The hot, hot heat and the repercussions of rain

You read it right, all right, but how could it be true? How could there be repercussions of rain in Jamkhed, and throughout all of Maharashtra, when the arid, drought-prone area hardly received more than 10 inches of rainfall last year?

It seems contradictory. However, Jamkhed did not only experience rain: we had a downpour – rain falling so hard you could hardly hear someone right next to you as it pelted the tin roofs – AND it was accompanied by golf-ball sized hail! Though we had just three or four storms, each lasting less than half an hour, some serious damage was caused.

IMG_2368

Post-hail storm craziness: patches of the new preschool building’s paint gone 

The precipitation was so unexpected because this region of Maharashtra typically has two/three seasons, depending how you interpret it: a rainy season (July-September) and a dry season (the rest of the year); Lexi and I divide the ‘dry’ season further, into ‘bearable temperature’ dry season and the ‘too hot to do anything’ dry season. We are currently entering the ‘too hot to do anything’ season, and temperatures have been hitting 37 and 38 degrees C – not to be confused with the 37 or 38 degrees F that New Jersey is still enduring. You know it’s getting hot in Jamkhed when the man who used to visit campus with a cart full of fresh pineapple now rings a bell to notify us the ice cream man is here!

image

If only he had mint chocolate chip in that cooler!

This time of the year, farmers are harvesting sorghum and onions, and wheat has been planted. About two weeks ago it was really beautiful to go on a walk to the lake (yes, there is a lake because there was so much rain this past year!) because on either side of the road are fields and fields and fields of green onion grasses and sorghum that just run into the horizon. The sunsets are beautiful. On one particular walk, I ran into Datta, who is CRHP’s main electrician, but, like many CRHP staff, has a second job as a farmer. He proudly took me on a walking tour around his fields, and explained to me how they harvest the onions.

Datta is a luckier farmer this year, because the rain and hail destroyed the wheat crop. One of CRHP’s other workers, Vishnu, lost Rs. 300,000 worth of his crop, about 45% of his yearly salary. Vishnu is a relatively well-off farmer, and so although this lost is devastating, he and his family will be okay. This, however is not the case for many: over two dozen farmers in Maharashtra have committed suicide since the hailstorms damaged sugarcane, wheat, pomegranate and mango crops. Maharashtra has always been one of the worst five states in India for rates of farmer suicide because water is such a scarcity; in 2011, the state showed an increase of 196 farm suicides compared to 2010. This is a great article that talks a bit more about the rising pressure of farmers, especially in the face of population growth and urbanization. CRHP has worked with communities to plant trees, helping to raise the water table, develop watershed programs, and teach farmers techniques of drip irrigation, rather than flood irrigation, which requires less water.

Matt and Richard are working on a film now that will feature interviews with farmers from various CRHP villages, highlighting their daily lives and struggles associated with drought. Again, how ironic that their first day of shooting – during this hot, hot dry season – was cancelled due to rain.

IMG_2129

Onions are harvested and their stalks are cut off. The bulbs are made into a heap, and the stalks placed on top to cover them. The onions dry out for about a week before they are ready to be collected, packaged and shipped. 

Women’s Day

On March 8th the world celebrated International Woman’s Day, a day dedicated to the empowerment and betterment of women and girls everywhere, and to recognizing the remarkable, compelling women leaders in our lives – both those in the spotlight and in our everyday lives.

Ratna, CRHP’s Manager of Domestic Training and Women’s Programs, invited Margaret, Lexi and I to join her at a gathering the women’s self-help groups members and adolescent girls of Misergao, a village about thirty minutes away, were holding to celebrate the important day. About forty women and twenty girls were present; many participated in songs about women’s empowerment and drama performances portraying the harmful outcomes of dowry. Some even gave short speeches about their experiences gaining financial independence and confidence through participating in their self-help group. Stories and jokes were told, and while the topics were serious, a sense of security and commonality pervaded.

DSC_0526

 

Vrushali, her mom, and Ratna singing a song at Woman’s Day

At Ratna’s request, we three foreign-teers delivered (impromptu) speeches. I was the last to talk, and after introducing myself in Marathi, I told the room of my motivation for coming to India – to learn about the health determinants and healthcare in an environment completely contrasting my home, and to learn about the uniquely beautiful culture and everyday life. I thanked them, not only for being the greatest teachers, but also for being the most incredible inspiration. I encouraged the women to continue working together, teaching each other and growing as a whole, and praised them for acting as role models for the younger women in their families and communities, especially the adolescent girls.

To embark on a journey to attain self-sufficiency and self-respect, to encourage a daughter to complete their education and maybe even continue on to a college degree, to speak up for women’s rights or out against injustices, especially when the tides of the past have deterred precisely this, is beyond commendable. We should celebrate this everyday.

In rural India, gender inequality manifests in a variety of forms – domestic violence, bride-burnings, female feticide and infanticide, abandonment. Unfortunately, examples of these horrors are not difficult to call to mind: an aunt crying upon hearing her sister gave birth to a second girl child; a young mother from the slum across the road who came into the OPD one morning with a bleeding and swollen-shut eye, wailing that her husband beat her with a brick; a brave long-term patient at CRHP’s hospital who arrived three years ago with 69% burns across her chest, back, face, arms and limbs, the result of her mother-in-law dousing her with gasoline and setting her on fire because her family refused to pay a higher dowry.

Girls are seen as a burden to the family, because after a girl gets married, she leaves her village to move in with her new husband, taking any skills or education with her. As a result, young girls are often an afterthought, getting food only after a brother counterpart has eaten, or getting pulled from school in order to help out in the fields or around the house – why invest in someone who is inevitably going to leave? Despite improved education and community development, this backwards mindset persists, intoxicating the youth, the future.

