Impact India Foundation – Day 5
To every Cinderella story, we always admire the combat kid, but let’s just say if there is no combat kid to every Cinderella story?
In India, to be born into the Tribe population is to be forgotten by society. The Tribe population is a disenfranchised group that for centuries has existed and falls outside the Indian caste system.
The social inequality that is faced by the Tribe population is similar to the social injustices that are faced by the Native Americans in the United States. Aside from poverty, the health issues that plague the Tribe population range from maternal and infant mortality, malnutrition, anemia, and alcoholism.
For the Tribe population, the rural area of the Thane District is home and is located three hours from Mumbai. Our social entrepreneurship group had the privilege to meet with the general director of IMPACT India Foundation, Neelam Kshirsagar, who has been working with the Tribe population for seven years. The organization has provided a community health initiative that has provided the baseline in basic health care to the Tribe population from breast-feeding lessons for new mothers and their newborns, regular check-ups for anemia, and an array of other services such as the Lifeline train and medical mobiles.
We were able to see Impact’s work in progress when we visited a residential school that houses an estimated 500 children at the primary school grade-level. We had the opportunity to meet a group of young girls that where being checked by a doctor for any health aliments. Among the group of young girls, four girls are given the honor and responsibility of being called health monitors. As health monitors, the young girls are trained to pinpoint classmates for eye and ear infections, colds, and other aliments common among young children. It has provided the opportunity for children to become aware and understand how to prevent diseases by being hygienic and it has also allowed parents to learn from their children for the overall health and welfare of their families.
As I observed the girls, I noticed that the girls took pride in helping their classmates. A part of me eventually began to wonder if one of these days a child from the Tribe population will eventually leave this poverty and become someone in life. When a member of our group asked if these children will eventually receive vocational training after the primary and secondary-level, Neelam was blunt and responded that be a member of the Tribe population, one is only destine to be just a field laborer. Neelam was brutally honest that a member of the Tribe population will never be destine to become a doctor, a lawyer, or even a Bollywood star due to hundreds of years of total oppression.
For some members of my group they walked away disappointed. I walked away understanding the unfairness of our classicism society. I am not denying my idealism in changing the world, but I did not walk away with a white flag.
I am a realist and where I come from, you will always have the people that make it out of their communities to never return or the ones that leave, but do return. For the ones that stay behind, it is the usual story of the individual that fall between the cracks of society to be found a dysfunctional penal system, lost in the abyss of drug addiction, or never given the aspiration to be beyond meagerness. For the ones that do make it out and return, I call them the comeback kid. Those are the Jay-Z’s and Sonia Sotomayor's that are able to overcome the oppressive obstacles of poverty.
Maybe in my lifetime there will be no Jay-Z emerging from the Tribe population, but I am hopeful that the mother of a child that does give birth to a future Jay-Z is provided with the basic health care to thrive and raise her family with the inalienable right and access to health.
Tuesday, August 09, 2011
Day 5 - Impact India
First off – Today has been my favorite day.
The morning started off with an early bus ride to a rural region in the Thane district. We had the pleasure of having Mrs. Neelam from IMPACT India accompany us today. She provided an extensive background on the projects IMPACT India is apart of and an introduction to the tribal community we were visiting.
IMPACT India is apart of many projects, and the one main one that struck out to me was the medical service/hospital train - Lifeline Express - also known as "the magic (jadoo) train". This is the worlds first hospital train. How amazing is that!? A developing nation being the first to bring this type of innovation to life! GO INDIA.
A little bit about the train - The train travels all year long and reaches 12 cities each to serve the tribal people in undeserved and poverty stricken rural regions of India. As I was listening to Neelam explain the train and the services it provides, the amount of staff, supplies, organization, funding, planning it requires, I was VERY impressed. The train provides medical, educational, and preventative services to the tribal people in various regions every year. I never knew facilities like this existed, and came to find out there are similar ones all over the world. This type of innovative programs reach hundreds of people in rural difficult to reach areas.
My passion lies in the combination of clinical services and preventative measures for under served populations. The lifeline Express train is a prime example of something I would like to be apart of in the future. They are providing services to a community that has been shunned, and regarded as non-existent and bellow the traditional Indian caste system. Neelam addressed the fact that many clinicians from India as well as all over the world come and ride the train for 2-3 weeks. Along with clinicians, the train requires a volunteer staff, training students and many additional workers to maintain all aspects of the program.
We visited many sites today, and another IMPACT India project that stuck out to me was the tribal school. We were greeted by a classroom full of lively young girls between the ages of 12-18. They were so happy to see us, and I was very happy to see them as well. The girls sang us a beautiful welcoming song and all I could think about was that they were just children. Innocent, and eager to be filled with opportunities, knowledge, and experiences that could drastically change their lives. Assuming they had never left the rural regions of Thane, were they aware of what lies beyond their community? One of the girls told us she wanted to be a doctor, and reality hit when Neelam immediately told us that will never happen for her. The potential I saw in those girls today was devastating, and potential is not something to be devastated about.
Now that I think about it, today may have been the first time they have ever seen people that looked different than them - since majority of our group is Caucasian. They were amazed by our size. As we handed them their vitamin and iron supplements I felt the same way about them, they were quite small.
Today was the best day, and yet I am sitting here confused and sad. How can every child all over the world be born at the same starting line, same opportunities, and same potential? Is this even possible?
Goodnight Mumbai.
