Episode 101      26 min 01 sec
Making a Difference: Kiran Martin and Asha in the slums of Delhi

Paediatrician Dr Kiran Martin recounts the story behind the founding of ASHA, which now helps over 350,000 Delhi slum dwellers to improve their lives. Global health specialist Dr Peter Deutchmann weighs in on how research institutions in rich countries can work to empower and embolden work done by organisations in developing nations. With host Jennifer Cook.

"Higher education is something that I am very excited about. We sent the first cohort of students in July 2009 and this is the first time it has been structurally attempted." -- Dr Kiran Martin





           



Padma Shri Dr Kiran Martin
Padma Shri Dr Kiran Martin

Padma Shri Dr Kiran Martin is founder and director of Asha.

Kiran trained as a doctor in Delhi and graduated from the Lady Hardinge Medical College in 1985 with a postgraduate diploma in Paediatrics. Shortly after this, she began working voluntarily to contain a cholera outbreak in the Dr Ambedkar Basti slum in the south of the city.

Originally working single-handedly at a borrowed table outside the slum, Dr Martin went on to create a community health and development society, Asha, that has transformed the lives of over 300 thousand slum dwellers in Delhi.

The year 2001 saw the publication of "Urban Health and Development", a book co-authored by Dr Martin in collaboration with two well-known public health doctors. In 2002 the President of India presented Dr Martin with the Padma Shri - India's second highest civilian award - in recognition of her remarkable achievements in the field of social work.

Assoc Prof Peter Deutschmann
Assoc Prof Peter Deutschmann

Associate Professor Peter Deutschmann is Associate Director of the Nossal Institute for Global Health and Executive Director of the University of Melbourne's subsidiary company within the Nossal Institute. As the Head of the Inclusive Development Practice unit Peter provides direction to a team of development specialists and to the Institute's growing program of disability-inclusive development.

Peter originally trained in clinical surgery and subsequently in public health whilst working in rural north India. With over twenty five years experience in international health, Peter has developed special interests in the integration and delivery of essential services through a primary health care approach in resource poor settings, including those services related to disease prevention, specifically HIV prevention.

Dr Deutschmann has considerable experience in the planning and implementation of health programs in many countries of the Asia Pacific, especially India, Nepal, Burma, Cambodia, Papua New Guinea and East Timor, for government and international agencies that include the Australian Agency for International Development, UK Department for International Development, UN agencies, the World Bank and the Bill and Melinda Gates Foundation.

Credits

Host: Jennifer Cook
Producers: Kelvin Param, Eric van Bemmel
Series Creators: Eric van Bemmel and Kelvin Param
Audio Engineer: Ben Loveridge
Voiceover: Nerissa Hannink

Images courtesy of Asha. 

View Tags  click a tag to find other episodes associated with it.

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Making a Difference: Kiran Martin and ASHA in the slums of Delhi


JENNIFER COOK
Hello, I’m Jennifer Cook. Thanks for joining us. US President John F. Kennedy famously said that one person can make a difference and every person should try. It is easy to dismiss this as a noble sentiment from a simpler time, especially when the reality of our world is each year 18 million people die from preventable causes – a figure higher than the annual death rate for world war one. But as overwhelming as such statistics are, there are people who simply get on and get the job at hand done, with extraordinary results. In this episode of Up Close, we are talking with one such woman. In 1988 Kiran Martin was working as a paediatrician was working in Delhi when she heard of an outbreak of cholera in a slum to the south of the city. She offered to help. After wading through rubbish and refuse, Dr.Martin worked at a borrowed table on her own to help the community. From these simple beginnings was founded Asha, an organisation that now helps more than 350,000 slum dwellers from 48 slum colonies around Delhi. Asha is the Hindi word for hope. And today, along with the associate director of the Nossal Institute of Global Health, Dr Peter Deutchmann, we are discussing just what that means. And, how it can transform the lives of some of the most disadvantaged people on the planet. Kiran, Peter, thank you both for joining us.

PETER DEUTSCHMANN
Thanks Jenny.

KIRAN MARTIN
You’re welcome.

JENNIFER COOK
Kiran, I would like to begin by asking you to take us back to that moment when you reached that slum. What did you see and what did you do to try to help?

