"These Girls will Never Leave"

Day 4 - Thane District

Today will be a bit scattered brained for me as I really not feeling well. It made it really difficult to be a part of the experience and I missed out a lot. However, I was able to take in a lot and learn a lot from my peers and what I saw for the children.

We got up early today and headed over with Neelam, a member of the Impact India Foundation to Thane District, a rural area three hours outside of Mumbai, and approximately 25 kilometers away from the border state of Gujarat. Neelam, was kind enough to be our tour guide of the day. En route to Thane district she also explained what wonderful things Impact India Foundation has done for rural areas in India, such as Thane District. Impact India has been around for approximately 20 years, working specifically in the following three projects:

1. The Lifeline Express - a hospital on a trail that halts for about a month at each rural location which each project.
2. Community Health Initiative (CHI) - decreasing the incidence of existing disabilities through preventive and curative measures
3. Ashramshalas - A model project for improvement of the tribal residential schools for holistic development of rural children.

We had a lot ahead of us that day. We did not get to see the Lifeline Express but heard lots about it. How this hospital on a train is able to reach numerous villages and individuals that normally would not have access to care. The physicians and nurses on the train perform common surgeries to restore movement, hearing, sight and correction of clefts -- giving individuals a new sense of light, hope, and future.

We did have the opportunity to understand more about the community health initiative and ashramshalas. Our first stop was the Bapugaon Ashramshala (Village Residential School for tribals).

I loved it here. For one, the quiet and stillness of the village, coupled with the greenery that spread miles long. It was beautiful. We visited a school here that boarded over 500 students of tribal families. In order to provide these children with access to an education and a future, an association was formed with the Government. Even so, these girls and boys lacked so many resources and access to care. Though between the ages of 11 and 14, they looked six. Physicians, volunteers and individuals such as Neelam, have worked with these children to conduct body mass indexes, A1c testings, counseling on Vitamin A and importance of immunization. The girls we met, were able to tell us the importance of Vitamin A and conducting biomarkers. They were eager to share with us how they have learned to conduct BMI's as indicators to help them stay healthy. Yet, two of the questions they posed to us was: "How come you are so much bigger than us?" and "What can we eat so we can be as big as you?" It was heartbreaking.

After we sat in a group for awhile, we had a few minutes before our next visit, to have some one-on-one conversations. We used this opportunity to ask what these girls wanted to be when they grew up. Many were shy at first but one girl spoke up and said she wanted to be a doctor. Neelam later told us, these girls will never leave and have never left, for there is not even a name for how low they are in the caste system.

The rest of the day, our group went to a Primary Health Centre and a Mobile clinic. Unfortunately, I wasn't well and had to miss these site visits. I was sad to have missed such an experience. From what I gathered from my peers, spending time with tribal families in the outskirts of Mumbai was life-changing. Understanding how medical care is reached to the indigenous people of Thane District and how they seek care is fascinating. I also wish we had an opportunity to visit the Lifeline Express, or as Indians refer to it as "The Magic Train of India".

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This day was hard because back home, I get questions from so many people asking me if the caste system is still in existence. All this time I said it wasn't. Today, I realized that as far as India has come, the country has not done justice in educating so many people and for that reason certain fallacies, will never be trumped. All you can do is continue to bring hope and empowerment through education and expression of education.

Hesitation with trepidation leads to exaltation.

08.05.11

Tumultuous ride
Vast green fields are spreading wide
Here lies unknown land

The window is blurred
The clouds linger blearily
The world feels heavy

My body rejects
My mind feels toxicity
Imodium please

Many miles pass by
Within a gate we do find
A microcosm

This school is my heart
This tribal clan is my kin
This unknown is home

I find purpose here
My path is suddenly clear
This school is my home

Their smiles are loving
Their interest is sincere
These children know me

Their laughs enchant me
But I see their hidden pain
All, deficiency

One NGO works
Impact India does help
But is this enough?

Many dreams they have
But what could be their future
No college for them

These children are bright
Some strive to be doctors
But how can that be?

I feel great sorrow
I feel great, fiery passion
I want to bring change

This school is the start
Education is a must
Opportunity

Invest in knowledge
Without school, there is no hope
The rice fields await

I wish I could stay
Spend my life helping these kids
I am here for you

This school is the start
Education is a must
Opportunity

But, alas, I left
I may never see them again
That thought breaks my heart

But I am hopeful
Another school I shall serve
Valsad waits for me

This trip gave me hope
This school is where I should be
Teaching tribal kids

This school is the start
Education is a must
Opportunity

This school is my heart
This tribal clan is my kin
This unknown is home.

this school is the start.

