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Permanent sterilization-incentive based and target based health services: a glimpse from Rajasthan March 26, 2013

Filed under: Uncategorized — paintedpostcards @ 12:29 pm

My elder sister in law was the one who suggested that I should go for female sterilization, if I get lucky I may win a motor cycle in the lottery….. 

The Ration Unit and Fair Price Shops in Bundi District of Rajasthan have been given instructions by the State Health Department to meet the target of at least two sterilizations before 30th March. There is also an incentive attached. The dealer s with the maximum cases will be certified and rewarded.  Targets are distributed further to the fair price dealers because the health department workers could not meet their family planning targets, which focus heavily on sterilization….. (Source: local newspaper, Rajasthan Patrika, 22.03.2013).

In a family planning camp held in a Community Health Centre (CHC) in Raipur Block of Pali district of Rajasthan on 22.03.2013, though the district collector announced various prizes including motorcycles, Colour TVs and home appliances to be distributed to ‘lottery winners’ among couples who opted for permanent sterilization as well as targets of village health providers to motivate women for sterilization; this camp did not see much of a turnover. The service providers shared that this could be because of Holi (a festival of colours in India) and during Holi people in the villages were busy.

Women present in the camp at Raipur were going under the knife without fully understanding the risks, precautions, consequences and their rights as claimants in case of failures, as nothing was explained o them or read out to them from the consent forms on which they gave their thumb impressions.

There are national guidelines of the Ministry of Health and Family Welfare that have a detailed description of the contents of medical history, Personal characteristics and reproductive history, menstrual history, obstetrics history, contraceptive history that is to be recorded in detail before female sterilization is done, however, this has not yet been built into the MIS system of the facilities. The only records that were maintained were the social-demographic profile and the consent form of the acceptors.

Follow up instructions, discharge cards, monitory incentive to sterilization acceptors were not given to the women before they left the facility. The families of women arranged their own transport to get back homes after the camp concluded at 3:00 pm on 22.03.2013.

Family planning should be regarded as a matter of choice and rights by both the service providers and the community. But this is not at all the case of what is being recorded and reported. While the National Population Policy has seen no place for targets, rural women continue to be seen as family planning targets and family planning camps as best models to meet these targets. This approach is problematic as there is no equal precedence given to post operative care and follow-up.

The government must audit and ensure strict compliance to the quality assurance mechanisms that have been established. There is an urgent need to understand both population issues and health service delivery within in the perspective of ‘women’s rights’ and justice, by the service providers.

Written by Leena Uppal – http://www.coalitiontcn.wordpress.com

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Go Deeper Into The Maze March 24, 2013

Filed under: Uncategorized — paintedpostcards @ 6:35 pm

My visit to Lucknow was on occasion of SAHAYOGs annual retreat. SAHAYOG has been working in the area of women’s health and gender equality in the community for more than 20 years. Along with learning about SAHAYOG, the retreat was a good opportunity to learn about the challenges and nitty grittys of work in the civil society. The issues of partnership, networking, funding, internal teams, vision and mission for the next few years were being discussed. While for the participants, having the retreat within the office posed the interesting challenge of artificially divorcing their minds from the pending work on their tables; for me it was the best possible situation as it connected my thoughts to their real time environment and actual work and confusions of daily life in an organisation.

Delhi is usually referred to as being a historic city and Lucknow also has its culture of Nawabs and while I was expecting some history in Lucknow, I had completely forgotten the role Lucknow played in recent Indian history. While being taken around the city, I saw Hazratgunj and was told about Begum Hazrat Mahal and her speech at the time of the Revolt and the linkages between the Revolt and Lucknow.  Sometimes not knowing too much about a place adds to how much you like it later. I was quite taken in by Imambara and its Chinese room, the Baoli with its very frightening flight of stairs around each bend and the Bhool Bhulaiya. The guide at the Bhool Bhulaiya expertly led the way through the numerous corridors in the maze and kept filling me with interesting tales. Then he told me that he would leave me alone in the maze and let me find my way out. I was up for the challenge, except when I started retracing my steps, nothing was where it should have been. To complicate things, the guide kept returning back from all directions- sometimes I would meet him when he was in front and within a couple of second he was behind me and then again, sitting on a bench just ahead of me. It led me to wonder that while working in IT and on computers, we feel that new generations are getting smarter and are very capable. In places like Bhool Bhulaiya and Baoli, with their complex architectural calculations, one wonders how unskilled we have become over time.

