Saturday, April 30, 2016

Play deepens democracy

The sun beat down strongly on the group of children and volunteers playing in the grounds. But they were not to be deterred. The fact that it was the hottest summer in 85 years did not seem to bother any of them. When it was time to leave, the children all cried out, “noooooooooooooooo akka (older sister), nooooooooooooooo anna (older brother), please don’t go, let’s play some more”. The volunteers promised to be back the next day and packed up the materials at the summer camp before returning to base. On the way out, they had to wade through the sea of children waiting to say bye or inviting them to visit their homes or just hugging them and giving them one of their favourite crafts which they had made that day as a token of their love.

This was the usual scene which was witnessed in all the five summer camps held during the hottest summer that any of the team members of headstreams had ever experienced in their lives. The day after the last camp, as we sat down to share our memories of the summer camps, everybody was brimming with stories and anecdotes of what had happened during the 20 days of camps when a team consisting of 26 of us had reached out to over 1100 children through play. As we reflected on what we had achieved, the list was endless. Physical development, cognitive development, psycho-social development, relationships built, strengths affirmed and so on. These were points which had convinced us to use play as an approach in our work with children and youth in the first place, but one thing that really stood out for me was the one where we arrived at the fact that what we did actually helped deepen democracy. The reasoning was simple but not simplistic, it was deep and plain for all of us to see.

Our summer camps which were built around the concept of play provided children and the volunteers the opportunity to use different mediums such as art, craft, music, stories, theatre and games to express their thoughts, feelings, ideas and build relationships. Children had the autonomy to choose what medium they wanted to use, the type of expression they wanted to display and how they wanted to do it. There were no competitions in identifying the best artist or musician or actor but each one used the medium that connected to them, to bring out the best in themselves. There were minimal hierarchies in terms of age or skill or position and in play each of us just learnt from each other and supported each other in the various tasks we did throughout the day. Shining examples of spontaneous equity was seen when those who needed more help were eagerly supported by the other children or volunteers who stayed with the child until they had completed the chosen activity. Freedom, autonomy, respect, dignity, equity - these were not mere theoretical concepts but were visible in some form or the other all through the twenty days.

We also reflected on how in our mainstream education system these concepts were often overlooked. A top-down, didactic model of education, where everybody was forced to learn the same things, irrespective of interest, aptitude, context or relevance was what most children experienced. Standardised tests which valued those who could learn by rote and reproduce from memory created a new hierarchy of “good students” which excluded more than it included in its graded system of finding favour with school and society. Any skill other than the one recognised by the mainstream school system was not valued among children. For instance, you could be a great artist, or have an interest in music or the liberal arts or even be a really kind person, but none of these were valued. By the time one navigated through the schooling system, many of them ended up labelled as ‘misfits’, ‘good for nothings’, ‘not much talent to speak of’, and so on, with most of them believing it to be true of themselves. So for most children, the ideals of democracy were only concepts printed on paper in their text-books and not something they experienced until perhaps when they were 18 years old and could begin to vote. The summer camps in contrast turned out to be sandboxes where the children could exercise their notions of freedom, autonomy and choice in an environment which fostered equity, respect and dignity.

As we were winding up our meeting, we received a call from a child who asked for her favourite volunteer. ‘Anuakka’, she complained, ‘why didn’t you conduct the summer camp for a longer time this year. What do you want us to do for the rest of the summer?’

Saturday, September 28, 2013

No health without social justice

The framework of social justice goes beyond the confines of justice and even beyond the concept of equal distribution of facilities and resources. It recognizes the inherent inequality of a system which is framed from a perspective which is far removed from people’s natural context. And it identifies itself with a perspective which is in line with people’s existing context and practices. It builds on their strengths and resources because social justice is not a quest for a better tomorrow but is a call for a healthier today.

The dominant discourse on health, views health and healthcare as alien to the body of the people, especially the ‘underclass’ or those who fall ill often, and hence seeks to “provide” its external intervention to the receiver through the mass availability of healthcare facilities and providers. Medical history is replete with stories of how the colonial rulers had to bring the army in to ensure its health campaigns like vaccination and quarantine was successful. It continues even today when local knowledge and holistic practices are discredited, shamed and silenced and a dominant system imposed on all irrespective of its relevance, availability of means to achieve health, or even the dangers of the system. The approach still emanates from the top and pushes its way down to the masses and we all chug along because if we say the emperor has no clothes, we would be forced to stitch new ones. According to my view, the view from the bottom is that the emperor has no clothes and the sooner we acknowledge it the quicker we begin on the path of social justice and health.

