SAKINA KI BIMARI



"Sakina's illness"
and
other stories

Weaving a tapestry	2
Asma decided to have an abortion and a tubectomy	11
Safeeda and Babu:	15
Khodeja and Mairun:	18
Self Medications: "Dear Dr. Gazadar" and her magical medication	23
Rehmat and her son who had scabies.	25
Our own immunization campaign 1980-83:	27






SPARC.
March 1991.








Weaving a tapestry

These  stories  were  written  in  August 1984. Many  of  us  who founded SPARC worked in a community centre at that time..  Several of our friends came as volunteers and as a result there was a range of skills and human resources available to those of us working at the centre. We worked together for several years where we expereinces the most powerful expereinces which have shaped our practice subsequesntly.  We all finally left that  centre  because its institutional structure limited what we believed to  be role  that NGO's needed to play. These stories were our  personal farewell  to the several years when we interacted with many  poor communities  and women. Through these stories we recall  some  of the most powerful experiences we shared with women there...  most of who now form the core group of Mahila Milan.

As  a group of community workers who gradually developed  insight into  and  respected the process by which women  learn,  we  used these insights in our work with groups of women in urban  settlements  of the poor. The most valuable lesson we learnt was  that  each individual/group knows what is best for them - they don't need to be taught   - what everyone needs is to know of options available and how to reach them.

These  are OUR stories. They are written by the  some of us and are, based on our perceptions. However, the experiences belong  to the women...  those  whose experiences  initiated  this  process, and later the collectives who listened to these stories, participated in them and made them the collectives "resource". Most of  us, at that time were unable to explain what  was   happening.  We  all knew that a typical heath  program,  a  traditional welfare  centre  was going through an  upheaval.  Everything  was changing, and being part of that change, we were too caught up in what was happening   to analyse it.

There are a few selected stories in this publication.  Every  woman, every  worker had several stories which were their  favourites...  stories which they would start narrating given  an opportunity...  a process which this newly evolving process intuitively  supported.  Clearly it was the most effective communication between  all of us. It made us laugh, often at oursleves, it gave us insights,  most  important .....  we all believed in these  stories...  because they  were OURS. Not some propaganda about what is good to  do.. something poor women are sick of hearing, but rarely  tell  anyone.

This  process  was not invented by anyone. Infact it  has  always been the most routine and traditional method by which women  talk to  each other. Stories have a special place in women's  lives... they reflect the manner in which women are socialised from childood from  where they derive their immageries about what  they  should aspire to be.

We  used  the form, but changed the content. Rather than  further  enhance  the sacraficial and "sati savitri"  imageries,  we replaced them with events in which all or some of us participated, wherein we felt some sense of personal or collective achievement.  Rather  than confront those traditional  stereo  types, we subtaly began to replace them with NEW alternatives. Just as  the original  stories  never directly forced women  to  accept  their "moral",  so  the new stories and their messages did  not  demand acceptance.

These  stories focus on issues of health. There are similar  stories  related to other areas of their lives. These  stories  were originally  written up to be part of another publication  on  non formal education strategies in health which was published by PRIA (Delhi).

We have revived these stories again to serve several purposes:

1.  To  illustrate processes by which a group or  federation can first  support individuals and groups to achieve what they  need, and  through the communication network, absorb the  learning, the achievements and the insights into its larger work thereby allowing those processes to be useful to others.

2. Women and their survival strategies form the foundation of how poor communities subsist in the cities. Yet most processes rarely touch  on  their needs, their recourses and  even  worse,  rarely build up women's capabilities to deal with those processes.  What we began in 1980 when this kind of work evolved, forms the  basis of how SPARC integrates women, their learning and insights into its work.

3.  Each story further tells many stories... we hope  the  reader will  delve into these and think of the issues in  learning,  in problem  solving  and sharing that they unfold. It is  time  that everyone paid a lot of attention to ways in which women teach and learn  and hopefully we can create mechanism by which women  participate in the development and change process rather than become objects and consumers of that process.

4.  Finally, this kind of material is precious because it is  our history.  Rarely  do community activists have the honor  or  the privilege of working with the same people for 15 years, and even more rare is the opportunity available for them to link what they do today with what they did with those women many years ago.

SPARC has that privilege. Most of the women in those  collective now form the core leadership of Mahila Milan. We continue to tell stories,  and in many instances major  organizational  strategies have  emerged  from such events and stories. To  illustrate  just one,  there is the story of our first immunization  campaign. In 1990,  we undertook a mass immunization campaign for  measles for the  Bombay  Municipal  Corporation (Attached as  annex  A).  To others it was a FIRST. To us it was an expansion of a process  we had begun 10 years ago.

Before  we  move  to the stories, we will  briefly  describe  the institutional set up within which we worked, the manner in  which we formed these groups and the context of the health program.

Setting up the process: The Community center is located in the crowded and inner parts of central  Bombay. It is an old and established  community  center, established  in 1926 by American Missionaries in the tradition  of Neighborhood  Centers  in the USA. The center  provided  a  wide range of programs which included a comprehensive health center, day care for babies, a nursery school, various classes in stitching and typing, counseling centers and so on. IN 1979,  sponsorship  of poor children was initiated whereby  monetary  assistance was given to children from the poorest homes in the area. All the women  who formed part of this process first came together  under the aegis of that sponsorship program.

These  women were mainly heads of their households (i.e.  they  were widows, deserted women with children or women with husbands,  who were either not working or incapacitated) and in routine  circumstances would have interacted with the project to take the money, reply to the sponsors letters and to utilize any services which  the center would provide them. Not content with this kind of arrangement,  these 600 women were organized into 7 groups.  Each  group comprised  of women from a particular geographic area. They  were to  meet once a month for a period of one hour to an hour  and  a half.

This formulation was initiated under vague feelings that such collectivity would promote solidarity amongst the women, that those of us who were administering the program were not content to just efficiently transact monetary processes. But there was no idea or plan in anyone's mind of what exactly would occur in those sessions. We therefore translated these concerns into two main objectives for ourselves. Firstly, to help women from each area to operate as a collective, and to be supportive of each other at times of crisis.
Secondly, to evolve through their own experiences, a meaningful learning experience which over a period of time would become a meaningful alternative which helped face daily crisis and other situations in life more effectively.

Health was an area on which we frequently dwelt on. It was suggested that we start volunteers training program. Infact, given the popularity of training programs in health evolved by various groups in the city, we were very seriously considering this possibility. However, we decided against it for two reasons. We were of the opinion that such a model was relevant in areas where there were no doctors and hospitals (e.g. rural areas).  In Bombay there were enough basic facilities. What was needed was an orientation to use these. So whatever basic health education was necessary we felt should be given to all. Secondly, most of the health workers were given some monetary compensation for the work they were doing. That in fact, seemed to carry its own implications and a host of problems rather than advantages.

For instance, although this was seen as an honorarium, workers saw it was a "wage."  This made them identify with the agency rather than with the community. Besides, given the financial problems which voluntary organizations face perpetually it seemed to be asking for trouble to initiate a program and know from the start that you could never pay minimum wages.

Finally, there was serious misgiving about sharing any knowledge with a few from the larger group. Often the difference in knowledge levels initiates the process of exploitation. For instance, it has been a common event in our neighborhood slums, that whenever somebody needs immediate hospitalization, the  "dalal" (agent) or some intermediary who has knowledge of how to use the hospital will do so for a fee. It could well be that by training a few; we were possibly creating a new batch of  "exploiters", when in fact our intention was just the opposite. However, we did have a group of about 20 women and a series of young persons who were all called volunteers who met initially twice a week, and gradually once a week, and later met whenever the need arose. These groups fulfilled dual function. They were women who were very excited with what was happening in the groups, had tried to utilize this in their lives. They  found  it effective  and were keen to learn more. Most of them were  either already leaders, others were potential leaders.

We utilized this enthusiasm to give them knowledge that they were keen to acquire, but also, sought something in return. There  was an unstated demand that each person who was "assisted" would then assist  the  next person in need. Often the initial  process  was uncomfortable  to  women, but we sought to support them  in  that role rather than help the next person reach the service. Initially  women  hesitantly  began to help other women  in  their  own areas, but gradually began to revel in their expertise and  assist others from the "outside".

This  gave us an inkling of how we could get all six  groups  together.  They  also shared weekly events which occurred  in  their slums.  This  provided  us many live instances  to  evaluate  and analyze,  and  to become sensitive to the type of  problems  they faced  and how they resolved it. They were encouraged to  discuss their  own  problems, and that of others as  well  as. Often  women would  go back to their settlement, talk to the  other  women, and seek group assistance to solve some problems.

As a result, although they were not trained as leaders, or health workers,  they  would  collectively take on that  role,  and  the entire  experience  centered around sharing new  knowledge  rather than just gaining knowledge. Much of the weekly conversation  was also to evolve a variety of strategies for communication. Knowing that this was vital, women from the collectives became partners to the workers in the organizations in closing the gap of communication. It soon became clear that their levels of communication were more efficient that that of the worker.

In this manner, gradually they also took over the role of leadership at the weekly meeting. Often we would have spent part of the month assisting a particular woman with her problem, and would draw upon her to relate this experience. Since this experience was live, and the woman known to them, interest and absorption of knowledge was greater.

Almost every woman who attended the process had a story to tell. The ones included in this case study are those, which are every one considered the most effective, and which were retold the most. It is also true that every woman did not succeed in everything she took on or that each benefited to the same degree. But the confidence to deal with the traumas was palpably present.


