A few members of The Banyan’s Rural Mental Health Programme (RMHP) went to Gudalur in the Nilgiris last month to visit Ashwini’s Tribal Hospital and Mental Health Programme. Ms. Malavika Subramanian from the RMHP team reports on this huge learning experience.
“Ashwini Tribal Hospital emerged to address an urgent lack of quality, accessible health-care for the tribal population in Gudalur and the wider Nilgiris region. With a 25% tribal population, there was a large demand for specialised services in the district. Staff at government hospitals a) couldn’t speak their language b) did not have the patience to persevere with their cultural differences c) likely also discriminated against them. Ashwini hospital is state of the art and even includes a blood bank and research labs. They have an established presence in the area through their services and currently also run a school for tribal children in the area.
Ashwini’s mental health programme is very new and runs with existing community workers (known as ‘health animators’) who have been given training to pursue mental health related activities and a few volunteers. Their rural outreach operates on a model based on the government health system with a main centre (being the main hospital) and several smaller area sub-centres. Ashwini’s community workers, who are also trained nurses visit these area centres almost every day as well as conduct home visits in their assigned area. From April, Ashwini, with NRTT funding will roll out mental health services with full time, trained mental health professionals and on a larger scale with awareness, trainings and other such activities on the horizon.
Day 1: Home Visits
During our short time with Ashwini, we were given the opportunity to accompany a community worker Uma and the coordinator of the mental health programme Mr. Sathyaseelan on a day of home visits.
Home visits in the tribal forest villages of the Nilgiris are an elaborate process in themselves with each house being a fair distance away from the next; to illustrate, we walked a total of 10 km through the rugged, hilly forests to visit six homes, all in one village, Chembakolli. Along the way, we were told that elephants destroyed nine houses in these parts a couple of weeks ago and were enthusiastically shown the giant footprints for proof!
The home visits were extremely illuminating to the challenges faced by the tribals in the area as well as by Ashwini. Although we were visiting, what Uma described as a more “modernized” tribe, none of the houses had electricity, relying instead on the tiny, one-per-house government issued solar panels. Water access was from a nearby stream, whose quality was suspect and was easily 3-4 kilometres away for most people. Nonetheless, Ashwini’s work seems to have had an enormous impact in the area. We were told that people, by and large were becoming very regular in attending their follow-ups and getting medicines for both physical and mental health issues, even though Ashwini’s closest sub-centre was a decent 7-8 kilometres away. Additionally, to further ensure treatment commitment, Ashwini’s community workers often carry medicines with them on home visits as well.
Ashwini’s community workers are superstars in their own right, much like our own. Coming from the tribal community themselves, they possess a nuanced and detailed knowledge of the area, people and its customs; invaluable when working with the population, especially in a field like mental health. We found clients, wary of outsiders, who would refuse to speak to or look in the eyes of anyone but the community worker. We were told that, although Ashwini has a large and accepted role in the tribal communities now, building up the trust was a painstaking and gradual process that would have been impossible without the talented community workers.
The six clients visited were all diagnosed with ‘psychosis’; as Ashwini’s mental health programme is still in its early stages, they do not have a psychiatrist to issue a more detailed diagnosis. Instead, upon administering a couple of standardised scales, clients are classified with having either psychosis or one of the common mental disorders such as depression or anxiety and are given widely accepted medication accordingly prescribed by their general doctors. This is supplemented by regular counselling with Mr. Sathyaseelan and combined, this has, at least from what we say, proven to be very effective and resulted in great improvements in the mental health of these clients. However, Ashwini recognises that it could benefit from a more professionalized, systematised mental health programme and eagerly await the start of the project in April.
Day 2: Tour of the hospital
We were given a detailed tour of the hospital and its facilities on our second day and were genuinely impressed with the efficiency and quality of their services. Most of their hospital staff come from the tribal communities themselves and are trained in their fields with the support of Ashwini. In addition to full time doctors, the hospital gets doctors from partnered medical colleges in Bangalore on rotations.
After our tour, we sat with Mr Sathyaseelan for a few hours engaged in a stimulating conversation about the nature of the work both our organizations do. In the process, we were able to share ideas– ranging from software recommendations to new ways to do a case intake, to ideas for new projects–and expand our understanding of the field. It was the perfect conclusion to what had already been a fantastic trip!
Updates from Thiruchelvi, BALM fellow placed at Ashwini
Thiruchelvi accompanied us throughout our trip and we looked forward to getting some insight into her work at Ashwini as a BALM fellow. Thiruchelvi works as an assistant to Mr. Sathyaseelan to implement the Mental Health programme, counsels non-tribal clients and is responsible for the subsequent follow-ups. Thiruchelvi commutes 27 kilometres (a one and a half hour bus ride) to make it to the Ashwini OPs and is extremely committed to carrying forward their Mental Health programme.
We saw her meticulous follow up notes, her office space and her undying enthusiasm on the field and were able to get a sense of her positive contributions there. It was great to see Thiruchelvi in her element, doing valuable work in her home environment.”
– Malavika Subramanian
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