ROLE OF SOCIAL WORK IN CANCER PREVENTION AND CANCER CARE

 

Cancer is, to a large extent, avoidable. Many types of cancers are preventable. Others can be detected early in their development, treated and cured. Even with late stage cancer, the pain can be reduced, the progression of the cancer slowed, and patients and their families helped to cope.

The profession of social work has great strength in tools and techniques especially in the areas of community mobilization and in providing psychosocial support that the medical profession doesn’t have. Some other example of the strength of social work will include social action and mass mobilization; understanding of community’s dynamics and eliciting community participation; social welfare linkage and management; counselling, group work and community work for educational purpose and psycho-social support, etc. The tools of social action especially mass motivation, mobilization and participation of the community will be very effective at the preventive level of cancer.

In the Curative level, social work can provide supportive roles to the doctors and patients by providing psychosocial and emotional support which is today, widely accepted as a critical component of medical treatment. It can provide motivational, educational and therapeutic counselling to the cancer patients; it can links patients with necessary resources like funding and treatment aids from the governmental sector as well as non-governmental sectors, etc.

At the rehabilitation level, there is even a greater role for social work by taking care of the palliative unit. At the palliative level, taking care of the psycho-emotional needs is critical not just for the cancer patients but also for their families for any eventualities.

The Government of India under its National Cancer Control Programmes (NCCP) followed four principal approaches in controlling cancer in India. This paper will also follow that approach in exploring the possible roles of the profession of Social Work in Cancer Care and Prevention, with one more heading added, i.e. Policy level.  

1. Prevention
2. Early Detection
3. Diagnosis and Treatment
4. Palliative Care
5. Policy Level

1. PREVENTIVE LEVEL

Prevention should be the key element in any disease control programme. Prevention means eliminating or minimizing exposure to the causes of cancer, and includes reducing individual susceptibility to the effect of such causes. This approach offers the greatest public health potential and the most cost effective long-term method of cancer control.

Cancer prevention at the individual and community level, social worker can take a leading role by ensuring community participation in taking preventive actions, awareness generation at all level from school, neighbourhood, to community.

• The most useful prevention strategy is reduction in tobacco consumption (all forms). Currently about 50% of cancers in men and 20% of cancers in women are related to tobacco use. Social workers can take a leading role in spreading the health implication of tobacco, helping people deal with tobacco addiction, and rehabilitation of tobacco farmers and those whose livelihoods depended on tobacco in one form or the other by helping and generating alternative source of livelihood;
• The social workers can ensure in involving all levels of the population in the educational process regarding cancer. The contents of cancer education should focus on, tobacco control, physical activity and avoidance of obesity, healthy dietary practices, reducing occupational and environmental occupational exposures, reducing alcohol use, immunization against hepatitis B virus, safe sexual practices to avoid human papilloma virus infection.
• Campaigning for a healthy lifestyle, which includes eating plenty of fruits and vegetables, avoidance of alcohol and adequate physical activity, is protective for many of the non-communicable diseases including cardiovascular disease and diabetes, and can be considered as part of the overall health promotion programmes.
• Cancers related to infectious agents such as human papillomavirus and hepatitis B virus can be prevented through vaccination strategies, and social workers can take a leading role in mobilizing the communities.

For the above mentioned prevention measures at the community level, a variety of methods can be employed to educated the community:

• Among School and University student: Conducting drawing and essay competitions, debates, discussions, seminars and street play competitions, etc.
• Among Community organization, Municipal, District and State Health Administration: Organizing Participatory workshops and training sessions.
• In the Mass Media: Participatory programmes on radio and television, descriptive articles in newspapers and magazines,
• Among the General population: Conducting exhibitions and public lectures, conducting street level awareness drive, focus group discussion with community members, health camp, etc.

2. EARLY DETECTION OF CANCER

Early detection of cancer is critical in combating cancer mortality rate. In India, almost 60 – 70 % of cancer patients are detected at advanced stage which reduced the chances of recovery and raise the cancer mortality rate. 

Cancer Screening is the application of a relatively simple and inexpensive test to asymptomatic subjects to classify them as being likely or unlikely to have cancer. A screening test in itself will not prevent cancer; it needs to be followed up through a systematic medical approach. Still, this is a relative simple measure for early detection of cancer that can be undertaken even by those who have no advance training in medicine but are familiar with medical processes like medical and health social workers with minimal training about the screening process.

• Opportunistic screening or case finding can be done by the Medical Social Welfare Unit in selected pockets of community based on the populations’ likelihood of getting cancer (this can be determined by many criteria like life-style, community living in industrial areas, or in a waste disposal or waste treatment areas, community whose livelihood are related to radiation or tobacco industry, etc.). This will help not only in early detection but also in increasing the awareness level of the community.
• Clinical breast examination can be made feasible for women above the age of 40 years, which can be carried out by general practitioners besides community mobilizers like Social Workers. Also there are some simple breast self-examination techniques for women which social workers can teach to groups of women in the communities.
• Cancers in accessible parts of the body like the oral cavity may be detected at an early stage or even in a precancerous stage through simple inspection and examination; medically familiar personnel like medical social workers can be trained for this purpose.
• Self-examination of the oral cavity (MSE) and breast (BSE) can be useful methods and each can be propagated widely as a strategy through simple IEC (Informational, Educational Communication) materials, community meeting, focus group discussion, etc. for the early detection of cancer.

