Mobile Medical Van/Waste Site

FUN FACT: India has the largest number of post offices in the world. (www.india.gov.in/myindia/facts)

Today was our first day in India, and we were given the opportunity to work with AmeriCares India in their mobile medical van.

7 am - Afer eating a quick breakfast we started off the day trugging through the heavy Mumbai traffic (only normal) and made our first stop at the AmeriCares India office. Here we met Dr. Purvis M. Parikh and were given a brief introduciton of what type of work AmeriCares India does - distribution of free medical supplies and service via mobile van to regions of Mumbia that recieve minimum NGO support compared to the other areas.

After the introduction, back to the van for all us, and off to the site in East Andheri. Before take off, we all recieved matching AmeriCare India hats - just incase we would get lost on site. Bellow is a picture of our TA Megan Landry and two of our classmates, Nitasha Chowdry and Angela Rojas.

We arrived to one of the Slums in East Andheri and that is when it hit me. I was in India, a developing country with poverty and never ending problems (hopefully this is not true one day). We stepped out of the bus to be standing next to the main waste dumping grounds in Mumbai, and where all of Mumbai's trash is dumped. Obviously it smelled great. Some of us covered our noses while the locals giggled and stared. Filled with "rag-pickers" and mounds of trash, we observed, and walked on to a small street where the AmeriCares India van was waiting for our arrival.

As soon as we arrived, a crowd of women began to line up for their medicines/medical support. The van arrives in the same area every 10 days, and women are notified via text (thats technology for you) of its whereabouts. I was amazed by the fact that although it was pouring and crowded by unknown Americans, these women were in line for services for some longer than an hour. This to me showed the desparity of health care among poor individuals and that anything they can get is worth the wait. Due to the rain AmeriCares India improvised by setting up shop in a small dark garage and then began taking height, weight, age and symptoms which then the doctor spent 3-5 minutes with each patient distributing medicaiton.

Due to the large size of the group and small space it was difficult to be helpful to our full potential, but observing how AmeriCares India take action, changing their initial plans and followin their overall objective of providing care to their potential was facinating.

Coming from an Indian background, my family and I have visited India multiple times over the past 23 years. I have done the whole schmeal of riding the elephant, admiring the Taj Mahal, eating street food, shopping till my suitcase bursts, and of course visiting my grandparents, but I have NEVER had the opportunity to be so close and personable with the poverty and issues India faces. I feel as if my past summers in India were overly sheltered and that I have been missing out on the real India. By coming to India with our group, and not being surrounded by family this experience as allowed me to finally look beyond this wall and face the realities of this country. I keep asking myself what I can do to help? After finishing my MPH , what can I do to help, where do you start? How many challenges did AmeriCares India face to get to where they are now? As these questions begin to fill my head, it is now finally time to get some rest and start a new day of adventures tomorrow.

Goodnight everyone, and thank you for reading! Tomorrow we will be visiting Astha Parivar and providing sex workers training in menstration, breast cancer and menopause. I am excited to see our plan in action.

- Rashi

Waste

Our class excursion yesterday was shocking and difficult. We received a briefing at the offices of Americares India, an organization that provides free medical care, responds in disasters such as floods and bombings, and builds the capacity of healthcare professionals in disaster response. After some brief Q&A in their offices, we accompanied one of their field teams to a slum in Andheri. Here's a photo of the mobile health van we accompanied to the Govandi slum:

The slum lies at the edge of Deonar, a mountainous heap where all of Mumbai's trash is dumped. To put that in perspective, Mumbai is India's most populous city and the world's 6th most populous. According to an article I read online, this slum is home to the lowest Human Development Index in India and has overtaken Dharavi (made famous in Slumdog Millionaire) in size. I couldn't get a shot of the dump itself that did any justice to its size, but here's a photo of a fleet of garbage trucks at the base of the hill. The child in the foreground is searching for material to recycle and sell:

As I stepped off the bus, I inhaled and my stomach turned as the stench stung my nostrils. I had to pause and physically collect myself, willing myself not to gag. Followed by curious stares, we entered the slum and met up with Americares staff, who were setting up an intake station in an empty concrete stall. Even though we're students and here to learn, I was nagged by a feeling that we were poverty tourists. After snapping some photos and spending a few hours, we'd be on our van back to a parallel universe where this place and these people are invisible.

