“Primary health care means empowerment. Human beings, regardless of their station in life, have innate unlimited potential within themselves. People have been empowered through a process of discovery, experimentation, trial, and error, rerouting when necessary, and by being non-dogmatic in sharing values and skills. Rural communities have been empowered through information, training, and imparting medical, economic, and social skills… Through these practices individuals and communities have gained in self-esteem and self-confidence and have realized that they have to capacity within themselves to determine their own lives.” (Arole, Mabel & Arole, Rajanikant. Jamkhed: A Comprehensive Rural Health Project. Pune: 1994.)
Thursday, I began working on the diabetes project with part of the Mobile Health Team. We travelled to a nearby village to work on CRHP’s World Diabetes Fund program. CRHP received a grant for six years to teach communities about diabetes and monitor its success through taking patient weight/body measurements and glucose levels. They will be working with a variety of different communities throughout a total of 13 training sessions.
As interns, Shireen, Ellie, and I will be in charge of logging patient data into electronic files after each session, photographing each training session for records/social media, and assisting the mobile health team with transporting and setting up materials. During the training session today, Ratna, Madu, and Sureka lead lessons five and six of the 13 lesson program on diabetes incorporating large posters and songs to make it more entertaining and understandable for the community. Ratna is the woman who manages the rehabilitation farm and works as a village health worker whose story I included in my last post. Madu is a farmer who works with the farmers’ clubs that CRHP creates in communities to improve nutrition, farming practices, and gender equity in communities. Sureka is a social worker who works largely with the adolescent girls’ programs CRHP creates in communities to teach young girls about women’s health, self defense, gender issues, and much more.
Twenty people were recorded for patient data, but many more were present throughout the lessons. Sadly, only one woman came. When the mobile health team visited people asking them to come learn about diabetes, all of the other women said that they were busy cooking or doing housework and were unable to make it. However, we were very happy to have that one woman sit with us and be a part of the group. Sureka told us that recently the community’s village health worker completed nursing education, and is no longer working with the community. She stated that the lack of women was likely due to the lack of a village health worker, but CRHP is actively searching for a new woman in the community to take on the job. On Friday, another community was visited for lessons 5 and 6 of WDF, and this village had a village health worker. At this village the women actually outnumbered the men in attendance.
Sarubai is an increadible village health worker who shared her story with us, and her story can also be found in the Jamkhed book. Sarubai was raised with four sisters and one brother. Leprosy was prevalent in her family, and leprosy stigmas often make marrying was difficult. However, marriage is often considered necessary for survival and social acceptance in this area. When her aunt mentioned that Sarubai marry her son, her mother and father gladly accepted. At age three, she was engaged to her eighteen year old cousin and taken to his house to be taken care of by her aunt. With her family being of the Dalit caste, more commonly known as untouchable caste, their main source of food was often from people throwing old chipati to them. They were forbidden from using the open well in the village and had to go to the river for water and bathing. She would bathe by scrubbing dirt in her hair and on her skin, since she did not have soap. Sarubai only had one sari, so she had to bathe in her sari and wear it wet until it dried. As soon as she had her first menstrual cycle, her and her husband consummated, and she got pregnant. She had three children.
CRHP began coming to her village and building relationships with the community members. The mobile health team, a group of medical professionals and social workers from CRHP that travel to communities to provide health education and care, began treating people for free. At first the community resisted due to strong beliefs in spiritual healing and “quacks” (this is the word used by staff and community members to define the people who would use tricks and charge high fees for fake spiritual healing). However, Sarubai and other leprosy patients who couldn’t afford other methods of care began going to the mobile health team for free leprosy treatment, the community began to see leprosy patients cured and began to believe in the benefits of the medical care that CRHP provided. The village began asking for their own nurse from CRHP to stay in the village, but CRHP instead asked for the community to select a socially minded person to become a village health worker that would be trained at CRHP’s learning center. Upper caste women were not permitted to take on the village health worker position due to very strict gender roles that prohibited them from leaving the house and working on nondomestic duties. However, lower caste women’s gender roles were slightly more relaxed due to the fact that they had no other option but to work to provide food and income for their families. The community chose Sarubai, due to the fact that she was from the Dalit caste. At first, her family resisted due to the fact that they believed she was cursed by spirits and couldn’t leave the village, but finally, after meeting another village health worker from CRHP, they agreed to let her train to become a one.
