Sunday, 29 September 2019

Conversations with Gi and Tha

I've tried my best to capture the learnings from our conversations with Gi and Tha here. (Note that the statements are not quoted but are reflected from my learning)

While we were having conversation with Gi, he got a call and then he took us with him to SOFA (Sittilingi Organic Farmers' Association) in his car where they were showing the documentary of Tribal health Initiative to a group of people from Teach for India organisation. The documentary is partly here.

The above part of the video also covers one of the major messages I took. They talk about a man who had fractured his finger and how they talked to him about fixing it with a small procedure. In that conversation when they learnt that he wished to go to a traditional healer who would immobilise the finger and probably some additional techniques, they told him what that might cost him. His finger might not get straight and that he would remain with certain amount of restricted mobility. He was okay with these consequences and hence they agreed to not do any procedures. Patient preference and shared decision making to it's fullest!
This portrayed several principles-
1. Keeping patient at the centre and doing the rest with the intention of getting him/her better is the first thing. This approach helps in dealing with our internal inconsistencies with our notion of what is right and what we think the patient wants compared with what actually the patient wants.
2. Having a healthy working relationship with all providers as much as possible to bring the best to the community. In the above they didn't blindly object him to not seek care from the traditional healer but told him the consequences.

Gi was also later telling us how he dealt with the healers who go on vehicles and give injections. To avoid transmission of infections, they helped the healers in at least using fresh syringes and needles. 

Post the documentary, members from Teach for India interacted with questions posed to Gi.
When asked how they (Gi and Tha) dealt with disappointments when certain things didn't work, he narrated how they had to be persistent for 2 years with several meetings for 4 farmers to join in together to start organic farming and now they are 500 members running this association of organic farming which has helped them have better crops.
Being open minded to different solutions, coming from anywhere is something they follow. For eg, they had initially trained young girls from the communities as health workers so that they could care for their community. When they learnt that the community were not accepting the advice from these young health workers due to their age, they shifted their focus on training the elderly. Also the young girls became excellent health care professional at the hospital. They do everything!
So the shift from solution focused thinking to problem focused thinking is what kept him going, trying new things, taking on new challenges and solutions.

How he chose that community to work-
Gi and Tha wanted to work at a place where people needed them the most. Since they already were familiar with Tamil Nadu, they listed 5 places that were back then very poor in terms of health and health care access. They planned to visit each of those places and decide on one. Sittilingi was the first in the list and they fell in love with that place. Honest and practical answer :)

I later asked him, how he deals with the fact that there are several communities like Sittilingi out there who need this but he can't reach all of them.
He simply replied saying that time would teach us that. When we start out, we have the attitude of "I will change the world", but world can be changed bit by bit, block by block by several people I guess.

How do they find enough time to do all the things they did or were doing? Like seeing patients, talking to farmers, etc
If the purpose is clear and work starts, adrenaline would just let you work and somehow make time for everything.

How did they manage to have enough money for personal life?
He described how people doing such work often don't expect to make a lot of money. He was explaining how if one doesn't have a major financial commitment like taking care of parents, loans etc, one then need money only for one's survival. And while doing such good work, things often fall into place. Basically at least to start with such journeys, we need to be open to expecting time when we'll be making just enough money to survive. Which is alright. Risks are to be taken. He gave us the example how when he tried admitting his sons to school with a substantial fee, the school administrative waived off their fee due to the good work they were doing.
So money will always be a problem and with good will solutions will eventually come our way.

He asked me and Akshay to think and discuss amongst ourselves about what each of us would want to be doing in life after 10-15 years from now. Where we'd be living, what work we'd be doing etc in order to have clarity of each other's space, synergies, strengths and to understand each other.

Interesting conversation about whether we need to do postgraduate degree-

The approach that he takes is that any training and learning adds to the skill set of oneself and thus will only benefit the people we are serving. So learning and getting degrees in fields like surgery, obstetrics, which are of much need in communities would definitely help you serve better. It will also help us to be safe from legal regulations present or those yet to come. While certain other fields like medicine usually doesn't require a degree more than MBBS for regulatory purpose. But an attitude to learn anything and that it's possible to learn anything is much needed. To decide on whether one wants to take PG or not, one has to decide on how deep he/she wants to get into treating patients or clinical medicine. This is something I'm thinking about.

Speaking of learning anything, the approach that he took was based on the need. So Gi said he learnt how to do ECHO and recognise basic heart diseases when he was 59 because he realised that they were referring quite a lot of patients only for this; He learnt how to do ultrasound, even did a certificate training to be legally safe in order to benefit the community. In fact on the OPD day we got to see him scanning.
I loved that they continue to be in OPD, practice, and still are involved in all the other activities, administration, and social aspects.

We caught a conversation with Dr Lalitha (Tha) on another evening at Porgai (meaning "pride" in Lambadi language) and here it is-

How did she decide that she was ready to stick to Sittilingi and work in one community for such a long time?
She gave a very genuine perspective of how in her generation people were expected to and were even judged based on how committed and long they worked at one place/job. That was the norm. But the recent generations she has seen have a lot more interests and often jobs don't offer space for all of them and thus fail to keep them and hence people explore and move to different places/jobs after 1-2 years to explore further.
All she knew is that she wanted to work for a community. Once she got into it and started working with them, she realised it takes one's lifetime to bring about transformation. And communities also grow with time. Their needs change, old problems are no more problems, there are new problems envisaged or not. So there are always new experiences and mindset required for growing with the community, recognising these, accepting these and thus she finds it interesting.

She said certain consequences have to be thought of and made peace with. Letting go of some interests that may not be possible to continue..dancing..singing..etc that doesn't find space.

How she decided that she had to get a degree in Obstetrics?

Initially due to the gender expectations, people were expecting her to take PG in OBGYN and she clearly had resistance to this attitude. But later when she realised maternal health was such an unmet need, she pursued it with an internal drive and desire. Resisting the resistance she had before.

She has a very warm perspective on child birth experience and encourages even assisted home delivery but "Safe delivery" is what she thinks should be endorsed.

When the current health system brings frustration, how does one decide whether to fight the system or just continue to work around it through our own ways?

Fighting the system is an ideal thing to do and she often feels frustrated that their response to certain political events are passive. But she also said that when an organisation becomes a part of the community, it is no longer about personal interests alone but decisions have to be taken collectively. Also that such rights based approach usually needs to be done from the beginning. Instead of Either or approach a combination of these efforts are needed. You can't expect a community who aren't even getting their basic life necessities getting fulfilled to spend their effort in only fighting for their rights and demand accountability.

She encouraged us in our endeavors, gave us a warm hug and asked us to visit them again. While we walked with her in darkness and a torch to her home, she described how safe  Sittilingi people were from each other. As in, she has not locked her main door in the last 16 yrs. She can trust people, but this is changing. But as stated before communities grow, change, we accept the new developments and also new problems.

Next morning, we wished Gi, met doctor Jerry and left Sittilingi with a lot of contentment and inspiration.  


No comments:

Post a comment