work closely with the management, meeting their priorities, and persuading them to adopt a worker friendly approach with regard to HIV/AIDS, while trying not  to infringe on their time.  The other was to keep most of our follow-up interaction with the employees outside the portals of the company, and try to build-in  peer influence  in the direction of safer sex.

With the Management our strategies were as follows, we  first classified the companies into three groups:

 (i) those that were not favourable to HIV/AIDS intervention in company premises; (ii) those which gave us space to interact with employees within a restrained  time  frame and (iii) those which valued our intervention and facilitated it willingly.

With the first group our strategy was to use the Associations of Management which is where policy decisions are made for  members and which lobbies with the external environment on issues concerning member industries.  We held discussions with the Executive Committee members both individually and in group, and explained to them the  reason  why many leading industries both in the industrialised and developing countries have formulated policies favourable to HIV/AIDS prevention in the workplace. 

These associations then allowed us entry into their Council meetings, which gave us  a good opportunity to convince them further.  The Association also gave us space in their news magazine, to feature information pertaining to HIV/AIDS prevention on a regular basis. Debates, seminars and workshops were held for the management to motivate and sensitise them on the need for and the benefits of including HIV/AIDS related intervention in their policies and administration.

Some of the industries requested us to organise health camps for their employees, as  display  of staff welfare concerns towards gaining their goodwill.  We saw  this  as an opportunity of working for our own gain.  Thus we organised health camps which included  screening for diabetes, hypertension, tuberculosis, as well as   obstetric and gynaecologic care to the women.  But we always included  in these camps, an attractive stall on STDs/HIV/AIDS with different kinds of audio-visual aids. Condom demonstration was an important part of these camps.  Counsellors were available  at the stalls for consultations.

We were able to reach many workers on HIV/ AIDS,  and young girls with STDs and RTIs  found these camps particularly useful as they could access sensitive and professional care,  as well as counselling with regard to safer sex, early and complete treatment of STDs and partner treatment.   The management was pleased, and we  were able to achieve our objective.  

With those management that were more cordial, we continued to provide our inputs,  tailoring them to the time they allotted to us.

We also held sensitisation workshops for the management through their associations.  Here we discussed the progressive steps – employee friendly HIV/AIDS policies at the workplace  made by the industrial sector of developed countries such as Canada as well as that of Zimbabwe and Uganda, and the recognition by Confederation of Indian Industry of the need for HIV/ AIDS education in the workplace,  all of which had been widely covered by the media. We shared with them the ILO convention related to this issue. Case histories relating to employees, housewives, and children, especially, evoked interest. Slowly the understanding grew that HIV/ AIDS could be  a threat to the prosperity of their businesses and also something that could disrupt their own lives and those of their loved ones. A remarkable change in attitudes came about after these workshops, especially among the large  industries. Seeing this trend, the smaller industries also started opening their doors to us, atleast for   the sake of recognition equal to their larger colleagues.

Another strategy we used is to go through the Employees State Insurance Hospitals [ESI Hospitals] which are the official caretakers of the health of the employees and which is closely connected to their reimbursements, medical certification, retirement schemes, and Insurance and accident schemes. The medical officers were sensitised and we had good acceptance among them. We also held counselling sessions in these hospitals. Exhibitions here became quite popular. This also furthered our acceptance by the industries.

Our close association with these Associations and entry into their council meetings has brought about a significant reduction in the tendency of the management to retrench workers infected with HIV and to do compulsory pre-employment HIV test of employees.  Some of the companies carry out mandatory VDRL/HIV testing of provisionally selected employees with or without the knowledge of the persons concerned as part of the selection process, training or promotion. There is a long-standing  feeling among the employer’s that they have a  right to conduct mandatory medical examination in order to protect themselves from  low productivity and medical expenses that may ensue if unhealthy employees are selected. Any employee challenging  such examination or blood test would  be  refused employment on some other pretext. A deliberate refusal to submit to this medical requirement would be construed as in insubordination, and therefore liable to disciplinary action. The mandatory HIV antibody testing as a method of screening out individuals is not only inefficient and ineffective but also violate the  basic individual right to privacy and dignity.  We continued to lobby with the management on this issue and after about three years have been able to bring about  a change in the attitude of the management  with regard to this.

 

WORKER STRATEGIES

Despite these successes, we were convinced that we could not rely  totally on the management to take ownership of this intervention as they were under other pressures  for effecting tangible increases in productivity. Since HIV/AIDS prevention is PREPARE’s mission, it is we who have to find the means to reach the employees and work with them towards safer sex and behavioural change. Therefore we started to explore means to  strengthen our access  to the employees.

We made ourselves available to the employees outside the gates of the industries, in order to be able to reinforce our STD/ AIDS prevention messages, to be able to spend quality time  and be available for counselling towards behaviour change. We put up small tents and  exhibitions  by the roadside which employees had to transit through  to go to the bus terminus. We held video shows, street plays, role plays, or simply played music to attract the crowd. We even hired a magician, trained to  impart AIDS prevention  messages.

Information through a periodical newsletters proved helpful. PREPARE circulated a bi-monthly newsletter called SAVAAL (challenge) in Tamil and English, giving brief  and clear messages. Within the company premises, in order to reinforce our other efforts we put up AIDS prevention messages.

During festivals celebrated by the company and in the colonies where the employees’ families stay we organised street plays and cultural shows.

The garment industries have a large number of young women working in them. Here we held regular  counselling. Counselling on sexual health hygiene and HIV/AIDS  was also effected through the phone .

Periodical health camps focussing on STD/RTI care were organised at company premises. With the help of local medical institutions, NGOs, Government hospitals and ESI hospitals,  these camps were held  especially for garment industry workers.

Condom promotion was geared up, popularising it through promotion of conventional and non-conventional outlets within and outside company settings. Initially the company heads were reluctant to agree. They feared misuse and protests from workers that would create labour problems. Periodical persuasion and a sustained approach enabled us to convince them to agree to this. A pilot test was done by placing condoms at company toilets and departments.