SAKINA KI BIMARI:

Sakina is the grand old lady from the Central Railway Zhopadpatt. She is a widow with two sons and several grandchildren. She and as a well loved woman, known for being very favorable to her daughters-in-law. Both the staff and the members of the group had labeled Sakina as a hypochondriac. She had a dramatic manner of proclaiming that she was ill after which she would proceed to describe in great detail, all her symptoms and then claim that she could not be cured by any doctor.

In order to understand what was wrong with her, we sent her first to our medical center. The doctor stated that since she had several symptoms and some chest inflammation as well as signs of TB, we should get her chest screened. And therein began her saga.  Veena, who was then a volunteer and who was assigned the job of assisting patients who needed an "escort" for the first time, went along with her to the Foras Road TB Clinic.  Veena could barely restrain her temper because Sakina proceeded to tell all the doctors at Foras Road TB Clinic that there was nothing they could do to make her feel better. All the doctors had tried their best to get her history, but all they heard was her own diagnosis.

Due to Veena's insistence that they should ignore Sakina and her talk, the doctor felt that she should first take a course of antibiotics so that other inflammations could be ruled out. Sakina had to take 4 large colorful capsules a day for a week.

Then she had to go back to the clinic, at which time all other investigations could be made. But a fortnight elapsed, and Sakina never went. Veena went there with another patient, and the doctor inquired with Veena about Sakina's whereabouts.   In her enthusiasm, and exhilarated that the doctors were gradually increasing their involvement in this process, Veena rushed to Sakina's house and found that Sakina had no intentions of going back to the clinic.

There was a head on collision between the two stubborn, strongly-willed women and Veena stormed out, came back to the clinic stating she would have nothing to do with Sakina in the future. She felt upset that Sakina felt no sense of obligation or gratitude for all the care and concern that was being showered on her. She felt that Sakina was a good example of why the doctors did not care for the poor patients.

In an unusual moment of inspiration, there was an impromptu meeting of all the persons who were there to share their views on what had just occurred. Most of the people present shared Veena's views and would have liked her to wash her hands off her.  However, some of us began to play the devils' advocate, and began to defend Sakina. It began like a game. But as we got deeper into it, what we were discussing began to sound viable.

May be, it was argued, she is frightened, and was using this big talk as a bravado. Or may be, by always complaining, she kept getting attention, something she needed more than the cure. May be for us this is trivial, but it is important to her. We already had enough experience sharing, in which we saw that unless a woman was very ill, neither she herself nor the family paid any attention to her or sought medical assistance.  Often, stress manifested itself in the form of psychosomatic illnesses, and we wanted to acknowledge that for it by providing women some space to seek help. It was not the most effective or positive method of seeking attention, nevertheless, we also knew the circumstances, which led to this.

Any way, after some hectic discussion, we were all ready to accept that Sakina may have reasons to behave like this which at the moment we must accept, but we also needed to know how we could help her to overcome it. While we were not sure whether or not she had TB, we felt that somehow this would be an important milestone in our women's groups. In a way, in her exaggerated manner, Sakina had crystallized the problems, which most women show.  We knew we were on the brink of something, but we had no idea of the fantastic breakthrough this was to offer.

Sakina's group meeting was to take place the following week.  At the meeting, we used TB detection and the usage of the facilities at the TB clinic as a new topic. There was a role-play done by the volunteers, and much time was spent on relating the experiences of the women's reactions to TB.  How women tended to hide that they or that any one in their family had TB. -  How often, the doctors did not tell patients that it was TB and as a result, despite the patient taking treatment, the family did not know the seriousness of the illness and the necessity of the treatment.

We  went into a detailed analysis of why there is a  stigma,  why people hid the fact that certain diseases are prevalent in  their homes  and we shared the statistics of the  Wards(Municipal  District) with them. Everyone listened but did not react. Then as if it  was a very routine question, we asked Sakina whether she  had gone  back  to the TB clinic to see the doctor. She  was  stunned that we should ask her this question in front of the group.  When she  tried  to change the topic, we made a  bold  statement to  the effect,  that while we admired her for being one of the first  to actually go to the clinic, we were disappointed with her  because she had not gone back. Infact, we were all concerned that she had not and wanted to know the reason why.

We all continued in this vein for some time, re-emphasizing that she  was a brave and a very smart woman who was investigating  by herself what was the cause of all her problems. Besides, we  said since  she was a well-admired woman in her slum, her  undertaking this  venture would set an example to the rest of the  community. Her  going for investigation did not necessarily  mean  that  she had  TB  . Besides even if it is TB, was it not  better  to  know that.  Was  it  not better to treat it rather than to  ignore  it until it would kill her, because it would not only kill her,  but it would also infect all her family and neighbors. Poor  Sakina, with every positive stroke that she got,  and  with every admiring glance that she got from the women, she was pushed into  a corner. We had gambled on her forthright nature  and  her decisiveness.

Once  having decided that she would, after all, concede and  participate,  and become the "heroine" of the day, she also  decided to hog the limelight, and dramatically, took out all the  antibiotics and flung them on the "chattai" (the straw mat on which  we sat),  saying that she could not swallow them because  they  were TOO LARGE.

The next 15 minutes were unbelievably enlightening, funny, and so very dramatic, that in themselves they provided so many lessons. They not  only electrified the group, but in later sessions, have never failed to have the effect as we anticipated.

She  proceeded to state that she had gone to several doctors  and in fact,  by the time she finished, she had mentioned  every  well known private practitioner in the areas. But, she said,  she  was disgusted  that none of them could give her the kind of  medicine she wanted. She did not like injections, they poked - she did not like  pills or tablets because she had trouble  swallowing  them, she did not like liquids because they tasted vile. Why are  there no other kinds of medications? She had the women spell-bound  and very  sympathetic. If we were not careful, this would rebound  on us. So very dramatically, we suggested ....that maybe what Sakina needed  was a "soonghanenki dawa"..., medication which she  could inhale... In this vein, it continued, all of us were in splits of laughter thinking up pleasant ways in which we could take medication which then would not be unpleasant.

Then every one sobered down. When we came back to the reality. We discussed.... Illnesses were not a joy ride, none of us fell  ill out of choice, and often, despite all our efforts, our loved ones fell ill. Unlike earlier days, when one could not have access  to medications,  there  was some improvement now. We  could  at least feel confident now that we understood what the cause was and what had  to  be done. We also knew that the methods the  doctors  use were  alien  and  often frighten us. Was running  away  the  only answer?  Making excuses in the start was Ok, but even that  meant wastage  of precious time. How were we as a group going  to  deal with  this problem. Were we going to make excuses, or  make  them listen to each other? or were we going to be supportive and  help face fears and resolve it?

We added another dimension to this matter. Veena was sufficiently calm  to relate how she felt about this matter, and how  she  had initially  evaluated  Sakina's behavior, and how  let  down  she felt. That she had  not wanted to have anything to do with  Sakina.  This became the basis of indicating to the women, that  they were also responsible to come halfway when someone agreed to help them,  and  to treat this as an equal  relationship.  After  all, unless it was meaningful to both, this could not be sustained.

Subsequently, Sakina completed her course, and also underwent the investigation to find that she did indeed have TB. Instead of not taking  medicines,  now, she would come  and  grumble,  complain, discuss  this  treatment.  Since we were  all  involved  in  this strategy,  and  we all wanted to see Sakina through  this  trial, whoever  was present listened to her tales. Besides she knew  how to keep an audience involved. While these discussions were on, we began  to read as much about TB and learn about it  from  doctors and discuss it when Sakina was around. She would actively participate  in the discussions, and seek explanations. Some  instances like  "drug resistance." Why does it occur... what are  the  reasons, or, we would talk of the various detection symptoms and  so on.

As  expected Sakina began to talk about all that occurred at  the Center  in the community. She would have a couple of people  from her  slum, tagging along with her, sheepishly stating  that  they were going for a check-up. Initially, Sakina wanted an  "escort", but  gradually, she relented to taking a referral note,  and  soon was confident even without it. It seemed that we had been  fairly successful  in the messages we transmitted, and   because  Sakina was tough. She would not take anyone who would not undergo treatment if found ill. Once she even went to the extent of getting  a very  ill  person from Matunga, stating that he  was  not  taking medication.  She felt that he needed to be hospitalized, and  she knew  we would help firstly to convince him that he should go  to the hospital, and secondly to admit him if he agreed.

Sakina  was a priceless investment. Right in front of his  family and  all the others who were around, she gave him a near  replica of  the treatment the group  had meted out to her at  that  first meeting!  She proceeded to draw for him a picture of  what  would happen  in the future, how he was going to infect every one,  and how he was finally going to die!  No small wonder, at the end, he begged to be taken to hospital.

This  provided us with the contents for our women's meetings  for the  next three months. Whenever Sakina could come,  she  related her  experiences herself. There were others who were  also  going through the same process and they too assisted in the process  of educating  the rest of the group. Gradually, each  women's'  group took on a commitment to first of all, take their own family for a TB check-up by going to the clinic, then, to assist in the  motivation  of at least 5 families in the vicinity. All those who  had already  gone  to  the community would volunteer  to  take  their neighbors for the first time, and several others volunteered  to come at least once a week to take any one who wanted to visit the clinic.

As  a  result,  we evolved several small  details  to  make  this strategy  work.  For instance, we worked out that if  the  people were prepared in advance about what to expect, it was easy.  They could  complete all investigation when they go with  their  early morning sputum in air tight bottles. Then they needed to go again at 9.00am, the x-ray would be collected on the third day, and  so on.  All these things were repeated on and on, and all those  who had  TB  had to get all their neighbors motivated to  check  out their  health. This serves a very valuable function. It not  only fulfilled  preventive functions of screening the neighbors,  but since the patient was assisting in this, there was reduced  stigma.  Patients  and  the community were now aware  that  once  the treatment  was  established, the patient would not  transmit  the illness.

