Though ASHWINI as an independent organisation was started only in 1990, its genesis dates back to 1986 when Stan Thekaekara and his wife, Mari started ACCORD, a Non-Governmental Organisation in Gudalur. Their main objective was to to fight against the unjust alienation of the adivasi lands and other human rights violations by organising them as a strong group.
They facilitated the formation of village level sangams and these sangams enabled the adivasi families to prevent any of their land getting encroached by powerful non-tribals of that area or by the Government authorities. More than 200 such village sangams had been formed within two years. These sangams were federated at the taluk level into “Adivasi Munnetra Sangam” which till today remains the representative organisation of the adivasis, fighting for their just rights and striving for the socio-economic development of the adivasi community. [For more details, click here].
But, it was not only the problem of land. The village sangams again and again brought up the issue of health care. Women were dying during childbirth. Children were suffering from easily preventable diseases. Some intervention was urgently required. But, Stan and Marie were not doctors. They started looking out for some doctors through their contacts. Fortunately, they met two young doctors, Dr.Devadasan and his wife, Dr. Roopa, quite eager to take up the challenge.
COMMUNITY HEALTH PROGRAMME
Deva and Roopa joined ACCORD in 1987 just after their graduation from the Christian Medical College, Vellore and launched a community health programme in the adivasi villages. The main focus was to train village level Health Workers (HW) selected from the community itself, to identify and prevent illnesses like diarrhoea, to provide immunisation and nutrition to the pregnant women and young children, and generally to improve health awareness among the adivasi community. The team went from village to village, participated in the sangam meetings and regularly monitored the progress of the pregnant women and children.
Within a few years, the preventable deaths among the adivasis (like due to diarrhoea or during childbirth) were more-or-less eliminated. The HWs did a tremendous job in the programme, kept highlighting the health issues in the villages and closely followed-up the individual cases. The immunisation status of the children & pregnant mothers dramatically improved with the launch of the community health programme. Issues like growth monitoring and nutrition were constantly brought to the notice of the parents by the health workers.
Thus far, the health programme consisted entirely of these field activities. In spite of the successful community health programme, there were inevitable cases needing hospitalisation, there were high-risk pregnancies which required the women to deliver in a hospital, and acute cases of diarrhoea and fever among children too needed hospitalisation. Deva and Roopa used to refer such patients to the local Government hospital or to the private clinics.
But the experience with these hospitals was not very encouraging since the care and treatment given to these patients was not satisfactory, the doctors weren’t there many times in the Government hospitals, the costs of treatment in private clinics were high (ACCORD subsidised these costs). Deva and Roopa were torn between following a few cases in these hospitals and visiting the villages all over the taluk.
Quite encouraged by the success of the community health programme and the role played by the adivasi health workers, the adivasi community felt that the next logical step would be to start a hospital of our own. There was a heavy demand from the village sangams to start a hospital. But the doctors were reluctant, saying that Hospital is a permanent institution which needs to be run 24 hours a day, all through the year – and for many years. The health team at that time was not equipped to handle such an institution. Moreover, the ACCORD team strongly felt that their intervention had to be time-bound and they will withdraw after a few years when the AMS can take over the initiative of protecting the rights of the adivasis. But, hospital is a permanent form of intervention which cannot be withdrawn. And, in any case, where are the nurses in the adivasi community ? Another basic philosophy of ACCORD was to identify youth from the community itself to deliver all the services to the people and to train them ! And, Doctors ??
GUDALUR ADIVASI HOSPITAL
However, the community was strong in its demand and felt that the community health programme needed a hospital of its own to make it much more effective and acceptable to the people. So, they started a search for suitable people. Again as a curious coincidence, there landed up a doctor couple, Shyla and Nandakumar, willing to be part of the health programme. Having the ideal combination of skills as Gynaecologist and Surgeon, they were what the “doctor ordered” and the people were looking for ! Young adivasi girls were identified by the sangams and the new doctors started training them as nurses. Thus was born the “Gudalur Adivasi Hospital” [GAH]. In 1990.
