Friday, September 23, 2016

East and West - a slice of Odisha in Gujarat

Surat is a bustling, prosperous city, known for its diamond cutting and polishing industry, as well as for the largest production of man-made fibre in India. It has one of the largest wholesale textile markets in the country, and has thousands of powerloom units for production of cotton and synthetic textiles.
Surat the textile city, by night.

Last Sunday, I was given a glimpse into a part of what makes this city the capital of India's textile industry.

Raju's Dance Academy in Meena Nagar
Meena Nagar is one the areas where powerloom mills abound. Its busy streets and narrow lanes are all bustling with activity - with no women to be seen. This is one of the hubs of migrant workers from Odisha - an estimated 700,000 of them in the textile sector alone.

Raju (name changed), who shows us around, wears jeans and a full-sleeved T-shirt. He is thin and wiry, with bright eyes and a cheerful smile. He is also from Odisha, and proudly points out his shop on the first floor of a larger building. This is the Realy Dance Academy which he runs and says is doing well. (It teaches hip-hop, Bollywood, Canterbury, Kathak, Break, Step-up, Fri Style, Sambalpuri, Classical, Pop and Bebop). He moved to this after he saved up some money working on the looms. He was fortunate not to have family members needing support and is one of the very few who could move out of working on the looms at a young age. He is most probably a second generation migrant in his family - many migrants have brought their families here and settled down, creating a mini Odisha, complete with Oriya schools and cinema theatres showing Oriya films.

We first go to see the "mess" where the loom workers live - one is through a narrow dark , damp corridor, up three flights of crumbling, sometimes slippery, narrow stairs with no railing to hold on to. At each landing is a smelly toilet overflowing with water (and perhaps worse), which sometimes drips onto the landing below. The smell is overpowering and nauseating.

On the third floor we enter the kitchen where enormous quantities of rice and daal are being cooked. I see no signs of any vegetables other than potatoes and onions. The mess in charge is here, who manages the kitchen as well as the facilities for the migrants - water and electricity and the rent. The building is rented by him from the owner. He charges Rs. 2200 per month from each man for stay, and for the meals. The floor above the kitchen is where the workers live - over a hundred of them in a room barely 100x40 feet in dimensions. There are no windows to this room. Clothes lines criss-cross across the room, sagging beneath the weight of wet and dry clothes. Along the wall are tin trunks and rexine bags holding the belongings of the men who live there. Several are fast asleep, but about a dozen gather around us to talk. They have just completed a 12 hour shift in the looms, and have had a bath. They will now eat and sleep for most of their shift off. For entertainment they watch movies loaded onto their cellphones in nearby shops for a small fee.

They are all from Ganjam district in south Odisha, and are surprised and pleased to know that I know the language, and that I have lived in Ganjam for four  years.They range from 18 to about 45 and have worked here from five to twenty five years and more. They say the work is tough - 12 hour shifts with no days off; no sick leave or leave to go home to Odisha. They go at their own cost once or twice a year, not earning when they are away. Each month they send some money home through small shops that facilitate money transfer through banks. These shops charge a steep Rs. 25 per Rs. 1000 that they need to send home, but it is convenient for the workers to hand over money to these entrepreneurs. The banks are reluctant to keep transacting small amounts of cash each month from the worker to their account in Odisha. Besides, most are asleep during banking hours.Still, the pay here is better than what they would earn at home. A novice is paid around Rs. 8000.00 per month after he has spent some months learning the job (when he is not paid at all, but usually a senior family  member who is already working on the looms looks after him). More experienced workers earn upwards of Rs. 15000.00 per month. I listen in silence, wondering how we as a country can be utterly indifferent to how workers in our factories work and live and eat and earn.

There are many such messes in this part of the city.

Raju next takes me to see some of the looms. We go into the next street, into a series of three and four storeyed buildings which are crumbling and have not seen a coat of paint in years. The path in between the buildings is littered with knots of synthetic fibres that have been discarded after the weaving process is done. There is a steady clack-clack-clack sound emanating from the buildings, which only gets louder as we draw closer. Visiting one of the powerlooms takes a fair amount of negotiation with the supervisor who checks with the owner that he has been informed of our visit. Finally we are allowed in.

