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Thursday, 2 July 2015

पुस्तक परिचय

‘Putting Women First:
Women and Health in a Rural Community’
Review by Heather A. Gardner
 “What we see in the clinic is a mirror of our society.”
-         Dr. Rani Bang
        
    If the clinic is the mirror, then ‘Putting Women First: Women and Health in a Rural Community’ is a clear reflection.  Not limited by narrowly defined schemes and targets, Dr. Rani Bang shares the breadth of her direct experience fromover25 years of clinical practice, revealing the nuances and complexities of rural women’s health in Gadchiroli district. Her account is not merely a rigorous scientific study; it maintains a human-tone throughout by including case studies that illustrate her observations through women’s stories and circumstances.  For this reason, I found the book very compelling, sensitizing me to local women’s health needs and the multiple forces that shape them.  The text was also helpful in setting a context for observing Dr. Bang in her OB/GYN clinic at the Maa Danteshwari Hospital here at SEARCH. 
            In this book review, I intend to share some lessons I have learned from ‘Putting Women First,’ including quotes from the text. Additionally, I share my interpretation of these lessons in an attempt to integrate them into my own public health practice.  Whether you are a clinician or not, I believe the teachings in this book provide critical insights into people, policies and systems and are applicable to women’s health as well as other disciplines.  However before I share my lessons learned, a note about the book’s contributors. 
            Like most major projects, collaboration is essential and ‘Putting Women First’ was no exception.  Rupa Chinai, a co-author, documented the cases presented throughout the book and is also an accomplished journalist who has written and commented extensively and authoritatively on health issues in India.  Sunanda Khorgade’s contribution was similarly invaluable.  At the time of publication, she stewarded the women’s health programme at SEARCH.  As stated in the book’s Foreword, “her ability to look beyond what is evident and identify social, economic and community reasons at the root of many of the complaints registered by Dr. Bang’s clinic have impacted the understanding of social medicine in Gadchiroli, and by extension, rural India” (pg. xiv).
Lesson 1:  “. . . health is not merely about medicine and healing; but also about being sensitive to one’s patients.  A doctor’s understanding must encompass anthropology, sociology and economic factors that shape people’s lives.” (pg. 2)
Personal interpretation: Our profession is not purely about the field we have studied but it is inherently interdisciplinary.  For example, an architect’s new building project will likely involve various aspects of art, ecology/geology, politics, city planning, finances and community coordination.  Instead of approaching a project with “tunnel vision,” you can bring a holistic view to your work.  The breadth of your skills can grow with time and direct experience as can your capacity to discern when expertise from a particular field is truly missing or required. 
Lesson 2:  “Research-based interventions have strengthened our belief that sound study and not just service, strengthens the work of an NGO.” (pg. 257)
Personal interpretation:  It has been said, “No data, no problem.” High quality qualitative and quantitative data along with community participation are critical to assessing community needs, advocating for funding and evaluating a program’s impact.  Effective community-based research can bolster the credibility of an NGO while, most importantly, ensuring that those most in need are effectively being served.
Lesson 3: “Medical professionals and NGOs who maintain a strong link with grass root reality have a duty to communicate their understanding of that reality to policy makers.  While highlighting the good work done and achievements made, we need to develop our ability to see the wider picture and pinpoint the linkages that make a difference.” (pg. 253) 
Personal interpretation:  Grassroot realities and policy are directly related to each other.  Similar to the opening quote of this article, grassroot realities are a mirror of the society.  Those of us working at the grassroots level have a responsibility to share-back what we see in that “mirror” with those that intend to shape it at a policy level.  Policies are only as effective as their reflection on the ground.
Lesson 4:  “Our primary health system needs to be equipped for dealing with the various manifestations of reproductive health.  The current vertical approach which only concerns itself with a few isolated programmes is woefully inadequate to deal with the range of problems and circumstances.  The country’s programme of reproductive health must encompass adolescent sexual education, access to safe abortion, provision of appropriate conception, treatment of reproductive tract infections and mental health counseling.” (pg. 259)
Personal interpretation:  Lesson 4 is an example of Lesson 3.  Be aware of policies and schemes yet do let them limit your understanding.  Think for yourself and make your own observations.  Your direct experience becomes your teacher – pay close attention to it.  To what extent do your observations align with the priorities reflected in established policies & schemes?  What gaps exist and are you willing to address some of them?  Which gaps do you choose to address and how?
Lesson 5:  “. . . the case studies in this book are included as reflections of universal human experience.  The purpose of this book is not to serve as a collection of exotic stories, but to allow the readers to draw from common experiences, and relate these to their own lives.  It is in this sharing that human beings find inspiration for change.  Through these case studies, I could relate the life experiences of these people to mine, that of my family, my community and realize how I could be an agent of change within my own sphere.” (pg. 27)
Personal interpretation:  Do you view your studies/work as something entirely separate from your own life experiences?  Alternatively, can your life experiences support you in connecting more fully with your daily studies/work?  How do you discover the “universal human experience” in the particulars of your studies/work?  Ultimately, how do you direct your own life experiences towards making a positive change within your community?
In conclusion, this is not a comprehensive book review but rather my comments highlight some core themes that stood out in my reading of the book.  Overall, the book reaffirmed the values and practices that drew me to SEARCH in the beginning.  ‘Putting Women First’ is a testament to Dr. Bang’s dedication to direct experience and a holistic perspective, service and research, grass root practices and policies as well as the personal and universal.  ‘Putting Women First’ is a true inspiration to exploring the path of positive social change. 

PUTTING WOMEN FIRST: Women and Health in a Rural Community
By Rani Bang with Sunanda Khorgade and Rupa Chinai (2010)
288 pp. STREE publishers. Rs 700.00 Available at SEARCH

NIRMAN Newsletter Book Review, Word Count: 1,082 words
Source: Heather Gardner, hgardner16@gmail.com
(Heather Gardner has done her Masters in Public Health from Emory University, USA. She has expertise in the field of Program Evaluation. Heather was an Intern at SEARCH for 6 months) 

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