3. DIAGNOSIS AND TREATMENT LEVEL

In the Curative level, social work can provide supportive roles to the doctors by providing psychosocial and emotional support to the patients and their families which is considered as a critical component of medical treatment. It can provide motivational, educational and therapeutic counselling to the cancer patients; it can links patients with necessary resources like funding and treatment aids from the governmental sector as well as non-governmental sectors, etc.

At the diagnosis and treatment level, the roles and functions that a social worker can play in cancer care are:

• Motivation counselling to patients to seek medical help and enabling resources for the treatment and providing proper referral services
• Educational counselling to the cancer patients about their medical status, preparing them for future course of treatment and treatment process and the possible outcomes of the treatments.
• Therapeutic counselling to deal with the psychological stress and trauma that can have severe implication on their already weak physical body;
• If the patients and/or the family are in crisis because of the treatment, crisis intervention has to be undertaken
• Emotional support to the family of the cancer patients, and eliciting the involvement of the family in the treatment process
• Providing the cancer patients with various social welfare resources that will enable and enhance their access to better health care and treatment
• Linkage of cancer patients with governmental and non-governmental welfare resources
• Organizing therapeutic and/or peer support group for cancer patients
• Since cancer patients are under extensive emotional and psychological anxiety and stress, organizing recreational and entertainment for them is important
• A diagnosis of cancer and subsequent treatment can have a significant impact on self-concept, the way in which people perceive or react to themselves. Living with cancer may affect personal self-concept (facts about the self or a person’s self-opinion); social self-concept (perceptions of how one is regarded by others); and self-ideals (perceptions of oneself with respect to how one would like to be). Social worker can provide support and counselling for such patients.

4. PALLIATIVE CARE

Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment, and treatment of pain and other problems – physical, psychosocial and spiritual. Palliative care is particularly important in less developed countries where a high proportion of cancer patients are diagnosed in advanced stages when treatment is no longer effective. These patients can be relieved from suffering with relatively low-cost interventions.

The various issues that crop up in palliative care especially in the terminal stages are:

• Physical issues towards the end of life incudes loss of function and curtailment of activity and physical effects to perform activities of daily living, including self-care activities, mobility, physical activities and role activities.
• Psychological issues towards the end of life include fear, distress, anxiety, anger, frustration, disappointment, depression, etc.
• Social issues towards the end of life include disruption social relationships as a result of impaired ability to pursue normal activities and maintenance of social contacts.
• Existential and spiritual issues towards the end of life include confrontation with mortality, the meaning of life, isolation and worth as a person. As patients reached terminal stages, spiritual issues gain importance as determinants of quality of life. Spiritual considerations may also assist the individual to endure present discomforts and, if need be, to face death with courage and dignity.
• Impact of towards-the-end-of-life issues on the family includes general depression, concern about old parents or young children, unclear role and power structures in the family, unclear source of income and means of livelihoods, etc.

The role of the social worker is to help the family and patient deal with the personal and social problems of illness and disability, as well as to provide support during the progression of the disease and the bereavement process if the patient is at the end of life.

• The social worker’s assessment helps define the patient’s and family’s needs from a psychosocial perspective, and helps anticipate problems within the family that may result from dysfunction and financial difficulties, particularly as the family begin planning for the future.
• Social work offer such interventions as referral to needed community services, emotional support (including individual counselling of patients and family members) and bereavement counselling.
• At this stage, social worker can help in finding help and assistance for the patients if there is no one to take care of them, find a nursing home or palliative care unit that can take-care of their personal needs, and helping the family of the patients on how to deal with this physical issues.
• The social worker can help the patients in coping and dealing with the issues of their medical condition, including the possibility of death, ensuring that their personal concern and worries are taken care of as much as possible, and if the need arises, finding spiritual guide and person to interact with the patients.
• The social worker can help the patients in staying in contact with family and friends and other loved ones, explain to the family how he is unable to maintain or reciprocate the relationships, etc.
• Conducting support group for the family, along with therapeutic counselling to cope with the situation.

5. POLICY LEVEL OF CANCER CARE

There are many ways that a social worker can get involved at the Macro level of cancer prevention and cancer care:

• Many types of cancers can be prevented to a large extent through a comprehensive tobacco control programme including education, legislation, and tobacco cessation services.
• Ensuring leadership that create clarity and unity of purpose, and to encourage team building, broad participation, ownership of the process, continuous learning and mutual recognition of efforts made in cancer care.
• Ensuring involvement of stakeholders of all cancer related sectors, and at all levels of the decision-making process, to enable active participation and commitment of key players for the benefit of cancer control programme.
• Creation of partnerships to enhance effectiveness through mutually beneficial relationships, and build upon trust and complementary capacities of partners from different disciplines and sectors.
• Responding to the needs of people at risk of developing cancer or already presenting with the disease, in order to meet their physical, psychosocial and spiritual needs across the full continuum of care.
• Ensuring decision-making based on evidence, social values and efficient and cost effective use of resources that benefit the target population in a sustainable and equitable way.
• Ensuring the application of a systemic approach by implementing a comprehensive programme for cancer with inter-related key components sharing the same goals and integrated with other related programmes and to the health system.
• Seeking continuous improvement, innovation and creativity to maximize performance and to address social and cultural diversity, as well as the needs and challenges presented by a changing environment.