With the establishment of the Hospital, we realised that this intervention is going to continue for a many years, and structurally it has to be different from that of ACCORD or AMS. So, the health programme, activities and the staff were hived off from ACCORD and a separate legal entity called ASHWINI was registered. From then onwards, Ashwini took care of the health issues concerning the adivasis and poor people of this area. While Deva and Roopa continued their focus on the community health programme, Shyla and Nandakumar started training tribal girls as Nurses. It was a major cultural change for the girls – from innocent village life to a three-shifts-a-day routine in the hospital. Training had to start from elementary Maths and English.
These adivasi nurses have come a long way in the next 18 years. They have become experts in conducting deliveries, in assisting the doctors in surgeries, in the general administration of the hospital, in ordering and managing the drug stocks, in designing systems to monitor the performance of the hospital (All the patient details have been computerised after 1996) and in analysing the financial aspects of the hospital management. They are constantly trained and their skills are upgraded to keep up with the growth of the programme.
Today, the Adivasi Hospital is one of the most sought after hospital in the Gudalur valley, not only by the tribals but also by the non-tribals of the local area. Patients are brought from distant villages by ambulance and good quality care is given. As all the staff are from the community and can talk the tribal languages, the tribal patients feel at home. Efforts were constantly made to keep the place culturally acceptable to them and the community gradually adjusted to the change. Today, there are cots in the hospital, they come forward for surgeries and many of them regularly show up for antenatal checkups etc. Some more young doctors came and worked in the hospital for brief periods – the health team getting enriched by the interaction with each of these doctors. Some quantitative details on the functioning of the hospital are given in the Statistics section.
Till 1994, the health programme consisted of preventive care given by the HWs at the villages and curative care provided at the GAH. However, during many interactions with the sangam members, a need was felt to have another intermediate level comprising of a group of villages. The AMS had already divided the sangam villages into eight administrative zones called “Areas” and an Area Centre was coordinating the sangam activities of that particular Area. From 1995 onwards, a health Sub-Centre was started in each of these Area Centres.
These Sub-Centres coordinate the community health programme in the villages of that Area, provide first aid and primary level curative care by dispensing medicines, Screen patients regularly, refer those needing doctor’s intervention to Gudalur Adivasi Hospital and follow-up the patients discharged from the Hospital. Initially the senior nurses and health staff took responsibility to manage these sub-centres. Later, a few more adivasi girls were trained specifically to run these sub-centres – They are called “Health Animators”. As per the need, they keep shifting between the hospital and the sub-centres, so as to strike a balance between the curative and preventive programmes and to keep their skills sharpened and updated.
Monitoring and review of the activities, both in the villages and in the hospital are done by the staff themselves in the monthly meetings. Besides, a Working Committee comprising of a few senior nurses and health animators has been constituted. This group looks ahead, takes care of the long term planning, budgeting and other policy issues.
ASHWINI is registered as a Charitable Society under the Tamilnadu State Societies Registration Act. The General Body of the Society is constituted from the senior AMS activists, the adivasi nurses / health animators and the doctors. All the members of the Executive Committee are adivasis. Thus, though ASHWINI is legally an independent identity, it continues to function under the umbrella of the AMS as an institution owned and managed by the adivasis themselves for their own development.
The Community Health Programme was started in 1987 with the financial assistance of Action Aid, a charity agency from UK. The Hospital programme was supported by CEBEMO (at present called CORD AID), a Dutch funding agency for about six years till 1997. There were many individual donations from friends in India and abroad.
At present, there are a few Donor Agencies / Institutions supporting our work. Sir Ratan Tata Trust, Mumbai is supporting our Health Insurance Scheme, by providing the Insurance Premium for the last five years. SRTT is also supporting our community mental health programme. During the last few years, we are able to mobilise resources from the Government of Tamilnadu as well for HIV / AIDS control programme, tuberculosis control programme and for the mobile outreach activities.
Even though the hospital is able to generate income from the non-tribal patients and the Health Insurance Scheme, the community health programme needs to be subsidised for some more years. Hence, the financial support of these institutions and many individuals / friends is quite crucial to continue our work.