The Programs and their strengths
PATH has been able to achieve its objectives and goals in a large measure. Awareness regarding education of children, general health and citizens’ rights have grown. More girls are going to school. Many young women are daring to dream and cross the thresholds of their home to work outside. The staff members have also become role models for many girls and women in the community. A lot of the early settlers are economically better off. Mental problems are no longer that much under wraps. Cases of family tension are also coming out in the open.
For a smooth functioning, every program unit has a Program in-charge and 1-4 teachers or health workers. The class and field work is facilitated by this team.
The activities of path revolve around health and educational concerns of the communities plus their access to basic amenities.
In both health and education components, the organization, in addition to responding to direct needs, engages children, young women and patients in raising awareness. Community work is integrated with education and health programs.
Spending time at the centres, the clinics, the office, the school and walking in the community and talking to a cross-section of people gave good glimpses of the different components of the program.
The Educational Program has 4/5 units –
- Non Formal Education (NFE) which functions under the Sarva Shiksha Abhiyan (SSA-Education for all campaign of govt. of India), mainstreaming children into govt. school system.
- Balwadi (Pre-school) which prepares children for school.
- School adoption program run in govt. – school in the evenings, to support weak students from the areas.
- Skill Training for young women- tailoring, embroidery, pottery, glass-making, flower-making.
- Information Centre comprising mostly of documentation.
Health has been on the agenda of the organization since its inception. The health program is focused on health education, preventive care and people’s rights.
It has broadly 4 components-
- Community and family health care, where health workers take up 5 to 7 topics with 25-30 families each for 4-6 months, help in problem solving and refer particular cases to outside agencies.
- The clinics provide services to tuberculosis patients through the govt. DOTs program, provide medicines for several types of common illnesses, refer patients to dispensaries/hospitals run by Bombay Municipal Corporation (BMC) and health education through trainings and individual and group counseling for prevention and care.
- Counselling is provided by multi purpose workers at the primary level, then taken up by the social worker and if need be, by an outside agency. The attempted is to address peoples’ mental health problems.
- HIV/AIDS is a comparatively newer area of intervention by PATH. Main activities are identifying HIV/AIDS patients, educating people, specially TB patients on this issue and raising general awareness.
- In addition to concrete programs of educational and health interventions PATH takes up issues of community concern and joins hands with other agencies. They may include water, electricity, women’s issues, demolition etc. Networking with local groups and government departments is part of day to day work.
PATH tries to reach out to children who are drop outs, who have never been to school, who are going to school but need support and who are preparing to go to school. PATH tries to get parents involved in the education of their children.
Interacting with several parents, it was obvious that they are satisfied that through PATH’s centres, their children are able to go to school. They are happy that PATH is providing a basic foundation of learning at the Balwadi, in the NFE centres and under SAP. There are a few interesting cases where girls who were earlier in the classes have felt motivated enough to pursue higher studies. Rita (Cheeta camp) was in the tailoring class of PATH. She is now in M.A. and plans to take a B.ed. degree to become a teacher. This type of an indirect and invisible benefit has come to many girls.
Non-formal Education (NFE)
The NFE centre at Ekta Nagar has on its roll (today) 70 children – half boys, half girls, (and all were present), in classes I, II and III. The teacher is a graduate with training inputs from PATH as well as from Bombay Municipal Corporation (BMC) school-system, and has been with PATH for four years. She is assisted by a young man who is an alumni of the organization, having studied here and then enrolling in a municipal school; he is now studying in B.com.
