Andheri

I finally made it to India! After having my itinerary changed about 4 times, we finally landed in Mumbai yesterday around 2am and were welcomed by a busy crowd and the monsoon season (which in India means 80%+ humidity!).

After failing at getting some much needed sleep we were thrown right into the depths of India. The group visited the offices of AmeriCares, an organization that strives to provide mobile medical services to India’s largest slum, East Andheri. The main focus of the organization is to provide on site medical care, free medications as well as disaster relief whenever needed (Note:

Did you that about 50% of the population live in slums? Unbelievable).

It’s hard to describe what I saw once we got to the slums. We got off to bus and were hit by a strong putrid smell coming from the enormous mountain of waste sitting right next to the slums. If you didn’t know any better you’d think it’s just another mountain decorating the horizon.

The medical van parked in front of a garage-looking structure and proceeded to set up so they could start seeing patients. In the meantime we stood there, trying to take it all in as we started to get the attention from people in the community. The little kids were the first ones to come over to take a closer look and pose for the cameras. Then women started to line up to so the doctor could see them.

Looking around you realize these people have no access to clean water, health services, education or a steady income. Living in unsanitary conditions, among animals and waste is the norm for all the people in slums.

I left E. Andheri feeling disheartened. How can we help? Where to even begin? I hope by the end of this trip I will have a better idea of how to answer these questions.

Can't wait to see what India has in store for us on Day 2!

Smiling through the stench

I am pretty sure I dreamt all of this morning’s events. I am still running through everything that happened, everything that I saw and trying to comprehend it in its entirety.

We woke up early this morning so we could make breakfast at 7:30am, before we left the hotel at 8:00am. Fair to say I was not really hungry when I woke and Lord knows I was nowhere near awake, but I shoveled as much food as possible into my mouth, knowing that we would not be eating again until nearly 3pm. We had a busy day ahead of us.

Dr, Vyas had scheduled our first site visit in the East Andheri slums. We were to go out with AmeriCares India and their mobile medical van to administer routine check-ups and distribute free medicine.

The organization we were volunteering with, AmeriCares India, gave us an insightful presentation before we ventured to the slums. The director, Dr. Purvish M. Parikh, told us about the entire AmeriCares program, how it has been working in 147 countries over the past 29 years, providing free medication, medical services, and emergency response (disaster response) efforts. According to some data that Dr. Parikh shared with us, AmeriCares India’s efforts have been successful throughout Mumbai’s slums: their infant mortality rates have dropped from 190 infant deaths per 1000 children in 2000 to 32 deaths per 1000 children in 2009. What a phenomenal difference one organization can make!

I knew very little about AmeriCares India before this trip and even less about slums in India. I don’t think my mind was able to truly comprehend what extreme poverty was; how literally the poorest of the poor live. I have seen poverty before – the shanty towns on the perimeter of Santiago de Chile, the ghetto in Granada, Nicaragua, and even the many homeless park-dwellers of Washington DC. But all of those experiences are shadowed by what I witnessed today. And what I am still trying to understand.

After surviving the hottest bus ride of my life – quite literally a sweat box with no air-conditioning, no open windows, in the middle of summer/monsoon season – we arrived at one of the main roads that lead into the East Andheri slum. It was an unimaginable sight – next to a huge shanty town, made of makeshift homes from concrete, tarps, and metal scraps was the largest dump in Mumbai. Apparently all of the city’s waste is dumped next to Andheri and this dump is where most of the slum’s population gets their goods for their household and as well as to sell. This dump is a part of their lives.

According to Dr. Parikh, one-third of Mumbai’s population lives in slums. With a population of over 21 million, that’s an unfathomable amount of slum inhabitants. And that’s how it felt when we entered into the slums: unfathomable.

