WALKING WITH + Ves
It was a Sunday and around 3.45 p.m, my white Qualis screeched to a halt near a shop a Chathanoor on the NH47. The shop had an attractive array of toys ranging from Spiderman to Donald Duck, sure to kindle the child in you..The toy display drew my colleague and me in. Of course, we had a purpose in having a closer look at those toys. With hardly any hesitation, we picked up a cute duck and scruffy hare. "Rs. 40" the shopkeeper said in a rather gruffy voice, when asked for the price. What followed was a bout of haggling over the price. Preferring to leave the job to my colleague, I walked towards the car.
Minutes later, may colleague joined me with a sparkle in his eyes. For, he had with him the duck and the hare and two colourful balls as well. Sensing my quizzical look at the extras he had with him, he hastened to explain that the balls were gifts, courtesy the shopkeeper. "While bargaining with him, I just made a casual reference that two hapless children were in dire need of such toys. He immediately asked me whether it was for Bency and Bensen of his native Chathanoor village. He gave two colourful balls as his contrbution. The magnanimity of the shopkeeper, who was curt just minute ago, convinced me that the fountain of compassion and love for two forsakened HIV + children was not dry after all.
A 15 minute drive took us to Bency and Benson’s residence. We were pleasantly surprised to see the local Parish Priest and two young men at this otherwise desolate and gloomy house of the late K. C Chandy. For sure, there was a marked change in the atmosphere. During my visit, on May 14, 2003 hardly anyone took notice of the presence of senior Government officials who spent three hours on a mission of purpose. The mission: to ascertain the welfare of Bency and Bensen, the two innocent children who were denied of their fundamental right to education, just because they were HIV + Ves and children of two human beings died of HIV AIDS recently.
No doubt, it was a painful, yet purposeful visit. It was painful because the candid statements of the aging maternal grandparents, the sole refuge and shelter of the two kids, moved us. Yet, it was purposeful because it enabled us to chalk out a strategy to take care of the stigmatized children. “What on earth did these children do? Why are they being denied education? Why do the looked down upon? Why are parents of other students in the Kaithakuzhy Government Lower Primary School vehemently oppose their presence? asked the virtually blind grandmother. She narrated the turn of events. “My only daughter, Princy, was married to Chandy, who hailed from our village. He had been working in Mumbai since mid 80s and the first child died of HIV AIDS, when she was only 31/2 years old . Chandy, who returned to his village, settled down by building a house and opening a ration shop. In December 2001, he died of HIV AIDS. But he bequeathed his infection to his wife and two children. For, Princy too soon walked into the death’s claws. what sin did my daughter commit to suffer such an untimely and cruel death? the grandmother, Sally, veiled. Chandy married Princy knowing fully well that he had HIV infection. Non one suffering from such an infection should marry a hapless girl and infect her,moaned the old woman.
Death was cruel for her daughter, because society looked down up on her with stigma. She was almost ostracized, before death saved her from more excruciating pain. As is the case with all people living with AIDS, Princy too succumbed to her infection in 2001, leaving behind Bency and Bensen. But tragedy continued to haunt Benny Bungalow. For, the two kids were also diagnosed positive for AIDS. Once friends, relatives and neighbours got wind of the Chandy's infection, they started boycotting the two kids and their grandparents.
