The mind’s a short-changingHuckster with a crafty Wife and five Scoundrel children. It won’t change its ways.
The mind’s a knot, says Kabir,Not easy to untie.
(Kabir, translated by A.K. Mehrotra)
I thought for my final blog post before leaving India in a few days I’d do a brief wrap up of my work with Karuna Trust’s Manasa Project focused on mental health care and then follow with some reflections on what I will miss most about India.
I completed a final draft of the Manasa Project standard operating procedures manual last week and it is currently being circulated among senior leadership. I hope that the document turns out to be useful to the Trust, even in the short term. Writing it was an excellent way to understand the full scope of the Manasa Project, which not only includes the women’s Transit Care Centre where I’ve spent many days, but also a public private partnership with the state of Karnataka to provide mental health care to homeless men at a state facility, a helpline for anyone to call who has concerns about a homeless person, and an initiative to integrate community mental health into the primary health centre (PHC) network. In addition to working on the SOP manual, I’ve also written some case studies of successfully “reintegrated” Manasa Transit Care Centre residents; that is, women who have been rehabilitated and have been sent home or have transitioned into independent living accommodations. Contrary to what I said in an earlier post, some women do not go back to their families, for a variety of reasons, so Karuna Trust finds alternative accommodations for them. I was able to visit one of these residential facilities a few days ago and speak with some of the former Manasa TCC residents about what things are like for them now. As you might imagine, things are not easy, but they are not bad either. All have remained on their medication, are living productive lives, and have good social skills. Yesterday I sat in on a large planning meeting that was based on the results of the PHC visits that I participated in a few weeks ago. The Karuna Trust team that managed the 5-PHC tour presented on their findings and recommendations for intensive integration of community mental health into PHCs. A preliminary action plan has been developed and they have identified the critical components for a successful launch. Primary among these is training for PHC staff. This work is ongoing but the hope is that by the end of the summer there will be a plan in place to begin an intensive launch with the five pilot PHCs. I was glad to be able to listen to this discussion, as having traveled to two of the PHCs in the information-gathering phase, I was very curious about the overall outcome. I plan to stay in contact with the Trust over the upcoming months to learn more about this project as it gets underway. A critical issue is developing effective ways to measure success of the initiative. This has to be planned from the beginning so that all five PHCs are gathering the same data upon which a final evaluation of the integration efforts can be based. Since the ultimate goal is scaling up these efforts to the entire PHC network managed by Karuna Trust, careful definition of variables and measurement of impact is critical.
I am now happily turning homeward. I have been away from my family for a very long time, longer than I have ever been before, and I can’t wait to see them again. However, living in India for two months has been an extraordinary experience. I feel privileged to have been offered this opportunity by the University of Pennsylvania Office of the Provost, the Center for the Advanced Study of India (CASI) and Karuna Trust. When I think back upon the past two months about what I will miss about India, I come up with a list heavily weighted towards sounds, sights, tastes, and people. This is, I suppose, why I like to travel in the first place. I will miss:
· The click-purr of the frogs outside in the garden at night.
· Boys and young men walking along holding hands or with their arms around each other’s waists.
· Cold bucket baths in the evening after long sticky days. Hearing the special tympany of water hitting the bottoms of plastic buckets elsewhere in the hostel.
· The faint, beautiful sounds of the muezzin’s daily calls to prayer drifting through my window from a mosque somewhere in the city.
· Indian drivers with a loose respect for traffic laws but an extraordinarily deep respect for speed bumps.
· Mangoes juicy, mangoes sweet, so many delicious mangoes to eat.
· Pre-dawn walks to Kukkarahalli Lake to run laps. Sharing that special time with runners, walkers, meditators, and men and women with their dhotis and saris hitched up and hand scythes in their waistbands bundling fodder from the lake.
· Smart, medium-sized, short-haired dogs of all colors proceeding with their daily schedules side by side with humans, with neither creature taking much notice of the other.
· The way standing women on buses hand their babies to seated women who are complete strangers because they have a lap available.
· Very tiny cups of very sweet, very hot tea served in metal or thin plastic cups that appear to be specifically designed to scorch your fingertips and lower lip.
· Delicious South Indian vegetarian food.
· Babies and small children bundled into woolen balaclavas and sweaters when the temperature plummets below 75°F.
· The warmth and hospitality of the students and teachers at the VGKK Graduate Finishing School and the Indian interns with Karuna Trust whose accommodations at the Technology Resource Centre hostel I have shared while working in Mysore.
· The dedicated doctors, social workers, psychologists, nurses, ASHAs, and other health care practitioners with Karuna Trust who work long hours with constrained resources because of their deep commitment to meeting the health care needs of poor and rural Indians.
Karuna Trust – Mysore