Much  later, we also got the government to agree to allow  us  to become  a sub center and after the initial detection  and  establishment  of the regimen was done, the clinic would give  us  the medications  to  give out. We also made a slide  show  of  Sakina talking  about  her  experience with TB, and just  a  few  months later, we began a campaign of checking all children under five by doing a Montous' test. With the awareness about TB, and the readiness  with which they accepted this program, we were able to  set up a schedule whereby the doctor and other volunteers would go to any slum, and administer the test with the help of the women from each area who came to us for meetings.

The local women would gather all the children. Once the test  was administered, they would be told how to check if it was positive, and to bring the child to the clinic to show to the doctor. Since the indication was a swelling, this was easy,  and many  children were  detected  at an early stage. This led to screening  of  the whole family again, and starting of the drugs. All women from the community  were  now  taught about TB by those who  came  to  the Center.  Infact they were encouraged to bring them along  if  any questions  were left unanswered. This led to many others  joining the groups and attending meetings.

We have had many instances of people going to the village, taking drugs  with them and also, taking a letter from the doctor  about their  illness, and seeking information in the village about  how treatment  can be sought there. They claim to have  taught  their families  about the symptoms, and often accompanied them  to  the district  hospitals,  where they claim they talked  of  how  well Bombay hospitals treat the poor, as a means to get similar  service!.


Asma decided to have an abortion and a tubectomy

Asma  has been staying outside the community center  for  several years.  She  had the most smiling disposition  when  relating  to people  on the street and for a long time  (about two  years), she would  chatted with various community workers. When  groups  were formed, she  did  not know of this as none of the women  from  her particular pavement came. We began to relate to her when she  became noticeably pregnant, asking her whether she had registered in the  hospital. She seemed very puzzled about it.  She  said  that she did not know anything about hospitals and registration.

So  we suggested that she come to the clinic and get a  check  up and  maybe she would get some nurse to take her to the  hospital. As  a  result, our relationship developed - very  slowly.  In  the beginning, it created several problems. For instance, she was very theatrical and on the basis of the fact that she considered  herself our friend, she would prance into the medical department and demand immediate attention.

While  we  perceived her proprieterial behavior as a  shield  or  a cover for her feelings of fear and inadequacy and allowed her  to relate  in  that manner, the medical  staff,  at least  initially, resented  this  behavior.   There were many  scenes  and  often, though she was in the wrong, she would get away with it. Anyway, she was registered in the hospital. But finally, when  she was  ready to deliver, there was a hospital strike and Asma  gave birth  in extremely traumatic circumstances, in heavy  rain  with help  from her neighbor and her 10 year old daughter  -   Asma's daughter  from her first marriage who she had brought along  with her from Bihar.

When  Asma  had come into Bombay, she had started  working  as  a maid.  Another  lady,  also from Bihar, had advised  her  to  get married again and even suggested the name of the man.  It  seemed that this man was younger than her, had a wife in the village who did not come to Bombay and hence, Asma was the second wife.  This man  treated her carelessly, and on that particular day,  he  did not  come to help her. In fact, for the first year after the  baby was  born,  Asma had to fend for herself and  her  two  children, totally alone and as a result, this child became the center of her existence.

Her older daughter who had always trailed behind her as she  went from  house to house, was now to stay in one of the houses  as  a live  in maid.  Although they gave her no money, she  lived  there and her food and clothes were taken care of - this was Asma's way of removing her young daughter from the pavement and keeping  her "safe".  Seeing the struggle she had with her baby and her  work, we suggested that she put her baby daughter in the crèche to keep her  safe. This would be better than being on the street or  with her neighbor. Asma agreed. However, within a week of joining the crèche,  Asma began to fight with the crèche workers and  removed her child. Two weeks later, she wanted to admit her again.

Meanwhile,  other  children had been admitted and  there  was  no place for her child. So, every week she would come and chat  with us. As a result, she began to meet the other women, to attend the meetings and with her extrovert nature, she soon began to  interact  with others and absorb many of the happenings in  the  meetings.   Over  a period of time, we all became familiar  with  her complicated relationship with her husband. He was almost like her third  child. She would feel hurt when he deserted her.  When  he took money from her to gamble, she would rant and rave and  throw him out of the house but invite him back after a few days.

None  of  us understood this behavior but we  accepted  it.   We would argue with her, other women would try to tell her that  she did not need this relationship, but she always had ready explanations and continued to behave in the same way.  She also began to bring in her friends from her pavement...they began to come quite often and we noticed the gradual change in all these other women.  But Asma did not change......or so we thought.

At  one  meeting,  we  were  discussing  the  phenomenon  whereby women, after  resenting  the  way they were  treated  with  lesser priority than the boys in the family, proceeded to do the same in their adult life.  Women shared various examples of this attitude and there was a lively discussion about how women had to have  as many  girls as were chanced to be born before they got  the  SON. Since  we had already discussed the modern city culture  and  its effect  on  the sons who never look after their  parents,  women, at least  in the discussion, agreed that it was better to  nurture daughters  who at least came running to care for old parents  when needed than the son who never bothered.

When we came to work the next day, Asma was waiting  with a  grim face.   She had found out that she was pregnant. Though her  husband was happy about it as he hoped for a son, Asma did not  want this  child.  She wanted to know where she could go for an  abortion.   We  were a little worried - we did not want  her  to  get carried away by the group discussions and decide on something she might later regret.  So, instead we asked her to finish her  work and  come back in the afternoon.  When she came back, there  were several  women who were there for other work, so we all  gathered together  and   asked Asma to explain why she wanted to  have  an abortion.

She  said that she had just lived through two harrowing years  of  the  birth  of her baby and trying to cope with her work  at  the same time. She felt that things were getting better now - she was feeling  healthier and her baby was growing well and she did  not want  to go through it again. Her husband, she dismissed as  only wanting to prove his manhood by hoping for a son but as usual, at her  cost.  She had two daughters and she did not want  any  more children. Her husband could decide whether he wanted to live with her or not. Infact, she wanted to have an operation( a tubectomy) so  that she would not get pregnant again.  All the  women  questioned her, asked her to think it over - even we did that.  All of us were dazed as Asma spouted all the concepts and arguments  and discussions that we had had in the past four/five meetings.

Finally,  we  decided that she had every right  to  maintain  her decision.  We told her to wait for a day or two.  Meanwhile,  the nurse,  Sunanda, who was asked to find out about the  details  of  where  Asma could go, without realizing the consequences  of  the information, told Asma about the clinic etc. in front of her husband...not only that, Asma's neighbor wanted to have an abortion too  as  she had a two month old baby and was suffering  from  TB herself...NOW every one knew.

Asma's husband threw a fit, he threatened to hit Sunanda, said he would  kill anyone who thought they would assist Asma, and  asked Sunanda to go away. Sunanda came running to us, frightened by the outburst.  While we were deciding what to do, Asma  strolled  in, and  comically,  seemed to be comforting Sunanda and  us  stating that we should not take her husband seriously, and that  tomorrow she  was  ready to go to the hospital. The next  day,  the  other women  at  the pavement told us that Asma had a  fight  with  her husband, he had beaten her, and then she had asked him to get out and leave the hut... which he had. Asma came up and was ready  to leave.  She  even had her little baby with her. Sunanda  and  the others wanted to wait for a few days, worried that she would  not be  able to cope with her husband's fury, and not wanting  to  be party to a hasty act of bravado.

But  there was no stopping Asma, she said if no one was ready  to go  with her, then she would go on her own. At last she  was  escorted to the clinic had her abortion, her tubectomy and she came back  home.  Being Asma, she then proceeded to talk  to  all  the people  in the area about it and earnestly spent the  next  three days which she had taken off from work to talk to all and  sundry about her abortion, and why she did it. We too were amazed at her capacity not only to talk so much, but on such tabooed  subjects, and  at the same time, gave her all the support she  needed  emotionally, which meant listening to her talk.

What  happened  was that women who heard her talk,  both  on  the pavement and at the Centre, were all secretly admiring her  guts. They  did  not like the concept of abortion, but they  also  felt that  it was a possible action. At this time, we  introduced  the concept of contraceptives, what they were, why, how and so on.

Within a month of Asma's abortion, about 10 women came quietly to seek  copper  T insertions, and many more for  advice.  What  was fantastic  was that this whole topic came out into the open,  and from then on  we were able to initiate several other such personal  topics. In the meanwhile, both men and women in the  pavement slum,  gradually  began to take Asma's side, and  felt  that  her husband  was  in the wrong. Their attitudes were  based  both  on their observations of how he had treated her, and the discussions she had conducted on the pavements. As a result, her husband  who did not want to face community hostility, and who was in any case ready to come back to her, returned. He went to the dramatic  end of  asking  her if she wanted him to rub her back  or  press  her legs! A piece of news, Asma broadcasted to all the next day!!

Asma continues to come to the meetings, her general  relationship with  her  husband is the same, he comes and goes,  but  we  have found  that we have changed the way that we perceive her. She  is very  much  in control of her own life. In her own way,  she  has gradually  begun  to change many of her actions,  she  comes  and consults  the  group whenever she needs help, she  gets  everyone exasperated  with  her  attention  seeking  behavior,  but   her presence  is invaluable to the group. She is a constant  reminder to  us that knowledge is assimilated by different people in  different ways, and the manner in which it is used also differs.  It serves no purpose to demand compliance of a particular kind,  for that  in  turn  demands that a specific  behavior  pattern  must change  in  order to help us evaluate that we have  succeeded  in instituting change.


