A Shining Example of Community Based Health

What lies at the heart of Sambhavna is community. A community united against the atrocity that has been forced upon them for the past 26 years, and who will never give up in the name of justice for the people who have died as a result of gas exposure and water contamination, and for those who suffer from chronic ill health, congenital defects and the psychological trauma of having lived through unimaginable suffering.

Although born of a depressingly desperate situation, what has bloomed here is a mobilised community, many of whose citizens are politically active, aware of their human rights and who are willing to come together and fight against the relentless oppression of multinational companies and government. This community action affects many aspects of peoples’ lives here, it allows them to be better informed about their choices and have more autonomy on the political, educational and health issues that affect them.

Healthcare is an area that has been particularly successful for the communities who attend Sambhavna. It is primarily, of course, a healthcare facility and so this is perhaps to be expected, but the thing that has struck me most is the community-based approach to health that exists within the bastis. The seven community health workers employed by Sambhavna go to the bastis daily, training community health volunteers, teaching local people about health in a participatory way and empowering them to take responsibility for their own learning,healthcare and treatment.

The people who live in the areas surrounding the Union Carbide factory site not only face a daily struggle with the myriad health issues that exist from living in urban slums and bastis such as TB, diarrhoeal disease, typhoid and type 2 diabetes (which is rapidly becoming a huge health issue for low-income communities) combined with the leftover long-term health effects of gas exposure. They have the added insult of being poisoned every day by the meagre groundwater supply they have access to. They face gynaecological complications, respiratory disease, and increased rates of cancer and congenital defects.

Of course, this situation could begin to be remedied were the shiny silver pipes laid by the government six months ago actually delivering clean water to the people. It seems a cruel taunt that this basic human right is so close and yet, due to Indian governmental apathy, logistics or however else one chooses to name it, still isn’t being provided. I recently watched women access water which they explained could be used only for cleaning and washing, because of sewerage contamination. A few meters on, 15 people huddled around a groundwater pump with pots and cans collecting clean drinking water: the irony lies in the fact that this ‘clean water’ is contaminated by toxic waste dumped by Union Carbide, and left to be absorbed into the ground year after year by Dow Chemicals.

The choice between drinking dirty water that will almost certainly cause acute illness and the long-term risks of drinking contaminated water is one that simply shouldn’t have to be made, particularly in these boomtown days of ‘India Shining’ or whatever the latest slogan that promotes India’s emergence as one of the big economic global players. In a nearby basti household after household complains that they haven’t had any water for days. Unfortunately as the summer months approach water scarcity is only just beginning and it will be a long few months until the monsoon rains arrive.

Sorry, I think I may be ranting again, I was talking about the positive impact of community health approaches but it seems obtuse to not mention the current health issues affecting the people here. There is a growing recognition globally that community empowerment is the way forward if we are to meet the Millenium Development Goals laid out by the United Nations in 2000 (no laughing please).

There will never be enough doctors or nurses globally to address health needs in low income communities, but there will certainly always be local people (particularly women) who are willing to learn and who can be great promoters of healthy behaviours in communities.

International organisations now accept that the top-down approach to healthcare, where people are told what to do by professionals from different cultural, economic and educational backgrounds simply doesn’t work and much has been written on the benefits of giving local women the skills to provide peer support, and encourage their communities to learn how to live healthier lives and minimise disease transmission.

The Sambhavna-based community health team is a shining example of how this approach can work, and it is encouraging and uplifting to watch and be involved in. They have trained over 60 people, mostly women but some men, to be community health volunteers (CHVs), who in turn do health education about diabetes (left), gynaecological issues, TB, malaria prevention and hygiene practices in a way that is accessible to local people, many of whom are illiterate. Their role doesn’t stop at health promotion, the CHVs can test urine for sugar, and blood for malaria and they are key in identifying people who are sick to the community health workers who can then refer them for medical treatment at Sambhavna if necessary.

One of the key advantages of having local people as community health advocates is the intimate knowledge they have of their community. In areas where housing is crowded and small, and where people spend large parts of their day together, everyone knows everyone else and health needs, domestic violence and other social issues can be quickly identified and dealt with. The ‘do no harm’ ethos of Sambhavna continues to be demonstrated in the work of the community health teams. Ayurvedic medicine is used as a first-line treatment option for many minor illnesses, and people are actively encouraged to use the community herbal gardens that have been grown by local people

The future looks bright for Sambhavna’s community health programme. The clinic is currently hoping to secure the funds to establish satellite health posts in gas and water contamination affected areas. This would mean people do not have to go so far for basic health issues and it increases the scope for the role of the community health volunteers. We are working on some interesting health promotion projects for diabetes education and TB using peer support from people who have been affected by illness and engaging young people in the community to get involved with health promotion and health research within their communities, which I will update you on soon.