CRHP’s Adolescent Girls and Boys Programs (AGP/ABP) were designed to turn these tides, educating and empowering girls and boys 12-18 years old. Programs are different for each gender, but include a similar array of health and social topics: health and hygiene, sanitation, reproductive and sexual health, nutrition, self-help groups/young farmers’ clubs, the importance of education, gender-based violence, alcohol abuse, leadership and decision-making. The AGP was created first, yet the ABP soon followed, as it became clear that sustainable, impacting change at the societal level cannot be achieved without addressing the attitudes and mindsets of both the oppressed and the oppressor.

Two crazy dedicated and passionate members of our Jamkhed intern and fellows crew, Irene and Anirudh, have launched a campaign to gain funding for our ABP – check out their video and webpage here: http://www.indiegogo.com/projects/shaping-a-brighter-future-adolescent-boys-campaign

Though this entry might be a bit late for International Woman’s Day celebrations, it is definitely not too late to show or tell an inspiring woman in your life how much you appreciate her strength, how greatly you respect her decisions and are in awe of her demeanor, how she makes the world a better place. Here are a few of influential, wonderful women I am lucky enough to have in my life:

DSC_0808

some of the strongest (mentally and physically!) women I know

DSC_0495

 

a dynamic, resilient trio, each with the most infectious of laughs

 

 

 

DSC_1070

 

Lalanbai, a Village Health Worker who has been working at CRHP since it began in 1970; over the years she has safely delivered over 700 babies!

January: A “bang-on” start to 2014

Lesson learned: do not wait a whole month to write about it! A glimpse at the beginning of my 2014…

New Years Eve

After  a long ride of trivia games, we returned from out Pune trip around 9pm on New Years Eve; immediately we kicked into cooking mode: Richard and Irene made pasta, Lexi and I made salsa, and Matt got some music going and drinks together. It was comparatively a low-key night, but when the countdown to midnight began, we joined together to say goodbye to 2013 and welcome in the New Year, raising our glasses of white wine sangria. Cheers and hugs were shared among all in our eclectic crew; even Biru was there to celebrate, his infectious smile and laugh initiating a domino effect of joy and gratitude. Though I’ve always thought NYE was incomplete without heels & shiny dresses & champagne, I was perfectly content in my jeans and sweatshirt – all you really need are people who will help you bring in the new year with laughter and love.

Presenting at the Nursing Conference in Sangli

An honor and a privilege, Irene, Lexi and I were invited to speak at the Nursing Conference held at Bharati Vidyapeeth Deemed University in Sangli, about a five hour drive south-southwest of Jamkhed. The theme of the conference was “Changing Demands and Improving Quality Outcomes in Nursing – a Global Perspective”, and we divided the topic among us to speak about the U.S. healthcare system (Irene), the community-based healthcare system the Jamkhed Model promotes (Lexi), and the shifting health demands of the world’s population and how health professionals can meet these needs (Alyssa). Preparing for the conference and our presentation was a little bit stressful – I felt like I was catapulted back to Elon and was preparing a final project on which my entire grade depended – but during a late, delirious night of preparing the night before, we accepted that, in addition to representing CRHP, this would be an incredible learning experience.

DSC_0670

We had no idea what to expect, and were greeted by representatives of the university with incredible hospitality. On the opening day of the conference, we were recognized as distinguished guests, sitting alongside the chancellor of the university on stage. I’m not sure how qualified we were to receive this distinction; I’m pretty sure it was only because we are Americans. After the introduction ceremony, we were the first presentation. You couldn’t tell that none of us had delivered a speech to that large of a group before; we spoke with poise and assurance, and the crowd was very engaged in our presentation. After our speech, the room broke for a chai break, and we breathed a collective sigh of relief that our presentation was over and our brains could rest.

The rest of the conference was spent listening to research abstracts, getting a tour of the on-campus hospital, meeting other speakers (most notably, a representative of the Ministry of Health of Oman), and being in the audience for the ‘cultural show’, of which the most memorable acts were the hilarious woman who was MC for the night (where do you think I got “bang on” from??), and a group of hip-hop-dancing clowns.

Elon and Calvin group

January is a super busy time of the year for CRHP (hence why I wasn’t able to write until now)! We had three student groups come – Calvin College, Nossal Institute in Melbourne, and Elon! One of my favorite things about CRHP is the opportunity to meet so many different people – different countries, professional backgrounds, passions, and perspectives – and January has been a whirlwind of all of these. Amid the chaos of coordinating village visits and scheduling were many walks to the lake, welcome & goodbye dinners-turned dance parties, fireworks shows and snake nights. The Elon group especially was a much-appreciated small dose of home.

Sankrat

Sankrant is one of the only Hindu festival that is especially for women. The celebration is to pray or give thanks a healthy and loving husband, as well as to resolve disputes and start fresh. To celebrate, all the girls got dressed in saris and headed to town to join the rest of the village women at the temple… which had turned into a madhouse! As women pushed their way to the main shrine, they traded multi-colored halwa (sugar granules coated in sugar syrup), seeds, and nuts from trays they carried, exchanging the tokens of goodwill with a phrase meaning ‘Accept these sweets and speak sweet words’. By the end of the afternoon, our foreheads were covered in red and orange turmeric powder.

DSC_0702

me and my main squeezes

DSC_0714

trays of sweets, nuts, vegetables and powders the women at Sankrat carried

DSC_0705

Elon chickadees before the festival! 