At the intake station, patients lined up and one by one. Staff recorded their chief complaints and vitals like blood pressure and weight. What you can't see in the picture below is that there's absolutely no privacy. Dr. Parrish observed that the line of women would lean in as each patient spoke with intake staff. Considering the fact that they were surrounded by their neighbors, we thought it was likely that the women might censor themselves when reporting their medical concerns.

After handing women their prescription, staff took a photo of each patient holding it up with their name just below their face. Later in the office they'll align medical records with photos for more complete patient files. With their prescription, women met with a doctor in the Americares van and received medicines. This was a bit more private than intake, and I hope they felt more free to discuss any issues they may have held back on earlier.

After a few hours it was time to go. During the bus ride to dinner, my stomach was tight. More than sad, I felt angry. With so many NGOs working here, where is the impact? How can so many people, like the trash they live alongside, be discarded? Society's detritus. I'm still processing the experience and what I saw, and I don't think pictures or this post come close to doing it justice. Some more photos below might begin to paint the picture.

Thanks for reading and until next time,

C

Confronting the Rich-Poor Divide of Globalization

Our third day in India had us conducting a site visit to an Aastha Parivar (“Family of Support”) site that centered to helping and empowering individuals working in the Mumbai sex trade. The visit to the Women’s Welfare Society, a community based organization (CBO) that provided educational, clinical, and social support to the sex workers was interesting in that it challenged many of our conceptions of the community and our role as public health experts and educators. Shortly after we arrived for our service project (to help train the CBO leaders and volunteers, we quickly realized the shoe was quite literally on the other foot. It was they who had much to teach us and our role was to listen and learn about what were the actual ground conditions. In sharing our training materials and seeking feedback to improve them, we learned how the women in the trade dealt with health issues and how they already negotiated respite to conserve their health and support one and other.

Ultimately we left with several excellent ideas to improve upon the training materials and a lot of exchange of good will on the part of both sides. Some of the key lessons include the age old need to survey real-time ground conditions in developing public health training materials, really listening to the target audience to learn what their concerns are, and realizing that in the end everyone is part of the human family and that all women around the world share the same concerns, stories and ways of coping.

From the depths of Byculla and Grant Road, our team proceeded to the heights of cosmopolitan Mumbai and the Colaba area with its fancy shopping, hotels, monuments and skyscrapers. Although, somewhat disorienting, it nevertheless provided an interesting contrast to the earlier experience and added to our understanding of the multifaceted nature of the city and country.

Slums

The first time I ever got to see a slum was when I was eight years old. It was during the Salvadorian civil war and it was going to be the first time I was going to meet my extended family. I remember sitting in the taxi cab with my twin brother and my parents as we rode along a highway and perched on top of a mountain top was for the first time where I saw a sea of shiny iron roofs that reflected against the hot sun. As we passed by the shanty houses, I asked my mother, if the people in these homes own televisions. As with any mother that wants to protect their children from the realities of poverty, she said yes. As a kid being born in the United States, I did not understand the significance of war, anything in relations to poverty, or what it was to live in a slum. All I knew where the comforts of my own home where I had running water, food in the refrigerator, a roof above my head, and cartoons to watch on Saturday morning.

It was until adulthood that I began to understand the history and how civil war pushed my parents out of their beloved country to come to the US. It was these childhood memories that would play an important role why I chose the public health path and to one day start up my own social entrepreneurship venture, but it has also taught me to understand empathy on the struggles of poverty. My public health education has allowed me to visit the township of Khayelitsha, Cape Town, South Africa, and the tent cities of Carrefour, Port-au-Prince, Haiti after the 2010 earthquake, but nothing was really going to prepare me for what I was going to see in the slums of Andheri today. While the slums of Khayelitsha and Carrefour where perpetrated by racial segregation and natural destruction, the slums of Andheri are perpetrated by the rapid growth of urban sprawl and economic growth.