- Rashi
International Governmental Collaborations
On our first day in New Delhi, we met with Nandita Chopra, the United States (US) National Institutes of Health (NIH) Representative to India. Although in the midst of hosting a US Senate delegation, Ms. Chopra graciously spent some time with the GWU team to describe NIH’s work in India.
As we learned, most Institutes within the NIH family conduct international work either by scientifically collaborating with foreign research institutions and/or providing grants to fund research conducted outside the United States as part of scientific diplomacy efforts. The NIH has representatives in several key foreign countries including China, Brazil and India. One impetus for NIH’s efforts overseas lies in the realization that improving public health in developing nations ultimately positively impacts those countries, the United States, and the rest of the world by creating a healthier population.
Ms. Chopra arrived in India approximately eight months ago to oversee NIH funding efforts here. As part of her activities she helps monitor existing funding efforts and identify potentially new areas for further research and funding. In addition to hosting US Congressional and other governmental delegations to showcase NIH’s work in India and provide the basis for further appropriations for subsequent efforts, Ms. Chopra also attends conferences and research meetings to describe the scientific collaborations and their impact on public health in India.
One new area of endeavor that Ms. Chopra envisions lies in the environmental-occupational health arena. Slated to attend an upcoming conference, she indicated the possibility of identifying some new areas of focus for the NIH overseas efforts. It was gratifying to learn about this development as throughout our trip to India, we saw numerous instances of where environmental-occupational health could be expanded. Some examples include (1) the various small-scale industries operating in urban slums like Dharavi, in Mumbai without occupational health protections or enforcement; (2) lack of general sanitation and solid waste management in cities like Mumbai; and (3) limited green spaces and access to clean drinking water.
Conversely, it is clear that several governmental institutions and non-governmental organizations and green initiatives exist throughout the country that are devoted to environmental health issues. For example, there is a National Institute for Environmental Engineering with zonal offices in multiple parts of the country, the New Delhi Bus system, billed as a green bus service that runs on natural gas, gasoline-natural gas hybrid taxi services like Meru Taxicabs that operate in many major metropolitan areas, and one of the largest solar cookstove initiatives in the Southern India City of Chennai. We also passed several billboards on major thoroughfares that advertised initiatives such as “Clean Mumbai, Green Mumbai: Because we need Green Cities not Scarcities.” The recycling industry operating out of slum areas and manned by ragpickers itself offers an insightful lesson in recycling and solid waste management!
Hence there both exist several existing initiatives that offer the potential for scaling up as well as avenues for further scientific and technical research.
As we learned, most Institutes within the NIH family conduct international work either by scientifically collaborating with foreign research institutions and/or providing grants to fund research conducted outside the United States as part of scientific diplomacy efforts. The NIH has representatives in several key foreign countries including China, Brazil and India. One impetus for NIH’s efforts overseas lies in the realization that improving public health in developing nations ultimately positively impacts those countries, the United States, and the rest of the world by creating a healthier population.
Ms. Chopra arrived in India approximately eight months ago to oversee NIH funding efforts here. As part of her activities she helps monitor existing funding efforts and identify potentially new areas for further research and funding. In addition to hosting US Congressional and other governmental delegations to showcase NIH’s work in India and provide the basis for further appropriations for subsequent efforts, Ms. Chopra also attends conferences and research meetings to describe the scientific collaborations and their impact on public health in India.
One new area of endeavor that Ms. Chopra envisions lies in the environmental-occupational health arena. Slated to attend an upcoming conference, she indicated the possibility of identifying some new areas of focus for the NIH overseas efforts. It was gratifying to learn about this development as throughout our trip to India, we saw numerous instances of where environmental-occupational health could be expanded. Some examples include (1) the various small-scale industries operating in urban slums like Dharavi, in Mumbai without occupational health protections or enforcement; (2) lack of general sanitation and solid waste management in cities like Mumbai; and (3) limited green spaces and access to clean drinking water.
Conversely, it is clear that several governmental institutions and non-governmental organizations and green initiatives exist throughout the country that are devoted to environmental health issues. For example, there is a National Institute for Environmental Engineering with zonal offices in multiple parts of the country, the New Delhi Bus system, billed as a green bus service that runs on natural gas, gasoline-natural gas hybrid taxi services like Meru Taxicabs that operate in many major metropolitan areas, and one of the largest solar cookstove initiatives in the Southern India City of Chennai. We also passed several billboards on major thoroughfares that advertised initiatives such as “Clean Mumbai, Green Mumbai: Because we need Green Cities not Scarcities.” The recycling industry operating out of slum areas and manned by ragpickers itself offers an insightful lesson in recycling and solid waste management!
Hence there both exist several existing initiatives that offer the potential for scaling up as well as avenues for further scientific and technical research.
Day 3: Dharavi
After a quick yoga session we headed out to the largest slum in Asia - Dharavi. Most people may be familiar with Dharavi through the hollywood-ized "Slumdog Millionaire" slum, creating a bollywood picture for a $1.5 million people community bombarded with problems and poverty.
We were given the opportunity to visit ACORN with the director Mr. Vinod Shetty. Out of all the people we have met in the Indian NGO sector so far, Mr. Shetty has been truly inspiring. He shared with us his background as a labor and human rights lawyer, and ho
w he came to ACORN.
