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By Psycho-social rehabilitation team, Udayam#
The Evolution
On 23rd March, the Government of India ordered a nation-wide lockdown for 21 days, limiting the movement of the entire 1.3 billion population of India as a preventive measure against the COVID-19 Pandemic in India. Kerala was among the states with the highest number of cases, as of that date. State and local governments were entrusted to provide community education and to take actions to stop the spread of the disease. This included closing schools and government buildings and cancelling public meetings or other events where individuals might gather and transmit or contact the virus. In order to prevent the spreading the disease among the community, streets in Kozhikode were being evacuated.
The lock-down situation had forced many people to be stranded in the city. The District Administration took-up the cause of their rehabilitation by equipping various Government hostels in and around Kozhikode. The rehabilitation efforts were coordinated by Department of Social Welfare and Justice Department along with various NGOs. The homeless street dwellers were brought to the East hill camp under the leadership of District Administration on the same day, initiating the rehabilitation mission. The following days saw more members being shifted from the streets to the camps by Kerala Police.
The rehabilitation efforts started with providing food and basic living amenities including clothes, toiletries, sleeping mat, pillows, etc. The medical interventions extended by the public and private hospitals started with screening to quarantine of suspected cases to free treatment for the needy. In addition, a private hospital conducted frequent medical camps and providing medicines. Psychiatric rehabilitation process started with making social profiles and planning appropriate psychiatric interventions to the inmates. Appropriate referral services and counselling services are happening subsequently. The team involved in the noble mission believes, this is an opportunity to save people from the deadly disease as well as to bring many to a normal dignified living condition. In continuation to these efforts, the District Administration had taken a lead in coordinating a group of socially committed individuals from various professional backgrounds and organizations, who have come together to support and develop a sustainable solution for them to ensure that they live a dignified life. But once they started distributing materials among the inmates it became difficult for them to identify and co-ordinate the crowd and hence decided to collect basic details of the inmates for the easier functioning.
While taking the data, volunteers identified a need for expert advice in different areas, including physical and mental health, addiction, family issues etc. This led to the involvement of professionals from the field of psychology and social work. A notice was put out asking for volunteers willing to join the team and in two days, fourteen volunteers joined the team and the psycho social support team was formed. After several sessions of brainstorming, a process for psycho- social intervention was formulated. The first step of which was collection of a baseline data of all the people present in camps and analyse them to get a clear picture for planning the further process and interventions.
Individual interviews were conducted from each camp and the data acquired was used to formulate the database. During the data collection, the team members realised the necessity of accommodating people according to their medical conditions and hence people with communicable illness, psychiatric illness, geriatric issues were shifted to different hostels and those with travel history were quarantined. Routine checkups and medications were provided and timely management of medical issues was taken care of. Emergency cases were taken to the hospital among which a few were hospitalized. The camp followed a need based approach and interventions were provided considering the immediate need of the inmates, which led to a more sustainable plan towards rehabilitation of the inmates.
The challenge faced by the team in the camp was the diversity among the population. The majority of the camp inmates are street dwellers who are not used to a “structured” lifestyle.
The team focused on educating them to be hygienic and bringing in some order to their routine. This brought changes in their behavior and approach towards volunteers and psychosocial team. The team divided themselves and took up the responsibilities of different campsites, which helped in building rapport with the inmates and also to make more focused interventions.
This transformation among inmate gave the team confidence to form a more sustainable plan for a Community Based Rehabilitation – The dream for a street free of dwellers, were nobody sleeps on streets or dies without an identity. Hence Udhayam came in to picture. This came out as a result of several brain storming sessions, discussions and experiences. The psychosocial team, the police force together with the consent of the District collector and Sub- collector formulated the further proceedings following a Rights based approach as having basic survival needs is everybody’s right. The plan was to empower them to be a better individual, equip them with all the resources available and connect them with the community or their families.