As an alpha world city, Mumbai (Bombay) continues to be the most populous city (26 billion) in India and sixth in the world. Overshadowed by the trendy skyline of south Mumbai, the slums of Andheri are a byproduct of a country that is still coming to terms in how to assist the most destitute in providing free and accessible health care.
We had the privilege and opportunity to observe the organization, Americares as they conducted their own mini-medical clinic in the Muslim section of the Andheri slums. It was an educational experience because it made me realize how the lack of resources can impede the health care coverage of a disenfranchised population. In the past, I have been very fortunate to participate in two medical service trips and the experience has allowed me to understand and learn the limitations of working with low resources. In public health, money speaks louder than words and organizations like Americares are doing good in serving the underprivileged, while working with existing limitations. The need of monetary, medical, and human resources are essential to provide effective and free health care coverage to the people of the Andheri slums, but of course there is always a disconnect.

The disconnect where organizations like Americares can do so much with their limited resources, and where the people of the Andheri slums ask why is there not enough help.

It is this disconnect why social entrepreneurship is so important and it has left me asking how can someone like me help organizations like Americares gain more monetary resources and self-sustainability to continue the work they do. Issues like these are very important to me because at the end of the day, I was a visitor at the Andheri slum, and I left. The people of Andheri stay behind and they continue everyday with their struggles and wonder where are they going to get clean water and wonder when will the Americares mobile van will once again visit their neighborhood. When I look at the children’s faces when I visit slums like Andheri and I always wonder if that child could have been me. These are always the thoughts that run my mind.

What can you do, when you can't do everything?

How on earth do you prioritize one health topic over the other when the need for help of all different types is greater than anything you've ever dreamt was possible?

That sentiment followed me all day today as our group worked in the E Andheri slum, outside of Mumbai. The smell of human and animal excrement, the standing water, the garbage, the cows and chickens, the small children running around without shoes, the infants being taken care of by five year olds – it was almost too much to bear. AmeriCares, who we were lucky enough to accompany today, has the saintly goal of providing a mobile van and clinic every two weeks. They see 80-100 patients on each of their daily visits and the patient presentations range from fever and dizziness to joint pain or a persistent cough.

As I witnessed all of the sights and sounds that the slum presented, I just couldn’t help but think “how does an organization like AmeriCares prioritize the who, what, where and when?” The need is overwhelming and seemingly insurmountable. Tetanus, Hepatitis, blindness, parasites and worms, HIV/AIDS, asthma --- this is only a fraction of the list of ailments that immediately popped into my mind when I glanced at the faces of those who lived in the slum. What AmeriCares does in the slum is indubitably making a difference. It may only be one van, once every two weeks to deliver health services, but there are many effects that last much longer.

Amidst all of the filth, disease and misfortune; however, there was an undertone of hope. Children and adolescents from all ages were excited about us being in the slum. They wanted to practice English, talk about Shakespeare as one 14 year old did so well and sometimes they just wanted to stare at us. More than once, we were told thank you or that our visit to India and the slum was appreciated, although maybe not in those specific words. As I continue to reflect on my experience today, I can’t help but smile at the juxtaposition between the good and the bad; the hopeful and the hopeless.

This journey, although only a few days old, has already taught me so much. I truly believe that exposure to other cultures, locales, foods, perspectives and ideas and livelihoods is one of the most important ways a person can make themselves better. Our group is a veritable melting pot of backgrounds, interests and personalities and it is so interesting to see and read how this journey is being experienced differently by us all.

Brooke

Americares Mobile Medical Van in E. Andheri

The group set out for our first visit with the Americares Mobile Medical van early Tuesday morning. The organization works to provide health care to the slums in India and we had the opportunity to stop in at the Americares offices to meet with one of the physicians that runs the program. He provided us with an idea of the goals set out by the organization as well the living conditions within the slums. Even with a brief orientation of where we would be traveling to with the van later that day, it didn’t prepare me for the experience. I’m not sure any explanation would suffice.

I stepped off the bus in the E. Andheri slums and the smell consumed all of my senses immediately. As I walked towards the alley where the medical van had set up shop, I was immediately dodging massive piles of cow manure while out of the corner of my eye, children are rummaging through heaps of garbage. You can’t help but feel a little sick while experiencing the horrible living conditions these people face every day, which I’m sure the hour long bus ride through Mumbai traffic without AC didn’t help the cause either. We talked later on the bus about wanting to feel stronger about the situation and not quietly gagging while the smell just overcame our senses… but you really couldn’t help it.

