Laxmi Chhaya: Devise Public Health Messaging
Mid-Year Public Progress Report
Laxmi Chhaya graduated from Aston Univarsity, UK with a degree in Psychology and Management. This year she is partnered with Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, Maharashtra, and is developing effective communication tools to disseminate health information in the villages around SEARCH.
SEARCH began several years ago, and still continues to serve the rural and tribal communities in the dense forests of Gadchiroli, Eastern Maharashtra. The story begins with the journey of a young couple – Drs Abhay and Rani Bang. After completing their Masters in Public Health at the John Hopkins University (United States), Drs Abhay and Rani Bang made the choice to address the health issues in the Gadchiroli district. A choice infused with understanding and action, very quickly began what is now known as SEARCH – Society of Education, Action and Research in Community Health. What started as informal discussions with villagers, late into the night around fires, blossomed into a series of health programs that is both people-led, using the participatory approach, as well as thorough research.
The communities that SEARCH serves are both rural and tribal, yet they are held together by one overwhelming fact – they lack a healthcare system that is accessible, affordable and that communities believe in. Dr Abhay Bang, and Dr Rani Bang, came together with villagers across Gadchiroli district in 1988 to discuss and identify the main health issues in need of addressing. Amongst the most important of these were infant mortality, sex education, alcohol addiction, and spine and back pain. This formed the path to a number of major developments, of which one important one is ‘Shodhgram’. Shodhgram, literally translates into the ‘village in search’. Created on the philosophy of community living and participation, Shodhgram has a hospital designed to take into consideration the concerns that local communities have that prevent them from seeking healthcare. For instance, the entrance has a temple dedicated to Maa Danteshwari – the Goddess revered by the local Madia Gond tribals. Moreover, the design of the building itself are similar to local traditional huts where patients are able to stay with their family. These unique considerations create an environment that feels familiar and comfortable to local people, respecting their beliefs and needs.
Initially, my ‘project’ at SEARCH was to strengthen the present health messages. I spent the first few months of the fellowship year with individual teams/camps on alcohol and tobacco de-addiction, sex and gender education, and hospital services, to gain a firsthand understanding of some of their key messages. From this I was able to identify some of the ‘gaps’ and issues in the way messages were communicated. Some of the challenges that stood out to me as most fascinating were that the format can often be one way, rather than a two way dialogue – this is due to (or leads to) low participation from the community itself. Furthermore, there were long periods of time between the camps and actual follow-up programs, which meant that the effects and ‘support’ created in the camp setting gradually decreased over time.
Although these initial experiences gave me some perspective into how messages are being shared into the communities, I felt that this was somehow one-sided and that I still had no idea of what the actual communities thought of these messages and the ways in which they are shared. Moreover, how did people communicate information in villages? What type of information were people more likely to share and what were their sources of information? These were some of the questions that I endeavored to explore when I lived with Rekhatai and her family in a local village called Gilgaon for two weeks. While I carried out some informal discussions and interviews, my most valuable experiences came from simple and intention-less interactions with people from washing clothes to farming. I was amazed at how rapidly information spread, especially via women who surprisingly for me, got a lot of their daily ‘news’ and gossip around the bore-well waiting to fill their water. It was fascinating to appreciate how different people share and receive information at this micro level. This also allowed me to think deeper about how SEARCH can tap into these community ‘hubs’ and layers to explore alternative ways of communicating , such as mobile technology or community radio, supporting current health programs.
Over the past few months, I have had the opportunity to work with the NREGA (National Rural Employment Guarantee Scheme) team at SEARCH to ‘experiment’ with ideas on how to inform and educate people on what they would need to do to demand for work. This involved two main streams. The first was to hold ‘NREGA Stalls’ at bigger village bazaars inaugurated by local prominent figures, as well as distributing leaflets, talking to different vendors and the general public alike, and playing NREGA songs. We did this for three continuous weeks and could easily see important it is for people to have a space to ask questions related to their individual circumstances.
