More indians with access to mobile phones than toilets!

So a recent UN report on sanitation says that India has more mobile phones users (45%) than people with access to toilets or sanitation facilities (31%):
http://www.hindustantimes.com/News-Feed/india/India-has-more-cell-phones-than-toilets-UN/Article1-531449.aspx
I'm curious to know the amount of overlap, or people with mobile phones and no toilets. From my experiences over the last few weeks, I think it might actually be a decently high number. I downloaded the pdf of the report, but havien't finished reading it yet. If I find the overlap number, I'll edit this post.

End of my stay at Prayas

I leave Chittorgarh tonight on an overnight train to Delhi, and so ends my internship at Prayas. Its been great, I learned a lot, and met a bunch of cool people I hope to meet again.

Some interesting things I've seen since last post:

District Hospital, Chittorgarh
Saturday night I visited the District Hospital in Chittorgarh. This is basically the highest level of service that a public clinic/hospital can provide. Kiran and I went to the generic medicines shop outside the hospital to pick up some stuff (this is an initiative Prayas helped to start: pharmaceutical vendors that actually sell at reasonable prices. It has brought down the prices in a lot of the private chemist shops in the area too!) Afterwards, Kiran brought me in to show me around a little bit, and we were lucky enough to run into a GNM (General Nursing Midwife)-in-training, who just got off his shift. He showed me the entire hospital: surgical operation room, post-operation recovery room, women's ward, men's ward, etc. Some interesting features:
- There were a lot of minor user fees for services like diagnostics, ICU stays, etc. Kiran said these were way lower than at corporate hospitals, though.
- The hospital has a "BPL" counter, where poor people below the poverty line can get access to reduced or free services.
- There was a separate room for BPL patients in the in-patient wards, so as to prevent confusion on cheap/free services to the right patients. I would be concerned though about different treatment standards.
- There was a stray dog hanging out near the patient wards. Kiran said he's seen district hospitals with a lot more dogs, and that this one was relatively clean.
- The ICU had oxygen and heart rate monitors for almost every bed. This is apparently is really rare for government hospitals, which usually have just 1 or 2 for the whole ward.
- No doctors stayed overnight in the wards, but there were some on call at their homes. Kiran said that at corporate hospitals, there would be overnight shift doctors.
- There was a separate ward being built for people who wanted to pay a high price (I think around 500 rupees a night), which had 1 to 2 beds per room, air conditioning, private bathrooms, and generally luxurious accomadations. These were sort of similar to some of the US hospitals I've been in. Dr. Narendra is not so happy about this kind of unequal accomadations initiative.
The GNM was going to look for a job in Canada when he graduated. Woohoo brain drain! He was a really nice guy, though.

Immunization Day, Rajpura Village
On Monday I went back to Chotisadri, where one of the field workers, Manganlalji, picked me up on his motorcycle. I knew I should have been concerned when he wore a helmet and bandana covering his mouth. He is the only person I've seen wear a helmet. As I soon figured out, this is because his motorcycle is like twice as fast as everyone else's I've been on. Also, he doesn't particualrly like to slow down, even when the road turns into dirt/gravel, or kind of generally vanishes and becomes more of a foot path. I'm really happy I held on, but my fingers were kind of cramping by the end of the short 15 km ride.

Anyway, he brought me to one of the Prayas field offices, near the village of Rajpura. Every month each village has 1 immunization day, where they immunize children and pregnant ladies for things like measles, TB (BCG), diptheria, tetanus, and more. They also give iron folic acid to pregnant ladies, and test for malaria by dropping blood on slides and delivering to the local CHC lab for processing. The ANM/GNM, ASHA, Anganwari worker, and local NGO worker all take part. Every Monday and Thursday an ANM/GNM from the local Sub-Center arrives at a new village with the vaccines, and they rotate until the month is complete, then going back to the first. I went to the Anganwari center at Rajpura village, where all these folks were hanging out waiting for people to come by. Rajpura is a tribal village with about 680 people. Apparently the immunizers dont go house to house, they just wait for people to come. They only do about 3-4 immunizations a day. I talked to the GNM for a while, who showed me all the vaccines and explained their use. Here's a picture of him with his vaccine cooler:He apparently used to work for a couple of corporate hospitals, but then applied for a government job because his parents thought it was more prestigious. He said he was really bored though because he didn't really have an interest in village health, and found the work much more interesting at the corporate hospital. Sigh.