KIRAN MARTIN
I come from a middle class family and I’d seen some slums from a distance. I had never really gone inside one before. And so, I was really quite shocked. Because, first of all, there was no way to even enter. There was mountains of garbage that greeted me. The stench was so powerful I could hardly stand. I made my way by jumping a fence at the back, because there was no main road. There was so much slush and so much mud; my feet went in right up to my knees. When I went inside I found that children were playing with excrement, there were pigs everywhere, there were huge rats running around, there were puddles of dirty water all over the place. People didn’t have any place to throw their sullage. People would just defecate out in the open, on top of open drains. Find any patch of land on which they could squat. And there was so much illness it was just unbelievable.

JENNIFER COOK
And there was this cholera outbreak, how much were you facing there?

KIRAN MARTIN
I actually started my work, in a small little open space. Because I had just entered and I didn’t even have a building. And the demands were so immediate that I had to respond immediately, so, I was actually given a little space up outside the slumlord’s home and he actually lent me his furniture. Which was all broken and I sat there under a tree seeing these cholera patients. And there were so many children dying of cholera at the time. Government hospitals are really crowded. And they are very frightening for slum dwellers. And they are very dirty also. Sometimes there will be seven or eight little kids on a bed, there are floor beds with IV drips hanging from everywhere. So, these kids, whose parents saw them getting severely dehydrated with cholera would bring these kids to me and say ‘do something right here’. So, I found myself giving intravenous fluids in their huts.  Just putting a needle in the wall and hanging a bottle out of there to somehow re-hydrate them.

JENNIFER COOK
And you started by yourself. Do people come and help you?

KIRAN MARTIN
Yes, I mean, I began in this way. And then of course, there were others who joined and then we became a team. And then there was a little clinic that I constructed there in that slum. There was a little bit of space in the slum and I was able to make a proper building there to be able to somehow run a primary health care service for the slum dwellers.

JENNIFER COOK
We go from, a woman on her own, climbing a fence, wading through garbage, setting up a little clinic, to, now we have Asha, which is helping over 350,000 slum dwellers in India. Tell us, what is it about Asha that makes it work that it is able to make these connections?

KIRAN MARTIN
Very early on in my journey, I realised that it was very important for me to partner with slum communities in order for any tangible change or for any real change to happen. I found that the men in the communities were very political. They had strong political allegiances. It was hard for them to think of slum development. And I found that the women were a far more effective group. And I began to dialogue and discuss with women on how they could get together and bring about change. It wasn’t easy at the start. Because they were passive. Fatalistic. They were resigned. They’d given up. They had given up because they had been living in that slum for more than 25 years. And everybody had exploited them. Politicians had also. So, they just felt that people come here, they make all sorts of false promises, they show us all these dreams. Nothing really happens. And so they wondered whether anything in what I was really saying. So, they actually had to taste a bit of success in order for them to really believe in themselves. You know when, just four deep-bore handpumps were installed in that slum, that brought clean water to the slum –

JENNIFER COOK
Yes, something as simple as clean water. I mean, how far were they walking to get water before then?

KIRAN MARTIN
It was awful because they had these shallow handpumps that went only 30 feet deep or so and the water that was coming out was contaminated with sewerage. It was brown, it was dirty and that was the reason why there was that cholera epidemic. It was not just in that slum. It was all over Delhi’s slums. Because that was the kind of water they were drinking. Because they had no other option there really.

JENNIFER COOK
So, you started that important clean water and that changed the mindset a little bit, did it?

KIRAN MARTIN
There was so much happiness and celebration in the slum. And this was a small measure of success which helped them to realise that actually if they got together and organised them well enough to be able to articulate their demands effectively they could do a lot. I began to work with the women in helping them learn how to advocate their cause before various authorities, be it water, be it the sanitation department, you know, there is a department called ‘The Slum Department’, actually, which is responsible for the welfare of slum dwellers. But they never visited it. They didn’t even know how to approach it. And we also have municipal councillors that are elected members of the civic body. We have MLAs, because Delhi is a legislative assembly and actually all of these slum dwellers are the ones who are going to vote for these people when they fight elections. And of course, during election time, they do say that ‘we’ll come into your slum and we’ll do a lot for you’, but, in practice, it usually doesn’t happen. So, I started helping the women to build a democracy at the grassroots where the women’s group had representation across religions, across castes, across socio-economic groups. So, groups were socially inclusive. So that everybody in the slums aspirations are represented. And that they have a voice. And they have a channel there. A vehicle through which they can say what they want. And be able to realise what the government has said they would provide.