Safeeda and Babu:

Safeeda  is a widow. She came to Bombay about 9 years  ago,  with her  husband,  in search of medical treatment because  she  could have  no children. After a year's stay in Bombay,  she  conceived and  did  not miscarry as in the past. She had a  son,  whom  she named ALLA RAKHE popularly known as BABU.

Subsequently she had another child called Shabbir, who is now 3-4 years  old. She lost her husband soon after this  child's  birth, and  decided  to  stay on in Bombay rather than go  back  to  the village. Here, she was able to feed herself and her two  children and  find work. Besides, she was independent and need not  depend upon relatives, who were uncaring about a widow.

She  used to be very untidy and looked like she never combed  her hair.  Later in discussions, it emerged that she was expected  by the  rest of the people to be like that because she was a  widow. Combed/tidy hair was a sign of seeking attention.

While  she  seemed to think that she could feed herself  and  the children, there were a series of mishaps which occurred one  after the  other.  The most traumatic was that since she lived  on  the street, when she went to work, her children sat or played on  the pavements. One day, while playing, Baby went on to the road,  and was  run over by a bus. Luckily he escaped with a multiple  fracture in one leg.

He  was  immediately taken to the hospital, his leg was  set  and after two months the cast was removed. He must have been asked to do  some exercises, but she claimed that the doctor did  not  say so, and as a result, Babu could not put weight on the leg,  which was now slightly bent. He started dragging his leg.

It  was at this point that the women's groups were formed and  in one  of  the  many experience-sharing meetings  she  shared  this trauma  with  the group. She also seemed to come  the  conclusion that  she was very grateful for the help she got at the  time  of the  accident,  but her feelings after the whole  experience  was that the hospital frightened her, she would not have been able to go  there on her own, and that nobody there cared for her  child. Now, he could not even walk.

This  led to a discussion of why such accidents occur,  what  are the  measures possible at the time of crisis like  this.  Safeeda then  related  details of the entire experience and it  became  a lesson  for the women on how to admit an accident  casualty  into the  hospital.  Some very interesting details  emerged.  For  instance,  all the women used the ward boys as the ones  who  would give help. The ward boys would negotiate a price for this assistance and make the admission into a favor, possible only, because of their involvement.

Behavior of each member of the hospital staff was given  special significance.  For  instance if the nurse just smiled,  then  she liked  the  patient and she was absolved of all  future  neglect, under the excuse that she was busy. On the other hand, if any  of the  staff yelled at them in the beginning, then they  were  bad, did  not give  medication and wanted to harm the patient. It  almost  seemed as if much impressions were stamped into  permanence based on incidental, initial reactions at the time of the crisis.

Since  Safeeda stated all this in the group meeting, most of  the women felt very comfortable to express their similar  experiences at that point. No opinion was expressed by the workers.  Instead, we were ready to accept these statements at face value. We decided  instead to develop for ourselves and for the group, views  on this subject based on shared experiences. So to start we  decided that  we would collaborate with Safeeda in initiating  investigation about whether Babu would be able to walk normally.

Over the next three months, we had our first taste of how  indifferent  the  hospital is to the poor. She was on her own  in  the beginning  but  after her third visit, (after three  weeks),  she came to see us to one of us to accompany her to the hospital. Our first visit was a disaster. Then, through a burst of inspiration, Leena chose to act like a doctor, breezed through all the formalities, and demanded something be done.

What  occurred after that is history. There were sets of  doctors, one  wanted  to operate and while another did not. Twice  he  was admitted for surgery and brought back just before the  operation. Throughout  this  period,  several of the  staff  and  volunteers accompanied Safeeda to the hospital. While this dialogue  between two  sets  of doctors continued, we all  waited  very  patiently. Finally,  when it occurred the third time, there was  much  furore and shouting.

As  far as Babu's leg was concerned, the doctors were now  apologetic,  and  gave us a series of physiotherapy  exercises  to  be followed. At the same time, they seemed curious as to why so many people  were interested. At the meetings, these experiences  were shared.  Interestingly,  at that time, many other women  who  had problems  would seek to go along with either the  volunteers  and Safeeda  to the hospital. Without realizing it Safeeda, who  considered herself to be helpless and unknowledgeable began to  show others  how to use the hospitals. Infact, what began as a  tentative strategy is now a practice.

For instance, it is now a matter of common standing that no woman goes  alone to the hospital, she always goes with a group.  As  a result, there is less indifference to face and many brains  working together. Over a period of time, we have been able to  understand the hospital hierarchy and how different OPDs work, so that there  is better management of time. People know how to get  case papers,  what are the hours of various OPDs, and gradually,  have evolved a growing confidence in dealing with this large  hospital machinery.

We  had found that in the past, whenever the patient went with  a letter from the doctor, he or she was promptly dealt with. In the beginning, we put that to some kind of doctors' code.  Gradually, we  began to write official sounding letters on a special  letter pad, and  we would ask the doctor to reply on the letter  stating what the diagonsis and follow up was, for us to be able to understand  the problem. The result was fantastic. It seemed that  the patient felt boosted with the letter, which they considered as  a special  privilege.  What the letter did in reality was  that  it identified the exact OPD, the doctor whom the patient had to see, and described, although briefly, the nature of the complaint.

This  made  communication clear, and since patients  insisted  in getting  a  written reply 'for didi's' who wrote the  letter,  we were  able to explain to the patient on her return  what  exactly the ailment was, and what treatment was being given.

During meetings, all these happenings were discussed. Women,  who had  experiences to relate would do so, and with the help of  the workers, these experiences would be analyzed. As a result,  there was a definite impact on the second visit to the hospital. In the beginning, the doctors attributed this to us, commenting that  we were  taking  special care of the patients we  sent  through  our agency. However, gradually, as patients took others, demanded the same treatment, wanted explanations, all of us were  collectively branded as those 'people from Nagpada'.

Over  a  period of time, there was a great  feeling  of  security among  the  women in consulting with the Centre  about  what  the doctors said. Often decisions had to be taken about  hospitalization and treatment. All this was discussed with the staff at  the Centre.  Usually, each instance like Safeeda's was dealt with  on its own and as many of the neighbours who could be involved  were roped  in to help out. At the time of meeting, they were  encouraged to share this with the rest of the women, with a little help from  me,  the  staff and the volunteers in  twisting  the  event around so that the various facets became of educational value for them. By implication rather than by action, we were able to  show that  government  provided  services were funded  by  money  from everyone's pocket, and the poor had as much right to the services as  the  rich.  The hospital was not going to open its  arms  and invite  utilization of its facilities by the poor.  Instead,  the poor, who otherwise spent such a large portion of their money  on fees  to  private  practitioners and  medicines  purchased  could understand the medical services, and learn how to use them.  Then they could demand these services from themselves.


Khodeja and Mairun:

In  1982,  through the routine check-ups that  we  conducted  for various  groups, Mairun, the 4 year old daughter of  Khodeja  was found  to  have  a severe nutritional deficiency.  For  this  the doctor  had to give her six vitamin injections. While  undergoing this the doctor screening her out for other illnesses, found that she also had TB. She had to have 60 streptomycin injections.

We arranged with the TB clinic that we should be given the drugs, and  that we would give the injections. So we called  Mairun  and asked her to get her mother to the clinic, and we planned to work out the details of the treatment with her. When Khodeja came  she struck  us all with her quality of 'quiet strength'.  She  hardly talked, she listened a lot, and always got another woman, usually Safeeda,  who  could translate for her in their  Bihari  dialect, that all the people living on the pavement spoke.

She  was not a member of the group at that time, she stated  that she had to go and work, and that Mairun would come on her own  to take the injection. We were quite worried about this and we  felt that  this  might  mean we would have a terrified  child  on  our hands.  Mairun  turned to be quite the opposite. She  would  come everyday exactly at the same time in the afternoon, and she would proceed  to call Sunanda, our nurse, from whatever task  she  was doing,  jump upon the bed, and calmly wait for the prick  of  the injection on her rump!

Gradually, all the other children who were part of the  non-formal education program which NNH runs, (called the Happy Times  club), would  accompany  her and ask to be allowed to watch  this  daily routine.  Once  Mairun's treatment was established, we  were  now ready  to  check the rest of the family. We were  absolutely  depressed with what we found.

Khodeja's husband was a TB patient who had started treatment  but had stopped midway. He was not absolutely clear, but he was  also very  sick and refused to take treatment. Khodeja  was  pregnant, and  due to deliver any time. She already had three children,  of whom  Mairun was the eldest, then two sons, of which the  younger had a heart murmur, and was very vulnerable to infections,  coughs and  colds. Khodeja worked as a house-help in three  houses,  and earned for the family while the husband who was too sick to work, looked  after  the children. At that time, there was  nothing  we could  do to make her husband take treatment, and instead of  arguing  uselessly, we decided to wait for the right moment  to  do any further convincing.

Khodeja's baby was born on the pavement one night late in September  that year, and as a matter of interest, I shot a picture  of  her and the baby and the family and put it on the bulletin board.

Around  that time the meetings began and Khodeja began to  attend the  meetings. She would always come a little late,  sit  quietly through  the meeting, never open her mouth, and leave.  Only  her intense  concentration indicated her involvement in the  proceedings  of the meeting. During the next three months, Khodeja  went through  the  most harrowing period. Her son Zakir, who  had  the heart murmur, had measles and had to be hospitalized. Soon  after that  the  new born baby was very ill, and was detected  to  have primary cox. She lost her job, had to be in and out of the hospital,  and  during that time, most of the  pavement  dwellers  got together to give their family food.

