NORTH WALES MEDICAL AID TO TAMIL NADU

Tamil Nadu is a southeastern Indian state with Madras (now called Chennai) as its capital. Kanchipuram, an ancient town in Tamil Nadu, is 75 miles from Chennai and is renowned for its 7th – 10th century temples. The area around Kanchipuram is comprised of poor and remote villages with little or no health or social care.



Dr. Viswanathan, a consultant psychiatrist whose working life was principally within North Wales, was born in Kanchipuram. Taking early retirement in 1989, he and his wife worked voluntarily in the slums of Madras before moving their efforts in the health sector to the village of Irumaram, a village some 15 miles from Kanchipuram.



The establishment of a primary health clinic in the village was the main objective and in this task he was aided by colleagues in North Wales who established the registered charity North Wales Medical Aid to Tamil Nadu. The Bishop of St. Asaph agreed to the chairmanship of the charity, which was established in 1989. In 1992 a fund-raising arm of the charity, the Friends of Tamil Nadu, was established under the chairmanship of Mr. Edward Lyons, retired consultant ophthalmologist. The present chairman is Mr. Srinivasan, consultant urological surgeon. Tamil Nadu Village Trust was established in Kanchipuram in 1993, again a registered charity with FRCA approval.

Historical Perspective

The villagers, for centuries, never had the opportunity in life and they didn’t have access to formal educational system until recently. It was impossible for them to aim for any more than menial jobs and unskilled labour. Land has been given to them by the government but it is infertile and without irrigation. They are consequently poor, malnourished and generally unskilled

Many adults are illiterate. Only about a half dozen of the adult males in Irumaram work in nearby towns. The rest work as agricultural labourers under landlords from the towns for wages of as little as 50 pence per half-day. Although the villager might have status within the village because of the land he owns, the land itself does not bring in any significant income. They are caught in a poverty trap.


Activities between 1990 and 1999
1990 Commencement of clinics in Irumaram
1991 Commencement of clinics in Adavappakkam
1992 A community hall is built in Irumaram – foundations laid by the pupils and teachers of Denbigh High School, North Wales.
1993 A jeep for mobile clinics in surrounding areas is presented by the North Wales Medical Trust
1994 Annual visits to the area by students and lecturers from Llandrillo College, North Wales for the purpose of health education.
1995-1996 Various programs on health and education were introduced, i.e. bringing fresh water and electricity supplies to the village, obtaining the title deeds to the villager’s huts, adult literacy classes, arranging training in small trades and crafts such as tailoring, making footwear, soap powder, bathi and greeting cards. Vitamin and deworming tablets were regularly distributed to the villagers, goats were bought and regular veterinary inspections were organised. Educational excursions were undertaken and specialists in various subjects were enlisted to advise the villagers on law, agriculture, alcoholism, aids and leprosy. Six toilets were built for six families chosen by the villagers themselves.
1997 District 18 of the Inner Wheel raised £9,000 to build a child development centre in Irumaram.
1999 A successful Lottery Grant application (now called the Community Fund) brought in £67,000 to run the child development centre for five years. This period came to an end in September 2004.


Activities between 1999 and the present

a. Child Development Centre
This is a pre-school establishment for 25 children between the ages of 2½ and 5 sited in Irumaram. Half the children are from Irumaram itself with the other places filled by two children from each of the six neighbouring villages. Parents have to ensure that their children are properly washed, clothed and groomed before they arrive at the centre. They are delivered to the centre by their parents at 0830h and collected in the evening.
When the children assemble in the morning the day starts with a prayer followed by Kural and Atthichudi (moral couplets). Then learning through play starts in earnest with all the children involved in these activities are split into three smaller groups based on their age. In general the day consists of prayers, health checks, lessons and games. Snacks of dates and milk as well as a midday meal are provided. They clean their teeth before they go home. The children are taken on regular nature walks and once monthly they are taken on special excursions to such places as the Bird Sanctuary in Vendanthangal and the Crocodile Park in Chennai.