JENNIFER COOK
I’m just trying to imagine this sense of empowerment that a woman, she would feel.

KIRAN MARTIN
The transformation is quite dramatic. Because it is a feudal society. Very patriarchal, in India. In the slums, really men are the ones that rule the roost. Women don’t have a voice at any level. Be it the family level or the community level or even the level of city. And so, it was very important for them to understand that they have an equally important role to play in affairs of the family as well as the community. And what has happened over this period of time is that they have become such effective agents for change that everyone is looking up to them for leadership now. Because not only have they brought about major changes in the physical environment, you know, there is plenty of clean drinking water, there are drains, there are brick paved roads, you know, there is even electricity which is something they never had. I mean, imagine them living in the dark resorting to illegal tapping of electricity. Stealing of electricity out of sheer compulsion and necessity. These were the major changes that the women brought about.

JENNIFER COOK
I’m really interested in how the men within this patriarchal, feudal society and the slumlords as well, how they reacted to this change, this shift in power.


KIRAN MARTIN
It was really hard at the start, because it was a challenge to their authority. Of course, we tried not to confront them aggressively because that wouldn’t ever have worked. There would have been too much opposition. We thought that a non-confrontational approach would work best. And so there was a lot of transparency in our dealings. We would encourage them to come and listen to what the discussions were all about so that they didn’t feel threatened. But then, when they found that the women were getting so active and then they were able to achieve so much for their communities, the power base was shifting. There were so many problems they have actually done a lot of things. They’ve surrounded our health centres and sometimes protested against women entering for meetings, they’ve often deflated my car tyres. Or, thrown stones at my window panes. These kinds of things have happened over the years. Especially in the early years. Although we always try to take the slumlords into confidence and the philosophy was to actually accept them as persons and reject their deeds rather than reject them as people. After all, they’re also a product of their own childhood and their own environment. And we wanted to reject their deeds but in the context of a relationship and that seemed to be a very good strategy.

JENNIFER COOK
And gradually over time did the focus shift to what was best for the community and for the children?

KIRAN MARTIN
Yes it did. The slumlords, of course, there was a lot of opposition at the start, but by and by their power got neutralised. And when they started coming alongside us in the work that we were doing, a time came, after a number of years, when the slumlords really had no power left at all. And the power mainly with the groups of women and not just with the groups of women but with the passage of time there were other vehicles for partnership, such as young boys and young girls and so on.

JENNIFER COOK
This is Up Close coming to you from The University of Melbourne, Australia. I’m Jennifer Cook and our guests today are Dr Kiran Martin and Dr Peter Deutchmann. Now Kiran, we have spoken how you have helped empower the community to make those connections with local councillors, with government, with people who are meant to represent them that’s one thing. But you also managed to convince banks to give loans to slum dwellers. Tell us about that.

KIRAN MARTIN
That was a remarkable point in Asha’s journey. Up until very recently, slum dwellers had no relationship of any sort with financial institutions and banks. So much so that they even did have a bank account, let alone access to other banking services such as credit. And, they were always at the mercy of loan sharks and money lenders – informal money lenders, who would come to their doorstep and give them money and then come to their doorstep and if they didn’t give the money back with a rate of interest of 120% per annum, they would just take away all their belongings. They have been known to push their hands into the pockets of people and just take out their notes and walk away. Or walk away with jewellery or walk away with anything that they can find. They are ruthless. And, people have had to resort to them because what else could they have done? When they needed money and financial discipline was never part of their lives. And so, what I did, I actually invited India’s finance minister at the time, in 2008, to visit Asha and it was remarkable that he actually paid us that visit. And to him it was an eye opener. In fact, I was given to understand later that never has a finance minister of India visited a slum before. He was the first. And so, it was just amazing because he came in and he saw the various components of Asha’s work in the area of health care and the area of environmental improvement, land titles and so many other different sectors. But he was himself quite amazed to find that there was a complete absence of any relationship between slum dwellers and banks. And so he actually got the ball rolling. He invited public sector banks to the finance ministry and under his chairmanship, there was a scheme that was actually formulated by these banks and Asha together to provide loans to slum dwellers. And this has been launched for the first time in our country and hundreds and hundreds of slum dwellers have now received loans. Accounts, of course, every slum dweller has opened. And you would be hard pressed to find a slum dweller in Asha without an account. In fact, not just one account, but even you know, separate accounts for husbands, for wives, for students and so on. And they have received loans for home improvement; they have received loans to expand businesses. Their incomes have gone up by two or three times in many cases, by even ten or twelve times. And, the most exciting part is they have even received loans for higher education which means that slum children can now actually dream of going to university which is something they would never ever thought at all of.