Life became rather difficult for Bency and Bensen when their story came under Media glare. One school after another shut its doors firmly on them. Parents of Kaithakuzhy Government Lower Primary School, where they were initially admitted, refused to send their wards to school and vociferously demanded the kids’ ousterA meeting was held in the school on March 4 2003 to resolve the issue that had become quite knotty by then. A few did sympathize with the childredn; but none came forward to lend them a helping handOur May 14 visit had its effect. The two children were immediately put though the paces of medical tests. They are now under the treatment of Dr. Noel Naryaanan, one of Kerala’s well-known pulmonologists. The words of Dr Narayanan, who examined the two childredn with his bare hands, were quite revealing “HIV\AIDS doew not spread be it through sitting, sharing, eating, playing, studying or other associations with the infected”, he had opined. For a moment, another small incident came as flashback – July 27, 2003, the day I visited the Marthoma Church, nestled in the Chathanoor hamlet (The kids belong to this Church). I was asked to say a few words after the Parish Priest, who himself was standing in for his colleague, gave his sermon.I appealed to the congregation to show compassion to the two children. “Stigma and segregation are not part of the teachings of Jesus Christ and there is no point in remaining a Christian, Hindu or Muslim by name,” I said inviting their attention to what Christ said at the time of his crucification –“O Lord, They know not what they do. Forgive them.Requested the gathering to be compassionate and treat the kids with love because Jesus Never Fails (GOSPEL??) and advocates for sympathy and love to those who suffer. I called upon the faithful to take care of these hapless children and see that they continue to be part of the community. I urged them to follow the teachings and preaching of great saints/apostles/sons of God/Messiah so that all of us could be real and good human beings.Honestly I never thought my appeal would have an affirmative impact in the young and the old alike who had assembled there. The responses assured me of the proverbial beacon at end of the tunnel. The day’s happenings left in me a deep conviction that sensitive issues can be settled if delicately handled. Coming back to our current visit, we spent some time with the children, their grandparents, the Parish Priest, and other members of the church and some youths of the village. The children were naturally overjoyed by the gifts they received.We stirred out of Benny Bungalow half an hour later for a stroll around the village. Alongwith us were Benson and Bency, their grandfather, Parish Priest and two youngsters from the congregation (Incidentally, one of them is a teacher who had taught these children in the Parish Nursery School). Abraham Mathew, Project Director, State Management Agency, Kerala, District Mass Media officer anil Kumar and his driver Vijay Mohan Pillai. Of course, the stroll, a Padayatra of sorts had a purpose. Our aim was to make the local people realize that there was nothing wrong in walking alongwith people living with AIDS, eating with them, visiting them and playing with them.There were not many people around when we headed for the narrow village streets. But as we walked along the road, quite a few come out of their homes, talking in hushed tones about the +ve children. The progressive among them promptly responded to the Parish Priest’s invitation to join the walk. Some merely smiled and weakly stated they were otherwise preoccupied. A few college going girls joined us in our walk. And as we wandered through the Chathanoor lanes, the assembly of people grew in size.Bency and Benson are attracted to Vijay Mohanan Pillai the Driver. Naturally so, because he has been their escort tot the doctor, the clinic, the beach, the park, and for their shopping. Pillai gets the kids whatever they want, be it pens, tops notebooks, or ice cream. He drives them around as if they were his own children. I am tempted to callhim the Saviour, because of his rare commitment. The devotion he has taken up this self imposed assignment and his compassion can not be narrated in words. Will there be many more such noble souls to work for the sick and deserted.Our walking with the +ve children has made us realize that the people of Chathanoor are not all that bad as depicted. It convinced us that they would collectively whether the storm and take care of the children if given a chance. We are confident that the children would be able to break the barriers of stigma, given the present for Bency and Benson, help them get re-admitted to the same school that threw them out and demonstrate to the outside world that Kerala is God’s own country in its truest sense.Given the sentiments of love and hope that pervades this hamlet, we are secure in our sentiments that Bency and Benson would live longer than expected and that in the next few years a vaccine would be invented for curing HIV/AIDS.Then, the millions of orphanded children like Bancy and Benson could live and lead a normal life, bereft of stigma, exploitation and denial of fundamental rights.
BRIEF SKETCH OF THE DOCUMENTSRY
Subsequently, actor Sh. Suresh Gopi oined us on Sunday, the 12th October, 2003 another day (13.10.2003). Subesequently, during his visit to Kochi, I was asked to take the children to H.E. the President of India .He briefly met the children and appealed to all (at a subsequently meeting in Kochi) to show love and compassion to Benson and Bency
Mrs. Sushma Swaraj, Union Minister for Health & Family Welfare who visited Trivandrum wanted to meet these children. I took these children to her and suggested that GOI should have programme for treatment of HIV/AIDS patient. She announced at the press conference at the Press Club, Trivandrum that Government of India would provide for anti retroviral drugs HIV/AIDS patients. She also announced that the Hindustan Latex Lted would extend financial assistance to Benson & Bency for their treatment during the next 5 years to the tune of Rs. 3 lakhs. The M.D of HLL handed over a cheque for Rs. 60,000 (amount for the treatment for the first year) at the birth day party of Benson & Bency on at--------- at the public function organized in Adichanalloor village. As per the announcement made at the Press Conference, GOI are supplying anti retroviral drugs to high prevalent statesPHOTO OF SUSHMAJI KISSING BENSON All my individual efforts with the active support of some of the members of staff DMO, and the local people have finally yielded results. Benson & Bency have been readmitted into the school in December, 2003- in 9 months from the day they were thrown out of Govt. L.P. School KaithakuzhyLetter from the Secretary to the President of India.
