Making health care appropriate, accessible and affordable is the main focus of AWD initiative, to enable the elderly live with dignity (Photo courtesy Mitra team)

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Raygada: It has been said that life is a terminal disease. All who are born, will die. The time between the two defining events varies and is often not in our control. But one value we hope to hold on to through childhood, adult life and old age is dignity.

India has a growing proportion of people who are living longer, but not necessarily living better. Despite the myths we perpetuate of a universal respect for our elders, the reality is often a life of loneliness, especially after one’s spouse passes away. Sometimes the elderly feel a loss of worth and loss of dignity. This is true in urban as well as rural communities

What can be done to help our senior citizens feel needed and wanted; or at least respected and valued? Doesn’t everyone have a right to live, to age and to die with dignity? Ageing with dignity (AWD) is an initiative that addresses the concerns of the elderly.

Rural hospital

Bissamcuttack is a small place in Rayagada district of south Odisha. The Bissamcuttack administrative block has about 90,000 people living in 315 villages. About 63% of the population belongs to the Kuvi Kondh tribe, an Adivasi community. Another 17% belongs to the Dalit or scheduled caste (SC) community.

Christian Hospital, Bissamcuttack (CHB) is a 200-bedded mission hospital, started in 1954 by Elisabeth Madsen, a Danish lady doctor. The Community Health Department (CHD)of CHB seeks to improve the health status and quality of life of the people in the region.

CHB also conducts training in Nursing and Lab Technology, and runs a tribal school with Indian Certificate of Secondary Education (ICSE) curriculum.

Improving health

Madsen’s Institute for Tribal & Rural Advancement, commonly referred by the acronym Mitra, is CHD’s operational identity. Mitra works with 13,000 people in 54 predominantly tribal villages. Mitra works towards a dream where everyone would be healthy, educated, and live with dignity, with no sign of poverty or hunger.

The Dakulguda cluster is a geographically contiguous group of 15 villages with a population of about 6,000. Mitra has run a health center with residential nurses in Paika Dakulguda village since 1980, on the request of, and with the help of the village community.

Dreaming up solutions

The Mitra team comprises of health and education professionals and members from the community served. Mitra’s way of doing things is to first brainstorm with multiple groups to arrive at a dream for each activity ; and then to allow the methods to evolve through action and reflection, over the years.

The annual mela helps inculcate self-worth and self-respect among the elderly, in addition to helping them bond with each other (Photo courtesy Mitra team)

The advantage of dreams is that they can stay comfortably nebulous – not subjected to the stress of constipated objectives that are squashed into sterile frameworks to see if they are measurable, achievable, etc. Dreams provide the space for uncertainty and fertile flexibility.

There is an ongoing dialogue that helps identify pain points ; issues that need addressing. These are then nibbled at and fleshed out through community discussions. The idea of the Ageing with Dignity Initiative came up through such a process.

Senior citizens’ concerns

In 2008, the Mitra team undertook a gap analysis, to find out the unaddressed pain in the community. In Dakulguda, it was the elderly that needed attention. A survey and focus group discussions threw light on the key issues facing the elderly.

The team discovered that the biggest fear of the elderly is the feeling that they are a burden. There was a feeling of loneliness, a feeling that there is no point living, especially after one’s spouse dies. In other words, the loss of dignity. The team discussed the issues with the elderly, the youth, staff and community members.

The community dreamt that all the village elders would be able to age with dignity, with

  • Health care that is appropriate, accessible and affordable
  • Social support that provides safe space, leisure, advocacy support, and scope to contribute to society
  • Economic security, in terms of food security and health care security.

Most of the elderly receive government’s monthly old-age pension. Health care being Mitra’s expertise, the team decided to focus on the same.

Ageing with dignity

Ageing with dignity is a small initiative that was started in 2009 to address the problems of senior citizens. The primary aim is to prevent loss of dignity due to health issues in old age, mainly stemming from the feeling that one is a burden to the family.

Under AWD, anybody above the age of 60 years in the Dakulguda cluster of 15 villages can choose to join the club meant for them, by paying an annual subscription of Rs 10. In the AWD program there are currently 636 members, which is almost the entire elderly population of the program villages.

The annual mela helps convey a message to society, especially the youth, that the elderly matter (Photo courtesy Mitra team)

The subscription gets them a membership card and free access to benefits including primary health care services, participating in an annual mela meant for the senior citizens and an annual gift.

  • Primary health care services

Mitra’s community health nurses who had been trained at CHB College of Nursing make fortnightly visits to each village to address the health issues of the elderly. The subscription provides the elderly access to preventive and curative care for issues as diverse as respiratory infections and hypertension, malaria and tuberculosis, anemia and the aches and pains of old age, besides the common illnesses.

Health Issues that can increase dependence Strategy
Hypertension causing strokes Monthly BP check and treatment as needed
Anemia Daily iron and folic acid
Fractures due to osteoporosis Daily calcium tablets
Blindness due to cataracts Screening and access to eye surgery

(ii) Annual AWD fair

The annual AWD mela is a get-together organized on or around Gandhi Jayanthi i.e. 2nd of October. The mela is held in two places, to enable easy access for the elderly. Hundreds of members of the club meet and catch up with each other.

There’s fellowship – meeting others, building relationships with each other and with the Mitra team members. The mela cultivates a sense of belonging and self-respect, knowing that after death, each would be remembered with a moment of silence in the next amoro (our) meeting.

There is entertainment and fun – with songs or dance or drama or a movie and snacks. There can be dissemination of information on issues of the elderly, on Gandhiji, on the AWD work of the previous year, and the rights and roles of the elderly.

The mela also conveys a message to society, that the elderly matter. It aims to sensitize the younger generation on the importance of the dignity of the elderly, and their needs, issues, etc. The not-so-subtle message is “Your children are watching you”, based on Premchand’s story Kaki. i.e., how you treat your elderly is how you may be treated one day.

(iii) Gift for the elderly

A few weeks after the mela, in each village, the youth hand over a gift to the elderly. It could be a blanket or a shawl or an umbrella or a sari / dhoti. Each year the gift is different, but aimed to reaffirm the dignity and respect of the elderly. The cost of the gift is around Rs 200 per person.

Positive results

These are simple yet deep ideas that the elderly highly appreciate. It has evolved over the last 10 years, an idea that can easily be adapted, replicated and improvised. It is small compared to what can be done, what needs to be done and what others seem to do. But this is home-grown and sustainable.

The program was started with the hospital’s own resources. Mitra Primary Health Care Program takes care of cost incurred on human resources and medicine. Cost of the annual mela and the gift are logged AWD program.

Over the years, partners have generously supported the work of Mitra and AWD. Over the last 12 years, Tata Trusts supported the work for eight years, Mitra managed with internal resources for three years. Currently Azim Premji Philanthropic Initiatives supports the program.

The AWD initiative is a simple and sincere initiative, tailored to the needs and context of a specific community. But there are ideas in it that may have cross relevance. Each year’s actions are the subject of review and reflection, leading to the growth and refinement of the idea. And the process continues.

Atulya Bora, Balakrishna Himirika, Bhimsen Kulisika, Jyoti Tuika and Johnny Oommen are members of the Mitra team, serving in various capacities.

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