claudine_c

Last week I spoke to a group of people from St Paul’s Cathedral about my visit to India. I was asked to speak for 30-45 minutes. I’d never spoken on my own for that length of time before. When speaking in public, I generally try either of two strategies, both of which have problems:

- Write the whole talk word for word beforehand and read it, forgetting to look at the audience.

- Write a basic outline and notes and get nervous, lose my place and forget what I’m trying to say.

I didn’t have time to write the whole talk this time, so I prepared an outline with a few introductory paragraphs so I would at least be able to start. I brought some photos and encouraged the audience (about a dozen people, none of them strangers) to interrupt whenever I wanted. It worked! I talked without getting stuck; the audience brought up many interesting questions and comments; and I filled up my allotted time perfectly. It helps that I have a lot to say about the subject and 45 minutes is much better than being asked for a “brief summary” of the trip -- most travellers know that a few minutes with distracted friends doesn’t do justice to the experience! I’m much more confident about my speaking abilities now.

Notes from the talk are at http://chionh.org/travel/indiatalk06.html

The last week of the course at CRHP was like the headache of final exams/assignments, multiplied by 18. In the second week we began a group project on planning a hypothetical primary health care program. There was a four-day recreational trip to Aurangabad, the Ellora caves and Bhandardara, but when we got back the assignment was practically the only thing on everyone's mind. When I'm at studying at home I can take breaks away from my books and talk to people who don't have anything to do with my studies, but in the confines of Jamkhed we couldn't do that and it was very intense. The minor epidemic of colds and flu among students didn't help.

After the work, a small graduation ceremony, group photos and a party. The group was driven to Pune railway station this afternoon and split up. About half went on to a train to Mumbai, others flew to other parts of India, while I stayed behind in Pune for a night. There's only so much movement I can take in one day. Goodbyes were sad and gentle -- most of us are based in Melbourne and around April we will be meeting at the university to present our experiences to the next batch of potential participants. There is plenty of talk of other, informal reunions; time will tell whether these will take place.

Tomorrow I'll be in Mumbai, meeting some people at the Hilton -- a mind-boggling prospect after three weeks in modest, dusty villages. I return to work on Wednesday and classes for my next subject begin in two weeks. We were given some advice on re-integration into our normal surroundings. This has been the longest period of living in such different conditions that I can think of. I may outwardly, physically return to Melbourne, but I don't expect re-integration to really happen quickly.

One of the strategies of primary health care is to keep children -- especially girls -- in school as long as possible. Child health and education are strong focuses at CRHP. The program operates a kindergarten and also provides a home for children of seasonal workers who have to leave home to work throughout the year. There are always small children around the compound, playing cricket, jumping on people and posing for photos. They don't need much to keep entertained: sticks and stones, a few words of English, and tall, pale foreigners to play with. This kind of childhood is spent mostly out of doors, physically active and in the company of other children. This seems much healthier than the isolated and sedentary lifestyle of many children in technologically advanced societies.

All of our five village visits have featured lots of children. Rising levels of school attendance are a matter of pride for village schools. At Kusudgaon, we visited a couple of classrooms where children showed off their knowledge of English and afterwards mobbed us for autographs. In this area the school day seems to go from ten to five, with lunch provided, giving children the opportunity to work at household chores or play with others in the morning. In all the villages we were able to talk to children about their daily lives and their aspirations.

Women may still be regarded as workhorses and baby factories with expensive dowry requirements by some people here, but CRHP has been working to change these beliefs. All children are expected to complete at least seven years of school. CRHP has recently started a program for adolescent girls centred on health education and self-esteem. A number of these girls have learned karate and demonstrated their defenses against male predators. They also learn about puberty, reproduction and sex, dispelling the silences and myths they may receive at home and school.

The village health workers supported by CRHP provide services and education to their villages and the process of becoming a village health worker is itself a source of empowerment and self-awareness. When the Aroles arrived in Jamkhed in 1970 they found women and untouchables who had internalised the hatred and contempt to which they were subjected. The Aroles decided that female volunteer health workers would be an effective means of health education, but before they could be trained as health workers they needed to find faith in themselves as humans. The training program for village health workers begins with teaching them to celebrate themselves as women and respect each other regardless of caste.

Local village health workers meet at CRHP every week to brief each other on the week's events and to receive further training from more experienced VHWs and CRHP staff. On Wednesday we observed one of these training sessions and later heard from some of the women about their lives and what changes CRHP had brought them. It was common for women to be given names like 'burden' or 'garbage'. Some of them had changed their names to more positive ones, and all who had daughters had given them positive and beautiful names.