Physically being in Dharavi and seeing how this self-contained community worked together to survive was eye awakening. People from various parts of the country travel to Dharavi to start a new life. Many of the individuals of Dharavi have been shunned from their previous communities, have no place to go, no money, perhaps no family and strive to make a living. Most of the individuals we saw today were men, and barely any women. Mr. Shetty was explaining to us that majority of Dharavi is male, because they come to earn money to send back home to their families.
I was in shock by their working conditions. Coming from a country full of rules and regulations concerning occupational health hazards we were walking into a world that may not be aware/care/can do anything about it - These men (there were barely any women)
were risking their lives by working barefoot, without gloves, eye or ear protection and using heavy sharp machinery. The men also ate, worked, and slept in the same area every day. Staying and continuing to work in Dharavi suggests that for some of them perhaps their previous homes may not have been better, and working in Dharavi, making almost less than $5 a day is something they can be proud of, especially when they send/visit home. It was fascinating yet disturbing to know that this community is the result of years and years of digging into an area where "civilized" people of India have shunned the people of Dharavi. Hopefully, the future of Dharavi is promising and new development brings more to the community.
Today was a lot to take in, long and exhausting. Goodnight everyone, and thanks for reading.
- Rashi
Aug 5 – Making an IMPACT
Friday, hands down, was my favorite day thus far. Our 7:30 departure time and 2+ hour bus ride was totally worth the first breath of fresh air I inhaled when we arrived at our first stop in the Thane district, a rural area north of Mumbai. Neelam, a mid-60's tiny spitfire of a woman, from IMPACT India led our group and gave us a lovely overview of the organization's mission and activities – “Actions today to prevent disability tomorrow”, for IMPACT India means working with over 2 million people living in tribal populations, includes the Lifeline Express, the world's first train hospital. The train, painted in bright colors with flowers and rainbows, moves throughout the country year round providing services such as cataract and cleft palate surgery, and other basic medical procedures to rural populations who call it the Magic Train.
In addition to the Lifeline Express, IMPACT, in conjunction with the government, provides services within the general community, hostel schools, not unlike boarding schools, rural health clinics, and also had a mobile unit for eye exams and prescribing glasses.
On the way to Thane, Neelam described how IMPACT and their services got off the ground, and to the point at which they function today. It sounded like a story out of a public health fairytale. She made it sound so seamless – a disparity was recognized – the tribal communities and rural areas lacked access to basic health services, and so she and her team rallied the necessary troops and brought them what they needed. Voilá! Magic! In reality, of course, I am sure it was not as easy as her rhetoric described. Blood, sweat and tears went into these initiatives, and it really shows. It is most apparent in the services provided exclusively for women. Physical health as well as social factors emphasize the importance of enrolling these rural children in hostel schools: they are provided high quality diets to curb anemia, and by providing the girls with an education and a place to learn and grow, child marriage is also curbed. By providing the mothers in the community with birthing services and breastfeeding support in the maternal and child health clinic, IMPACT is working to decrease maternal and infant mortality rates, as well as ensure a healthy start to the babies' lives. They made it look so easy, and I hope someday to be a part of an organization which makes such a significant IMPACT.
In addition to the Lifeline Express, IMPACT, in conjunction with the government, provides services within the general community, hostel schools, not unlike boarding schools, rural health clinics, and also had a mobile unit for eye exams and prescribing glasses.
On the way to Thane, Neelam described how IMPACT and their services got off the ground, and to the point at which they function today. It sounded like a story out of a public health fairytale. She made it sound so seamless – a disparity was recognized – the tribal communities and rural areas lacked access to basic health services, and so she and her team rallied the necessary troops and brought them what they needed. Voilá! Magic! In reality, of course, I am sure it was not as easy as her rhetoric described. Blood, sweat and tears went into these initiatives, and it really shows. It is most apparent in the services provided exclusively for women. Physical health as well as social factors emphasize the importance of enrolling these rural children in hostel schools: they are provided high quality diets to curb anemia, and by providing the girls with an education and a place to learn and grow, child marriage is also curbed. By providing the mothers in the community with birthing services and breastfeeding support in the maternal and child health clinic, IMPACT is working to decrease maternal and infant mortality rates, as well as ensure a healthy start to the babies' lives. They made it look so easy, and I hope someday to be a part of an organization which makes such a significant IMPACT.
India's Version of the American Dream?
Dharavi Slums – Day 4
I am all about shopping bargains when a sale comes around the corner. Always looking forward to finding a high-end outfit for half the price, but after visiting the Dharavi slums, I am now more aware where my threads come from and who makes them. On the fourth day, the social entrepreneurship group and I had the wonderful opportunity to visit the Dharavi slums. Spread over 1.7 km2 with a population of over 1 million people in the world, it is considered as one of the largest slums in the world. We met with Vinod Shetty, director of the Acorn Foundation India and the organization that runs the Dharavi Project.
The goal of the Dharavi Project is to advocate for the welfare and legitimize the profession of “rag-pickers” or garbage collectors and informalized laborers that have become the essential players responsible for the sustainable recycling, waste-management, and unregulated work for the Dharavi slums. On a daily basis, the city of Mumbai accumulates an estimated 8000 tons of garbage for a population of approximately 25 million and where municipal government fails to bridge the gap on garbage collecting, the “rag pickers” are the unnoticed heroes that bridge this gap.