PEER EDUCATION

The value of peer educators is recognised the world-over. However in the industry setting,the employees were available to us neither during working hours  , nor  after work.

We resorted to using the worker education group for this purpose.  Every established company has an institution called the ‘worker Education Group (WEG) the members of which  are hand-picked by the management, based on their seniority experience and work performance. The role of these WEGs is to train other workers of their respective departments in the latest developments. We are able to successfully persuade the management  to let us train them as peer educators in a limited way for HIV/AIDS prevention.

OUTREACH TO OTHER STAKE HOLDERS

PREPARE recognised the need to include actors in the local communities with a strong potential to influence off-workplace behaviour – autorickshaw drivers, barbers, tea shop operators, laboratory technicians, wine shop owners, petrol station owners and local unemployed youth.

There  is  a well knit network of barbers in this area and this was made use of by us. The barbers were first sensitised to their possible role as health educators, and to facilitate this role their saloons were transformed into dispensing outlets for calendars, pamphlets and, signboards with AIDS messages,  and condoms

Involuntary HIV testing has become an instrument   to identify and discriminate against persons who are found to be HIV positive. Besides hospitals, local general practitioners and companies casually carry out HIV testing. The results are used either to deny employment after interviews or to terminate an employee found to be HIV positive.  In this connection 52 local  laboratory  technicians were identified, satisfied and trained in the clinical and ethical aspects of HIV/AIDS, and encouraged to refer their clients to us for counselling.  

We surveyed the local petrol station employees and sensitised them   to the issues relating to HIV/AIDS. We were able to negotiate with them the placement of a few condom dispensers in these stations. The condoms are replaced fortnightly and the  distribution audited.

As found in the adjacent states where PREPARE is working, there is a national-wide effort by oil companies to put up large scale departmental stores and retiring rooms  adjoining the petrol stations, to cater to the various needs of the consumers. This could be easily exploited to our end, by including prevention education and  condoms for distribution and sale.

The drivers of autorickshaws  a popular three wheeler mode of transport were an important audience for our efforts. Besides  being exposed to high-risk situations themselves, they contribute a major link between sex workers  and their clients , who often consist of industry employees.

These drivers were identified and trained as peer educators, and encourage to display HIV/AIDS prevention messages on the  rear portion of the autos,   and below the meter.  The drivers  also refer customers to us for counselling and treatment.

INTERIM NARRATIVE REPORT

 FOR PERIOD BETWEEN

1st April ‘99 to 31st March 2000.

1. Health Education

 During  this time the focus for sensitisation on STD/HIV/AIDS was on Smaller & tiny sector units.  This was because there was good reception from there units.  We also learnt informally that workers’ rights were not given importance to by this sector.  

We moved from the South phase of Ambattur Industrial Estate  where we had concentrated so far, to the North Phase.  We   covered the following units spending atleast between 15-30 days to complete one unit.

Best & Crompton	Devi Heat Treaters
Samsun Rubber	Enjoys Engineering Works
Cookson India	Nadeem Leatherware Exports
Ashok Leyland	Kishore Engineering
Madras Conveyors Pvt. Ltd.	E.S.Haji & Co
Vijay Industries	Elfab
Tal Bros Industries	Electrical Construction & Maint. Co.
Basker Fabricators	Mathura Auto Co.(P) Ltd.
Bright India Ltd.	Vidya Enterprises
BOC	Venkateswara Chemical & Plastics
Arasan Timbers Ltd.	(P) Ltd.
Suster Tools Pvt. Ltd.	Sterling Industries
Coromandel Garments Ltd.	Sri Matha Fabricators
Unimax International	Spinax Chemical Industries (P) Ltd.
Neo Textile Industries (P) Ltd.	South India Marketing Agency
Apollo Leathers	Gorval Galvanising Works
Kaleen Corporation	Precision Controls
Univaac Convertors	Siva Plastics
Renusood	Quik Lite Industries
Ambattur Clothing Factory	Quality Engineering Works
Standard Switchgears	Solker Industries
Sri Balaji Steel Industries

No. Of Industries Contacted                        112

No. Of Industries Covered                           42

No. Of Sensitisation discussions held                     210

(Average of 5 education sessions in batches for an Industry)

No. Of Workers Covered                 2520     (Men – 1624 ; Women – 896)

At the garment industries a regular clinic was conducted with Dr.Sathyavathi Mohan, M.D., D.G.O. as the Lady Medical Officer.  The  Companies benefitted are Dignity, Innovations, Fabulous International, BNT Connections and G.V.Exports.  During the clinic and health camps we had the opportunity to discuss in open with the workers (Male and Female) about sexuality, Myths & Misconceptions, reinforce messages on AIDS & Counsel them.

OUTREACH TO FAMILIES OF INDUSTRIAL WORKERS

The employers were motivated to hold health camps  to their workers and families with a focus on STD/RTI treatment, HIV/AIDS education and counselling on sexual health.

We approached the industries whom we have a good rapport with for the above.  

The following camps were held accordingly :

S. No	Name of Industry	Date	Resource Team	Specialisation	Group	Nos.	STD/RTI Treated
1.	TI-Diamond Chains	16.3.99	Abimaan (NGO)	STD & …	Women Worker	186	–
2.	Tube Products of India	15.7.99	Purush Male only Clinic	STD Camp	Men	23	–
3.	Hindustan Photo Films MFG Ltd.	23.8.99	Govt. G.H.	Dermatology & STDs	Worker Men	46	–
4.	Labour Tenement Unit-Ambattur Estate	30.10.99	Govt. G.H.	RTI & General	Worker Families (Mixed group)	112	4
5.	TI Millers Ltd. Kakkalur Unit	17.11.99	KKR ENT Hospital	ENT	Worker Men	86	–
6.	TI Cycles	3.6.99	ESI Hospital	STD	Canteen Boys	67	44
7.	TI Diamonds Putlur Village (Thiruvallur)	15.11.99	Eye Camp	Dr.Balakrishna Hospital	Worker Families	102	–
8.	TI Diamond Chains India Ltd.	10.3.2000	Govt. GH.	Derma	Worker Men	186	5
9.	TI Cycles of India	19.3.2000	Govt G.H.	RTI	Worker Wives	50	3
10	TI Millers, (Madanakuppam) Village	21.3.2000	General Hospital	STD, General Health	family	126	–

During the camps we had attractive stalls for Condom Promotion and separate rooms for confidential discussions on sexual health.  Persons  with history of unprotected sex were screened for STD at request.  We do not encourage HIV testing, though requested by the Management.

