Americares India & the Slums of E Andheri

Today we had the pleasure of meeting the head of Americares India- All 19 of us crowded into a humid and humble office, merely a preview of what would develop as we traveled to the E Andheri slums.

Americares offers care to those in the slums of Mumbai via mobile medical vans. This is no small task in a city where half the population resides in slums. The three main objectives are distribution of medication, disaster preparedness training, and provision of on site medical care. Medications are donated by large pharmaceutical companies, then stored and distributed by the Americares non-profit. One of 3 mobile vans re-visits each site every 15 days, leaving a 15-day supply of medication for each individual diagnosed with a chronic illness. To keep track of the patient, vital statistics and a digital photo are taken at each visit. These steps aid in continuity of care-a vital component that often lacks in mobile clinic ventures.

While continuity of care is a substantial step in the right direction, much—MUCH more is needed.

Crowded, congested, chaotic—

The smell of the slums is putrid. Slum dwellers make their lives less than a quarter mile from a mountain of trash created by the entirety of Mumbai. The housing is congested and the homes themselves crafted from whatever material can be found to keep the rain out. There are no street names; there are no addresses. As a few of us walked further into the slums, Dr. Parrish pointed out the significance of lacking an address; almost a similar concept as lacking a name—it is as if these families are invisible to the rest of the world.

Children walk around barefoot; they play with rocks and dirt. There is no to little clean water. Few children attend school in a population where the rate of illiteracy is 50-80%.

Many NGOs exist in these areas to tackle such issues, but there is little communication about the help offered, in what manner it is offered, and where it can be accessed. NGOs are even unaware of each other’s activities in the SAME regions. Aid is needed, but it cannot be taken for granted that management and proper allotment of resources is JUST as necessary.

Tomorrow’s site visit; Aastha Parivaar—teaming up to deliver a women’s health service project.

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.

Day 2: Witness of true poverty

Today was the first eye-opening experience of many that I predict to have on my trip here in India. For some reason when I first arrived, the poverty didn’t seem to be that unfamiliar to me. Maybe it is because I was raised in Kingston, Jamaica, and have seen the sad sight of poor areas, misfortunate children, beggars on the street, and unhealthy living conditions, or maybe because so many people warned me about it. Today, however, everything was multiplied by 1000.

We began by visiting AmeriCares India Foundation; an “independent registered trust in India.” Since 2006, their mission has been to help people live longer and healthier lives. They receive their funding from various donors such as Pharma Donors for the medicines they give out and other company and individual donations to just keep their organization running. Not only does AmeriCares help the citizens of Mumbai, but they also give free medicines to 11 other cities and also lend a hand when it comes to emergency response; such as in the Leh mudslides of 2010, the bomb blast in Ahmedabad, and the flood in Bihar.

We had the pleasure of meeting and speaking with Dr. Purvish Parikh, the VP and Managing Director of AmeriCares India. He told us that half the population of Mumbai is living in slums and that ‘shanties’ can be found right next to high-rise expensive apartments. This is truly opposite of the United States; where ‘ghettos’ are usually far away from the affluent suburban areas.

A great question that was asked by Jen during our discussion with Dr. Parikh was: How do you prioritize which areas get help? His response was “we work in areas that fewer people look at”. This suggestion can and should be taken to the states in regards to public health outreach and upcoming social entrepreneurs’ missions. It’s great to have the same cause and reach out to a community that may already be getting services but at the same time shouldn’t we also reach out to those that have not been helped or listened to; making sure that less-represented communities are receiving the same services and treatment that others may get. At the end of the day isn’t that what Public Health is all about? Decreasing the gap of health injustices worldwide?

I found it amazing that Dr. Parikh had stats on the rate of infant mortality over the past 5 years. He was able to conclude that with the help of AmeriCares India along with other NGOs infant mortality has drastically decreased. AmeriCares India promotes proper health by giving lectures, group sessions, and assimilation. They have one objective for each subset (for example immunizations for young people and sexual health for adults). They recently launched a mobile clinics program to bring medical services and medicines directly to India’s urban poor”. We had the exciting opportunity of being able to work alongside the mobile clinic in the Bhagonwali-Ghovandi slums. This is home to a dump that hosts all of Mumbai’s trash…I repeat the entire city of Mumbai’s trash! It was here that I was made aware of true poverty. The AmeriCares van would pull up to a side street, and just open up an empty garage and set up their work area right there. Women would then line up to wait to speak to the doctor. First they would explain their pain, next get their blood pressure and weight, and then they would be allowed to go into the van to speak with the doctor. Looking at this process from the American standpoint, one would say that it was disorganized but these people were getting the help they need, and if AmeriCares didn’t do it: Who would?

In the beginning I was nervous thinking about what the citizens would think of us, we stood out like a sore thumb, and as a result we got endless stares. But after a while, with a few smiles and hellos here and there, they finally warmed up to us, especially the younger ones. Little girls and boys would ask us our names; sadly because of the language barrier there was not much that we could communicate with one another. They loved taking pictures with us, and talking about Bollywood. It was heart-warming to see smiles on their faces. Later when getting back on the bus, we saw children using the bathroom outside, in the middle of the streets- beside trash, filth and animals with who knows what diseases. Also as a side note yesterday was the start of Ramadan for the Muslim faith. Which led to the question of their interaction with Hindus. We found out that though they live together, but there is sometimes violence between the Hindus and Muslims.

