Down Load PDF  




Supervisory staff of the National Tuberculosis Institute was the pivot around which the fieldwork of the survey revolved. They were the pillars of strength during moments of crisis and adversity encountered during the course of the fieldwork. The supervisory staff members stayed away from the cozy environs of their homes for several months at a stretch in far flung areas performing multifaceted roles. The term 'supervisory' was indeed misleading for they did much more than just overseeing the quality of implementation of the fieldwork performed by the contractual health workers specifically recruited for the survey. They were entrusted with several administrative functions and particularly commendable was the fact that the team leaders achieved and sustained high degrees of proficiency despite their very limited numbers.

The staff had to undertake a planning visit to the survey sites before the commencement of the field work and had to make arrangements for setting up of a camp office, arrange for hiring of vehicles to be deployed for the field work, ensure that there was parking space available for the vehicles, etc., All this was in addition to co-ordinating with the local health officials and maintenance of cold chain for tuberculin. Getting the continued support from the local health administration was not always easy. The supervisory staff used their persuasive and motivation skills to achieve this. It was at times difficult to negotiate with avaricious house and vehicle owners as they hike their charges on learning that it was government money that was being transacted. The supervisors not only ensured that government money was not laundered but they often spent lesser than the modest budget allocated for accommodation and transport and invariably ended up saving money for the government. The ILRs or refrigerators in the District Tuberculosis Centres (DTC) stored the entire consignment of the tuberculin vials but were often not open in the wee hours of the morning when the teams set out for the fieldwork. To overcome this, the supervisory staff established good rapport with their neighbors and requested them to store a few vials of tuberculin in their refrigerators, which would be periodically replenished from the stock in the DTC in the evenings.

The operational challenges posed to the supervisors during the course of the fieldwork were myriad. Obtaining support and cooperation from communities from varied cultural, traditional and linguistic backgrounds for participating in the survey was more than a challenge. It was beyond doubt that the inclusion of health workers from the districts helped in overcoming these barriers albeit to a limited extent. More importantly, the communicative skills and attitude of the supervisory staff ensured enthusiastic community participation. The supervisors used their persuasive skills to enlist the cooperation of village leaders, opinion makers, ANMs, Anganwadi workers and teachers. In some places, the people were not happy with the health services provided by the government. They were soon won over by the supervisors as study had a service component.

The children with large and unpleasant reactions were referred to the local health centres for further investigation and if required, given anti-tuberculosis drugs provided by the survey team.





Field Camp for Tuberculin



In one urban area of Hardoi district, the local populace hauled up the supervisors during the planning visit as they mistook that the area was being scouted with the motive of committing robbery at night. The response from the elite in Delhi was taciturn and far from forthcoming. At the other extreme, people whose children were not required to be tuberculin tested in accordance with the study design, protested at the discriminatory attitude of the survey team. The reception accorded by the backward and marginalized groups belonging to Baliband in Purbi Singhbhum district turned hostile when a few student leaders threatened to blow the vehicle ferrying the survey members when they observed that the vehicle belonged to the Central Government. In a few places, villagers accused the team members of administering injections, which would render their children sterile thereby forcing family planning on the gullible unsuspecting villagers. A lady panchayat leader in a village in Jaunpur district alleged that the chocolate given to children after testing was laced with drugs. In a village in Kangra district, the team was viewed suspiciously as a week prior to the visit quacks had injected saline instead of the hepatitis vaccine, as claimed by them and pocketed hundred rupees for each injection. This created a furore among the villagers. Only when the team members showed their identity cards, were the villagers pacified. In places like Jhabua, the team had to keep sticks in hand to ward off attacks from ferocious dogs. In some villages, the Pradhan insisted on setting up the testing center in his house for political gains and this was not always entertained. Many a time the team members had to forego their lunch as it could not be accommodated during the working hours. In places like Delhi, the team had to work in two shifts as the children were going to schools in two shifts. As per the ethical requirements it was necessary to obtain the consent of parents or guardian of each child prior to tuberculin testing. Sometimes, this was time consuming if they were not available and the team had to wait for their arrival. If tuberculin testing was a challenge, the reading of the reactions was not always uneventful. Some tested children fled fearing a second prick and had to be cajoled to be brought back. Large and unpleasant reactions were greeted with wrath and apprehension from parents. The compilation of these weird but irksome anecdotes would be more than exhaustive; but what is germane to these experiences is the ingenuity and knack displayed by the supervisors, which ensured that no cluster was abandoned for want of community support and participation. Moved by the abject poverty in several villages, the supervisors doled donations from their limited resources.

To supervise the fieldwork efficiently despite the vagaries of the harsh weather in some areas was a challenge in itself. The fieldwork in the scorching and patched lands of Junagadh, Jabhua and Cuttack districts was exhausting. In fact, the availability of water dictated the choice of campsites in Junagadh district. In contrast, water logging at the survey sites due to the incessant monsoon made fieldwork difficult in parts of Kota, Hardoi, Kangra, Kamrup and Papum Pare districts. The supervisors motivated the sagging spirit of the field staff on these occasions and ensured the smooth conduct of the fieldwork. The monsoon rains uprooted trees and caused roadblocks in some areas. The team members cleared these obstacles often without local help.

At the conclusion of the arduous day's fieldwork, the supervisors could not afford to relax as they were saddled with administrative and financial responsibilities. They had to maintain all vouchers, stock books, log books, cash registers, submit accounts regularly to the head quarter and ensure that the valuable data was transported through couriers to the head quarter. These responsibilities forced them to work into the late hours of the night. They also had to maintain harmonious relationship among the team members and inculcate the qualities of team spirit and unity.





The vagaries of field work



These multifaceted roles of the supervisors entailed several responsibilities of which maintaining high standards of research disciplines were but one requirement beside the tremendous toil, patience and communication skills while dealing with communities of widely varying beliefs and cultures in the length and breadth of the country. But the rich oasis of experience made winners of the supervisory staff in terms of man, material and time management.

Kind rememberance: with great reverence we salute the dedicated services of Mr. G Krishnaswamy and Mr. Basudev Verma who expired on field duty. May their "Noble Soul" rest in eternal peace.