Feminine Strength?

Last month has been truly hectic and tiresome. I had to complete a few project and meeting reports, start on a few new projects that required travelling to villages and districts and my daughter had her school exams. It was more stressful to be around a nine-year old unable to sleep at night and constantly reminding herself of revising essays on topics such as International Women’s Day (which I am sure, she doesn’t fully comprehend anyways). I am not sure what our education system has come to, should children be subjected to stressful exams, memorized speeches on topics that are alien to them? A few of my friends have opted for more unconventional schools with novel methods of teaching, more similar to programmes that ran in ancient India, where children were taught more by observing nature instead of chapters to memorize. I have often thought of letting my daughter be in one of those schools instead of the one she is presently at. I have to find the time to do some school research too.

At one point during our tiresome week, we were both too fatigued with work, home and studies. One evening, I just gave up and sat with her doing nothing. We listened to soothing music, danced around with Tina Charles and ate a warm plate of ketchupy, spicy, egg fried rice. We did have a great sleep that night and promised ourselves to do this more often.

I also thought about the women public figures in my life who have lifted my spirits so many times. It’s not just singers like Kaushiki Chakravarty, Tina Charles but my chef heros like Julia Child and Manngchi, authors like Carol Shields, Julia Glass, Mahashweta Devi and Maitreyi Devi, fictional female leads like Ms Phryne Fisher and wonderful directors like Aparna Sen and The Wachowskis. These women have helped me focus on more important and productive things in my life and move on from things that do not require my time and attention. More importantly, like my closest women best friends, the above women have helped me laugh and be calm at times when I did not have much to look forward to.

Along with these women, fortunately, my work has provided me opportunities to observe strong women who are based in some of the poorest communities where most have never experienced necessities like clean water and hygienic sanitation. I have met some of the strongest women in these communities who inspite of everything, relentlessly pursue every avenue to keep their communities healthy and well informed. It is not the meagre salary that these front line health workers get for their job (ASHAs), but the tremendous respect that they obtain from their neighbors, peers and elders that keeps them going.

One of the greatest feminine strength is perhaps the capability to nurture and care. I have seen it amply not only in the women in my family and network, but also in the men in my life. The men in my family have always stood like pillars in support of every member. Many of my male teachers, supervisors and colleagues were extremely supportive to my growth and learning. On March 8th, the Director of the Institute where I work held a special tea meeting in commemoration of women colleagues. We were asked to speak on the moment when we felt empowered to be 21st century women in India. My reflections were that I have never faced a divide between man and woman while growing up, in my adulthood nor in my career up till now. I have never felt that I was denied anything because of my sex. Isn’t that empowering in itself? Maybe I am the fortunate few, but I wish my daughter and every daughter in India has the same experience too with their life.

The only real stumbling block is fear of failure. In cooking (like everything else in life) you’ve got to have a what-the-hell attitude. Life itself is the proper binge – Julia Child

 

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Family based care

A friend called a couple of days ago, after a gap of several months, informing that her life has suddenly become very busy and unpredictable. A family member is terminally ill and so she is taking care of their child, in addition to her own. She is also rescheduling her work life along with her spouse, to actively care for the person who is suffering. As a result, she has no social life, along with cutting down on better growth opportunities at work… indefinitely. We may all plan our lives, but life’s learnings have other plans for us.

In spite of best hospitals and advanced medical care, we all have at some point of our lives cared for sick family members or relatives either for long term or short term or like my friend for an extended indefinite term. Unpaid contributions of family caregivers were valued at as much as US$450 billion in 2009 globally [1], and two thirds of these care givers were women with additional jobs outside home. Similarly, in India, the total unpaid contribution in health at home in 2010 by women was US$ 22 billion and by men US$ 5 billion (at a minimum wage rate). For the care seeker, family-based care is cheap, home based and in familiar surroundings. For the care giver, it will incur time management, resource mobilization (leaves at work, salary revisions) and sometimes (maybe often) mental hardship. But perhaps the biggest issue here is that no one tells, teaches or trains us of the right ways to take care of our own family members in times of need.

At a time when there is a definite shift in global disease profile from communicable (infectious diseases) to non- communicable diseases like diabetes, cancer or cardiovascular and injuries; family-based care can keep the healthy out of hospitals and those at risk out of sudden need of treatment (and sky high health expenses). Could family care be an integrated process just like sitting together and having tea in the family room in the evenings and politely reminding everyone of the daily medication schedules, quantity of medicine left for consumption in the house, doctor appointments, designated drivers or transport for the appointments etc? Could there be someone designated as the leader for providing this care within the family? How well would other family members accept this designated family health provider? Is there a possibility for this designated member to be trained in providing a first response to emergency care, identifying key symptoms, understanding when to reach out to a healthcare facility?

