Sunday, August 16, 2009

Working with the homeless of Delhi.

I am very late with this update I know, I apologize.
I have been in India for a month and two weeks at my internship.

What am I doing?
I am going to be generating a report on the health clinics for the homeless of Delhi. This report is for Ashray Adhikar Abhiyan (AAA), a program of ActionAid. AAA is a shelter rights campaign for the homeless of Delhi. They have a variety of projects for the homeless – shelters, health clinics, community organization and outreach, legal aid, identity cards and voter registration, and some programs for street children. AAA uses the participatory approach with each of their projects and with their office staff. What does this mean? It means that things are done with input from everyone. There is a basic type of hierarchical structure but all problems, solutions, and program design are done through open discussion with staff, volunteers, and the homeless. Most of the volunteers are the homeless themselves. The program has been in operation since 2001and most projects are now run almost entirely by the volunteers.
ActionAid is a rights based organization and so is AAA. This means that they are focus on their beneficiaries knowing what their rights are and what they are entitled to through the government. This means right to health care- a government hospital can not refuse a patient (even though they do), the right to vote – very few of the homeless have any official identification and no permanent address.
Who are the homeless?
The homeless in Delhi are 90% men who have migrated to from their towns and villages in the hopes of finding employment and sending money home. About 90% of these men are employed on a regular bases. They work as labourers, rickshaw pullers, street venders, sweepers, cleaners, rage pickers, and during wedding season many are employed as catering staff, event staff, etc. These jobs, if I remember correctly, make up 80% of the Indian labour force. They are the backbone of the economy and the way of life here. These people are paid so poorly that they cannot afford to pay rent. If person comes to Delhi with little to no education or skills, no family with a residence, no contacts, then they are likely to end up sleeping on the streets.
My misconception:
When I first heard that I would be working for AAA and that they worked with the homeless I took a deep breath, thought about they shanty towns India is famous for and thought this is going to be hard. Rural poverty is hard to see, but urban poverty is much worse. Well as it turns out a shanty is a residence, a tarpaulin and a mud floor is still a home and can even have an address. The homeless in India are pavement dwellers. This means you have no roof over your heard, not even a tarpaulin, unless you want to classify an overpass as roof.
Where do they sleep?:
There are an estimated 150,000 homeless in Delhi (that’s the top figure, could be only 100,000). They homeless are very hard to count, particularly the women as they do their best to stay hidden. The majority of homeless in Delhi live in what is known as the Walled City – Old Delhi. If you life in Delhi, and you don’t live in this particular part of the city, you don’t come here. Tourist do as Delhi’s famous Red Fort and largest mosque (Jama Masjid) are here. There is also a bit of the flavour of old traditional India. You can walk down winding lanes/alleyways where everything needed for an India wedding can be found, each at food stalls that have been around for hundreds of years. It is a very busy place, very crowded, often smelly (can be a good smell), and of course dirty. There are very little access to clean water (clean for Delhi I mean), and as few toilets. It is in this region of Delhi that an estimated 50,000 homeless can be found. You won’t notice many during the day (they are working) but in the evenings they come and even a few hundred are shocking to see. They figures are the estimation of AAA, you won’t find government stats that high, but then the government would like to imagine there weren’t any.

The Health Clinics:
So my department. AAA, in partnership with several other organizations (including government organizations) has several health initiatives for: general health, chemical dependents, mental health, and a separate clinic for rickshaw pullers. They have clinics on Mon, Tues, Thur, and Friday. The clinics are held in the evening so patients don’t have to miss work to go. They are held in three different locations, all in or around Old Delhi. They treat as best they can (mostly acting as a pharmacy), and for those in need of hospital care they make referrals and volunteers personally take patients to the hospital to make sure they get seen. Their treatment in the hospital is also monitored and recorded. The clinics are not entirely free, the cost is about 2-3 rupees a visit and the medicines are included. The doctors volunteer their time.

General Health: this clinic sees patients with a variety of conditions, the most common seem to be breathing problems, joint pain, and injuries. Many of the conditions are chronic.

Chemical Dependents: this is a clinic for drug addicts. In order to attend the clinic it is mandatory to attending the sharing sessions held every week. This is a group therapy, AA style, to coincide with the drug therapy. The vast majority of patients are addicted to smack, a form of heroin, that is very readably available here (go Afghan poppies!). The drugs they are given have the same basic effects as the smack but without the harmful side effects. The doctor I was speaking to this week seems torn with this initiative as while giving them the pharmaceuticals is technically better for them from a health perspective, it is just another cocktail of drugs they get addicted. I asked him why he volunteers his time if he feels it doesn’t help. He responded noting that since these drugs are free the chemical dependents are not engaging in the illegal activities that they may be drawn to in order to be able to afford their addiction, and the harmful side effects are not there. Rock- Chemical Dependents- Hard place.

Mental Health: this clinic is still new, only about 9 months old. It treats the mentally ill homeless with drug therapy. There are not a huge number of patients at this clinic, some are voluntary, others involuntary, but it is having pretty good success. How do they treat involuntary patients? Well they hold a court at the Monday clinic, a magistrate comes and judges the patient according to the psychiatrist, patient records (whatever exist), testimony, and an interview with the patient. If deemed unfit, then medications can be given by force. Hospitalization of patients also takes place if needed.

Rickshaw Pullers: I am still trying to figure this clinic out. Why is there a special clinic for them? Well I believe it has something to do with the fact they make a bit more money. There are many levels in the homeless community. You all know about the Indian caste system I presume, well there are many castes within castes, and my guess is that since the rickshaw pullers are consider the higher end of the homeless population, this means they get a separate clinic. Maybe they would refuse to go to the general clinics. I will be finding out this information very soon.

I could use your help!!
I have never done anything like this before (shh don’t tell anyone) and I want to do it right. This report is for internal use but it is going to be their most up to date documentation on these clinics, 2003 was the last report. I am to observe, understand, make suggestions.
I have prepared a four page list of questions for the staff and volunteers (about 88 questions) on the clinics. Don’t assume I have asked all, or the right questions. If you have questions you want answered please, please, please send them my way.
Also if you have any tips on how this report should be done, please pass them along. I want to do this well. Perhaps there are those of you who have worked with homeless populations or with organizations who try and aid the homeless and can give me insight.

Thanks for reading.

p.s. I will be using this blog mainly to update about my work. I will keep future updates short now that you have the background. I may, from time to time add a bit about my personal life, but mostly this blog will be about my work. You can always email me if there is something you would like to know about that I am not included here. Thanks.