The visit to Residency was also attempted in a race against time. My workshop session got over around 4pm and I had time only till 7:30pm. As I entered the compound, the air was so clean and fresh and I was completely taken in by the monuments. I read about the Revolt and saw the marks made by cannons on each building- on the Banqueting Hall and Treasury also. I saw Dr. Fayrer’s House and it was so reminiscent of all the English period films I had seen and I did actually imagine Dr. Fayrer running up those stairs to enter his large house. Also, with the Independence struggle having been fed to us all our lives, it was a different experience to see the grave of Maj. Henry Lawrence and how important he seemed for all the people in the Residency. In front of the treasury, I liked the way the names of the Indian people were written- Shivcharan Singh was Seuchurn Sing! Delhi has its glorious Mughal monuments but Lucknow opened me to the Revolt of Independence of 1857 and the history of India’s struggle with the British for Independence. This is a part of Indian history that was so touchable in Lucknow and it seemed as if it was just from yesterday.

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Other experiences continued. There was so much to learn in Lucknow. SAHAYOGs journey was shared in Bhimtal and now it was again a part of me and I a part of it. The rooms in Indira Nagar opened up to more rooms and the office was endless- another Lucknawi Bhool Bhulaiya! The food was delicious, including two fabulous lunches and dinners and lots of kebabs. Some confusions remain in my mind, especially around organisational journeys, around people’s personal journeys in organisations, around how an organisations’ history affects people inter-generationally.

This is what the Guide from the Bhool Bhulaiyya said to me when I failed to find my way out- There are around 500 doorways. People have got lost in the maze and even died. The Government has now made it mandatory for tourists to be accompanied by guides and several paths are now not open for the public. There is a way to get to the top, by climbing a separate set of stairs which takes you straight to the roof while avoiding the maze completely. However, if you do get into the maze, then to get out of the maze, you have to leave the comfort of the outer periphery. To get out of the maze, the guide said, you have to actually go deeper into it, where it is darkest, where you lose all reference of the world outside– for it is when you get to the core of the maze, only then will you find the way out.

Should I accept the challenge?

By Lavanya Mehra, in Lucknow during 21-22nd March 2013

 

अलग अलग लोगो से मिलने का मोका मुझे CHSJ में ही मिला है March 11, 2013

Filed under: Uncategorized — paintedpostcards @ 1:16 pm

CHSJ मैं काम करते हुए मुझे आज चार साल हो गए  है पता ही नहीं चला कब समय  बीत जाता

है ! नयी  नयी  जगह जाने का अवसर मुझे यही मिला है, इस बार मुझे मुम्बई जाने का अवसर मिला है ! Excitement से ज्यादा मुझे चिंता थी,  क्योंकि मुझे Admin Support के लिए जाना  था , इससे पहले भी मैं Chandigarh गई  थी! पर वंहा पर मेरे साथ प्रतिभा, जाया जी, राजेस थे, और वंहा पर हमारी Admin Support  VHAP कर रही थी ! और इस बार हमे  ही  Manage  करना था , Logistic भी Travel Relinquishment भी डर भी लग रहा था,क्या मैं यह कर पाऊँगी या नहीं ?

शुरू से  ही मेरा सफ़र interesting था, हुआ यूँ  की मैंने Advance नहीं लिया था, मैंने सौच की ATM से पैसे जाते वक्त निकल लुंगी , इस लिए छोड़ दिया , और जब निकालने गई तो पता चला की ATM मैं पैसे  नहीं है,दूसरा ATM मैं भीड़ बहुत हो रही थी, तो सौच की रेलवे स्टेशन मैं निकलूंगी , तो वंहा हम बिलकुल टाइम पैर पहुचे, वंहा भी नहीं निकल पाई ! मेरे पास ज्यादा पैसे नहीं थे! मुझे ज्यादा Tension इसलिए भी थी की वंहा पर कैसे ऑटोया टैक्सी  वाले को पैसे दूंगी ! मेरी सीट जंहा  पर थी उस Cabin  मैं सिफ Men ही थे,  तो मैने किसी  से अपनी सीट बदली ! वंहा पर मैंने केबिन  के लोगो से गोरेगांव जाने का रास्ता पूछ लिया था,  और सरिता जी के साथ भी coordinate कर ही रही थी।

मुंबई बांद्रा स्टेशन मैं पहुचने के बाद मैंने ऑटो किया,  पहले  तो उसने कहा की उसे मालूम है,  बाद मैं वो पलट गया, फिर  लागतार सरिता जी के साथ coordinate से कम के कम एक  घंटे के बाद हम Pious Collage Complex  गोरेगांव पहुचे, पहले मुझे यह लग  रहा था की Mumbai मैं एसे  ही घूम लुंगी ! वंहा पहुचने के बाद   पता लगा की सामान  भी खुद ही उठान पड़ेगा, और यह भी पता लगा की वंहा पर kitchen  नहीं है चाय और कॉफी भी सुबह शाम ही मिलेगी