There is usually a Village Health and Sanitation Council meeting after the immunization day, but this one was going to take place late at night because most of the people were away on a NREGA (National Rural Employment Guarantee Act) project. Manganlalji did take me, however, to meet the president of the VHSC, who was a pretty goofy guy. Here's a picture of him and another woman who run's the village's women's self-help group:Manganlalji is on the right, and they are holding a Prayas banner. Manganlalji has been working with Prayas in the area since 1999. Before Prayas worked there, the health problems were much worse, but apparently now they currently weren't that bad. (Disclaimer: Manganlalji spoke almost no English, so once again some communication difficulties on details) There's no HIV/AIDS in the village, and Manganlalji said you only really find it outside of the "Tribal Belt" that Rajpura belonged to. About 10% of people got malaria in September/October every year, but the treatment was good and accessible now, so nobody died. I think 4 people had tuberculosis in the village. Apparently diahrreal diseases were not a problem (although maybe this was a communication difficulty, because I find that hard to believe). The main health problems seemed to be viral stomach illnesses.

As far as education, about 15% of boys and 10% of girls could read and write to some degree. There was a primary school in the village, but it had only 1 teacher to teach 8 grades. About 15% of kids went through 6th grade, 8-9% through 8th grade, 2% through 10th, and pretty much nobody further than that. The people who go through 10th have to go to a secondary school in another village. I think Manganlalji said nobody over the age of 20 there could read or write.

In between these visits, I have been finalizing some of the documents and office work I did at Prayas. I am now going stay with my cousin Maneesha in Delhi until Friday, when I will fly to Bangalore and stay the weekend with my cousin Aman. I then begin volunteering at Karuna Trust/VGKK next Monday. Apparently the head of the project, Dr. Sudarshan, is really awesome: http://en.wikipedia.org/wiki/Hanumappa_Sudarshan

I am really excited to eat a brownie sundae in Delhi, which I have been craving for about 2 weeks. Maneesha has promised me one.

Ambedkar's Birthday and Khemraj's Place

Wednesday: Ambedkar’s Birthday!

Prayas celebrated Ambedkar’s birthday, which is a national holiday in India. As mentioned before, Ambedkar was an untouchable who got educated and became the champion of untouchable and lower-caste rights in India. He also wrote the Indian constitution, converted to Buddhism, and hated Gandhi. You can read his Wikipedia page for more info: http://en.wikipedia.org/wiki/B._R._Ambedkar

We went to the Chittorgarh’s Ambedkar statute to put garlands over its head. There were already a lot on the statue when we arrived. Here is a picture of everyone in front of the statue:

And here is a picture of some people putting garlands over the statue.

I spent the rest of the day helping Dr. Narendra put together invites for a May 4^th panel on Patterns of Health Spending, Access to Medicines, and Free Treatment in India. This event will take place in Delhi, and will involve members of India’s parliament. Unfortunately, I will be in Karnataka by then.

At night, Dr. Narendra invited a bunch of old professor-types and otherwise important people over to talk about Ambedkar’s significance. As usual, I missed the details, but generally they taked about Ambedkar being awesome, and a little bit about the current Maoist Naxalite movement in India, which has been a subject of intense debate over the past week. Dr. Narendra also brought up Subaltern Studies and Ranajit Guha, which made me happy. Subaltern Studies is an Indian history movement that focuses on lower class/caste groups that generally have had no voice in colonial, nationalist, or Marxist histories of India. I took a class with one of the founders of the movement at Columbia, and it was one of my favorite classes ever. Apparently Dr. Narendra has read all the compiled volumes of Subaltern Studies, which is intense. Also, one of the historians of the movement, David Hardiman, actually stayed at Prayas for a couple of months with his girlfriend at some point. I think we actually read one of his articles in Gandhi’s India or Subaltern Studies.