Looking at the prevalent trends in the spread and magnitude of cancer and its non-discriminate penetration of every sections of the society, cancer is already a health concern that needs urgent attention from all sections including policy-makers across the world. According to the World Health Organization, death from cancer and other life-style diseases in the developing world including India is expected to increase 104% worldwide by the year 2020. In India, the total cancer cases alone are likely to go up from 979,786 cases in the year 2010 to 1,148,757 cases in the year 2020.

The profession of Social work, especially medical and health social work must take this opportunity in order to survive and thrive in this fluctuating and complex environment in which it is reduced to a supporting role. Social workers must either accept this challenge to change and re-evaluate the services provided and expand their horizon of works or lose the opportunity to be players in the field of cancer prevention and cancer care.

[This is an extract from my Research Paper titled: Exploring the Role of Social Work in Cancer Care and Cancer Prevention submitted to the Dept. of Social Work, Jamia Millia Islamia (New Delhi) and conducted in BRAIRCH of All India Institute of Medical Science (New Delhi) between September 2011 – March 2012 ]

EMPLOYING A MINOR AS DOMESTIC HELP

 

It is becoming pretty common to see young couple within our community here in Delhi and other major cities around India raising their children without the help of the traditional pattern of child-rearing –the grandparents. But in most instances, the young couples are bound to employ domestic help, especially the help of young girls.

It’s good to see our younger generation seeing household chores as worth a full-time job, but in doing so, there are certain rules and laws, as well as human rights involved that one must be fully aware of, so that we don’t destroy someone's life in the process.

It is rare to see cases of young children being sexually abused within our community, but financial exploitation like underpaying could be rampant thought it is conveniently swept under the carpet. In order to raise awareness, here are few points to note especially child labour and child abuse.

CHILD LABOUR

What is Child Labour?
Child Labour, in simple term, refers to work performed by children that HARMS them or EXPLOITS them in one or more ways (physically, mentally, morally, or by blocking access to basic rights like freedom, education, etc.).

Not all labour of children constitute child labour, and there is no universally accepted definition of ‘child labour’, however, if the work done by the child is considered to be harmful or exploitative, or that the child feels that he/she is being harmed or exploited, it is considered as child labour.

Who is a child?
Any child yet to attain the age of 14 years [Child Labour (Prevention & Regulation) Act].

However, depending on the kind of work being done by the child, the employer can also be prosecuted for harbouring child labour by employing anyone yet to attain the age of 18.

Punishment for Employing Child Labourer:
Penalty for violators: 3 months – 1 year of imprisonment and/or fine of Rs. 10,000 - Rs.20,000, Penalty for repeat violators: 6 months to 2 years of imprisonment.

A child working as a domestic help is also considered as child labour if the work done by the child in any ways comes to disrupts, hamper or block the child’s basic human rights. The child’s basic rights include the right to survival (food, nutrition, shelter); to develop to the fullest (cognitively, physically and developmentally); to be protected from harmful influences, abuse and exploitation; and to participate fully in family, cultural and social life.

Majority of child labourer are in need of care and protection, as such, the Juvenile Justice Act, which define a child as anyone yet to attain the age of 18 years, will be applied. Which means, if the domestic help you employed is younger than 18 years of age and the Child Welfare board think he/she is in need of care and protection, the Juvenile Justice Act will be applied. The Juvenile Justice Court is not a civil court, as such it is pro-child, trials are swifter and punishment are much harsher than under the Child Labour Act.

CHILD ABUSE

What is child abuse?
Child abuse is the INTENTIONAL injury or maltreatment of a child by any significant people in the child’s life which lead to temporary or permanent impairment of the child’s physical, mental or psycho-social development, or disability or death.

‘Significant people’ includes anyone of any age, any sex, related or unrelated to the child, including parents, legal and non-legal guardians, employers, etc.

Who is a child?
Anyone yet to attain the age of 18 years of age [Juvenile Justice (Child in Need of Care & Protection) Act].

What constitute child Abuse?
Abuses are of three major types – physical, emotional & sexual. But financial exploitation is also considered as a form of abuse nowadays.

1. Physical Abuse includes – any act of physical aggression including beating, trashing, slapping, punching, pinching, pulling by hair or clothes, pushing, throwing, biting, burning with hot object, branding, aggressive handling, arm twisting, etc.
2. Emotional Abuse includes – verbal and non-verbal; cursing, humiliating, degrading, frightening, threatening, belittling, name-calling, habitual blaming, constant hostility toward them, etc.
3. Sexual Abuse includes – touching and non-touching behaviours including kissing, fondling, touching private part, rubbing genitals on the child, forcing them to touch your private parts or forcing them to any kind of sexual activities, and inserting body parts and/or objects in into the private part, anus and mouth of the child or attempting to do that. The non-touching behaviour includes undressing, voyeurism, exposing them to pornography or exhibition of private parts to them.
4. Financial Exploitation includes – paying less, not paying or not paying in time, withholding payment for reason or no reason, etc.