After spending less than 10 minutes in E. Andheri, you can spot multiple fundamental health needs that consume this population. Dr. Parrish pointed out the massive water issue as we walked by fly invested jugs being filled by a water truck that comes to the slum three times a week. The need for water sanitation is apparent. We were in the middle of a down pour of monsoon rains at one point and the rain water barrels I see in backyards throughout the US came to mind to use for some kind of water collection and sanitation process.

On this specific day, the medical van was focused on women and children. It was explained later this was to provide sex workers the opportunity to seek medical care without signaling them out. The intake process was performed in the open and unfortunately didn’t provide the privacy of a standard doctor’s office… so any stigmatized health issues were probably not discussed. The doctor sat inside the van and saw patients for an average of 3 to 4 minutes at a time. They left the van with various medical supplies and the next person stepped up. As they waited in line you could sense the anxious anticipation to see the doctor.

It was clear after thirty minutes our group was causing more raucous than good. Our presence was adding fire to the flame to the already swarming crowds around the van so we piled back on to the bus. The Americares Mobile Medical van does phenomenal work and it takes truly devoted people to maintain the mission. Those living in the slums welcomed the assistance and unfortunately only the emergent care is able to be address as of now. The need to not only triage the situation but create some fundamental development such as permanent access to clean water is necessary. Now we're off to Aastha Parivaar... more to come!

Andheri

I finally made it to India! After having my itinerary changed about 4 times, we finally landed in Mumbai yesterday around 2am and were welcomed by a busy crowd and the monsoon season (which in India means 80%+ humidity!).

After failing at getting some much needed sleep we were thrown right into the depths of India. The group visited the offices of AmeriCares, an organization that strives to provide mobile medical services to India’s largest slum, East Andheri. The main focus of the organization is to provide on site medical care, free medications as well as disaster relief whenever needed (Note:

Did you that about 50% of the population live in slums? Unbelievable).

It’s hard to describe what I saw once we got to the slums. We got off to bus and were hit by a strong putrid smell coming from the enormous mountain of waste sitting right next to the slums. If you didn’t know any better you’d think it’s just another mountain decorating the horizon.

The medical van parked in front of a garage-looking structure and proceeded to set up so they could start seeing patients. In the meantime we stood there, trying to take it all in as we started to get the attention from people in the community. The little kids were the first ones to come over to take a closer look and pose for the cameras. Then women started to line up to so the doctor could see them.

Looking around you realize these people have no access to clean water, health services, education or a steady income. Living in unsanitary conditions, among animals and waste is the norm for all the people in slums.

I left E. Andheri feeling disheartened. How can we help? Where to even begin? I hope by the end of this trip I will have a better idea of how to answer these questions.

Can't wait to see what India has in store for us on Day 2!

Smiling through the stench

I am pretty sure I dreamt all of this morning’s events. I am still running through everything that happened, everything that I saw and trying to comprehend it in its entirety.

We woke up early this morning so we could make breakfast at 7:30am, before we left the hotel at 8:00am. Fair to say I was not really hungry when I woke and Lord knows I was nowhere near awake, but I shoveled as much food as possible into my mouth, knowing that we would not be eating again until nearly 3pm. We had a busy day ahead of us.

Dr, Vyas had scheduled our first site visit in the East Andheri slums. We were to go out with AmeriCares India and their mobile medical van to administer routine check-ups and distribute free medicine.

The organization we were volunteering with, AmeriCares India, gave us an insightful presentation before we ventured to the slums. The director, Dr. Purvish M. Parikh, told us about the entire AmeriCares program, how it has been working in 147 countries over the past 29 years, providing free medication, medical services, and emergency response (disaster response) efforts. According to some data that Dr. Parikh shared with us, AmeriCares India’s efforts have been successful throughout Mumbai’s slums: their infant mortality rates have dropped from 190 infant deaths per 1000 children in 2000 to 32 deaths per 1000 children in 2009. What a phenomenal difference one organization can make!

I knew very little about AmeriCares India before this trip and even less about slums in India. I don’t think my mind was able to truly comprehend what extreme poverty was; how literally the poorest of the poor live. I have seen poverty before – the shanty towns on the perimeter of Santiago de Chile, the ghetto in Granada, Nicaragua, and even the many homeless park-dwellers of Washington DC. But all of those experiences are shadowed by what I witnessed today. And what I am still trying to understand.

