5 visits in rural India

The weekend was filled with some more adventures that included munching on some delicious tapas and learning some traditional Indian dance moves. Bollywood, anyone? More on these adventures later – for now I’d like to share my experience venturing into rural India with the Impact India Foundation (IIF). After the formal GW program ends this Friday, I will return to Bombay for a couple of weeks to complete my practicum (120 hours of fieldwork required to complete my MPH) with the IIF, so I was exceptionally excited to have a first-hand look at their work. IIF has been in operation since the early 80s with the following tagline: “action today to prevent disability tomorrow.” In India, they are perhaps most well-known for their Lifeline Express train, which travels throughout the country performing life-saving surgeries at each stop. The outside of the train is decorated in rainbows and flowers and inside it is equipped with state-of-the-art medical equipment and operating tables. The train has been in operation for more than 20 years and has served more than 700,000 people! Using the Lifeline Express as a trust-building mechanism within communities, the IIF has vastly expanded their work into rural parts of the country where they focus on health education to prevent future disease and disability.

Our day began with a couple of hours on the bus driving to the Thane District in India, which is north of Bombay. We were accompanied by the CEO of IIF as well as some staff members and the local press who were working on a story about our visit. As we left Bombay, I could feel my entire body beginning to relax and take in the green scenery that quickly filled our view from the bus. Crowded streets were replaced with lush landscape and rice fields and the honking horns gave way to the sound of rain. It was quite beautiful. Our first stop was to a school for children ages 6-10. They were in the process of their daily health lesson. One group of children played a game that closely resembled snakes and ladders only all of the stops on the game board were health-related. Another group was seated in a circle while the class health-monitor went around with a small notebook examining and questioning her fellow classmates: did you wash today? are your ears clean? are your nails clean? do you feel hot? Based on the responses, she either recorded an “X” or a “check.” If one of the students was not well, he or she would be sent home with a note with a recommendation to visit a local health center. I was amazed at the level of patience and participation by each of the students. They take this process very seriously and obviously value their health. Upon leaving the school, they sang us a few songs and wished us well.

Working the rice fields

Children playing snakes and ladders

Class health monitor marks her notebook

Children singing about the rain

Our next stop was to an immunization center where rural families (well, rural women) bring their children to be immunized. They offer shots for things like Hepatitis B and tuberculosis and they keep cards of each of the children so they know when they are due up for future appointments. With an infant mortality rate in the district of approximately 50 per 1139 live-births, which is quite high, these immunizations are critical for the survival of children. (FYI, the infant mortality rate measures the number of children who die within their first year of life per all live-births.) At that center, they also provide prenatal care to women who visit at a minimum of four times during pregnancy. In an area where many women deliver their babies at home and receive no prenatal care, this is impressive and hugely important.

Nurse prepares syringe 

A child waits to be immunized

Next we visited a government-operated daycare center. Here, the IIF provides training one day per month to someone called an asha who is responsible for then subsequently relaying this health information to the community. After the asha is trained, he/she gathers community members in the daycare center to hold a class session. Instead of the IIF going into the community and trying to relay important health information, they’ve found an outlet from within the community to serve as a catalyst for these messages. This helps to build trust and credibility and messages are much more well-received – a brilliant model. While we visited the center, the asha was finishing up a presentation on anemia to a large group of tribal women and girls. We tried to engage in discussion with them about what they had learned but they were too shy to respond. I can’t say that I blame them – a large group of Americans parading into a community meeting is far from their norm.

An asha (lower left facing crowd) presents to her community

Home in a rural village

Our second to last stop of the day was at another school, this one exclusively for adolescent girls. We were previously asked to prepare a session for them about anemia and I think it was a hit! We drew simple photos of four main take-away points that we wanted them to remember: wash your hands, take your vitamins, drink your water, and eat your vegetables. The girls participated in our activities and I was impressed by their knowledge on the topic. For example, when I held up my picture of a carrot and asked them why it is important to eat vegetables, one girl responded that they were important for your eyesight. Well done, my friend! We emphasized the importance of vitamin intake because the girls receive packets of vitamins from the government but often choose not to take them for fear that they make cause harm. I hope they will remember and practice the lessons we left them!

Adolescent girls listen to our presentation

Finally, we stopped at a primary health center, which serves 60,000 people in the district. Residents first visit the sub health centers and if they have an issue that cannot be addressed, they are referred to the primary health center. At the primary center they so things like deliver babies, treat people for snakebites, and doll out drugs for malaria and tuberculosis, which are both highly prevalent in the area. We met with the medical doctor on site, toured the facility, and then we were back on the bus to Bombay.

I am truly impressed with the work that the IIF is doing in these otherwise largely neglected parts of the country. They set out with an initial goal to reduce existing disability among the 2 million tribal people living in the Thane District by 50 percent over the last several years. To date, they estimate that they’ve reduced it by 72 percent. Now, they are focusing on prevention of future disability through their educational efforts. Their approach is well-tested and uses resources from within the community so that the changes they make are sustainable. They also partner with the government of India to make sure that the free services offered to the people by the government are being fully utilized and understood. I commend both their approach and their tactics and look forward to serving them well over the next few weeks back in Bombay. For now, I’ve got to hop on a plane to Delhi – see you there!