Community Health

Full Title: *Community Resources and Health*

_Address delivered at the International Health Conference on Interaction of Health and Development, Washington, U.S.A. March 28th – 30th 1977, National Council for International Health_

‘This whole system of values – the techniques and structures – were superimposed so it was not easy to break through them. When we were children, we still remember that, for most of the illnesses, for which we now rush to the doctor, there were very effective home remedies both curative and preventive. This system was a type of a primary health care, prevailing in our society. These systems were not killed by our people, but they were smothered out of existence by the surreptitious introduction of so-called modern systems of western medicine’!
Friends, I was wondering why I accepted the invitation to address a professional group like you, particularly, as I am a village worker. Human beings have strange ways and when I got the cable asking me to come and speak to you, promptly I responded, without thinking why.

Now I am here and I will think aloud on the theme you have given me, Community Resources and Health. I represent the movement which was introduced as Sarvodaya: ‘Sarva’ means all, ‘Udaya’ means awakening – awakening all. So, to me community means everybody – all of humanity. If I may go further, community means the entire living world, because in our culture, health or even medicine is defined as something that is found everywhere. It cannot be taken out of any experience or situation which affects the mental or the physical well-being of man.
To give a good example, in Buddhist literature the most famous physician was a man called Jeevaka. He had to undergo training for a very long time under his teacher in the city of Taksila. For seven years, he studied under this teacher and he was a brilliant student. One day, he asked his teacher, ‘Sir, I have been with you for seven years. Everything you taught me, I have studied. Could you tell me how much longer have I to study under you before I could start practising’? The teacher told him, ‘You had better go around the City, an area of sixteen square miles, make a list of things that cannot be used for medicine, and then come back’. So this student went around everywhere, trying to make a list of things that he could not use for medicine. He came back and told the teacher, ‘Sir, their is nothing I could find that cannot be used for medical purposes’.

Now, in the Eastern part of the world, this is the way that we look at things. For example, our science of medicine is called ayurveda – science of life. So, to me, to build up the health of a people, the greatest resource we have is our physical and our living environment. First, the human being. In my country, I have had experience for the last almost 25 years in trying to mobilize the resources for the well-being of man. When you have to mobilize human beings as a resource for their own well-being you have to find out what the most valued thoughts in their culture are.
In my culture, every human being was supposed to work towards the total awakening of his full personality, based on certain principles. To awaken one’s personality people believe that the first principle they should accept is the thought of well-being of all – respect for all life. Respect for man, animal and plant. Respect for all life, therefore, was the fundamental principle on which all great cultures in Asia, particularly in India and Sri Lanka, were built.

In my own country, people had a sort of a national anthem which they sang for nearly 25 centuries in which they said. ‘May there be seasonal rains. May there be non-violent economic prosperity. May the entire world be happy. May the rulers be righteous’. Now, this was the wish of the community – the wish of the nation. In other words, they never thought in terms of the well-being of the majority. When you look at the figures which Dr. James P. Grant just gave, my country happens to be one of the better off countries in the developing world. But, are we going to be satisfied with this? Personally, I am not going to be satisfied until such time as every single human being is free of disease.

There is no equivalent word in our language for disease. We call it dukka. Dukka means contact with suffering. Suffering may be due to a number of reasons, thus a person can become ill due to a number of reasons. One may be due to the introduction of a certain virus or germ or bacillus; secondly, there may be physical ailments due to your metabolic process not functioning well; thirdly, there may be certain mental disabilities; fourthly, their are natural causes such as hunger, thirst, senility and, finally, death. All these conditions result in contact with suffering.

So, the culture to which we are born provided us with a method by which a form of healing was evolved whereby we could experiment and discover the four causes of suffering. In the case of the first, perhaps they resorted to surgery; in the case of the second, they may have used medicine; in case of the third they might have applied a sort of psychiatry or some similar type of treatment. Fourthly, in the case of natural diseases – when I say natural, I have in mind conditions like senility. Why are we born? Why do we die? Why do we get old? There are some spiritual answers to these rather cryptic questions. That is why, in certain holy texts, Lord Buddha was referred to as the ‘Biggest Healer’; not because he healed physical ailments, but because he relied on the inscrutable power of nature in curing even deadly diseases. He said, ‘I have found a way. Here you are! You also try it out’.

Therefore, I say that personality ‘awakening’, is the foremost thing in life, and acceptance of the thought, ‘respect for all life’, leads one to compassionate action. What I do now, including my coming here, can be regarded as a compassionate action. I believe that every body should have welfare, but there are people who are suffering. As a human being, if I go in search of those who are suffering, and do something – some compassionate action to remove the causes that lead to their suffering – I become happy, because I have made a positive contribution to ensure another’s happiness.

So, there is a thought – respect for life – and there is compassionate action – to remove causes that lead to suffering. Third, there is an immediate result, the joy of sharing one’s joys with others. And this would almost effortlessly lead to a fourth state, namely, mental balance. This state may be described as equanimity. These are the four principles which determine whether a human being is on the path to true progress. So this line of action provided the philosophy for the individual.