This was truly an experience that I will carry with me for the rest of my life, and this was only Day 2!

I’ve gotten a few questions from friends and family (please keep them coming):

The Food: AMAZING! It feels great to finally eat true, authentic, Indian cuisine. And it’s sooo cheap! Last night we went to Atria Millennium Mall one of Mumbai’s biggest malls with very luxurious products and high-end designers. We went to a very nice restaurant here at the top floor of the mall; the tandoori chicken was out of this world. Today we went to 5 Spice, which was actually recommended to me by a friend that lives here, it’s an Asian infused Indian restaurant. The Mongolian chicken and 5 Spice chicken were my favorites, but of course I tried everything.

The Weather: Honestly anything is better than DC humidity and heat in my opinion. Yeah it’s monsoon season but heavy rain only last for a few minutes and when it’s over there’s a nice breeze. Places with AC blast it so the long sleeves have actually come in handy; also with the bugs.

The Traffic: whoever has complained about traffic before…COME TO INDIA! A commute to work can take around 2 hours here!

Well that’s it for now…I’m super tired. Goodnight and thanks for following my blog!

Courtnay

A busy day in Mumbai

While it make have taken us longer than expected to finally get here, Angela, Dr. Parrish, Chance, and I, all made it to Mumbai around midnight last night, and arrived at our hotel just past 2:00am. Whatever feelings of jet-lag I may have had when de-boarding the plane were immediately eliminated the second we stepped outside the airport to meet Netra. The reality of finally being in India began to set in as we made our way through a large crowd of people. Driving away from the airport towards our hotel I was overwhelmed with stimuli. There were no lines dividing lanes of traffic, drivers honked at one another more frequently than a New York City cab driver, and trash is so abundant in the street that the first time I noticed it, I had to look twice to be certain I wasn't imagining things. Pulling up to the hotel I remember thinking to myself that the first time I learned about India from a public health perspective was just 3 and a half years ago in Professor Skolnik's undergraduate global health course. The time has finally arrived for me to experience public health for all of its successes and failures first hand, and I could not be more eager to learn.

I'm embarrassed to admit how grumpy I was this morning having only 3 hours of sleep. I'm even more embarrassed to admit that on behalf of our entire class we were all feeling a bit grumpy that the first bus to pick us had such poor ventilation that the windows steamed up, and we had another bus sent- one with air conditioning. Everyone gets grumpy when they don't feel rested, and we all complain about heat and humidity, especially living in DC. So why am I embarrassed to admit those feelings? Because it all seems so trivial after witnessing the level of poverty and discomfort some people in India endure every day.

Our first stop this morning was to the AmeriCares office to meet Dr. Purbish Parikh, the Vice President and Managing Director of AmeriCares India. All of the staff that met us at the office were incredibly friendly, and gave us a warm welcome. Dr. Parikh did not hesitate even for a minute to let our group of 19 pile in to his office and crowd around his laptop to watch his presentation on AmeriCares India. AmeriCares India provides medical supplies and health care services to varying regions around India in addition to providing disaster relief services. One of the vans was heading out to begin work for the day and was willing to let us follow them to observe how operations are conducted to deliver these services. Just one physician and three volunteers from AmeriCares accompanied the van.

As we drove through the slums in Bhagonwali–Ghovandi, I felt like I was witnessing Public Health and Water 101. Sewage, debris, and garbage contaminate every water source imaginable. It is not surprising that sanitation systems in this region are inadequate and water borne diseases are widespread. Sacred cows and roaming dogs are just as likely to be stumbled upon as masses of feces. It doesn’t seem possible that the makeshift roofs covering each home could ever withstand the monsoon rains. Despite these observations, we were immediately greeted with the welcoming smiles of children playing in the street when the AmeriCares van reached its destination to begin delivering services.

The location where AmeriCares set up shop for the day appeared much like a half bay garage. Two chairs for two of the volunteers, two short bar stools- one for the computer, one for the blood pressure machine, and a chair for the patient- these were the only items to fill the space. The physician remained in the van, and after each person had their weight, blood pressure, picture taken, and information entered into the laptop, they were permitted to see the physician in the van. Most patients left with medications, and none stayed in the van longer than 5 minutes. Those waiting in line were patient, polite, and predominantly women and children. Organizationally the operation could have been run more efficiently, but it is tough to say whether or not things were running as smooth as usually with so many distractions (us) being there. The doctor did see what I thought to be a good amount of people while were there. While not observing the volunteers, most of us in the group remained in the street to speak to whoever was willing to talk to us. We intrigued many of the children and it was exciting to see so many of them knew English. There were also a lot of people passing by wanting to know what the van was for. This came as a surprise to me because I assumed everyone knew why the van was there. It did seem to make sense that so few people knew what the van was doing, or were willing to seek services because the line to be seen was not too significant in comparison to the size of the population in the area. We did not have time to go back to the AmeriCare’s office, but I would have like to ask them what efforts they have made to improve outreach to ensure the greatest number of people are aware of the organizations efforts.