Employing anyone below the age of 14, no matter what are the conditions and terms you agreed on, is a crime. In such case, if any other person like the parents of the child agreed to let the child be employed, the parents too could be prosecuted for human trafficking.

Abusing anyone, no matter what type of abuse it is, is a crime, and the crime become graver if the abused person is yet to attain the age of 18. The JJ Act also includes the parents/guardian as possible perpetrators, so it is applicable for the family as well i.e. if you abuse your own children, your children can charge you for abuse.

Concluding Remarks: We the north-eastern are often labelled as westernized, it is true to some extent. However, we still have this traditional tribal mind-set when it comes to laws and legal matter by solving it through traditional channel, or making traditional arrangement to help with domestic chores by providing basic education to the child while helping with the domestic chores, or taking children under guardianship.

It is good that if we are providing education to the less fortunate children of our relatives, and it is good if we could maintain consensus and avoid ugly legal wars by solving serious matter including murder using our traditional channel. But in many instance, societal sanction against certain behaviours is just not enough to deal with the magnitude of the crime and the crimes of the perpetrators. In cases like child sexual abuse, the abusers usually are serial abuser. And there is no denying that there certainly must be some such cases among us.

PS: In cases that come under the Juvenile Justice Act, the child can be made to undergo medical test to determine his/her age even if a proper birth certificate is provided.

Child Helpline : 1098

That Little Village My Parents Love So Dear…

Every alternate year, I went back to that little village despite dreading the seemingly endless journey.  Despite being provided with options and having alternate and much better places to live, my parents insist to continue living in that obscure little mountain village often inaccessible during rainy season, with a distant mobile phone network that works just a few days a year.

That little village is also the place where they brought us up their six children.  It must be the one place they wanted to brought up their children and grandchildren but that’s not the case for my parents.  None of us stayed back and none wanted to live there in the future so we all tried to make up by spending our summer and/or winter holidays with them rather than getting away to one of those exotic location often advertised in those glossy magazines like most people do.  Of their eight grandchildren two were born in their presence and the last one was over a decade ago now.

That doesn’t meant I don't like the place.  No matter what that little village is the one place I still called home and my heart still beats for it.  Despite my untiring complaints of  everything, from the lack of privacy to my inability to use my mobile phone or wifi-internet connection, and despite my unending whining about the lack of basic infrastructures and the government’s apathy, I still yearn for that village and the simple people who live there.

My mother sent me off to live with my Brother just before I entered my teenage years not only because of the ethnic troubles at that time, but also to escape the drug-prone environment.  Moving to Delhi has been dramatic for me in many ways.  But I'm not complaining or blaming my Mother, rather I thanked her for letting me face the real world early without waiting for the inescapable reality we are ought to face in the future and being caught unprepared.

My whole family has been scattered across India and abroad.  My parents are getting old and there are slim chances of a family get-together.  I often wondered if my parents ever felt lonely and regret sending all of us off.  Mother always explained that it’s for our own good and with the hope that we can make something out of ourselves. 

I can’t say we made something out of ourselves with pride –to other, we are still nothing but we did it okay.  We all would loved if our parents wanted to live with at least one of us in a city, but they have sacrificed enough doing without us and we are not going to ask them to part with the one place they love.  Apart from that, I often observed how handicapped and worthless they felt in the few occasion they came to visit us. 

In the village, they have farm and garden to keep them busy, animals to take care of, have close relatives as neighbours who sought their advice for every decision and can take care of them if the needs be. They have a full and dignified life there, the only thing amiss is their children. If they had lived with us, they have to give up all that since life in a city call for a totally different life style. We don’t want them to make so many changes and adjustments so late in their life or feel sorry about themselves for the remaining years of their life.

We know how much they miss us and we miss them too.  It’s a sacrifice –a sacrifice to maintain dignity, to show our respect and love and as a token of thanks –a sacrifice that we all understand.  That’s the reason why we never wanted to drag them away from the one place they love –the place that we all realized we are still in love with.

The Ties That Bind Us

There are many things that bind a family together. Apart from the usual family things, there are small things that hold together our conversation and help us avoid those awkward moments during dinners. For instances, my Father’s sense of humor made us one of the most envied family when we grew up. It is our shared love for music, especially Southern Gospel/ Country Gospel music that keep my conversation going with my big Brother. On the other hand, Robert Ludlum keep us going with my other Brother.

All of the above are shared interest, so how about personal troubles. Sometimes situations like death, personal tragedy and other unusual situations make us stronger. The troubles one is going through, the problem the other faced, trials and humiliation, etc, can all be the bridge to a much stronger family.

As I often said, my family is far from dysfunctional even thought there are many resemblances. But these past few weeks had turned our world topsy-turvy and I’m no longer sure what is going-on in my family. The most unlikely situations took place, and totally changed our stands.

A few weeks ago, my big brother went through a nightmare, that too publicly. I thought this could be the end and feared he will never recover from it. But I thought it wrong, not only he comes out much stronger, the whole family comes out much stronger.