During her first training session with CRHP, she was in shock due to the intermixing of castes. Everyone ate together and shared food, which was extremely uncommon in her village. Dr. Mabel Arole, one of CRHP’s founders, asked her one day if she had sufficient food, and she was surprised that anyone would ask her such a thing. That was the first time that anyone had shown her compassion. She took home her food for her family after eating with the CRHP staff during trainings, so that her family wouldn’t go hungry. As a gift, CRHP staff gave her a second sari, so that she no longer had to wear and bathe in a wet sari that caused health problems.
One of the first things that she did as a trained village health worker was start a feeding program for children in her village. However, all of the children had to eat together, and castes had to intermix. The children were extremely hungry, and despite being scolded and punished by their parents for intermixing with other castes, their hunger won them over. They began regularly attending Sarubai’s programs. Eventually, upper caste pregnant mothers began asking Sarubai to save them some extra food and send it home with their children. She was confused why upper caste women would want to eat the food that she, a low caste woman, prepared. Eventually the whole village began attending the programs and eating together. This greatly helped reduce both malnourishment and caste discrimination in the village.
After this program, the village began trusting her more and she was able to distribute medicine and treat their health needs. She also applied for government grants for roads to be constructed and homes to be built for the people living in slums. She requested that CRHP send busses to her village so that the people could use a more effective form of transportation to markets and hospitals.
She also started up a women’s group in her community. CRHP helps village health workers create women’s groups, farmers’ clubs, adolescent boys’ programs, and adolescent girls’ programs to improve social equity and health education in villages. When she first started the women’s group, the men would follow their wives and sit in on the meetings. The women would get chairs and be served chai first, but the men would be forced to sit on the ground and be served smaller portions after the women had already been served. The men were outraged that they were being treated how their wives were supposed to be treated. Sarubai calmed them and explained that men came from women, and that without women, men would not exist. She stated that she was not asking for women to be treated better than men. Sarubai was simply requesting that they be treated with respect and as equals. By switching the typical roles of how men and women were treated at the women’s group meetings, she was able to put men in a situation where they could better understand the perspectives of their wives.
Sarubai continued to have many successful accomplishments. She began selling chilis and art made from bangles and was eventually able to buy her own piece of land as well as a home. Since then, CRHP has created a program called Helping Hands that teaches women, especially village health workers, how to create jewelry, coasters, picture frames, bags, scarves, and clothing out of sari fabric and crushed bangles. From her own income, she now has 15 saris, not just one. She was also able to purchase 9 sewing machines for herself and other women in the village to earn their own cash and improve their independence. She was able to afford for her two sons and her daughter all to attended college, and they are now working in successful careers.
Sarubai began receiving multiple prestigious awards throughout India for her accomplishments as a village health worker. She has travelled all over India speaking to various audiences of doctors, public health workers, and social workers to help improve life quality in other communities as well.
Sarubai’s story is an important reminder of how every person has incredible potential for greatness. However, people’s success can so often be squandered by social standing and lack of education. There is so much potential in this world, yet so often, people are held down by factors that are out of their control. Our professor, Apurna, who runs many of our training courses holds discussions with us and continuously reminds us to compare what we learn here to our own culture and country, because so many of the issues here are related to the United States. Though caste discrimination has been outlawed for years in India, it is still very prevalent, and people are often held back by those discriminations. In the same way, racism and minority discrimination is outlawed in the United States, but it is still very prevalent and so many people with capacity for greatness are unfortunately held back by the limitations society places on them.
Sarubai completed her story by saying that power is knowledge, and through it, people can be empowered to improve equality and health in their communities. This is why the WDF project is so important. By spreading awareness and knowledge of diabetes, a non-communicable disease that is of high concern currently in India, the people are empowered to improve their own health through healthy eating habits, exercise, and medications. As Shireen and I logged diabetes patient’s glucose levels from WDF, we noticed that after each training session, the patients’ glucose levels continuously decreased by large increments. This shows the success of the program and how knowledge can be used to empower people, just as Sarubai discussed.
Learn more about CRHP at their website: www.jamkhed.org