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Are 'Good' Practices after all really 'good' or just goody!

In this era of transition, (I don't know how long this transition is to last, or will it really last!)we look at practices which are good. I mean. look at the issue of malnutrition - we spend hours (governments have spent years) to ensure nutrition - to the deprived, the hungry with the aim of reducing their hunger, their appetite. Wait a minute, let me correct myself, we do it to reduce deaths - of children below 6, people who may die due to hunger! We do it to reduce IMR! Or thats what we measure to what we did was correct or not...

I have not heard of any feast, meal, parties which is designed for this purpose. We do it to satiate us, or those who are enjoying it! We measure by asking them,"Hope you liked it". Now, when I go around looking at the Anganwadis, I look at the register but no children. If I meet them I look at their weighing scale's face for their weights but not their faces - happy or sad!

So, now I have been having some 'dip-tinking' about the Good Practices in RCH I which we had studied. The document is available on linkage given on the left side.

It talked about activities which increased RCH's programme outputs. outcomes and impact. I am now rephrasing it as 'Good Practice Study for Women, men and children happiness!'I may restrict it to health services only but isn't joy and happiness is a part of mental health! I am sure the study would definitely reduce one type of death - the death of sensitivity!

Stray Thoughts: We need 3 (million) idiots!

I saw ‘3 Idiots’ at a conventional (not at a cinemax type one!) cinema hall.‘Vinod’ Chopra and Rajkumar Hirani once again pulled away the red carpet from under the elite feet. Space pen v/s lead pencil, electrified spoon as a ragging preventive mechanism, scooty v/s ambulance, theoretical v/s practical learning, cost v/s need etc. were demonstrated effortlessly and effectively.

‘Aliswel’ as the punchline has spread as a wildfire. (In the last few days, I have heard this phrase million time amongst co-travellers, roadside heros, co-eaters etc. Such non chemical anesthesia – a verbal acupressure at some day would be a refined art of non invasive anesthesia and I will not be surprised if clinical psychologists can also become eligible for an MD in this superspeciality. (They anyway deserve to be.)

We all have bumped into such idiots in our life. About thirty years ago, I and a well known activist were traveling on a mobike from Amravati to Nagpur. It was quite late in the night. Somewhere on the way, the mobike conked out. Plug, carburetor was checked and to our shock, we found that the floater had stopped floating! It was full with petrol. We cannot remove it and of course it needed to be soldered again. We decided to to dump it at a safe place. When we approached a local house, the farmer said, “Why don’t you consult a local mechanic in the nearby village. He repairs everything – a cooker, a stove, a diesel or electric pump, radio etc., etc..” Skeptically, we went to him. He was a 15 -16 year old boy! We told him the problem. With a lot of confidence he asked us,: Did you check the starter, battery and the plug.” We said yes. And showed him the floater. He said, “it is simple, do you have a matchbox?” My smoker companion gave him the matchbox. The boy gathered dry grass and lit them. Rotating the floater at a distance from the burning (rather just glowing) grass, he kept shaking it every minute. “The petrol would go out but the remaining solder would remain intact.” He said. In about five minutes the floater stared floating. Mentally, we were breaking our heads. My partner was a PG in Chemistry (this nacheez was also an inter science pass with chemistry as a subject!) and he knew about oil refineries and lead etc. but we never thought that burning grass would generate adequate heat which, if used cautiously can evaporate petrol without affecting lead! The 15 year old idiot (The Millimeter) did it! We reached Nagpur, about 100 km away safely without any stress.

Another example in our own field – the community health worker. A CHW - woman of about 60 or more year old. She belonged to a primitive tribe – Katkari. She was not trained with reading and writing skill but had developed her own system of memorizing medicines. During a monthly meeting, she shared her experience. As a part of medicine kit, CHWs had Gentian Violet as a standard drug for wound dressing. When a person with a wound under his left thumb came to her for dressing, she realized she did not have GV. She could not have been able to get it refilled because the whole community was working far away. She realized that the person needed an antiseptic medicine o be applied. So she prepared a paste using crushed and finely sifted sulfa tablet and oil! We had not trained her for using sulfa powder like Nebasulf etc. I asked her why sulfa. She said, ‘You had told us to use sulfa tablet for infected sore throat. Since the wound was also infected, I used it as a powder for dressing! (In the parlance of knowledge, she had reached the level of Application!)

We know of such great ‘idiots’ who have demonstrated changes even in our own fields. Fredrich Engels in public health, Florence Nightingale in statistics, Dr Jenner in immunization, David Werner in Rural Health Care System. They have demonstrated ideas and their application which spread like a wildfire. We have Collectives also - Dais for normal deliveries, Vaidus for herbal medicine or for that matter Dabbawallahs of Mumbai in Supply Chain Management, Bhishis in microfinancing are such examples. Incidentally, this film has been added to the syllabus of Management Science!

We need such idiots now for universal health care system. Today’s system is not easily available, accessible and affordable. Cost of health care is soaring up. We need them for ideas, not just 3 but many, many more. We also require a Suhas, who shouts at his fiancé because she loses a gift. Not because it is a valuable one but because it has a high price. After all, cost can be a concern.

