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Alleviating the Angst of Aged Women - Initiative of the Calcutta Metropolitan Institute of Gerontology, Kolkata



West Bengal is one of the most densely populated states in India. According to Census 2011, the state has about 7.5 per cent of the country’s total population, or a little over 91.3 million in absolute numbers. A variety of factors like slow economic growth and industrialization, high levels of migration and dependency on agriculture has left the state of West Bengal far behind its counterparts like Punjab, Kerala and Himachal Pradesh etc.
West Bengal is also burdened with the dynamics of an ageing population. Nearly 35 per cent of the elderly (36% males and 34% females) are in the age group 60-64 years, and 27 per cent in the age group 65-69 years. Another important feature is the feminization of ageing in West Bengal – 72 per cent of elderly women in the state are widowed, 82 per cent of these woment are migrants compared to only 36 per cent of men, and 48 per cent women has had no formal education.
While life of the elderly people in the rural areas remains a challenge, the living conditions of the poor aged people in the urban areas are becoming worse. In the capital city of Kolkata, about 75,000 people who are above 60 live in the slums. These people are not only financially weak, they are also mentally and physically abused.
In Bengal, the traditional concept of social security is prevalent and hence economic dependence of the elderly on their children is high. Providing care to seniors in the Bengali families is often termed as seva. A survey conducted by the Calcutta Metropolitan Institute of Gerontology in 2012 shows that 80 per cent of senior citizens in Kolkata prefer to stay with their children and feel that this is the best living arrangement. However, the rise of the middle class and the rapid disintegration of the joint family system in West Bengal have lead to increasing economic struggle and inadequate availability of resources for the elderly.
Such socio-economic changes along with demographic transition necessitate the involvement of the State to provide the elderly with suitable social security systems. Unfortunately, though a draft Old Age Policy is in the making in West Bengal, most of the social security schemes in the state are under the aegis of the Central Government and shared by the state, like the Indira Gandhi National Old Age Pension Scheme (IGNOAPS), Annapurna Scheme and the National Programme for Health Care of the Elderly (NPHCE).
Apart from a few initiatives of the West Bengal government in health care, expenditure on the aged is very low. The NPHCE was only introduced in 2013 and is still in its first phase, being implemented in only three districts of West Bengal. As a result, some of the local NGOs and institutions have come together to focus on ageing and elderly care.
One such institute is the Calcutta Metropolitan Institute of Gerontology (CMIG) which was established in 1988 with a view to rendering all possible help and relief to the aged and at the same time, instil in them a sense of confidence in their capability and worthiness as active citizens.
CMIG’s objective was to promote research in the field of gerontology and implement its findings, so as to rehabilitate the elderly belonging to different socio-economic groups and to fulfil the basic needs of the downtrodden elderly. There was no model or precedent to follow.
During the last two decades, CMIG has been engaged in a movement to create a community where inherent human values, experiences and expertise of senior citizens are respected and utilized. To achieve this, CMIG has started a wide range of programs ranging from day care centres to provision of livelihood options to the formation of social capital. Since 1993, CMIG has been receiving a Government grant to run their day care centres for the BPL elderly.


Some Innovative approaches to Old Age Care in Bengal
The Kolkata Police and an NGO “Bengal” started a program called ‘Pronam’. It is a unique attempt to provide physiological and physical support to the elderly through a helpline number. Pronam also provides emergency ambulance facilities and financial support in a restricted way. The same program has been replicated in the Salt Lake City under the name of ‘Saanjhbaati’ to provide assistance to NRIs living alone in that part of the city (Hindustan Times, 10 September, 2012).
Another notable initiative in West Bengal is of the Indian Medical Association (IMA), Behala. This is a doctors association that provides various medical services to the elderly population residing in Behala. Services provided include- hospitalization at subsidized rates; home visits by professional doctors; ambulance facilities and medical insurance for some of the fatal diseases (UNFPA, 2014).
Implementation Strategy
CMIG has developed a community development model for the povertystricken elderly living in urban localities, especially elderly women. Being a research based organisation, CMIG has collected data on the elderly poor of Kolkata city through surveys and other studies. There are about 25 lakh BPL elderly and about 75,000 in slum areas.
As a prelude to providing holistic health care to this under-privileged community, CMIG conducted an exhaustive identification process of the acutely vulnerable elderly from this population. Social researchers were engaged and they followed standard methodologies for identification of the vulnerable 60+ women through a doorto-door survey. Through this process more than 500 beneficiaries were identified.
In the initial assessment, the research team analysed ‘Health Profile’, ‘Awareness’, ‘Literacy Level’ and ‘Deprivation’ in the family environment and affordable, feasible and supportive programs were developed. CMIG started Mobile Medicare Service and two Day Care Centres in two different areas. The centres are located at negotiable distances from the slums in the two localities.