After surviving the hottest bus ride of my life – quite literally a sweat box with no air-conditioning, no open windows, in the middle of summer/monsoon season – we arrived at one of the main roads that lead into the East Andheri slum. It was an unimaginable sight – next to a huge shanty town, made of makeshift homes from concrete, tarps, and metal scraps was the largest dump in Mumbai. Apparently all of the city’s waste is dumped next to Andheri and this dump is where most of the slum’s population gets their goods for their household and as well as to sell. This dump is a part of their lives.

According to Dr. Parikh, one-third of Mumbai’s population lives in slums. With a population of over 21 million, that’s an unfathomable amount of slum inhabitants. And that’s how it felt when we entered into the slums: unfathomable.

The first thing to hit you will be the stench. It was described by a member of our group as so foul, it made her want to vomit immediately. Imagine human waste mixed with cow/goat/dog feces, add a copious amount of rain, humidity, and the nice addition of tons and tons of city waste and that pretty much begins to describe the smell. Foul. I have to admit, I had to quickly have a come to Jesus with myself and realize what was going on. In between the chauffeured group buses, swanky, air-conditioned hotel, and high-class meals, I have lost track of the reality of poverty in this city. I am still struggling to comprehend that I am in fact in India. Well, the smell of Andheri knocked me to my senses. Literally.

As we walked into one of the main streets on Andheri, we were quite the site. A large group of mostly Caucasian females, wearing bleach white “AmeriCares” hats and snapping pictures left and right. We looked like a walking parody of an Asian tour group. “Now to your left, ladies and gentlemen, you will see a child relieving himself out on the street. And if you look to the right you will see 6 goats running around while children without shoes chase them.” We were quite the spectacle. We walked further and further into one of the streets and with each passing minute more and more children, women, and men gathered around to see what the commotion was. Who are these strange people? And so we just stood there and stared. And the community members just stood there and stared back. It turned practically into an observation competition – who would blink first?

Honestly, though, I have never smiled more in my life. When you have a language and cultural barrier I feel like there is nothing more universal than a sincere, heart-felt smile. And that’s how I communicated with all the people who were swarming around me. I took my hat on and off throughout the morning in the slum, never knowing what kind of mayhem I would cause by having probably the whitest white person ever walking into that community. But everyone was so friendly and so incredibly curious. I must have posed for nearly 10 camera phone pictures and one little girl even asked for my autograph. Most of the children and adults did not speak English – so my relentless smile, respectful “Namaste” and head bow, along with the occasional “hello” were my means of showing this community my respect and care.

This was an exhausting venture though. What I witnessed was some of the worst slum settings in the world. Many foreigners have heard about one of the world’s biggest slums in Mumbai, Dharavi, which was aggrandized in the movie Slum Dog Millionaire. Yes Dharavi is home to over one million of poor Indians, however, that community apparently already has a large amount of local and international NGOs serving them. Slums such as Andheri tend to be forgotten, left to waste next to the city’s landfill. If it wasn’t for Americares India and their relentless efforts, Andheri would most likely have continued to deteriorate into disease. But AmeriCares has stepped up as quite the heroes.

Before the trip we were asked if we had any clinical expertise that could be made useful on this trip into Andheri. I pretty much said my clinical knowledge is limited to putting on a band-aid. We were given the impression we would be working alongside AmeriCares, helping them take vitals (weight, blood pressure, ailment consultation) while serving some worthwhile purpose for not only the organization but also for the community. To my disdain, everything coordination wise ran a bit amuck today. We got lost on the way to the slum, we were given no instructions on what to do once we got to the slums, and we pretty much just stood back and observed the mobile medical unit’s work. Mind you, I am incredibly grateful to have been able to see how a local NGO, who has made such a significant difference in one of the poorest areas in Mumbai, works out in the field. However, my since of disservice was upsetting. Besides being a walking circus for the community members, we really weren’t able to aid AmeriCares to the fullest of our capacity, in my opinion. I know we’re not doctors, but handing out medications would have been something; taking weight and blood pressure; hell, even helping to form a line outside of the shack garage that the medical unit worked from would have provided some purpose for us 20 odd foreigners clustered around the medical van. Anything, something, just please let me feel like I can offer something to these families!

All I can do is hope that my smiles, “hellos,” handshakes, and high fives made some impact in this community. That I might have made someone’s day, that I might have made some of the kids curious and excited about the world outside of their slum, that my attempts to communicate “study hard” were not in vain.