The noise inside is deafening and throbs through you, as well as through the floors and walls of the building. The building seems to be vibrating too, and I wonder whether it will collapse on our heads - it seems decrepit enough. On the floor are a row of powerlooms, each with a red light glowing as the machine works and the shuttle races back and forth across the loom between the frames. When the thread breaks, the light goes off and `the machine stops. The worker then has to restore the thread and start the machine again. Each worker monitors twelve looms. We can barely hear ourselves speak as the noise of the looms drowns out all sound - indeed, all thought as well.
Thread being wound onto the spindles for weaving.
The floor above has rows of machines which wind the thread from large reels onto the spindles that will then be used in the looms.

I tried to discreetly record a few seconds of the sound inside the loom - a bad recording with my low-end cellphone, trying to keep my clothes from getting caught in the machinery. To get an idea of what it is like, play this sound clip on the maximum volume your device will allow. The sound is much, much louder than this.


Twenty minutes inside the powerloom shed and we came out with our ears ringing and a temporary deafness. What does it do to people standing there for twelve hours every day, day after day, week after week, month after month without a break? Noise induced hearing loss for sure; stress due to the long hours and the high level or noise (Powerlooms typically generate 90-100 db of noise, whereas city traffic noise level is about 85db, and ordinary speech is 55 db). Every 10 db increase means a doubling in loudness. At the noise levels in powerlooms, and working for twelve hours at a stretch, hearing loss is guaranteed. Additionally, noise induced stress as well as inability to concentrate are well known.

All the powerloom sheds have officially less than ten employees, thus keeping them out of the purview of the Factories Act where certain rights and privileges of the worker are guaranteed by law. Most of these workers are in the informal sector, vulnerable to exploitation by the employer.

Power looms like these are also now struggling to keep up with the competition provided by more efficient water jet looms and newer designs of looms. Hence the lack of investment in upkeep (apart from the minimum to keep the machines running), and the reduction in the workforce (where earlier one worker tended to four machines, now each worker looks after twelve looms), in an effort to cut costs.

I left Raju at his Academy after visiting three powerloom sheds and two messes, marveling the hope and joy in youngsters who have enrolled in his dance academy, even living in this environment of displacement across the country for hard work, poor living conditions, and even poorer wages. I feel angry and depressed too.

Driving back to the hotel, the glittery buildings and the flyovers of Surat are not so impressive any more.

Sunday, May 1, 2016

Uttarakhand diary

Forest fires between Ramgarh Malla and Bhimtal
Smoke rises from fires near

The mountains are on fire. Literally. I was in Nainital district for a week, and smoke haze lay thick in the air. Driving up from baking hot Kathgodam last Saturday afternoon, the driver Dinesh tells me the Gaula river running past the town has been dry for some weeks now, and each year there is less and less water in it. Our destination is a village called Khansyu in Okhalkanda block in Nainital district. The normal route is past Bhimtal, but Dinesh seeks an alternative, longer route as the Bhimtal road is blocked, and there are many fires along the Bhimtal road.

I try to ease my nausea induced by the numerous hair-pin bends by lying down in the rear seat of the taxi, but it not helped by the acrid smell of wood smoke. In some places the smoke smells of pine. We drive past tree trunks charred and still burning.

The dry river bed of Gaula river near Khansyu
Khansyu is in a valley in Okhalkanda block. The Gaula river flows at the base of the valley, and is completely dry. This is the river that supplies water to Kathgodam. Nain Singh, the local co-ordinator of the project I am visiting, tells me that in the six years that he has been here, this is the first time it has run dry.

The place is beautiful, layers and layers of mountains all around. That evening, though, I see a fire creeping up the hill opposite. I cannot see other fires, but I know they are there. The next morning, the valley is full of a smoke haze.

A fire creeps up the hill near Khansyu
Smoke haze in the valley at dawn.
The reason for the fires are discussed locally - was it the locals who tried to burn the grass? Was it the dry winter with no rain at all? Is it the pine forests that help to spread this fire far and wide? Some blame the pine (an import by the British) for it all, saying it depletes ground water, does not allow other trees to grow, and that it is highly flammable.

There is a terrible water shortage in Khansyu and the villages around, and indeed all over Nainital district. Water is guarded jealously, and having your water tank emptied in the night is not unusual. During the week I was there, water was supplied twice.

Driving back to Kathgodam on Friday, we cross large tracks of mountainside that have already burnt out - blackened tree trunks (some still smoking), an eerie silence with no bird calls, no crickets chirping, and an overall bleakness. Would the earth look like this after a nuclear holocaust, I wonder - such total desolation?