Visiting the Dharvai slums was a sensory overload experience at every level. The first vision at sight was a landscape that has been bulldozed a month early by the the municipal or state government. The excuse was to clear and fix the water pipes, but it is believed that the ultimate goal of the bulldozing was to reinforce the power of the government over the illegal settlement. Mumbai is growing consistently every year and Dharvai is considered prime real estate land because it sits right in the middle of the city. The bulldozing of this small portion of Dharvai is no different from the historical contact of District 6 in Cape Town, South Africa. Still the inhabitants of Dharvai do not stop and continue on surviving and thriving everyday working by picking up garbage and working in the unregulated factories.
From my western perspective, it very easy for some of us to criticize of the social injustice of working in garbage and in unsafe and unregulated factories, but for a man that leaves his family and children behind in his village, it becomes a lifeline to pursue higher income and a better livelihood. Dharvai becomes home and where they find work.
As I walked through the small muddy alleyways of Dharvai, I passed by a man that was working a whole room of automatic embroidery machines. At that moment, I related to the man.
My father spent over a decade in the embroidery industry working $12.00 an hour. It was his first job after escaping the civil war in El Salvador and the job that supported my family. My father worked the night shift and in the mornings he made us breakfast and took us to school. As I looked at the man working with finesse the embroidery machines it made me wonder how lucky I was to have my father at home, while this man worked and possibly was miles away from his family.
I eventually realized that the fancy clothes that I buy back in the US or anything that is made in India can possibly come from a man working the embroidery machines in a slum like Dharvai.
It made me more aware and put a human face to the clothes I wear.
I am all about shopping bargains when a sale comes around the corner. Always looking forward to finding a high-end outfit for half the price, but after visiting the Dharavi slums, I am now more aware where my threads come from and who makes them. On the fourth day, the social entrepreneurship group and I had the wonderful opportunity to visit the Dharavi slums. Spread over 1.7 km2 with a population of over 1 million people in the world, it is considered as one of the largest slums in the world. We met with Vinod Shetty, director of the Acorn Foundation India and the organization that runs the Dharavi Project.
The goal of the Dharavi Project is to advocate for the welfare and legitimize the profession of “rag-pickers” or garbage collectors and informalized laborers that have become the essential players responsible for the sustainable recycling, waste-management, and unregulated work for the Dharavi slums. On a daily basis, the city of Mumbai accumulates an estimated 8000 tons of garbage for a population of approximately 25 million and where municipal government fails to bridge the gap on garbage collecting, the “rag pickers” are the unnoticed heroes that bridge this gap.
Visiting the Dharvai slums was a sensory overload experience at every level. The first vision at sight was a landscape that has been bulldozed a month early by the the municipal or state government. The excuse was to clear and fix the water pipes, but it is believed that the ultimate goal of the bulldozing was to reinforce the power of the government over the illegal settlement. Mumbai is growing consistently every year and Dharvai is considered prime real estate land because it sits right in the middle of the city. The bulldozing of this small portion of Dharvai is no different from the historical contact of District 6 in Cape Town, South Africa. Still the inhabitants of Dharvai do not stop and continue on surviving and thriving everyday working by picking up garbage and working in the unregulated factories.
From my western perspective, it very easy for some of us to criticize of the social injustice of working in garbage and in unsafe and unregulated factories, but for a man that leaves his family and children behind in his village, it becomes a lifeline to pursue higher income and a better livelihood. Dharvai becomes home and where they find work.
As I walked through the small muddy alleyways of Dharvai, I passed by a man that was working a whole room of automatic embroidery machines. At that moment, I related to the man.
My father spent over a decade in the embroidery industry working $12.00 an hour. It was his first job after escaping the civil war in El Salvador and the job that supported my family. My father worked the night shift and in the mornings he made us breakfast and took us to school. As I looked at the man working with finesse the embroidery machines it made me wonder how lucky I was to have my father at home, while this man worked and possibly was miles away from his family.
I eventually realized that the fancy clothes that I buy back in the US or anything that is made in India can possibly come from a man working the embroidery machines in a slum like Dharvai.
It made me more aware and put a human face to the clothes I wear.
Day 5: Thane
Our bus crawled its way out of Mumbai’s congested roads on the way to Thane. It didn’t take long for the scenery outside our windows to become lush and green. We were all weary from gray, dank Mumbai and longing for fresh air. We bumped along the main road north, passing people hunched over in their rice paddies and tilling the soil with oxen drawn plows. On our way, Neelam Kshirsagar gave us an overview of her organization – Impact India – and their programs – the Lifeline Express ("the world's first hospital on a train") and the Community Health Initiative (CHI).
With the Lifeline Express stationed in Orissa, hearing about the "magic train" had to suffice for this trip. Usually I'm wary of projects that rely on a tremendous amount of volunteer support. Even though volunteering is noble and makes a difference, it rarely gets so the root cause of why the volunteering is needed in the first place. Impact India addresses this issue by providing training to health workers and NGOs, and ensure that local government and providers follow up with Lifeline patients. It was reassuring to see such a comprehensive, thoughtful approach.
Our first stop was a CHI-supported residential school for girls, where we were greeted with smiles and curiosity.
Among CHI’s interventions, the appointment of school health monitors is particularly ingenious. Chosen by their peers, the monitors are tasked with identifying emergent health issues among fellow students. These school leaders sang us a song (occasion #935 on this trip that I wish I knew Hindi) and gave us roses to welcome us.
