The sheer amount of malnutrition-related anemia I saw while at VGKK was frightening, so I'm getting more interested in nutrition and food security issues. This BBC article was pretty interesting, and completely depressing. It's called "Diet of mud and despair in Indian village."
http://news.bbc.co.uk/2/hi/south_asia/8682558.stm
Besides all the rest of the heartbreaking stuff, note the mention of the changing poverty line. Recently the Indian government decided to use better standards to define the poverty line, and percentage jumped from the mid-20s to a little less than 40%. Apparently even these standards aren't as stringent as international poverty line standards, which would make the number even higher.
Saturday, May 15, 2010
Embrace
Yesterday I visited the Bangalore office of Embrace, a non-profit out of the design school at Stanford that makes low-cost neonatal incubators. I heard about them when I interviewed at Stanford, and got in touch with them through a friend. They were totally impressive. You can check this link for more info:
http://embraceglobal.org/
http://embraceglobal.org/
Wednesday, May 5, 2010
VGKK, Karuna Trust, BR Hills
I am now in Bangalore, Karnataka. I just spent a few weeks at a place called the B.R. Hills, which is about 5 hours away from here. The hills were absolutely beautiful:
http://en.wikipedia.org/wiki/Biligirirangan_Hills
The hills are home to the Soliga tribe, who used to practice shifting cultivation back in the day. A Forest Conservation Act in the early 1970s set up the B.R. Hills as a wildlife sanctuary, and prevented a lot of the activities the tribe had been doing for a long time. They were in a pretty sad situation with little exposure to other economic activities and pretty much no education with which to integrate into non-tribal ways of life. This was pretty much the state they were in when a man named Dr. Sudarshan first saw them. He began to wander around the jungle with a medicine bag looking for tribal people, who ran away from him at first. Eventually he was trusted enough to stay in their villages, and roamed from village to village treating people. He eventually set up a hut as a home and makeshift clinic, which is actually still standing:
He also started holding informal night classes for 6 tribal children in his hut. (One of these students now has a PhD, and another has a master's degree). Since then, the hut has evolved into an enormous, beautiful campus with a hospital and school, run by the NGO Dr. Sudarshan founded: Vivekananda Girijana Kalyana Kendra. Here is a picture of the school and hospital:
The school teaches 540 tribal children at a time, through 10th grade. Above 95 percent of the tribal children attend the school, and 99% of them pass the national 10th grade standardized exams. Many of the students are now working in some capacity for VGKK, and others have gone on to further education. Unfortunately it is vacation season, so I didn't get to see 500 kids running around campus.
This internship was very different than Prayas. It was much more of a clinical shadowing experience, in an incredible variety of clinical settings. As I was not helping draft documents for policy advocacy and such, I was perhaps less useful to the NGO than at Prayas, but I did help in minor ways such as taking blood pressures and keeping patient records. One of the tribal people working for VGKK said something like "We are showing you everything now, so come back one day and help us." Here are some of the clinical settings I volunteered in:
VGKK Hospital
The hospital has a daily outpatient clinic from 9 to 5, where I spent many of my days. It has a doctor, nurse, lab technician, pharmacist, and two medical students from Mysore Medical College. It sees about 40-50 outpatients a day, and has a handful of inpatients at any given time. There were two inpatient wards, male and female, each of which had about 10 beds. All consultations are free, as are the medicines given. A lot of the medicines are purchased from an organization called LOCOST, which produces low-cost generic medicines for use by NGOs and health organizations. (Incidentally, the head of LOCOST gave me a lot of input and advice on the FAQ I wrote at Prayas!). They have an operation theatre, but the surgeon they had on staff left a couple of years ago, and they have done few operations since.
While at the hospital, I saw quite a few exotic injuries. We redressed a surgical wound for this one guy who broke his foot while running away from an attacking elephant. Another 0ld woman was charged by a bull, and was kept as an inpatient for observation. I also saw a non-venomous snake bite on a guys foot, which had evolved into a large and nasty infected wound, as he didn't seek treatment for a few weeks. Another woman with a similar wound was now on crutches.
