Talk for Friends of St Paul's Cathedral, 2006-04-06. Repeated at Melbourne Unitarian Peace Memorial Church, 2006-07-23.
Talk about a visit to a rural health centre in India that has enabled people to improve social and physical conditions. Demonstrates value of humility over hubris on the part of health professionals.
Part of my Master of Public Health studies. Public health is the use of many professional disciplines and techniques to understand and improve the health of wellbeing of communities. It has a broader scope than professions like medicine or nursing, which are usually focused on individuals. Public health isn't just concerned with biology. It is more concerned with building systems to make health care accessible, to evaluate how well these systems are working, and to teach people about all kinds of health issues.
The University of Melbourne runs a short course in collaboration with the Comprehensive Rural Health Project in Jamkhed, India.
Jamkhed is a small town in Maharashtra, a state in central India. Mumbai or Bombay is the largest city in this state, Pune is the nearest large city. Jamkhed is inland, and most of the people who live in this area are farmers. In 1970, Raj and Mabelle Arole, two Indian doctors who had studied in the USA, returned to India with the aim of building a hospital that was accessible to the rural poor. After some false starts they settled in Jamkhed. They built a hospital but also realised that to maintain good health, the people needed clean water, education and self-esteem. The Comprehensive Rural Health Project that they established has become a model for other parts of the world where people cannot afford expensive, high-technology health care.
The programme in Jamkhed has a training centre where people from India, Nepal and other developing countries learn about the Jamkhed model. Three years ago the University of Melbourne started sending students there for short courses. Some of the Australians who go to Jamkhed are interested in working in developing countries. Some want to learn about reversing the effects of inequity and discrimination. Australians can learn a lot from Jamkhed because the Aroles haven't just tried to give the poor the same things as the rich. What they have done is give the poor the power to improve their circumstances themselves.
In January I went to Jamkhed with 17 other students, two lecturers from Melbourne and their children. The students included nurses, speech pathologists, a physiotherapist, a pharmacist and a doctor.
In the spirit of CRHP, we learnt from local people as well as experts: visits to villages, talks from village health workers and CRHP staff, and lectures from Raj and Shobha Arole.
CRHP is a model of PHC.
In a developing country context, primary health care means an approach to health care that is holistic and focuses on how the physical environment and society affect people's health.
Health systems based on PHC principles are:
PHC uses a positive definition of health:
A state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity. (Alma-Ata)
Health is a fundamental human right.
Holistic understanding of health includes physical, mental, spiritual wellbeing; ability to maintain livelihood; social relationships.
Health promotion and preventive medicine, not just curing symptoms.
PHC is inter-sectoral: it recognises the importance of agriculture, infrastructure (sanitation, roads), education.
Cooperation between people from different backgrounds and profe ssions. Doctors, nurses, community health workers, limb technicians, educators etc. work in teams with minimal hierarchy.
Complementary health systems: Western and indigenous. In India, this means being open to non-Western health systems eg Ayurveda, herbal medicine. Use what is appropriate for the situation.
The Aroles wanted to work in a poor area. Consultation with community leaders, false starts. Wanted to work with the whole community, not just leaders.
Agriculture is important to people's lives in this area. Don't just talk about health on its own but address the felt needs of the community.
Women have gone from being treated as sub-human to becoming respected health workers and leaders.
Christian upbringing enabled him to see through traditional barriers of caste and gender. When he was a child his mother was sent to Jamkhed as a teacher but could not find a home because she was an outsider and not a Hindu. Attitudes in Jamkhed have changed a lot since then, through the Aroles' efforts.
The Aroles had two children. Their daughter, Shobha, is a doctor, has studied some complementary medical systems like homeopathy, and is also a minister in the Church of North India.
Prayer every morning for staff and visitors. Not all staff are Christian but they recognise the value of its social outlook. An alternative to caste: Everybody is equal before God.
Visit from the local bishop in the Church of North India: Dr Arole is highly regarded.
Inequalities: rich/poor, urban/rural, male/female.
Poor people often cannot afford health care or medicines or can't even access services -- lack of infrastructure.
Health care needs to be accessible to the many people living outside of cities without the resources that health professionals take for granted.
Origins in Hindu traditions.
Social/occupational groups.
Four main Varnas, and Untouchables (Dalits or Harijans) beyond.
People from different castes don't mix with each other, and untouchables are excluded from normal society, to the extent of having homes outside the town limits.
Buddhists, Muslims, Christians etc aren't supposed to believe in caste, but it is so entrenched in society that many non-Hindus follow caste rules. Gandhi and Ambedkar tried to abolish caste during the independence movement but weren't successful.
Female infanticide and selective abortion mean that girls face discrimination before they are born. Girls are regarded as useless burdens. (Dowry is expensive.) They may not get as much food or medical care as their brothers.
Improve maternal and child survival, especially for girls.
Nutrition.
Preventing infectious diseases--hygiene and immunisation. Many people lacked basic sanitation facilities and clean water.
Collaboration with local people, responding to their perceived needs (which may not initially include health).
Help with farming and sanitation.
Key to change.
Often women, middle-aged (have experience of childbirth and raising families). Generally have little education or literacy (because women didn't have these opportunities).
Identified by villagers, trained by CRHP staff.
Maternal/child health, simple medications, referrals to hospital when needed.
Educating the village through drama and art.
Child feeding programmes: mixing boys and girls of different castes.
Learning to overcome caste and work with all women.
Women with little education realise that they are as good as men, that they can understand health and teach others about it.
Prefer locally available and effective medicines to expensive pharmaceuticals.
Catalogue of local herbs/medicines.
Made of cheap materials and built for squatting (traditional posture) rather than sitting.
Date: 2006/07/26 21:45:55