1 circus bus

Thursday was Raksha Bandhan here in India, a holiday that celebrates siblings. As a result, a few of the organizations we had initially planned to meet had to do some schedule rearranging and so we found ourselves back at the AmeriCares India headquarters bright and early. There were a total of six of us feeling up to the excursion – five students and Dr. Parrish (one of the GW professors). The AmeriCares staff invited us to join them on their morning mission: delivering medical commodities to Chembur, an urban slum in Bombay. After packing up the AmeriCares car, our bus followed them for about an hour until we pulled into a narrow, rickety side street. Immediately I knew that this was not the sort of slum we visited previously. The smell was intense, trash was piled high, roads were muddy, and when we stepped off the bus it was as though the circus arrived in town. Children came running over, thrilled to walk with us through their neighborhood. Some kids spoke English well and we talked with them as we walked to the medical station. It seemed as the further we walked, the more children accumulated. Their energy was infectious and each one was eager to say something. They wanted to know our names and giggled like crazy when I repeated their names back to them. One boy talked about his school, how he loved studying science and math. Another told me his favorite color was green. They sang songs and acted as our personal bodyguards as we navigated their alleys.

A boy sitting in the entry way to his home

Me and some of the kids!

When we arrived at the medical clinic, we were able to enter and see how the operation worked. Lines formed at the door, information was logged into the laptop about each patient, and paper records were filed. The head doctor at the center pulled out a file for a woman who was being treated. He showed us where they had logged her last visit and how they were tracking her progress. Given the sheer number of people, it’s quite a feat to have such reliable patient records. The doctor visits this location once every two weeks and sees between 100-150 patients in the few hours he is there. Can you imagine if clinics in the U.S. could treat so many people in such a short time? So as not to disrupt the flow of traffic, we didn’t spend too long taking up precious space in their small workspace.

A staff member (left) checking in a patient

Dr. Parrish looking at the medical records with the on-site doctor from AmeriCares

Our growing cohort of kids eagerly greeted us upon exiting. They wanted to bring us to their school. We walked through dark, damp, narrow alleys lined with homes to get to school. Running directly down the center of the alley was an open pipeline, likely a sort of sewer system. We hopped from one side of the opening to the other, trying to avoid goats, people, laundry lines, buckets, food, trash, and of course, the kids. When we arrived on the grounds, they showed us their school building and then they proudly pointed out their jungle gym. My heart immediately sank and I could feel a welt building in my throat. Their playground was a rusty, old, piece of medal that resembled a Ferris wheel. Around it sat muddy, trash-laden grounds. Of course I warmly acknowledged their prized playground, but inside I couldn’t help but swallow feelings of utter sadness. These kids will never know the triumphs of making it across the monkey bars successfully or the thrills of swinging just a tad too high. Yet, they appreciate what they have and make the most of it. In our consumptive-centric society where we are always waiting for the next version of whatever Apple’s releasing, these kids provided me with an overdue reminder to appreciate some of life’s simple pleasures. Truth be told, not everyone has this opportunity.

Our growing cohort of children

The payground

As we wrapped up our whirlwind tour, I found myself reminding the kids to stay in school and study hard and thanked them for their graciousness, albeit intense at times. When we got on the bus, one of my classmates rightly pointed out that, unfortunately, even if those kids do stay in school and study hard, few if any, will ever leave that slum. Driving away from the chaotic experience of children hungrily vying for our attention while simultaneously trying to process the world in which they live, we all felt a bit deflated and helpless. Yes, helpless. The irony is not lost on me. We all wished we could have done more than provide them with much-craved attention for a short while. Alas, until the government of India along with its many NGOs can catch up to its growing populations’ health and environmental needs, these grave disparities will exist. This experience reminded me why I study public health. It reminded me why investing in innovative solutions to address health needs that are sustainable and scalable are the way to a brighter and healthier future. Change, especially behavior change, doesn’t occur overnight. In fact, it takes time, energy, persistence, and leadership. I am hopeful that change is on the way, but it doesn’t make it any easier to process the current realities in the interim.  

Homes in the slum

Later in the afternoon, our group visited SNEHA’s warehouse where women create bags, quilts and rugs from leftover fabric scraps. As I mentioned, through this process women are able to earn up to four times as much as they would otherwise. Their products were incredible and our team virtually bought them out! Stay tuned for more about SNEHA’s other initiatives… 

Quilts!

Mini Doctors

 Impact India has instituted a program where one child is the “health commissioner” over ten of his or her friends. Weekly checkups are given to see if the group is staying healthy and those findings are then reported back to the child’s family and then community doctor. We got to visit this program and I watched the children gather in a circle as the health commissioner of that group would grab his or hers friends hands and look at their nails to see if they are clean and then rotate their ears to check for wax. While observing this, the word that came to mind was accountability.