Both my maternal aunt and her husband were bedridden for long periods until their sad demise. My cousin took care of them, all alone though and it took its toll on him. But he had to learn a lot of ways through his life’s learning in palliative care- by observation, reading and talking to medical professionals within his community, to understand what was expected of him before he could chalk out a customized care system. I cannot say that anyone in my family of my parents, myself and my child is equipped at this moment to even identify symptoms that may lead to a near future health catastrophe at home, let alone what to do in case of an emergency. Like everything else in life, perhaps health of family members should not be left out to adhoc arrangements.

There are states in India where best practices, pilot projects and examples of successful family based care exist, however, unfortunately, health policies or even guidelines in primary healthcare systems omit this most important area of healthcare. If family and community-based healthcare is made stronger, and well connected with health facilities and medical practitioners, much of our health expenses could be reduced. In a country where the out of pocket expenses in healthcare are the highest in the world and families are pushed into poverty each day due to medical expenses, family-based care could perhaps help us in many ways. For one, knowing someone in the family is a designated care giver and formally trained (beyond google!) to respond during an emergency situation would help me sleep well!

[1] Ana Langer et.al. Women and Health: The key for sustainable development (2016). The Lancet Commissions, Vol386, September 19.

Neighborhood Engagement

The roads in my neighborhood are in a bad shape. For the last month, the municipality has been digging and filling and digging them again for revamping sanitation, kitchen gas and water pipelines. Working professionals in the neighborhood had to make alternate arrangements for transport since parking and plying cars was a great hassle (especially those with small children who had to get to school by 7:30am in the cold wintry mornings!). Small businesses such as vegetable, fish, fruit, houseware vendors bore the brunt too, as practically there was no movement through the neighborhood streets. There were no flyers or communication regarding what the municipal officials set out to do, how long it would take and how we could all cooperate. Hence, like many other decisions in the past, common citizens were once again expected to abide by adhoc policies and implementation procedures that someone somewhere may have designed, keeping the community in mind, but without minding to inform them.

Why do most government programmes fail? Why do citizens often associate well designed programmes with election gimmicks? Time and time again, I have seen the same in my work area of public health too. One big factor is the total closure of communication with beneficiaries -who ultimately define the success or failure of the entire programme!

Sometimes I wish we could borrow a few learnings from the marketing departments of commercial businesses. New products introduced in the market go through a rigorous process of research evidence, pilot testing, people engagement and proper canvassing. Although many a times these can be extended beyond reason for profit making, but without proper need assessment and participatory engagement, projects are on a downhill trajectory.

However, the present irritation in the neighborhoods has not been a bad experience so far. Through this process, I recognized a few neighbors with great potential in community engagement. A reclusive neighbor from the adjacent house came out with a flask containing tea, some paper tea cups and packets of cookies for the workers on our street. In India, daily wage earners mostly work in all construction/infrastructure projects. Men and women completing the physically challenging work of digging the dirty roads, could at least spend 5-10 minutes refreshing themselves with a hot cup of tea. Another neighbor led an active engagement with the workers. Asking them how long they would take, what utilities they were covering, and informing the neighborhood of the same. It was only through his information, that I could plan out my alternate transport schedule for the 4 weeks. One other proactive neighbor informed about the application forms for the new gas pipelines, without which, our house would have been surely left out from this initiative.

Although my neighborhood is covered in a mass of dust and people are constantly sneezing, coughing or both, and although we are on a make shift time plan, scampering around making last minute arrangements for keeping to our daily schedules, I am more or less happy to see that there are definitely some leaders in my neighborhood who act when the time comes with spontaneity and grace. While my contribution to the entire process may be limited to admiring them from my balcony and highlighting them on my minuscule blog or for voicing the lack of information at my neighborhood gossip sessions, the feeling of belonging to a community, of being part of a proactive neighborhood is motivating and cheerful.

A ‘Christmas’ moment

End of the year is not a very happy time for me. It brings with it the assessment of my ‘happy meter’ for the year gone by and in some year the meter is not really turning in a clockwise direction. This year things are a bit different, with a promise of new venture and new direction in the new year. Although there is no surety of these taking the happy meter in the right direction, but one can only hope for the best before starting on a new journey.