Thursday: Khemraj’s Community Organizing

One of the older members of Prayas, Khemraj, was in the office on Tuesday, and invited me to his place on Thursday for a community meeting. He lives near a village called Amarpura, nexted to a small town called Badesar, which is about 30 km from Chittorgarh. I took a series of cramped strange vehicles to his place, and managed to only pay 15 rupees (~35 cents) total.

Khemraj now runs a sister NGO called Pratirodh. I’m not entirely clear on the goals of his organization, but I know it’s not primarily public health based. I think it’s more of a rights-based approach to helping poor people. Khemraj is basically an Obama-style community organizer, who spends his mornings and evenings walking around in villages and chatting with people. People discuss their problems with him, and he either connects them with law or health services that can address their problems, or organizes an agitation if multiple people are facing the same issue. He and his wife also run a school for poor girls from villages in the area. The girls are adorable, and apparently study really hard late into the night. Here are some pictures of the outside and the inside of the school:

(The portraits are of Bhagat Singh and Ambedkar, two nationalist rivals of Gandhi. Bhagat Singh was a young nationalist who supported using violence against the British. He was caught and schedule to be hanged. A lot of people think Gandhi had the power to prevent his death, but chose not to. Bhagat Singh is Khemraj’s nationalist hero of choice.)

Khemraj has 9 employees, and I’m not fully sure what they do, other than generally help him with these tasks. For the past few weeks he has been asking people to come to this community meeting. He was hoping for about 100 people or so, because he wanted to march in Badesar to protest some issues surrounding BPL (Below-Poverty-Line) status benefits. Unfortunately only about 30-40 showed up, so we stayed at his place and had a meeting there.

At the beginning, everyone went around the room and said why they had come. Here are some of the issues people were facing:

-Several women were below the poverty line, and even had a card that certified their BPL status, but still were not getting benefits that the government specifies for BPL people, such as subsidized wheat, kerosene, and other things. They were all from the same area, and it seemed to relate to one center of the PDS, or Public Distribution System, where the guy was generally being a jerk. Khemraj ended up writing a petition, which one of the literate people there helped everyone sign, and the women brought it to the jerk’s superior in Badesar.

-Another woman worked on a NREGA (National Rural Empoyment Guarantee Act) project, but was receiving below minimum wages. Her husband is ill and too weak to work, and she has children.

-Another woman had three children, and a mentally ill husband who vanished 11 years ago.

-One man had a small plot of land to his name, but for some reason I couldn’t understand, he could not grow anything on it. He is currently an agricultural laborer.

-One 10^th grade boy was a brilliant student, and was interested in science and wanted to become a doctor. His father was a bonded laborer, however, and he didn’t have much food at home and the boy generally was finding it difficult to focus on school. Khemraj asked me and Scott (another American who came to the meeting), if we could organize some sort of donation campaign in America for him and a few other students like him.

- A huge Maoist attack happened last week in the state of Chattisgarh. One man wanted to know more about it. Surprisingly, he was the only person in the entire room, outside of Khemraj and Pratirodh people, who had even heard that it had happened, even though it has been headline news every day.

Another part of the meeting consisted of Khemraj’s wife talking to parents of the girls in their school about the importance of studying and nutrition. Scott and I were used as examples of what good nutrition can do. I became sheepish about my belly. At some point we were asked about the literacy rate in America, and about children in school. One of the parents asked “Don’t they work?” They were shocked when we told them child labor was illegal.

After the meeting, I chatted with Khemraj. He is a self-proclaimed Marxist, and every once in a while slips “the revolution” into his sentences. I tried to ask about Marxism in the context of caste instead of class, and about whether Marxism can apply when the lower class consists mostly of super-poor, largely unproductive rural villagers instead of an industrialized productive labor force. The language barrier finally kicked in though. He speaks decent English, but I think not enough for this kind of a conversation. Which was sad, because I was pretty curious.