We had the opportunity to meet the worker’s wives and families in the nearby towns and living in  high risk situations.  Proper use of condoms was focussed and Condom promotion took up well.

The Programme Staff visited the villages for follow-up of the Camp and  counselled those who were VDRL+ve for treatement.  Those who were infected  were treated through the ESI or Govt. G.H. under the personal support of programme staff.

Meeting Workers after working hours

We held health education sessions through Street Theatres at 18 industrial colonies identified as strategic places where workers hung around   after working hours for  shopping, boarding the bus, or while refreshing themselves with a sip of tea.  The street theatre sessions helped to relax these people  and were received well.  We saw many women gathering to watch the street plays standing on the road for more than half-an-hour to listen to message on STDs, Condom use and the need for compassion towards those infected and affected. We took this opportunity to address the additional messages of HIV/AIDS, reinforcement to those already covered  and making them comfortable with the issue of STD/HIV/AIDS.

The cultural programmes were conducted by the teams of  NESAKARAM & Jeevajothi.

After working hours  we met the workers individually on their way back  at convenient points and discussed further on these areas.

LIASONING WITH ESI HOSPITALS

We continued to liaise with ESI Hospitals as they are  officially responsible for the  treatment   of all the industrial workers.  We had built a good coordination and amicable relationship with all the divisions of ESI hospitals – the State Administrative Office at Teynampet, ESI hospital at Ayanavaram – K.K.Nagar in Chennai and ESI dispensaries  under the jurisdiction of Ambattur and Padi.

On 29th April’99 we had an exhibition at STD Dept.,  ESI Hospital, Ayanavaram during the out patient (O.P.) hours.  The exhibition gained good response and we replicate this at other ESI dispensaries in Ambattur and Padi.

We discussed with the concerned authorities about Managing workers with HIV/AIDS and tried to understand their existing policies on this.  We are convinced that the ESI policies would be ‘AIDS friendly’ when it comes to caring for those infected and affected.  There are provisions to provide for funeral expenses, care and support to the terminally ill and supportive ethics in terms of recommending insurance, leave and other benefits to the affected employee.  We would like to discuss this with other NGOs working on this area and build on this initiative.

Imprinting  aids prevention  message in the minds of workforce:

The past years of our experience has made us to understand that workers are liable not to give importance to what they have learned.  They are preoccupied with reaching  too many targets set forth by the  Management.  This calls for the need to work  out a plan to remind them each time about the presence of STD/AIDS and the need for protection.

We modified our BI-monthly SAVAAL to simple monthly illustrations / messages targeting the message of STD/AIDS. These illustrations were displayed on the company notice boards and departments for attention of the workers.  This initiative enabled us to further  reinforce messages, facilitate referrals and  enhance the  use of telephone  counselling services.

Addressing the enabling environment

We organised periodical exhibitions and mass events   with attractive stalls and games at roadside places covering Ambathur & Padi, to draw the attention of shop owners, vendors etc.  to sensitise them on  STD/HIV/AIDS, as they  form the enabling environment with whom the workforce have regular contacts and relationship.

TRAINING OF GRASSROOTS   CBOs

We had continued to build the skills and capacities of CBOs   by information sharing, IEC distribution and training.

We have continued to work with a network of NGOs working on prevention of HIV/AIDS among, sexworkers and their clients .  The 7 NGOs are – WORD, ATSWA, MEDAL, WLLEDS, MERCY TRUST & CSED.

They had been trained on the following areas

• Programme implementation of AIDS related projects – Needs assessment, building on objectives and activities, program planning and review.
• Guidance on setting quantitative and qualitative parameters / targets for monitoring and evaluating HIV/AIDS work.
• Condom programming.
• Inbuilding AIDS prevention in  developmental initiatives.

Working with auto drivers

We continued health education on regular basis and had strategic discussions with auto leaders for STD prevention, condom promotion and sexual health counselling.

Through the cooperation of auto leaders, we organised STD camps at the following auto stands;

1.       Muthamilzh Auto Stand, Mogappair

2.       Wavin Auto Stand

3.       Golden flats Auto Stand

At every level of our planning and distribution we discussed with other NGOs experienced in  similar areas and incorporated their suggestions and insights.

• TNVHA
• Rural development Society
• Indian Network of people living with  AIDS
• South India AIDS Action programme
• Initiatives for women in Development.
• Purush Mala only clinic, T.Nagar
• KKR ENT Hospital, Poonamallee High Road
• Madras Medical Mission Hospital, Collector Nagar
• ABIMANNA, SRP colony
• Field Publicity Board, Sastri Bavan
• Rotary Hospital, A.I Estate

CONCLUSION

At the end of  three years of working,  we in PREPARE  believe that we have gained substantial ground and have a good rapport with many industrial units in this area. This has resulted in a few companies contributing towards the programme cost where we have moved from a ‘care giver’ to ‘consultant’ role. This is an indicator that the programme has  gained importance. The employees turn to us for counselling and themselves introduce us to other companies which need to be sensitised. Women workers in particular are in regular contact with us . There seems to be a higher condom usage.