Volunteers  and staff of the Centre would work out  her  hospital stay  for  arranging  necessary medication,  getting  doctors  to finalize the diagnosis, and to explain to her and the rest of the community what had happened. Sometimes this would be done at  the meetings, sometimes in smaller groups. It became evident that the feeling  of the entire group towards Khodeja was similar to  that of our staff. She was a very special lady.

At  the next meeting that Khodeja attended, Sakina already  begun to relate about the TB experience and she and all of us  stressed the  need to be very clear about the dangers of proximity with  a not completely treated TB patient. A few days later, Khodeja came up with Safeeda and Khaneja and stated that they wanted to have a discussion with me. It was her husband who was not taking  treatment and therefore causing these bouts of ill - health. She  said that  his wife, she was willing to be the main financial  support of  the house. She was ready to reverse role of husband and  wife with  him,  but she was not ready to do this at the cost  of  the children's health.

She  also stated that she was just over one very major crisis  in her life, and had come out of it with the help of NNH and all the people  from the community. But she was frightened of  having  to face it again. Now she had just managed to get a job and soon she would get more, but what was she to do with the feeling of  guilt that she had? Her husband was not only infecting her - the  children,  he was infecting the rest of the community, and  the  very same  people who had cared enough to support her.  Besides,  they were  were  living in the jhopda of Khaneja, and  Khaneja  had  a child...

We  all listened in stunned silence. There was nothing  that  had prepared  us to hear with such clarity the synthesis of  all  the information  we had generated and dispersed. So I asked her  what she wanted to do. Surely she had not come up only to explain  all this  to me. She took a deep breath and hesitantly said that  she and  her husband had argued about this subject the  night  before and several times before. Her husband was of the opinion that the drugs  harmed  him, and that she had no right to demand  that  he undertake treatment. He was the man, he was her husband, and  she had  better listen to him. So she had said that I had  threatened her that unless she brought her husband to me and got him started on  the treatment. I would encourage all the people on the  pavement  to  isolate him, I would not allow Mairun to  come  to  the centre,  and  I would stop all the medical treatment that  I  was giving her.

I  was absolutely flabbergasted!  What in the world was I  to  do now?  Did I really have a choice, I wondered because Safeeda  and Khaneja  said that they were already circulating that rumor  and that they had arranged for two of the other women to confirm this by  telling  it  to Mohd Muslim, Khodeja's husband.  I  was  very curious  as to why they had thought of this particular  strategy. Khodeja had her answer ready: she said, that she was very fond of her husband and he really was a nice man. He was a better husband compared  to all the other men who lived on the  pavement.  Since his illness, he was just not ready to take medication and all the time  he would find excuses to not take medication. In the  past, she  had accepted this type of statement calmly, feeling that  it was her 'naseeb'. Now, over the last six months, she had begun to see  that there were many alternatives which were open  to  them, but unfortunately, although she was convinced, she could not make him understand. She knew that he would die if he did not take the medication,  and probably kill her and the children. So  she  had decided  that  she  would use this strategy. She  knew  that  her husband, like all the men on the pavement outside were in awe  of me.

This  awe was partially due to the way I expressed  myself.  They were  also sure that my support was always with the  women,  and, that  during crises, there was always help. While this  was  comforting, it was also awe-provoking according to Khodeja, and  she saw  no reason, why with a little play acting it could  not  work out.  After  all, she had heard at one of the  meetings,  that  a woman from another group had threatened her husband who had  come drunk  late one night, that she knew my address, and that  I  had specifically asked her to take a cab and come to my house if  her husband  got  violent.  And  her husband  had  gone  off  to  bed quietly!!

So now, Khodeja's husband, very frightened of what this  "dragon" was  going to do to him, came to see me, and we arranged for  him to  be  taken to the TB clinic. We assured him that we  would  be very  helpful,  that we would assist him and that he  should  not worry.  Nothing we did or said could convince him that the  drugs would not kill him.

The doctor at the clinic said that he had abandoned the treatment twice before, and as a result he was now ready for the last  line of  treatment, and that if he stopped halfway, then it  would  be very  difficult to do any thing. We talked about this to him,  to the people who lived around Khodeja, and in the women's  meetings Mohd Muslim began to take treatment.

All went well for a month, but suddenly, one day, Khodeja came up to  me stating that for the last few days, he had stopped  taking medication,  and that he now refused to take them. In  her  anger and frustration, she had told him that she was not going to  look after him now that he had stopped taking medication, and that  he had  a choice of either staying with her and taking  the  medication, or he could leave the house and go. He had decided that  he would  go  and he had taken the train the night before  and  gone back to the village.

She  talked  for a long time, first with me alone,  then  in  the group about her mixed feelings, and admitted she could not decide how to judge her own actions. What struck all of us at that time, was that the groups who heard of her story, extended support  and sympathy to her as a friend, and talked about how they would have handled  it  but no one passed a judgement on  her  action.  Many women  shared their own worries about people in their  own  house who  had TB and who refused to stop spitting or take  medication. They  all  admitted that in their hearts, they  would  also  give priority  to  the health of their children, but  none  felt  they would have the guts to make such a confrontative choice.

For  almost  6-8  months her husband stayed in  the  village.  At first, he was spreading rumours that she had deserted him and was living  with another man. Khodeja was very hurt, and would  often say so, but she seemed to magically get support from all  others. At  one time, one of the relatives who had gone to  the  village, had  challenged  her  husband in a meeting of  the  "jamat,"  and related  the entire episode of what had really led to the  reason why Mohd Muslim had left.

Khodeja  gradually began to settle into a routine.  Her  youngest son,  now  two, was in the crèche, all the  older  children  were attending municipal school, and would attend the Happy Times Club in  the afternoon. Whenever she had time in between  her  various jobs, she would come up to the Centre with friends or alone,  and quietly sit and listen to whatever she found was happening around her,  and  accepted the roles, we pushed her into  in  her  quiet dignified manner.

For  instance,  she would relate her experience with  taking  patients  to the clinic, or to the hospital, or about how  she  had admitted her children to the school - often she would just relate what was happening in her life, and gradually, she also began  to talk on her own.

Suddenly, one day, her husband arrived back in Bombay. Two of the relatives who had gone to the village had found him on the  verge of death, and forced him to return to Bombay with them.

He was in a terrible condition when he arrived. Within a day,  he was taken back to the clinic, and they said that he had  deteriorated, and that he would have to be taken to the Sewri  Hospital. When he was taken there, the doctors advised that we  hospitalise him until they completed the investigations. When the  investigations  were completed, they told us that the chances of  recovery were dim, but if we still wanted to pursue this, we should  admit him into one of the sanatoriums in the suburbs.

We did that, and Khodeja would go once a fortnight to visit  him. It  was amazing the effect each of these visits had on her,  they seemed  to drain her completely and she was torn between  feeling concerned  for what was happening to him - feeling sorry for  the state  he  was in and at the same time resenting  the  manner  in which  every few months he broke down whatever semblance of  normality  she tried to bring to her life and that of the  children. She  would share this so honestly with all of us, that it  was  a lesson  to  everyone, on how we all live with  dualities  in  our existence.

A  few  months later, the sanatorium closed down, and we  had  to shift  him back to Sewri Hospital where the doctors  were  openly hostile  to taking in a terminal patient. After great  persuasion they agreed, but after a few days stated that the patient did not eat,  and  neither did he take his medication.  So  Khodeja,  our nurse, the ambulance driver and some other volunteers took  turns to  be  there at least at meal times to feed him and to  make  him take his medicines.

It  was no longer only Khodeja who was involved, we all were.  It was  as though, we were all fulfilling a commitment that  we  had collectively  taken,  a responsibility that arose from  the  fact that  we had all shared knowledge which had made us sensitive  to what had happened, and we wanted to see it through to the best of our  ability. We all knew that he would die, but we would try  as such as we could.

And  finally, he did die. Early, one rainy morning in  July,  the ambulance brought him back, after all the formalities were  over. All the people from the pavement pooled in money for the funeral, and one of the women for whom Khodeja worked, sent the shroud for the  body.  Her  uncle gave her a white saree,  and  Khodeja  sat dried-eyed while all this happened.

She  stayed home for a day, then went to work the next  day.  She was  listless  and we were all worried about  her.  A  hysterical woman we could have comforted. But Khodeja... she baffled us all. Two  days later, she found that her nephew, Samiulla had Rs.4  in his  hand. She asked him where that came from, and he said,  that the  teacher had asked him to sell four notebooks of the  10  his father had bought for him at a subsided rate from NNH.

She took him to the school, and to the teacher and very  politely asked  her to please return the notebooks to the child  and  take her  money  back. The teacher miffed at the way  this  illiterate woman  was  talking  to her asked why? Khodeja gave  her  such  a dressing down. She said that the notebooks, which cost double the amount,  were specially provided to very poor children as an  incentive  for  parents. They were not to be sold. If  the  teacher wanted books, she should find out for herself if she was eligible and  seek to take them directly, and not from a child  who  would not understand the significance of such an act.

She came to the Centre after this, calmly related the incident to all  of  us, and stated that she was really concerned  about  how much she had to learn, and that every step of the way, women  had to  keep thinking about whether what was happening was for  their good  or not, and she had finally come to the decision  that  she was  not going to wait to listen, - Now - after  work,  everyday, she  would  come  and spend time at the Centre,  learn  and  help others..