The day I was in the class, the general atmosphere was joyful and children were happy. Stories, songs, and play are part of the routine. But the focus is on basic literacy and numeracy. The two teachers handle the three classes with efficiency and care. While I was in the class, it started raining heavily, the teachers, very wisely, did not allow the children to go home even though the class time was over. Instead they engaged them in games and songs. The children are quite comfortable in their company. Parents seem satisfied with what children are learning at the centre. Textbooks of Bombay Municipal schools are followed with innovative inputs from PATH. A lot of students are dropouts. Children prepare to enter mainstream schools. Averagely 75% students are able to get into formal schools, mostly govt. schools. The program comes under the Sarva Shiksha Abhiyan (SSA) the campaign for education for all, of Govt. of India. During the last year 40-50 children got admitted to formal schools. Averagely the drop out rate is 10%. The effort is to make them at least literate. Parents teacher meetings ensure that problems can be addressed jointly. Home visits by teachers help in understanding children better and in building relationships with family.
A lot of records have to be kept not only of attendance and performance, but of things like time at centre, BMC school entrance, retention and follow up etc. Municipal authorities keep checking the records. All files and records have been kept meticulously.
In Ekta Nagar itself, there are 2 Balwadis. In one, there were 47 children (9 were absent that day) and in the other there were 22. The spaces for classes are nice, clean, airy and lighted. In each centre there was 1 teacher, she was transacting the syllabus prepared by the Program in-charge in consultation with the Social worker. The teacher also gives inputs to the syllabus. Children feel loved and happy. They were having fun. Creative activities like poems and songs with action and drawing and colouring are undertaken. Children are keen on writing. They were also learning through play way methods and teaching aids created out of waste-material, It was good to see that varied and serious attempts were being made for recognition of alphabets, numbers, animals, birds, vegetables, fruits, colours and shapes through pictures. Teaching of a value like ‘a mother is like god’ was pursued at one centre, keeping the level of small children in mind. During recess children eat from their tiffin-boxes brought from home. Attention is paid to their contents and if lacking in nutrion (as in fried snacks) it is pointed out to the parents in regular meetings with them. Health checkups are done regularly by doctors in the presence of teacher and parents. Parent-teacher meetings are held at least once in two months. For immediate needs, the teacher pays home-visits. From the Balwadi, approximately 20-25 children gain admission in formal schools, every year.
School Adoption Program (SAP)
PATH works directly in one municipal school (opp. Trombay Police Station) where children from their target area enrolled in 6 BMC schools come for coaching. PATH has access to 15 class rooms in the building. Students weak in studies are identified by the school-class teachers. Coordinating with the class teacher, who provides the list of such students, PATH enrolls them for their evening classes, for classes I to VII. Supportive tuitions are provided in Urdu, Tamil, Hindi, English and maths, according to the need and mother tongue of the child. Mumbai has a system of schooling where medium of instruction is the mother-tongue, hence there are Tamil, Urdu, Marathi, English and Hindi medium schools. Most children are weak in English and maths.
There are 15 part-time animators/teachers in this program, tackling multi-grade teaching. They are from the community and are picked up for their qualifications and proficiency in the specific subject. Their sensitivity and commitment levels are important criteria for selection. Many of them are energetic and eager to do things even going out of their way. Most of them have passed Higher Secondary (HSC) exams while some are pursuing graduation. Their primary job is to get the children to learn the basics. Regular training inputs are provided to them. They meet every Saturday to plan and assess with the program in-charge. The program caters to 250-300 students annually. Since the response of the formal school system to the needs of the marginalized and first or second generation learners is very poor, the children lag behind in classes. SAP helps weak students in their academics and overall social development. The understanding with BMC is that completing the syllabus is the responsibility of the school. The tuitions given by PATH in the evenings help them catch up with studies, in their formal classes during the day. Exposure and camps provide opportunities for the inculcation of values like cooperation, team work, and friendship.
The coordinator has to constantly liaison with school-authorities and parents and keep meticulous records maintaining different lists. The organization conducts its classes even during some holidays, as there are too many official holidays for the school. An understanding has to be reached at, on this matter, with school-authorities as well as parents.