Closer to Bhimtaal we see and hear fires again, and just a few kilometers before Kathgodam I spot large areas of mountainside that have been sheared clear of trees and dirt. Landslides during the monsoons last year, Dinesh tells me. They stand out as ugly white streaks many metres wide, against the brown and green of the mountainside, ending in a pile of boulders at the bottom of the valley.

The mountains are achingly beautiful, but how long can we preserve them that way?

5 pm: Just received the sad news that Nain Singh's landlord died on Saturday, trying to save people of his village when the fire threatened to engulf their homes. He sustained 80% burns and was taken to the hospital in Haldwani, but could not be saved.

Thursday, April 7, 2016

Where do we go from here?

Bicky, 9 and his sister Vaishali, 6, are children of a gardener who works for our landlady downstairs, as well as for several other house owners in this relatively better off part of Bhopal. They are both first generation learners, their parents having moved to the city to give their children a better education than they could get in their village. You can see them last year, elated with their new uniforms and ready for the new school. (They moved schools to one in the neighbourhood, when their parents moved to live in this area).

Vaishali and Bicky, 2015
Bicky is in Standard 3, and is in a Hindi medium private school. He is not able to read simple words in Hindi, nor construct a sentence. His English textbooks have been selected by the school, and have words far beyond his comprehension, telling stories that he cannot relate to. While he struggles to spell "table" and "door", his English textbook talks of the "quest" of a prince in search of the "most beautiful princess in the world" and of the beautiful girl who knocks on his palace door on a night of "torrential" rain. 
Bicky can neither spell or understand what all this is about. Yet his workbook is complete, and correctly done. 
How is this, I ask him. 
The teacher writes the answers on the blackboard, and we copy them down, he says. Then she marks them as correct. 
His parents send him to a tuition teacher each afternoon, paying the same amount as the the school fee each month. 

Vaishali is in Standard 1, and her parents put her in the English medium section of her brother's school, hoping she will have an advantage over others studying in the Hindi section. She has a problem recognizing alphabets and numbers, though her English workbooks, too, are full of words copied from the blackboard and marked as correct answers. However, her maths skills are passable, and she can do two digit addition (don't ask her to recognise and name the numbers, though). She is in a class full of upper middle class children in this neighbourhood, and is not getting the extra attention she needs to learn. 
She, too, attends the same tuition classes her brother does, and neither seems to benefit from the tuition one bit. 

When they come upstairs to study, I keep trying to make sure they learn their basics, while they are under pressure to prepare for the test the next day. I am aghast at the quality of teaching going on in their schools, and how they and their parents are being cheated. If they cannot be provided a proper primary education, where do they go? Who regulates the quality of teaching in all the small neighbourhood "private" schools that spring up like mushrooms everywhere? 

Don't we owe our next generation anything? Can we honestly look these children in the eye and say we have given them a fair chance?

Tuesday, December 29, 2015

An inspiring man

I find that my blogs related to health services in rural India have mostly told negative stories, of services not provided, of indifferent or hostile care providers,of difficulties in access and availability of basic services. I have met many cynical or jaded or dishonest health care providers, be it ANMs or doctors, ready to misuse the system, or just be indifferent and do the bare minimum possible. There are any number of excuses - some valid, some not - as to why they are not doing what they are supposed to be doing. There have been a few very good ones of course, and the effect is immediately apparent - a motivated team, or a community that is immunized or gets the services it should. And these people keep the system going.

Dr N Saxena, Civil Surgeon, Rajgarh
Last week I visited Rajgarh district in Madhya Pradesh. It borders Rajasthan and the district headquarters town of Rajgarh is dry and the landscape more akin to desert areas - in complete contrast to the southern part of the district that is forested. My colleague and I visited the district headquarters hospital which is housed in an ancient building. We met the Civil Surgeon Dr Niranjan Saxena who is in charge of the running of the hospital. In the hour we spent talking to him about facilities provided at the hospital, and constraints faced, I watched him process several files. These were of patients who needed more care than the hospital could provide - facilities that were often available only in private facilities, at a cost the patient could not afford. He was instructing his assistant about which scheme could be utilized for which patient, and what amount. For instance, there was one child who had come with headaches, who turned out to have a benign brain tumour. The family could not afford the treatment, and Dr Saxena recommended a grant of Rs. 1 lakh from the State Illness Assistance Fund.