सरिता जी के साथ मैं चाय और कुछ  खाने के लिए बहार Udpi restorent  गई ! हम खा ही रहे थे रक्ष्या का फ़ोन आया की उसेभी Venue तक पहुचने मं मुश्किल हो रही है , तो उसे भी सरिता जी ने Guide किया उसे एक point बताया जिससे हम उससे मिल सके,  उन्हें लिया वापस venue पर पहुचे , वंहा पर अभिजित सर से मिली फिर उन्होने भी मेरे travel के बारे मैं पुछा ! सर भी कुछ चाय नाश्ता  खाना चाहते थे,  पर जब पता चला की Dinar  का टाइम 7.30 है उन्होने कहा की फिर Dinner ही करते है! वंहा पर एक और  group था! जिनका खाना लग गया था हमे लगा  की हमारा ही खाना है हम भी शुरू हो गए  , लेकिनजब उसे बताया की हमरा नहीं है, तो थोडा बुरा भी लगा , फिर मैंने ही Food provider  को कहा की जब खाना आ जाए तो बता दे ! एक खास बात थी वंहा पर वंहा के Service Provider  जिस  तरह Delhi मैं होते वैसे वंहा नहीं थे , वंहा खुद जा कर सब खुच करना पड रहा  था , उनका behavior  कूछ अच्छा नहीं था ,  उन्हें बोलते रहो वे अन  सुनी कर  रहे थे। थोडा सा मैं रुकी फिर उनके पास जा कर मैंने कहा की बस तुम ही हो जो हो,  मेरे हाथ मैं अब  कुछ नहीं है आप ही कहो की  क्या करना है , क्योंकि अगर आप हमारा साथ नहीं दोगे तो यंहा तीन दिन का Workshop  करना मुश्किल हो सकता है ,  आप का support होगा तो ही हम अपना Workshop  यंहा ठीक तरह से कर सकते है ,शायद उनको  समझ आ गया फिर उन्होंने मुझे  बहुत Support किया,  और सब कुछ आराम से हो गया !

वंहा पर सब कुछ Manage  करना मेरे लिए मुश्किल था, वंहा  पर आए participant के सपोर्ट  से आसन हुआ, जैसे वंहा मछार बहुत थे, kitchen नहीं था काफी लोगो को bed tea पीने की आदत थी, पर उन्हीने शिकायत नहीं की! Photocopy, printing सब बहार ही था ! सब कुछ  ठीक ठाक  हो गया, मजा बहुत आया काम करने मैं!

Learning बहुत रही जैसे सबसे पहले आप पर control, Soft behaviour, बहार जाने से पहले  अलग से एक Event की checklist बनाना जो तुम्हे Emergency मैं काम आए, और अपना First Aid Box लेना नहीं भूलना ! Venue पर हो सके तो कम से कम पूरा एक दिन पहले पहूचना  वंहा पर मेडिकल शोप से लेकर printing, photocopy, cybercafe के साथ मार्किट का पता लगाना !

अलग अलग लोगो से मिलने का मोका मुझे CHSJ  मैं ही मिला है और घूमने का भी!  मैने वंहा पर Marine Drive , Crawford Market, Juhu Chopati, Film City , अमिताब जी का बंग्लो, Linking  Road के साथ साथ Local Train मैं जाने  का अवसर भी मिला!

Mumbai Delhi से सेफ सिटी है, वंहा लडकियों के चेरे पर यंहा जैसे डर  नहीं है और बेझिझाक  आराम से यंहा वंहा आ जा सकते है !  थोड़ी  चमक कम है buildings मैं खाना का स्वाद थोड़ा गुजरती औ थोडा साउथ का है! बस एक येही रह गया की मैने वंहा पर Maharashtra का स्पेशल खाना नहीं खाया! हाँ एक बात और मैने India की चार मेट्रो सिटी मैं से तीन देख ली है अब सिर्फ चोथी सिटी kolkata देखना बाकि है, यह सपना भी जल्दी पूरा होगा इसी  के साथ नमस्कार सुहावना सफर !

By Tulsi Manimuthhu, in Mumbai for the COPASAH workshop during 20-22nd February 2013

 

The Cloudless Skies March 8, 2013

Filed under: Uncategorized — paintedpostcards @ 11:40 am

Once again headed away from the big crowd to a smaller one. We reached Morena. After the long tiring night our breakfast next day was in front of a veterinary clinic where buffaloes were being dragged out of the clinic into the busy road. Every noise on the street seemed to bother them, the vehicles almost butchered the buffaloes.