The health commissioner was there is make everyone accountable for keeping in good health. I thought it was such a clever and innovative way to engage children in their health at an early age. It was making them aware of health issues and empowering them to change their behavior in order to get better marks from the health commissioner, which in turn was benefiting their health. Behavior is noted as being the hardest aspect to change in the realm of public health. One reason for this is the challenge to make a person consistently engage in a certain action or behavior. When someone is not held accountable on regular basis, it is easy for the individual to become lax and disengaged. The theory behind having the weekly health commissioner checkups is to reinforce participating in healthy behaviors on a daily basis. At ten years old these children are learning better habits and becoming more knowledgeable about their own health than perhaps their parents. This program gives the hope of setting a precedent for healthier generations to come. 

5 team members and one great map

On Wednesday our team met with AmeriCares India, a non-profit organization making a remarkable impact on the health of people living in urban slums in Bombay. In 2009 they were voted the best NGO in India, and when you’re in competition with some 3 million NGOs, that’s quite a title to earn! 

AmeriCares sign

Their work focuses around three main pillars: medical commodity assistance, disaster response and preparedness, and mobile medical units. Perhaps what I enjoyed most about this site visit was that we were assigned a task that would greatly benefit the AmeriCares team: a mapping exercise. Because many of India’s slums are so densely populated in such a haphazard fashion, it is exceedingly difficult to be able to monitor and evaluate population coverage of various medical services. Therefore, the GW cohort broke up into three different groups and set out with AmeriCares staff members to map the Chandivili Pipeline area of a slum in Andheri East. 

GW team and AmeriCares staff preparing to head out for the mapping exercise

My team consisted of five members: myself, Dr. Vyas (one of the two GW professors on our trip), our teaching assistant Nitasha, Dr. Seema Peterson (one of the doctors from Americares) and one other AmeriCares staff member. Let’s just call us the Fab 5 (Olympic gymnastics, anyone?). We were assigned to map out the first section of the slum by identifying lanes, bylanes, and sub-bylanes and within those lanes, counting the number of doors. We also noted any landmarks that might be useful such as corner stores, latrines, temples, etc… It wasn’t the most scientific operation considering we used pencils and papers, but I think we did a pretty good job! 

Working on the map

While we were walking around, we stopped into one of AmeriCares medical centers and got to meet the staff members who were treating a line of people that formed at the door. They use laptops to log patient information and each patient has a unique 14-digit number used for tracking (similar to a social security number). All of the services are free. The map we produced will help them to better track their services within the community.

The Fab 5 in one of the AmeriCares medical centers

As far as slums are concerned, this was by far the nicest one I’ve visited. The streets were mostly laid with brick or stone and the houses had sturdy foundation. Now, don’t get me wrong, this was still a slum with trash mounds aplenty and poor access to potable water, among many other noticeable problems, but as I would learn later in the week, it could have been much worse. People also seemed highly interested in what we were doing, inquiring about the purpose of our survey. There were satellites scattered about the streets, a sign that televisions were likely to be found in many of the homes; everyone seemed to have a cell phone. Being the only white person on the Fab 5 team, I stuck out a little and seemed to get some lingering stares and waves from many residents. It’s not often that they get a freckle-faced girl from the States parading around their neighborhood! So, I just waved back with a smile, which seemed to excite many of the children. All three groups wrapped up their work and returned to the AmeriCares office for some lunch and discussion.

Community water pump

Over lunch, we learned more about some of the high-tech medical devices that they are in the process of piloting and my mind was blown! They are testing out a machine in which a person is identified either by their fingerprint or by face-screen recognition technology. Usually these devices are used for security (like in those crazy Jason Borne movies). Here, they are using it to better healthcare! Using a cloud-based computing system allows AmeriCares to track people and communities over time to identify health trends. I mean, wow! They also use a texting system, which reminds people on their cell phones about upcoming appointments or when to take their medications. I’d say this pretty much defines cutting-edge, especially given the environmental context in which they work.

After picking our jaws up from the floor, stunned from the technological devices, we returned back to the hotel, rested a bit and then prepared for dinner. Unfortunately, several students fell ill with some sort of stomach bug, so by the time dinner rolled around only five of us remained (plus our professors and TA). We piled into two taxis and after getting lost for a bit, arrived at the home of Fiona, a volunteer for the Society of Nutrition, Education and Health Action (SNEHA), where our group would visit on Friday. She had a beautiful home and graciously cooked dinner for our whole team. It was a feast! We ate with her and her family and got a sneak peek into some of SNEHA’s work. She talked in-depth about one of their many programs. One in particular employs women living in urban slums by collecting leftover scraps of fabric from local stores, training women on how to sew, and providing them with warehouse space, thus enabling them to create handbags, quilts and rugs. These products are then sold and the women earn up to four times their average monthly salaries throughout the process. This project epitomizes social entrepreneurship and the products were beautiful and exquisitely crafted! As a part of this course, we have to write a business plan using a social entrepreneurial model, and mine will focus on getting their products more widely marketed. I am thrilled to take on this task! We visited the warehouse later in the week. More on that to follow… 

Feasting at Fiona's!

