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.
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