In the evening we went on Khemraj’s electric scooter to a village called Bhil Khera, one of the villages of the Bhil tribe. The journey there was comical, because his scooter was low on power, and we drove at a moderate jogging pace. Bhil Khera is pretty much what you would imagine an Indian village to be, with barefoot people, huts, chickens, and other livestock. It has a population of about 175. I didn't take pictures because it felt too weird. But here are some of the interactions we had at the village:

- One man, who was bicycling by, stopped to say hi (Everyone in the area knows and loves Khemraj, which made it easy for me to find his place in the morning). He had a pretty cool headdress on. When he learned I was from America, he said something like “Your country is very good. Our country has lots of problems. Right now our worst problem is water.” Apparently the rains have been very low for the past two years, but they are getting some water through government distribution.

-We sat outside the hut of another man, who lamented the general behavior and manners of the community. He wants to change them, but doesn’t know how. He said all other communities are improving, while he feels like his is only getting worse. He himself was decently well off, as he had sixteen sheep and one goat. He had steel and brass dishware, which Khemraj pointed out as a sign of his relative wealth. Through Khemraj’s translation, I asked about the literacy rate. Apparently in the entire village, there are three boys who can read and write. Outside of the two girls that attend Khemraj’s school, the female literacy rate is 0%. The guy said that his daughter is pregnant and due for delivery any day now, and Khemraj gave him the number of a free ambulance service run out of Chittorgarh. He also called a guy from the ambulance service to tell him about the upcoming delivery. The man gave me chai made with his sheep’s milk, which according to Khemraj has about 8-9% fat, whereas cow’s milk has 3.6%. I have no idea how he knows that.

-We sat with another family, whose somewhat distant relative passed away 15 days ago. They decided to throw a massive feast in his honor, which cost them 7000 to 8000 rupees. They had to borrow the money, and the money lender has now mortgaged their land. The three young men in the family are now bonded laborers as a result. Khemraj told them how stupid an action that was, and said something along the lines of “if you do things like this, you will drag your entire community down.” But he also will try to help. Apparently there is a law that says a moneylender cannot mortgage the law of Scheduled Castes or Scheduled Tribes (categories for certain groups of poor people in India). But the owner of the land has to know about the law and make the complaint to the court themselves. There’s also apparently a law that says no one can mortgage someone else’s land for more than 5 years, but apparently this is never enforced.

-We stopped at the hut of a girl, who used to attend Khemraj's. She got into a lot of quarrels, was eventually socially boycotted by the other girls, and left.

- We stopped at the head-of-village's hut, and Khemraj asked him why had the family thrown the death feast. The village-head said he didn’t support the decision, but I guess he did let it happen. So Khemraj was still pretty unhappy.

One thing I was kind of surprised about was the government either was addressing or could address some of their problems. For instance, the government was distributing water due to the drought, a free ambulance could come to take the pregnant woman to the hospital, and there was a law protecting against moneylenders mortgaging land. These maybe pale in comparison to what a lot of people think the government could be doing, but it was more than I expected.

On the slow scooter ride back home, Khemraj told me he and his family have been beaten several times by landlords/moneylenders/other people who unhappy with his activities. Two years ago they were beaten pretty bad.

I slept Thursday night at Khemraj’s place, and ate his papayas (he has 16 papaya trees!). I returned to Chittorgarh in the morning. Here is a picture with Khemraj and his wife:

Busy Week!

Its been an active few days, so this is going to be a longish post. I’ll break it down by day:

Thursday: Chotisadri; Age-determination for Pregnancy

I went back to Chotisadri (the small town where Prayas bases its community health activities) with Dr. Narendra for a meeting with all the health workers. One of the interesting debates at the meeting was about age of pregnancy. Prayas workers had been surveying women in the villages in Chotisadri block to assess at what age they first got pregnant. There’s a 2.5 times higher risk of maternity complications below age 18 than after age 18. The legal age of marriage in India is currently 18 for women, 21 for men (I’m not sure what the age of “consent” is, or if they even have such a concept). Unfortunately, many villagers have no idea how old they are (If you took Gandhi’s India with me, you’ll remember Prof. Bakhle talking about this in relation to the census). Dr. Narendra pointed out that Prayas had been using no standard set of questions to try to determine age. They called a few surveying organizations for advice, and I think it’s my roommate Kiran’s task to come up with a standard age determining protocol.