The first thing to hit you will be the stench. It was described by a member of our group as so foul, it made her want to vomit immediately. Imagine human waste mixed with cow/goat/dog feces, add a copious amount of rain, humidity, and the nice addition of tons and tons of city waste and that pretty much begins to describe the smell. Foul. I have to admit, I had to quickly have a come to Jesus with myself and realize what was going on. In between the chauffeured group buses, swanky, air-conditioned hotel, and high-class meals, I have lost track of the reality of poverty in this city. I am still struggling to comprehend that I am in fact in India. Well, the smell of Andheri knocked me to my senses. Literally.

As we walked into one of the main streets on Andheri, we were quite the site. A large group of mostly Caucasian females, wearing bleach white “AmeriCares” hats and snapping pictures left and right. We looked like a walking parody of an Asian tour group. “Now to your left, ladies and gentlemen, you will see a child relieving himself out on the street. And if you look to the right you will see 6 goats running around while children without shoes chase them.” We were quite the spectacle. We walked further and further into one of the streets and with each passing minute more and more children, women, and men gathered around to see what the commotion was. Who are these strange people? And so we just stood there and stared. And the community members just stood there and stared back. It turned practically into an observation competition – who would blink first?

Honestly, though, I have never smiled more in my life. When you have a language and cultural barrier I feel like there is nothing more universal than a sincere, heart-felt smile. And that’s how I communicated with all the people who were swarming around me. I took my hat on and off throughout the morning in the slum, never knowing what kind of mayhem I would cause by having probably the whitest white person ever walking into that community. But everyone was so friendly and so incredibly curious. I must have posed for nearly 10 camera phone pictures and one little girl even asked for my autograph. Most of the children and adults did not speak English – so my relentless smile, respectful “Namaste” and head bow, along with the occasional “hello” were my means of showing this community my respect and care.

This was an exhausting venture though. What I witnessed was some of the worst slum settings in the world. Many foreigners have heard about one of the world’s biggest slums in Mumbai, Dharavi, which was aggrandized in the movie Slum Dog Millionaire. Yes Dharavi is home to over one million of poor Indians, however, that community apparently already has a large amount of local and international NGOs serving them. Slums such as Andheri tend to be forgotten, left to waste next to the city’s landfill. If it wasn’t for Americares India and their relentless efforts, Andheri would most likely have continued to deteriorate into disease. But AmeriCares has stepped up as quite the heroes.

Before the trip we were asked if we had any clinical expertise that could be made useful on this trip into Andheri. I pretty much said my clinical knowledge is limited to putting on a band-aid. We were given the impression we would be working alongside AmeriCares, helping them take vitals (weight, blood pressure, ailment consultation) while serving some worthwhile purpose for not only the organization but also for the community. To my disdain, everything coordination wise ran a bit amuck today. We got lost on the way to the slum, we were given no instructions on what to do once we got to the slums, and we pretty much just stood back and observed the mobile medical unit’s work. Mind you, I am incredibly grateful to have been able to see how a local NGO, who has made such a significant difference in one of the poorest areas in Mumbai, works out in the field. However, my since of disservice was upsetting. Besides being a walking circus for the community members, we really weren’t able to aid AmeriCares to the fullest of our capacity, in my opinion. I know we’re not doctors, but handing out medications would have been something; taking weight and blood pressure; hell, even helping to form a line outside of the shack garage that the medical unit worked from would have provided some purpose for us 20 odd foreigners clustered around the medical van. Anything, something, just please let me feel like I can offer something to these families!

All I can do is hope that my smiles, “hellos,” handshakes, and high fives made some impact in this community. That I might have made someone’s day, that I might have made some of the kids curious and excited about the world outside of their slum, that my attempts to communicate “study hard” were not in vain.

During one part of our trip, a group of us walked down some of the community’s side streets (if you can even call them such) to see some of the living conditions and how the community gets their water. Apparently there are large fuel tank like trucks that come into the slum twice a week to deliver water free of charge to whomever can get it. We saw rows upon rows of empty, blue 5 gallon plastic water bins and groups of individuals waiting to collect their weekly ration of water. This is not our clean, American tap water. This was, though it looks clear, filthy contaminated water not safe enough to drink. I will never complain about DC water ever again. These families, hopefully, will take the water back and boil it before using it for drinking water. However, unless we visit each house, and observe each use of the water, we can only hope that some messages regarding water sanitation and hygiene are reaching these residents. This slum is a water sanitation nightmare. It is, in general, a public health nightmare.