Regional Resource Centre for Northeastern States (RRC-NE)
The North Eastern region of India is considered one among the most complex regions of the country in terms of its diverse culture, language, ethnicity, accessibility,development etc. Despite of many years of effort, the region remains under developed in terms of health care facilities, health indicators and many others.
The launch of Reproductive & Child Health II and National Rural Health Mission in April , 2005 brought in a paradigm shift in the planning process in the health sector in the country with significant rise in the investments in the health sector. These programmes entail upon the state governments to undertake participatory planning starting from the grass root level to strengthening of its managerial capacities so as to effectively plan interventions and execute the same.
Considerable amount of funds have already been released to all the 8 NE states. Over the last few years with the support of NRHM, these states have achieved many milestones but many more are to be achieved. In these states, efficient managerial functioning with sound technical back up is seen as an issue, which many a time results inadequate absorption of funds released to the state. That was the time, It was at his point of time, I joined the Ministry of Health & Family Welfare as Joint Secretary. I was mandated to set up the North East Division so that special attention and focus could be given to this region
Accordingly, the Ministry in association with the Development Partners like European Commission, UNFPA, DFID etc set up the Regional Resource Centre for Northeastern States (RRC -NE) at Guwahati in September,2005 in order to handhold the the region by augmenting the technical and managerial capacities of the NE states at all levels.
The main objective of the RRC is to provide technical assistance to the North Eastern States, help identify core areas to be focused in the short, medium and long run and plan for providing the missing technical and managerial capacities to these states. The major tasks of the RRC-NE included preparation of Situational Analysis on various aspects of the Health Sector and prepare policy proposals, re-structuring of the health system at the State, District and sub-district levels, institutionalization of integrated planning and management, taking stock of the financial resources available and the critical gaps and strengthening and streamlining of financial management systems, devolution of financial and administrative powers, strengthening and streamlining of procurement and logistics ,standardization of norms (services, staffing and infrastructure) at the primary and secondary levels, strengthening and streamlining of health management information systems (HMIS) , development of drug policy,advise on inter-sectoral convergence etc.,
In addition to the above, the Regional Resource Centre is also required to conduct workshops and
meetings on behalf of Government of India for effective operationalization of NRHM in the NE
Region.
The RRC-NE is organized as a ‘hub-and-spoke’ structure. The hub is headed by the Director (full time) with a Core Team of experts in Public Health,.Finance, Accounting and Audit, .Procurement and Logistics,Health Management and Information System,Community Mobilization and Civil Engineer-cum-Architect
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A BRIEF REPORT ON THE ACTIVITIES CARRIED OUT IN NE STATES DURING THE TENURE OF SHRI. K. RAMAMOORTHY, JS (NE), MOHFW, GOI
During my tenure (2005-2008) as Joint Secretary(NE) the northeastern states achieved many mile stones. One of the biggest challenges in any programme implementation the set up of institutional arrangements at the State level, District level and at Facility level.
It was mandated that for getting assistance under the National Rural Health Mission , the concerned state government should sign Memorandum of Understanding (MoU) with Government of India , followed by setting up of State and District Health Missions.The State NRHM has to be headed by a Mission Director. It was also mandated that all the existing vertical health programs are to be merged while forming the State Health Society. Periodical discussions and monthly video conferences led to the achievement of these basic goals.
