Rikin Himat Tank: Public Health for Migrants
Mid-Year Public Progress Report
As one of the only premedical students majoring in International Development Studies, Rikin’s interests lie in the realm of healthcare development. His travels have exposed him to life and cultures throughout the world from Buenos Aires to Rajkot. As an August 2009 fellow, Rikin is partenered with Aajeevika Bureau in Ahmedabad focusing on public health in migrant communities.
NGO & Background Information
The NGO I have been partnered with for the fellowship year is Aajeevika Bureau (meaning Bureau of Livelihood). Formed in 2005, Aajeevika Bureau is a pioneer organization dealing exclusively with migration in India. Based in Rajasthan, the Bureau focuses on providing security, support, and services to migrants that migrate in and out of Rajasthan, as well as parts of Gujarat. The origin of a majority of the migrants Aajeevika works with is south Rajasthan. A dry and arid region unsuitable for large scale agriculture, the region forces its inhabitants to seek employment away from home for the 9 month long dry season solely for the purpose of maintaining a livelihood. While most of these seasonal migrants are males, the effects of the mini-Diaspora can be seen throughout the household as wives and children live without a paternal figure for most of the year. One of the major destinations of these migrants is Ahmedabad, where roughly 1 million migrants work in nearly all unskilled labor sectors like construction, head-loading, domestic work, and restaurant service. They earn a nominal salary, usually around Rs. 2000-3000 (roughly $50US) monthly. It is at these destination cities that Aajeevika Bureau plays a huge role in the success of migrant laborers.
One of the primary services that the Bureau provides is a government sanctioned photo identity card. In addition to allowing migrants to purchase mobile phones, and open bank accounts, the card provides a sense of identity to an otherwise unrecognized population. Migrants face cases of harassment both in the workplace and in society but are unable to report it to authorities due to a lack of identification papers. The identity card gives them a sense of belonging, pride, and individualism. Additionally, Aajeevika Bureau provides various legal, financial, occupational, and health services to migrants that are unfamiliar with the availability of such programmes. Perhaps most significant, however, is the provision of skills-training by the Bureau to unskilled laborers. Through this provision, migrants are often able to improve not only their individual livelihoods, but also the livelihoods of their families.
At the source level, the Bureau has eight centers that serve to facilitate skills-training and pre/post migration services and support. Source centers also help families cope with the difficulties of migration, and promote safe health practice, informed economic sense, and the importance of education. Most migrants move together, migrating with others of their home community and living together at the destination. Their typical day involves a 12 hour work shift that ends in the evening, leaving a couple hours to wash clothes, make food, and complete any other tasks before sleeping and starting over early the next morning.
My project focuses on building the model of healthcare services for Aajeevika Bureau in Ahmedabad. As one of the most important concerns of migrants, health services have been at the forefront of the Bureau’s goals. Sickness is not a luxury migrants can afford, as absence from even one day of work can put both salary and job security into jeopardy. When migrants fall severely ill, they typically leave the destination and move back to their homes. This reality highlights an irony wherein migrants leave the advanced healthcare services of urban areas and move back to their rural homes where proper healthcare is virtually non-existent.
The broad nature of this project allows a great deal of room for creativity (which can be a very good thing and at the same, very challenging). One of my goals for the project is to promote awareness of the health services available to migrants in the city and in their communities through the creation and distribution of literature and media. Along with awareness of services already available, my goal is to provide a guide to safe health practices like hand washing, sanitation, and abstinence from substance and unprotected sex. In addition to this, I am trying to develop partnerships that Aajeevika can use to provide services like free health camps, clinics, and other services directly from health professionals. This will hopefully serve to show how migrants do not have to leave their workplace and destination communities if and when they become ill, as well as promote better health and nutrition.
A second goal that I have set for this project is the research and targeting of one of the biggest health concerns for migrants in Ahmedabad: occupational health hazards. Working in hard labor and harsh environments, most migrants face several hazards in the workplace ranging from physical injuries to chemical exposure to dehydration. Thus far, this aspect of my project is only just beginning on account of a second project I have undertaken.
My primary project has centered on the creation of several youth clubs within migrant communities in Ahmedabad. A significant plurality of migrant laborers are under the age of 21. As such, the youth element of migrant communities plays a large role in the Bureau’s agenda. Many migrants have left schooling at their homes, either out of necessity or voluntarily due to failing. A popular saying amongst migrant communities goes “8th pass tho zindabad, 8th fail tho Ahmedabad” showing how often migrant youth leave the education system to pursue a life of earning. The problem is that most youth expect a life of opportunity, excitement, and change by leaving their homes and beginning work in the city, but they soon realize that this is an unrealizable dream as life in the city is harsh, unforgiving, and anything but inviting. Lifestyles are typically lonely and dry, as many of these youth begin to quickly lose the spirit to dream and aspire towards something more. It is at this juncture that the my project attempts to intervene, and promote improvement in the lives of youth not just through upgrading skills, but also through inspiring them to think, consider, and dream. By forcing youth to re-engage with the thought of opportunity and improvement, I hope to confer within them the capacity to take charge of their own destiny.
With regards to the youth project, I have had quite the journey. From not realizing that youth work would be my primary project, after signing up for a health project, to engaging on a project where results are virtually invisible, this project has certainly tested me in strange and wonderful ways. One interesting challenge is that Aajeevika Bureau works on a need-basis. The “need” for a youth programme is much harder to understand because it offers little (if any) short-term benefits. Convincing a migrant worker who has just finished a 14 hour shift that they ought to come and play a game that involves team-work is no easy task. The fact that such field work happens late in the night (between 9 PM and 12 AM) as a result of laborers’ work schedules does not help because migrants become tired and have to finish cooking, eating, showering, and washing clothes in the 2 hours they have between getting off work and sleeping. Nevertheless, some important realizations have dawned upon the team and myself, including the necessity for a solidified space to have such youth programmes in each community, the importance of interaction in these activities, as well as the maintenance of a light-hearted and amicable environment.