The culture, on the other hand, provided another set of principles for the society.

If, as a group, we are to progress within the ambit of a family, or a village, or a nation, or even the world community there should be certain basic principles guiding us. Most important of all principles is the principle of sharing – sharing of knowledge, sharing of resources, sharing of love, compassion etc. This should be cultivated as a fundamental quality among human beings. Then comes ‘pleasant language’, the refined art of communicating with one another. You know in the world today, how much money, how much resources, are being spent to alienate man from man, rather than to integrate different groups of human beings. Third in importance comes ‘constructive activity’. As a general rule, human beings should get together only for the purposes of constructive activity. Fourthly, equality in relationship with others.

So, based on these eight principles, four of which are meant for the individual, and four for the group, we started a movement to bring about a type of all-round development, starting from the grass roots level. We are a country of village communities, like most others in the world. We have about 23,000 villages in our country. In these 23,000 villages, over 85 percent of our people live. And these people have had, as I pointed out earlier, a rich culture. How far can we harness this culture to bring about betterment in their lives? Groups of us, who accepted these ideas, started going to village areas, not with a patronizing attitude, but with a certain feeling of oneness with the rural communities. We lived with them; we talked with them; we planned out development programmes with them; and then we worked together, shoulder to shoulder, with them to solve some of the basic problems that they were faced with. In this process, whether they were engaged in education or trying to increase the income of village communities, one fundamental factor emerged, that is that all the problems in village life have a strong inter-relationship.

Unless we learn to look at these problems sympathetically, we may fail to appreciate that a problem in a rural community in Sri Lanka may have a direct relevance to your way of life in this country. We cannot escape that fact. There is however, a vicious circle that is operating. We have to break this vicious circle that is operating. We have to break this vicious circle – a circle which is composed of illiteracy, disunity, disease and ignorance – which has to be correctly identified for a solution to be effected. Because of illiteracy, a man may have a low income; because of illiteracy, a man may suffer from disease. Because of illiteracy and low income and disease, a man may be subjected to a political and economic type of exploitation. In other words, this whole thing works in the form of a vicious circle.
When we go to a village community, the first thing we have to do is to lay a psychological infrastructure in the village which will enable us to transcend all man-made barriers and try to think together. I think I should explain to you what I mean by the psychological infrastructure. This is very important, because various people have various notions of people’s participation. Everybody speaks of people’s participation. A bureaucrat going into a rural area in his brand new imported jeep, and having a few words with the village people, comes back to the office and speaks jubilantly of ‘People’s participation in planning’. That is just poppy-cock!

During the last two centures or so, our country, which was subjected to colonial rule, evolved three dangerous structures. The first of these can be regarded as the system of economic exploitation, where the rural areas were exploited by people in urban areas for the preparation of which a certain legal base was supplied by their successors. The second obnoxious structure can be regarded as the highly bureaucratized administration in which the administrator was not responsible to the village community, but was responsible to his superior administrator – the hierarchy ascending up to the administrative capital, Colombo. This type of bureaucratic system did not represent the aspiration of the people but represented the wishes of the rulers. Third, although of very recent origin, a political system – a party political system where the village – level party politician did not represent the wishes of the village people, but rather was an instrument of the people in the city or in some instances reflected the views of entirely alien countries – grew up quite menacingly!

So, people had to work within these systems. The ethos of rural people was destroyed by the aforementioned three systems, and one of the fundamental principles we had to face was to find ways and means of changing the unpleasant situation arising out of these systems and evolve some positive paths to progress, introducing in the wake a judicious health-care system, as well.

Other countries had departments of health. So it was natural that we also should have a department of health! They had a director for this department. Therefore, we too, should have a director. They had superintendents of health services, so we also should have superintendents of health services. The doctors in other countries received a very high income and enjoyed a special social status. So it came to pass that our doctors should also be well paid, whether people live or die, and maintain their status at all cost.

This whole system of values – the techniques and structures – were superimposed, so it was not easy to break through them. When we were children, we still remember that, for most of the illnesses, for which we now rush to the doctor, there were very effective home remedies both curative and preventive. This system was a type of a primary health care, prevailing in our society. These systems were not killed by our people, but they were smothered out of existence by the surreptitious introduction of so-called modern systems of western medicine! Of course, now, a new respect for traditional systems seems to emerge unobtrusively, and we of the movement have not failed to take cognizance of this trend and push it whole-heartedly to the benefit of the country.

In this context, it would appear that problems of health in rural areas are interrelated to a number of other problems – issues that affect the community as a whole. So in our Sarvodaya Shramadana Movement, we first think of some activity – may be an access road to the village, may be a system of irrigation for the village and the rice field, may be the sinking of a series of wells or latrines, something that the people feel they badly need – and set about to achieve it. That is the genesis of a Shramadana work camp, where we who have come from a number of other villages will live together, eat together and work together, planning out collectively and arriving at decisions by consensus. Here the people join for a common purpose motivated by the ideals of brotherhood of man, working shoulder to shoulder as equals in a common endeavour, and the end result is a successful development programme fulfilled, while imparting of a kind of non-formal education. But we will not fail to get expert advice when deemed necessary. This actually is an effective exercise in reversing the existing bureaucratic process.