When it comes to big brother, we always put him in a different category, because he’s a little more adventurous than the rest of us. But when it comes to this ‘nightmare’, we were more outraged than him. We called each other and consoled each other. We talked like we never talked before, and we discussed things like we never discussed things before, and we all realize that he had been our inspiration all along.

I often thought he is the one responsible for breaking my family apart, and putting us in the situation where we are now, and I’m blubbering not without justification. But he’s the central of our universe right now and I pray he will do so in the future as well.

There are other changes, positive changes that are nothing sort of ‘miracles’ happening in my family after that ‘nightmare’, but I’m not going to this easily give-up my ‘pessimism’ tag, so I’m going to ‘wait and watch’ before I holler about them.

Still, I’m happy. We are far from the prefect family, but we all are happy with the way things turn out. It will sound a little ironic or apt to say ‘thank you’ for this ‘nightmare’, but I definitely am thankful for the changes it brought about.

T h a n k Y o u ! ! !

Pipi & Pupu in Delhi

Nobody liked changes, especially the older generation; it hit them hard and square. They have a notion of things, place, situation and life and don’t want to see that notion derided or banished. Neither would I. But with many of us living outside our native place, many parents are forced to follow along their children and live outside the world that they had spent their life.

It must be hard for them to make so many adjustments and changes so late in their life. It is understandable that most of them are totally handicapped when they moved to a territory unknown to them. We, the children, have to understand and take care of their psychological and mental need as this is the time when they started thinking that they have no purpose and are useless around the new places.

In places like Delhi, there are number of aged population from our community who had come to live with their children. And it is understandable most of them don’t like the place at all. Both my parents still choose to live back home even though all of us, their children, are living outside.

My parents knew what life is like in Delhi as they have visited us more than once. Though my mother, unlike my father, never complained about life in Delhi, I can feel from her look and the little word she spoke that she dreaded the time when she would be left with no choices but to live with us.

When my mother came to visit us recently, I took her around the various departmental stores in Dwarka. I piteously looked at her as she stands there flummoxed by the varieties of toothpastes, and struggling to choose one. Then, she gasped and an awkward grin spread through her face as she saw the ordinary white Colgate that was available back home. As she tightly grasped the toothpaste, she said beneath her breath that she always preferred those.

I looked at my mother –lost; lost for word, lost for what to do next, afraid to take the next step. Late at night when we were alone, she complained bitterly how she had become invalid around here. I told her not to be silly, what else can I say?

It breaks my heart to take away my parents to this foreign land where they will be eternal aliens, incapable of moving around on their own and relying on their busy children for even the smallest of needs which I may not always be able to take care of. The last thing I want to do to my parent is to clip-off their wings and take away their self-worth.

While my Mother was in Delhi, she once told me this is not the world as she knew it. It’s an unfamiliar territory for her. She would definitely miss our little village where she walked up to the shop keeper and asked for a tooth-paste and was given one without being asked the type, variety or flavour.

I once asked my Parents to come and live with us in Delhi. My Father joked if I would be willing to baby-sit both of them at all time. I am not a good babysitter. Rather I am the one whom everyone around me baby-sitted. They, especially my mother, would tell me when to eat, when to sleep and when to visit relatives and whom to visit.

I don’t need to be reminded of these small details, but that’s what she chooses to do. But now, the babies here would be my parents, and they knew better than me that hitting one’s head against the wall will hurt us and not the wall. And here, their emotional needs will be more than their physical, and those needs are available only at home -back home, where they are free.

On the other hand it breaks my heart to think that my aged parents do their own laundry, fetch water and do all sort of household work by themselves. But the bottom line for me is that I would not take away their independence as long as they wish to have, and even if they choose to come and live with us, I would promise them that I would make sure that I would not part them from their loved ones if they choose to, as and when they die because that is one of their biggest fear.

And that definitely would be a sad ending…

"October 1 is International Day of Older Persons (as recognized by the UN), it is also world Vegetarian Day"

Manipur among the Best Place to be a Mother in India!!?

On mother’s day, a leading newspaper in Delhi published the result of a survey listing the best states to be a mother in, and it nearly shocked me when I saw Manipur in the top three. It definitely amused me –shall I believe it or call it a sham! What do our women folks have in their favour that the rest of India seems to lack? I try to find some reasonable answer, apart from the slight difference in cultural factor and higher awareness level (I want to believe this), the three main criteria seems to be far-fetched for Manipur.

The survey was conducted by ‘Save the Children’, an NGO that compiled the data from the National Health and Family Survey 3 (NHFS), and the Sample Registration System (SRS) bulletin. Their main three criteria were: infant mortality rates (IMR), antenatal care and institutional deliveries.

I have no details of the survey, so I cannot comment on which sector did our women scored their points. But I think it must be Infant Mortality Rates since the other two criteria are not the stuff Manipur is known of. Even though I don’t have any supporting data, there certainly are some reasons to believe that the mortality rate of Manipur is lower than the other states even with simple observation.