There was a few sad trauma cases: a car crash occurred at a temple up the road, and a woman came in with a concussion and deep gash on the top of her head. The driver of the vehicle's lower lip was split completely in two. They stitched the woman's wound while a free Karnataka state ambulance arrived, which took both patients to a bigger hospital in a nearby down.
For the most part though, the patients have had normal complaints of fever, diahrrea, vomiting, cough, etc. As expected, there were more infections than one would see in the US. One interesting note is that they check under the lower eyelids of almost all the patients for signs of anemia. Also, the prevalence of tobacco smoking was remarkably high among men in the area, and there was an inpatient with COPD. For very complicated things, VGKK generally refers to the nearest tertiary care hospital at Mysore Medical College. This is a public hospital, but still has some fees, which makes some of these patients unwilling to go.
Mobile Medical Clinic
Every Friday and Saturday, VGKK sends out a mobile medical clinic to surrounding villages, which is basically a jeep loaded with medicines for minor ailments. I went out with the medical students to various villages, where they held informal consultations with sick people, and gave them appropriate medicines. Some villages had only 2 or 3 patients, others had more than 20. If necessary, there were also home visits.
In one village, we visited the hut of a couple who had been attacked by a bear. The woman had broken her hand, and the man had a badly hurt lower back, and was lying on the floor. He had to use a rope which was dangling from the ceiling, to pull himself into a half-way sitting position. They had already gotten some treatment and x-rays somewhere, but I got conflicting reports about where. The medical student tried to convince the man that he needed further observation at Mysore Medical College, but the man was very relucant to go.
In my last two days with VGKK, we went on the mobile clinic to another region called the M.M. Hills, staying overnight. The villagers in this area seemed to be in generally worse shape than what I saw in the B.R. Hills. There was an incredible amount of anemia, so much that we ran out of ferrous sulphate about 2/3 of the way through the first day, and had to restock at a local Sub-center. One woman's anemia was so bad it was beginning to lead to heart complications. It was pretty sad to realize that the iron supplements would only help these people for a little while, but they would soon degenerate back into anemia without drastic changes in food availability. I also witnessed my very first leprosy diagnosis: a boy had been told he had a skin allergy, but the med student noticed a few signs that pointed to leprosy infection, and then the mother mentioned that he didn't feel pain when he touched burning hot surfaces. He was directed to a PHC to test for leprosy. The medical students were particularly awesome on this outing, as they walked us through almost every diagnosis. Some of the villages had more than 50 patients. I took a few blood pressures, gave an injection, and got to participate in patient examinations. I heard rhonchi lung sounds, heart murmurs, and plenty of other things that excited my geeky medical obsession. But generally, I was pretty sad about malnutrition and anemia.
Karuna Trust and Gumballi PHC
Dr. Sudarshan and colleagues also began a sister NGO in the mid 1980s called Karuna Trust, which is focused on rural development (whereas VGKK is focused on tribal development). It began as a health project in response to the high prevalence of leprosy in the rural areas at the bottom of the B.R. Hills, but has since spread into trying to provide comprehensive primary health care and development. Probably the coolest thing about Karuna Trust is that they were able to convince the Karnataka state government to allow them to take over operations of the Primary Health Center in Gumballi, at the foot of the B.R. Hills. They turned this into a model PHC, and are now operating PHCs in every district in Karnataka, as well as in five other states of India.
I visited the PHC at Gumballi, and saw what a government clinic could look like when operating at its theoretical best. The PHC has a doctor, several staff nurses, a pharmacist, lab technician, optician, opthamologist-in-training, three dental surgeons, as well as a general surgeon who visits every once in a while to do tubectomies (female sterilization). They have programs for mental health, epilepsy, TB, leprosy, and more.
