Nurses—Making a Difference in Global Health

 Nurse Stories: Eradicating extreme poverty and hunger

Community Organization: The Key to Empowerment

Kusadgaon is a village in rural Maharashtra, India. Of the 274 families living here, 75 have toilets. There were 30 births in 2009 and no deaths. All deliveries were safe deliveries and most babies were delivered in the village. Only 32 villagers were hospitalized in 2009. One villager was cured of TB and one is having treatment. In Kusadgaon, 92% of the children go to school, 154 girls and 159 boys. The village council puts chlorine in the drinking water daily.

There is a farmer's club and women's group, working together to meet identified health and development goals. The mobile health team used to visit once a week but village health has improved so much, they now only visit once each month. A woman sings in Marathi, 'Have a cup of tea instead of children,' a family planning message she has learned.

Children are clean and so are their clothes. Their hair is black and shiny. Their skin is soft and their tummies are full. Roads are cleared of garbage and lined with wastewater channels.  Alleys behind homes have soak pits so water doesn’t pool in the streets. There are few mosquitoes and no cases of malaria. Cement homes provide shelter from heat and rain. Both men and women are income earners and contribute to Kusadgaon’s development.

Kusadgaon is a Comprehensive Rural Health Project (CRHP) village.  CRHP is a long-standing Primary Health Care Project established in 1970. A major arm of the project takes into account the need for accessible, available, affordable and acceptable health services, by training indigenous Village Health Workers to deliver quality, basic and essential health services and essential drugs in the villages where they live.

The settlement of Indiranagar is a nomadic community. People come and go. Tired looking elders caring for small children, sit outside cloth tents, which provide little protection from heat and rain. Some live in metal shacks. There are few cement homes. Wastewater covers the roads and alleyways, providing a breeding ground for mosquitoes, increasing the risk of malaria. Garbage is strewn about and is mixed with pig and dog excrement.

Thin, dusty children, some with reddish dry hair typical of malnutrition, play in the dirt in tattered clothes. Many have runny noses and dry coughs. An adolescent girl begs for help. Her father is working away from the settlement for several months; her mother just committed suicide, leaving her the impossible task of caring for her five younger siblings. They live under a tarp and rely on others for food scraps. Many people in Indiranagar struggle to survive, living well below the poverty line of 15,000 Rupees per year (approx. $342 Canadian).

So why has Kusadgaon progressed while Indiranagar has not?

CRHP never forces the project on a village. The community must invite CRHP to work with them. The villagers must make group decisions and work together to improve their health and living conditions.

Indiranagar is not a typical rural village with families that have lived together for generations. It is more like a transient camp. Families that know each other and care about each other's well being can more easily engage in community action.

There is a local saying that one branch is weak; several branches bound together are strong. Indiranagar has not yet formed a cohesive, strong community. It is made up of many marginalized families with no firm roots, families that feel powerless and that are separated and oppressed by cast discrimination, religious beliefs, and their nomadic lifestyle. There is no glue binding them together. Indiranagar lacks consistent leadership.  It is not an organized community.

Although CRHP has not been invited to work within Indiranagar, CRHP is helping individual families who have come to them asking for help. Through private donations, CRHP is building homes for several needy families, including one for the young girl and her siblings living under a tarp.

A CRHP school bus arrives in Indiranagar six days a week to transport children across the busy road to the preschool within their compound. The children sing and dance together, oblivious of caste and religious differences. They are responding to gentle discipline and a structured daily routine. They learn about, and practice personal hygiene and receive two nutritious meals a day plus a snack. The children are growing, are energetic and are happy to be in school.  Hopefully, over time, these preschoolers will become the branches that will bind together to build a strong Indiranagar.

Until change takes place, too many of India's children will never have the opportunity to go to school. Not only will these children be unable to realize dreams of a better future, India will be denied the creativity, resourcefulness and intelligence that these children have to offer.


Comprehensive Rural Health Project:

Author’s Contact Information:

Lee Mantini RN, MHScN
Health and Development Consultant
RR3 Picton, Ontario Canada, K0K 2T0