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.

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.