"I want to be a Doctor when I grow up"

Today at lunch we had a group reflection and discussion on the time we spent in the rural area north of Mumbai, the Thane district. We had a lovely representative from Impact India, Neelam, as our guide and leader throughout the day. She brought us to two different schools, a maternal and child health clinic, as well as the government sponsored community health clinic which is responsible for the primary care of over 50,000 individuals.

At the second school we visited one of the young girls, perhaps 9 or 10 years old, expressed her interest in becoming a Doctor. This, of course, thrilled us – seeing a young girl so full of ambition and aspiring to help others. Neelam had a different perspective; however, and upon leaving the girls’ ear shot quickly proclaimed that this sentiment was simply a pipe dream and was out of the realm of possibility.

This specific experience drove a lot of today’s conversation about the entire days’ experience and leads me on a thought path that branches at many different points. On one hand, how heartbreaking to think that this young girl has such a wonderful dream yet currently has very, very few if any resources to achieve it. On the other, perhaps it is almost a naïve bliss that she knows what she wants but perhaps her scope of understanding is narrow enough to spare her from extreme disappointment. Even yet another thought leads me to believe that it IS entirely possible for this astute young woman to pursue a career in medicine but perhaps not as a traditional American might view it. I would find it entirely possible for her to achieve some level of ayurvedic or tribal education and then be able to practice her medicinal trade throughout her village. Even though she wouldn’t be a Doctor in the sense of the word that we understand it, wouldn’t she still be providing the same type of support, care and service?

For every child we met on that day, there is a story. There is a story of who they are, where they came from, where they want to go and ultimately where they will end up. As budding social entrepreneurs and practitioners of both public and clinical health, it is our job to understand the present and future of our patients and community members, and also to truly understand their past. Without this knowledge, I feel that it may be impossible to impart information, treatment or any type of appropriate care.

Through the eyes of the one little girl, who so aspires to help people through medicine, it is possible to begin to see a global landscape that so greatly affects every part of each human on this planet. Understanding where we come from is the only way to truly understand where we can go.

Making an IMPACT

We wrapped up a whirlwind week with a whirlwind day in several rural villages with IMPACT India. It felt wonderful to get out of the city, and we were able to observe some of the activities IMPACT does in the rural areas working with tribal people, including an ashramshala (residential school), a breastfeeding education session, a primary care center, and a mobile eye clinic. One thing we did not get to see was the Lifeline Express, a train the visits approximately 10 rural locations a year delivering life-saving surgeries free of cost to patients. The train, which is sponsored by members of Parliament and corporations, has nearly eliminated cataracts and has transformed people’s lives by, for example, fixing cleft lips. IMPACT India seems to be an example of public-private partnership that actually works.

Our day was like a smorgasbord of public health interventions in action. At the Bapugaon Ashramshala, we were welcomed by the girls of the school and participated in a Vitamin A and Iron/Folic Acid supplement distribution. We learned that the school has health monitors, girls who are elected by their peers to BMI and report any illness (eye infection, lice, etc.) among the groups of 10 they each represent (see picture below). I was really moved by this empowering role for the young girls, and the potential long-term impact in can have on their ability to recognize illness in their children someday.


Later that day we saw a hemoglobin testing to identify anemia, a mobile van performing eye exams (picture below), and a primary care center that serves 50,000 people, providing everything from antenatal care to snakebite treatment.

The most interesting part of the day for me was listening in on the breastfeeding counseling provided to a group of 10 or so women by a nurse midwife. The messages the midwife delivered were spot-on. It almost seemed like she was following Dr. Ramiah’s bullet points from the Maternal and Child Nutrition course I took earlier this summer. It was so refreshing to hear that accurate health messages from WHO and others are making it to women in rural areas.

An inspiring day, filled with hundreds of adorable children, but we also had to face reality. What I found most disheartening was when we talked about how most of the girls in the school will be married off at age 18, if not before, and few will have the opportunity to chase their dreams, like one girl who told us she wants to be a doctor. IMPACT’s general director stressed that the most practical intervention for these girls is keeping them in school until 10^th grade and then providing vocational education so they might be able to learn tailoring, weaving, and so on, to earn a living and provide for their families. This is where social entrepreneurship can come in, but it takes time and may not drastically change lives. Thus I felt like today was a good example of the potential of social entrepreneurship, as well as public-private partnerships, but also its limitations.