The children ran around barefoot, with lesions, scabs, blisters, and infections on various limbs of their bodies, as well as missing or diseased teeth and gums. What was amazing, though, was that the children looked put-together and clean (relatively speaking). Most of the children we saw were wearing button up shirts, clean jeans, looked as if they had washed their face and brushed their hair. I was taken back and quite impressed. It goes to show that human beings are absolutely extraordinary and are able to adapt and survive in any setting. And in some sense, thrive too (once again, relatively speaking). Obviously these children cared enough about themselves to take the time to clean and prepare themselves for the day. I was expecting a community of half to fully naked children with dilapidated hair and some form of waste all over them. However, that was not the case. Even the mothers whose main responsibility was to care for the children during the day were dressed in complete sari’s and looking absolutely gorgeous. Makes me wonder if Andheri’s residents could teach some of us about how to make the most out of every day.

I was heartbroken to have to leave but I will admit my own exhaustion that came for our over2 hours venture into the slum. It was an emotional rollercoaster for me. I wanted to cry at the devastating living conditions of these families but needed to keep a smile on my face; to stay strong and just be there. I kept having out of body experiences, never sure of what was really going on around me – what was I actually seeing. It’s amazing what the brain is able to process, and what it needs time to comprehend. I really hope we get to do more work similar to this today, or at least get to work more in the field, on site, with these local nonprofits that are making serious differences.

Being in Andheri made me question joining the Peace Corps – yet again. This has been a serious debate inside my head for years now. Quite literally, years – since starting high school, some odd 10 years ago (holy crap I’m getting old!). Being out in the field is where I think I strive. I need to make those person-to-person connections, really see how the resources come to fruition out in the communities – not behind a desk in some cube in some fancy air-conditioned building in some city that doesn’t understand. I am definitely not your typical 9 to 5 kind of gal. And I am learning to embrace that. I was so incredibly happy in the slum today. Sure, the stench needed a hint of febreze and I wasn’t exactly sure what was on the hands of those children that I gave high fives to. But dear God, I loved it. I even relished stepping into a puddle of lord knows what, because I was at least out IN the community, seeing the reality for myself. This is where I want to be, I just need to find a means to do the work I feel I was meant to do. Like my Berry College Professor Dr. John Hickman loved to say to me, “You seem like someone who would love to go spend their life [defecating] in a hole.” I couldn’t have said it better myself. (original word replaced for sensitive eyes)

I am working to remaining focused on my purpose here; on my personal growth and how these experiences can shape my potential life path. This is and is not all about me, a perplexing dichotomy of sorts. I am here to learn about the challenges and successes of local non-profits, the public health struggles of one of the fastest growing (population and economy wise) countries in the world, and how a small set of people can truly make a difference for a community. This is some pretty cool stuff. And very much real.

We’re in India – in the middle of monsoon season, in the middle of the summer. It is going to be hot, and sticky, and we’re going to smell, and there’s not going to be bathrooms or air-conditioning or English-speaking individuals. But, that’s okay, because we’re in India.

Tomorrow we head to the Red Light District where we are going to be leading a training workshop/ focus group on public health issues for the sex worker community – which consists of men, women, and a transgender population. We will be working with Aastha Paarivar, a local organization that focuses its efforts on empowering the sex worker community with HIV/AIDS and STI (sexually transmitted infections) prevention education. Despite the struggles to coordinate discussion information amongst all of the GW students today, I believe this workshop will be very successful. At the very least, an insightful afternoon.

For now, I bid you adieu until we meet again.