Sambhavna is growing from strength to strength and the more time spent here the more I am convinced that what is occurring here is an outstanding example of the way that health, the environment and well-being should be approached in both developed and developing countries.

A Little Bit of Magic

I'm becoming obsessed. About a few things actually.
Having clean feet, obtaining a weekly fix of chocolate,how to perfect the art of making French Toast on a hot plate and making the perfect coffee with limited ingredients (real coffee would be a good start)
Perhaps I have begun the demise into obsessive compulsive neurosis, pushing 30, wondering what I'm going to do with my life and obsessively washing my hands (or feet) 67 times a day. . .
I am also becoming obsessed with Bhopal, for which I can perhaps afford to be a little more forgiving of myself .
I just spent 36 long hours on a train with nothing to entertain me but my own mind. ..a dangerous situation I'm sure many of you will agree. Between hours 6 and 10 I tried to write a blog. I wanted to write about how Bhopal affects us all, about how we may be able to ignore what is happening to people whose lives don't directly affect us but that we should at least be moved to speak out against the actions of multi nationals that certainly are affecting us, and our future generations. I tried to find the words without being condescending or overly critical of the way we in the West live our lives, and grappled with my thoughts around why Bhopal should be our problem. While I scribbled and scored out and huffed and puffed and was about to give up and write a blog about the hilarities of daily life in India the universe sent me a little present via the i-pod an amazing woman named Eirene gave to me before I left London. So instead of trying to put my thoughts succinctly on paper, I am going to post this speech, given to 2008 graduates of Harvard University. Thank you Eirene, for your unbelievable thoughtfulness in putting together an astounding collection, and thank you JK Rowling, for being a little bit better at expressing your thoughts than I am ! To listen to the entire speech http://www.the-leaky-cauldron.org/2008/6/5/entire-text-of-j-k-rowling-harvard-commencement-speech-now-online

"Unlike any other creature on this planet, humans can learn and understand, without having experienced. They can think themselves into other people’s places.

Of course, this is a power, like my brand of fictional magic, that is morally neutral. One might use such an ability to manipulate, or control, just as much as to understand or sympathise.

And many prefer not to exercise their imaginations at all. They choose to remain comfortably within the bounds of their own experience, never troubling to wonder how it would feel to have been born other than they are. They can refuse to hear screams or to peer inside cages; they can close their minds and hearts to any suffering that does not touch them personally; they can refuse to know.

I might be tempted to envy people who can live that way, except that I do not think they have any fewer nightmares than I do. Choosing to live in narrow spaces leads to a form of mental agoraphobia, and that brings its own terrors. I think the wilfully unimaginative see more monsters. They are often more afraid.

What is more, those who choose not to empathise enable real monsters. For without ever committing an act of outright evil ourselves, we collude with it, through our own apathy.

One of the many things I learned at the end of that Classics corridor down which I ventured at the age of 18, in search of something I could not then define, was this, written by the Greek author Plutarch: What we achieve inwardly will change outer reality.

That is an astonishing statement and yet proven a thousand times every day of our lives. It expresses, in part, our inescapable connection with the outside world, the fact that we touch other people’s lives simply by existing. . .

If you choose to use your status and influence to raise your voice on behalf of those who have no voice; if you choose to identify not only with the powerful, but with the powerless; if you retain the ability to imagine yourself into the lives of those who do not have your advantages, then it will not only be your proud families who celebrate your existence, but thousands and millions of people whose reality you have helped change. We do not need magic to change the world, we carry all the power we need inside ourselves already: we have the power to imagine better"

At times it is hard to believe that this is true. When we see the power of multi-national companies and the global destruction they create it often seems insurmountable. Pharmaceutical giants tucked up cosily in bed with food production companies,pumping our food full of antibiotics and steroids before it reaches our plates. Pesticide companies who own GM seed corporations, driving farmers to suicide the world over. The influence exerted by capitalist companies on governments, on nations, on individuals, on us is phenomenal and the more I learn about the way the world operates the easier it is to become overwhelmed with hopelessness and despair.