Going to Pune with Elon

Before the Elon students returned to the US, they had a scheduled pit stop in Pune to meet with STAPI, the Sosva Training and Promotion Institute, to learn about urban health and how it compares to what they had learned the past three weeks in rural Jamkhed. I decided to tag along, eager to create some balance to my knowledge about urban and rural health in India, to get off campus for a bit, and to spend some more time with the Elon girls, who were a feeling of home. STAPI arranged for an excellent array of speakers on the first day, including a woman who spoke about female feticide and sex-selective abortion, the policies that the Indian government has in place to deter these tragedies from occurring, and the existing social barriers that prevent these policies from being truly effective.

Most eye opening was our visit to an urban slum, which reminded me of a dirty, trash-ridden touch-tunnel. As a representative from STAPI led us through the slum, women and children poked their heads out from behind curtain doors. Smoke from small fires for cooking and heating water for washing, combined with the occasional whiff of urine and feces, was mildly suffocating. I asked our guide where a toilet was, and the slum woman she asked didn’t know. We weaved in and out of a maze of tin-slat huts that all leaned on each other and connected, ducking under clotheslines and ladders, and turning our bodies to fit through small spaces. Somehow we made our way up, and emerged on a railway track that was absolutely crowded with young children, men, and women.

DSC_0028

DSC_0036

 

over a week later, all of my senses are still digesting this experience

New kids on the block

In addition to welcoming 2014, we also welcome new interns and a new doctor! Three new interns – Margaret from North Carolina, Sarita from Texas, and Lindsey from Virginia – have joined the crew and have already begun working on the Adolescent Girls Program, Helping Hands shop and social media. There are a total of 9 international fellows & interns on campus now – a group big enough to take on the Australian students in a cricket match, with the help of Vishnu, Ganesh and Ohm.

So far, so good, 2014! February promises to be wonderful thanks to another special guest – JP comes to visit in LESS THAN A WEEK!

5 Cups of Chai: Christmas in Jamkhed

On November 29th, my creative side kicked in and decided to make an advent calendar in the form of a Christmas tree. I hoped that, just as Lexi had shared her Hanukkah traditions with us, I could share some Dilly Christmas traditions and impart some Christmas spirit as well. Each day was a holiday-related activity – bake cookies, play holiday-themed charades, drink hot cocoa on the roof and stargaze, watch Elf, etc. We did one or two of the activities, but the calendar fizzled. I was bummed. I was sad the Christmas on the horizon was one without Tupperware containers overflowing with Jojo’s snicker doodle and peanut butter cookies, Christmas music playing endlessly on the radio, nights spent in front of a fire sipping hot chocolate while watching a holiday classic, reuniting with family and friends, and one of my favorite traditions, my crazy loving grandma dressing up as Santa Claus.

In a backwards way, I was actually happy that campus wasn’t celebrating too much because it made it easy to forget it was Christmas-time and forget what I was missing at home.

And then it was the week before the 25th, and Christmas exploded everywhere: our maintenance staff worked tirelessly decorating campus with beautiful lights, and donned the old hospital roof with a giant glowing star; Jabbar unexpectedly set up a Christmas tree garnished with cotton ‘ice’ in the intern office; stockings were hung by the tree in Ravi’s house that we collectively decorated one night after dinner; the pool room overflowed with saris and toys to wrap; Pooja began running (intense) dance practices for the annual talent show everyday at 6pm; and campus bubbled with excited anticipation of the Christmas Eve gift distribution, all-staff dinner and fireworks show.

It was as if I was sucked up by a Christmas tornado there was suddenly so much going on and so much to prepare for. Caught up in this drastic transition from ordinary Jamkhed to Christmas overload, I continued to neglect to think too much about home.

DSC_0250

my favorite Christmas-lights-lit pathway on campus

DSC_0260

star light, star bright

My favorite December memories include the Secret Santa exchange among interns, our intern performance at the talent show – a hilarious rendition of The 12 Days of Christmas that reminded me of my aunts’ singing performances – and opening stockings together on Christmas morning and immediately all putting on our temporary tattoos. Thinking back to the afternoon Lexi and I gave our presents to Sultana, Shahabai, Reshma, Shakila, Biru and Ganesh, which turned into an awkward orange practice, makes my abs hurt from remembering how much we laughed, and looking back to mine and Irene’s dance to a very popular Bollywood song, I am overjoyed we didn’t crash into each other during the spinning choreography. To my inner-child delight, we even had not one, but TWO Santas.

DSC_0312

Lexi and Matt, Jamkhed’s Santa(s)

DSC_0426

Siddhi, Irene, Rachita and I during our dance performance

DSC_0470

evidence that temporary tattoos are appropriate gifts for 20, 30 and 40-something-year-olds 

Jamkhed Christmas 2013 was special and memorable for many reasons. My first Christmas away from home, it was by far the hottest holiday I’ve ever experienced, and the first Christmas I didn’t make it to church (I confess..). The CRHP way of celebrating this wonderful time of the year was uniquely memorable, and I am excited to welcome 2014 with my Jamkhed family.

Since we’re on the topic of memories, I am compelled to tell the story of last night’s events, or the Bohemian Rhapsody Richshaw Adventure, as we’ll call it. It begins with an ending: finishing an incredibly delicious family-style-sharing meal of sushi, Burmese noodles, lobster, a vegetable dish called ‘Three Aunties and Three Grandmothers’ and fancy fun drinks at Malaka Spice restaurant in Pune. Our much-anticipated after-dinner plan was to go to a karaoke bar. I suppose Matt, Richard, Irene and I were a bit too excited; our antsy-ness got the best of us and we set out to hail a rickshaw while the rest of the group finished calculating the bill. Equipped with a GoogleMaps image of the karaoke place, Richard began asking some drivers if they could take us where we wanted to go. While this sounds straightforward, to understand India and the rest of the story, you must know that addresses aren’t really a thing in India, and that “directions” are almost always lost in lack of translation. Blind sighted by our excitement to sing, we hopped in, two interns to a rickshaw.