Our pilot programme of trying to install Condoms at industrial sites (toilets & departments) did not work out well because of industries feared it would encourage promiscuity this was  especially with garment factories, where women and men work together.  So, we tried making it available to Worker Education Groups,  Personnel Officers & Occupational health staff.  A limited quantity of condoms was distributed to the social and occupational health departments of the big industries and the workforce informed about it.  Workers were able to get the condoms from the above sources.  Stigma related to condoms was slowly came down by sustained sensitisation .  The approach succeeded to a considerable extent wherever there was no ‘bureaucratic’ gap existing between the workers and personnel officers and occupational health staff.  The personal officers were accessible to the workers as the latter periodically meet them reg. their labour welfare. 

The condom off-take was closely monitored by Programme staff who made periodical visits received feedback from WEG, personnel officer is occupational health staff.  Condoms were replaced when the stock dwindled to a hundred.

There were practical difficulties of sustaining this process as the period of functioning of the Worker Education Groups was brief.  They were changed almost every year.  The Program staff each time had to sensitize the new WEGs and this hindered our progress.

We also chose to work with ESI authorities.  Initially condom promotion through their many ESI dispensaries, where workers and their partners seeking STD or RTI treatment could be given condoms.  Once these persons are familiar with condom usage, they tend to use it as preventive method whenever a high risk situation is encountered.

Though companies are now open to talk about HIV/ AIDS and workers sensitised to the issue, there is still lethargy among  others who deny the reality of AIDS. When our approaches do not work we feel that there should be some mandatory directives from the Government, to bring these companies to comply with worker education and a supportive environment with regard to HIV/AIDS.

The industrial sector will continue to expand and play a major role at all levels in countries like ours, and we need to find ways for a sustained intervention with regard to this important issue of HIV / AIDS.

As doctors we enjoy respect in society because we are able to relieve physical and mental ailments by virtue of our education, training, and experience.  We also function as counselors and educators on health-related subjects.

‘Medical ethics’ have been carved out ages ago by conscientious doctors and statesmen and women, and is defined as ‘a system of moral principles that apply values and judgments to the practice of medicine. As a scholarly discipline, medical ethics encompasses its practical application in clinical settings as well as work on its history, philosophy and sociology (pleases clarify). The medical profession has long subscribed to a body of ethical statements and statutes developed primarily for the benefit of the patient.

1. Respect for autonomy – the patient has the right to refuse or choose the treatment
2. Beneficence – a practitioner should act in the best interest of the patient.
3. Non maleficence- ‘first, do no harm”
4. Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment ( fairness and equality)

Other values of relevance are

• Respect for persons wherein basic international human rights laws are incorporated
• Truthfulness and honesty

As doctors, we have a higher and special stewardship to God not only in relation to patient care but also in areas related to our work environment, work ethics and practice. Christian principles to be applied to any profession and workplace are relevant to doctors as well. I would confine this article to what is increasingly being viewed as acceptable by Christian doctors working in private medical colleges.

Medical colleges are places which educate and transform young men and women into proficient, skilled ethical, committed doctors practicing the Hippocratic Oath and medical ethics. In India we have internationally acclaimed and ethical Christian medical colleges such as Christian Medical College Vellore and Christian Medical College Ludhiana, Spicer memorial Pune, Bangalore Baptist Medical College and the alumni have served sacrificially all over the country.Over the years many private colleges have sprung up. Love of money and corruption has changed medical education into a money spinning racket, run by the rich with no human values or principles. It is scary to think that thousands of spurious doctors have been created and let loose in our country  which is rife with diseases old and new, preventable and not, simple and complicated, curable and incurable.

Some of the dark areas of practice in these institutions are as follows:

• Fake documents are prepared concerning  period of service, so as to make candidates qualify for the posts of associate professors and professors. Doctors are pressurized to sign these, and this is more so if you head a department.  This compromises the quality and capacity of doctors in general
• There are many instances where the required infrastructure is not available but the staff is required to vouch for their existence under the control of the institution. The implication is that students are not trained adequately
• Patient records are constantly being created to show a high outpatient attendance, inpatient admission, in the different wards and units, number of investigations done, number of surgeries conducted, blood transfusions made, children immunized, patients under treatment in  national health programs, community interventions, camps and attendance.Institutions where healthcare is not proper, and which are shunned by the people get recognized to function.
• There is coercion to pass  students who have not achieved the required standards, as it would irk the ire of the parents. Their attendance is being manipulated to make them eligible to appear for an examination. Questions are leaked, and help provided in the exam halls to answer questions.
• Unnecessary investigations are done to boost to meet the required numbers. Patients are pressurized to get admitted to fill the wards during  medical inspections. Even unwarranted invasive procedures are carried out, in the guise of diagnosis and  treatment.  Informed consent forms for procedures are so confusingly worded and patients/ relatives are constrained to sign these, without questioning – it is just a routine documentation they are told. The common man suffers , loses money. Lives are lost unnecessarily.
• Equipment, and educational materials basically required to teach the students are not available.
• Bribery, false bills, lies breed in every possible area of  the colleges.
• Part of the remuneration is still not being given in cheques/ bank payment  which therefore requires  less income tax to be paid
• Basic ethics of patient care are not followed. The emphasis is on profit and greed. Patients are seen merely as numbers to reach targets set by the Medical Council of India

While there are some institutions that are not totally guilty of these, sadly most are. Some of us doctors had no idea of what we were stepping into, when we joined such medical colleges just to work and teach.  Some others among us felt that we could influence the management to change and adhere to all requirements and become an ethical institution, committed to train the students to its best.  Some continue to justify it all , saying that today’s world being corrupt, we need not ruffle feathers but just go with the crowd; and some of us actively join hands with the management in their corrupt, profiteering ways. 

