A shining example of community-based health

What lies at the heart of Sambhavna is community. A community united against the atrocity that has been forced upon them for the past 26 years, and who will never give up in the name of justice for the people who have died as a result of gas exposure and water contamination, and for those who suffer from chronic ill health, congenital defects and the psychological trauma of having lived through unimaginable suffering.

Above: Children visiting Sambhavna’s community healthworkers; the boy on the right has a tracheotomy, not uncommon among Bhopal children.

Although born of a depressingly desperate situation, what has bloomed here is a mobilised community, many of whose citizens are politically active, aware of their human rights and who are willing to come together and fight against the relentless oppression of multinational companies and government. This community action affects many aspects of peoples’ lives here, it allows them to be better informed about their choices and have more autonomy on the political, educational and health issues that affect them.

Healthcare is an area that has been particularly successful for the communities who attend Sambhavna. It is primarily, of course, a healthcare facility and so this is perhaps to be expected, but the thing that has struck me most is the community-based approach to health that exists within the bastis. The seven community healthworkers employed by Sambhavna go to the bastis daily, training community health volunteers, teaching local people about health in a participatory way (left and below) and empowering them to take responsibility for their own learning, healthcare and treatment.

The people who live in the areas surrounding the Union Carbide factory site not only face a daily struggle with the myriad health issues that exist from living in urban slums and bastis such as TB, diarrhoeal disease, typhoid and type 2 diabetes (which is rapidly becoming a huge health issue for low-income communities) combined with the leftover long-term health effects of gas exposure. They have the added insult of being poisoned every day by the meagre groundwater supply they have access to. They face gynaecological complications, respiratory disease, and increased rates of cancer and congenital defects.

Of course, this situation could begin to be remedied were the shiny silver pipes laid by the government six months ago actually delivering clean water to the people. It seems a cruel taunt that this basic human right is so close and yet, due to Indian governmental apathy, logistics or however else one chooses to name it, still isn’t being provided. I recently watched women access water which they explained could be used only for cleaning and washing, because of sewerage contamination. A few meters on, 15 people huddled around a groundwater pump with pots and cans collecting clean drinking water: the irony lies in the fact that this ‘clean water’ is contaminated by toxic waste dumped by Union Carbide, and left to be absorbed into the ground year after year by Dow Chemicals.

The choice between drinking dirty water that will almost certainly cause acute illness and the long-term risks of drinking contaminated water is one that simply shouldn’t have to be made, particularly in these boomtown days of ‘India Shining’ or whatever the latest slogan that promotes India’s emergence as one of the big economic global players. In a nearby basti, household after household complains that they haven’t had any water for days. Unfortunately as the summer months approach water scarcity is only just beginning and it will be a long few months until the monsoon rains arrive.

Sorry, I think I may be ranting again, I was talking about the positive impact of community health approaches but it seems obtuse to not mention the current health issues affecting the people here. There is a growing recognition globally that community empowerment is the way forward if we are to meet the Millenium Development Goals laid out by the United Nations in 2000 (no laughing please).

Everyone joins in on community health (above)

There will never be enough doctors or nurses globally to address health needs in low income communities, but there will certainly always be local people (particularly women) who are willing to learn and who can be great promoters of healthy behaviours in communities.

International organisations now accept that the top-down approach to healthcare, where people are told what to do by professionals from different cultural, economic and educational backgrounds simply doesn’t work and much has been written on the benefits of giving local women the skills to provide peer support, and encourage their communities to learn how to live healthier lives and minimise disease transmission.

 

The Sambhavna-based community health team is a shining example of how this approach can work, and it is encouraging and uplifting to watch and be involved in. They have trained over 60 people, mostly women but some men, to be community health volunteers (CHVs), who in turn do health education about diabetes (left), gynaecological issues, TB, malaria prevention and hygiene practices in a way that is accessible to local people, many of whom are illiterate. Their role doesn’t stop at health promotion, the CHVs can test urine for sugar, and blood for malaria and they are key in identifying people who are sick to the community health workers who can then refer them for medical treatment at Sambhavna if necessary.

One of the key advantages of having local people as community health advocates is the intimate knowledge they have of their community. In areas where housing is crowded and small, and where people spend large parts of their day together, everyone knows everyone else and health needs, domestic violence and other social issues can be quickly identified and dealt with. The ‘do no harm’ ethos of Sambhavna continues to be demonstrated in the work of the community health teams. Ayurvedic medicine is used as a first-line treatment option for many minor illnesses, and people are actively encouraged to use the community herbal gardens that have been grown by local people.

The future looks bright for Sambhavna’s community health programme. The clinic is currently hoping to secure the funds to establish satellite health posts in gas and water contamination affected areas. This would mean people do not have to go so far for basic health issues and it increases the scope for the role of the community health volunteers. We are working on some interesting health promotion projects for diabetes education and TB using peer support from people who have been affected by illness and engaging young people in the community to get involved with health promotion and health research within their communities, which I will update you on soon.

Sambhavna is growing from strength to strength and the more time spent here the more I am convinced that what is occurring here is an outstanding example of the way that health, the environment and wellbeing should be approached in both developed and developing countries.

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We believe Dow & DuPont must finally accept responsibility for Bhopal. Until then, The Bhopal Medical Appeal funds two award-winning clinics in the city. Both offer free, first-class care to victims of the gas disaster or the ongoing water contamination. The survivors have nowhere else left to turn – please help if you can.