During one part of our trip, a group of us walked down some of the community’s side streets (if you can even call them such) to see some of the living conditions and how the community gets their water. Apparently there are large fuel tank like trucks that come into the slum twice a week to deliver water free of charge to whomever can get it. We saw rows upon rows of empty, blue 5 gallon plastic water bins and groups of individuals waiting to collect their weekly ration of water. This is not our clean, American tap water. This was, though it looks clear, filthy contaminated water not safe enough to drink. I will never complain about DC water ever again. These families, hopefully, will take the water back and boil it before using it for drinking water. However, unless we visit each house, and observe each use of the water, we can only hope that some messages regarding water sanitation and hygiene are reaching these residents. This slum is a water sanitation nightmare. It is, in general, a public health nightmare.

The children ran around barefoot, with lesions, scabs, blisters, and infections on various limbs of their bodies, as well as missing or diseased teeth and gums. What was amazing, though, was that the children looked put-together and clean (relatively speaking). Most of the children we saw were wearing button up shirts, clean jeans, looked as if they had washed their face and brushed their hair. I was taken back and quite impressed. It goes to show that human beings are absolutely extraordinary and are able to adapt and survive in any setting. And in some sense, thrive too (once again, relatively speaking). Obviously these children cared enough about themselves to take the time to clean and prepare themselves for the day. I was expecting a community of half to fully naked children with dilapidated hair and some form of waste all over them. However, that was not the case. Even the mothers whose main responsibility was to care for the children during the day were dressed in complete sari’s and looking absolutely gorgeous. Makes me wonder if Andheri’s residents could teach some of us about how to make the most out of every day.

I was heartbroken to have to leave but I will admit my own exhaustion that came for our over2 hours venture into the slum. It was an emotional rollercoaster for me. I wanted to cry at the devastating living conditions of these families but needed to keep a smile on my face; to stay strong and just be there. I kept having out of body experiences, never sure of what was really going on around me – what was I actually seeing. It’s amazing what the brain is able to process, and what it needs time to comprehend. I really hope we get to do more work similar to this today, or at least get to work more in the field, on site, with these local nonprofits that are making serious differences.

Being in Andheri made me question joining the Peace Corps – yet again. This has been a serious debate inside my head for years now. Quite literally, years – since starting high school, some odd 10 years ago (holy crap I’m getting old!). Being out in the field is where I think I strive. I need to make those person-to-person connections, really see how the resources come to fruition out in the communities – not behind a desk in some cube in some fancy air-conditioned building in some city that doesn’t understand. I am definitely not your typical 9 to 5 kind of gal. And I am learning to embrace that. I was so incredibly happy in the slum today. Sure, the stench needed a hint of febreze and I wasn’t exactly sure what was on the hands of those children that I gave high fives to. But dear God, I loved it. I even relished stepping into a puddle of lord knows what, because I was at least out IN the community, seeing the reality for myself. This is where I want to be, I just need to find a means to do the work I feel I was meant to do. Like my Berry College Professor Dr. John Hickman loved to say to me, “You seem like someone who would love to go spend their life [defecating] in a hole.” I couldn’t have said it better myself. (original word replaced for sensitive eyes)

I am working to remaining focused on my purpose here; on my personal growth and how these experiences can shape my potential life path. This is and is not all about me, a perplexing dichotomy of sorts. I am here to learn about the challenges and successes of local non-profits, the public health struggles of one of the fastest growing (population and economy wise) countries in the world, and how a small set of people can truly make a difference for a community. This is some pretty cool stuff. And very much real.

We’re in India – in the middle of monsoon season, in the middle of the summer. It is going to be hot, and sticky, and we’re going to smell, and there’s not going to be bathrooms or air-conditioning or English-speaking individuals. But, that’s okay, because we’re in India.

Tomorrow we head to the Red Light District where we are going to be leading a training workshop/ focus group on public health issues for the sex worker community – which consists of men, women, and a transgender population. We will be working with Aastha Paarivar, a local organization that focuses its efforts on empowering the sex worker community with HIV/AIDS and STI (sexually transmitted infections) prevention education. Despite the struggles to coordinate discussion information amongst all of the GW students today, I believe this workshop will be very successful. At the very least, an insightful afternoon.

For now, I bid you adieu until we meet again.

Love, Char