Despite India's impressive economic growth over recent decades, the country continues to face challenges of poverty, illiteracy, corruption, malnutrition and terrorism. Approximately 70% of the country lives on less than U.S. $2.00 a day. Yet, India is a home to over 3 million NGOs. Many of these leaders are working tirelessly to improve the social conditions of the country.

"Introduction to Social Entrepreneurship: A Case Study of India" will challenge students to confront more advanced issues faced by today's social entrepreneurs. The field experience of the course will take students to Mumbai and India. Students will meet Social Entrepreneurs and NGOs working at all societal levels to understand grassroots' needs as well as the overall public health infrastructure in India.

Monday, August 06, 2012

Day 9: Impact Making An Impact

Today was a super early day! We met on the bust at 7am to meet the folks at the Impact India Foundation. I loved their mission’s motto wish is: Action today to prevent disability tomorrow. We met with their CEO Mrs. Zelma Lazarus who welcomed and oriented us to their organization’s work over breakfast. She spoke briefly about the fact that they are most renowned for their Lifeline Express train which is a really amazing mobile hospital that provides free treatments and surgeries to those who are poor and disabled in India. The idea of a mobile clinic is something that I’ve noticed even the United States as a best practice for NGOs to impact hard to reach populations. We learned that since the lifeline project was launched in 1991, it has served thousands of people and is sustained by the donated services of medically trained professionals from all over the world. She then quickly shifted gears to talk about the main impetus behind their work which is their community health initiatives (CHI) that includes a model called the “Ashramshalas” for comprehensively educating tribal schools/communities about the benefits of public health. After the introductions at breakfast we got back on the bus and traveled for about another hour to visit the various CHI sites. 

Five site visits:
We first went to the primary school where we saw babies that ranged in age from about 1-8 years. It was immediately a wake-up call for me because I realized that not only were we as students unable to communicate with the tribes but a lot of the Impact staff was unable as well. I then wondered how the rest of the day was going to progress and on a larger scale, how were they going to ever reach their 50% reduction goal for the incidence and eradication of disabilities/preventable disease? We stayed for a while taking pictures and eventually listened to the children sing their national anthem. It was interesting that they had elected classroom officers and a governor that maintained the order. The elected student apparently makes the rest of the class accountable for incorporating their basic health education such as sanitation and hygiene into their daily lives. We left shortly after we realized our presence was making the younger babies cry. Apparently they thought we were going to give them their vaccination shots!

Next, we traveled to the immunization center where we only saw women gathered with their new babies. Before entering the space however, we were blessed by the lead nurse who on most days womans the station by herself. There were at least twenty women packed in the space, some with babies and some without. A few of the new mothers were breastfeeding which was really encouraging to see since one of Impact India’s programs is focused on encouraging breastfeeding for six months. It was so sad listening to the babies cry after their shots. Since a lot of them were malnourished, their screams were very faint. We learned here from the lead doctor of the CHIs that they have pretty thorough medical records’ protocols that is regularly updated and coordinated with the government surveillance team as a measure to ensure that the registered babies have updated shots. We were also assured that the doctor has an outreach team that regularly follows up with the women in the fields to encourage consistency and compliance.

Third, we went to see a health education workshop in session. The teacher was a tribal woman that had obviously been trained by Impact India to share information about various health topics. When we entered, she was reading about the consequences of anemia, how to avoid it, and what supplements/foods are needed to manage it. This session was open to the public but only women attended which I thought was quite interesting as it mirrors some of the trends/public health frustrations in the U.S. We tried asking the women questions about the workshop and how it impacted their day to day lives but they were incredibly shy and/or confused about why we were there. The Impact staff seemed to have a distant relationship with the women so I sensed that our presence made them even more uncomfortable. We did learn however that they had a lot of concerns around prenatal care. The trained facilitator/teacher of the group was able to translate for us that they were mostly concerned about what to do about fertility problems. I kept thinking about how imposing we must have been to this group of women and wished that they were more informed about why we were there. I also learned later that they were embarrassed to talk about their health concerns around men. All in all, I think that good work happens here but I wasn’t sure how they were able to monitor the improvement correlations. It did seem like more of the women attended the health centers to the recommendations of Impact India which is a major plus in terms of meeting organizational objectives.

Fourth, we went to the school for adolescents. There were boys and girls in session but the classrooms were split so we met with the girls. Our goal on this visit was to learn a little about what Impact India was teaching them but also to host our own health education workshop on the importance of nutrition and good pre/postnatal care. This was my favorite site visit because it was engaging, relatable, and I felt like our presence was appreciated and understood. The girls there were very curious about our marriage goals, how we lived in the U.S. and all of our names. It was a give and take discussion thanks to Netra who stayed around to translate our conversation. When they warmed up to us, they even asked how we ate back home and what our daily schedules consisted of between school, life, and work. After talking to them about the importance of having personal goals before committing to marriage I felt less and less enthusiastic about teaching the young girls (6 or 7th graders)about pre/postnatal care. Luckily, we were able to quickly adjust and decided to focus on the importance of nutrition broadly. We taught the girls a quick song and asked them to sing along. Then we taught them through picture art how water, vegetables, and vitamins can help them grow into strong, beautiful girls. The trend in this school is that the girls have a early and high drop-out rate due to a host of family obligations but largely because the school has no bathrooms. Impact India just got funding to be able to install a toilet dock there which is amazing! And by next year the girls’ studies won’t be interrupted simply because they have their periods during school.  Since they were seemingly impressed by us, we told them that staying healthy and taking heed to their lessons would allow them to be just as impressive!

Lastly, we went to the community health center where we saw how and by whom the community received care. We learned that only two doctors staffed the health center for a population of 60,000 tribal residents!! The doctor seemed very calm and in touch with all his patients but just hearing that the number made me exhausted yet he was happy to take our million questions and didn’t even seem burned out! We learned that the biggest issue for the residents is getting malaria as well as having snake bites since so many of the people work in the fields. He told us that all the care was provided at a very low, subsidized cost- 5 rupees which in the U.S. is less than $1. On a first come first serve basis, the tribal residents come to the center to get minor outpatient surgeries, medications (they have a free pharmacy on site), medical advice, and treatment. If the needs of the patients are too high, then they are referred to and provided free transportation to the main hospital for care.

In all, Impact India had a complex operation that served many functions to improve the tribal community’s health outcomes and dismantle the cultural myths that perpetuate health disparities. Impact India staff used blue hats to gain the community’s trust and to identify who they were. Still, I worried about the overall attitudes of the people. Did they really trust and embrace Impact India’s strategies? Were there any real, cooperative relationships between Impact India and the tribes? I think their mobilizing strategies can be improved by hiring younger staff and putting more emphasis on their each one teach one, train the trainer model. I think this will allow the residents to have more ownership over what they are learning and will inevitably reach their families and neighbors quicker. I look forward to hearing from Sam how this organization really operates since today was so controlled by the staff.  
















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