I have already been in Jamkhed for a week and everyday was so packed that I rarely had time to update. It has been...a week fully loaded with "what is this?", "why did this work so well?", "I am completely baffled.", "you gotta be kidding me", etc.
I am currently so overwhelmed with all these new things that I have to process. I don't even know where to start. For those of you who don't know much about Jamkhed and Primary Health Care, I want to first give you some background of the project I am learning from now. One Christian couple, Dr. Raj and Mabelle Arole graduated top from the most prestigious medical college in India four decades ago. Instead of going to shiny medical centers, they took a vow during their marriage to promise only work for the poorest of the poor. They came all the way to the poorest area of Maharashtra and started working at a rural hospital. Slowly, they realized that the poorest people were not even able to come to the hospital and there's entire section of the population they did not reach. Through a long process, they established what is now known as the Comprehensive Rural Health Project (CRHP) in Jamkhed.
One of the themes that we observed through learning their approach is that medicine is the one of the most mystified disciplines. Health care professionals love to come up with complicated terms that make other people unable to understand what they were doing. However, in a rural area, a lot of the health problems can be treated and prevented by very simple measures that do not require professional doctors. This is why Primary Health Care (PHC) is so important in terms of development. When in 1978 WHO declared the importance of PHC and Health for All in Alma Ata, CRHP has already started that approach and shown significant results.
Over the past week, we went to visit villages that CRHP has not been working with to just see what a typical Indian rural village is like. We also had a lot of discussions on principles of CRHP, PHC, factors of health and the caste system. During weekends, we visited some of the other programs like the pre-school and the adolescent girls' program.
Visiting Jamkhed is the first time I said to myself "This is what true empowerment is about." Just to give you an example, when the village health workers were asked that what happens if CRHP leaves one day, they said, "We will be very sad. But the work will go on." How many NGOs can say that after they leave, the community can continue the programs as they are there? This is really the key difference between CRHP and other donor-driven NGOs. People usually go into a community and say "Okay. What does this community need? How are we going to achieve that in the most efficient manner?" Then different projects get drafted and executed. After a few years, some of them work and some don't. When people say their work is sustainable, are they talking about the sustainability of the organisation or the projects? But in Jamkhed, it's the completely opposite way around. They go into the community, gather socially-minded people and let them discuss, "what are our problems? why do we have these problems? what do we really want? how can you, as an outsider, support us?" Everything generates so organically from the ground. I was truly amazed to see how these people have done such brilliant work not by following instructions of "professionals" but the ideas of their own.
Not just that, there are so much that happened here that I even find hard to believe. This is like a utopia and I genuinely don't understand how they reached this stage. If you know anything about the Indian caste system, you should know how deeply it is ingrained in rural Indian and how unjust it is. When the village health workers were telling us their stories, one of them said that in the past, because they are the dalits (the "untouchables" in the caste system), they could not even accept food from others. When others pass them food, they had to hold their saree and catch it. If the people from the higher caste touched them, they need to go through a purification process, which is drinking cow's urine. Do you see how ironic and ridiculous this is?! They'd rather drink cow's urine instead of touching a human being! But this same woman, is now elected as the major of the village after proving herself as a village health worker in CRHP. I find this so hard to believe but this person right in front of me. I really cannot wait to know more and understand their whole approach in the weeks to come.
During our village visit, we had some really interesting observations. This village we visited is a non-project village and tomorrow we will visit a project village to see the differences. But when we went around, we realised that the better-maintained households are closer to water sources. I asked them whether it is the same in other villages. I was told that in project villages, it is the opposite. They purposely built the well at low-caste households to force the higher-caste people to go to those areas and take water. This is one of the tactics they use to try to increase the interaction between different social sectors. We also went to a snake temple. Usually, when people got bitten by snakes, they will be sent to the temple to pray. The people who were at the temple said that they are very unhappy that nowadays, more people go to the hospital instead of the temple. But then, the interesting thing is, people send male to the hospital but still send female to the temple. So that means they know that hospital is the right place to go, but why only for male?
There are so many interesting things that I went through this past week and I constantly felt mind-blowing. The controversies in the non-profit world, the caste system, women's status, the difference between rural and urban India, community empowerment and primary health care - there're so much to learn and I'm not fully understanding everything I'm seeing. I'm indeed very anxious to see how the next few weeks will turn out. This is going to be fun.