There are two centres of tailoring – one in each area, catering to around 50-60 girls and young women. In addition to tailoring, designing and embroidery, some other craft skills (only in Cheeta camp) like glass-painting, pottery, soft toys, fabric painting, candle making and artificial flower-making are also imparted. Apparently, information on health and hygienic and on common illness is shared with them from time to time. The groups are keen to learn more and are also happy to come to the centres as it gives them an opportunity to get out of the humdrum of life. Several of them said that they are able to save on tailoring-sewing costs of the family. A few of them were able to open their own shop or start taking tailoring classes at home. Some of the girls have ambitions of becoming designers. Excitedly they showed garments designed and worn by them. All are eager to talk about child-marriage, education, marriage, freedom etc.
PATH looks at health holistically as a concept of well being. The emphasis is mainly on sharing information and enabling people to take care of themselves. Preventive and curative aspects are important.
Community and Family health care
The present Community and Family Health Care Programme addresses some of the problems faced in the previous programme, namely possibility of demolition, frequent change of residences and trips to native places. Therefore the unit for activity are both the community and individual families. The programme is designed to operate as per the needs of individual families and community needs. The target population is mainly women.
Apparently in the year 2009 – 10, the health workers completed working with 474 families and they continue to work with 92 families. In addition to education related to health, the workers take up issues such as making birth certificates, getting school admissions, taking a patient to government hospital etc. Some problems get solved and this gives some confidence to the family concerned.
The health-workers visit the homes of patients-especially TB patients whose progress has to be monitored closely and entered into records. They also identify new cases of TB. Health workers also advise and guide expectant and lactating mothers, e.g. for safe institutional delivery, nutrion and breast feeding and on home remedies. Every year they reach out to approximately 1000 families through these different activities.
Both the areas have clinics run by PATH. Since PATH began its work through clinics and health-work, their identity as a ‘chaar ana walah dawai khana’ (the clinic which gives medicines for 25 paisa) is well established in the communities. Two competent, caring, soft spoken and devoted doctors serve the clinics for 4-5 hours every alternate day. They have been with PATH for 24 years. Every year, the clinics have addressed the needs of 6-7 thousands patients. The DOTs (tuberculoses-cure) program of the govt. is implemented through these clinics. Government hospitals do the tests and provide medicines. Identifying, giving of medicines, keeping individual records, follow-up and all other services are provided by the organization. Here again detailed, meticulous records are maintained. Cases of T.B. are apparently increasing.
Medicines for some common ailments are provided to people from the communities at cost price. Daily collections are deposited and records maintained at the office. Doctors and health workers provide counselling on various issues related to health in the clinics as well as in the communities. Cases are referred to bigger govt. hospitals and private charitable hospitals, according to need. There is a referral service well-established with govt. hospitals like BMC Nair Hospital and Sion hospital. During the last 6-7 years, around 600-700 T.B. patients have received treatment. About half were cured, some moved out, 2 patients died, and some continued with treatment.
Health and immunization camps are held every year, in collaboration with govt. hospitals. Contact is maintained with a few public spirited private medical practitioners also. In awareness-programs theatre, posters etc. are used, especially on T.B. day and AIDS day.
Members of the communities have a lot of faith in the clinics run by PATH. One case can be illustrative of this. While I was sitting at the clinic, Naeem Ahmad came to show his papers and medicines from Nair hospital where he had started T.B. treatment, to the doctor here. He had faith in her as his wife had been cured by her. The doctor explained that she would have given him the same treatment; however she gave him some paracetamol etc. for fever and instructions for better and cheap nutrition, under the con-commitent care, so that he goes back satisfied. Later, when I chanced to meet him at his home, he shared how he was helped in taking care of his alcoholism too, through the organization. There are many such cases where the health of the patients is looked at holistically.
The term ‘Counselling’ is used by PATH in a broad sense and not in a narrow clinical sense. It includes giving information, encouragement, emotional support and facilitation to find a solution to a problem. Apparently this was practiced by field workers, especially in the community health care programme. It was from this that the Family and Community Health Care Programme was evolved.