· One major thrust under the NRHM was to form Rogi Kalyan Samiti( Hospital Management Society) at District Hospital, SDH, CHC, PHC etc. I still remember the days I used the chair the Hospital Development Society at the taluk level during my days as Assistant Collector/Sub Collector during 1980-82. It dawned on the Ministry of Health & FAmily welfare to have such set up in all the district,taluk and sub divisional levels. I also remember my step to give total financial autonomy to Hospital Development Societies meaning thereby that the income generated by the hospitals would be retained at the facility level and ploughed back into the system for repair of equipment, furniture,maintenance of building,water supply,electricity,telephone and purchase of medicines in case the stock gets exhausted. of course, I had a wage a war with the Finance Department of Kerala during 2006-07.
F The only addition here is that the Ministry of Heealth provided recurring financial support to the committee to carry out its own plan for the development of the hospital. In NE states also, the RKS was formed in different categories of hospitals, as mandated. Many of these committees have been doing many innovative works in NE states.
· A
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XXXXXXXX -Fig 1 Items procured by RKS using profit of the laboratory at Melagarh Sub-Divisional Hospital, South Tripura |
XXXXXXXX---Fig 2 Heat Radiant Warmer is procured by RKS and using profit of the laboratory at Melagarh Sub-Divisional Hospital, South Tripura |
Managing any show is always an art, which necessarily requires skills. Majority of the Medical Officers lack these skills. To support in this front, it was decided to engage staffs at State, District, Block with managerial background so that the programme can be managed efficiently and it can deliver goods. It was named as State Program Management Support Unit (SPMSU), District Program Management Support Unit (DPMSU) and Block Program Management Support Unit (BPMSU). Engagements were made as per the state’s requirements from State Program Manager, State MIS Manager, State IEC/BCC Expert, State Finance Manager etc. The same types of engagements were also made for the district. At Block level, Block Program Manager, Block Accounts Manager was engaged. In NE states also, for majority of the state the SPMSU, DPMSU, BPMSU staffs are in place.
· State Programme Management Support Unit and District Programme Management Support Unit were formed and all required personnel were placed.
The Government of India launched National Rural Health Mission (NRHM) to address the health needs of rural population, especially the vulnerable sections of society in April 2005. The Goal of the Mission is to improve the availability of and access to quality primary health care for the people, especially for the vulnerable groups focusing the women and children. To serve the rural community, the Sub-centre is the most peripheral level of contact with the community under the public health service delivery system. This caters to a population of around 5000, but is effectively serving much larger population. With less than 50% MPW (M) being available in the State, the ANM is heavily overworked, which compromise the quality of services & community aspects of services. The very nature of her job responsibilities makes it difficult for her to take up the responsibility of a ‘Change Agent’ on health in a village. Thus a new band of community based activists, named as Accredited Social Health Activist (ASHA) has been positioned to fill this void of community processes. 1 ASHA is engaged per 1000 population in plain areas, which was relaxed for hilly areas, like NE states.
.Because of the active persuasion of Sri Ramamoorthy, all the NE states could take initiatives for selection of ASHA and train them. A total of 49000 ASHAs were selected during 2007-08. Provision of drug kits for each of the trained ASHAs was made available.
The condition of the health infrastructure was in a very bad shape before NRHM, so it was mandated under NRHM to give major thrust to the infrastructure strengthening. 33% of the total fund is earmarked for the strengthening of infrastructure. To know the status of infrastructure of the different hospitals and to take up infrastructure strengthening on priority, massive drive was carried out for doing facility survey (as per IPHS) of District Hospitals and CHCs in NE states. The facility survey findings were also shared with the Ministry. Based on the facility survey findings, facilities were taken up for infrastructure improvement. Identified CHCs from NE states were given Rs. 20 lac for infrastructure strengthening. 56 District Hospitals (18 from Assam, 3 from Meghalaya, 14 from Arunachal Pradesh, 11 from Nagaland, 2 from Manipur, 2 from Sikkim, 6 from Mizoram) from NE states were given Rs. 1 crore each during March’07 for improving the existing status of the infrastructure. State like Assam has compiled a booklet on the findings of the facility survey. The District Program Management Support Unit staffs are taking lead role in getting the facility survey done of different health facilities. With the technical inputs given by the Engineer of the Department, work is executed with the support of Hospital Management Society.