Accompanying the AmeriCares team to the slums today was important in solidifying just how strong of an impact an organization is capable of having. It was encouraging to see so many people willing to speak with us, and to see how grateful they were for the resources being offered. The community members were not only welcoming, but patient in waiting for their chance to be seen by the team. It was also encouraging to see an established physician along with three volunteers to be so willing to spend their time in the community. Our class thus far has taught us how NGO’s are established and how social entrepreneur’s begin their quest, but this knowledge has come from textbook, readings, and guest lecturers. Actually witnessing the impact such organizations have on the people they seek to help has contributed an important piece in learning the impact a well thought out organization can have on a great number of people.

Day of Arrival!

I glance at my watch, “Okay, two and a half hours. Just put one foot in front of the other, and breathe.” As Charlotte, Rashi, Jenn and I achingly walk from our 3-day stint in Istanbul, we arrive at the airport-a little worn, but with irreplaceable memories. We navigate the bustling departure terminal, conduct some minor re-arrangements, engage in a slight sprint through security, and finally board our India-bound plane.

We’re here-India. Novel sights. Novel sounds. Novel smells…And rain.

Sixteen public health students, myself included, will spend the next two weeks learning how to effectively and positively work in the realm of social entrepreneurship. We’ve spent a month beginning to develop an understanding of non-profit funding, public relations, management, and innovation. Now we’ve been given the opportunity to apply our knowledge and gain experience in the rapidly growing economy and communities of Mumbai and New Delhi, India.

Dr. Amita Vyas founded the Global India Fund (GIF), in partnership with Samhita after her “Journey of Hope” visit to India in 2007. GIF allows anyone who wishes to research global philanthropies to do so on a level of personal interest. Philanthropies can be broken down based upon country of interest, target population, and even upon the way in which one would prefer to contribute. No longer is monetary donation the only way to provide aid to non-profit organizations, time and ideas of innovation may also serve as useful contribution. GIF also allows small, grassroots organizations a platform in which they may display their mission and welcome aid. Donors are able to follow their contributions via the GIF website, adding a personal plane to philanthropy. Because due diligence is required, the donor can be assured his or her contribution is going straight to their cause of choice-this confidence and personal connection fuels continual support.

Other sites of philanthropy include Kiva, and Global Giving, which follow along similar lines. These sites welcome giving whatever amount of time or money one desires, in the manner that is most comfortable, and with the guarantee that each contribution is used exactly how it is intended.

As the next 11 days ensue, we will be visiting 9 NGOs on site and learning directly from those in the field. The lessons will be quick, but the processing and impact of such lessons will no doubt last for years to come…

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.

India and Social Entrepreneurship

“Can someone please pitch me!” were the constant words repeated in my head when I arrived to India at the early hours on Monday morning. My reality of being in India finally set in when I ended up hitting my head against the marble sink in my hotel’s bathroom. I have a tendency of being a klutz, but this time around I am going to blame it on the jet-leg. As I put my hand over my throbbing head to stop the pain. A sense of reality finally set in that to be in India is not a dream, but the path I am meant to walk as I pursue my passion for learning and public health.

My life-long compassion to help the disenfranchised has always pushed me to leave the comforts of my regular life in the United States. My life experience and public health education has taken me to countries and cultures where the aftermath of war, natural disasters, inequality, and the plague of diseases are a norm. It is these settings where I have witness the human suffering of others and has allowed me to redefine how I should view the world as a social entrepreneur in-training that will one day help create innovating and out-of-the-box solutions to the most common health problems. It is the power to fearlessly take the opportunity to crisscross traditional paths and become the facilitator to make a change in our niche of the world.

Organizations such as Global Giving, Kiva, Global India Fund, and Samhita in India have taken the opportunity to crisscross traditional paths by changing the playing field in how to help the disenfranchised population by providing accountability, transparency, and strong partnerships with donors, corporate organizations, and NGOs. It is the spirit of social entrepreneurship, but the building blocks of trust that these strong partnerships are built on and are succeeding. Along with a marketing framework and creativity for innovation, these organizations ensure donors that their money is being put to work at every level that support projects such as training rats to sniff for landmines in Tanzania or literacy for women to find employment in India. The common thread that makes all of these organizations similar is that it empowers the donor (an average Jane/Joe Doe) to become a hero by supporting a personal cause with a small donation. In other words, it is the concept of matching the average hero and marketing the right NGOs with a common cause. It’s about including everyone as a network to take part in making that difference in their own niche of the world.

It is this spirit of social entrepreneurship that has brought me to India and the training ground where I am going to learn how I can contribute one day with my own innovating ideas and influence others to also become their own hero by supporting their own causes.

I am very lucky to be out here and I'm looking forward to the incredible experience that are ahead in the next few days. Ok,I no longer have to be pinched. ;)