After sometime this general practice of ‘counselling’ needed to be better organized and a three tier system was introduced. At the first level every field worker of all the programmes identifies persons who need any counselling. At her level she tries to provide help. At the second level the field worker refers the cases to multi purpose worker to deal with the problem, as she finds it to be beyond her scope. What is done at this level is treated as dealing with minor problems. If the multi purpose worker refers the problem to a professional (Social Worker or a Doctor) then it is treated as a major problem. Apparently this practice became diluted when target achievement became a major concern of some funding agencies. The organization feels that it needs to revive the in-depth analysis and understanding of counselling in the context of today’s complexities.
However, at the counselling centre today, cases are taken up and family conflicts and tensions are sorted out. Many recent migrants especially women find it hard to cope with city life. Their adjustment problems have been sorted out in a large measure. With women acquiring some education, economic independence and consequent assertion and confidence, issues of conflict have increased. The organization tries to address them or/and refer to competent agencies. During the last few years, over hundred cases were solved and tensions diffused.
Another area of concern for PATH is HIV/AIDS-awareness. Posters, rallies and theatre have been used to spread awareness. But more importantly, half an hour classes have been taken with small groups. Last year 25 to 30 classes covered 500 people-mostly tuberculoses patients. The lessons contain issues like modes of transmission, taboos unscientifically linked to the disease, precautions to be taken, check-ups needed, references to municipal hospitals, pre and post counselling etc. Doctors shared that taking up the issue of AID with any group is a very delicate one. The directives of Medical Council of Maharashtra, which they follow, are stringent. For instance ‘voluntary’ testing for HIV is mandatory for all T.B. patients. As social and medical taboos linked to AIDs are very strong, patients are very reluctant to go in for it. They are already suffering from T.B., so all sorts of questions hammer their minds. A lot of counselling is required. The organization has taken a maturer view in not ‘forcing’ T.B. patients to get HIV testing done. Instead, patients are given the form and explained that if they so wish, they can get the tests done. In any case the tests are done in specific govt. hospitals. Often doctors and health workers of PATH found it difficult to cope with the queries and demands of people regarding the disease. The discrimination against suspected cases is so strong that many a time identification is a huge problem. They try to identify cases also while on follow-up visits for T.B. patients. PATH-workers also feel that there are so many other rampant common diseases which are affecting people adversely and which are easily preventable and curable, that it is important that more medicines for these are provided.
2.3 Community concerns and Networking
On issues like water-scarcity and electricity, the organization has worked hand in hand with the community when there is a need, by providing information on relevant govt. agencies and strategies to decide on actions. Cooperation with govt. administrative machinery is in-built in service-delivery, so that patients/people can access state health services and also understand that it is their right to get them.
For many other actions and events (like 15th Aug. or 26th Jan.) PATH has joined hands with other organizations as well as communities. Good relationships are kept with different organizations like Nagarik Seva Sangh, Niramaya Niketan, Jeevan Dhara, Shivsena and Darul-uloom (the latter run an orphanage and give financial assistance to cancer patients). PATH is aware and cautious about the dynamics of local politics. For events and programs many groups come together. PATH works closely with schools of Social Work like Tata Institute of Social Sciences and SNDT University. Students come here for placements. Infact two social workers today are placements of last year, who decided to join the organization.
An important aspect of community work is addressing any problem that emerges in the community, especially that which demands urgent attention. Examples of this are the cases of flood and demolition in 2005, which claimed the time and energy of the entire staff, and which in fact derailed several of the ongoing programs.
Small and large community meetings are regular features. PATH-members provide advice and guidance to neighbours informally also. Guidance is provided on issues like documents needed for admissions to schools and hospitals, for obtaining a ration-card or any thing that people need.
Apparently, taking up women’s issues in community-events, through songs and skits, has helped in raising awareness. Many a time workers face the dilemma of whether to take up and pursue a community/family issue or not. For instance, whether to devote time and intervene in a case of domestic violence and of a child being taken to the police station (under the J. J. Act) or not. Sometimes, such cases are taken up, sometimes not.