Along with the infrastructure strengthening, it is equally important to put qualified Human Resources (both medical and paramedical) at the facility so that ultimately, people who come seeking services get the desired services from the facility. So, provisions were made under NRHM for appointment of health professionals at different categories of hospitals starting from SC to District Hospitals. Accordingly, 2nd ANM as per the mandate of NRHM was introduced at SCs of NE states. The provision of engaging 2nd ANM at SC has not only reduced the work load of the existing ANM but also it has increased the overall performances of the SC. Also, a number of Specialist, Medical Officer (Allopathic), MO (AYUSH), Staff Nurses, Lab Technician and MPW (Female) were made available at the health facilities. While giving engagement of staffs at different health facilities, it has also been ensured that the staffs stays at their place of posting and deliver services. Many states in NE states have come up with their own innovative plan to ensure that the staffs engaged stay at the place of posting.
Most of the NE villages lie in remote areas,where it would be impossible to make available health care. So we decided to press into service Mobile Medical Units. Going by the past experience of the Ministry in supplying unwieldy Mobile Medical Vans, my division specially designed MMUs( nos) with essential equipment,medicines,manpower etc. for the NE states bearing in mind the hilly terrain. I was also responsible for assisting the Ne states particularly Assam to go in for Boat Clinics to reach out to its riverine pockets I also suggested that Union Territories like Andaman & Nicobar and Lakshadweep should get support for Boat Clinics.We found that they were popular among the people living in reverine belts of Brahmaputra.
ii. TakInitially, I was required to operationalise the North East Indira Gandhi Regional Institute of Medical Sciences (NEIGRIMS),Shillong for which the late Prime Minister Rajiv Gandhi laid the foundation stone way back in 1986. The construction phase of the institute at a cost of Rs.469 crores was progressing at snails pace. with a missionary zeal I took up the task, convened fortnightly review meetings with the agency Hindustan Construction Company ( a PSU under the Ministry), the Director and the others and speeded up the process.Then came the question of recruiting manpower( both teaching and non teaching) and procurement of high end equipment required for the 500 bedded multi specialty teaching hospital and institution. It was a Herculean Task to get suitable candidates for the faculty positions.However, with faculty recruited 300 beds were operationalised. Departments like ------------------------------------------------------------- were started. I also got the Nursing College Building completed and admitted the first batch of B.Sc Nursing students during the academic year 2007-08.Now, the first batch of B.SC Nursing students are passing out of the college this year. we also admitted the first batch of M.B.B.S students, who are in the third year now.
During one of the visits to Manipur in early 2007, the Hon'ble Prime Minister promised that the Regional Institute of Medical Sciences,Iphal, Manipur would be taken over by the Ministry of Health & Family Welfare. Making use of this assurance, the North Eastern Council prevailed upon the PMO to instruct our Ministry to take two of their institutions such as - Regional Institute of Paramedical & Nursing, (RIPANS) - Mizoram, Lok Nath Priya Mental Hospital -Tezpur, Assam. Reluctantly, we agreed to take them over and started working on their upgradation.We released Rs 85 crore for setting up a Super Specialty Hospital at the Gawhati Medical College,Assam.
Photographs:
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Figure 1 K. Ramamoorthy, JS (NE) is seen while welcoming Dr. A. Ramadoss, Hon'ble H & FW Minister, GoI |
Figure 2 Dr. A. Ramadoss, Hon'ble H & FW Minister, GoI in seen while inaugurating RRC-NE. Ms. Jalega, AS cum MD, NRHM, India is also seen |
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Figure 3 Dr. A. Ramadoss, Hon'ble H & FW Minister, GoI, Mr. K. Ramamoorthy, JS (NE) and Dr. A.C. Baishya, Director, RRC-NE is seen |
Figure 4 K. Ramamoorthy, JS (NE) is seen while giving speech. Dr. A. Ramadoss, Hon'ble H & FW Minister, GoI. and Dr. B. Barman, H & FW Minister, Assam is also seen |
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Figure 5 Mr. K. Ramamoorthy JS (NE) is seen while presiding over the launching regional meeting of NRHM in Guwahati |
Figure 6 Mr. K. Ramamoorthy JS (NE) is seen in the dais during ASHA Sanmelan held at Assam on 8th July'08 |