The first thirty rupees-worth of the ride was pure bliss – singing to each other as the rickshaws exchanged leader/follower positions, laughing and sticking our hands out of the vehicles to catch the wind. Around forty rupees we realize that the “us” dot on the map is going in the complete wrong direction of the destination dot, but are still excited and laughing about it, hopeful we’ll figure it out. Around fifty rupees, laughter dissolves. Concern sets in. We are clueless to where we are and, despite having a map, the distance between the dots on the screen is increasing. Sixty rupees and the shady surrounding neighborhood instigate firm voices, second guesses, extreme annoyance; our drivers have no idea where they are taking us, and instead of admitting so, continue to rip us off. Our furiousness is twofold: we’re paying for a load of bologna, and we’re getting further and further from our glorious night of ridiculous singing. At seventy rupees we demand to stop, exchange words of frustration, and reluctantly pay while angrily calling our incompetent drivers names that they do not understand.

A flustered quartet, we set off to find a different, more promising rickshaw. We start down a hardly-illuminated street. Our frazzled-ness is quickly replaced by alertness as we realize we are venturing down a very sketchy alleyway. We hang a louie, end up back on the busy street and, after barely attempting to bargain, pile into a rickshaw bound for the Pune Railway Station where Atul will meet us to bring us back to the hotel.In the twenty minutes we were at the station were spent, we reflected on the ridiculous, unforeseen events of the past hour, witnessed a policeman brutally whack a beggar away from us with a wooden pole, and filmed a music video to Bohemian Rhapsody.

I had never been so happy to see the Expo 2020 stickered van. We finally made it back to the hotel and rejoined the group outside on the patio for a midnight BBQ. We recounted our adventure; although it was one of aggravation, disappointment, and fear, we told it with huge smiles, bursts of laughter interrupting our trying tale. Was it foolish of us to follow our karaoke ambitions so boldly? Maybe. Was the thrill of adventure worth it? Heck yes. In the end, we even had our sing-along, serenading the patio with none other than Bohemian Rhapsody, and belting the 12 Days of Jamkhed Christmas – Ravi orchestrating – as we rode the elevator up on the way to bed.

I am writing from our van, currently en route back to CRHP, for New Years Eve, Jamkhed style. We won’t arrive until late, so our original plans for cooking something extraordinary will be put on hold until tomorrow night. It is crazy to think of where I was one short yet eventful year ago, crazy to know my fellowship is halfway through, and crazy to anticipate the challenges, growth and adventures that are waiting just around the corner in 2014.

A walk across the street into a new world

Yesterday morning, a group of the Australian students, Matt, our new videographer/photographer intern, and myself went to Indiranagar, the slum community across the street from campus, to pick up the children and bring them to CRHP’s Joyful Learning Preschool. Meena, their sweet, warm and kind-hearted teacher, and Kaat, a woman who fell in love with CRHP, especially the preschool, in 1994 when she enrolled in our Diploma Course and has since become a much-appreciated donor, led us on the eye-opening morning stroll.

Although it is merely a 30-second walk from CRHP’s main gate, Indiranagar is not a project village. An essential element of forging a bond with a potential project village is CRHP’s building of rapport and trust with the community members: Indiranagar is ‘home’ to many nomads who leave every six months or so to work in sugar factories, and to a constant influx of people who have nowhere else to go. CRHP has tried to work with the community and train a Village Health Worker on three separate occasions, yet all have been defeated by the rough and uncooperative community. Only last year, when the drought was so terrible, did the community leaders reach out to CRHP for help.

Though I run past it a couple times a week, I had never ventured into the community. Here are some observations, as well as stories Kaat and Meena told us about the various families they’ve come to know over the years:

  • A family brewing moonshine, which sells for 10 rupees/glass (25 cents). Alcoholism is a big problem in the slum, so making moonshine is a semi-stable income. The cyclically destructive nature of this issue is quite obvious: making and selling more moonshine fuels the fire of alcoholism and abuse.
  • Renuku is 4½, with a scar on her forehead from when her father tried to kill her. Born dumb, she was (and is) ostracized by her family. Last spring, Meena spotted her sitting alone, too weak to swat the flies out from her eyes and nose. Since coming to the preschool, she has begun to smile, make eye contact, and use easy signs to show what she wants. Her family still does not accept her.
  • Uncleanliness was one of the main concerns when the school began. Meena used to give children baths on campus, but she soon realized that she needed to instead teach the mothers how to care for their children. It became a rule that kids who were not bathed could not come to school. Though heart breaking to send ‘dirty’ children back home, the value of bathing and cleanliness has been made clear. Children who go to preschool are distinguishable by their cleaner clothes, washed faces and combed hair.
  • Tons of children, probably between ages of 6-10, are all over the place! Are they going to go to school? Meena points out families who stubbornly resist sending their kids to preschool, instead bringing them to beg.
  • As we turn a corner, a man who is visibly drunk stumbles and addresses us in a slurred attempt at English. I hear someone say, “Being drunk looks the same around the world”.
  • The enormous pink building I’ve been wondering about for the past 5 months is finally revealed to be a boarding school built by the Indian government two years ago. A prime example of the government doing something just to check it off of their list, to simply say its been done, the school was vacant for a year because there were no teachers. Now, about 80 children attend. The building is twice as big as CRHP’s hospital, probably five times as big as our preschool. It is a prime example of how community cooperation and input is vital to making a program successful.

indiranagar

slum children, and puppies, pose for a picture – Indiranagar

photo credit: Matt Barwick

As we completed our loop and made it back to the center of the community, we immediately saw the CRHP vehicle practically overflowing with children. The group of children that had been walking with us during our tour ran to the car and piled in the back. Meena made a spot for Renuku to sit, and a small arm wrapped around her, a reflex of another child to protect her.