Apart from that, most of the north-eastern states have strong and liberated women compared to mainland women, educational achievement may not be higher, but overall literacy rate is definitely higher, and thus awareness. High awareness level in every aspect of life is important since it helps us prepare for whatever that comes and help us make the right choice.

Institutional deliveries and antenatal care, on the other hand, are still on the stage of dreams for the women of Manipur. Whatever antenatal cares they got are within their own capacity and effort, and there are very, very few institutions where women can deliver or approach for cares even in cases of complications.

In fact, there are very few women from the rural area, especially in Churachandpur district, who came up to the district hospital for, forget about weekly, monthly check-up or even to deliver. Delivery as well as antenatal cares were taken care-of at home. May be this is the reason why Infant Mortality Rate is low in Manipur.

This survey seems to prove that our traditional practices and cares of pregnant women –before, during and after delivery are not unhealthy or unprofessional. It seems our mothers knows as much as those goddamned nurses who don’t do their jobs. Kudos to our woman, they know how to take care of themselves and, oh yes, the family! Strong Women, God bless them all (excluding the Nurses and Doctors)!!!

As I can see, it may not be too presumptuous to say that the National Health and Family Survey-3’s data were rigged or the Manipur government must have supplied imaginary data since it is a rare sight to see a functioning Primary Health Centres in the rural areas of Manipur, and since most of the nurses and doctors posted in the rural areas have happily lived in their respective home irrespective of where their home is. Oh! I might just add ‘happily ever after’ –with no works and no one to pull them up!

A BITTER CHRISTMAS

Christmas is here once again to heralds -from many other things, the coming new year. Once again, it is time for introspection –and that is the part I hated the most. I hated it because I know it well how I’ve wasted the year, I hated it because I know it well there were many things that I could and should have done, and I hated it because –because I had the best Christmas gift last year and it was taken back.

This year, I got all the time I needed to continue my education but I didn’t, I got the chance to travel around the world (well, at least half the continents) but I let it go, I got some offers which I should have not declined and there are many more that will be and should be lost in the pages of my diary only.

But the year also gives me few things to cheers for, moments and memories that will linger on for the rest of my life. I don’t want to confine those memories to my diary alone, I’d love to remind myself of those moments when I’m down. But, alas, since those moments were blotted by as much bad moments, they will hardly lift my spirit –for optimism is not one of the qualities usually associated with me.

For I am born a pessimist –sarcasms and ironies are the words that I live by. Loneliness is my constant companion and I hate that. But it is a lonely world here and if you ask me, I think your life is as lonely as mine. At least I know what I am talking about –that my senses are intact.

Life in a city has always been lonely. But I never felt as lonely when Christmas approaches. It is the time of the year I missed home the most –with emphasis on home and the things associated with it.

I have a home here in Delhi and most of my close family members are here in Delhi only. We often have a family gathering during the festival seasons including Christmas, still I longed for home and I don’t know, why?

May be life in a city has become so complicated that it is not easy to have some simple and pure fun. One has to go through nightmares just to have some fun and that fun always comes with a price tag. I missed the days when I had pure and honest fun doing the simplest things and those very things that I cannot afford here in the city.

May be the chasms between the privileged and the under-privileged has become so wide that we the under-privileged failed to savour our time and surroundings as we are constantly engrossed with our contempt and envy of the privileged.

Maybe life in itself has become complicated, for, a few years ago, I spent a Christmas back home and still found something missing. May be it’s the price I paid for growing–up, or may be, it got to do with my feeling of belonging neither here nor there.

I don’t want answer for all my questions, for I know I’ll not be willing to accept the answer. But one this is clear that I am a bitter person right now, for Christmas is the time I look back at the harsh reality of my life and it's not easy to be constantly reminded of your failure and missed chances. And this Christmas, I’m especially bitter for I was cheated with a gift last Christmas, which was the best gift that I ever got. It was taken back a few months later and now, tomorrow is Christmas and there’s no chances that I’ll get it back.

Well, may be I should try what a true optimist would do in this situation by saying “Well, at least, I can savour the memories!”

Merry Christmas!

Tags: mizo, zomi, zogam

Just What I Don't Need

When I planned to go home one sweaty night a month ago, I never planned for one this. Well, looking back now, there are many things which I failed to foresee and forget to put it on my plan, but then I can manage with them or without them. But the last thing that bothered me was to be used as a guinea pig!

A week at home at 1400+ metre above sea level, I was down with typhoid or they said so. Well, in this God forsaken village, the doctor is the pharmacist, and they said he is as good as a doctor but he is not a trained one so everywhere else, he will be called a quack!

The first two day, I was down with fever with high temperature. At high noon, I was shivering with cold even after covering myself with three blankets. I was given a combination of 'Combina Forte’ and 'Nimesulide + Paracetamol’ tablets. Later when I complained of my foot being ice-cold, the said I could be typhoid and my medication was changed accordingly. I was given tablets of 'Chloramphenico’' which I took thrice a day and after another two days, when my situation did not improve they changed my medicine to the more effective (that's what they said, not me) 'Ciprofloxacin - 500 m’.

That medicine seemed to work as on the first day itself it reduced my regular two-three fever a day to one. Another two more days and when my one fever a day did not decline further, my parents suggested that I could be contracting malaria!

