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Swasthya Program |
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Program Information Swasthya functions within a 30 km radius
of Sringeri town in Chickmagalur District, Karnataka State. Through a
unique collaboration between the Sharada Dhanvantari Charitable
Hospital (SDCH) in Sringeri, an international student group, and local
village women, Swasthya aims to generate dialogue among local
community women and health and medical professionals about health, and
to provide health care services to the women and men of the Sringeri
community. The impetus for Swasthya came from a
group of Indian and American students of medicine and public health
who had independently been considering the possibility of working in
India. In July 1997, under the aegis of VISIONS
Worldwide, Inc., a student-run non-profit organization in the
United States, they forged a partnership with the Sharada
Dhanvantari Charitable Hospital and women residing in villages
served by the hospital. Thus, Swasthya, which is derived from Sanskrit
and means “comprehensive well being,” came into existence. The hospital and the students have
identified five local women, the Swasthya Community Health Workers (CHWs).
The CHWs have undergone training in nursing and are participating in
an ongoing training program on public health, community mobilization,
and group facilitation. Now, each
Swasthya nurse works in her own village community, promoting
health awareness through dialogue and action. By linking local resources and training
local women, the Swasthya partners have made Swasthya a permanent,
self-sufficient health promotion program based in Sringeri. The
Swasthya Kendras: “safe spaces” The partners teamed up to establish Swasthya
Kendras (health centres) in the native villages of the Swasthya
CHWs: Kigga,
Vidyaranyapura, Addagade,
Hanumanthanagar, and Kalkatte
in Sringeri Taluk and Guddethotta
in Koppa Taluk. Based at these centres, the nurses’
activities include: Ä
Daily fieldwork:
The CHWs provide personal outreach services tailored to the needs
of individual women and families by making daily home visits.
Through this fieldwork, the CHWs ensure that continuous care is
accessible to families in remote areas.
These regular visits have made the CHWs a trusted resource in
the community, enabling them to build open dialogue with women and to
provide holistic care to families.
The CHWs also organize small group discussions, presentations,
and workshops on health-related issues for women, adolescent girls,
and entire villages. These activities take place in homes, schools,
and community spaces. Ä
Daily provision
of primary care and counseling: The CHWs focus on providing
gynecological and obstetric care for women. They also engage in
counseling women (and some men) on antenatal care, contraception
including condom negotiation, alcoholism and domestic abuse. These
services are provided in homes, community centres, SDCH, and the
Swasthya Kendras. Ä
Weekly outreach
clinics: A team from SDCH including a Medical Officer and nursing
assistants visits each Swasthya Kendra once a week. The Swasthya CHW
refers all individuals requiring consultation with a physician to this
clinic. Swasthya’s outreach activities and the
regular physician visits have helped to institutionalize the Swasthya
Kendras in their respective villages.
In order to further operationalize the concept of the Kendras
as "safe spaces for women," we are attempting to do the
following: Ä
organize group
activities for women, such as knitting classes for adolescent
girls, rangoli sessions, and participatory development of health
education pamphlets; Ä
furnish the Swasthya Kendras with health
information materials such as pamphlets, books, and games; Ä
stock the Swasthya Kendras with other supplies such as
condoms, community resource information (government development
schemes, resource directory, etc.), and basic medications. Swasthya Programs:
generating dialogue and promoting local action Raising health awareness: In
the last year, health awareness efforts have focused on the
socioeconomic aspects of such health issues as alcoholism, smoking,
and violence, as well as nutrition and oral hygiene.
Moreover, by examining factors such as economic instability,
gender, occupation, food availability, and local practices related to
smoking and tobacco, the CHWs are able to understand the relationship
between prevention of illness and social environment.
Swasthya CHWs have worked with local organizations to develop
new workshops to raise awareness and promote community discussion
using audiovisual aids, role plays, street theatre and story telling. Educating children and adolescents about health: The
Swasthya team is developing and implementing comprehensive health
awareness workshops in schools and junior colleges. In these
workshops, interactive, participatory learning methods are utilized to
increase understanding about the
growth and development of the body.
The CHWs create an environment that allows youth to discuss
specific health issues such as pregnancy, contraception, HIV/AIDS,
sexual abuse, etc. Linking
health education and the performing arts: Sringeri is an extremely
culturally active community. Following the production of a video of
short dramas on local health issues, Swasthya plans to work with
interested artists to generate more such videos. Further,
Swasthya is making efforts to integrate other art forms such as dance
and theatre. We plan to stage such events
in local communities and film them for distribution
as educational videos. Organizing
local community women to
address health issues: Through its work during the past several
years, the Swasthya team has encountered a number of women in
surrounding villages who exhibit an impressive ability to think
critically about the role of women in their respective communities.
In August 1999, we held a Women’s Conference that focused on
domestic violence and that served as a platform for the exchange of
ideas between local women and the CHWs.
As a result of this momentous event, the CHWs are launching
efforts to establish their Swasthya Kendras as not only as a
safe-space for women, but also an environment for sharing and growth.
In the future we hope to see local women initiate their own programs
and utilize the support and resources available through the Swasthya
Kendras. Swasthya
Programs: encouraging sensitivity and empathy Counseling
services in the community and at SDCH:
In the last year, efforts to make health care more inclusive
have encouraged the development of a counseling program.
During the CHWs’ fieldwork, they encounter women experiencing
depression, anxiety, abuse related to alcoholism and other forms of
violence. In response to
the needs of these women, the CHWs have received training on
counseling and on providing support services to women and families.
These services are offered on-site in the villages, as well as
in SDCH patient wards. Through
these efforts to address social and mental health, the CHWs encourage
and support women to bring about healthy changes in their own lives
and in that of their families. Counseling services at SDCH are
available to anyone requiring them, but are specifically extended to
women seeking prenatal and postnatal care; women seeking medical
termination of pregnancy; women undergoing surgical procedures such as
tubal ligation, hysterectomy; women experiencing domestic abuse;
individuals with diabetes and/or hypertension; and individuals
diagnosed with tuberculosis. By offering counseling support to clients
of SDCH, the CHWs not only improve the quality of hospital care, but
also assist in the healing process. Providing preventive and curative gynecologic care: The CHWs run “Well Woman Clinics” in villages and estates in Sringeri and Koppa Taluks. They provide comprehensive women’s health exams, including health history, anemia screen, thyroid, breast and pelvic exams. The Swasthya team makes a special effort to ensure that the exams are conducted in a private space, and in a sensitive manner. Each exam takes approximately forty minutes as it includes a pre-exam and post-exam counseling session during which women’s concerns and problems are addressed. These clinics have considerably enhanced the CHWs’ esteem in the eyes of local women and health providers. Women residing in rural villages in Sringeri have very little access to gynecologic care and hence, are most grateful for the nurses’ new knowledge and services.
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