It was difficult to listen to the women's stories; unimaginable to live through them. Being married at the age of eight; being thrown out by a husband for giving birth to daughters; having no property of one's own... Meeting with other village health workers allows them to enjoy the company of their peers and validate their own experiences.

After a day of serious lessons our group threw a party for some other overseas visitors who were moving on, and invited the village health workers and the migrant workers' children. The children and women bashed at piñatas filled with toys and Australian souvenirs, then sang and danced around a bonfire. The women had even more fun than the children, shrieking and scrambling for toys and dancing to folk songs sung by visiting students from Nepal. Perhaps while the children play out of simple innocence, the women who have survived incredible adversity have more reason to rejoice.

Days at the Comprehensive Rural Health Project in Jamkhed can be said to have a certain routine. Breakfast is followed by morning prayer. The Aroles, the founders of CRHP, are Christian, as are some of the staff. Christian principles of justice and service are the basics of the work of CRHP, and provide an alternative model of society to the inequitable caste system. The Aroles set out to work with the poorest of India's poor and were able to establish themselves in Jamkhed, one of the poorest areas of Maharashtra. They have deliberately targeted their services at women, untouchables and the poor, who have mostly been neglected by the Indian health care system.

Much of the day consists of lectures from CRHP staff on their activities and from Australian International Health Institute staff on general principles of primary health care. We have been able to learn from Dr Raj Arole himself this week. We have also visited some of the villages serviced by CRHP and heard from some village health workers. The VHW is one of the keys to CRHP's success: a generally middle-aged woman who is endorsed by her village elders and carries out health promotion activities, and provides basic treatment and referrals to the CRHP hospital.

This course is a socially intensive experience. There are eighteen students who have come through Melbourne, as well as two AIHI staff and their children. There are CRHP medical, auxiliary and housekeeping staff. There are students and academics visiting from the USA, Germany and the UK. We all live in shared residences on the CRHP premises, eat and, in some cases, pray together. We share an interest in primary health care but our cultural and professional backgrounds are diverse. Highly social extroverts and recluses are all accommodated. This is a far more intensely connecting experience than we would have in a modern city, but still with enough space to allow for different personalities.

From the busy, crowded cities of Mumbai and Pune to the small town of Jamkhed in Ahmednagar district. Now I see that I really am privileged, something that I previously knew only intellectually. People here have what they need to live, and little more. I'm going to live for three weeks without a shower, which will be interesting. Electricity fails sporadically. The Comprehensive Rural Health Project compound has two computers with internet access to be shared between about thirty people. Apart from showers, adjusting to life in the compound has been easy. But living conditions in the town and surrounding villages is different.

On Tuesday our study group visited some nearby villages for a transect walk -- a walk through the village to observe and meet with villagers. Kusudgaon had a population of about 1000. Most of the adults of working age worked on farms, cultivating wheat and sorghum. Women cooked and kept house as well as working on the farms. School was available up to year 10 and was compulsory up to year 7.

Churchill is said to have described India as one big latrine. Hygiene and sanitation was the first area that Gandhi targeted in his constructive programmes. Clean water and sanitation is one of the basic reforms promoted by the CRHP. But in Kusudgaon, which had benefited from village health workers and mobile health visitors for a few years, only about a quarter of houses had latrines -- a greater proportion had TVs.

Before coming to Jamkhed I read its history which described villages in the 1970s driving bullock carts and drawing water from wells. Townspeople now have TVs, cars, computers and mobile phones but many aspects of daily life seem not to have changed much for centuries. One of the biggest surprises I got in Mumbai was seeing bullock carts in the middle of a big city. I still cannot adjust to this coexistence of ancient and modern in the same place.

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In much of the animal kingdom, males tend to be more colourful and vibrant than females, but this is the opposite in humans. This effect is quite exaggerated in India. In Jamkhed and surrounding villages, older men have a fondness for bright pink turbans, but othewise men tend to dress in drab white and off-white. Black, grey and white are rarely seen on women, who favour bright colours in clashing combinations.

Transport varies here. Trucks roam down the highway, "Goods Carrier" painted on the front and "Horn OK Please" on the back. They have to share the roads with bullock carts, cattle and goat herders, cars, motorcycles, bicycles and crowds of pedestrians. The roads are narrow and dusty and everyone pushes their way through as it suits them.

Water still mostly comes from common wells and pumps, and is carried on the heads of women and girls. Ownership of cows and goats is a sign of prosperity. Traditional trades persevere. Most villagers work on nearby farms. In addition, some also work as potters, metal-workers, jewellers, barbers and tailors. These crafts are performed much as they have been for hundreds of years, without the aid of electricity or complex machinery.