He informed us that he uses this fund, as well as the Chief Minister's Scheme for health assistance, in addition to the Deendayal programme for financial assistance in health care. He is a surgeon by profession, and carries out all kinds of surgeries - general and orthopedic surgeries (including amputations where necessary); obstetric and gynaecological surgery when the obstetrician is on leave; and cancer surgery. They see about 20 cases of oral cancer each month, and 1-2 cases of breast cancer. Post-operative cancer patients are then referred for radiation or chemotherapy to higher centres that have these facilities. Day care for chemotherapy is provided at this hospital, once the regime has been prescribed by a higher centre.

Not many women with cancer of the uterine cervix are seen, he said, probably because too many women have their uterus removed at an early age. A sad commentary of our times.

Dr Saxena was full of energy and enthusiasm, and informed us he retires at the end of the year, when he turns 65. One would not think it, to look at him. An inspiring man and one that the health system could utilize for some more years to come.

Friday, April 3, 2015

'Acche Din' in Salumber block

Palash amidst the all-pervading brown
Salumber block of Udaipur disrtrict in Rajasthan is a study in brown. Brown hills, bare trees, brown rocks absorbing and radiating heat in the harsh sun - hardly a welcoming place at this time of the year. Bright orange Palash flowers defiantly add a splash of colour amidst all this drabness. The only greenery is are a few thorny shrubs on the roadside or the occasional palm. I have seen these same hills in the monsoon - lush green, streams flowing, fields green with crops, so I know this brown is just a passing phase. Still I put on my dark glasses for the drive from Salumber to the clinic at Ghated, half an hour away.
The road to Ghated

The Ghated clinic opened four months ago, and is staffed round the clock by three nurses, while a doctor visits once a week. Today I accompany the regular doctor to the clinic. Amidst a range of patients who attend, I meet and talk to Bhanwarlal who is 32, and suffering from tuberculosis. 

The oldest of five children, he migrated to Ahmedabad as a teenager, working at polishing granite for nearly a decade before he fell ill and developed tuberculosis of the lymph glands and of the skin nine years ago. He tried treatment with various doctors, but did not find relief. As he got weaker, he started taking on lighter work to fund his treatment but now for the past five years he has been unable to work and has come back home. Last  year he had some months of anti-TB drugs too.

Bhanwarlal at the Ghated clinic
What stands out about Bhanwar are his eyes -large and distressed, they seem to look at you with hope that he can still be healed and get well. His eyes stand out because the rest of his face, like his body, is extremely wasted. At a 170 cm, he weighs a mere 41.9 kg, which gives him a body mass index (BMI) of 14.5. A normally nourished adult has a BMI of at least 18.5.

The scars and wounds are disfiguring and Bhanwar comes to the clinic wrapped in a shawl in spite of the heat. He has been started on Anti-TB drugs but the chances that he has multi-drug resistant TB (MDR-TB) are high.

Two younger brothers are also in Ahmedabad as migrant workers  - one polishes stones; the other works as a headloader at construction sites. The youngest brother is in college, and the family hopes he will get a better paying job than a labourer does. The youngest child, a 12 year old sister, also has swellings in the lymph glands of the neck now.

The deforested Aravalli hills: one the way to Bedawal
The next day I travel to Bedawal, to another clinic. The road to Bedawal winds through more hills, now bare and revealing half-hearted efforts at reforestation. However, these cannot hide the fact that the Aravallis have been devastated over the years through unregulated cutting of trees, and, in some places, mining for granite and marble.

Rajudi, 40, Devliya village

40 year old Rajudi of Devliya village awaits me at the clinic, with cough and breathlessness. Her husband died of TB and she herself was treated six years ago with some drugs (unsure whether correct dose or duration). She too, like Bhanwar at Ghated, is wasted, weighing only 33.2kg at a height of 153 cm (BMI 14.2). She is severely anaemic and on examination I find evidence to suggest that part of her right lung has probably collapsed. It is difficult for me to make out whether her breathlessness is due to her anaemia or her collapsed lung. Her children too, like her husband, are migrant workers in Ahmedabad.

Phuski, 65, comes in with nausea and giddiness. She says she is not hungry. She too is severely anaemic, with a hemoglobin of 5gm%. I ask her who she lives with, what she ate the previous day. She tells me she lives alone, and ate one roti the day before. When I ask her why did not eat more, she looks away and mumbles that she is not hungry. I ask about her old age pension: she gets Rs. 500 per month, she tells me, and uses it to buy spices, some jewellery....I wonder what she is hoarding jewellery for. Again, I am not sure whether her giddiness is due to the anaemia or her hunger. I can see she is starving - weighing only 33 kg at a height of 153 cm, her BMI is below normal. She insists she is OK except for her giddiness.
The senior health worker tells me her oldest son takes away her pension each month as soon as she gets it, and the neighbours feed her, depending on what they can spare each day.