Thursday, March 1, 2012

A parable of three daughters - aalamba

A mother had three daughters. She was poor and her daughters were always hungry. The first daughter was upset that they did not have enough food to eat, and hoped that some opportunity would come her way to get some food. The second daughter felt angry that they did not have food while those around her had plenty to eat. She began thinking of ways in which she could get some of the food that others had (through hook or crook - whatever worked). The third daughter also looked around her and found that others had enough to eat. But the hook or crook method didn’t appeal to her. She set out to explore how the others had such abundance of food. She thought , if they could have it, so could she. That was the stepping stone to the change in her life.
At aalamba, many of our participants start out as the first daughter, hoping to find any livelihood opportunity to meet their needs. They soon become like the second daughter who had the vision to look around her, but her focus was limited solely on getting a share of the food. If she got that, she was satisfied. But the third daughter made a giant leap. She was similar to the second but differentiated by her values. She was a thinker - she wanted to change her situation; a learner – she wanted to learn from other’s experiences; and a doer, she carved out a path for herself, creating value for herself and others. That is the transition our participants make – from hopelessness to being inspired to creating value.
- Naveen I. Thomas

Thursday, November 17, 2011

Livelihoods of low-income families

- Some reflections on micro-enterprises as a livelihood option

After working with over 100 families on livelihood issues, engaged in different micro-enterprises, we are now looking at how do these micro-enterprises become sustainable livelihoods while enhancing the quality and life of the people we work with. A few thoughts about our approach, about what are we hope to achieve, and about what we want to promote through these micro-enterprises.

Let us remind ourselves once again about the nature of the enterprises the families are engaged in. While, 'enterprises' or 'businesses' are administered to earn profit to increase the wealth of their owners, our surveys have shown, what these women do are neither 'enterprises' nor 'businesses' in the classical sense of the terms.
- They are subsistence activities which mostly help in their survival (or meeting their daily needs, if all goes well). We call it 'livelihood activity'.
- The capital is very small in most cases.
- They are mostly conducted among family members and friends within the neighbourhood.
- They are based on 'trust' and 'hope', rather than 'records' or 'business projections'.
- They are more trade-based, rather than skill-based.
- They are integral part of the person's personal life. For instance, the workers are mostly family members, the resources are mostly family-based, the dependents are mostly family members, and the whole purpose is to add to the family's kitty - money for education of children, life-style expenditure of spouse (such as drinking alcohol, jewellery, clothes, etc.), or social occasions expenditure. This can be contrasted to businesses/ enterprises where workers may be hired, resources are raised from the market and profits increase the wealth of the share-holders.

These distinctions have very important implications for our training and approach. What we are addressing through these livelihood initiatives are not business issues, but more of family and community (or neighbourhood) issues. Adopting mainstream business strategies and models for these will fall short as the context is very different. While the market is the parameter for the scope, functioning and purpose of the business, the family relationships, the neighbourhood linkages, the development state of the community in which the woman lives are all issues which will affect her livelihood.

Just to give an example, if a proprietor of a big business, say a large retail chain, falls ill, the business does not get affected instantly. But in case of a subsistence livelihood, the whole livelihood collapses. If family members/ neighbours are fighting in the proprietor's family, his/her client base need not get affected. But if the family members/ neighbours of a person running a livelihood activity are not in good terms, it can greatly affect the person's business as client base is largely local. If the economy of an area drops either due to disasters/ general economic downturn, it need not affect the big business, because it can always shift its market or bear losses briefly, while that is not the case for subsistence livelihoods which will collapse.

A key to the subsistence kind of livelihoods is the family & neighbourhood relationships and environment. The focus has shifted from the market to the home and neighbourhood. What we are saying here is that, if the person is doing well on the home front and the neighbourhood in terms of relationships and stability, then it provides an enabling environment for the livelihood activities to take place. We know this because many of the livelihood activities which fail are because there was no family support, or there was a health or some other emergency in the family, or the neighbourhood was not able to provide enough income for the activity. How can our approach then address this reality?
I see it at two levels:
i) Address the relationships part of the livelihood (the family, the neighbourhood), with an emphasis on values in relation to self, close family, extended family and the community.
ii) Address the needs part of the neghbourhood which can be addressed through the livelihood, again with an emphasis on values such as leading a better life, improving social conditions, peace, etc.