The second idea we pursued was to pilot the use of SMS messaging. With over 70,000 mobiles in the Gadchiroli district, SMS could be an effective and feasible tool for SEARCH to send relevant information to a large number of people at very little cost. We sent a number of SMS in two villages, followed with a short survey to find out two main things; did it increase awareness about NREGA? Did it increase the number of people demanding NREGA work? Our learning was mixed – technically people were able to receive and understand the information, which was positive news from a feasibility point of view, and many of those surveyed also felt that they were given new information that was interesting and necessary to them. Yet, this awareness and information did not necessarily lead to any action on their part. What happened? Why didn’t people act? I felt a gap in my understanding and approach. Looking back over this project, I can now see that my role could have been more like a facilitator in understanding how they want NREGA information and that the communities in these two villages could’ve been involved in designing this project from the beginning, rather than only at the implementation stage. Going forward in this year (and onwards), my biggest learning has been that any communication tools from SEARCH need to come from the communities themselves and must involve them from the very beginning.
Project Implementation Progress and Future Plans
Progress towards ‘goals’ has been, at times, frustratingly slow, yet when I look back over this year, it will be these very frustrations that have not only given me a deeper understanding of what role communication plays in a rural setting, but also my own strengths and challenges.
Over the last few weeks, my project has taken another form; to look at the role that communication tools play in supporting the ‘participatory approach’ at SEARCH. The participatory approach at SEARCH is very much integrated into their core philosophy as an organisation; “Go to the people, Live among them, Love them, Listen to them, Learn from them, Begin with what they know, Build up on what they have”. Often coming from an idealistic place, I have thought of alternative ways in which we can share messages amongst our community here, to which the response is always ‘go try it’ and ‘speak to people’ to learn what their thoughts, experiences and needs are.
With this in mind, I have recently started asking myself many of the same questions that I asked when I first arrived, but this time actually understanding why these questions are crucial. These questions include do people actually want new information (in particular health related)? What information is relevant to them? How can SEARCH share this information in an interesting, yet feasible way without physically being there? Can SEARCH build capacity within villages so that individuals themselves identify and address their own (health) needs?
From dialogues with women in Gilgaon, many women often feel that they have no voice to share their issues, and they question who will listen to them. The main focus of this part of the project will be on women, especially women who are already part of a Self Help Group. Being part of a collective group may encourage thinking about collective interests. I am in the process of moving to Gilgaon to spend more time with these women and their families. Over the coming weeks I will facilitate an initial meeting with some of the SHG members to understand and identify their information needs and ask them to collectively rank them in terms of priority. They themselves will then select 3-4 of these suggestions and discuss how they would like to receive this information. The content of these issues and the communication tool(s) will then be designed in partnership with both the SHGs and SEARCH. While it is unknown how effective this approach will be in empowering these women to take their lives and needs into their own hands, I have faith the process is fully worth it.
The choice to spend a year in India to serve as an Indicorps Fellow was one sparked by a restlessness to be part of something bigger than myself and my world. It is difficult to share what personal growth I have experienced. Over the past few months, I have been challenged to rethink the lens through which I view the world around me and question who I am. Being in a village like Gilgaon, where people are more likely to choose a TV than a toilet made me think twice about words like ‘freedom’ and ‘development’. Who am I to decide what is best for others? In an environment where I do not speak the first language Marathi, I have been pushed to follow through on my actions in spite of these struggles. ‘Be the change you wish to see in the world’; that infamous Gandhi quote that we see and hear all the time. But nothing could make any more sense to me in this space and in this moment, where the only real ‘project’ is me. This is an ongoing journey and something I want to continue into life past this Fellowship year. I would like to be a good human being. What is a good human being? I don’t know exactly, but from the humble experiences I have been fortunate to have, it would mean being sensitive to the world around me, to live with integrity and to recognize that the word ‘service’ is more than a period of time in my life, but a form of love for others that can be expressed in whatever I do and wherever I am.
Laxmi Chhaya, August 2009 Indicorps Fellow