Caring for Auroville – the Auroville Health Services (AVHS)

Auroville Health Services (AVHS), a team of eight members, is a non-profit service in the area of public health and health care for seniors. It was set up by Dr. Beena in 2001. Rebecca, a member of the original team who is still working with AVHS, remembers that Dr. Beena’s experience of treating villagers in the Multi-Purpose Health Clinic in Bharat Nivas made her realize that preventive work in the villages was essential. So AVHS set up education programmes in hygiene. It also raised funds for the Aquadyn project to provide free clean drinking water in 24 public places in Auroville, and for the first ambulance for the Auroville Health Centre.

When Dr. Beena stepped back, Manfred took up her work. “Initially, we continued the work in the villages,” says Manfred. “AVHS, together with the Palmyra Centre for Rural Development, constructed 19 compost toilets and provided training in using them in Thenkopakkam village. We also ran a clinic in Morattandi for some years. After closing this clinic the AVHS team decided to again focus upon Auroville instead.”

The present team also continued this work of improving hygiene in Auroville units. Today they advise and monitor about 40 units weekly, including Auroville farms, restaurants, schools and units that provide food products. Among other things, they ensure that people cooking food for the public are wearing proper headgear, and that the sanitation and waste disposal facilities of the units are clean and operating correctly. The standards they adhere to are the ones specified by the Government of India. In 2007 AVHS organized a contest between all the units. The winners were awarded prizes. In the following years, the units fulfilling the conditions were issued certificates. Two members of the team, Veeramani and Chitra, also provide training on request for start-up units.

“We have seen a huge improvement in hygiene standards over the years we have been running this scheme,” says Alice, another team member. Now the Government of India makes its own inspections. “However, we will continue with our inspections,” says Alice. The names of the units that fulfill the conditions are published in the News and Notes.

Has there been a ‘knock-on’ effect? Have villagers working in these units taken over what they have learned about hygiene and waste disposal and to practice that in their own homes? The team hopes that this is happening but no survey has been done to ascertain this.

AVHS also organizes hospital care for Aurovilians. Indian hospitals insist that a patient is accompanied 24 hours a day. “Sometimes family and friends take up this responsibility for the short-term but finding volunteers to take up this work on a shift basis for longer hospital stays is a big job for a small team like ours,” says Alice. “For the past six months we have had at least one Aurovilian hospitalized at any one time.”

Medical Care for Senior Aurovilians

At present 20% of Auroville’s population is over 65 years old and this proportion is likely to grow. The challenge of caring for the aging population is another one of the functions of the AVHS team.

They were pitched into this some years ago when an older Aurovilian developed dementia. Initially there were plans to send him back to his home country, but some Aurovilians decided they would find a way of caring for him in Auroville. AVHS became involved and organized not only 24- hour nursing care but also took over his financial, administrative and social care.

When a hired nurse proved too expensive, the team started experimenting with volunteers. Aurovilian Friederike, who is a professional geriatric nurse, coordinated and trained additional caregivers for a number of years.

Today there are 360 people over the age of 65 in Auroville and this figure is projected to increase to 440 by 2018. At present six seniors over the age of 85 years are receiving full-time homecare and this number will surely increase in the future. So is the team capable of taking on such a responsibility?

“The main problem,” says Manfred, “is to find skilled attendants to work with us in homecare for elder patients.”

“People have limitations in their time and energy. This is one factor. But I also think some people are scared to work with old people,” says Dany, the professional geriatric nurse who replaced Friederike one year ago. “Not only because they lack the skills, but also because they are afraid they will become like that themselves. Even when people are asked to pass by daily for a few minutes to check on someone in their own community, often they don’t do it.”

Personal relationships also play a part here. If someone lacks friends, it is harder to find people to visit them. However, it is a fragile support system when homecare is dependent upon the patients having many friends with the energy to care for them for what may be months, or even years.

Medical Home Care

The new team member, Dr. Amarnath, provides medical treatment around the clock. Kailash Clinic offers a 24 hours ambulance service with emergency doctors on call, while the Auroville Health Centre and Kailash Clinic provide out-patient consultations in the daytime.

But neither the Health Centre nor Kailash Clinic has an in-patient room for intensive care patients. “As in the past, palliative care for dying patients has to be improvised in the patient’s home.” says Dr. Amarnath.

And then there is the financial aspect. Senior healthcare, when it involves professional outside help and specialized equipment, can be expensive. Who will pay the bills?

