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.
José Guadalupe Posada
José Guadalupe Posada
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
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