JENNIFER COOK
Peter I would like to talk to you about that delegation that you took over to Delhi and you also witnessed the hopes of the children of slum dwellers.

PETER DEUTSCHMANN
Indeed and it was in the context of a very high level university presentation and engagement with the government of India and in that context Kiran’s team hosted a visit to one of their communities one afternoon. I think that which impressed us most was the commitment of the women of the community to the futures of their children. Something we didn’t expect to see. We expected to I think see that which Kiran described at the very beginning. And what we saw were vibrant, active women. But what was disarming and most encouraging and challenging was the presence of young people born in that community and been educated as a result of the support of the Asha program, now entering university. And Kiran has told us there are some 200 students now and part of that enabling of course is through the credit system possible through the banking arrangements. And the young students took us into their community, welcomed us into their homes. And of course their homes, where four, five, six or more live are not much larger in terms of floor space than our bathrooms of standard Australian homes. But of course, it is not a constraint. These people have enormous ambition and opportunity and that is largely to the credit of their families and parents who, and back and behind that the support of the Asha program over these 20 plus years.

JENNIFER COOK
And Kiran, could you just explain to us, connections with universities around the world and other organisations, how important is that to Asha?

KIRAN MARTIN
Very, very important. In so many different ways. We are working at the national level with governments to advocate for slum dwellers all over the country not just for the slum dwellers of Delhi, because for example these banks are national banks and these new schemes and policies are actually meant for the entire urban poor population of India. And to have these sorts of links gives us the necessary profile that we need to be able to advocate at that level and that is really necessary for us. Also because these are institutes of higher learning and the area of higher education is a new initiative for Asha, we think that they can provide immense amounts of input into the kinds of models and the kinds of approaches that can not only bring about success in Delhi but they can be scaled up nationally. And India, with its success story of growing at 9% in the years 2006, 7 and 8 and still growing at around 7% now is not really demonstrating its success in poor communities and therefore I think the input of universities such as Melbourne University is extremely important for a scaling up.

JENNIFER COOK
On Up Close this episode we are speaking about the work of Indian aid organisation Asha with Dr Kiran Martin and Dr Peter Deutchmann. I’m Jennifer Cook. Now Kiran, I just want to take us back to the very, very simple, but I think crucial issue of land ownership. These slums weren’t even recognised as legal, were they?

KIRAN MARTIN
Absolutely. What happens is that when a slum is in existence for so many years in a city such as say Delhi or Mumbai, politicians call them ‘vote banks’. Which just means that the only reason why they want them their in the city is for their votes and they really couldn’t care less about how they live. Now the fact remains of course is that they are contributing immensely to the city’s economy. They are the driving force behind the city in many ways because the cheap labour for the entire city is construction work for example comes from slums. And so, they actually deserve to be able to live in decent living conditions, which is actually the government’s duty and responsibility. In the late 80s when I started my work, slums were very much looked upon as an eyesore rather than as a group that must be integrated into the society of our nation. In the early 90s I did some pioneering work in the whole area of land titles. I convinced the government to help slum dwellers to get land titles on the same land on which they had been living for the past many years without land titles. And the fear of demolitions was so immense in their minds that they didn’t feel like improving their lives at all because they weren’t sure whether they were going to be there tomorrow or not. So, the motivation to send their children to school or to improve their homes wasn’t there at all. That project was remarkably successful and it was able to demonstrate to the government that providing a land title makes such a huge difference to the outlook of a slum family. And, these people who have got land titles in the early 90s are today middle class citizens. So, you can imagine the kind of transformation that is possible.

JENNIFER COOK
Must be enormously satisfying work. I’d just like to ask you on that personal level, how does it feel for you?