But if the creator of Harry Potter can say we can change the world without magic, then that is good enough for me.
I've come to the conclusion that the answer lies in focusing on simple changes. We may not all be able, or indeed inclined, to tackle Goliath directly but we do have the power to choose. To choose to avoid filling our homes and gardens with toxic pesticide and chemical filled products, packaged in plastics that are changing our DNA forever. We can choose to rest and drink honey ginger and lemon instead of demanding an antibiotic for our coughs and colds, or to try yoga and meditation instead of reaching for anti depressants. We can choose to take a little bit of control over our own lives instead of looking to profit making companies for a quick fix answer. We can learn about what is put in our food before it lands on our plates and the real constitution of 'clean baby' products that we saturate our children in. We can refuse to buy into the clever advertising campaigns and catchy jingles that convince us that we need chemicals to be clean. We can cycle and recycle and choose to travel by train instead of plane (no comment on how I got to India please!). We can if we want to, protest, write to governments, send emails or make make others aware of the things we learn.We can donate to causes we believe in, or volunteer our time to make a difference to others. There are many ways we can exert our influence to change things, some more easily achieved than others. Demand is met with supply and as long as we continue to demand the way of living we currently experience the supply will be gladly met by those who profit from fulfilling our requirements. As long as this continues there WILL be more Bhopals, and can we really protest or complain about it when through our apathy we allow these situations to occur

I'm not asking everyone to jump on my proverbial Bhopal bandwagon. I'm asking you to think about what happened there, and what continues to happen, and consider the implications it has on all of our lives.It could be our back gardens that some company decides to build on, it is our planet that is being systematically destroyed to meet our demands, and it is our lifestyles that are consistently contributing to Bhopals in almost every single country in the world.

Having said all this I truly believe that the measure of humanity still lies in our every day interactions.The moments we share with loved ones, the kindness extended to people that we meet and which is reciprocated to us and the issues we address that are important to us. The people we advocate for, be it our children, our neighbours or those unknown to us. The influence we exert on those around us and the difference we make to peoples life every single day through our actions, words and love no matter how big or how small. We cannot change the world as individuals, and neither should we try but collectively we can all do our bit, be responsible for that for which we can be and work towards a brighter, fairer, more sustainable future for everyone in the world and our future generations.

In the Guts of a Monster

Firstly, I have blatantly plagerised the title of this blog from Eric, a beautiful spirit who is incredibly talented, intelligent and inspiring and who just left Sambhavna to go back to high school in Pune. I would like to say he doesn't mind, but I haven't asked him. I can't think of a more acurate description of what I'm about to write though so there you have it, I have a pathetic imagination and have resorted to stealing the lyrics of a Guatemalan teenager whos native language is Spanish . Doesn't bode well for the rest of this blog does it. . .

My sister Katy, who is pretty wise, once told me that the importance of life to every living being is evident when a fish is caught on a hook. Most people don't place an awful lot of value on the life of a fish but it will do EVERYTHING in its power to survive. It wants to survive, and is willing to fight until the last breath (if it can be said that fish breathe) That, I've been thinking, is what it means to be alive. The will and the determination to survive, to live and to breathe, no matter how tough the struggle is and no matter how little others value your life. Individually we, and our loved ones value our lives more than anything in the world.

The right to life is one which is clearly set out in the Universal Declaration of Human Rights and is one that should be protected by law. One would think that it would offer people some degree of protection from needless death caused by corporate lack of responsibility, yet it seems that the world over people are exploited, poisoned and ultimately killed by the global demand for 'development'. Is it because society places less value on the lives of the poor, do we think that they don't matter so much because they live in slums or are illiterate. Or is because they are less likely to speak out, and don't have the money to fight huge legal battles with powerful people.Is it, as some would have us believe, an unfortunate but inevitable consequence of development, that a few souls will be lost as we strive to make the world a 'better place'. I don't have the answers to these questions, Ive just been musing over it the past few days and wonder what people think.




I visited the Union Carbide factory yesterday, the site where tonnes of lethal gas leaked across a town full of sleeping people in 1984. The first thing I was struck by was its beauty. Not what you expect from a toxic waste site that has been abandoned for years and been allowed to plant its chemical waste firmly into the soil and ensure that everything that comes into contact with it is poisoned. But its hard not to notice the way that tall green tree branches have crept in the window, and that plants have sprouted in the unlikeliest of spaces, between iron bolts and steel bars, stretching up towards the rays of sunlight that cast bright sunny beams across broken glass and dusty chemical bottles. Those plants look healthy, strong and nourishing. The farmers who come to graze their cattle and goats think so too, as do the children who climb the trees and play hide and seek in the bushes, hoping that the government security guards who play cards and chit chat in the sunshine wont notice them. . .or if they do, wont chase them away. It seems the perfect playground for a child. The trees however, hold deep dark secrets that lie in their roots and penetrate their leaves. The entire site is completely contaminated with various chemicals that have been left to leach their deadly components into the ground.

