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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