Karnataka, from the ground up

For the past month and a half, I have been getting to know my neighbouring state a little bit better. With some of my colleagues from the University of Hyderabad's Department of Communication, I've had the opportunity to visit different parts of Karnataka and speak with some of those who are trying to bring public health care to the poorest communities in both rural and urban areas. As part of the wide-ranging public health initiative known as the National Rural Health Mission, the Karnataka State Department of Health and Family Welfare has been attempting to scale up the intensity and range of its activities. The specific project that drew us in was the strengthening of the Department's IEC activities (Information-Education-Communication), particularly, building the capacity of its frontrunners (the block level health education officers) in social and behaviour change communication (known in the profession as SBCC). Supported by UNICEF, this effort involves training the 170 or so BHEOs from the state's 30 districts in new ways of approaching health communication, focusing more on interpersonal communication and participatory methods of engaging communities.

It's been a challenge, to say the least. The diversity of issues across the districts, representing relatively affluent and high literacy areas like Udipi and Shimoga to extremely disadvantaged regions like Raichur and Bidar, the structural hurdles and entrenched corruption in the system, all serve to create a very dubious foundation upon which to build the dream of equitable, accessible, good quality health care. The NRHM is a beginning, and in its seventh year of implementation, it seems, a very small beginning. The BHEOs--many of them in their 25th or 26th year of service, sometimes more--are doing what they can, travelling among the villages they serve, talking to mothers and panchayati raj institutions, persuading medical professionals and para professionals, mobilizing self help groups to pitch in...and somehow keeping their heads above the water.

I have no idea whether or not our feeble efforts to provide some new ideas and new ways of doing will have any impact. But for us (and I know I speak for the whole team here) it's been a learning experience. Now when I travel to Mysore I will look beyond the perimeter of the royal city to see the infant mortality rates that continue to pose a challenge to the villages in Mandya, or when I decide to take that holiday in Coorg, at the back of my mind will dance the awareness of the hill communities in Kodagu that have little or no access to a doctor's healing hands in an emergency. When I trek through the fort in Bidar, a part of me will be thinking of the young women who are not sure they will get to a hospital in time to have their babies there.

There is still a lot to understand, about health care in Karnataka, about how communities can become more active and informed participants in decisions about their own health, and about how the system can be truly strengthened on all fronts.

But there's been another side to the travels as well. There's been the incredible hospitality and warmth of the health workers we've met. The varied landscape of the state, from the rocks and boulders along the Mysore highway to the thickly forested tracts of Uttara Kannada to the deep valleys of Hospet and dramatic ruins of Hampi. In the pauses between workshop sessions, and at the end of long interactive days, we have managed to see a little more of the other side of the places we've visited. Stopping to sample the sugarcane straight from the fields in Mandya, or taking a walk in Brindavan gardens with not a single tourist in sight, walking along Malpe Beach after a long day of talking about communicable diseases, or stepping on the very rock from which Rama is said to have shot at Vali in the area now known as Anegundi near Hampi, the state has unfolded, bit by bit.