When the pomp and circumstance was done with, the girls got down to work and began their periodic check of the heights and weights of fellow students. They were take charge and methodical, taking their responsibility seriously but good naturedly. Seeing their determination made it all the more frustrating when we heard from our guide that college for these girls is an "impossible dream." As women who have been told all our lives that the sky is the limit, many of us were deeply disturbed by that thought. We had some interesting conversations around the idea of social change and asking "what's enough?" Is it enough to raise the baseline of a generation - get them healthy and a basic education - giving their children a better shot at attaining more? It seems more realistic but insufficient.
Afterwards we were invited to help hand out Vitamin A supplements. It was fun to jump in but felt a little trivial. Throughout the trip, I think many of us have struggled with a feeling of being poverty voyeurs who drop into a community and leave shortly thereafter. We’ve had many reminders on this trip that we are getting immeasurably more from the people we meet than we’re able to give. On the other hand, I can’t think of another way to get such a comprehensive view of the work NGOs are doing here in India.
Next we were greeted by the clinic's nurse who was conducting a training for young mothers on exclusive breastfeeding. The girls formed a line and handed us flowers - so welcoming! After we entered the clinic, a nurse dressed in a gleaming white sari applied the kumkum in between our eyebrows. At first I felt a bit foolish about being received with such ceremony and kindness for just showing up - but reflecting on it a bit more, maybe (for now) it's enough to show up, ask questions and learn.
Our final stop was another school, where Impact's Lifeline Express Mobile unit was stationed. The children at this school, who also greeted us with smiles and a song or two, had never seen foreigners and asked us why our skin was so white. I was grateful when Dr. Vyas told them that many people in the US try to tan their skin to get darker. Light skin is a premium here - I've seen a ton of skin lightening commercials by American companies like Vaseline. Strongly worded letters to said companies are forthcoming.
For good measure, here are some more pictures of adorable children. I hope that at the least, our visit brought them some excitement, joy, and curiosity about the outside world.
"These Girls will Never Leave"
Day 4 - Thane District
Today will be a bit scattered brained for me as I really not feeling well. It made it really difficult to be a part of the experience and I missed out a lot. However, I was able to take in a lot and learn a lot from my peers and what I saw for the children.
We got up early today and headed over with Neelam, a member of the Impact India Foundation to Thane District, a rural area three hours outside of Mumbai, and approximately 25 kilometers away from the border state of Gujarat. Neelam, was kind enough to be our tour guide of the day. En route to Thane district she also explained what wonderful things Impact India Foundation has done for rural areas in India, such as Thane District. Impact India has been around for approximately 20 years, working specifically in the following three projects:
We did have the opportunity to understand more about the community health initiative and ashramshalas. Our first stop was the Bapugaon Ashramshala (Village Residential School for tribals).
I loved it here. For one, the quiet and stillness of the village, coupled with the greenery that spread miles long. It was beautiful. We visited a school here that boarded over 500 students of tribal families. In order to provide these children with access to an education and a future, an association was formed with the Government. Even so, these girls and boys lacked so many resources and access to care. Though between the ages of 11 and 14, they looked six. Physicians, volunteers and individuals such as Neelam, have worked with these children to conduct body mass indexes, A1c testings, counseling on Vitamin A and importance of immunization. The girls we met, were able to tell us the importance of Vitamin A and conducting biomarkers. They were eager to share with us how they have learned to conduct BMI's as indicators to help them stay healthy. Yet, two of the questions they posed to us was: "How come you are so much bigger than us?" and "What can we eat so we can be as big as you?" It was heartbreaking.
After we sat in a group for awhile, we had a few minutes before our next visit, to have some one-on-one conversations. We used this opportunity to ask what these girls wanted to be when they grew up. Many were shy at first but one girl spoke up and said she wanted to be a doctor. Neelam later told us, these girls will never leave and have never left, for there is not even a name for how low they are in the caste system.
The rest of the day, our group went to a Primary Health Centre and a Mobile clinic. Unfortunately, I wasn't well and had to miss these site visits. I was sad to have missed such an experience. From what I gathered from my peers, spending time with tribal families in the outskirts of Mumbai was life-changing. Understanding how medical care is reached to the indigenous people of Thane District and how they seek care is fascinating. I also wish we had an opportunity to visit the Lifeline Express, or as Indians refer to it as "The Magic Train of India".
*******************
This day was hard because back home, I get questions from so many people asking me if the caste system is still in existence. All this time I said it wasn't. Today, I realized that as far as India has come, the country has not done justice in educating so many people and for that reason certain fallacies, will never be trumped. All you can do is continue to bring hope and empowerment through education and expression of education.
Today will be a bit scattered brained for me as I really not feeling well. It made it really difficult to be a part of the experience and I missed out a lot. However, I was able to take in a lot and learn a lot from my peers and what I saw for the children.
We got up early today and headed over with Neelam, a member of the Impact India Foundation to Thane District, a rural area three hours outside of Mumbai, and approximately 25 kilometers away from the border state of Gujarat. Neelam, was kind enough to be our tour guide of the day. En route to Thane district she also explained what wonderful things Impact India Foundation has done for rural areas in India, such as Thane District. Impact India has been around for approximately 20 years, working specifically in the following three projects:
- The Lifeline Express - a hospital on a trail that halts for about a month at each rural location which each project.
- Community Health Initiative (CHI) - decreasing the incidence of existing disabilities through preventive and curative measures
- Ashramshalas - A model project for improvement of the tribal residential schools for holistic development of rural children.
We did have the opportunity to understand more about the community health initiative and ashramshalas. Our first stop was the Bapugaon Ashramshala (Village Residential School for tribals).