The medical education scenario  that has changed so rapidly poses a challenge to us . Many of us on the first instance chose to be doctors, persuaded by the love of Christ, and the example He set to us (delete). Jesus during His earthly journey as a man, did not compromise with  shady situations. He advocated giving to Caeser what was due.  He did not tell lies. He was the truth. He healed out of compassion and He healed freely– not out of love for money. He fought against wrong- and did not keep silent.

By being silent we are party to all the wrong doings of the institution and can never plead ignorance. Secondly we are prescribing a low standard of training to medical students in whose hands thousands are going to entrust their health in the future. They are the ones who are going to decide health policies, deal with life and death of precious children and adults. We are creating a multitude of qualified, coat clad and stethoscope adorned quacks who will be strutting along the corridors  of Indian hospitals. Secondly we are sending a strong message to the world that we who bear the name of Christ  are also  willing to go along with all the unethical practices and values that are building up so fast

There is among us, this philosophy of keeping religion confined to the church and home  and considering workplace as altogether different. If our  religion is just a ritualistic way of life, there is no further discussion needed. But for the majority of Christians, who have promised to live as instructed by Jesus Christ – it is required of us to take a stand.

If we do not compromise, we may not get or keep our jobs in such institutions- although there is a very small probability that they will put up with us if our work and life are outstanding. Could we be His ambassadors in these dark shady days, daring to stand up for what is right? Would we have the inner strength not to earn our salaries through a compromised stand? Jesus said in Luke 9 25’ for what profit is it if one gains the whole world and is oneself destroyed or lost’. He did not bow down to Satan when he was tempted in the wilderness. Do we not have trust in God to supply our worldly needs- including position, authority, leadership, recognition and not go after money and position?

My intention behind this brief article to voice out aloud that which  is lamented of behind closed doors, and even in the open. The situation is most often compromised as the straight and narrow way is not easy or luring.  Churches and Christian leaders who are in charge of such institutions, require to again stop and take stock of what they are adhering to or even promoting. May the almighty give us clarity, conviction and wisdom and most importantly bring about within us, a change like what Zacchaeus the tax payer experienced.

Having set in motion the village based health care, we needed to find a referral hospital. The nearest Primary Health centre was hardly functional. There were no doctors round the clock, let alone someone who could handle complicated deliveries or emergency newborn care. The closest such facility was about 2 hours away and the roads were not well laid. There was no ambulance, and anyone from the village had to be carried in a bullock cart or a cycle.

Therefore PREPARE built a referral centre/ hospital cum dais training centre. We had residential healthcare personnel round the clock and could handle emergency cases. We also got an ambulance that could transport patients whom needed specialised care to the tertiary hospitals in Chennai or Kancheepuram which were about 30-40 Km away.

Thus we set in motion a much needed health care delivery system. Other specialists visited the hospital from Chennai on a weekly basis. Our own operation theatre started functioning and we were able to take up elective surgery. Women with gynaecological problems, other lesions which needed surgery were operated upon here by surgeons and anaesthetists from chennai at a no profit level. It gave such a respite to the poor.

The rich and the poor were able to access the facilities. Those of different castes also were our clientele, and so the hospital became a neutral ground for all to access. The poor families were treated at a huge concession. The medicines we used were generic and bought from a Christian mission enterprise- the CMSI and were not expensive. The surgeons and other service providers charged us very little compared to their normal rates.

Through the women’s groups which we called Informal banking groups IBGs we were able to empower the women with regard to gender, caste and economic equality and equity. All the IBGs together formed a large Federation of women, and almost all were dalits. Women became articulate. They also networked with other similar groups in the state and at national level. They were systematically trained by the project to analyse their situation and find means to liberate themselves of their bondages.

Informal banking consisted of their own savings matched by Project funds and saved in the banks. The money was also available for them to meet their own needs. The groups framed their rules and regulations regarding borrowing and repayment. This meant that they do not have to borrow money from money lenders or their land owners who were highly exploitative.

PREPARE also provided sectoral loans to men and women towards agriculture, animal husbandry etc at soft interest and the repaid money was pooled into specific funds which were regularly recycled. This enabled many to break out of the heavy debt burdens and the related bonded labour.

Alcoholism was a means by which the rich controlled the poor. Parts of wages were paid as alcohol and the men were addicted to alcohol. All the births and deaths and marriages had to be necessarily reported to the rich landlords and village heads who kept a tab on these. Literacy was low and PREPARE provided both adult education, functional literacy and ensured that most of the children were enrolled in schools. We provided benches in schools so that the dalits could sit on benches too, and not on the floor , practising equality and not giving room for schools to exercise this discrimination. Educational loans could be availed through the IBGs.

The communities were actively advocating for their rights of housing water food education and healthcare. Thus Government had to heed their demands. Women groups met the district level officials such as the Collector and placed their demands and requests. The Women’s federation was their backbone.

In health there was demand for antenatal care, immunisation, growth monitoring forcing the village government functionaries to shift their emphasis from family planning to maternal and child health and water and sanitation as well. T services at the PHC – Primary health centre started to improve. We closely collaborated with the PHC in order for them to start meeting the health needs of the people. Every maternal death was analysed and amends made such that the same mistakes were not made. Health education and behaviour change communication were important activities changing the myths and misconceptions people had about diseases. Health seeking behaviour was a major change that had an impact on the health of the people.

We had a very successful community based rehabilitation program for persons with disability. Principles of SELF RESPECT, LACK OF DISCRIMINATION, ACCESS TO PREVENTION, TREATMENT AND REHABILITATION were in place and leadership and self reliance were created among them. They were organised like IBG groups and federated and were able to network with similar organisations at district, state and national levels. Social barriers were dealt with by sensitisation and demands by them.

The state government started economic assistance to self help groups and the IBGs were able to easily get integrated into those, while retaining the life experiences gained over years of sensitisation and empowerment.

The lakes were auctioned every year for fish farming and for the tamarind trees and this was customarily taken over by the non dalits. Now with the strength they had gained through the efforts of PREPARE the dalit groups won the auction ad profited in terms of money, experience of handling these new ventures and above all in self esteem and self confidence.