The vehicle began driving away, off to school, and I felt tiny fingers slip out of my grasp. The little girl who had been holding my hand throughout the visit began walking in the opposite direction of the vehicle’s cloud of dust. She looked straight at me as she backed away, and I extended my hand and called to her to come walk with the group. She hesitated, then disappeared around a bend.

The Joyful Learning Preschool is unique for many reasons: Meena is more than a teacher, she also acts as a liaison between CRHP and Indiranagar – when she visits each morning to collect the children, she also visits their families, observes their health situations, and inquires about any community updates; children are taught in both English and Marathi, which is invaluable for future learning, and engage in educational songs; lessons include not only counting and the alphabets, but extend to clean water and basic health topics; every child is given two nutritious meals each day they come to school.

DSC_0797

Meena, our jubilant preschool teacher, and her daughter, Angel – CRHP

It is truly an enriching and happy learning environment, and a hiatus from the difficult life that exists across the road. Meena is kind and comforting and genuinely bubbly – a beautiful mother to her own two children, as well as the fifty or so children she teaches and looks after daily. CRHP is very excited to announce the grand opening of a second preschool building, which will occur later this week.

Perhaps if she hears of a new preschool center on campus, the little girl who held my hand will find her way to school.

DSC_1240

a recent fellows/interns project was painting the outside of the new preschool; can you spot the pattern? – CRHP

The new Spanglish: Spanathi

Marathi is a very challenging language. The alphabet has multiple ‘D’, ‘K’ and ‘T’ letters, whose different sounds I have difficulty discriminating, and the language has grammar rules that are backwards and  complicated compared to the rules of English and Spanish. It is both frustrating and fun to learn; it is discouraging that some words just won’t stick in my head, but the staff at CRHP are eager to teach and encouraging instructors. I enjoy spending time in the library exchanging English phrases for Marathi with Dnyaneshwar, a worker on the Mobile Health Team, chatting with Dr. Raju in the hospital learning parts of the body and how to ask medical questions, and going out with the MHT for village visits, where a Marathi lesson is almost guaranteed. It is gratifying to learn and even more exciting to facilitate others in learning my language.

IMG_0900

no notebook? no problem: Madhu teaches how to write ‘wait’ (white) and ‘balk’ (black) in the script

I never really considered learning another language besides Spanish because its utility in America couldn’t compare to that of Spanish, and its interesting how my head is handling this new tongue: since coming to Jamkhed and beginning to learn Marathi, my brain has interjected Marathi phrases with Spanish words, defaulting to Español to fill in gaps in sentences. I’ve found myself saying, “Kuthe vas?” or “Ya ikre por favor”, as if the wires are crossed and I output mixed signals. I have also found that its becoming harder to recall Spanish vocabulary, as more Marathi is pushing its way into my brain and being.

In the whirlwind of Jamkhed work and life, I haven’t exactly made learning Marathi my first priority, and sometimes I am really disappointed in myself for not being able to communicate and missing out on a a joke or a serious discussion. This linguistic barrier, however, has made explicit the value of being able to communicate appropriately, clearly, and personally with one’s patients; on the flip side, it has made me realize that a great deal of medicine and caring for a patient is involved in non-verbal communication, including attitude, respect, even the atmosphere of the office.

Today a baby boy was born in the hospital, and I scrubbed in and assisted with the delivery(even though it was the woman’s 4th child and it was a breeze!) and gave the newborn a bath. I was able to tell the mother it was a healthy baby boy, weighing 3.25kg, and ask her how she was feeling and if she wanted water or preferred to rest. As I carried the wide-eyed little bundle out of the OR into the maternity ward, I was able to ask the family members who they were in relation, and make small conversation about it being lunchtime and the baby’s chubby cheeks. I was also able to explain my camera, ask if it was okay to take a picture, and apologize when the flash almost made the newborn cry. These are ‘baby’ steps (that pun is for you, Richard), but as I look back to the first baby I saw delivered, I feel much more connected to the family and this miracle today than I did then, simply because I could speak with the nurses and mother and family.

When you get bit by a snake, you have to suck out all the poison

Chandu, Uma, Pandit and I set up on mat in a temple in the center of the village Kusadgaon, just another day in the village working on our HIV/AIDS study. We had just enjoyed chai and groundnuts offered generously to us by Baby, Kusadgaon’s Village Health Worker of ten years. The temple had a bell hung right in the entryway, and whenever someone entered, either to pray or have their blood drawn, they rang the bell, which echoed loudly, a bold announcement of your arrival. Ratna was walking through the village to spread the word that we were here and cajole women to leave their cooking, cleaning, washing or fieldwork to take our 5-minute test.

Ratna returned to the temple, her smile sending a message louder than that darn bell ever could. She beamed, holding the hand of a woman who trailed her. They sat down in front of me, and Ratna proudly introduced her as a very good friend. They giggled like young girls and spoke in Marathi too quickly for me to understand before the woman stuck out her hand to show me a big patch of discolored skin. “She was bit by a snake, and treated the wound by herself,” Ranta explained. “She sucked out the poison and told her family to take her to our hospital immediately. She refused to be brought to the temple, as most people would do. She saved her own life. She knew all of these things because Baby taught her during a Women’s Group meeting.”

DSC_0508

brownish blotch healed snakebite wound, and henna-dyed fingers

So far for this HIV/AIDS study, we have only found two women to be positive for the disease. This is great news – two out of the 823 women we have tested to date is a .0024 prevalence rate – ye it is also news that caused me to sit back and wonder how important (comparatively) it is for these women to be educated about HIV: when so few women are positive for HIV, but so many women suffer from anemia, malnutrition, or domestic violence, is learning about HIV/AIDS a high priority? Aren’t there other, more relevant topics to teach?