During these Shramadana work camps, we meet three times a day in what is called a ‘Family Gathering’. The idea is to foster and cultivate assiduously the spirit of brotherhood in the minds of all the participants. The farmer realizes how much modern knowledge there is, how much he has to learn. The professor realizes how ignorant he is with regard to the life of the village communities. Thereby a two-way communication line is established. In other words, it becomes an educational process for both these groups. This becomes all the more important because, if we are to change the present situation in our communities, we have to think of an integrated approach by which we can bring about a change in the thinking, in the attitudes, in the values, in techniques and in the change in structures.

All these three things have to go together. I will illustrate. About 18 years ago, as a young, very enthusiastic rural worker, I was very keen that every house should have a latrine. So with great difficulty, I persuaded a family to put up a latrine. About a year later, I visited that village again, and I found the same latrine beautifully locked up with a padlock. I went and asked the man what happened: ‘Are you not using it, or have you kept it very clean’? He said, ‘Sir, at that time we agreed to put it up because my daughter was expecting to get married, and somebody was coming to see the daughter, but that got postponed. Therefore, we are waiting until that occurs’.

Now what did we do? We gave them that instrument, but we did not change their attitudes. We did nothing else, not even in the area of techniques. Today, it is different. After the initiation stage where we get a majority of the people in the community thinking and planning together and participating in the implementation of those plans, we come to a second stage, where we build up a sort of a social infrastructure in the village.

There are pre-school children in the village and they are organized into a group. The school-going children seven to fifteen years of age are organized into another group. The mothers’ group, the youth group, out of school youth group, farmers’ group, and what we call others’ groups are organized, and inspired and trained to service.

So in a village, we get six functional groups organized, not one after the other, but create situations where the groups evolve spontaneously. And then, these groups start discussing. For example, my own nine year old son, from November 5th last year to November 5th next year, has organized about 300 children of his age. And what do they do? They have distributed an earthenware pot into which children have to put boiled and filtered water and drink water only from that.

In other words, in a very functional way, they learn positive health habits. In this way, not only the adults, not only the professionals, but even very small children, through song and dance and various activities, get organized so that they are able to play their role in building up the health of community – that is, the total health in all aspects of the group of people living in the village.

From the psychological infrastructure stage to the social infrastructure, we come to a third stage where we try to get the best use of modern knowledge by training people from those communities themselves in small institutions we have established. We have 50 small and six large institutions where people are able to come, individually, or as a group, and learn modern applications in the fields of agriculture or health or education. Now these people, when they go back to the villages, generally as teenagers or in their early twenties, there is an input of leadership that is not only an inspired type of leadership from cultural and spiritual values, but also leadership with scientific knowledge added.

These groups of people lay a foundation to activate the economic life of the village. In other words, they go into the areas of irrigation, improved agriculture, small industries, and now appropriate technologies. And these things need, sometimes, financial inputs. For this purpose, we have established a small revolving fund which we help these people to find the necessary capital for them to start their ventures. So, very briefly, starting from the cultural base of a people, we have been able to develop a programme whereby nearly 120,000 families have become participants in a self-development programme.

Of course, this type of programme in politically highly active societies like ours, is very difficult to develop, because various interest groups would look at this type of programme as a threat to their own well-being. In spite of this, we have been able to survive, because we have kept away from any party or ideological, political groups. We allowed this to develop as a movement, where people themselves are the masters of what they decide and implement. Therefore, we are able to survive.

In the Sri Lanka situation, as Dr. Grant very rightly mentioned, we were benefited by very early social welfare measures taken in our country. As early as the late 1940s, there was free distribution of rice which helped the vast majority of people in maintaining a minimum level of nutrition. There were free health services, and there was free education. These three measures taken by respective governments made our task much easier. Subsequently, for the last seven or eight years, there has been much legislation that brought about basic social changes, such as in land reform. These things helped us very much.

But all these things can be meaningful only if we do not lose sight of the importance of the quality of the individual in this whole process of development. In our mad rush to increase productivity, to increase per capita income, we lose sight of many things, and most often, forget the human being.

Now in the context of our world, I believe that there should be more consideration given to the mental health of our people. Today, our society – I can speak for my own Sri Lankan society – would have been much richer if the dicision-making groups in our country were healthier in their minds, because rash decisions on the part of mentally sick person holding immense power can bring about unwholesome situations to millions of people.

This is only an introduction. I believe that, during the course of the discussions, I will be able to explain to you in greater detail how, based on cultural and spiritual values, we are attempting to make use of all the available resources in the community – beginning from the village and going up to the world – and trying to better the health of our people.