Caste discrimination slowly disintegrated as the dalits became empowered socially and economically. PREPARe’s housing project contributed hugely to the self esteem of the dalit families who over hundreds of years had no ownership of land or a decent house. All the houses were registered in the name of women and this brought about a new respect for women among the dalit families who were equally patriarchal as others.

At this point of time there were some dalit leaders who had a political front and they were a great support in bringing down the power and oppression exercised by the higher caste communities over dalits.

PREPARE’S interventions with health as the inroad thus has been able to overturn the discrimination and domination that the higher caste communities exercised over hundreds of years. It was a slow process and there were many set backs and losses, BUT EVENTUALLY IT HAD BROUGHT ABOUT A GREAT SOCIAL TRANSFORMATION .

PREPARE gradually withdrew from the area and the dalit communities have been able to manage their lives in a more just society.

UK has included India in the amber list as my friends whatsApped me. Hey you could now book your travel to visit your daughter’s family in the UK. Great news indeed..

Yes I am ready. I am fully vaccinated with the so-called safer vaccine Covishield. So is my husband.

Now to find out the ideal flight.. it has to leave from chennai. Not too early in the morning as Jacob hates late night hanging around in the airports..Have just one stop in the way.. and reach Heathrow at a time not too early or late so that my daughter would find it not too difficult to pick us up.

Nothing fitting these criteria appeared on the screen. Am i going senile that i cannot find the right link. Are travel agents playing pranks on us to get us to cough out more money. Ahh i found one and gladly typed in my details and checked the price. It was a heavy 5 Lakhs rupees for 2 persons both ways. Na na.. not possible. Yes it was 5 Lakhs. No way am i going to throw around my hard earned money.

after such futile attempts I ate the humble pie and asked a new travel agent recommended by an acquaintance to find suitable flights. After a few attempts she said that Emirates airlines would come up with fresh flight announcements soon.. And true enough she was able to suggest convenient flights the booking of which were filling up. The costs of travel were double those of 2020.

Should we go? Well the gates are open now and may not remain so for long depending the mood of the corona Virus its possible mutations and the possible new vagaries of the disease. Go go go soon. So I asked our travel agents to book the flights.

well what are the rules and regulations that we should abide by.. Link the vaccination certificates to our passports. Be careful while keying in the details. It cannot be reversed says the app. With trepidation I first did mine and then my husband’s. There you go. I found a link which would deliver the document through wA right into your phone. Presto .. the vaccination certificate landed on my phone through wA.

Then was registering for tests in the UK when you arrive there. Days2 and8.. day 2 and 5..Also day 2, 5 and 8. Am o fully vaccinated. Of course the jabs and Cowin website confirm this fact. But wait a minute.. uk portal says that i am not unless I have taken a particularly named Covishield. Scurry around. Hey does anyone know the brand of Covishield vaccine that was given to us…Drew a blank there too..

Well, my pride was hurt. As an Indian doctor I KNOW I am vaccinated but here is another country doubting the credibility of my vaccine.. Now do i want to see my daughter or not.. So I started looking for an RT PCR testing lab nearer where my daughter lives. 20 to 150 sterling pounds was the cost of tests for ine person. Now wait.. why such a discrepancy in pricing.. that too in the UK. I thought that was the right of my country alone.

My nephew Vivek opened my eyes to the fact that almost all the labs charge you more than a 100 British pounds per person for tests for Days 2 and 8.. This is like you discover the hidden costs. Got the tests booked for the 2 of .us.. through vivek.

did i get the passenger locator form PLF as referred to so glibly by everyone. Yes I thought I did. But it never generated a form so being smart i took a screen shot.and saved it in my phone.

visa? YesI have a valid one. All set ? Of course. Am i not a seasoned traveller..Have globe trotted in my career so long. I took umbrage at my nephew for telling me what a RT PCR test certificate looked like. Look man I may be senior but remember i am a doctor..

So the day came for us to trVel. Armed with 3 sets of files with all the documents including the per test done within 48 hours we arrived at the airport 4 hours ahead asadvised by our travel agent. The gates were not even open..The verandah had about 15 travellers with relatives hanging around. The gates finally did open and we were ushered inside. The counters were still not ready if you please..

has the pandemic made everyone slovenly we wondered. Jacob complained of lack of sufficient sleep and yours truly reminded him that this was just once in a way sacrifice.

we were one of the first ones at the counter when opened. .The young lady went through all the papers and found our PLF papers missing. Mam kindly show the PLF form. The what? The passenger locator form. Oh certainly. Have i not the screen shot ready? Well. These don’t seem to be what we want. Let me check with another colleague…Who called another .. and finally some senior asked me for a reference number. Now whats that.. Madam he said just show us those numbers and we will issue the boarding pass.. Well i said sure. Its a matter of minutes. I came and seated myself and went into uk immigration website. The net stopped. The wifi of airport didn’t work. I was panicking. Could i use any if tour PCs to get those documents. Sorry Ma’m. That’s not allowed.. oh no that cannot be. How do I generate those PLF forms with QRCode and reference numbers. Ma’m see everyone has it. Do they… But how? My website page didn’t move beyond a certain page and so how did i know that the PLF form isn’t my smart screen shot.

A brilliant idea flashed through my mind. My nephew and niece who recently had returned to the uk had worked through these. So let me call them. Sure enough Vivek and his dear wife Dipali took my call sat up in the midnight and

generated these forms and that’s how we were permitted to fly into the UK.

