HOW I CAME ABOUT WORKING in RURAL DEVELOPMENT & COMMUNITY HEALTH
Dr. Marcella D’Souza (Batch 1971)
The internship period was path finding.
The compulsory rural posting was before me. I had seen rural India while travelling by train and spending some months out there appeared romantic. I decided to live it the full way, “enjoy it”, as I then said. I opted for the mobile hospital that took me to Ashti, a village in the Vidarbha wilderness (now notorious for its farmer suicides) of Maharashtra . The whole mobile hospital was set up in tents. When the lean emaciated and ‘dirty’ patients presented their medical problems to me in the OPD, I was challenged: What was the cause? If they were better nourished, if their habits were healthy and hygienic, if they could afford more, if they understood the connect, would they have these problems? We went around examining the children through the school health program. I saw stretches of meagre crops standing in the fields in the late monsoon season, as we walked through the surrounding villages doing surveys. I saw women walking long distances to fetch water and firewood and all the countryside was a toilet.
And then came the hospital posting, which I had done in a Government Hospital at Nagpur . Sitting in what is called the “Repeat Section” of the Medicine OPD, I had streams of patients coming in with thick files, and many of them were on antibiotics for years. Chloramphenicol is one I recall. Over years, the previous examining doctors just signed, “ct. all”, because, as the patient said, “I will not get better unless I have this medication”. That week I knew, I could not see my life as a medical practitioner being meaningful, if I continued in the same stream. “But what would be the alternative?” I decided patience would lead. I had a lot more to learn and understand.
After a few years in a city hospital (I needed some grounding in medical practice), it was time to venture into the unknown- “Follow my call”, as I then thought. I opted to live in tribal villages – for a year with the Kurkus in the Melghat, Vidarbha (still catching the news for malnutrition deaths) and the following year with the Gonds in Chindawara, Madhya Pradesh. I needed to understand their lives and so chose an “immersion experience”, with no dispensary or service to provide. I was out there to listen and to understand. Later I realized that I was to learn and benefit much more. I was beginning to understand myself.
Then came a request to work on the South Andes in Peru – to live in the mountains at an altitude of 4200 meters while reaching out to areas as low as 300 meters above sea level. During the first week of my stay in Macusani, an indigenous Peruvian said, “We are so happy to have you, a doctor here with us. When the Swiss doctor was here we were well taken care of. When he left, we were abandoned.” That was another decision-making moment: “Do not leave them abandoned.” I decided that my return to India (whenever) would not create a vacuum. There were no doctors in this region during my first 4 years and so my time was divided between curative, preventive medicine and health promotion. While the context was different from the central India that I knew, there was ignorance, poverty, ill heath and death. Malnutrition, infant and child mortality rates were high. I was attached to a rural development project of the diocese that included community organization, agriculture, livestock development, women’s empowerment. With my joining the project, health was blended. We would walk for 6 to7 hours along steep mountain tracks to reach immunization and health to remote villages. Almost 6 years later, when I left Peru in December 1994, I had left trained health workers, set up a small pharmacy that provided medical drugs at affordable prices, promoted herbal and home remedies and a community health program that reached many villages. Those were the years when terrorism (Sendero Luminoso) was at its peak and up on the mountains we had our share of fear and bloodshed. Yet, the years lived in Peru gave me satisfaction, joy and meaning. It was here I saw the impact of working with entire village communities in a holistic manner, empowering people with knowledge and skills. From the Quechua people of the Andes I came to appreciate and understand “Health as harmony with oneself, ones community, with nature and the divine”, very similar to the thinking of our tribal communities.
On my return to India , many requests and choices came my way. Going back to clinical practice was one. The half year spent in a rural hospital raised the same queries I earlier had. I thought, “Should I clean up the spilt milk, or prevent the milk from spilling?” I opted to work with the Watershed Organization Trust (WOTR), an NGO. It took me directly to rural communities and the approach was nearest to my Peruvian experience, though health was not included. What attracted me was that community-led natural resources regeneration appeared a holistic way of combating poverty. The interventions led to a remarkable increase in the water table and agriculture (and therefore food). People (especially women), now came together to improve their situation and education became possible. It seemed a sustainable way of addressing the causes of ill-health, malnutrition and ignorance I had encountered.
I joined WOTR end 1995 as Coordinator – Women’s Empowerment. There were challenges aplenty. In a male dominated land based intervention such as watershed development, what would give women the space to realize their potential and help integrate them in the development process? At that time (and largely even now) rural women themselves had no idea of their hidden capabilities, as Sunanda, a woman of Darewadi village said sometime in 1996, “We are ignorant, uneducated, poor; you tell us what to do, and we will do it.” The men said, “Woman’s role is to care for children and the hearth; we men will tell you what they need”. And then, in our fragmented ‘caste-ridden’ society, how does one bring the whole village together to take up their development process, address poverty and remove the basic causes of ill-health?