After having the berais (stuffed pooris), we headed towards the villages. The sky was clear and blue. Morena though famous for its ravines could locate only a few. All I could see was fields of dry mustard plants of which some were being harvested. The bright yellow flowers could be seen nowhere.

The four day training went on, more and more women I met with their sari pallus covering their faces upto their chins. It was a barrier as I could not see them, there was some discomfort as I could not see how their facial expression was to what I spoke.  Few women did speak from below the veil and as always it was disheartening as they relentlessly complained about the deteriorating health system.

Every report card prepared as field practice had a red mark which showed poor functioning of the health system at the primary level. My words could not make the woman believe that change was possible but they did claim that the exercise they did was fun.

The second part is the Sidhi story. The thought of Sidhi makes me feel  ‘Wow. Far from the maddening crowd.’

Bus journeys is not something  I prefer but to reach Sidhi one has to climb that bus. That bus which is usually stuffed with men, women and children and sometimes animals and crops and utensils …all sandwiched. We boarded the bus at the start point so we were lucky to get seats in the bus that too front seats. But…yes but never take a seat next to the door, every slam of it woke me from the sleep as it opened every 15 minutes.

We reached safely with my eardrums intact. This time out five star sweet was in one of the villages called Ghordand in a semi furnished hut. Till the end I could not find the person who committed the sin hence the village name. Evening passed and it was pitch dark outside and no electricity inside. I looked up and suddenly the darkness seemed to fade, it was glittering with infinite stars literally- a real life planetarium moment. Every night thereafter I had to look up not to miss that starry beauty.

Next morning was beautiful too as the sky also seemed bluer. Breakfast was under the sun after which work started. As we walked towards the villages I saw those bright yellow flowers- the mustard field was not yet ready.

All discussions with women had end number of complaints- it was needed.  Some delivery experiences were gruesome- delivering with few candles and a lalteen by the side- the stories were sad and scary. It was worsened when some women said that they were slapped and beaten too with a few abusive words. For a moment I thought darkness with family is always better than a stranger.

As discussions went ahead my learning enriched. The tribal music at intervals added flavor to the process.

Four days were over, there were mixed feelings. It was unfair to leave such a serene place yet wanted to return. How different Morena and Sidhi it, one knows it unless one heads towards that less travelled raod.

By Shreeti Shakya, in Sidhi and Morena during 25 February- 6th March 2013

 

An Unsung Hero of my World- Beautiful Countryside and Amazing People

Filed under: Uncategorized — paintedpostcards @ 8:45 am

Other people may find nothing new in it and may have experienced it several times in their lives. I am going to tell about a lady hero who inspires me in a very different way.

Probably that was my fourth visit to Maharashtra. I have been to 18 districts of Maharashtra on mostly work-related visits. My latest visit was entirely different from all those earlier visits. The visit left me completely thrilled.  I went to a very beautiful village called Morwadi Pachling situated in the foothills of a small mountain 50 to 60 kilometers from Pune city. The village is seven kilometers from the Pune-Bangalore highway (National Highway no 4).

The fond memories of this visit still linger in my mind and probably I am not going to forget them all my life. It was not merely the scenic beauty of the village but also the beautiful and kind heart of a lady.

We reached the village after having walked for almost five kilometers. The work we had done during the first half of the day and the long walk had made us hungry and we were desperately craving for food. We came to know that there were no eateries and besides, we did not have the luxury of time to walk all the way down from the hilly village to the highway, where there are many dhabas. We were almost helpless and dizzy from hunger. It was then that a lady overheard our travails. Even without discussing with any of her family members, she agreed to provide us food. Her house was a hut with a sliding roof made of slate plates and sunlight was scarce inside the house. The state of the house was a giveaway of the economic condition of the family.

She cooked very simple yet delicious fare within half an hour with her limited resources she had in her kitchen and kitchen garden. Then she graciously offered us the fare she had prepared. I had probably never had such simply yet tasty food in my life. To this day, I remember her as the most gracious host I have ever met and her innocent smile stuck to my heart. Without the food she provided us it would not have been possible to walk 7 kilometers to the main road wherefrom we took a taxi to our hotel. At that time the food tasted like manna. For her, time was scarce and after serving us the food, she had to leave directly for the field where she has to work in order to run the household and fulfil the needs of the family.

City dwellers like us cannot even think of providing or offer anything to anybody if there is no prospect of any hidden benefit. But this poor lady had offered us one meal that would have sustained herself for almost a week.Image

Although I cannot now remember her name, she is an unsung hero of my world and she still keeps whistling in my world of inspiration.

By Nibedita Phukan, during the field visit to Maharashtra during December 2010