Manfred says that in the past, it was a struggle to get financial help from Auroville, and even today professional help is not paid for by the Auroville health insurance. “However the attitude has changed in our financial services and now the Budget Coordination Committee gives us some financial support. But when an Aurovilian receiving homecare has financial means, we ask for a personal contribution towards the expenses.”

Does the change in attitude of our financial services reflect an increased awareness in the larger community of the need to care for our older people? The team is skeptical. “It is still only the people who are personally involved or who have friends in this situation who are concerned.”

Responding to the challenges

One of the problems in the past was that volunteer caretakers lacked proper training. Recently AVHS started a training programme. At present, six trainees are being taught skills like how to give a bed bath, how to lift a patient from a bed to a chair, and what to do in an emergency. “It is also important to stress good communication,” says Dany, “like talking to the patient and explaining what you are going to do for them.”

“Every Auroville community should have at least once member, ideally trained in first aid, to care for community members who need medical help,” says Manfred.

The team is aware, however, that there will not be enough volunteers to provide homecare for individual patients in their own houses in the future. “This is where the assisted living home for seniors comes into play,” says Manfred. This project is for elders who need some assistance and who wish to live together. Permanent accommodation for 10 seniors would be provided in a complex where they can be cared for on a 24 hour basis. Such a set-up would require less caregivers per person and medical resources could be shared.

The project has not been without its difficulties, however. When AVHS made a survey in 2008 to ascertain how many seniors might wish to use such a facility, it proved an unpopular option. Perhaps it smacked too much of “Old Aurovilians’ Nursing Home” and many people did not like the prospect of moving out of their own homes. However, when the team ran another survey in 2011, there was a more positive response to the idea. What caused the change?

“I think some people became more aware of what they would need when they got older,” says Alice. The assisted living project, (estimated to cost Rs 200 lakhs – approximately US $ 300,000) has been allocated a site in Arka and has limited seed money. They have site permission, but the building permission is still pending.

Regarding the financial aspect, Manfred’s ‘dream’ is that all Aurovilians pay extra into the Health Fund, or into a Seniors Fund, so that homecare has a more secure financial basis. When somebody is hospitalized and needs specialized treatment or equipment, this can be very expensive. Intensive care in a hospital like Apollo, Chennai, can cost up to one lakh rupees a day (approximately $1,500). However, if Auroville purchased certain medical equipment, this could lessen costs dramatically. “Recently a senior Aurovilian was hospitalized in PIMS. His one week stay cost Rs. 1,50,000, mainly because he needed oxygen,” says Manfred. “But to purchase an oxygen-producing machine costs only 1 lakh rupees. Auroville needs additional equipment like this.”

At present Arka community prioritizes two rooms with bathrooms for convalescent but not for permanent care. In the future more rooms will be needed for medical care for seniors. The new Integral Health Centre is being constructed nearby. Will rooms be available there? “There are two tiny rooms planned for in-patients,” says Alice, “but they are not really appropriate for our needs. We have to explore the options further.”

Psychological care for the elderly

AVHS is not only focused upon physical medical care. The AVHS team is also concerned with providing psychological care for all senior Aurovilians. One of the issues here is loneliness. “We know of people who are alone in their communities, who have nobody to visit them or accompany them in a taxi. I’m very saddened by this,” says Manfred. “There have been people who have been sick or hungry but we don’t know about them because they don’t contact us. So we plan that someone from our team will visit all the older people in Auroville in order to find out how they are doing. But, once again, this takes time and energy, and we are a very small team.”

Meanwhile, AVHS has organized computer classes and lectures for older Aurovilians so that they feel more involved and less isolated. “Transport is fundamental to allow older people to attend films, and enjoy activities,” says Franca, another member of the team, “so we have organized a taxi service for seniors which is proving popular. Our larger vision is to promote collective transport which will benefit everybody in the community.”

Another issue is mental health problems, which afflicts not only some seniors. “These problems are getting bigger and bigger,” says Manfred. “In the past we had a group who looked after these issues, but the group disbanded. Now we would like to set up a helpline for any Aurovilian or Newcomer who needs psychological help. We started this work with a guest who had experience in this specialized work but he left and we are looking for a replacement.”

While AVHS is clearly facing many challenges, perhaps one of the key ones is attitudinal. As Alice points out, “the concept of ‘eternal youth’, a ‘youth that never ages’, is a big thing in Auroville.” Does this make it more difficult for some people, particularly those pioneers who came here in their 20s, to acknowledge that they are aging and will require help in their later years? Does a community dedicated to physical transformation find it difficult to face up to the realities of aging? Whatever the reasons, it is clearly time that the dedicated efforts of the AVHS team receives more full-hearted support from the community.