A special questionnaire has been developed to assess the development of the children and this is administered every six months. A designated health worker takes the “mid upper arm measurement” and the “skull circumference” of the children every month. Guidance and help are given to those families whose children are identified as ailing or malnourished. Each child is medically examined every six months.

b. Parents Meeting and Health Educational visits
Health and educational staff hold monthly meetings with parents in Irumaram, Adavappakkam, Neyyedipakkam, Vayalakavoor, Kavampire and Magaral villages. The aim of these meetings is to educate the parents on various topics such as safety, food poisoning, dental care, nutrition, hook worm infestation, epilepsy, hypertension and asthma amongst many other topics. In Irumaram parents and teachers get a chance to discuss the children attending the child development centre. Charts and slides are used for this purpose. Popular snacks are served at the end of meetings to encourage parental attendance. Mothers of the “best dressed child” and the “most healthy child” are rewarded.

c. Toddler Group
These meetings are aimed at mothers with very small children and they therefore focus on issues relating to their unique circumstances, e.g. breastfeeding, rashes and nutrition. For mothers with babies this is a break from their everyday chores. Antenatal care is provided to all pregnant women.



d. Child to Child Programme
The Balwaadies run by the government have no teaching aids such as charts, toys, books, slates or chalk. Therefore, once each month the children from a nearby Balwaady are invited to the child development centre to spend a day with the children there and enjoy the facilities of the centre. The children of the villages benefit from meeting new faces and in this environment they learn to share. Financial constraints prevent expansion of this scheme.

e. Vitamin and Deworming Tablet and Nutritional Mixture Distribution
Vitamin A&D and B complex tablets are distributed freely to all children under q0 years old to supplement their poor dietary intake. Parasitic infection is endemic which compounds the underlying nutritional deficiency, so deworming tablets are given to all the children under 10 years every six months. A nutritional mixture of pulses such as fried gram dhal mixed with jaggery are prepared in sealed packets in the child development centre and distributed to all children in Irumaram and Adavappakkam.

f. Voluntary Services Overseas
In 2000 Sharon Robb, a trainer from VSO, was posted to the village to help in the child development centre. She proved to be a great inspiration to both staff and children. She lived in the village, introduced a number of new techniques and brought new ideas to the centre’s curriculum. Sharon spent nearly three years in the village until she finished her term in October 2003.

g. Curative Clinic
These clinics are taken once weekly on Sundays by voluntary doctors from Kanchipuram. They are assisted by health workers who dispense tablets to patients, dress wounds and give injections. During this clinic the health animator measures urine and blood sugar levels and checks haemoglobins if necessary. There is good liaison between the village clinics and the headquarters hospital in Kanchipuram with regard to referral of serious cases and special investigations. Periodically, special clinics for eye, skin, dental and leprosy are arranged.

h. Mobile Clinics
Mobile clinics are held for those who live in distant villages and who are unable to visit the clinics held in Irumaram and Adavappakkam. These clinics are often held in makeshift premises with borrowed furniture from a nearby school or Balwaady.

i. Aids Awareness Programme
TNVT animator was trained to educate the public about AIDS and AIDS-related illnesses. He is now giving talks on the subject to various sections of the public, promoting the idea of “protected sex for those who are not part of a monogamous relationship”. Free condoms are available from TNVT. Confidential guidance is given at special clinics and HIV testing is available. Young adults use “HIV” and “AIDS” as topics for discussion in the local debating society.

j. Volunteers
Volunteers from all walks of life have visited the village, often for a few weeks, some for as long as a year. A husband and wife (both GPs) from North Wales have run clinics. Several medical students have had electives in Irumaram. Recent medical student placements have carried out sophisticated surveys on skin disease and mental health in the local community.

Long-term Strategy

The establishment of a health facility in the villages was always considered as the first step on the road to self-sustainability. It was never considered necessary nor in the best interests of the villagers, to support them in the long term. Indeed, training of villagers in simple health care has occurred and some villagers have been sent away for further education.



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