I loved it here. For one, the quiet and stillness of the village, coupled with the greenery that spread miles long. It was beautiful. We visited a school here that boarded over 500 students of tribal families. In order to provide these children with access to an education and a future, an association was formed with the Government. Even so, these girls and boys lacked so many resources and access to care. Though between the ages of 11 and 14, they looked six. Physicians, volunteers and individuals such as Neelam, have worked with these children to conduct body mass indexes, A1c testings, counseling on Vitamin A and importance of immunization. The girls we met, were able to tell us the importance of Vitamin A and conducting biomarkers. They were eager to share with us how they have learned to conduct BMI's as indicators to help them stay healthy. Yet, two of the questions they posed to us was: "How come you are so much bigger than us?" and "What can we eat so we can be as big as you?" It was heartbreaking.
After we sat in a group for awhile, we had a few minutes before our next visit, to have some one-on-one conversations. We used this opportunity to ask what these girls wanted to be when they grew up. Many were shy at first but one girl spoke up and said she wanted to be a doctor. Neelam later told us, these girls will never leave and have never left, for there is not even a name for how low they are in the caste system.
The rest of the day, our group went to a Primary Health Centre and a Mobile clinic. Unfortunately, I wasn't well and had to miss these site visits. I was sad to have missed such an experience. From what I gathered from my peers, spending time with tribal families in the outskirts of Mumbai was life-changing. Understanding how medical care is reached to the indigenous people of Thane District and how they seek care is fascinating. I also wish we had an opportunity to visit the Lifeline Express, or as Indians refer to it as "The Magic Train of India".
*******************
This day was hard because back home, I get questions from so many people asking me if the caste system is still in existence. All this time I said it wasn't. Today, I realized that as far as India has come, the country has not done justice in educating so many people and for that reason certain fallacies, will never be trumped. All you can do is continue to bring hope and empowerment through education and expression of education.
Day 3: Aastha Parivar
We started off the day with our first yoga session in the hotel. Even though we were exhausted from a long day yesterday, I think we all felt it was definitely time to start doing some sort of exercise, especially after eating delicious heavy meals 3 times a day (eating can be exhausting too).
Today's agenda consisted of visiting Aastha Parivar (AP). AP is an organiation that works with female, male, and transgendered sex workers in Mumbai and Thane by providing them basic needs such as health and human rights, crisis intervention, literacy and legal support. Before departing DC our class was asked to devise a health education trainign session for AP. We had prepared two separate training for two locations.
Our training topics were menstruation, hygiene, breast cancer, and menopause. I was a bit nervous as we walked into a room full of women who did not speak the same language as most of us, waiting to hear what we, students, had to say. My fellow classmate Pavitra and I used our Hindi speaking skills and took lead as being the group facilitators. After everyone did their introductions and about 10 minutes into the mentruation discussion, we began to realize tings were not going to go as we planned. The women had previously been trained on most of our topics for the last 7 years, and the information we thought wanted to know, they already knew.
Like many public health ventures you adapt and hopefully overcome. Along with Dean Parrish's help we improvised a new plan, which was to get the womens' opinions on a potential trainig session for them to take back to the community to educate other women who may not have had training. Conversation began to roll, and prominent speakers among the group gave us great insight to their world. They were willing to open up their lives, concerns, and comments to complete strangers that looked, dressed, and talked different. This is when I realized the strength and importance of making connections with a community to learn from them and share knowledge as well.
Being a Maternal and Child health (MCH) MPH student, today was one of the first times I have been able to see MCH public health in action, and along with my classmates, we were able to use the skills and knowledge gained from our program to implement into community in need.
We ended the day celebrating Courtney's B-day, and a wonderful traditional Rajasthani thali meal. I am looking forward to what tomorrow brings, goodnight and thanks for reading!
- Rashi
Day 4. Thane District
Rural India is absolutely breathtaking. A vibrant green layer of vegetation covers both sides of the road setting up the stage for a few majestic mountains on the horizon.
Today we are learning about Impact India Foundation and visiting a couple of schools for tribal kids in the Thane District.
The fresh air and calm surroundings create the perfect environment for what we were about to witness. As we walk to the school building, lots of tiny faces start to show up on the windows curiously looking at the new visitors, and others were brave enough to come out of their classrooms to take a closer look at the group tourist that were now approaching their grounds. We walk into one of the classrooms where a group of teenage girls await for us, excited to share their health edu
cation initiative. All the girls are wearing white and blue uniforms with beautiful red flowers on their hair, which is perfectly done in either braids or ponytails. The girls sing a welcome song for us and hand each one of us a red rose to show their appreciation for our visit. Then they proceed to proudly show us what they have learned about nutrition and health in general. There are ten girls that have been trained to be health monitors for their classmates to help the doctor in-site check weights, and heights of the other girls as the doctor checks their eyes and listens to their hearts. It is very inspiring to see these girls help and teach each other how to better care for themselves. I can’t help but to think that out here, in rural India these girls are building a better future for each other.
To my surprise, I learned that this is not the case. Even though these girls are educated, fed, and have higher aspirations for their futures, none of the will live the area after school. Most will never live away from their families, either because of lack of financial support or because is part of the culture, and others will simply marry shortly after they complete their studies. There is no other option. During one of our class discussions this issue came up. When will these girls realize that their dreams and goals will never come true?
I still remember their smiles and bright red flowers adorning their hair. As I wave good-bye I leave with the realization that they will never live this place, and will not get to experience a different reality. At least these girls will have the knowledge and empowerment learned in this school, that will help them face the life that waits for them; a life that has already been written for them.