Friday: Chotisadri, Barisadri; Udailal’s Story

(Disclaimer: Almost everyone I met Friday and Saturday spoke little to no English, and my Hindi is still pretty bad, so everything I say about them was learned through a language filter.)

I went back to Chotisadri in the late afternoon, and then rode on a rickety old motorcycle to another town called Barisadri with one of the health workers, Udailal. The route included a bunch of small dirt roads that wound through villages, and it was very beautiful during sunset. Udailal’s story is pretty incredible: he’s the youngest of 7 children, and the only one to get any sort of education. I think he is from the Dalit or untouchable caste. (I base this mainly on the fact that he had a huge picture of Ambedkar on his wall. Ambedkar was a Dalit nationalist who got a PhD from Columbia and wrote the Indian constitution, among other cool achievements.) Udailal was educated through 11^th grade, and has been working with Prayas as a field health worker for the past 18 years. The rest of his siblings are working in agriculture. Two years ago, he registered his own NGO in Udaipur to work on health, education, and development in this district that is 95% Dalit. It might actually be the same district he grew up in, but I’m not sure. He’s also teaming up with a Harvard anthropology PhD student named Andy, who’s been coming every summer. There’s a lot of NGOs in Rajasthan, so he’s having trouble with funding right now, but his story is still pretty inspiring. He was doing meaningful work, and it was clear that everyone in Barisadri and the communities we visited the next day loved him. My mom said his story sent shivers up her spine. I slept in Udailal’s small flat in Barisadri for the night.

Saturday: Barisadri; Visiting Centers and Clinics, Drive to Udaipur

In the morning, Udailal took me around to a bunch of villages in the tribal areas surrounding Barisadri. He showed me a few Anganwari Centers, which as far as I can tell are day-care centers that also dabble in nutrition and maternal health. One of them had used their “Untied Funds” (10,000 rupees provided annually to each village as part of the National Rural Health Mission) to buy a cot and a weighing scale, which were the only two objects in the center. Here are some pictures of Anganwari Centers:

I also visited a “Sub-center” clinic, and met two ANMs (auxiliary nursing midwives), who gave me some orange soda. Sub-centers are one step below Primary Health Centers, and employ only nurses, no doctor. They existed before the NRHM, but the NRHM increased the number of ANMs from 1 to 2 per Sub-Center. There are also some Sub-Centers called “modal” (or something similar) which employ an additional GNM (General Nurse Midwife), and have a bigger facility for delivering babies. The Sub-Center I visited said they had about 10 patients per day. None came while I was there. One of the ANMs said she didn’t really like the work, and wanted to join the police force. But apparently it was too late for that kind of career change. Here are some pictures:

On the way we also went past some workers building a road as part of a National Rural Employment Guarantee Act (NREGA) project. This is a public works rural jobs project, somewhat similar to FDR projects during the Great Depression. Here’s a picture.

After visiting all these places, I returned to Barisadri, ate lunch, and then caught a three-hour bus back to Chittorgarh on bumpy roads. These bus rides are amusingly awkward, as they’re mostly filled with poor farmers, and I’m sure I look outrageously out of place.

When I got to Chittorgarh, I learned that Dr. Narendra was coming back from Jaipur in a car with people from another NGO, who were dropping him in Chittorgarh before continuing on to Udaipur. I was considering going to Udaipur on Sunday because its our day off. So I quickly got ready and hitched a ride in the car to Udaipur. One of the guys, Ranvir, is part of an NGO called Jatan, which partners with Prayas to do community health monitoring trainings in the Udaipur district. It also does a lot of work with youth, and Ranvir was actually part of one of the youth groups before joining the organization. He spoke English very well, and blasted Akon and Celine Dion for most of the ride to Udaipur, which was on a very smooth, fast, and huge highway. It was a totally surreal transition from the beginning of the day. I slept in the Jatan office Saturday night.