Additionally, the ever-changing nature of migrant communities in Ahmedabad is an interesting challenge because no community is the same and thus solutions must reflect the needs of communities. While this does not make community immersion impossible, it certainly changes the dynamics of its associated processes. Building rapport is necessary, as it is in most community development, but the opportunities one gets in being successful in building such rapport are drastically less due to the dynamic nature of the communities’ residents. For myself, I have slowly learned how such rapport can be maintained even in the changing environment, as it requires a constant presence that involves community members discussing your programmes in and out of the community. I have found that visiting the source communities that these migrants come from is extremely fruitful, as it shows them that you care for them not just in the community that you are living in.
Thus far, three youth centers have slowly been getting on their feet, and bi-weekly meetings are held in each center. The main activities are of most use for the youth in the city are those involving creativity and recreation. At first, the youth were expressionless during the sessions, not understanding why we were there or what benefit it might have. But slowly, I am able to see a transformation in many individuals regarding the exposition of their personal thoughts, opinions, and aspirations.
Secondly, I have realized how my experience in America and my education there can benefit the organization in a unique way. Often times, I felt that I could offer nothing unique to this organization, but I was wrong. This year is not only about me learning, it’s about me giving as well. While a bit superficial, I realized that my ability to network and gain the trust of potential collaborators is something valuable and something that I can use to the benefit of this organization. As such, my networking has taken me from local NGOs like Manav Sadhna to corporate leaders like Reliance to international organizations like UNICEF. If there is one thing that I do not associate myself with, it is fear. The fearless attitude required in creative and proactive behavior was something that I only recently realized, and hope to expand upon further in the months to come.
Upon arriving in India, I had very little idea as to what the year would end up looking like. While I still have half a year left in the fellowship, a great many things have challenged and spurred me to grow in ways that I never would have guessed. I came to India to do service, but also to live — live like my parents lived and discover what they already knew. Every time I visit India I live the life of a king, staying in 5 star hotels, drinking from cold Bisleri bottles, and hiding from the stories of 1 billion people. That was the problem. Often times we get caught up in writing our own stories that we don’t realize that life is a library, and it’s ok to put down our stories and read someone else’s.
One thing that no person in India can escape is the importance of community. In a land of a billion, it is nearly impossible to find privacy, but therein lies the unique nature of this country. In India, relationships unite the country. It is the bread and butter of work, friends, family, and progress. People and life move together, and this unity is unique to India. The importance that society gives to these relationships is of great magnitude, as curiosity makes the building of such relationships rather easy. Seldom will you find a time when someone does not want to feed you in their home, invite you to stay over, or let you share their space. Perhaps it is this reason that makes change so challenging, because the solution is not rooted in the provision of aid, but rather, in the ability to affect mindsets, not only of individuals but of entire communities.
One change in my own mindset was the goal of working with someone, instead of for them. Service work tends to have a very one-sided connotation, wherein one party gives to another and that’s that. But one quote by Lila Watson sticks in my mind that is a mantra of Indicorps philosophy and that I have adopted as my own: “If you have come here to help me, you are wasting your time. But if you have come here because your liberation is bound with mine, then let us work together.” This philosophy I have also seen translated by the work of Aajeevika Bureau, as charity is hard to come across. Instead, there is a constant transactional exchange (not necessarily of something tangible) that involves the commitment of both parties, both NGO and community. India’s expansive constituency is too big to be the target of charity. Sustainability is a popular buzzword in development dialect, but something can sustain itself only if all constituents are committed.
Another topic that I have been struggling with is how to be involved in the development sector, and more generally, what development even entails. I had a difficult time reconciling development work, because on the one hand it involves working with others to help them make a decision for themselves, but it also inherently involves imposition. I came to the conclusion that it is ok to provide choices and understanding to others of what is available, as well as your perspective on what choices you think are good and which are not. It is my responsibility to tell them what I think is right as well as be sure that they are aware of alternatives. It is then their right to accept it or refute it. Whatever ends up happening, the original care and heart behind it all must never lessen. Sometimes you realize that yes, washing your hands is a very good thing and IS the right thing to do. I realized that personal introspection is extremely important in grounding yourself and understanding what you really think. Questioning yourself is important in maintaining a balanced perspective. Patience is important in sustaining humility and empathy. And doing is important in giving back. All of these are necessary in making change, and I realized that I cannot forget any of them nor can I get caught up in giving one more importance than another.
A third change I have seen in myself is a better understanding of the plight of disadvantaged communities in India, especially women. Never have my eyes been opened up to the plight of Indian women more than this year. This plight I have begun to understood not only of women in India, but also of women in my family and friends circle in America. The context of what it means to be a feminist is now clear to me, and I am proud to call myself a feminist. The equality that women deserve but never receive is unsettling, and when I realized that I was a perpetrator of this victimization (intentionally or unintentionally), my world turned upside down. Many communities fail in providing equal rights to women, but India fails in more accounts than most other societies.
Finally, I have finally begun to understand what simple living means to me. Initially, I defined it in very superficial terms according to material wealth, expenditure, and what I thought people found important. Now I realize that in the realm of living simply, it does not matter what others think of my lifestyle. Only those things that matter to me are important. One can drive a Mercedes and live simply; one can travel by foot and live simply. Living simply is only determined by thinking simply. I realized that if my mind and spirit can think simply, relating to people without judgment, and accepting their story without question, then I can live simply.
Rikin Tank, August 2009 Indicorps Fellow