The doubt, quickly agreed to by the quack resulted in the addition of another medicine! From the next morning when I took my medicine, apart from my usual dose for typhoid, I have to take two tablet of 'Quinine Sulphate’ thrice a day.

The medicine must be very strong as I hears insects and birds chirping in my ears for the whole day and have to live the life of a deaf for two days. When I complained of not hearing anything and the chirping insects, they all knowingly nodded their heads to suggest that the medicines worked as it should be!

Thanks to the quacks (including my parents) I was up and going after two weeks in bed. The moment I was up, I rushed around the house poking all over the dust-bins searching for the empty covers of the medicines that I was given so that I can wrote down the detailed combination that makes up the tablet so that I can possibly look for their potential side-effect on the net once I was back to Delhi.

And hopefully, I'll be back in a short while!!!

Tags: mizo, zomi, zogam

Something about my Mother

My mother is a legend on her own right. Anyone who knows her cannot help saying that they love her and those are the very people on whose faces I can sense fear when they first interact with her.

My mother is not a typical stay-at-home mother, who would wept all day watching soaps on TV or always busy with the household chores. Rather she is an active one: socially, spiritually and physically, and I must also add -with an active and healthy tongue. She did not hesitate to stand-up for her beliefs and always speaks her mind.

Nothing can delute here views. She likes it or she dislikes it, and she would say so. If you rub her on the wrong way, be ready to face the verbal bullet she is going to fire at you, but if you are being your normal self, if she agreed with you and your view or not, she would treat you as her equal.

Even till now, I hardly remember my mother doing something for me that I can do it myself, like washing my own clothes, dishes and room. If my cloth is broken, she would know and stitch it up, but if it is dirty, she would remind me that my cloth is dirty. When me and my 5 brothers and sisters were growing up, she would divide all the household chores among us, and each one of us was expected to finish our duty -and I must tell you it never was a problem.

The only thing that I can say about my Mother that always annoy me in my younger day is that she would never allow me to have more than Four clothes at a time. From my childhood day till I left home at age 14, I never remember ever having more than four shirt, four pants, two shoes, two socks, etc. If I ever have an extra one, she would give it to some relative, friends or neighbours. At that time, it always annoy me, but now, I fully understand why she did that and I must say, I am proud of it. Here, I can only add -she also has a healthy Heart!

I have lots to write about my Mother, but I must stop here as I am sitting in a Cyber Cafe and I am running out of time. But here is a poem by my favourite Poet, Christina Rossetti...I dedicate this to my dearest Mom on Mother's Day.

SONNETS ARE FULL OF LOVE


Sonnets are full of love, and this my tome
Has many sonnets: so here now shall be
One sonnet more, a love sonnet, from me
To her whose heart is my heart’s quiet home,
To my first Love, my Mother, on whose knee
I learnt love-lore that is not troublesome;
Whose service is my special dignity,
And she my loadstar while I go and come
And so because you love me, and because
I love you, Mother, I have woven a wreath
Of rhymes wherewith to crown your honored name:
In you not fourscore years can dim the flame
Of love, whose blessed glow transcends the laws
Of time and change and mortal life and death.

-Christina Rossetti (1881)

The Best Christmas Gift

Once upon a time, Christmas is a festival for me. It means lots of gifts, love, holidays, ample of time to play with friends, and a time to feast. I remember what it feels like –being free and care free and oh- spending with friends the hard-earned pennies saved throughout the year just for Christmas and I must say I certainly enjoyed those Christmases. But as they said, that is the age of innocence, and once I grew up; it seems I somehow lost the essence of Christmas along the way.

Nowadays Christmas Eve, rather than being a festival is a time of introspection for me. It is the time when I retrospect and evaluate myself, my family and the world. And I must tell you that of the eight years I spend in New Delhi, there is not a single time when I spent Christmas with dry eyes. The only exception is the time when I spent it back home with my parents in Manipur, -it is too much like Christmas, I cried. And I must also admit, despite all my shortcomings and pathetic life, never once did I shed tear because of my life. You can blame it on my ego, but the thing that makes me cry are also, on a second thought, is all about my big fat ego.

Christmas, to my brother is also a time of introspection. It is the time when he retrospects and evaluates himself, his friends and his foes. And I must tell you that of the eight years I spend in New Delhi with him, there is not a single occasion when he was not drunk. It is the time when he unleashes his angers, frustrations and stresses of the passing year to -none but his family. And that is the time when I cry –not because he hurts me physically but because he remind me what Christmas would be like if I were with my dear Pa and Ma back home.

Every Christmas eve, I would look out at the dark and silent night and feel what it would mean to be free of worries and regrets. What it would mean to be roaming around with friends singing carols in the freezing night, and still sweat? What it would mean to hop from one church to another to taste whose food is better? It may sound a little silly now, but I know what all these feel like at that time. But, I don’t know why is it the silence that I can remember of the Christmases I spent here despite the loud annual argument played on every year in the next room? Why is it the coldness that I’m reminded of when I think of all the previous Christmas despite the heater and, why is it so dark when I think of the dazzling Christmas trees and decoration?