Self Medications: "Dear Dr. Gazadar" and her magical medication

Some time at the end of 1983, we felt that as a collective, women had  developed a fairly well worked out conception of health  and the usage of medical facilities. So far, we had been very supportive, always taking their side, and twisting the rules and  regulations  to  make them work for the people. We felt  that  having reached a state where doctors and medication did not frighten the people,  we should now move into new territory. At this  point  I want to state that all the women were not comfortable, only about half in the group could be in that category.

So  at one stretch of six group meetings, Dr.Mona Saxena  of  NNH spent  time with the groups, trying to make them  understand  the point  of  view of the doctors and the hospital, with a  view  to helping them to understand how routines were established,  admission  procedures, methods of doctors examining the patients,  the problems of very large numbers, the hierarchy within the  doctors and nurses, etc. At each point, several instances were related by the  women, and we were able to work out very meaningful  discussions. Then, we moved to the problem which Mona felt very strongly  about and that was the constant complaint of  patients  about 'Dawa ki assar', or the value and effectively of the medication.

She told them about the fact that most doctors usually start  off initially with the lightest medication... i.e. they should  start with  the lightest and least complicated medication.  On  finding that it does not work, they move to the next level, and then  the next. Often patients, either do not want to wait until they  have reached  the  right  dosage, or often, due  to  impatience,  they switch  doctors, and do not tell the second doctor that  she  has gone  before to a doctor earlier, and as a result, start  another first course, and consequently not have any effective medication. Then, one 'smart' doctor would start off with a heavy dose and... the patient felt miraculously better.

As  a result, there was a lot of discussion about doctors.  Women judged  the  effectively of the medication on the  basis  of  how quickly  they got to feel better. This, they called the  'touch', or 'haath ki goon'.  While this conversation was going on, Zamila Gazdar, wanted to  tell her story.

Zamila is a recently widowed woman, who was very comfortably  off when  her husband was alive. After his death, she found that  she was in a series of financial crises, and so far, she has resolved this by pleading to the well-wishers to do something for a  young widow with two small children. Her son Abbas is malnourished, had a  series  of  small infections, which were all  treated  at  the Centre.  Zamila was a very charming woman, who was fun to  watch, so  long  as she was not interacting with you. Then it  became  a strain to tell her not to put on such a heavy act. Anyway, as far as she was concerned, she made the things move her way ...

In  the  group,  she was a very  attention  seeking  personality, always opinionated, spewing inane phrases, which were part of the repertoire  that  she had developed, and she  always  refused  to accept others' points of view. Invariably, she would put  herself in a position of taking exactly the opposite views from the trend of the group, then get into an argument about it, generally lose, and  then  weep about her poor circumstances, and how as  a  poor widow, she was helpless, had no knowledge of the world so on...

So  at  this meeting, she wanted to relate about  her  method  of dealing with her own medical problems, and she started off... She said  that  she had been suffering with a terrible  pain  in  the joints  for quite some time. So she visited several doctors,  and told them at great length that she could not live with such pain. Many  doctors would give her medicines, and she would try it  and it  would do her no good. Finally, she must have gone to the  nth doctor  and wept at his feet, stating that he must  do  something for her. And... he gave her the medicine which stopped the  pain. But he had asked her to come again to meet him after ten days. So she  went  to meet him after 10 days, and he asked  her  to  take another  medicine,  she tried it, but found it did not  stop  the pain  in the manner that the other one had, so  triumphantly  she said,  you know what I did??, I started that older medicine.  Now for the last 5 years, whenever I feel the pain, I just go to  the shop (Chemist) and buy it.

We checked with her, she seemed to be using "Prednisolone"  which is  a steroid,! Mona was ready to tear her hair. Now  after  five years of fairly regular use, she could not stop this at once,  at the same time, to continue it was bad. There was a lot of discussion  regarding this matter. The group was able to understand  at that  meeting  some of the implications, and over  the  next  few months,  we were able to discuss the value, and harm  of  medications.  Zamila  Gazdar's story, sometimes told by Mona or  by  us would be the introductory vignette leading to the subject of  use and abuse, of all matters related, but Zamila Gazdar could  never be  convinced that she was not smart in doing what she  did,  nor could she be convinced to gradually reduce the dosage.

She  happens  to  be a very unusual member of  the  group,  whose contributions  at that point and during other sessions  became  a focus  of attention and taught the other women many concepts  but sadly,  Zamila never got back as much as she gave to  the  group. She  finally stopped coming for the last six months, and  we  are trying to locate her after her change of residence to see if  she wants to come back.

Women by and large do not follow a full treatment plan either for themselves or for their children. Often antibiotics, which should not have been prescribed in the first place are taken for a short time,  and this develops in the patient's body a  resistance.  So far only some of the women have understood it.


Rehmat and her son who had scabies.

Rehmat is a young 19-20 year old woman who has a 3 year old  son. She is a volunteer who comes very often to the Centre and  brings her  son  as there is no one to look after him.  One day  at  the meeting this normally happy and placid child was very upset.   So when  we asked her, she opened his shirt and showed us the  infection he had on his back.  She said that since it was the  weekend when  this had happened, she had bought medication from a  doctor but it was not giving any relief.

It  was  very obvious that it was scabies so we decided  that  we would use that as a topic of discussion. Someone asked her if she had  ever seen such an infection before so she and rest  of  them after  some time identified it as "kharooj" the marathi word  for scabies.   We discussed what it is due to, why it  spreads, how  it spreads, how  it can be prevented and how to treat it.  It  seemed from  the conversation that she had had with the doctor  (or  at least her version) that he had given her tablets and a cream  and since  she  did  not  have  it,  we  all  went  to  the   medical center, confirmed that it was scabies and showed her how to  apply the Benzoate on the child.

Four  days later, at another meeting she brought her son with  her and the whole bunch of women who were with her were giggling  and kept nudging her little son to tell me something. When he refused and hid his face, Rehmat said that the scabs had dried in two days and the little fellow was so pleased that he went around  telling everyone that Sheela didi had cured him.  The crucial part of the story  was  still  to come. Another lady's  (popularly  known  as "phoggewali")  husband was lying down and scratching himself  and this little boy dragged Rehmat to him and told her to give chacha the "didi wala dawai".

It was applied and he was cured.  So the women wanted to know  if it  would  be a good idea to go around their slum  and  not  only teach the younger children to identify scabies but also tell  how to deal with it just the same way as they had identified families needing immunization and told them what to do. This way, even  infectious diseases could be contained.

After that,they did go around their slum. In one slum, we gathered all the children and made them examine all their friends'  bodies to  see if they had any infections and then marched them  all  to the dispensary, where they applied BB on each other and talked  of how painful the itch was and what to do about it.



PART TWO:

LINKING PAST MEMORIES TO PRESENT DAY ACHIEVEMENTS

It  is  considered  "routine" in fact quite  typical  among  the communities of the poor (especially those which have been refered to  in  this report) for an educated person  to  "capitalize"  on experiences  they  (the educated) were a part of. Too  polite  to confront...  it is expected behavior of social scientists,  journalist to get excited with all the information that they get, the insights which they develop. So almost automatically, the  "natija"  or  result  is  "kajaj kala  Karna"(to  ink  a  white  paper black.. and  write about it... either to earn money or fame...  is the interpretation women give to such behavior.

Most  colleagues in the field of social sciences and health  have leaped  in  the defense of their behavior and  felt  angered  as aspersions  cast at what they consider valuable data  documentation.  How else will theories evolve? Few, however  persuade  this conversation with us. They accepted that what we were  presenting is  a  point of view expressed by women and  communities  of  the poor.  To  that effect it was a valid point. It has  infact  been these discussions which gave rise to such form of writing.  Later in  the end of the report we pursue these issues and present  the possibilities we see in it.

The  departure that we saw for ourselves in this  experience  was related  to  issues  linked to health on the one  hand,  and  the issues  of knowledge creation and its ownership and use.  Let  us take  issues of health first. Health interventions are part of  a larger  development and change process which is  affecting  large numbers of poor. "For their good", many changes have been identified as "good", tremendous investments have been made in alternative  infra  structures and training and personnel...but  none  of these  have sought in any real terms to include  the  perspective and  contribution  of the very constituency  which  this  enormous delivery system is seeking to address it self to.

While the manner in which the poor are treated as a group is  bad enough, the manner in which most development policies view  women many times worse. Women are wombs...is what poor women would  say if  their language allowed them to express this  succinctly.  But poor  women  communicate best in their own  way,  another  little story to illustrate!!!

In  one  of the endless meetings we have, women  were  discussing issues  related to health, hospitals, and doctors. Several  women were older migrants, while others had come more recently into the city.  Said Lakshmi, a recent migrant that she was finally  convinced she should go to the hospital to check out her pain in the stomach...maybe that treatment would suit her she stated.  Krishna,  who was sitting next to her asked, is this your first  time? Yes  said Lakshi, it is the first time, I had all my children  at home.  How  many children? she was asked... 5 she  replied.  Well, chanted  several in the group, when you go to the  hospital,  and the doctor comes to check you up, the first question you will  be asked  is : How many children do you have... don't say 5,  say  2, and say your husband has had a vasectomy! But why do you want  me to tell a lie? It is not to encourage you to become a liar,  came the  reply, it is the only way they will focus attention on  your stomach ache!!!

It  has  been a longstanding goal of this process to  make  women from slum communities central actors of change processes.  Health is  one of the "soft" areas... one which even  hostile  Municipal Corporations,  state government and august bodies like the  world bank  promote as necessary of homeless and vulnerable  population whom they consider "illegal" and unwelcome into the oasis of  the cities resource structures. In the next set of stories we link  up processes  which  we  began in 1980-81 to events  in  1990-91  to demonstrate  the alternate possibilities which can occur  if  investments in processes are made among people and they are allowed to benefit from them as well.