Since the mid-1990s, they have been combatting mental health. They are currently treating around 350 epilepsy patients, as well as 150 general mental health patients. Every Sunday, they hold an epilepsy camp, where one-fourth of their patients come for an update and to receive new medicines. I got to see this epilepsy camp in action, and read through a lot of the case records. Some of the patients had spouses who thought they were possessed, which made their lives really sad until their medicines brought their convulsions under control. Most of the patients were no longer experiencing seizures. I also kept records during a mental health camp on a Saturday, which is held once a month. These were incredibly fascinating patients, with interesting case histories. One interesting sidenote: on the forms there was a question for the average monthly income for the patient's family: some of these were as low as 500 to 1000 rupees, which is between 10 and 20 US dollars for a month for a family. It is incredibly fortunate for these patients that they have free quality medical attention through the PHC.
http://en.wikipedia.org/wiki/Biligirirangan_Hills
The hills are home to the Soliga tribe, who used to practice shifting cultivation back in the day. A Forest Conservation Act in the early 1970s set up the B.R. Hills as a wildlife sanctuary, and prevented a lot of the activities the tribe had been doing for a long time. They were in a pretty sad situation with little exposure to other economic activities and pretty much no education with which to integrate into non-tribal ways of life. This was pretty much the state they were in when a man named Dr. Sudarshan first saw them. He began to wander around the jungle with a medicine bag looking for tribal people, who ran away from him at first. Eventually he was trusted enough to stay in their villages, and roamed from village to village treating people. He eventually set up a hut as a home and makeshift clinic, which is actually still standing:
He also started holding informal night classes for 6 tribal children in his hut. (One of these students now has a PhD, and another has a master's degree). Since then, the hut has evolved into an enormous, beautiful campus with a hospital and school, run by the NGO Dr. Sudarshan founded: Vivekananda Girijana Kalyana Kendra. Here is a picture of the school and hospital:
The school teaches 540 tribal children at a time, through 10th grade. Above 95 percent of the tribal children attend the school, and 99% of them pass the national 10th grade standardized exams. Many of the students are now working in some capacity for VGKK, and others have gone on to further education. Unfortunately it is vacation season, so I didn't get to see 500 kids running around campus.
This internship was very different than Prayas. It was much more of a clinical shadowing experience, in an incredible variety of clinical settings. As I was not helping draft documents for policy advocacy and such, I was perhaps less useful to the NGO than at Prayas, but I did help in minor ways such as taking blood pressures and keeping patient records. One of the tribal people working for VGKK said something like "We are showing you everything now, so come back one day and help us." Here are some of the clinical settings I volunteered in:
VGKK Hospital
The hospital has a daily outpatient clinic from 9 to 5, where I spent many of my days. It has a doctor, nurse, lab technician, pharmacist, and two medical students from Mysore Medical College. It sees about 40-50 outpatients a day, and has a handful of inpatients at any given time. There were two inpatient wards, male and female, each of which had about 10 beds. All consultations are free, as are the medicines given. A lot of the medicines are purchased from an organization called LOCOST, which produces low-cost generic medicines for use by NGOs and health organizations. (Incidentally, the head of LOCOST gave me a lot of input and advice on the FAQ I wrote at Prayas!). They have an operation theatre, but the surgeon they had on staff left a couple of years ago, and they have done few operations since.
While at the hospital, I saw quite a few exotic injuries. We redressed a surgical wound for this one guy who broke his foot while running away from an attacking elephant. Another 0ld woman was charged by a bull, and was kept as an inpatient for observation. I also saw a non-venomous snake bite on a guys foot, which had evolved into a large and nasty infected wound, as he didn't seek treatment for a few weeks. Another woman with a similar wound was now on crutches.
There was a few sad trauma cases: a car crash occurred at a temple up the road, and a woman came in with a concussion and deep gash on the top of her head. The driver of the vehicle's lower lip was split completely in two. They stitched the woman's wound while a free Karnataka state ambulance arrived, which took both patients to a bigger hospital in a nearby down.