Sunday: Udaipur, Jatan, Migrant Health Workers

I spent most of Sunday going around tourist areas of Udaipur, which was nostalgic because I came here with my family in 2004. I also had a lot of opportunity to talk with Dr. Kailash, who runs Jatan. Part of their work is with migrant workers from villages, who have a huge array of health problems, particularly with communicable disease. I read Jatan’s annual report, which discusses how HIV and STD transmission to migrants when they are in towns and cities (many of them are early to mid-teenagers, and use commercial sex), and then back to women at home when they return to their villages. It was pretty similar to the Paul Farmer’s descriptions of truck drivers in Haiti, and the women they date or marry. Anyway, one of the Jatan projects is to give migrants wallets filled with health information and a condom. Dr. Kailash gave me a sample, which I’m now using as my regular wallet.

Dr. Kailash also broke down the pre and post NRHM differences for me: the main things the NRHM added that wasn’t universal before were the ASHA (Accredited Social Health Activist) and the VHSC (Village Health and Sanitation Council). This was basically the government accepting that the community health model and making it universal, which a lot of people in the NGO community are happy about.

I returned to Chittorgarh at night on an incredibly fast bus.

Monday: Chotisadri; Community Health Projects

I went to the annual project planning meeting of the community health group in Chotisadri, which was mostly in Hindi, but I got a better sense of what the community health group does. Here are names of some of the projects and meetings they are involved in every year, which were thankfully said in English:

Network for Health Equity, Health Awareness Program, Adolescent Health, HIV/AIDS, Village Health and Sanitation Council training and formation, Accredited Social Health Activist training, Women’s Group meetings, meeting with Primary Health Center and Community Health Center, meeting with ANMs, Women’s Health Assembly, Boy’s Health, Jan Mangal Couple Assembly, PRI workshop (head of VHSC)

Also, they plan celebrations/meetings for World Health Day, International Women’s Day, International Breast Feeding Week, World Population Day, and World AIDS Day

The details were mostly discussed in Hindi, so my understanding of what each of these things entails is still hazy.

Final Anecdote:

There’s a few other American students hanging around, and last week a villager asked one of them where he was from. When he said America, the guy said he’d never heard of it. Someone asked him to list all the foreign countries he knew, and he said “Pakistan and Gujarat”. Gujarat is another state in India, which borders Rajasthan…

World Health Day

Prayas celebrated World Health Day 2010! The theme was urban health, but Dr. Narendra didn't really like the theme for some reason.

They had a celebration in the district hospital in Chittorgarh, but I instead went to Chotisadri, the smaller town I've been trying to go to for a week. Chotisadri is where most of Prayas' health activities are centered, and they work with all villages in the Chotisadri "block". As soon as I got there, Govardanji, the head of the Chotisadri activities, picked me up on a motorcycle and drove me to the Community Health Center (see earlier post for organization of government clinics). There was about 100 women lined up with signs, and they started marching and chanting various health slogans in Hindi. Here's a picture:
We marched through the streets of Chotisadri for a while, continuing to chant. One of the nurses (who were all wearing white) gave me a hat, then giggled with all of her fellow nurses. We ended at a hindu dharamsala, in a large room where a bunch of other people were waiting. I think it ended up being over 300 people in the end, according to the woman sitting next to me. Almost all of them, except for some of the organizers, were women.

(Sidenote: I totally see what the EPW article on Tamil Nadu public health was talking about. Gender is super tied into health here, and a lot of the respected community health figures (ASHA - Accredited Social Health Activist and ANM - Auxilary Nursing Midwife) are necessarily women. On the other hand, the Block Program Manager, who was also at this meeting, was a man, as was the ASHA coordinator for the district of Chittorgarh, as was the District Program Manager.