This is the context in which the AMRIT clinics function.

Tuesday, December 30, 2014

...and the follow-up

Following my blog post below, a friend brought it to the attention of officials in the Health Department who took a serious view of the matter and ordered an inquiry. All the nurses on the evening shift that day were called, and Meera's case sheet was also reviewed.

The day before the inquiry, Meera's husband received a call from a woman who said she knew they had complained, and that they should come the next day to the committee and withdraw the complaint as it was a question of possibly losing her job. Meera and her family were too scared to testify or even to stand in front of a committee to deny anything. (In fact, they had not formally complained -Meera's sister had told me about their experience as a matter of course when I asked about Meera). They did not turn up at the inquiry to identify the nurses.

The nurses (as expected), all denied that they had taken any money, alleging that the family had  complained since they did not see Meera as often as the family felt they should.

An examination of the chart revealed no entries apart from admission details a day before the delivery, and the delivery details (over 24 hours later) about the baby weight and condition. There were no notes about her progress of labour,  nor any notes about the baby and mother during the 48 hours Meera remained in hospital after the delivery. The first page does not even have the date on which she was discharged from the hospital.

All the nurses on shift that day have been transferred out of the labour room and the maternity ward, pending a more formal inquiry.

One of Meera's neighbours who recently delivered at the same hospital said she had heard someone had complained and there was an inquiry and nurses had been transferred. The ones now in the labour room had treated her very politely and no one asked for any money, she told Meera.

A good first step, sending out a message that such actions will not be condoned. One hopes that the quality of care and record keeping is also pursued with equal vigour. 

Sunday, December 7, 2014

a hospital delivery

The young woman who helps me in the kitchen was pregnant with her second child and went to one of the Government facilities in the city here in Bhopal for the delivery. She is an undernourished woman who works much more than she should. In her first delivery she bled heavily and needed three units of blood transfused. This is her second child after a gap of seven years. Let us call her Meera.

She was in hospital for three days, having had leaking of the amniotic fluid, and therefore unable to just stay at home. A doctor saw her once on the second day of her admission and told her all was well. When she was in pain and wanted to go to the labour room, the nurses repeatedly turned her away, saying they would call her when necessary. Four other women were admitted in the same room as her. Her older sister (who is also expecting her second child) stayed with her in the evenings after she finished her round of domestic work. On the second day, one of the women delivered a dead baby, which worried the remaining women. On the third day (Wednesday) Meera's pains increased in intensity and the nurses would still not examine her.

Meanwhile, the woman in the next bed (a primi - first pregnancy - who had been admitted for eight days) went to report to the nurses that she could not feel the baby move for the past hour. The nurses scolded her and sent her back to the bed. When her husband arrived in the evening, she informed him and he went and raised a ruckus at the labour room door. At this, one of the nurses came to examine the primigravida, listened for the baby's heartbeat, and then informed her that the baby was no longer alive.

Hearing this, the remaining two women in the room were taken away by their relatives to some private nursing home. Meera remained alone in her room, and when her sister arrived, told her all about this, as well as about her increasing pains. Her sister was scared now, and they did not have the means to go to a private nursing home. She went up to the labour room nurse and offered her Rs. 200, asking her to examine her sister. The nurse told her the amount was not enough. Meera's sister assured her that she would bring the rest of the money later, and the nurse told her that in that case she would also examine Meera later. The sister collected some more money and finally offered the  nurse Rs. 500, after which she allowed Meera to enter the labour room. A second nurse was standing and glaring at them, so she was given Rs. 500 as well. She was warned not to tell anyone that she had given them money, or else "acchha nahi hoga" (it won't be good for you). The delivery then proceeded, and Meera gave birth to a healthy baby boy on Wednesday night.

"That was the only expense at the hospital", Meera's sister told me yesterday when her sister was discharged  -"the hospital provided good food three times a day to my sister, and all the medicines were free. Only problem is that the nurses are very rude, and to enter the labour room we had to pay the nurses Rs. 1000. I had saved it for my own expenses during delivery, but had to spend it.You can be sure I am not going there for my delivery. I don't know where I will go but not to that Government hospital."