May 2011 | Philip Chacko

Health and a lot more

The Mitra programmes being supported by the Sir Dorabji Tata Trust and the Allied Trusts are a rare bright spot in a blighted region rife with inequities and disparities

Sudhir Pani was born with sickle-cell anaemia, the most common form of sickle-cell disease, a genetically induced blood disorder that can be life threatening. For Pani, a tribal boy growing up in one of the most backward regions of one of India’s poorest states, it was a looming death sentence — till he found a friend in Mitra, a project spawned through the vision and efforts of the Christian Hospital, Bissamcuttack (CHB), a bright spot in a blighted corner of Orissa, in eastern India, and being funded, since early 2010, by the Sir Dorabji Tata Trust (SDTT) and the Allied Trusts.
 
Pani’s story is an exception rather than the rule in the tribal heartlands of Orissa, where the most basic of health care facilities can seem like a luxury. That’s the sphere in which exceptional institutions such as CHB are trying to make a difference. Started as a small dispensary by Liz Madsen, a Danish doctor, in 1954, the hospital has found the means to become self sustaining, and a multitude of ways to treat and heal people and communities who, as far as government services and infrastructure go, have fallen off the human development map.
 
Now headed by Dr Padmashree Sahu, CHB is essentially a 200-bed hospital that is the biggest health care institution in what are known as the KBK districts, a ‘misery zone’ that takes in the 10 most backward regions of Orissa. The hospital has a staff of 200, treats close to 400 patients each day, and handles some 3,500 surgeries and 2,000 deliveries in a year. But there’s a lot more to CHB.
 
It runs a 100-student nursing institution and an English-medium school with 350 students, the only one for miles around. The hospital’s ‘community health department’ has set itself up to be the window through which the most vulnerable communities in the region can access care and treatment. CHB’s Mitra project, though, may be its most important.
 
Mitra, an acronym for Madsen’s Institute for Tribal and Rural Advancement, works with about 12,500 people in 53 predominantly tribal villages and has a variety of operational programmes. Its ‘health of all’ initiative incorporates community health centres, mobile clinics, antenatal care, nutrition, malaria control, health information management systems and more. “Education for all’, another of its programmes, is currently focused on placing educated and motivated tribal youth as tutors in local government schools.
 
Then there’s Project ECCNE (early childhood care, nutrition and education), an initiative in 12 villages to improve the lot of the very young. Additionally, Mitra seeds and nurtures self-help groups and conducts social empowerment projects aimed at developing leadership skills and promoting the Kuvi tribal language and culture.
 
The Mitra Residential School in Kachapaju, set up in 1997, grew from a vision of a school where tribal children could grow up in the ethos and milieu of their culture. The Mitra training and resource unit seeks to broaden the impact of such interventions by taking lessons learned from the field — in health, education, advocacy and the like — and sharing them with other tribal groups.
 
United for a cause
The need for organisations such as CHB and initiatives such as Mitra is acute in this part of India. “In the last few years, this region has seen multiple, disparate and yet related trends that very few people understand,” says Dr Johnny Oommen, who has been closely associated with Mitra. “The tribal people here have been bypassed by the waves of national development. Penetration of government social welfare schemes has been inversely proportional to the distance of a village or a community from the main road. Education and health care services have been, by and large, only on paper, and what little has happened has been of extremely poor quality.”
 
This state of affairs has led, says Dr Oommen, to a societal and social polarisation that feeds off prejudiced politics. What you have is a region in an evolving mess, where the answers offered have little understanding of the real questions, where the provider perspective is far removed from the realities on the ground. The future does not look good, and the window of opportunity to make a difference and offer a humane and just alternative is quickly shrinking.”
 
It is to stop this shrinking that Mitra and SDTT have joined hands. The trust’s partnership with Mitra is actually a strategic alliance for community health and malaria control in south Orissa, to build institutional capacities and to make a difference to the lives of people who need all the help they can get. Started in March 2010 and scheduled to run for three years, the programme is being funded to the tune of Rs9.62 million.
 
The highlights of the partnership are a malaria resource centre that provides technical assistance to the trust and its non-profit partners in south Orissa; a malaria control programme that takes in 53 villages and delivers on-field training; and a community health programme targeted at tribal communities that includes schemes for health, education, economic security and social empowerment.
 
One among them
“Mitra is not seen as an outside agency by the people with whom it works,” says Dr Oommen. “The majority of our staff and almost our entire network of about 80 community volunteers are from the tribal community. We try to see issues from their perspective and to arrive at responses from within the community.
 
Our evaluation was done by a group of tribal leaders rather than external consultants. This helps us to stay focused on the issues that matter to the community.”
 
The challenges confronting Mitra are many: finding competent and caring health care professionals to keep their endeavours in the pink; coping with the political realities of a region caught between right- and left-wing extremism; and funding constraints that limit the scope of the work that can be attempted.
 
Governmental cooperation can make a significant difference to projects such as the ones Mitra is immersed in, but that has been minimal thus far. “There is a huge gap between governmental provisions and what actually happens,” explains Dr Oommen. “There is also a gap between presence and functionality, between quantity and quality of output. The government does not see people like us as partners, but as private agencies to be regulated or policed, as organisations of doubtful repute.”
 
In the circumstances, the support and funding extended by the trust has been more than welcome. “The trust appears to be very different from other donors,” says Dr Oommen. “There is a willingness to listen, a flexibility in approach, space for different approaches and immense generosity. This is not how it usually is with the top-down donors we have met in the past. I assume we will see things differently on some issues, and that is good, as long as we are both able to do that with respect and honesty.”

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