Also, I see what they were talking about when they said the predominant view of public health here is clinical. In the National Rural Health Mission website, the "public health standards" is a lay-out of clinical setups and what they expect of a clinic at each level. There are things on the NRHM website about vector control, disease surveillance, and other public health associated things, but nothing about sanitation or nutrition, which the article thinks should be a much bigger focus.) End sidenote.

Anyway, a bunch of people stood up to speak, but I could only vaguely understand what they were saying. I had to get up and introduce myself to over 300 women in broken hindi, which was hilarious and awkward. Then Govardanji went on a super long explanation of who I was and drew some sort of conclusion about "world" health, but the details were lost on me. At some point his wife mentioned me again, in connection with sitting, or asking people to get up for you, or something. The best understanding I could arrive at was that she made fun of me for constantly shifting because I'm american and not used to sitting on the floor for hours (all large meetings in India seem to be conducted on the floor), but still wouldn't ask for more comfortable seating. But I have NO idea if thats actually what she said, nor how that would at all related to world health day. I think I served as a source of fun and ridicule, which is fine, because at least I served some purpose!

After an hour or so they seemed to run out of speakers with things to say, so they kept asking for people to come up and say something. Women kept being pushed up reluctantly by their laughing friends to speak. Some of them talked about health, but others cracked jokes, and some just sang songs, which were potentially related to health, but I'm not sure. Apparently I was mentioned in the local newspaper covering the event!

Today I'm going to a monthly planning meeting of Prayas health workers in Chotisadri. I think this will be a meeting between government ASHA workers and Prayas workers, because I think as NRHM/ASHA work gets up and running in an area, Prayas pulls its health workers out. The government/NGO communication and collaboration here is remarkably tight, considering this type of meeting and the Prayas role in training of community health monitoring mentioned in an earlier post. In fact, I think each Village Health Council contains 1 NGO member that has been working in the area. A lot of the people I've met in the area now serving NRHM-associated government positions actually got their start at Prayas.

Tomorrow I believe I'm going to one of the Prayas "field sites" in the Chotisadri block, and staying 1 or 2 nights. Should be adventurous! Hopefully I figure out my water situation and don't get terribly sick (another American got severe diahrrea last week and got hospitalized overnight). I wish I had remembered to pack iodine tablets.

So my plans to go to the remoter district were put on hold until I think tomorrow, but I've spent a productive week compiling an FAQ on Indian drug pricing and access to treatment. It basically talks about generic vs. brand name drugs, profit margins and mark-ups to retail prices, affordability of the government becoming the primary provider of medicines, and so on. It was really fun to write, as I got to read a bunch of background papers and Prayas presentations to put it together. I also got to make it look pretty with the wonderful visual powers of Microsoft Word. It's being proofread by various partners of Prayas, and then they're going to publish and distribute it all over! I feel cool.

I also proofread and edited a letter Dr. Narendra was sending to Sonia Gandhi, who is the head of the UPA party that is currently in power in Indian government. It was about access to medicine issues. Dr. Narendra thinks Sonia Gandhi is the last hope, because everyone else in power positions in the government wants to "privatize everything."

I attended parts of a two-day training session that Prayas people were holding. As part of the National Rural Health Mission, there is a plan to have Village Health and Sanitation Councils monitor health services provided by the government. This training was held by District Trainers for Block Trainers, who will then go on to train every VHSC in Rajasthan over the next 10 months how to do the monitoring. Let's see how it works out.

I think tomorrow I'm actually going to a remoter district, so I think I'll actually have some interesting pictures to post. I took some pictures of the office and the training session, but the internet's too slow right now to upload them.

Interesting fact: My roommate Kiran is a doctor who also went to a Health Management school in Rajasthan. Apparently his friends, fresh out of their program, are placed into Hospital Administrator positions immediately out of graduation. They head an entire hospital at like age 24-25, which is incredible. It's interesting to value management education/training over experience. Or rather, it's interesting that there's not enough experienced administrators to choose from. Kiran said that the idea of health management being important is relatively new.