I mulled this over for a long while. I thought back to the snakebite woman. I hadn’t seen any other snake bit wounds until encountering her and her incredible story. I thought about Baby, and the many meetings and hours she must have spent instructing the Women’s Group members how to properly treat a snake bite, convincing them to trust modern medicine despite generations of traditions and local healers that mandated otherwise. If she had not conducted lessons in treating snakebites, this woman with the patched-skin hand would probably not be alive today.

It hit me: the knowledge these women gained empowered them to take matters into their own hands. Empowerment – there’s that word again – through education. Furthermore, each of these women is entitled to as much information as possible. Why not teach them about HIV/AIDS? If one person is diagnosed, the stigma that they would most likely face – people refusing to touch, care for, share food or chai, work with them – would be tragic. They would be scorned by their communities and disowned by their families. Perhaps, though, a woman has learned about HIV/AIDS from her VHW. Perhaps this woman opens her arms and cares for the infected individual, and perhaps they teach the ignorant community about the truths of HIV, breaking down associated discrimination. Perhaps this education redirects the fate of of the HIV+ person, diverting from a life of neglect towards a path of fulfillment and respect.

Perhaps not, if this education – moreover, this person’s life and the community’s camaraderie – is not high enough priority. “Knowledge is power” has never felt more real, more relevant, more potent. Although the efficacy of this value is something I am just now appreciating, CRHP identified education as a pillar to its mission from the very start, and exemplifies this value by demystifying medicine and empowering all members of society – despite caste, gender, age – with knowledge.

DSC_0509

“There are so many educated people in the world who have knowledge, but they are like stagnant cesspools because their knowledge does not flow.”

Keep your world big

1379649_10201181166027282_186444584_n

Yesterday we went to the farm for Lexi’s 23rd birthday! Her, Irene & I decided to ride on top of the van – an Indian version of the southern riding in the back of a pickup truck custom: the bumpy roads and crazy driving.. the wild wind rushing through my hair.. the view of the never-ending fields speckled with villagers’ homes and plots of bursting orange marigolds.. the hilarity of the awestruck faces of the men and women we passed by waving and smiling and singing.. the spontaneous bravery of releasing my death grip on the guardrail to throw my hands in the air like you do on a roller coaster.. it was an unexpected gift of excitement for all of us. Happy birthday, Lex!

Research

“In the early 1990s, CRHP and the National AIDS Research Institute partnered to determine the overall prevalence rate of HIV/AIDS among pregnant women in the population served by CRHP, revealing that CRHP’s rural population had a prevalence rate of 0.75% as compared to the urban Maharashtra prevalence rate of 3-5%. CRHP has been able to contain the epidemic within its project villages through the implementation of programs aimed at HIV/AIDS health awareness, prevention and promotion in a non-stigmatizing manner.

It has been at least two decades since the last comprehensive testing was done in the area, despite the many risk factors associated with living in rural India. Stigma-associated silence, heavily trafficked truck-driver crossroads and lack of education threaten low prevalence rates. Currently, CRHP is aware of at least ten villages in the project area that have HIV+ patients, but with so much HIV-related stigma and silence, the rate is undoubtedly higher. The vast majority of villagers will not utilize government hospitals where testing kits are cheaper because of the ill-reputed barriers associated with accessing quality care in a timely and appropriate manner. Furthermore, an individual test kit is outside the affordable range for most villagers.”

In the start of September, I volunteered/was assigned to take on a research project: “HIV Testing, Treatment and Education in CRHP Project Villages” as the study is formally entitled. The project is a result from a grant given to CRHP from UMCOR, focuses on women aged 18-40, and is twofold in design: in phase one, women in CRHP’s project villages will be tested for HIV via Tri Dot, blood test. In phase two, Village Health Workers (VHWs) and members of the Mobile Health Team (MHT) will be trained in Kalapathak – a creative method of educating others about disease by using dramas, integrating the health-related message with other social and health issues to reduce stigma.

DSC_0361
Chandu takes a woman’s blood in Padali

I work with a dynamic team: Ratna, a training coordinator and social worker, Pandit Uncle, a social worker and Chandu Mama & Uma, both lab technicians. Each morning, we leave campus around 8:30 and head for one of CRHP’s villages. We set up our work station (a mat, box that contains our syringes and tubes, and register) in a central location, often a temple or pre-school, and with the help of the VHW, begin spreading word that rukta tapasne – blood checks – are being held for women. The women gather and we take their blood, ask them a series of demographic questions, and then ask them if they know what HIV is. If they say ‘no’ we stop the survey. If they say ‘yes’ we inquire further, with the aim of understanding their knowledge and attitude toward HIV:

Can HIV/AIDS be transmitted by sexual intercourse?
Can coughing transmit HIV/AIDS?
Can HIV/AIDS be transmitted by mosquito bite?
Would you invite someone with HIV/AIDS into your house for tea?
Would you share food with someone with HIV/AIDS?

The results of this brief questionnaire have been very eye opening, and the amount of stigma, educated or not, is astounding. So far, we have worked in 8 villages and tested 638 women, chugging along on our way towards our goal of 1,000 women! Even better, we have only had two results that have turned out to be HIV+. The VHW and one of our female social workers, who is HIV+, began counseling immediately and treatment, which is covered by the grant, will begin soon as well.