Today is Christmas, a festival I have always associated with peace and warmth. Like all festivals, it brings together family members connecting them physically or in spirit over long distances. The perfect Christmas moment for me today was when I sat down with my family to eat a hot breakfast in the morning. It was a very simple semolina porridge that I had made, with aroma and spices from my childhood spent in southern India (and a little help from YouTube). But the togetherness and warmth of sharing a meal was hugely satisfying.

At that moment, I also wished that each and every one of us experiences these simple happy moments. Irrespective of our needs, aspirations, lacunae in life, of facing life’s challenges alone, or with friends and family; deserve these tiny flashes of positive energy to help us tug forward.

This weekend I also watched a few mini series on Netflix. One of them was the British detective drama, Paranoid. I loved the character of Lucy, who had changed her life from one of self indulgence to self realization. I identified with her and the happy zone she was in and the process of change that she practiced. Life changing experiences help us grow towards a more inclusive environment. I haven’t yet understood the ‘present’ moment concept of Buddhism, as past is important to me, but I value the present moment, as each of these are opportunities to make a balanced choice, a balanced decision. Each present moment is a chance at moving towards a higher self, irrespective of the baggage of the past that we all carry with ourselves.

And hence, simple happy moments in life reinforce the power of hope. Tomorrow may not turn out to be as bright as today, but the day after holds the promise of being better than today, isn’t it?

Who knows how 2018 will shape up for each one of us, but as long as we all tug along on a path of hope and acknowledge each of these simple pleasures in life, our year wont be too bad, would it?

Merry Christmas, Season’s Greetings and Wishing everyone a brilliant year ahead!

 

Beginning of a New End

If I get a chance, a single chance, to rewrite my life,

Would I take it? Would I seek the wishes that fleeted from time to time?

Or those that returned to knock at my doors like long lost childhood friends.

Would I have been happier with the choices I never made, the paths I never tread?

Or would everything somehow have brought me back to where I am?

Is this the beginning, is this the end? Is this how it was always intended?

 

Or perhaps, I would still make the same choices I made

And reach the same place I am at, whichever path it led

The lessons I learnt on this way, made me me, who I am today

The path I chose taught me a lot, with gifts of unforgettable moments

and golden memories

The path I chose brought me my little darling, my pride

For her, I think I have been blessed, to have found her with the choices made

Or would she be waiting at every road I would tread?

To hold my hand whichever choice I made?

 

No matter whichever way I walked

No matter whatever mountain I crossed

I think I would still have reached here

The place for endings and new beginnings

The place from where I would start again

To seek new paths, new dreams and new friends

To give new beginnings to old ends!

Gender Views

We received a wedding invitation last week from our professional network. The invitation card mentioned the name of the groom (whom we know) and the bride to be. Her name is ‘Trophy’. Now I know, one can only imagine how she would have gone through school and college with that name, and also of the innumerable puns (intended) that would have surrounded her at all ages. However, I was thinking of the day she was born. She must have made her parents so happy and I can practically visualize the pride and delight her parents would have felt in holding her and showing her off….you know…like a prized possession (almost like Lion King!)

Though gender bias exists throughout the world as per scientific literature, I may be one of the fortunate few who is yet to document this from any practical experience. In fact, my family may be quite weird. I am an only child and all my uncles and aunts (5 of them) have only a single girl child. Maybe it’s a genetic predisposition, but we have been a very contended lot with a house full of women. Sometimes I do feel, we have sidelined the male population to a background in our family. We do include them in decision making processes, but just so they don’t feel left out (J).

It is however, extremely important to have different perspectives while making important decisions for the family like health choices, financial choices, education for children, marriage decisions, buying a home etc and a balanced view emerging from all family members irrespective of their sex is valuable. I also think children and adolescents make good decisions too and should not be undermined in the process. More than stressing on gender, I am of the view that each person is valuable and has a lot to contribute. The dynamics of power distribution will change when we start valuing each person, instead of attaching adage of male female, girls boys etc.

The fact is that my family may be part of a very small microcosm. I have women colleagues who have felt domination every day of their lives, I have male colleagues who are constantly overruled by their mothers while making family decisions with their wives for their children. Power has and will always lead human kind through all ages.

There are three delays in obtaining timely healthcare, type 1 delays are those made at the family level, where the decision that the ailing person in the family needs urgent healthcare in a timely manner can lead to survival or death of the person. Type 2 delays are often transportation or means to get to the closest healthcare and can depend on decisions, economic conditions etc of the family or surrounding community, terrain and accessibility in remote areas and the type 3 delays are adequate and timely healthcare provided to the patient in a healthcare facility. All three delays together or individually can lead to survival or death. Gender plays an important role in all these delays and is particularly crucial at the type 1 delay stage. There is a lot of research evidence that type 1 delay causes extensive bleeding at child birth in mothers who deliver at home, especially in low and middle income countries and together with type 2 delay causes the largest portion of maternal death. Same is true for neonatal deaths.