Redefining Hope
Traveling to the Thane District, North of Mumbai, our fearless and feisty guide for the day, Neelam -all of 5 foot, and 1 inch of her- balanced against a turbulent bus ride through the city traffic to brief us on Impact India and the work being done at the rural sites we were about to observe.
For the past 28 years, Impact India has actively taken part in clinical care as well as prevention. This work includes addressing disability through health education, immunization, and access to appropriate healthcare. This NGO provides clinical care and treatment for curable disabilities such as blindness and deafness as well as physical deformities such as cleft palate and other facial malformations. A team of volunteer surgeons board “The Lifeline Express,” and ride this train through Northern India stopping in rural locations to perform corrective procedures. This train, literally painted with rainbows and clouds, is a beacon of help and hope for communities that have little access to healthcare. The train comes with all necessary equipment and operating space- for all intents and purposes- it is a hospital on rail. From this idea, similar mobile healthcare has been inspired, such as hospital trains in China and other parts of Asia, as well as riverboat hospitals in Bangladesh and Cambodia. This has been an extremely effective method of delivering healthcare, yet when asked about the vision for “The Lifeline Express” Neelam replied, “we hope for it to become unnecessary.” With this statement she made it clear that “The Lifeline Express” is a temporary solution while the ultimate goal is a proper hospital setting without reliance upon a traveling method of delivery.
Impact India also provides care through a mobile van program. This van travels to rural villages to test individuals of the community for vision and hearing impairments. Once again all the needed equipment to conduct these tests is available in the van. Travel to remote villages in the Thane district and similar areas throughout India require these mobile vans to drive through rough and often dangerous roads. With these road conditions and the remoteness of these villages, the mobility of this care is crucial to the medical attention and knowledge of the people with whom they reach.
The feel of the Thane district was altogether unique, no more bustling Mumbai-instead we saw the lush, agricultural view of India. Our first site was a boarding school where we were welcomed by a group of young ladies who were taught to become health monitors within their school. They were trained to look for signs of anemia and poor hygiene, and to encourage healthy nutritional practices- they were given vitamin A supplements to prevent unnecessary blindness. Also, regular hemoglobin testing is performed to monitor anemic individuals. These girls are sharp and proud of what they are doing within their small community. They are contributing to further the health practices within their village and endow the next generation with more knowledge than that of the previous. Slow, but steady improvement is better than false hope for complete extraction from a difficult reality.
We were welcomed and allowed to sit in on a breast-feeding education session delivered by a nurse within the community. It is common for new mothers to throw out their colostrum, or their “first milk.” This breast milk has antibodies that protect the newborn from illness. This is especially important in locations without clean drinking water, where often times children are given water with formula instead of breast-milk, exclusively.
The second site of the day was a rural clinic funded by the government. The doctors there treat everything from snakebites to delivering each child born to the village. Though it appeared from our visit and observations that little was done on part of the doctors to encourage preventative health, there hung a form of census data within the doctor’s office. Above his desk there was a sophisticated record of the total population, the number of households, the number of village wells along with more crucial information as to the breakdown of the population, and what major health procedures are most often necessary. This neat and well-maintained board of data appeared to be the beginning of a community needs assessment.
The visits on site in the Thane district served an invaluable purpose. From these visits we could truly get a feel for the work of Impact India. The realities were glaring, and sadly there is often the realization that the majority of the individuals we met will remain exactly where we parted-we board our bus to eventually go home while they remain. However, there is the promise that with programs like Impact India, each generation of families will be slightly improved. As Kelly Healy articulated well in discussion today, “it is important to simply raise the baseline.” An organization can measure success by raising the baseline of health standards and community knowledge. There is no magic bullet, therefore it is important to be honest and face the hard truths about poverty and lack of access to education and health. However, communities pull together when they have nothing, and as such the sites we visited were on their way to raising the baseline. No matter how slow the progress, it is progress nonetheless, and that has to be enough.
Hesitation with trepidation leads to exaltation.
08.05.11
Tumultuous ride
Vast green fields are spreading wide
Here lies unknown land
The window is blurred
The clouds linger blearily
The world feels heavy
My body rejects
My mind feels toxicity
Imodium please
Many miles pass by
Within a gate we do find
A microcosm
This school is my heart
This tribal clan is my kin
This unknown is home
I find purpose here
My path is suddenly clear
This school is my home
Their smiles are loving
Their interest is sincere
These children know me
Their laughs enchant me
But I see their hidden pain
All, deficiency
One NGO works
Impact India does help
But is this enough?
Many dreams they have
But what could be their future
No college for them
These children are bright
Some strive to be doctors
But how can that be?
I feel great sorrow
I feel great, fiery passion
I want to bring change
This school is the start
Education is a must
Opportunity
Invest in knowledge
Without school, there is no hope
The rice fields await
I wish I could stay
Spend my life helping these kids
I am here for you
This school is the start
Education is a must
Opportunity
But, alas, I left
I may never see them again
That thought breaks my heart
But I am hopeful
Another school I shall serve
Valsad waits for me
This trip gave me hope
This school is where I should be
Teaching tribal kids
This school is the start
Education is a must
Opportunity
This school is my heart
This tribal clan is my kin
This unknown is home.
this school is the start.