This  is the "story" of immunization of children. It begins  when the women's groups began their own immunization work.... and  the use made of a city wide campaign in 1991.

Our own immunization campaign 1980-83:

For a very long time, at least over a period of two years we  had been  encouraging women to get their children immunized.  On  the whole,  the experience was very dissatisfactory. It  seemed  that women  would  undertake the immunization only in the  context  of that particular immunization, and were unable to really grasp the meaning of the concept behind it.

Usually  some external pressure compels the woman to get a  child immunized. She does not understand the context, she does not know that particular dose of immunization is not all. Neither does she utilize  this knowledge for the benefit of either the same  child in  the  future  or for the other children. In  short,  she  just manages  to do what she has been told, at that  particular  time, because  the  person who told her to do so, is in a  position  to demand that behavior.

In  very rare cases, a woman with a small child would go  in  for completion  of immunization dosages. Our reason for focusing  on immunization was not only because we were concerned about the low level of immunization, but also because we realized that  dosages were completed only in one third of the cases. So we started this experience with a clear idea of what we felt discontented about. To seek answers, we turned to the women in the groups. There were some women who had in fact got all their children immunized. These women  seemed to share some very interesting features. They  were women who were generally familiar with the hospitals and  clinics and  were on good terms with the staff. They had either  accidentally or otherwise absorbed the concept of immunization as  being good for their children.

We had several small group meetings in which we showed these  and other women films about immunization, flash cards about types  of immunizations,  and also about methods of immunization.  However, we  found that all the answers were very mechanical, and all  the women  seemed  inclined to accept that immunization is  good  for them, because we said so, or the doctor said so.

So initially in a small group and then in a larger group, we took up the task of first examining what women perceived (on the basis of the information that they had) immunization as. We had a  very wide range of answers, some were close to the truth, while others far from it. Some women treated it as though it was a  "tonic"... they  said it was a medication given to children which made  them stronger. Others said that immunizations differed on the basis of whether  they were injections or  were oral. According  to  them, even the X-ray done to check for TB was immunization!

There  were several answers and synthesizing all of them  clearly showed that most of the women had some exposure to  immunization, but  as a result of their experience, they had a very mixed  version  of  the concept of immunization. It seemed  as  though  the interest  of the organizers of the health program was related  to the  immediate action of immunization of the child, and the  role of the mother was a matter of interest only as far as making  her co-operative in this venture. As a result, women seemed to retain messages, which after a period of time got washed away.

We  had enough experiences in dealing with women now, to  seek  a method of sharing information, which would seek to not only  help women attempt to resolve some immediate goal, but also serve some long  term purpose. As in all our other instances, we  felt  that immunization  to be an issue which was a powerful one.  It  would serve  to  reduce  the morbidity of children,  and  would  ensure women's'  participation at any given point. It would further  make them  capable of repeating this exercise on their own,  for  the same child, or other children, as well as become agents of change for  others  who are in their sphere of influence. Our  goal  was more  ambitious. This experience as a whole should help  build  a foundation  of women, taking on action after thinking  about  it, and feel more confident about initiating actions on the basis  of their analysis of the situation rather than persuasion by others.

While the order in which the following events occurred was not  as systematic  as  it seems in writing, this was more  or  less  the sequence in which they occurred. First, we sat down and  discussed what  we  thought was immunization. The  discussion  ranged  from protection  from disease to strengthening of the body.  The  dosages, the method of administering it, the purpose of the  immunization was not given much thought, in fact the very confusion was due to the fact that all these various factors were mixed up.

So  we  began with the basic concept of "Immunization -  What  is immunization?"   We  found that it required more  than  the  very simple  conceptualization. This concept is based on a  series  of other  concepts. So we tried various means - for  instance,  each person  tried to explain it in the manner they themselves  understood it. Then the person sitting next to them had to repeat  it, and then the group had to state whether it agreed with the manner in  which  the explanation was given. Finally, we  tried  a  over simplistic  example  -  Everyone was familiar  how  their  bodies reacted when they undertook a physically strenuous task for the first time.

Whenever the body had to do something new in the form of physical activity, it was some time before the muscles got used to the new form  of  strain, and s o, whenever we anticipated  that  in  the future we have to take up a new activity, we would try to prepare the  body  for  that activity. So making your  body  go  through "practice" of physical strain would make the "real thing easy  to deal with.

Drawing the analogy to immunization, it was explained that due to the  advances  of medical sciences, now it was possible  to  know some of the battles that the body has to fight in order to  fight the  germs which attack the body. So, in order to teach the  body how  to  fight the germs in case of a real attack,  there  was  a method by which dead germs would be put inside the body and  this would help the body develop a mechanism of fighting off the  real germs.

It  needed to be explained several times before we were  able  to get the women to understand this and relate it to others clearly. Once  that  was done, the rest was much easier. Infact  on  hind-sight, we felt that this basis of explaining immunization had not been  considered. Once this was understood, then the rest of  the information could be assimilated quite easily. So the next  thing we went on to discuss was the kind of illnesses that women recollected  in  their childhood as killer diseases. They  listed  typhoid, cholera, smallpox.

In  each of these instances, we drew their mind to the  immunization that they had either undergone themselves, or which they had seen  their children take. While all of them could recollect  the smallpox vaccine, due to the marks, there was confusion about the typhoid and cholera. It was only after we talked about the  children  getting this vaccine every year in municipal  schools,  the pain  that it causes, that they recollected it.  Many  sheepishly confessed  that they never sent their children to school on  that day.

From this we went to all the other diseases that can be withstood due to immunization such as TB, polio, tetanus, diphtheria, whooping cough, and now jaundice and measles.

We  then moved to the schedules that are necessary and  how  from the time the child is born, one has to keep is schedule in  mind. We also elaborated the different methods by which immunization is given,  oral or muscular. For all this, we had to stimulate  them into recollecting past experiences. We spent a lot of time making them  recollect  the reactions they had when their  children  had their  "shots".  Most of the women, as  mentioned  earlier,  went because of their faith in the doctor, or because their  neighbor had said this should be done.

We  then presented a possible strategy for action to  the  women. That  we  wanted to get as many women as possible  aware  of  the concept, and to encourage them to ensure that their children  are immunized.  After  much discussion, we hit on an idea  which  appealed to us all. We decided, that we would first of all talk  to the  women of the various groups, and once they were equally  enthusiasm,  and  able to appreciate the need of  having  all  the children of a certain area immunized, then we would suggest  that each  group  interested  would assist the  volunteers'  group  to enlist general participation of the women of a given area.

The  women  of the Apna Zopadpatti were the first  to  agree.  So about 15 women and volunteers went there one afternoon and divided themselves into 5 groups and covered a small number of  households. Since we had several women from that area, they knew which of  the households had children below the age of ten,(as  we  had decided to concentrate on triple antigen and polio). So in  about one hour we not only had a survey of how many households had such children, but we were able to work out how many of these children already  had  been immunized, who needed which dose,  who  needed boosters etc.

We then proceeded to give them an officious looking referral note and retained a copy ourselves. On this letter we wrote the  names of  children,  their  ages, and what immunization  needed  to  be given,  the name of the women was the main feature, and we  would work  out  a specific time when they would go to the  clinic  (so that at each given time, four to five neighbors would go together and would also remind each other).

At  the  clinic,  the nurses and the social workers  had  made  a master list of the names and so as the children came, they  would be  ticked off. Those who did not come would be then reminded  by the  local volunteers. They would also be given the date  of  the next dose, and asked to help each other remember when to  come ...  While all this was going on, we would all reinforce the necessity of  maintaining immunization schedules, and help women  recollect about past experiences about immunizations.

Apparently the most common problem seemed to arise out of  mobile medical  vans which come and give medication and immunization  at the  same  time, and often do not come back to  give  the  second dose. People did not seem to feel that they owed a responsibility to  themselves  and their children to find out  all  the  details about  who these people were, whether they were coming just  this one  time  or on a regular basis. It seems a  terrible  waste  of time, personnel and money to have muddled up services like that.

Whenever  we got news of a new born  baby in an area,   we  would encourage her to go to the hospital for immunization, in fact  we found  that many women thought they could go only if their  child was ill. So over the next three months, women would keep coming.

So  far as the concept of immunization was concerned, we had  now hit on an effective methodology to explain it to the women. Those who  learnt were able to further test the extent of their  knowledge  by trying to explain to others. And since we were now  able to  work out a method by which we could actually insure the  participation  of  all the mothers of that slum, we  felt  confident that this kind of a multiple exposure of action and word of mouth would gradually fulfill the expectations we set for ourselves  in this kind of work.

It is also very important to state at this point that by no means is  one round of such an exposure the end of this experience.  In fact,  we feel that it would take at least two to three  years  of yearly appraisal on the status of immunization to help  reinforce in the mind of the women, all aspects of immunization.

We  seek  to describe in this experience an attempt to  pool  all knowledge  that we had to evolve a strategy which would work  for us.  This  was based more on knowing what did not work,  what  we want and trying out several methods. In a limited way that  process continues in the spcific geographic vicinity of those groups.

Ten years later, another series of events gave us the  opportunity to  expand on these insights and to finally begin to  harness  our collective  insights  into  something which had  city  wide,  and hopefully larger urban implication.


"Making Immunization our Business"

A short report of events which occurred in Nov-Dec 1990, which we believe  have  a crucial influence on our work in  the  next  few years. Written by SPARC, Mahila Milan and NSDF 1991.