Love, Char

Five Minutes…Or An Hour

These were the words our bus driver said on the way back from a long day shadowing a mobile medical clinic. The trip there had been long and hot, without air conditioning or windows we could put down, and he assured us that the trip home would be short…unless there was traffic. Wow, Mumbai traffic. It seems like it is always rush hour. But as Meaghan so eloquently said, our temporary inconveniences, like broken air conditioning and traffic jams, are frivolous compared to the deep social problems we witnessed today while shadowing AmeriCares India.

I could not help but compare the mobile van to the mobile clinics I volunteered at with another GW group in Ecuador. The mobile van here certainly had tougher logistical challenges, including setting up shop right on the street and in a small garage/warehouse as opposed to an entire school campus. The process seemed a bit frantic, but that was likely due in large part to our disrupting presence. Another downside is there was little privacy for the patients, which may have prevented some from sharing the true reason for the visit, especially the sex workers that we learned were among the group. However, one huge positive of AmeriCares’ mobile vans that I was pleased to hear from Dr. Purbish Parikh is that they visit each neighborhood every 15 days, so there is continuity of care. If patients have chronic diseases, AmeriCares gives them medicine for that entire 15-day period and then returns with more. And, this reliability also means that patients come to trust the doctors and the organization. This was not true of the mobile clinic program we saw in Ecuador, which might get to a village once very three months at most. I came away from that experience jaded by the idea of mobile clinics as I had handed out five-day supplies of vitamins to kids who wouldn’t get more for months and two-week supplies of heart medication to patients who needed consistent care. I am pleased to see AmeriCares has limited its focus enough to provide reliable, consistent care.

Despite AmeriCares fervent efforts, however, the mobile vans could not address the community’s root challenges including clean water, sanitation, and waste management. We talked about how essential water is and how it seems these high-level challenges seem too daunting for any one organization to take on, or too costly for the government to intervene. I will be interested to hear and share ideas throughout the rest of the trip about what can be done to solve these structural level problems.

Perhaps most notable from the day was that, in the face of such daunting problems, the people we met were surprisingly happy and incredibly friendly. I enjoyed in particular joking with some of the local boys about Bollywood actors (through Rashi, one of our Hindi speakers!) and hearing some of the little girls sing.

The Mother of Landfills

Our second day brought a challenging experience which tested even the strongest wills and stomachs. The day was scheduled to be spent with AmeriCares India, the Indian subsidiary of an international NGO operating in Mumbai. After meeting with the managing director of AmeriCares, Dr. Purvish Parikh, to learn about the organization’s work and impact, our team joined a mobile health clinic as it made its bimonthly visit to the slums outside the Shivajinagar landfill area.

After dealing with the traffic (clearly building up to being a recurrent theme) for over an hour in a hot bus, and a bit beaten down, I was completely unprepared for the sight of the solid waste trash hillocks that appeared in front of the bus’ windshield. These 5-6-storey or more tall hillocks were the dumping grounds for the majority of the city’s solid waste. Over time and given the healthy monsoon rains coupled with organic materials mixed in, the hillocks were sprouting a mantle of greenery. From a distance it almost looked like pretty green hills in the misting rain but as we approached closer, one could see the plastic and other refuse poking through. And then amidst the collage of trash, like the 3-D picture puzzles that reveal hidden images embedded within as the visual focal length moves into an optimum range, we noticed people picking their way through the trash, looking for recyclable objects or merely using the dump like one big open-air outhouse.

The team joined the mobile van in a side street of the community adjacent to the landfill and observed their clinic operations. However even our mere presence was disruptive to the clinic’s work. Community members thronged about us curious about the visitors from overseas. Soon however, the residents turned their attention to the medical staff who provided free blood pressure and diabetes screenings, consultations and medicines.

Our guide explained that many residents in the community especially women and children made their living picking through the landfill trash looking for recyclable materials to exchange for money and that many of them contracted illnesses and injuries as a result of tramping through the trash. All in all it was one of the more disadvantaged communities in the city. The impact of seeing humans living under such environmental conditions was very unsettling on many levels and many in our group were unusually silent on the way back to hotel. Coming up with solutions to such abject poverty is not easy although the experience was critical to our holistic understanding of the public health issues facing India today.