It had become a Christmas tradition for me to run out of the house and spent the night at the nearby park. I would sit, lost, lonely and in total silence if not for the lavas of tear cracking the December frozen cheeks and the whispering wind that echoed the sounds of a heart breaking into thousands pieces. It has been a pretty long time since the moonless night mourned with me in her foggy white.

But living in this great world of the Lord, one can expect miracles everyday, in fact, every moment, as long as you believe. And I never thought that I can spend Christmas without tears! Last Christmas, my brother made a resolution that he will never drink again. True to his word –he didn’t drink a single drop this year. I know he had faced a lot of troubles –he had to part with some of his best friends who are also his drinking partners, have to avoid certain important people and worst of all, he had to fight the greatest demon: his urge.

This year, Christmas Eve is different. No one run around to avoid Christmas at home. We laughed together and prayed together. We sang carols and we feasted. There is no fighting and everyone is too busy to sit near the heater. Yet it is loud, noisy and warm. As the clock approaches midnight, I cannot help standing up on the side to admire my family. Once again, we are one big family! When my brother approaches me later on to enquire about me, I have no ready reply –I wanted to say I love you, I wanted to say thank you, but I just cried and for once, I allowed myself to cry. Tears say more than word. Then I gave him a big hug! Once again, it is Christmas!

Tags: mizo, zomi, zogam

Stranger at my Home

(This piece is an extract from my Diary dated 23rd December, 2005

when I returned back to my native place to the jungle tribal village of Manipur.)

People used to tell me home is where the heart is. But some times, like this very moment, one can feel like a total stranger at one’s home.

The feeling of homelessness is no stranger to me. I have traveled to most part of India which I called home but wherever I go, I remained a stranger. I reluctantly accepted the tag, forgiving them for their ignorance or at other time consoling myself as being a lesser Indian. But among my own people, I am not ready to be treated as a lesser one, at least not in my own village where I grew up.

As a child, I was given the notion that anyone from the mainland, especially the army, should not be trusted. I remember my mother going berserk when I, once, went to the army camp with my friends. Their fear is understandable as I myself had often seen and heard incidents to justify it. But this time round, my only crime is that I dared to say that I am an Indian and that India is my home.

It is true that I am an Indian (I want it or not) and India is my home (at least my home lies in India). But the sad irony is that my Indianess ends the moment I passed my region into the mainland. Wherever I go, people would ask me which country I came from. I would tell them that I was from Manipur. When people don’t know that I would substitute Manipur for Mizoram or Nagaland, it doesn’t help either. Most of the states in the North-east, according to their guesses, are in Nepal or China. At the end, I was so feed up of the question; I simply nodded to whatever country they guessed for me.

Then I would went to visit monuments and there they would charge me 500-600 percent more unless I am ready to spent some amount of time explaining the geography and demography of India. And in the sphere of education, every subject that includes Indian subject matter exclude me, and in the few occasions when the media picked up news from the north-east, they would be half-baked with most of the name being misspelled as if they were aliens’ names.

I traveled aboard to see people raising their eyebrows when they know my nationality. They thought I must be a Red-Indian. They wanted to ask me about Indian food, Indian music and Indian culture. But the Indian food, music and culture they wanted to know were alien to me.

During my stay in Delhi, I tried hard to learn and appreciate the ‘Indian’ language, food and culture. I forced myself to sit through an hour of ‘Indian’ dance recital, endured many three-hour long ‘Indian’ films and spent sleepless nights after stuffing myself with the spice infested foods which my ancestral would probably say ‘killed the taste buds’.

No matter how hard I try, the freaky question keeps popping out, and would irritate me as ever. I tried to take them as an innocent question but still, it fuels one’s feeling of alienation. People often tell me to take them easy but the prejudice, abuses and discrimination one’s faced cannot be easily taken by the stride. And it doesn’t help very much even thought they sincerely apologized after abusing you especially if your abuser happened to be someone as educated as your very own teacher.

Such situation, though infrequent, aggravate one sense of alienation. It is under many such situation that I started to believe myself as an alien in this country, and take that little jungle village in the tribal areas of Manipur to be my only home.

But now standing here in the middle of the road, surrounded by the chief and elders of the tribe, I certainly feel like a stranger. I was absolutely enthusiastic to return home after more than two years of absence, but the moment I landed up, the first reaction was of general disappointment. Everybody takes a look at me and the first comment was that I was a lost child. My language was adultered and my pronunciation stained. ‘Lost, absolutely lost’, the elders lamented whilst the youngster called me pretentious. And with that big crimes I was standing here with the elders who sermons me on our value, how we were free and independent, with our own land and laws.

I don’t know if it would be wise to remind them that the government doesn’t even want to recognize our existence. To me that is as good as being lost. The elders may think that we are free with our own lands and laws, many anthropologists may come to study our primitive ways and our wild photos may found home in galleries and museums around the world, but that may not be enough if a seven degree minority community living under the mercy of others wanted to survive. But I choose to remain silent.

I don’t know, as of now all I need is some one to talk to me and make me feel at home without pretension. Then I started to wonder, if I can call this place as home even after what I have been through, why cannot I do the same anywhere else? After all, the whole world is my home.