Day 6: Who Says You Can't Do It All?

Today we met with the founder as well as the program directors of SNEAH (Society for Nutrition, Education and Health Action). Their mission is to increase the amount of healthy women and children with the goal of creating a healthy India. Key to this organization-beyond its immediate ability to impact and improve communities- is its legitimate voice and expertise on maternal child health, sexual and reproductive health, as well as domestic violence issues within the government. SNEHA partners with the existing Govt Integrated Child Development Scheme (ICDS) that runs Anganwadis which addresses malnutrition in children under the 

 age of 6. I realized that this best practice helps them avoid resistance in government and tapping into some of the funding reservoirs affording them the ability to recruit more allies and stakeholders. They have a sexual and reproductive health program that addresses and empowers adolescents as well as women; they have a domestic violence prevention program; a maternal and newborn health program; and a child health nutrition program. 

SNEHA was the most impressive organization simply because despite the fact that it had so many different wheels churning, they are able to execute their plans in a manner that resonates and benefits the communities that they set out to serve. Not only are they able to meet their goals and maximize their impact, they also are open to expanding and taking suggestions that broaden their reach. For example, they have assessed that while they are successful in creating awareness about domestic violence and getting the police and the community to realize that a woman being abused by her husband is in fact a public health issue that needs to be addressed, the accountability piece doesn’t quite stick unless men are involved in the conversation as well. This to me was incredible because many organizations that I have observed/worked with are unwilling to broaden their scope, change their target demographics, or even express that things need to change in order for them to become more successful- certainly not to a group of imposing spectators. 

After the directors shared their presentations about what they did in their respective capacities, I then opted to follow Ms. Garima Deveshwar Bahl to learn even more about how the sexual and reproductive health program functions on a more practical level. Nothing could have prepared me for what I was about to witness. First of all, the Dhavari slum, one of the world’s largest slums, was such a humbling experience to consume. As I was walking on the tiny path hopping over different cracks in the narrow blocks of cement, I tried to imagine if that were my daily reality and how different my life/priorities would be. Then before I could even feel sorry for the community that did live there, I was greeted by all these smiling children and then invited into the home of one of the peer educators that works with SNEHA to make sexual and reproductive health a reality for the women of the slum. Her home was literally smaller than my bathroom yet she welcomed all of us into her space and was a gracious host. You could tell that she was proud of her space as she was among the few that was able to actually purchase it. She even rented out the unit above her for revolving tenants. She was definitely making smart business moves as she was also supporting her husband and family for the first time so her involvement with SNEHA was definitely a badge of honor. Three other women who also worked with SNEHA came inside to share their experiences while the program director, Ms. Bahl, translated what they shared from Hindi to English. It was so amazing learning that some of the same challenges that I face in America as a sexual and reproductive health advocate were quite similar to what these women face here in India. They were expressing how they navigated the stigma that circulates a woman safeguarding her health and negotiating condom use; how they had to convince other women to explore and celebrate their bodies by looking at their vaginas with mirrors; how they found their voices in the work; and how they support and learn from each other. It was also interesting to learn that they also had difficulty practicing what they preached in terms of translating what they knew about safe sex and demanding condoms use within their personal relationships. It was refreshing to hear that they have developed close relationships with each other as well as with the women that work with in the communities. Also, they talked about having expanded their reach to the transgendered community and how they have recently begun inviting them to their workshops. I would imagine that that level of engagement has certainly transformed how transgendered folks are viewed and valued in their town. We talked for what seemed like an eternity and I still couldn’t get enough. Just to hear that SNEHA had empowered these women financially, emotionally, and physically and contribute their strengths and talents beyond their expected roles. 

After we learned about the sexual and reproductive health program, we all went to see how the child health and nutrition program functioned which was amazing! Again in another slum, we saw how many children were in need of better nutrition. Interesting about this program is how practical it is! To emphasize the importance of nutrition, the mothers have access to SNEHA’s daycare center that uses the space to assess who is malnourished and in need of other services that could stimulate improved outcomes. This not only keeps the children and mothers in a concentrated area for follow-up and observation but it also allows the mothers to basically get free consultation and childcare without interrupting their workday responsibilities. I loved that the doctors and lead social worker that worked with these children and mothers were able to take their professional hats off and perform songs and dance theater as a way to infuse the benefits of healthy eating and breast feeding. Not only do the mothers learn about the importance of nutrition but this daycare centers serves as a coordinating system that provided what it is that they refer such as vaccinations and healthy foods. I hope that someone from our program volunteers their evaluation skills to program so that we can examine their needs and increase its impact!