International Federation of Red Cross and Red Crescent Societies - February 27, 2007
Patrick Fuller, Communications Coordinator, International Federation, Sri Lanka

From eight to five, in sunshine or rain, she balances on the terraces reaching for the choicest leaves that are then processed and shipped to markets in Japan and Germany. The rolling hills and cool climate are perfectly suited to tea production which was first introduced to Sri Lanka in the mid 19th century by the British and now represents the country's second biggest export earner.

To work the tea estates the British brought over a migrant labour force from Tamil Nadu in southern India. Traditionally, the Tamil estate workers have been politically and socially marginalized. Living largely in isolation within the confines of the tea estates, estate workers have not integrated into mainstream Sri Lankan society and are considered by many outsiders as 'backward' communities.

Over the years conditions on the estates have improved. The owners of the estates came together and formed the Plantation Humane Development Trust in an effort to provide better healthcare, education and living conditions for estate workers. The Trust has also been linking with a variety of development organizations that carry out welfare programmes with estate populations.

But development and exposure to outside influences have brought new problems. Increasing numbers of young Tamils are now looking for opportunities outside the tea estates and are traveling to nearby towns or the capital Colombo in search of work. With little education or street sense many of the young men are exposed to the lure of commercial sex, increasing their risk of contracting HIV, the virus that causes AIDS. With many men moving regularly between the tea estates and the city - the threat of HIV spreading amongst the estate population is a very real one.

Unlike other Asian countries the prevalence of HIV in Sri Lanka remains low. Reported cases number 872 while estimated cases stand at around 5,000. Under their joint plan to tackle HIV/AIDS in Sri Lanka, the Government's National STD/AIDS Control Programme (NSACP) together with WHO and UNAIDS classed tea estate workers as a vulnerable group. The Red Cross also recognized the health risks associated with the increasing mobility of young estate workers and decided to pilot a health project in the tea estates that was focused mainly on the prevention of HIV.

The International Federation together with the Sri Lanka Red Cross Society began consultations with the Ministry of Health and the Plantation Humane Development Trust. They were directed towards two estates in the districts of Nuwera Eliya and Badulla that were considered suitable for piloting the project.

'Out of Sri Lanka's 500,000 tea estate workers it is the women who spend their working day in the fields where they are unprotected and may be vulnerable to sexual harassment', explains Lene Svendsen, The Federation's Acting Health Coordinator. 'Alcoholism is widespread and casual and commercial sex is available around the tea estates - but there is poor awareness of sexually transmitted diseases and HIV/AIDS'.

The Health Centre on Mahagastota Estate is staffed by an Estate Medical Assistant who is qualified to run an outpatients clinic and prescribe drugs. There is also a midwife, creche attendants and pre-school teachers - all funded by the Estate. But while curative health care services are available, the emphasis of the Red Cross programme will be on health promotion and disease prevention.

'The idea is build a sense of shared responsibility around health promotion, prevention, care and support so that people don't just see it as the job of the health services', explains Lene Svendsen. While increasing peoples understanding of HIV/AIDS remains the priority, the programme will also cover issues such as personal hygiene and awareness of tuberculosis and sexually transmitted infections. It will address lifestyle issues associated with nutrition and the ill effects of alcohol and smoking and it won't just stop at the boundaries to the estate. The aim is to reach out to target groups in surrounding communities such as bars, liquor shops and schools.

According to Thuvilselvi and other female community leaders, alcohol abuse is the main problem on the Mahagastota Estate. 'About fifty per cent of men drink regularly and there is also a problem amongst many of the women', she says. Another community leader, Mohan Raj supports this view and is concerned that alcohol is fast becoming a problem amongst estate children. 'Some men are spending half their salary at the liquor shop and there are cases where children have taken to alcohol and are dropping out of school because they see their parents drinking every day'.

Tackling such problems requires a sensitive approach which is why the Red Cross programme will work through community leaders as well as through peer to peer education. Staff from the Sri Lanka Red Cross will give training to community leaders in health awareness and life-style issues. They in turn will take the message to the wider community. As part of the approach Red Cross volunteers will help to establish youth groups that will be geared towards helping to address some of the social problems on the estate such as alcohol abuse, by engaging young people in structured activities.

While there are only a handful of reported cases of HIV/AIDS on the tea estates of Nuwara Eliya and Badulla, the risk factors are increasing. 'People's understanding of the disease remains limited and there are a lots of misconceptions and myths', explains A.H Prematilake, Assistant Director HIV AIDS, with the Sri Lanka Red Cross. 'When we were designing the programme we interviewed 100 families to learn more about their knowledge of health issues and their attitudes and practises. Many said they wouldn't want to work alongside someone who was HIV positive because they thought HIV could be transmitted like a common cold or through a handshake'.

Volunteers from the Nuwera Eliya Branch of the Sri Lanka Red Cross Society will play a key role in backing up the community leaders to dispel such myths. They will become familiar faces on the Estate helping to keep the programme on track and monitor its progress. According to Prematilake there have to be incentives to engage people on the Estate. 'Most of the women are plucking tea all day and have little free time. The volunteers will help to organize activities that combine learning with fun by staging street dramas, film shows and sporting activities'.

Initially the programme will have a target population of 738 families, comprised of 2730 estate workers and their families, living on the Mahagastota Estate as well as a population of 4000 people from Pita Rathmale Estate in the neighbouring district of Badulla. Once it is up and running the plan is to replicate the approach on other tea estates over a three year period.

According to Tim Bray, the International Federation's Regional HIV/AIDS Coordinator, the programme is a breakthrough. 'The Red Cross and Red Crescent in South Asia usually works on awareness and advocacy issues with broader target groups such as schools. This is the first project in South Asia where the National Red Cross will be working so directly with such a vulnerable target group in this way'.

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