How do we translate this in our trainings? How does this affect our methodology of training? How does the current EDP, EAP, follow-up trainings address this reality? Some food for thought...

- Naveen I. Thomas

Saturday, July 25, 2009

Our tryst with medicines

- The investigations of a community worker

Vani earns her living, working as a domestic help in different houses in Bangalore. Her husband, a daily wage earner working in the construction industry, abandoned her and her children two years ago. She now works double time to ensure that they don’t go hungry, and that her children can go to school. Her younger son developed severe stomach pain some time ago. She did a round of the doctors, including the state-run hospital. Each day of absence from work meant a cut in her wages. In a bid to balance her work, income, taking care of her older child and taking the younger one to hospitals, she had to finally settle for a clinic close to her house. The boy was finally responding to treatment, but by then she had lost all her savings, and could not afford to buy the prescribed medicines.

We met Vani at this stage, when she approached our organisation for help, through a women’s Self Help Group which we had organised in her area. It was an all too familiar story for us. We had heard it over and over again – child after child, woman after woman, family after family slipping into poverty because of high medical costs, especially the costs of medicine. A closer look at the prescriptions she carried revealed the pathway to ruin – overpriced, irrational and unscientific medicines taken consistently over a period of time. When we told Vani that half the medicines that she had bought for her child were irrational, and that the other half could be bought at a fraction of a cost if she chose other trusted manufacturers, she was very agitated. She wondered how the doctor who treated her child could prescribe these medicines even after knowing that they were on the brink of bankruptcy.

How indeed? Was she a victim of the deeply embedded doctor-pharma industry nexus? Did the doctor not know the generic equivalents of the costly branded drugs he had been prescribing? Were these medicines prescribed because the doctor’s continuing education about new drugs was from the marketing literature provided by medical representatives of different companies? These questions and many others which arose as we worked in the community led us to investigate a bit more into the drug industry.

Our first shock came when we realised that the all-important issue of policy making in medicines was not handled by the Health ministry, but by the Chemicals and Fertilizer Ministry. This explained the vast difference in the goals of the Pharmaceutical Policy 2002 and the National Health Policy 2002. And it perhaps also explained why health care was the second-most leading cause of rural indebtedness in India, with medicines constituting 50 to 80 percent of health care costs (Medicine Prices and Affordability, AIDAN, March 2009).

The second shock came when we realised that the prices of the same type of medicine in India varied drastically, sometimes as much as 20 times more than the lowest-priced one. For instance, Risperidone 2 mg, a medicine used for psychiatric ailments which cost only Rs.1.69, was priced at Rs.27.00 by another company (16 times). Letrozole 2.5 mg – a medicine used in cancer treatment, which was priced at Rs.9.90 by one company was priced at Rs.181.50 by another (18 times). Sildenafil citrate 100 mg – a medicine used for Erectile Dysfunction was priced at Rs.29.16 by one company, while another company priced it at Rs.584.00 (20 times). With the way medical knowledge has been constructed, if a doctor chose to prescribe a costlier medicine, the patient had no way to determine if a cheaper equivalent was available in the market. That made us wonder why there was no rule which made it compulsory for medical practitioners to prescribe medicines by its generic name. Our research shows that it is already happening in India, in Chittorgarh, Rajasthan.

This discovery also led us to the whole issue of pricing of medicines in our country. We found out that even the so-called free market countries of the EU and UK have some form of control over medicines, such as price controls, volume controls or cost-effectiveness controls. On the other hand, in India the case was different, with the number of medicines under price control steadily declining over the years. Even if individual medicines were under price control, manufacturers found a way around it to get out of price control. In this situation, the very least the Government could do was to bring in price regulation on atleast all medicines in the National List of Essential Medicines based on therapeutic class rather than on individual drugs. Why has this not happened yet? Well, our investigations are still proceeding, and we are searching for the answer. If you get to know why, or how it can be done, do let us know.

- Naveen I. Thomas