Times have changed folks. Just sit down and get acquainted with the new norms and normals. Learn what QR codes mean; how to generate the forms. Don’t skip reading sentences and small letters in the websites as I did. Your last experience whatever and whenever it was, needs to be upgraded. Good luck

Those were times of turmoil in Sri Lanka where there were many Terrorist problems and uncertainty everywhere. I belonged to the minority group that faced terrible attacks. There was fear in many hearts. During the civil riots in 1958 and also in 1977, many in my community lost their belongings and also their lives. Although the government tried to solve the problems, there was no lasting peace. Terror reigned in many hearts. Poverty and uncertainty added to the existing problems. News of thieves snatching gold chains from young women was fairly frequent. In fact, I heard of a woman whose gold chain was snatched from her neck, very close to where we lived. In spite of that, I wore my gold chain all the time.

One particular afternoon, I had set out to accompany my friend, Lakshmi. She needed to go to an office five miles away. She was very outgoing and full of vitality. She raised her daughter by herself and took care of all her affairs with very little outside help. She was a very independent, self-assured woman who knew how to handle her affairs. While I would have liked to be self-confident like her, I was a timid young woman. She did not need my help, but I needed her help to get out of my comfort zone. But I was like most young women in Sri Lanka, who had the protection of their parents or their husbands. I was a home-bird who felt secure most at home. I would venture out alone, only to places I was familiar with, and always returned home before it got dark, which was around six o’ clock.

That is why I agreed to accompany her to the office. But I was wondering if I could return home before it got dark. Seeing my concern Lakshmi said, “That’s alright. I can go by myself. It may get dark by the time we get back.” She added, “I am used to getting around by myself; but you are not.” I hesitated just for a moment. Then I decided to go with her because I wanted to spend time with her. I thought that we would have time to talk on the bus, at the bus stand, and even in the office.

We finished the work in the office. Then we waited for a bus for quite a long time. It was already getting dark. Once we got into the bus and settled in our seats, Lakshmi said that she would walk with me to my home before proceeding to hers. “It would mean only an extra thirty minutes,” she said. I was aware that she had to take another bus to her home a few miles away from mine. I assured her that I would be fine in. At this time, it was raining heavily. Outwardly I sounded very confident: but inwardly I was full of fear. So Lakshmi continued her journey towards her home, reluctantly.

I stepped out of the bus and sought shelter under the eaves of a small store next to a post office that had closed almost two hours before. I had an umbrella; but the rain was heavy. I saw a few men also waiting for the rain to subside. While I waited I was aware that there were no women or girls around. Of course no women or girls would venture out in the dark by themselves!

I was afraid. I was standing under the shelter of the roof of the small store, looking at the pelting rain.  It was eight PM. It continued to rain heavily and it was dark. The awareness that all the stores were closed and that there were very few people on the street added to my fear of darkness that I had always had.

I started praying that the stormy rain would cease, or at least become milder. My little umbrella would have offered no protection for the ten to fifteen minutes’ trek up the hill, to my home. In answer to my prayer, the rain eased a little and I decided to leave.

A part of the road to my house is usually lit by some dim street lights and some light from the buildings nearby. But on that night it was so dark that I could barely see the road because the street lights were not working. But I started walking. Then I noticed that a burly man also started walking in the same direction. I started walking fast. He too seemed to be speeding up. I slackened my speed; he did the same.

About five minutes away the road would branch into two roads; one would lead to my home up the hill and the other, on the right, would lead into a thick forest. The forest had no wild animals. It had monkeys, snakes and birds. People would walk into it only at day time. The thought that I might end up in the forest was terrifying. Nobody would hear me even if I screamed aloud. The raindrops that were falling still would drown my voice and the forest would be too lonely a place for anybody to hear me. Anything could happen. I was petrified.

So I moved to the middle of the road hoping the man would go past me on the side. I prayed softly; I prayed loudly. Nobody would have heard me anyway because the rail drops continued to fall on the umbrella. Nobody except God could hear me. I looked back slowly under the umbrella. The man seemed to be getting closer behind me. I walked as fast as I possibly could, praying all the time. Just then a big ring of bright light appeared in front of me, just about a foot above the ground. I wondered if I would walk through it. But it kept moving in front of me at the same pace as my steps. I looked behind me to see if an oncoming vehicle had caused the light to appear. But I saw none.

I continued praying, wondering at the same time if the man had also seen the bright ring of light. To my great relief, the man overtook me on my left and walked away while I slackened my pace. I breathed a sigh of relief as I continued my prayer. But this time my mouth was filled with praises because my Lord had been my Refuge and Strength and a very present Help in trouble.

As I walked up the hill with my heart full of thanksgiving, I did not even realize when the ring of God’s protection and love disappeared. I continued home in the comforting thoughts that He would always be there, just a prayer away. God is my help and strength, a very present help in trouble.

As PREPARE we commenced health and development work mainly among the dalit communities in Sriperambadur because the District administration had classified this as one of the most backward areas in Kanchipuram District.

The villages were connected by mud roads. Villages were laid out as clusters. There was always a part of the village where the higher caste lived and a little away was a group of houses where the people of lower caste lived. and this was called the colony. For example there was the main Nemily village and adjacent was the Nemily colony. The main village had the village government buildings, the schools, the shops, markets temples, water sources . The roads were much better. Houses were pukka, as the landlords and the rich were from here. The agricultural lands were nearby. There was always an air of confidence that came from a much easier ife without

oppression and discrimination.

The colony always bore a somber look. Mud huts with thatched roofs. people tired, returning dirty in small groups at the end of the day. At other times, the huts were nearly empty with only the older women and men doing some odd work or having a nap on the verandah. There was hardly any food inside the huts, as they may have eaten some old rice or ragi kanji and gone to work. The main meal is cooked once the daily wage is receivd and they buy rice and vegetables on their way back. Naked or scantily clothed unkempt children below 3 years will be around, playing or sitting on their grandmothers’ laps.

Malnutrition, skin diseases, diarrhoeas, worm infestation were extremely common and more in the colonies than in the main villages. Literacy was very low . Their main occupation was as agriculture labour in the fields of the higher caste. They were paid poorly. On their way back from the fields the men stopped at the liquor shop and arrived home staggering , broke and in a stupor. It is mainly the earnings of women that fed the entire household. Many of them were also indebted to the landowners and could never repay as the interest charged was exorbitant.