As we walk around the factory, pushing past thorny branches and strolling along tree lined pathways I am shocked and saddened by what exists here. Rooms full of spilled jars of chemicals with hazard signs sill clearly printed after 26 years, left lying like the equipment of a failed science experiment. A factory full of the components required to make pesticides the world over, most of it extremely dangerous has been discarded when no longer useful to a profit making company. It was walked away from and forgotton about, just like the people who were employed there.

As we near the edges of the factory plot a smell of chlorine reaches us on the wind. Sanjay, our guide explains that toxic waste from the site was dumped in a pond on top of 3 layers of plastic sheeting while the factory was in operation, and of course no effort has ever been made to clear it up. He explains this shortly after he explains how on 'that night' he was 6 months old and he survived. His parents didn't. And neither did 5 of his siblings. Which left him, his sister and brother. His brother developed severe mental health problems following the gas leak, a problem unrecognised by the Indian government as a potential result of the gas, despite far higher than normal rates of anxiety, depression and severe mental illness in gas affected areas. In 2006 Sanjays brother committed suicide. He now has one sister in his family left. He is fairly matter of fact as he tells this story, I guess its not the first time a bunch of curious Westerners asked him these questions. He is also pretty matter of fact when he tells me he has no health problems from being exposed. 'Oh except I did have a stroke when I was 21 and was in intensive care for 3 days, the Drs said that was quite unusual"


Sanjay shows amazing strength of character and strikes me as one of those people who can do anything they turn their hand to. He is studying for a Masters, has a keen interest in photography, tutors children in his spare time and flits about town sorting things out for people on the motorbike his brother bought him, some years earlier. He is also pretty funny and has an inspirational ability to make jokes from the least funny of circumstance, but more on that in my next blog which is going to be a little more positive, I promise !! Keep going I know this part is tough reading and I appreciate you hanging in there.


As we near the gates to leave this monsters guts (as Eric so eloquently put it) the guards ask us how it makes us feel to visit the site. I don't know what to say. Shocked, Angry, Sad. A little guilty that I will rush home and change all my clothes and shower while people remain saturated in chemicals with no way of washing them out of their systems. . .I ask them how they feel about working there. "It makes us sick. We are all sick, and getting sicker. But what can we do. It is our job" I put to them the question "Do you think that senior government officials or Dow Chemical(who took over UC) bosses would come and sit here every day?" Of course as soon as I ask them this arbritary question I feel stupid, I hear my sanctimonious British self with the freedom of choice to ask questions and choose how to be employed (or not, as the case may be). The guards look at me pensively for a moment then one of them replies. "You have a point. But what can we do? We have to feed our families" The truth is that they want to survive, in whatever way they can. Like the plants, the farmers and the goats living alongside the monstrous factory and all it holds inside and out. Like Sanjay who lost almost his entire family thanks to a corporations greed and disregard for human life. Like the people who are continually contaminated by poisonous water from the factories sludgy waste dumps, the children born with horrendous birth defects who you will hear more about soon and the people living with the horrific memories of Dec 3rd 1984. Like you,like me like every living being on our precious planet they value their right to life above all else.

NB: I want to apologise for the depressing nature of this blog, but I'm not sure that I should. It isn't a political rant, its not even meant to be an anti capitalist rant, its just how things are here. All I will say is that I hope to focus more on the positive things that are happening in Bhopal, because there are many, but I think it's important that people know the nature of the situation that Bhopalis are facing here! XO

New Beginnings

       A very Happy New Year to all of you, wherever in the world you may be.
It seems fitting that I should begin writing this on the 1st January 2011. The start of a new year, a new place, new people and many new experiences seems a good time to pick up this blog, although that may be a good excuse for some lengthly procrastination.

      I did some traditional New Years Deep Cleaning today. It was all there, the dustpan the mop, the steel wool the dust and a tiny bit of a hangover from the night before. Also there, and not so traditional, at least for me anyway; was the Muslim call to prayer, the barking of 15 dogs at a passing goat, the call of "Hello Miss" from the children from the opposite rooftop and the smell of samosas and chai from the street below. As you might have guessed I'm back in India. Is anyone really surprised?