KIRAN MARTIN
Of course when I look back and I see the remarkable changes, not just the physical changes of a particular environment but the inner transformation where people live with so much more confidence, they hold their heads high. You know, the lost self-esteem and dignity has been restored back to them. You know, they are much more whole as human beings. They have evolved emotionally, they have evolved socially, they have evolved in so many different ways. It makes me very happy for them. But then on the other hand I do realise that there is so much more. I mean, I started in 88, but it was as late as 2008 that I was able to work in the area of financial inclusion and things like higher education and so on. So, I am very much aware that I am actually just at the tip of the iceberg. And there is still a lot, lot more to be done. And I am full of excitement and passion and I really do want to live my hours and days trying to do more and more for these people.

JENNIFER COOK
So, what is next for Asha?

KIRAN MARTIN
I think higher education is something that I am very excited about. We sent the first cohort of students in July 2009 and this is the first time it has been structurally attempted. The odd accident has been there, you know, you might have found a bright slum child who made it into university. But it has never happened in a formal organised, structural manner. And I am really looking to scale it up. Because I think that is the real passport out of poverty and I am hoping to liase with India’s education minister and other cabinet ministers who are prominent, who are passionate, who are dynamic to be able to enable the educational process to be scaled up in a way that slum dwellers can actually come out of their poverty.

JENNIFER COOK
Peter, could you please explain to us the work that the Nossal Institute has done previously in India and how you can transfer that knowledge and skills when you are working with an organisation such as Asha?

PETER DEUTSCHMANN
Indeed. Our current work, Jen, is through partnerships. We partner with a number of organisations in India, government and non-government alike to assist their work in the development of communities. To give you an example, in northeast India where we have been working for many years with a partner organisation, we have assisted the development of responses in the AIDS epidemic, the prevention of the spread of HIV among people who choose to inject drugs. This is the part India which shares a border with Burma where heroin and other addictive drugs are plentiful and widespread in their use. So, we have been able to explore with the affected communities and with our partners appropriate contextual public health interventions. What we have done in those settings, I think, bring our, if you like, research skills. We’ve been able to develop research tools to enable the affected community. So these are young people who either use drugs or may use drugs to undertake social inquiry. So, we set up a – we call it a research program – but essentially it is a conversation that happens within the community among young people; among young people with law enforcement;  young people with their families and parents about why they do what they do. And what some of the drivers are and begin to learn what the pathways are to for example injecting drug use, pathways to commercial sex work; what the drivers are. In order to understand early points of intervention and then together with the community plan what those interventions might look like. So, it is very contextual. For example, if that was important to the Asha program, if there were questions of, if you like, social inquiry we could bring those skills. But we don’t just bring those skills and do that work we bring those skills and teach local research teams. These are not necessarily formal researchers but people drawn from the community teaching research skills and working with the community to analyse the information they have gathered. I think scaling up the model is where we can assist. Again, an example from northeast India we helped local communities in local government understand there the power of scaling up public health interventions like needle and syringe exchange that now is part of a national program, a national roll out. Similarly here, I think, if the government and other agencies are to scale up that which are very successful in the Asha model, we need to be able to demonstrate what elements of that are reproducible and at what scale and what is the investment required from government or donor agencies. And that is where I think the Nossal Institute can work from strength. Bring those skills into that setting. But as I said earlier, it is bringing those skills into the setting and leaving them behind within the community and within the program in order that the ability to inquire and develop answers to questions and then use that for, if you like, advocacy with policy makers is a very important ingredient of maturing organisations. So, we are very keen to bring any elements of that required to assist the Asha program.

JENNIFER COOK
Look I’d like to thank you both so much for joining us here today on Up Close. It has been a most invigorating and I think informative discussion.

PETER DEUTSCHMANN
Thanks Jen.

KIRAN MARTIN
Thank you. Thank you very much.

JENNIFER COOK
Relevant links, a full transcript and more info on this episode can be found at our website upclose.unimelb.edu.au. If you are interested in learning more about the Nossal Institute’s work in India, we talked about this in episodes 70 and 71 of this podcast. Up Close is brought to you by Marketing and Communications of The University of Melbourne, Australia. Our producers for this episode were Eric van Bemmel and Kelvin Param. Audio engineering by Ben Loveridge. Up Close is created by Kelvin Param and Eric van Bemmel. I’m Jennifer Cook. Until next time, goodbye.

VOICEOVER
You’ve been listening to Up Close, for more information visit upclose.unimelb.edu.au. Copyright The University of Melbourne, 2010.


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