INITIATING  COMMUNITIES  TO  SPEARHEAD  THE CAMPAIGNMUNISE THEIR OWN CHILDREN.
A story of how we all got involved in this process.

Sparc,   Mahila Milan and NSDF are three  partner  organizations.  They  comprise   of  different kinds of people,  men  and  women, educated  and illiterate,  who have decided to seek many ways  to ensure  that  the poor  in the city... most of who have come from villages,   learn  to understand  how  the  city  functions,  and learn  to  ensure  that  it provides them all the facilities that it is meant to provide.

This   had   led  to  assisting groups of men  and   women   from poor  settlements   in  the city to learn many new   things,   to understand  better   their  own  situations,   and   to   develop capabilities   to undertake  many new activities which would lead them to gaining  the rights and recourses they want.

Immunization...   this  is the vaccination which the   government has  decided   to  give all children free... to   help   children  withstand common  diseases is one such service which is  provided through   the Bombay  Municipal  Corporation.  Its  health   centers  provide  this facility to all residents of the city. By and large,  most  community people know of Immunization  "TIKA",  and over  the years more and more people have been  immunizing  their children.

In  November of 1990, the Bombay Municipal Corporation  announced  that  it   was  not  satisfied  with  the  statistics   that   it  had   on Immunization.  The  figures  were  very  low,  said  the  Municipal  Commissioner,  and  he sought the  assistance  of  the citizens  to assist him and the corporation to find out why  this figure was so low.

It   was  around that time that we were approached  by   UNICEF..  which was seeking support from various voluntary organizations to  support  a   campaign for better immunization. In  that  meeting, SPARC,   MAHILA MILAN AND NSDF were asked if they  could  prove any assistance.

What   assistance could we provide? We have so far not got   ourselves associated  with  such  activities, besides we also   felt  (at   that  time),  that the BMC employed staff to  do  all  this work... so it  was their  job  to do motivational work.

But then, the children who were so  far  not immunized  were  the children from poor settlements... our  children! This   Immunization was a resource which was our due from the  state, and making sure that it reached the children was as much within  the purview of our commitment to ensure resources allocated to the poor reach them, as say for instance water, or electricity.

So  then what is it that we could so, which was  not  duplicating  what  the State had to do? What were the reasons why our  assistance was being sought in the first place?

In exploring this process, we felt that the State can make available  a service. It can create an educational campaign to  inform people  that  the  service is available, and  in  some  instances actually  plead  with the families to use it! But  that  did  not necessarily imply that people used the services.

We began to explore why people may not be using the services.  We thought of several possibilities. It may be that the people  look upon the service with suspicion...they do not understand  Immunization.  It  maybe that the communication system  is  faulty  and people are unable to understand what the educational campaign  is seeking  to tell them. It maybe that the services are not  available as and when stipulated, that the delivery of vaccination  is not  suitable to people, not within their reach and so on. Or  it maybe that people have not felt the urgency to participate.

So again the question, what can we do?
Oh  many things... and ideas began to pour in as  various  people who were participating in the discussion began to share possibilities:

All of us in this network KNEW this target population.. after all they  were  US. We knew how we reacted when we  saw  posters  and banners  and advertisements meant for us but which we  felt  were dysfunctional. Besides, ads and commercials sold soap, just  that form  was not sufficient to motivate us to do something  for  our children.  We knew this to be an issue to  influencing  community values. Our leadership and our women's collectives would have  to promote this as much through word of mouth as by this campaign.

But  some  suspicions remains... after all this  campaigning  and motivational  work,  will children brought to health  centers  be given  vaccines? It was essential that we had some  "control"  or say in this process. After all, our credibility was at stake.  We knew  that we would only get involved if our final  objective  of effective Immunization was achieved.

Both  the Bombay Municipal Corporation and UNICEF assured  us  of that. All health centers would be informed. All areas where there was  no  health center nearby would be  have  mobile  vaccination centers set up nearby for the children to be vaccinated.

Dear God, but just look at the time we have!!!! These discussions were  in  the last week of November, and the campaign had  to  be started in December and finished by the middle of January!!!

How many households can you cover we were asked. We began  counting the membership of various federations. And we came up with  a crazy number...3,50,000! So many? are you sure? Yes Ofcourse.

Formulation of the campaign:

The most central part of the campaign was the personalized "knock on  door" campaign. Through this process it was ensured that  the network  of  the Bombay Slum Dwellers Federation  (BSDF)*,  would knock  on the door of each household and check if there were  any children  below one year old. If there were, then they would  ask if  the  child had been immunized for measles. If not,  then  the child  and the mother would be given a Immunization  card  filled out with the child's name, and directed at a particular time  and day to the nearest primary health center.

In all instances, the volunteers and leaders who would  undertake this  house  to  house survey would have already  spoken  to  the doctor of the PHC and confirmed the timings. In all instances the first batch of children would be accompanied by the volunteers.

A poster designed and printed through the network members (in two days)  and in 5 languages, would be stuck in each settlement.  It would have written in  it how many children need to be immunized, along with the campaign messages.

Banners and posters were also strategically designed and  placed. The  campaign sought to provide local leadership support to  promote this campaign in their neighborhood. Do in the pamphlet,  as in  the  posters, local groups were at liberty to put  their  own names  rather than sparc, Mahila Milan or NSDF. All this  was  in creating  ways  by  which people could feel a  greater  sense  of  ownership over the campaign.

Similarly, when UNICEF representatives came and talked to the  50 key  leadership of the network, a video of about 45  minutes  was taken. This was duplicated and circulated to many areas and  used when  other leadership was harnessed into the project. That  tape was  their... As was a copy of many UNICEF  sponsored  advertisements on Immunization. Everyone was given copies each had to  use their own imagination to harness this.

The PHC staff and the teams from the mobile vaccination  campaign were  a  new entity for interaction. There were  a  few  initiate "skirmishes" In some instances they felt that maybe this campaign was  a  result  of their failure to achieve  targets,  and  their interaction with volunteers began in a defensive manner. But  the campaign fever soon got rid of this. And a more positive partnership began.

By the time the earlier target was achieved, demands began  pouring  in  from  the various ward offices of the  BMC  seeking  the assistance  of  the  volunteers to help them in  areas  they  had difficulty.  As  one  doctor  aptly  stated..."your  intervention liberates me. .I can now do a doctor's job, you make sure everyone comes here!".

A  totally unforeseen contribution came from the  street  children from "Sadak Chaap". They performed a street play which was  absolutely  fantastic. In the play was an abnormally large  injection being  administered  after much role playing to a  child.  All  the children  wore  T tea shirts with a message "have  you  immunized your child?" written on it.

In  one instance, the crowd gathered around this bunch  drew  the attention of a policeman who came and inquired... street children tend to generally run from the policemen... but in this instance, the child in view saucily turned around and asked the  policeman to  read what was written on the T shirt saying, "Policeman,  have you done this ? If not, go home and take your child to the health center!".  This episode was such a hit, it was soon  incorporated in the play.

All  of  us  who participated in this  campaign  have  been  very touched by the participation of almost 300 such street  children. Imagine kids who have run away from their homes, assisting you in immunizing your own child. But for the children the participation was  a spontaneous reaction. They are very involved and  closely associated with the leadership of Mahila Milan and BSDF who  are now their adopted aunts and uncles.

Many  of them hang around these settlements. This was their  contribution   to the families who have shown them love  and  affection.

The campain was over, we had statistics from the forms which  our volunteers filled out. We had reached out to 4,12,000 odd  households,  located approximately 63,000 children below one year.  Of these,  51,724 had already been immunized and 11,629  were  given cards and taken to the hospital.

The  campaign  ended with everyone feeling very good  about  what they  had done. Apart from the fact that children  have  received immunization, several other gains were seen to have been made:

*  In almost every slum settlement, there was evidence  that  the campaign was viewed as their own, and the leadership had  personally visited the health center and met the doctor and planned the vaccination... something which had not occurred before. This  was very valuable from the point of view of mutual accountability. If a  service had to be effective, it had to be administered and  it had to be utilized.

* It provided the group with "proof" of its effective  communication  skills. Those who are the targets of communication can  and should participate in the creation and execution of the  communication process ... especially if the process demanded a change of attitudes and changes in behavior. Our involvement proved to  us not  only that such a concept could be executed but also that  it could be successful and cost effective.

* It further illustrated the effectively of multiple involvement. We have always sought to ensure that people participate centrally in  development processes. To ensure that this  participation  in not  notional. What is notional? That people are not involved  to get a task done... that their involvement is not situational,  it instead  draws them into considering their need, and linking  the focus of the present "program" to that larger alternative.

To  that end, this campaign has demonstrated to all of  us,  that communities can and do have a vital role. The space for this role has  to  be made both by people and the state. That this  can  be built upon and over a period of time routinised.

* The challenge ahead of us now is how to build on this  success?
How to ensure that this small gain is not lost or forgotten.  How to communicate this possibility to other people like ourselves in other  cities  and towns. And most important not to  forget  ourselves what we are capable of doing.

It is March 1991 when we sit to write this story. We have made  a proposal to the Municipal Commissioner of Bombay. In that proposal  we have tried to build on this process by including not  only measles but also all other immunizations. We are translating this story in many other languages and  circulating it to everyone we know of who can either enjoy reading it, use it or learn from it. We are also sending this to the State administration, the Central government departments and other voluntary organizations who  can either  promote  this kind of process, or if they wish,  use  the core  group  which facilitated this process  to  trigger  similar participation in other cities.