Community Development model of CMIG

  • Community Economic Development: Two Day Care Centers & Programme of supporting Needy Grannies by the well-wishers in the community.
  • Capacity Building & Social Capital Formation: Geriatric Care Training & Skill Development of the elderly is the primary themes.
  • Community Based Participatory Research: All action oriented research works of CMIG are clubbed under this theme.
  • Community Empowerment: Associating with Planning process, Law making in respect of Rights & Physical Securities.
  • Community Participation: Mobile Medical Care Unit catering to the health needs of the elderly.

Holistic approach to health care
For improvement of health, a combination of conventional and nonconventional methods was adopted. Conventional treatment covers allopathy and physiotherapy while non-conventional treatment makes use of homeopathy, yoga exercises and magneto therapy.
Dietary counselling is another dimension of CMIG’s holistic approach to health care for the beneficiaries. Trained social workers and counsellors have been continuously trying to balance the diet of the poor elderly women by inclusion of inexpensive foods.
Mental health is another area of support provided by CMIG. Psychological counselling, visits to religious places, exposure to sports activities are the ways to boost the mental health of the elderly women beneficiaries.

Focus on Livelihood
Loss of income is common in old age. This leaves most of the elderly at the mercy of their children and most of the time their basic necessities are neglected in favour of other household expenditures. CMIG believes that the poor must continue to earn a livelihood which will not only help them meet their basic requirements but also increase their self-confidence. Hence, many of the beneficiaries are engaged in income generating programs in line with their profile and health status. One of the innovative measures adopted to increase self-respect and independence among the beneficiaries is paper bag making.
Since plastic bags have been banned, there is a big demand for paper bags and this is a niche which the elderly can fill. To cater to this demand, CMIG runs a small employment program for the elderly at its centres at Beliaghata and Purbalok. About 100 women come together every day to work from noon till 2.30 p.m. They sell the paper bags to the local shopkeepers, and make approximately Rs. 4 or 5 a day. The centre also provides a space for entertainment where they can have lunch and watch television. These women have sorrowful tales to tell but working together and sharing their experiences makes them feel independent and self-reliant.


Still going strong

Aruna Sili is 76 years old and her eyesight is failing. After her husband died her children married and moved away. They come to see her sometimes, but have no money to give. She stays with the wife of her eldest son who was deserted by her husband. Aruna, her daughter-inlaw and two grandchildren live in a rented room. After her cataract operation and nutritional support organized by CMIG, Aruna earns more than Rs. 10 per day by selling paper bags. She feels that with her meager earnings she can take care of herself and also contribute to the household expenses.










Bridging the Gap in Geriatric Care
Being a research and training institute, CIMG’s main focus is on training professionals to meet the demand for geriatric care. Based on experience gained from many years of research, courses have been designed in geriatric care. Some of the courses are:
  • Six Months Professional Geriatric Animator Course - CMIG is one of the regional resource centres identified to train professionals in geriatric care. The course provides in-depth understanding of the needs of the elderly to the animators, who are later placed in various NGOs, community level organisations and as home caregivers.
  • Courses in Gerontology & Age Management - The National Institute of Social Defence, in collaboration with CMIG, has introduced a one-month certificate course in geriatric care for NGO personnel. A post-graduate diploma course in Gerontology and Age Management has also been introduced and is recognized by Calcutta University. This course offers a perfect blend of the theoretical and practical aspects of care for the elderly and is taught by academicians from reputed institutes. Recently, an M.Sc. in Dementia Studies has been introduced in collaboration with the School of Applied Social Sciences, UK as a distance learning program for all health and social work professionals working in the field of dementia.
Technological Innovations
Recently, CMIG has developed technological interventions for the benefit of the elderly in the areas of Mobility Issues, Cognitive Impairment and Sleep Problems. This approach is unique and is being applied for the first time in India. Results are already receiving global attention.

Replicability
CMIG’s approach has been appreciated by the Ministry of Social Justice & Empowerment, Government of India. A National Award was given to the organisation for its excellence in sourcing and disseminating knowledge in the field of Gerontology. CMIG has also been accredited as a Regional Resource Training Centre (RRTC) by the Ministry of Social Justice & Empowerment, Government of India. CMIG will operate in the eastern states of Bihar, Jharkhand, Odisha and West Bengal to train and monitor the functionaries of other grantee organisations under the Integrated Programme for Older Persons (IPOP), Ministry of Social Justice & Empowerment, Government of India.

Conclusion
The health of elderly people in West Bengal is much worse than that of their counterparts in other states of India. Despite this, the State appears to be apathetic to the well-being of the elderly. Most of the schemes have either very poor reach or fail to trickle down to the most vulnerable sections of the population due to lack of awareness. Fund crunch in the state, lack of transparency in the social security system and lack of proper grievance redressal mechanisms make it even more difficult to implement policies and programs effectively.
Since its inception, CMIG has faced two major challenges. The first is a lack of funds and second is the low level of awareness among people. The Institute has been using platforms and forums like Varistha Nagarik Manch (VNM), physicians, college and university teachers, NGOs working in the district and government functionaries to create awareness and frame policies for the elderly. However, it has been a slow process as the support of a proactive Government and sensitized public is necessary to bring about any noteworthy change in the life of the elderly.
 
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