Udhayam focuses on five basic aspects for the rehabilitation of inmates involving the community resources. They are:
Physical and Mental Health
The population includes street dwellers, hotel workers, daily wagers and also people who were stranded in the city due to the lockdown. The first priority According to the basic demographic data, there were 26 members who needed psychiatric assistance, 13 members needed immediate medical assistance and a few of them showed withdrawal symptoms.
Medical assistance was provided on a daily basis at the camps by Govt. General Hospital, Medical College and a private hospital. Routine Check-ups and physiotherapy are also provided to the members. Psychiatric assistance is provided by the Government Mental Health Centre. Individual counseling, Group Therapy sessions, Meditation and Yoga were provided by the Psycho-social team.
Institution based Rehabilitation
As per the redirection survey conducted by the psycho social team, 758 street dwellers are working among the street community but many of them do not have secure and stable shelter facilities. As they are unorganized/skilled/unskilled laborers working for relatively lower wages, they did not get any privileges as an employee. Many of them sleep on the street which creates many issues like high vulnerability for crime, victimization and other undesirable acts. Moreover, their life in the street without proper access to sanitation facilities is at the risk of contagious diseases and puts community life at high risk. Most community-based rehabilitation initiatives emphasize the responsibility of the society to ensure feasible and secure housing for all. These shelters function as a safe and secure place to sleep and stay after their working hours with dignity.
Employment and Livelihood
Empowering the beneficiaries meant increasing their self efficacy and making them financially independent. For this, a profile of each inmate was prepared and the gap between their current employment status and desired goals were analyzed. Skill assessment and risk analysis helped to find job opportunities appropriate for inmates individually. Potential government and private employment providers were listed out and a detailed meeting with them was conducted in the presence of the Sub- collector and the labor officer of the district.
Social Security
In the initial data collection it was found that many of the inmates were not able to come up with proper details, due to different reasons. Some of them had left or eloped from their homes years before, some of them had age related memory problems, while some had psychiatric problems and many of them were not giving proper answers. This proved to us the necessity of having identity cards. Majority of the population are street dwellers and hence had lost or misplaced their identity cards and some of them had never applied for one. Review meeting was conducted with the district collector on 14th April 2020 and he made arrangements for conducting camps to distribute ID cards to the inmates. Along with it, health cards for hotel employees, ration cards, health privilege cards for inmates, etc. will also be provided to the inmates.
Family Reintegration
The one- to- one psycho-social interventions gave an idea about the family conditions of the inmates which was very alarming. A large number of them had eloped from home years before due to family problems. Accordingly, continuous assessments and individual interactions were directed and family status of the inmates were analyzed. The probable cases for family reintegration were listed out and regular follow up was done.
A guideline for family reintegration was formulated and the families were contacted through their nearest police station. The team contacted members of the family of whose numbers were known. The aim is to create a sustainable solution for livelihood and ensure the optimal individual functioning with the support of the Janamaithri police in the locality to prevent their return to the past life and if the individuals are aged above 60 and has a child who is currently employed under government, necessary protection is to be arranged as per the senior citizen act, 2007.
1) Sinu Jesin T [Social Worker, Alumna of Vimala College (Autonomous), Thrissur]
2) Haseena Kasim [MSW Student, Sree Sankaracharya University of Sanskrit, Kallady]
3) Muhammed Afsal K. K [District co-ordinator, Childline Kozhikode]
4) Hashir Ahammed A V, [M.Sc Clinical Psychology, Alumnus of Jain University, Bangalore
5) Muhammed Anas .C [MSW, Kozhikode]
6) Rithu K [MSW Student, Department of Social Work, Little Flower Institute of Social Sciences and Health (LISSAH), Kozhikode]
7) Dr. G. Ragesh, [PhD IMHANS, Kozhikode- 08]
9) Dr. Kurian Jose, [PhD Psychiatric Social Worker IMHANS, Kozhikode-08]
10) Aswathy Sajith [Research Associate, IIM Kozhikode]
11) Shabeer P K [Research Officer Iqraa International Hospital and Research Centre, Calicut]
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