The weekend was filled with some more adventures that
included munching on some delicious tapas and learning some traditional Indian
dance moves. Bollywood, anyone? More on these adventures later – for now I’d
like to share my experience venturing into rural India with the
Impact India Foundation (IIF). After the
formal GW program ends this Friday, I will return to Bombay for a couple of
weeks to complete my practicum (120 hours of fieldwork required to complete my
MPH) with the IIF, so I was exceptionally excited to have a first-hand look at
their work. IIF has been in operation since the early 80s with the following
tagline: “action today to prevent disability tomorrow.” In India, they are
perhaps most well-known for their Lifeline Express train, which travels
throughout the country performing life-saving surgeries at each stop. The
outside of the train is decorated in rainbows and flowers and inside it is
equipped with state-of-the-art medical equipment and operating tables. The
train has been in operation for more than 20 years and has served more than
700,000 people! Using the Lifeline Express as a trust-building mechanism within
communities, the IIF has vastly expanded their work into rural parts of the
country where they focus on health education to prevent future disease and
disability.
Our day began with a couple of hours on the bus driving to
the Thane District in India, which is north of Bombay. We were accompanied by
the CEO of IIF as well as some staff members and the local press who were
working on a story about our visit. As we left Bombay, I could feel my entire
body beginning to relax and take in the green scenery that quickly filled our
view from the bus. Crowded streets were replaced with lush landscape and rice
fields and the honking horns gave way to the sound of rain. It was quite
beautiful. Our first stop was to a school for children ages 6-10. They were in
the process of their daily health lesson. One group of children played a game
that closely resembled snakes and ladders only all of the stops on the game
board were health-related. Another group was seated in a circle while the class
health-monitor went around with a small notebook examining and questioning her fellow
classmates: did you wash today? are your ears clean? are your nails clean? do
you feel hot? Based on the responses, she either recorded an “X” or a “check.”
If one of the students was not well, he or she would be sent home with a note
with a recommendation to visit a local health center. I was amazed at the level
of patience and participation by each of the students. They take this process
very seriously and obviously value their health. Upon leaving the school, they
sang us a few songs and wished us well.
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| Working the rice fields |
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| Children playing snakes and ladders |
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| Class health monitor marks her notebook |
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| Children singing about the rain |
Our next stop was to an immunization center where rural
families (well, rural women) bring their children to be immunized. They offer
shots for things like Hepatitis B and tuberculosis and they keep cards of each
of the children so they know when they are due up for future appointments. With
an infant mortality rate in the district of approximately 50 per 1139
live-births, which is quite high, these immunizations are critical for the
survival of children. (FYI, the infant mortality rate measures the number of
children who die within their first year of life per all live-births.) At that
center, they also provide prenatal care to women who visit at a minimum of four
times during pregnancy. In an area where many women deliver their babies at
home and receive no prenatal care, this is impressive and hugely important.
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| Nurse prepares syringe |
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| A child waits to be immunized |
Next we visited a government-operated daycare center. Here, the
IIF provides training one day per month to someone called an asha who is
responsible for then subsequently relaying this health information to the
community. After the asha is trained, he/she gathers community members in the
daycare center to hold a class session. Instead of the IIF going into the
community and trying to relay important health information, they’ve found an
outlet from within the community to serve as a catalyst for these messages.
This helps to build trust and credibility and messages are much more
well-received – a brilliant model. While we visited the center, the asha was
finishing up a presentation on anemia to a large group of tribal women and
girls. We tried to engage in discussion with them about what they had learned
but they were too shy to respond. I can’t say that I blame them – a large group
of Americans parading into a community meeting is far from their norm.
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| An asha (lower left facing crowd) presents to her community |
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| Home in a rural village |
Our second to last stop of the day was at another school,
this one exclusively for adolescent girls. We were previously asked to prepare
a session for them about anemia and I think it was a hit! We drew simple photos
of four main take-away points that we wanted them to remember: wash your hands,
take your vitamins, drink your water, and eat your vegetables. The girls
participated in our activities and I was impressed by their knowledge on the
topic. For example, when I held up my picture of a carrot and asked them why it
is important to eat vegetables, one girl responded that they were important for
your eyesight. Well done, my friend! We emphasized the importance of vitamin
intake because the girls receive packets of vitamins from the government but
often choose not to take them for fear that they make cause harm. I hope they
will remember and practice the lessons we left them!
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| Adolescent girls listen to our presentation |
Finally, we stopped at a primary health center, which serves
60,000 people in the district. Residents first visit the sub health centers and
if they have an issue that cannot be addressed, they are referred to the
primary health center. At the primary center they so things like deliver
babies, treat people for snakebites, and doll out drugs for malaria and tuberculosis,
which are both highly prevalent in the area. We met with the medical doctor on
site, toured the facility, and then we were back on the bus to Bombay.
I am truly impressed with the work that the IIF is doing in
these otherwise largely neglected parts of the country. They set out with an initial
goal to reduce existing disability among the 2 million tribal people living in
the Thane District by 50 percent over the last several years. To date, they
estimate that they’ve reduced it by 72 percent. Now, they are focusing on
prevention of future disability through their educational efforts. Their
approach is well-tested and uses resources from within the community so that
the changes they make are sustainable. They also partner with the government of
India to make sure that the free services offered to the people by the
government are being fully utilized and understood. I commend both their approach
and their tactics and look forward to serving them well over the next few weeks
back in Bombay. For now, I’ve got to hop on a plane to Delhi – see you there!