DSC_0409

Uma laughing with village women as she asks questions for our survey

I’ve really enjoyed this project, for a variety of reasons: Working with the MHT is awesome, and I have learned so much about CRHP and the work we do through their telling me stories and answering my unending questions; Uma and Ratna encourage my Marathi-learning by teaching me phrases and putting me on the spot to practice; I am developing an understanding of the process of field research – the good, the bad, and the ugly – and learning how to be flexible when something that should go exactly according to protocol does not, realizing that the 30+ years of experience that Ratna and Pandit surpass the rigid rules of research I learned during Research Methods; my scope of life in a rural village has widened tremendously, and it has been fun to explore and experiment with my camera, which is like a new appendage. Last but certainly not least, this project has allowed me to witness the incredible impact the VHWs have on a community’s health and wellbeing: these incredible women are respected by all as leaders, healers, and educators. Although a white girl is visiting the pre-school seems to draw a hefty dose of curious women, it is the VHWs – concerned, convincing and confident – that truly persuades the women to be tested, and it is she who stays by their side as they wince at the sight of our needle, who omnisciently shares demographic information about each woman, and who will teach her village about HIV.

Heading Noth: Delhi and Agra

Burning desires to buy a camera, to experience India’s public transportation, and to see the Taj Mahal prompted a somewhat spontaneous trip to Delhi and Agra, two beautifully chaotic, history-rich cities that are a world away (in many ways) from quiet, rural Jamkhed. It was quite an experience, and I feel like I have seen a completely different side of India. I will reflect on these more personal experiences in another post; here are some of the adventures that went down on the journey to India’s capital..

Day 1: Jamkhed to Pune

After a delicious fried egg and toast breakfast, we were off to Pune, a city about halfway between Mumbai and Jamkhed. It is the closest airport to CRHP, and my flight to Delhi was scheduled for the next morning at 7am. I travelled with Shobha, one of CRHP’s directors, and Martin, an Elon professor on sabbatical in Jamkhed with the mission to set up a Science Center, and our first stop was the camera store. I purchased a fabulous Nikon D3200, and I am already in love with it. We then met up with Irene, one of the interns at CRHP who had been in Pune for the week for Ganpati, the 10-day Hindu festival that celebrates the rebirth of the Lord Ganesha. Irene’s couchsurfing host family extended their hospitality my way, and I was grateful for a warm bed, advice about Delhi, and intriguing conversation.

Day 2: Pune to Delhi

A taxi driver picked me up at 5am and drove me to the airport, which was absolutely empty, and by 7am our plane was boarded and ready for liftoff. When the drink cart came by, I requested tea, not realizing I would be charged Rs. 50. My shock was a conversation starter with the man sitting next to me, who, as it turns out, was from Westchester County, New York. One of the only people I met on this trip who was genuinely kind-hearted, he ended up helping me navigate my way on the Delhi metro, where I was planned to meet up with Rohan, a Fellow at CRHP and my travel companion for the week. The Delhi metro turned out to be one of my favorite things about the city. After finding Rohan and settling into our hotel, we were off to explore. But first, lunch. A cycle rickshaw guide took us to Paranthe wali Gali (literally “the bylane of fried bread”), a very narrow street in the Chaudi Chowk area that is famous for its paratha: cheese/veggie-stuffed roti that is then fried. [Sidenote: I ate more fried, blatantly-unhealthy food during this trip than I have in my entire life.]

DSC_0015

Feeling extremely satiated, we continued our tour: exploring spice markets and mosques, and enduring the winding, bumpy, crowded, deafening alleys and streets. We enjoyed a snack of fresh coconut outside the Lal Quila, the Red Fort, and then had our first monkey sighting just down the street from the India Gate.

DSC_0034

in front of Lal Quila – Delhi

DSC_0055

whoops; the one that got away – India Gate, Delhi

Day 3: Delhi

The next day, Rohan and I had a meeting scheduled with a representative from World Health Partners, an NGO based in Delhi that utilizes telemedicine to provide health services to poor, rural populations, predominantly in the state of Bihar. It was an awesome exposure visit; we learned a lot about their organization’s history and mission, approach to healthcare, fundraising initiatives, and current projects. We were even able to sit in on an actual telemedicine session – a patient in Bihar skyping with a doctor in an office in Delhi, explaining their health issue., a hurt wrist. They are an impressive organization, and Rohan and I were lucky to talk with their representative!

After this meeting, we headed to the Palika Bazaar – an incredibly overwhelming, easy to get lost in, network of underground markets. It was insane. The bargaining, however, was a lot of fun: although some items are “fixed price” aka non-negotiable, a lot of vendors are willing to compromise (many of them have to in order to make enough money to pay the daily rent for their shop). I inquired about the price of a necklace – Rs. 250. Nope, way too much. The man said, okay, 200. Under his breath, Rohan said, “Nope.” “No,” I said. This continued until we were at Rs. 120; Rohan still thought it was too much and so we began to walk away. “Just wait,” Rohan said. Sure enough, the little boy working the stand ran after us, the necklace in a brown bag, and said, “Okay, Rs. 100.” Deal.

For dinner both last night and this night, we went to a restaurant called Haldirams, a chain of sweet shop/restaurants that have all types of Indian foods. Definitely not as authentic as the restaurant from 1875, but the food was still quite delicious and cheap! Rohan was in charge of ordering (although I did make a good call on the veg seekh kebabs) and every meal was a lesson in Indian cuisine: pani puri, bhaturadosa masala, kulfi.. 

Day 4: Delhi

The next day I put my metro knowledge to the test and set out to explore Delhi while Rohan attended a conference. The Lotus Temple and Lodi Gardens were on my to-see list; I was feeling very claustrophobic spending the past two days in the heart of bustling Delhi, and I wanted some fresh(er) air. The Lotus Temple, technically called the Bahá’í House of Worship, is a place of worship for people of all religions; the Bahá’í Faith is a world religion whose purpose is to unite all races and peoples in one universal cause and one common faith. Bahá’is are the followers of Bahá’u’lláh, who they believe is the Promised One of all Ages. Its architectural design is that of a lotus flower, which is symbolic in Indian art and culture as being the fairest flower. After a walk down a long, flower-lined path to the temple, everyone was instructed to remove their shoes and turn off their cameras before entering for prayer. The Temple was beautiful, and it was nice to sit in peace and reflect on a myriad of things.