For the early ‘90s, WOTR had a different way of looking and development. While scarcity is generally considered a cause of discord, WOTR looked at scarcity as an opportunity for unity. “Land degradation and water scarcity are the most intense and commonly felt needs of a village community that can bring different groups of people together to begin their development process. Community restoration of the local natural environment makes the initiative sustainable.” Rather than pointing fingers at the government, WOTR worked to win their support (at field level, as well as state and centre) and goodwill. For without government, successful initiatives cannot be mainstreamed and up-scaled. If the development process is to be sustained, the local people (the target group) should own it; and agreements were signed to that effect with the project villages. The WOTR team would patiently demystify technology, such that even women could handle technology and important tasks. If people were not willing to give their contribution (16% of development work as sweat equity) and comply with the expected disciplines which were agreed upon, WOTR would move out of the village. For me, all this meant serious commitment to a development process and to the local people, a sine-qua-non for realizing desired outcomes. The WOTR strategy and approach brought the whole village (all castes and communities) to rub shoulders while they dug trenches, planted trees and regenerated their degraded lands. The best result was the visible surface and underground capturing of rain water. Water in wells was available almost throughout the year; earlier, water for drinking was ferried in tankers from elsewhere beginning February till the monsoons. Agriculture bloomed and production increased remarkably. People did not need to sell grain in distress. (Watershed Voices Sattechiwadi: Double Click on Icon ) The most important impact was on people and their organisations. Women initiated self-help groups (SHGs) to save money and obtain small loans. Soon they began to discuss their day-to-day problems with one another and sought solutions together. When a couple of years earlier they had not even known the names of each other, they now sat late into the nights discussing sanitation and ways of improving nutrition. Health surfaced in discussions, particularly that of their little children.
This was the moment I had lived and waited for!
Currently, in the over 120 villages across Maharashtra, Andhra Pradesh, Madhya Pradesh and Rajasthan as part of WOTR’s community-led watershed and natural resources development initiative, women promoters take care of children in the 0-5 years age group and work to reduce anemia in women. These aspects are taken up because food, water and a reliable income source are now available. All come together to talk, share and discuss, and there is a good relationship with the local government departments. (ref: “Watershed Development Inputs and Social Change: The changing culture of Child nutrition” Apoorva Pandit 2010; “Watershed Development and Health” Apoorva Pandit & Dipak Zade (under print – Rawat Publications); In many villages, the school water and sanitation intervention inculcates hygiene and health practices in children (“Making Sanitation a Clean habit” Marcella D’Souza & Alpana Bose 2008. Study available on WOTR’s web site).. Simple tools and a methodology have been developed to include these aspects into rural developmental projects. (WOTR’s Overview )
Today, other issues have emerged. The varying weather conditions -delayed monsoons, long dry spells between rains, erratic rainfall, fewer rainy days- and the consequent effect on water, agriculture and food security has steered WOTR towards adopting a “Climate Change Adaptation” approach (Double Click on Icon ) in 63 villages. In a climate changing scenario and increasing temperatures, the health problems anticipated are: increasing malnutrition; spread of vector borne malaria, dengue and others; water borne diseases gastro-enteritis, dysenteries, intestinal infections, etc; deaths due to heatstroke …... Another glaring manifestation is the increasing number of farmer suicides, particularly in the Vidarbha region of Maharashtra due to repeated agriculture failure. To address the psychological aspects of this tragedy, in partnership with other agencies, we have just initiated a Mental Health intervention. WOTR’s works towards developing people-led replicable strategy for adapting to the climate induced effects.
But there are two other serious concerns directly related to medical practice that we are now facing as a crisis: the increasing number of hysterectomies done on young women in our villages (Double Click on Icon ) and the skewed sex ratio (Double Click on Icon ). The findings in some of WOTR’s project villages urge us to delve deeper to better understand the scale of the problem, so as to develop an appropriate action strategy. What neither medical practitioners nor people foresee is the vast and far reaching negative consequences, direct and indirect, that will hit our society 10-15 years from now (symptoms and signs are already visible). To prevent further deterioration and reverse this potentially calamitous situation, the medical fraternity and development institutions need to work together.
I am happy to share the recognition that WOTR’s work has recently received:
- WOTR’s work has contributed to policy in the development sector. (Policy Impact )
- The Kyoto World Water Grand Prize (2009);
- a full feature article in the National Geographic Magazine ;
- A very recent on WOTR’s work in Christian Science Monitor: http://www.csmonitor.com/World/Making-a-difference/Change-Agent/2011/1207/A-success-story-in-parched-India, and World Watch Institute, http://blogs.worldwatch.org/nourishingtheplanet/a-success-story-in-parched-india-water-soil/.
- A visit by the German President in Feb 2010;
- Maharashtra state’s highest award in agriculture, the “Krishi Ratna” (Sept 2010);
- the JSW-TOI Earth Care Award in the category “Community Based Mitigation and Adaptation to Climate Change”,
- Many awards received by various staff.
Just as I write this, we have received an urgent request from the district collector of Ahmednagar, to take up the issue of under nutrition across the district as also to address the dwindling female child population. They would like a strategy and approach that can be replicated. I do know that what begins here can spread across the state and even the country. Head, hands, heart and any support are welcome!
For all who would like to hear and read about the basic natural resources concerns of our earth, about alleviating poverty, and about what WOTR is doing in this regard, we’d be happy to put you on our mailing list. Ecologic WOTR’s Newsletter: . Read more about us: www.wotr.org
For those of who are nearby or who interested, you are welcome to visit. For those who would like to connect, I would love hearing from you.
Thank you for taking the time to indulge my reminiscences.
You can contact me at:
Dr. Marcella D’Souza
Watershed Organization Trust (WOTR)
The FORUM, 2nd Floor
Padmavati Corner,
Pune-Satara Road,
Pune 411009
Mobile: +91-9422226415
Email:
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