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…