What are the barriers? Gender is only one of them; social, traditions, customs, faith, economics, illiteracy, ignorance make up the rest. What are the solutions? Education of every child, awareness of family and community, more participatory mechanisms to include women, men, community in government health schemes are a few answers, together with greater outreach of front-line health workers into urban and rural communities.  Often in Maternal and Children Health programmes, the men are sidelined, however, they should know the programmes and their views are as important as the women and mothers. Community empowerment and education of all will lead to better understanding of men and women in general and build stronger families. As part of a public health research organization, the best we can do is to include a equal gender lens in all our studies. To be inclusive and create projects that benefit everyone and don’t exclude men and/or boys. Health should be gender free, it is for and by all.

 

 

Being Present for the Future

Last weekend was a long weekend with 5 straight days at home. After a long time, I caught up with the movies I wanted to watch and also a marathon of the mentalist, season 6 and 7 from a while ago (don’t ask me why, no reason!). Since I am intrigued with sci-fi and hypothetical imaginary situations, I watched the Arrival, Coherence, Dr Strange(for the second time, mostly for Benedict and Marvel Comics) and Secret Superstar (new Bollywood movie, not sci fi, not based on anything hypothetical, but this was a family watch with my daughter).

I like the aspect of alternate realities and different lives in different times in different worlds, and Coherence was a great watch. I have watched Triangle a few years back and found that quite interesting as well. What if we get into that sort of a time vortex where our lives just get stuck in the present and we cannot move forward without breaking the cycle somehow? On the contrary, if we are happy and content with ourselves in the present, then probably it’s all alright. Why would I want to change my present if I am perfectly contented with it? And if the present is not perfect, I guess there is enough power in each of us to change ourselves and our environment in the pursuit of happiness. We all take different approaches, methods and preparations for changing our present and future, but the toughest and also the fastest way to get results is to perhaps change ourselves first.

In management, there is something called the SWOT analysis. A four square matrix where one can put down the Strength, Weakness, Opportunity and Threat while planning future strategies especially for an organization. I have found this very helpful in making individual decisions too, mostly for professional choices (although I have found these equally helpful for personal ones as well). The trick is to start with a very structured question (often driven by a very unstructured emotional need, in my case, such as happiness, prosperity, family security etc) such as how will this particular job provide me good career prospects in the future or how will this career position help me in self development or what would I need to change in my career path in the next 3 years to reach a career of my choice. The strengths and weaknesses help me figure out my present status and the opportunities and threats have future implications.

Even Secret Superstar, the Indian film did portray the strength within ourselves to change our own future. The story is about a 15 year old talented singer who is struggling with her stagnating family environment to build a future for herself in singing. She finds ways to express herself and inspires her mother to take steps to change the family environment in a positive direction. Plus the movie has Amir Khan who is superbly talented and I enjoyed his role of an obnoxious rockstar of yesteryears, who otherwise has a heart of gold. I asked my eight and a half year old, one thing she liked about the movie and one thing she did not like. Children have an amazing way of summarizing things and even if I don’t appreciate children enough for being emotionally cognizant or sensitive, she did say she liked the fact that the girl got recognition for her talent as a thing she liked and the scene where her father breaks her guitar as a thing she did not like. I am sure in her own way, she can connect emotional sensitivity with life.

I understand sometimes life throws a tough shot and we feel like we will never recover from the blow. There are often circumstances which are immobilizing, paralyzing. But it is important to know especially in those periods that self strength can bring in small changes that have longer implications. During those times, I quickly do a self appraisal of the good things I have in my life which I may otherwise not even appreciate routinely. The power of being positive and strong during adversities helps in a speedy recovery, though it takes a long time to bounce back and one has to be prepared for a lot of self work.  Reaching out is important too and one will always find supporters and positive company if one seeks it. A strong social fabric helps and I cannot say enough about empowered communities even in resource limited settings. Even if we are perfectly content about our present lives, it doesn’t take too much effort in recognizing people around us who need a little bit of reassurance. My own social experiments have demonstrated that listening helps in attitude upliftment, even more than providing tangible resources.  And though I have to work a lot on myself for being patient and understanding around my little girl, I hope she realizes that she has the power to change her environment for the better, through efforts that start with her and for the goals that she is free to set for herself.