We selected some girls who had completed school education and trained them on basics of health, health care delivery, monitoring , and in social skills as well as in midwifery. we then divided our the target area into convenient circles and selected strategic villages mostly in the colonies and hired a small house in each of these to be converted into a village health post. These VHPs would serve as a mini health centre offering curative service for simple illnesses, a referral point, coordination centre with government outreach workers, the place for health checkups, antenatal care, screening camps, health education, with the mobile health team visiting them on a fortnightly basis.

We visited the villages and discussed with people there to identify all traditional birth attendants, and recruited 1 or 2 to officiate as our contact persons in the different villages. We held an initial 1 week training followed by weekly training basically on maternal and child health, safe delivery, high risk pregnancies, immunisation, Growth monitoring, common infections of the newborn , warning symptoms and signs that warrant immediate referrals especially among antenatal mothers and children under five.

These TBAs /Dais 9 as they were referred to by the villages, were continuously supported by the Community health assistants (CHAs) who were in charge of the village health posts. The TBAs were provided a medicine box which contained medicines such as paracetamol, antihistamines, Oral rehydration salts, bandage, cotton and a delivery kit. The delivery kit had simple instruments for enema, cord tie, cotton, antiseptic, gloves, and a rubber sheet. The different medicines were marked with pictures to facilitate usage by illiterate dais. During weekly reviews, we found out the morbidity details, as well as about pregnant mothers, births and deaths pertaining to their villages. These data were gathered by the CHAs and reported in given formats at the monthly meetings with the coordinator.

The entire data was analysed by the project director every month and feedback given to the entire team including the TBAs, and whenever a harmful trend or a problem was detected these were attended to.

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

• 

There were no toilets and fields were used for defecating. Potable water was scarce. Water was never boiled. There were some lakes and people went there to bathe, wash clothes, But their livestock were also cleaned in these places. Nutrition was poor not only because of poverty but also because of lack of awareness. For their health needs they relied mainly on home remedies, the knowledge of which was handed down over generations. Immunisation was given in the main villages but the mothers away at work and could not ensure timely compliance. Antenatal care was a non existence. Deliveries were always at home attended by the familiar TBA /dai. at the last minute women whose delivery ran into problems , were taken to the neary Primary Health Centre which had no blood bank or facilities for surgery if it was required. So young mothers ad difficult deliveries and had long term comlications or even died. e same applied to the newborn as well. Tetanus wasnt commo as women had immunisation during pregancy but neonatal asphyxia, jaundice, neonatal sepsis, were common.

The caste oppression was blatant. there was violence, murder and rapes especially if dissent arose among the dalits against the non dalits. However the overall dalits were significantly much more than the others. There was also a dalit leader called Moorthy who used violence to terrorize the non dalits if there were atrocities against the dalits. This indirectly facilitated the change we wanted to bring about in health and dignity of the dalits, and for women in particular.

We had a small team of people who coordinated and implemented the interventions. Our entry was through mobile health and formation of women’s sangams (madhar sangams) in every village, including the main villages as well.

Health was a neutral platform and healthcare was a greatly felt need. We visited each village once a fortnight and thus we were able to reach the 60 villages we had chosen along three main roads from Sriperambadur. Our team of a doctor, trained health assistants focused on maternal child health while taking care of others as well. We collaborated with the local Primary health centre and assisted them especially in immunization of mothers and chidren. It was always more easier to function in the main villages, but we had made it a point to hold the clinics closer to the colonies.

At the same time, our development team visited all the target colonies in the evenings and spoke to the elders there. This led to formation of madhar sangams in each village, with a leader chosen among them. They met every week on a fixed day and one of our team members was there to discuss their life situation , sensitizing them to the fact that they need to organise themselves and gain the strength , skills and strategies to liberate themselves from their caste oppression and from poverty

We identified al the Traditional Birth attendants (TBAs) in the vilages and trained them on pregnancy, safe delivery, newborn care, and in common ailments. They were provided a tool box containing some essential medicines, bandages, and safe delivery kits.

By this time we had built a dais training centre in Sriperambadur

Reluctant Bunny goes to nursery

Once there lived a little bunny in a forest. He loved to go to the woods  with his Pappa Bunny and Mamma Bunny. They jumped over puddles which shone in the sunlight. The leaves in the trees were dancing ..one step here- another step there. Right-ho Left-ho. Right-ho Left-ho..

The little bunny also made beautiful boats with leaves. Small boats, big boats, green boats, yellow boats. He put the boats on the sparkling water. And away they went. Sush, sush.sazzy ho  sazzy ho. Little bunny jumped up and down. Clapped his hands clappa clappa clap.

The next day little Bunny had to go to nursery to see his friends. There was Ruby the bird with bright blue dress. Little bunny and Ruby the bird were good friends. They played with toys. Coloured chalks .. listened to so many nice stories..  They stomped on the floor together. chompa chomp chompa chomp.

But little Bonny just felt lazy. He did not like changing his clothes to go to nursery.  He was sitting on his little rocking chair saying “I don’t want to change my dress…I am not going to nursery today..”

Then Maybelle the butterfly flew into the room..  She called little Bunny.. Come on Bunny. Let’s run and play. Maybelle looked smart in her red and yellow dress, but little Bunny was wearing the crumpled night dress..

Butterfly said “Hey little bunny. Get dressed fast. You sure will look smart in your other dress..Put on your shoes. Let’s run and play with Ruby the bird.” Maybelle hopped from the flower to the leaf and to little bunny’s feet..

Little Bunny became enthusiastic. He did want to go out. He knew he could not go in his night gown. So he asked his mamma to change the dress. He put on his socks and shoes. He and the butterfly held hands and joyfully ran away to his nursery to spend the day with all his friends there.

•