As I cleaned the tops of cupboards and beat dust out of rugs, whilst reflecting on 2010 and the many wonderful experiences, opportunities and people it presented I became acutely aware of the smell of dirt, the feeling of grime on my hands and the fact that cleaning an 8 bedded dormitory with only me in it appeared to far more work than I originally anticipated. Was I just getting old and lazy, definitely a likelyhood, or could it have been the fact that nothing I was using to clean with contained ANY chemicals or synthetic products. Linseed oil on the mosquito netting, white vinegar on the windows and a concoction of natural soap melted in water as an all purpose cleaner. . .watch out Vanish, Flash and even Dr Bronner with your magical 'natural' soap (which I am, admittedly sill washing myself with) Sambhavna's in town, and they're doing a pretty incredible job, and not just at protecting my skin, lungs and clothes from chemicals that we, as a society, are conditioned to believe we need.

       Sambhavna is a clinic in Bhopal, Madhya Pradesh that provides allopathic and ayurvedic treatment, as well as yoga, panchakarma and an impressive community health programme to survivors of the 1984 gas leak. This gas leak, from a Union Carbide Pesticide plant built on top of a densely populated area was the biggest industrial disaster in history, killing over 7000 people in the first few days and over 15,000 in the years since. Around 100,000 people continue to suffer effects of gas exposure. The humanitarian catastrophe is ongoing thanks to the refusal of anybody responsible to clean up the factory site, meaning that the water supply for entire communities continues to be poisoned by tonnes of chemicals that are lying in the ground, 26 years after the initial leak.

Generations of people face a multitude of physical, psychological, psychiatric and developmental problems and it is at Sambhavna that they can find an element of relief. It is the only example of totally integrative care I have ever seen, where allopathic physicians work alongside massage therapists and yoga teachers. The aim is to treat people in a holistic manner, while allowing them to participate fully in their treatment, reducing the number of unnecessary pharmaceuticals people have traditionally been bombarded with and eliminating the top down approach that we are used to. This approach doesn't just apply to treatment. The organisation is almost entirely non hierarchical. Yesterday I sat, somewhat bemused in the weekly meeting where all 60 members of staff get together to discuss. . .well anything. From the seemingly trivial to the bigger political campaign everything is discussed at length and I was humbled, surprised and inspired by the confidence that everyone from the cleaner to the consultant physician displayed. There definitely was heated moments but in general everyone was free to make their point, opinions were respected and the chair-people, who change weekly so that everyone has an opportunity, were, organized and kept things running without being autocratic.

       So, having spent a few days orientating myself to my new surroundings and trying to put names to faces I am starting to make plans. I hope to work with the community health workers, who appear to do a phenomenal job of educating the 60 or so community health volunteers in gas affected areas, which are mostly slum colonies. I’m not quite sure what its all going to involve yet but it seems my first job is to make some friends, in pigeon Hindi and try to convince the Community Health team that I’m not quite as suspicious as they seem to think !! I’m hoping that some good old Scottish charm and a bit of translation from Shenaz the wonderful librarian/health promoter (and my only hope of ever understanding anything about the way things work here) will do that job. I also would really like to spend some time in the tranquility of the beautiful Ayurvedic garden where all the natural medicines are produced, learning about the variety of medicinal plants that grow and helping the friendly gardeners. I’ll let you know how that goes given that at the moment I can barely grow my fingernails never mind anything that is actually dependant on botanical ability !

        I am hoping to raise 5000 pounds for the Bhopal Medical Appeal www.bhopal.org who are doing a cracking job of raising funds for both Sambhavna and the Chingari Trust, which is run by some remarkable activist women and looks after mentally and physically disabled children. They don’t take any donations from corporate sources and they really need to funds to continue to do the work they are doing, and to expand in the ways they would like to. I’m already a good bit of the way there thanks to incredibly generous donations from friends and family -many thanks to all who have donated !!. The weblink is www.justgiving.com/lorryc so get clicking and help me out however you can !!!!!!

       Plug over, but seriously, the work that is happening here is truly inspirational. It’s important and it’s an example of the integrative and holistic approach to life that is so badly needed on our planet. The soap and cleaning products are just the very tip of the iceberg here. But the concept is the same throughout.

       As I sit in my very clean but not sparkling room, and contemplate how satisfying it feels to have worked a little bit harder with a little bit less and to have avoided the chemical filled gack of the multi-nationals I feel blessed to be spending time here, among compassionate, motivated and educated people who really do have the well-being of their communities at heart, and who continue to fight every single day for justice, health care and global recognition for the survivors in Bhopal. I look forward to blogging more detailed information on the different aspects of life here and I’d love your feedback on what is interesting and what is not (assuming SOMEthing is !!) For now Love and Om Shanti to all of you I’m off to roast some eggplants for dinner !!