Day 3. Dharavi
After our yummy breakfast we headed to another slum, Dharavi, to learn about waste management. Dharavi is often described as the largest slum in Asia, housing close to 1.5 million people (!). On the way there we picked up Vinod Shetty, director of ACORN India. This organization educates rag pickers and trains them in scientific methods of waste handling, segregation and recycling (Note: rag-pickers are those who pick up the tons of garbage littering the streets in Mumbai in order to recycle them. Most of them are women and small children).
I was not sure what to expect from Dharavi. In my mind I thought it was going to be very similar to the first slum we visited, extremely impoverished and somewhat hopeless. The idea of an organized waste management system in a slum was something my mind was having a hard time comprehending. We got off the bus and followed Mr. Shetty along muddy alleys and narrow roads to visit the many waste recycling sites.
I was very surprised to see so many men working in these small and crowded shops, recycling cardboard, plastic, metal from car parts, and a myriad of other things I can’t even remember. The rag pickers collect all the recyclable materials from the garbage around the city, bring it to these shops were they get processed and then sold to either paper or plastic companies for a very small profit. The men not only work, but also live in these shops, making the system sustainable. You’d never imagine to see a system like this in a crowded slum were most (if not all) people lack basic needs and most live on an income of $2-3 per day. Despite there being some level of organization and an income generating system, workers still work in precarious conditions (barefoot, no eye/hand/ear protection), and the money earned from the Dharavi recycling industry will never allow these people to move out of the slums or improve their life and health conditions. As impressed as I was with this slum, the current system is never going to allow social change.
Once again, what being done is not enough to help the community of Dharavi. My mind is still trying to comprehend the idea that earning an income is not enough to fight poverty. Earning a few dollars a day will not improve the lives of future generations. A sustainable system that allows the community to set solid foundations (ie. access to education, health care, stable incomes) will enable the change that is needed.
"I want to be a Doctor when I grow up"
Today at lunch we had a group reflection and discussion on the time we spent in the rural area north of Mumbai, the Thane district. We had a lovely representative from Impact India, Neelam, as our guide and leader throughout the day. She brought us to two different schools, a maternal and child health clinic, as well as the government sponsored community health clinic which is responsible for the primary care of over 50,000 individuals.
At the second school we visited one of the young girls, perhaps 9 or 10 years old, expressed her interest in becoming a Doctor. This, of course, thrilled us – seeing a young girl so full of ambition and aspiring to help others. Neelam had a different perspective; however, and upon leaving the girls’ ear shot quickly proclaimed that this sentiment was simply a pipe dream and was out of the realm of possibility.
This specific experience drove a lot of today’s conversation about the entire days’ experience and leads me on a thought path that branches at many different points. On one hand, how heartbreaking to think that this young girl has such a wonderful dream yet currently has very, very few if any resources to achieve it. On the other, perhaps it is almost a naïve bliss that she knows what she wants but perhaps her scope of understanding is narrow enough to spare her from extreme disappointment. Even yet another thought leads me to believe that it IS entirely possible for this astute young woman to pursue a career in medicine but perhaps not as a traditional American might view it. I would find it entirely possible for her to achieve some level of ayurvedic or tribal education and then be able to practice her medicinal trade throughout her village. Even though she wouldn’t be a Doctor in the sense of the word that we understand it, wouldn’t she still be providing the same type of support, care and service?
For every child we met on that day, there is a story. There is a story of who they are, where they came from, where they want to go and ultimately where they will end up. As budding social entrepreneurs and practitioners of both public and clinical health, it is our job to understand the present and future of our patients and community members, and also to truly understand their past. Without this knowledge, I feel that it may be impossible to impart information, treatment or any type of appropriate care.
Through the eyes of the one little girl, who so aspires to help people through medicine, it is possible to begin to see a global landscape that so greatly affects every part of each human on this planet. Understanding where we come from is the only way to truly understand where we can go.
At the second school we visited one of the young girls, perhaps 9 or 10 years old, expressed her interest in becoming a Doctor. This, of course, thrilled us – seeing a young girl so full of ambition and aspiring to help others. Neelam had a different perspective; however, and upon leaving the girls’ ear shot quickly proclaimed that this sentiment was simply a pipe dream and was out of the realm of possibility.
This specific experience drove a lot of today’s conversation about the entire days’ experience and leads me on a thought path that branches at many different points. On one hand, how heartbreaking to think that this young girl has such a wonderful dream yet currently has very, very few if any resources to achieve it. On the other, perhaps it is almost a naïve bliss that she knows what she wants but perhaps her scope of understanding is narrow enough to spare her from extreme disappointment. Even yet another thought leads me to believe that it IS entirely possible for this astute young woman to pursue a career in medicine but perhaps not as a traditional American might view it. I would find it entirely possible for her to achieve some level of ayurvedic or tribal education and then be able to practice her medicinal trade throughout her village. Even though she wouldn’t be a Doctor in the sense of the word that we understand it, wouldn’t she still be providing the same type of support, care and service?
For every child we met on that day, there is a story. There is a story of who they are, where they came from, where they want to go and ultimately where they will end up. As budding social entrepreneurs and practitioners of both public and clinical health, it is our job to understand the present and future of our patients and community members, and also to truly understand their past. Without this knowledge, I feel that it may be impossible to impart information, treatment or any type of appropriate care.
Through the eyes of the one little girl, who so aspires to help people through medicine, it is possible to begin to see a global landscape that so greatly affects every part of each human on this planet. Understanding where we come from is the only way to truly understand where we can go.
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