For the most part though, the patients have had normal complaints of fever, diahrrea, vomiting, cough, etc. As expected, there were more infections than one would see in the US. One interesting note is that they check under the lower eyelids of almost all the patients for signs of anemia. Also, the prevalence of tobacco smoking was remarkably high among men in the area, and there was an inpatient with COPD. For very complicated things, VGKK generally refers to the nearest tertiary care hospital at Mysore Medical College. This is a public hospital, but still has some fees, which makes some of these patients unwilling to go.
Mobile Medical Clinic
Every Friday and Saturday, VGKK sends out a mobile medical clinic to surrounding villages, which is basically a jeep loaded with medicines for minor ailments. I went out with the medical students to various villages, where they held informal consultations with sick people, and gave them appropriate medicines. Some villages had only 2 or 3 patients, others had more than 20. If necessary, there were also home visits.
In one village, we visited the hut of a couple who had been attacked by a bear. The woman had broken her hand, and the man had a badly hurt lower back, and was lying on the floor. He had to use a rope which was dangling from the ceiling, to pull himself into a half-way sitting position. They had already gotten some treatment and x-rays somewhere, but I got conflicting reports about where. The medical student tried to convince the man that he needed further observation at Mysore Medical College, but the man was very relucant to go.
In my last two days with VGKK, we went on the mobile clinic to another region called the M.M. Hills, staying overnight. The villagers in this area seemed to be in generally worse shape than what I saw in the B.R. Hills. There was an incredible amount of anemia, so much that we ran out of ferrous sulphate about 2/3 of the way through the first day, and had to restock at a local Sub-center. One woman's anemia was so bad it was beginning to lead to heart complications. It was pretty sad to realize that the iron supplements would only help these people for a little while, but they would soon degenerate back into anemia without drastic changes in food availability. I also witnessed my very first leprosy diagnosis: a boy had been told he had a skin allergy, but the med student noticed a few signs that pointed to leprosy infection, and then the mother mentioned that he didn't feel pain when he touched burning hot surfaces. He was directed to a PHC to test for leprosy. The medical students were particularly awesome on this outing, as they walked us through almost every diagnosis. Some of the villages had more than 50 patients. I took a few blood pressures, gave an injection, and got to participate in patient examinations. I heard rhonchi lung sounds, heart murmurs, and plenty of other things that excited my geeky medical obsession. But generally, I was pretty sad about malnutrition and anemia.
Karuna Trust and Gumballi PHC
Dr. Sudarshan and colleagues also began a sister NGO in the mid 1980s called Karuna Trust, which is focused on rural development (whereas VGKK is focused on tribal development). It began as a health project in response to the high prevalence of leprosy in the rural areas at the bottom of the B.R. Hills, but has since spread into trying to provide comprehensive primary health care and development. Probably the coolest thing about Karuna Trust is that they were able to convince the Karnataka state government to allow them to take over operations of the Primary Health Center in Gumballi, at the foot of the B.R. Hills. They turned this into a model PHC, and are now operating PHCs in every district in Karnataka, as well as in five other states of India.
I visited the PHC at Gumballi, and saw what a government clinic could look like when operating at its theoretical best. The PHC has a doctor, several staff nurses, a pharmacist, lab technician, optician, opthamologist-in-training, three dental surgeons, as well as a general surgeon who visits every once in a while to do tubectomies (female sterilization). They have programs for mental health, epilepsy, TB, leprosy, and more.
Since the mid-1990s, they have been combatting mental health. They are currently treating around 350 epilepsy patients, as well as 150 general mental health patients. Every Sunday, they hold an epilepsy camp, where one-fourth of their patients come for an update and to receive new medicines. I got to see this epilepsy camp in action, and read through a lot of the case records. Some of the patients had spouses who thought they were possessed, which made their lives really sad until their medicines brought their convulsions under control. Most of the patients were no longer experiencing seizures. I also kept records during a mental health camp on a Saturday, which is held once a month. These were incredibly fascinating patients, with interesting case histories. One interesting sidenote: on the forms there was a question for the average monthly income for the patient's family: some of these were as low as 500 to 1000 rupees, which is between 10 and 20 US dollars for a month for a family. It is incredibly fortunate for these patients that they have free quality medical attention through the PHC.
