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Country Profiles |
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Hope and Resilience: Anusha’s Story |
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MARCH 2009 — The road from the Government General Hospital in Anantpur to the small village of Bukkarayasamudram is a journey in metaphors.
It begins with the promise of exciting destinations. Autorickshaws move with abandon, buses snort disdainfully at smaller vehicles, cars honk pleadingly at cattle that gossip at intersections…animals, humans, and machines come together to accommodate each other in the great journey of life. A few kilometers away, a lane darts out from this arterial road and turns right into a quieter, more pensive world. Pits and bumps pockmark the entire stretch, making a pogo stick out of the occasional bicycle. One side of the road is bordered by large tracts of arid land and the other by a canal. Life thrives, lopsidedly, by the canal. Women bang bright saris on rocks, children jump in and out of the water like energetic amphibians, and cattle swim across lazily. It is pretty scene for those who are not a part of the landscape. The road finally dissolves into the alleys and bylanes that make up the village that is home to a quiet and pensive 13-year-old, Anusha. Like many other teenage girls, she is fond of bangles, fascinated by movie stars, and given to sulks—but for the most part there is no one to either notice or care. Anusha lost her mother when she was 6 years old. Her father walked out, leaving her to fend for herself, and her paternal aunt took her in. Over the years, Anusha fell ill frequently; a bout of blood vomiting led to a visit to a hospital in the village. The doctors referred her to the community care center (CCC) where she was diagnosed as HIV-positive. Then one day her father returned, just as abruptly as he had left, and Anusha was sent to live with him. It was far from an ideal arrangement for a child with HIV. Anusha's father was also HIV-positive. He worked as a daily wage earner, and was away from home for days at a time. He frequently consumed alcohol, and he cared little about his daughter's health despite knowing that good food and rest were crucial for a child in her condition. When he was home, Anusha was expected to cook, clean, and look after home and hearth. When he was not around, he didn't care what she did. While other children had mothers coaxing and cursing them through their meals and studies, Anusha could only rely on herself. She cooked and ate when and what she could, got herself to school, studied, and coped with an alcoholic father. Escaping from Deprivation and Neglect I came across a frail and lonely girl, looking after her household, when she was obviously the one in need of care. Poor nutrition and lack of care had left her demotivated and physically incapable of walking the three-odd kilometers to school. There was an urgent need to get her CD4 count done and see if she needed to be on ART. It turned out she did, and we immediately enrolled her for medications. Balasahyoga, or "active support to the child," is a program of the Government of Andhra Pradesh and the Andhra Pradesh State AIDS Control Society (APSACS) for children and families infected or affected by AIDS. Implemented by a consortium of Family Health International, CARE, and the Clinton Foundation, the program is based on an innovative family case management platform. To make a difference in the life of a child, the program works on the larger environment of the child's family, treating each household as a unique case, assessing and catering to individual needs to create an enabling environment for the family as a whole. The program offers a menu of services including healthcare, psychosocial support, nutrition, education, and a "safety net" linking beneficiaries to government programs and interventions relating to food security such as micro-enterprise initiatives, kitchen gardens and grain banks. These services are leveraged from existing programs, so there is no duplication of offerings and needs are met within an established system. There is a very strong emphasis on linkages.
A Fresh Start What motivates an unsupervised child to fetch her medicines on her own, cycling through bustling traffic and tiring roads? Anusha herself answers this question, in her shy and quiet way. He [Ramanjeyulu] and other people often come over and enquire after me, asking me if I am eating and taking my medicines. It makes me feel nice. It makes me feel if they come all the way to ask me that, then I can go all the way to the hospital to get my medicines. Then she grins impishly and adds: I love cycling. What inspires this girl? Better food and medicines? The fact that people ask after her? The comfort of having someone to turn to? Or is it her own uniquely resilient personality? Perhaps it is one or all. Or maybe the answer lies in the simple statement she makes as she leaves for her science exam and we wish her the best: Thank you. One day I hope to become a teacher myself. PHOTOS: Working with local partners, the Balasahyoga program ensures that Anusha has the nutrition support she needs and the means to get to school and the ART center for lifesaving medicines. (Kaushik Saha, FHI/India) |
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This approach requires careful prioritizing from the family case manager. After Ramanjaneyulu enrolled Anusha for ART, he realized that she had two parallel needs: nutrition and continuing education. Anusha was linked with existing nutrition programs, thus making her diet independent of her father's whims. But it was school, more than three kilometers away, that posed a problem: walking that distance tired her out. Ramanjeyulu presented Anusha's case to the Rural Development Trust (RDT), the partner NGO that implements the program in Anantpur, which has a department that runs child health and education programs. The result was a brand-new pink bicycle.