Just a word of caution, however. The 3 Idiots have demonstrated that in unforeseeable situation their ideas were the best. But they are not always safe and appropriate. Bringing to a hospital, an unconscious person in a sitting position is not safe in every situation. But if no ambulance is available using whatever is available is better than not doing so. After all, before developing the Space Pens, conventional pencils were used. But there were flaws in them. The granite and so does the wood - break at the variable temperature in a space craft – 1500C in shadow and 1200C under sunlight. Broken pieces float in the space craft and can create a disaster. And both can burn in 100% O2 environment! (Please see http://www.snopes.com/business/genius/spacepen.asp) So, idiotic ideas should be tested – are they harmless or potentially harmful? So, we need a Silencer, too!

Moral of the story - Always say ‘Aliswel’ when you are applying an idea, even when it has been tested. After all, saying so is not harmful! Isn’t it?

My Walong Visit

Please see my ebook ' Visiting Walong'

CLICK ON THE SLIDE GIVEN IN THE SIDEBAR

Some stray thoughts on professional teaching methods –

Nowadays, several of us are involved in training-teaching-learning processes. Whether, as resource persons in a workshop or as a trainer in a training session or module developers, we are in adult education. If we are not educationists, or not psychologist, are we competent? It is only recently that faculty development among health professionals has started but most of us become trainers on self learning or experiential learning methods. Are these only applicable as adult learners? I don’t think so. In fact, Julie Conlan, Sarah Grabowski, Katie Smith, Department of Educational Psychology and Instructional Technology, University of Georgia (Authors of Review of Adult Learning at http://projects.coe.uga.edu/epltt/index.php?title=Adult_Learning) also believe that these methods are applicable even in childhood.) My belief is on small experiences again at my school Sardar Patel Vidyalaya.

Some expirience of ‘experiential and self learning’

In August 1965, the India – Pakistan War broke out. We were early teen agers studying Social Science text book when the war started. A normal reaction of fear and excitement – of black outs, of combats and of war propogandas – was natural. Every morning there was siren exercise at the school ground. But, our social science teacher changed the syllabus and his role – he took permission to adapt the 6 months syllabus into Kahmir issues, Indo Pak War, the military structure, role of UN etc., etc. Sources was supposed to be magazines, newspapers, radio like AIR, VOA and BBC, some stories, II WW comics etc. We were to prepare a daily news item and inform the daily prayer session of the whole school! We had groups for projects – about the structures and strengths of Indian and Pakistani Armed Forces, about history of Kashmir issue, history of Indo China War etc. etc. For the first time the ‘boring’ subject became an exciting and action oriented one. The groups competed for better presentations and better knowledge. A group actually went and met some high rank in the 3 wings! Incidentally, the whole class passed with bright marks! Involvement of the children was high, converted fear factor into a creative one. Its imprint is still palpable – I can ‘see’ the face of Shri M L Sharmaji – my ‘facilitator’ cum teacher!

What I am saying is nothing new, all our eminent schools have this as a part of teaching method. I am questioning ourselves: do we have in medical, para medical education such methods? How much of our education is based on problem based, learner centered, experiential/action learning methods? To what extent are we flexible in teaching in the formal education system? A survey conducted among medical students by CHC a some time back had pointed out a similar problems.

My loud ‘diptinking’

Have we done so in our ASHA/CHW training? We stick to one approach, one manual and train the trainers accordingly and defeat the very purpose of flexibile, learner centric approaches. My dilemma is what to do can be fixed but can how and who be also fixed? In an action learning, there can be a group of learners and a facilitator/learner’s coach or counselor (in the Open Distance Learning’s parlance). The trainer can learn how to train while doing, so the ToT should be an orientation workhop and the real ToT should be while working as the facilitator and not in the classroom! Let there be an observer and review meetings for discussing the Pros and Cons, areas of improvement etc. Even comparatively less educated self learn, learn while doing but trainers are not so less educated. They are doctors, nurses, social workers who have their own experience, knowledge of education, knowledge about the content etc. How much of instructions would have retention when action is in different environmental settings required?

What are your thoughts? Experineces? Experiments?

How and Why - did I get became the worm in the apple of health!

I was in my Higher Secondary – 9th standard at Sardar Patel Vidyalaya at Lodhi Estate, New Delhi. (Walking through the Lodhi Gardens and coming out from a gate where World Bank has an office today was a routine exercise.)

Trigonometry (we used to call the exercises as tanning by sins and its coses) and Chemistry were my pet and scoring subjects. Biology, particularly dissecting cockroaches, earthworms and frogs were interesting activities.

Once, we dissected an earthworm and removed its brain. We put it in cockroach’s head! Our biology teacher spanked us orally but we called it The Transplantation of the Brain! This was a couple of years after the first human to human heart transplantation was done by Christiaan Barnard.

While biking back from the school to home, we argued if it is possible to transplant Leyland engine into a Tata Benz bus! Because the Delhi bus service was dismal then but they were TATA Benz buses. Mumbai had Leyland but services were excellent. The hypothesis was: the cause of DTC’s dismalness was the bus engine! At the end of the day - and of 12 golguppe each, we concluded that transplantation was biologically possible but mechanically not and closed the chapter. One of the argument was – you can’t transplant the mercury barometer’s dial to the anerobic baromenter, can we, so shut up. I think peer and unauthentic sanskars of intense, logical but futile debates during the school days were essential to become an mfcite!

I found math and physical sciences as very interesting and scoring but biological ones exciting! The Adolescent Kink retained me in bio though I scored better in HSC in PCM and when testing self in the IIT Entrance Test scored fair. A wrong decision not to go in engineering field landed me in medical.

So, I am here…sometimes weeds also get medical value, isn’t it!