The clinic is also following two leprosy patients, and 17 TB patients. (The leprosy rate has gone down dramatically since their control efforts). An optician does eyesight consultations, and they make glasses at the PHC. An opthamologist-in-training does eye consultations and cataract surgeries, and a new one rotates in every 3 months. Two volunteer opthamologists come from a private hospital in Bangalore every Saturday to do cataract surgeries and train the intern. All consultations and surgeries are free for patients. They invited me to watch last Saturday, and I got to scrub in.
(Thats me on the left in the picture)Three dental surgeons also rotate in every 15 days, and operate a mobile dental clinic, where they are able to do consultations and minor operations. They consult out of the mobile clinic in the PHC parking lot, and drive it out to villages every few days.
The pharmacy was well stocked at Gumballi, which is more than many government clinics can say. They are provided to patients as a fixed nominal cost of 15 rupees for all medicines, whatever the quantity or relative expensiveness. They also have a well-equipped laboratory for tuberculosis sputums, blood sugar measures, urine analysis, and more. They have a trained staff nurse who performs many of the deliveries, people cultivating a medicinal herb garden, and a rangee of other activities that have gotten too numerous to keep listing. In summary, the PHC is incredible.
There was also a group that did health education teachings in villages in the block. They go to villages for 2 days at a time. On the first day, they parade around and get a lot of attention. Then they put on street plays and sing songs about water quality, infectious diseases, nutrition, and more. They did a demonstration for me and another volunteer at the PHC, singing songs and dancing. We were supposed to go out to a village, but they were asked not to by the government because Gram Panchayat (Village-level) elections were taking place.
B.R. Hills Sub-Center
This was a government clinic sub-center about a 2 km walk from VGKK. It is one of five subcenters attached to the PHC at Gumballi. It serves 8 tribal settlements and 2 non-tribal settlements in the B.R. Hills, for a total population of 2,383. There is one ANM on staff, who was actually trained at VGKK's nursing school. There are an average of 20 patients per day, mostly for minor ailments. There used to be about 2-3 birth deliveries per month, but the Karnataka state government is trying to get all deliveries to happen at the hospital level now. They favor squat delivery of babies rather than lying down, as it is believed to be less dangerous for the mother.
Karnataka has a pretty remarkable compensation system in place to try to reduce maternal mortality. (I think this is Karnataka-specific, but its possible the NRHM is trying to implement this in other places. I at least didn't hear anything about it when I was at Prayas in Rajasthan). A family will get 500 rupees if their home delivery is supervised by a healthcare provider, 700 rupees if the delivery happens at a hospital, and 1500 rupees if she gets a C-section. If the mother comes regularly for Ante-Natal Care check-ups, she will get 100 rupees before delivery, and 1000 rupees after. This benefit system is only in place up to 2 babies, as they do not want to encourage overpopulation. For a female baby, 100,000 rupees will be given to the mother when the daughter reaches 18 years. This is to discourage female infanticide, which has led to some pretty gross boy/girl ratios in a lot of states of India. (Girls are seen to be less economically useful, as the family will have to marry them off and pay a dowry). The ASHA system from Rajasthan is in place here, with 1 ASHA for every 2 or 3 villages.
The ANM at the SC did immunizations, which VGKK helped out with. We followed one of the VGKK health workers to some of the villages, where he visited the houses of people who were due for vaccination and reminded them to go. There was also a mentally ill patient who had TB, who had been coming irregularly for his TB medications. The health worker and the guy's father scolded him, and he promised to come the next day.
VGKK was also up to a bunch of other cool projects, such as training tribal people in honey processing and the sustainable harvesting of non-timber forest products. They are partnered with a biodiversity conservation organization called ATREE (Ashoka Trust for Research in Ecology and the Environment), whose B.R. Hills field office is actually run by one of the first 6 students in Dr. Sudarshan's hut in the 1970s. He is now working on his PhD.
http://www.atree.org/
Part of their mission is to do research on the ecological sustainability of the Soliga tribe's way of life, so that the tribals will be given more flexibility by the forest conservation act.