DSC_0089

Zen found, I navigated my way back to the metro line and set a new destination: the Lodi Gardens, 90+ acres of green field sprinkled with small lakes, park benches and ancient tombs. It was a trek to get there, and upon asking 10+ people for directions, I was told “just straight ahead” over and over again – where the heck was it!? Shouldn’t a park be relatively easy to find in a concrete jungle? I was finally pointed to a small gate, and, feeling like I was in a movie and peeking at something forbidden, pulled back some tree branches to reveal the long sought-after park. I explored a bit and found a nice spot in the grass, laid out my scarf as a blanket, and laid down to eat lunch and read the afternoon away.

Rohan came to the park after his conference – a HUGE success, by the way – and we walked around discussing the themes and ideas brought up at it, and how they can be helpful for CRHP. This conversation continued over dinner, which we had at a small Tibetan restaurant in the Tibetan refuge section of Delhi (picture little Italy of NY, but little Tibet of Delhi). Our brains were like a honeycomb, buzzing buzzing buzzing, wheels turning and ideas churning.

Day 5: Delhi to Agra

We caught our 7:10am train at 7:05, just in time to put our bags in the overhead compartment and recline our chairs. I passed out. Awoken by men walking up and down the aisle selling chai, tomato soup, and tin-foiled breakfasts, I sat in my seat and excitedly thought about today’s agenda: the Taj Mahal.

Agra is an assaulting city. I don’t konw if it was me, an Indian-dressed white girl, or Rohan, clean-cut and armed with a large, expensive-looking camera bag, but we were heckled like no other. Taxi drivers, rickshaw drivers, fruit and food vendors, men to claimed to be tour guides, small children selling souvenirs – all were inches from our faces, persistently trying to convince us we ‘needed’ their service or product. I imagine that is how celebrities might feel with paparazzi getting all up in their business.

We made it to Agra Fort jussst in time for the rain to begin: 10 minutes on, 20 minutes off, 10 minutes on again. Rohan and I hopped around the fort taking pictures of this red walled city, which was built by Mughal royalty in the 1600s. From a balcony of the fort, I had caught my first glimpse of the Taj. Cue ‘Castle on a Cloud’ from Les Mis..

DSC_0124

Fort conquered, we had an excellent lunch of roti, yellow daal, and a dish I think was called bahar bajar – tomatoes and carrots and peas in a spinach sauce with bananas on top. Think what you will, but I’m telling you it was fabulous! Feeling recharged, we told our driver, off to the Taj!

The Taj Mahal, “crown of palaces”, is magnificent. Rohan and I hired a tourguide, who turned out to be a really nice guy who was obsessed with taking pictures for us, of us. In addition to being a great photographer, he also told us a lot of fun facts about the Taj. A white marble mausoleum, it was built by built by Mughal emperor Shah Jahan in memory of his third wife, Mumtaz Mahal, who died during the birth of their 14th child. Construction began in 1632 and continued for 22 years! The emperor and his wife are buried there, though the tomb is not open to the public to see. 

DSC_0208

DSC_0251

Flower or symbol of ‘om’? One of the secrets of the Taj’s design – Taj Mahal, Agra

DSC_0279

We walked in and around the Taj for a good hour and a half. Many people were skeptical about my going to Delhi and Agra with the main intent to see the Taj – the cities are dirty, crowded, expensive, and you spend an hour staring at the Taj – although the first part is more than true, it was completely worth it, in my humble opinion, to be awed by the Taj. I think it was the most beautiful building I’ve ever seen, and for the time we were there, I felt like I was in a pocket of peace, inspiration and grandeur.

Day 6: Agra to Jamkhed (with some hurdles along the way)

Our original plan was to take a train from Delhi to a station close to Jamkhed, and have a CRHP driver pick us up from there. When we realized, at 2am, that we booked our 3:10am train for the day before, our plans were thrown to the heavens. I panicked – how were we going to get back? Were we going to get kicked out of the first class waiting room into the station – hot and dirty and home to the homeless? I was useless in helping figure things out. We had Rs. 800 (not enough) to buy different tickets. My credit card was not working at the ATM. As they said in Jamkhed, “what to do, what to do?!”

A collaborative effort saved the day – money was wired to us and we got help figuring out how we could get back to Jamkhed, and we bought tickets for an 8am train at 7:30 (we like to cut it close). Sitting in first-class AC, we were served breakfast, soup, and lunch, along the 7 hour train ride to Bhopal, Rohan’s hometown. From Bhopal, we would rest at Rohan’s house for a bit before boarding a 14 hour bus from Bhopal to Ahmednagar. This was not just an ordinary bus – it was a sleeper bus, and instead of chairs the aisles were lined with bunk bed compartments. I loved it. In my little cave, I finished my book (Aravind Adiga’s Last Man in Tower, if you are interested!) and had a great night sleep. We arrived in Nager the next morning, were greeted by Sudhir, one of CRHP’s drivers, and were finally, safely, off on our last leg in the journey back to Jamkhed.

All in all, it was a great trip. Rohan and I now laugh about the Agra Train Disaster of ’13, and I feel like my scope of India has widened. Traveling in the big cities has rekindled my love for the humble, rural life – the quiet mornings, the bullock-carts in the streets, the people who know and accept me, who are genuine and kind and generous.

Though my ‘burning desires’ have all been met, I am itching to adventure again.