I'm now back in Bangalore. I'm going to visit relatives in Mumbai for a few days, then off to my last NGO in Dharamsala. This trip has been incredible so far.
The pharmacy was well stocked at Gumballi, which is more than many government clinics can say. They are provided to patients as a fixed nominal cost of 15 rupees for all medicines, whatever the quantity or relative expensiveness. They also have a well-equipped laboratory for tuberculosis sputums, blood sugar measures, urine analysis, and more. They have a trained staff nurse who performs many of the deliveries, people cultivating a medicinal herb garden, and a rangee of other activities that have gotten too numerous to keep listing. In summary, the PHC is incredible.
There was also a group that did health education teachings in villages in the block. They go to villages for 2 days at a time. On the first day, they parade around and get a lot of attention. Then they put on street plays and sing songs about water quality, infectious diseases, nutrition, and more. They did a demonstration for me and another volunteer at the PHC, singing songs and dancing. We were supposed to go out to a village, but they were asked not to by the government because Gram Panchayat (Village-level) elections were taking place.
B.R. Hills Sub-Center
This was a government clinic sub-center about a 2 km walk from VGKK. It is one of five subcenters attached to the PHC at Gumballi. It serves 8 tribal settlements and 2 non-tribal settlements in the B.R. Hills, for a total population of 2,383. There is one ANM on staff, who was actually trained at VGKK's nursing school. There are an average of 20 patients per day, mostly for minor ailments. There used to be about 2-3 birth deliveries per month, but the Karnataka state government is trying to get all deliveries to happen at the hospital level now. They favor squat delivery of babies rather than lying down, as it is believed to be less dangerous for the mother.
Karnataka has a pretty remarkable compensation system in place to try to reduce maternal mortality. (I think this is Karnataka-specific, but its possible the NRHM is trying to implement this in other places. I at least didn't hear anything about it when I was at Prayas in Rajasthan). A family will get 500 rupees if their home delivery is supervised by a healthcare provider, 700 rupees if the delivery happens at a hospital, and 1500 rupees if she gets a C-section. If the mother comes regularly for Ante-Natal Care check-ups, she will get 100 rupees before delivery, and 1000 rupees after. This benefit system is only in place up to 2 babies, as they do not want to encourage overpopulation. For a female baby, 100,000 rupees will be given to the mother when the daughter reaches 18 years. This is to discourage female infanticide, which has led to some pretty gross boy/girl ratios in a lot of states of India. (Girls are seen to be less economically useful, as the family will have to marry them off and pay a dowry). The ASHA system from Rajasthan is in place here, with 1 ASHA for every 2 or 3 villages.
The ANM at the SC did immunizations, which VGKK helped out with. We followed one of the VGKK health workers to some of the villages, where he visited the houses of people who were due for vaccination and reminded them to go. There was also a mentally ill patient who had TB, who had been coming irregularly for his TB medications. The health worker and the guy's father scolded him, and he promised to come the next day.
VGKK was also up to a bunch of other cool projects, such as training tribal people in honey processing and the sustainable harvesting of non-timber forest products. They are partnered with a biodiversity conservation organization called ATREE (Ashoka Trust for Research in Ecology and the Environment), whose B.R. Hills field office is actually run by one of the first 6 students in Dr. Sudarshan's hut in the 1970s. He is now working on his PhD.
http://www.atree.org/
Part of their mission is to do research on the ecological sustainability of the Soliga tribe's way of life, so that the tribals will be given more flexibility by the forest conservation act.
I'm now back in Bangalore. I'm going to visit relatives in Mumbai for a few days, then off to my last NGO in Dharamsala. This trip has been incredible so far.
Wednesday, April 21, 2010
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.
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.
Tuesday, April 20, 2010
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.
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.
Friday, April 16, 2010
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 4th 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 10th 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:
Tuesday, April 13, 2010
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 11th 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…
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