Final Thoughts

Our official time in India ended this morning over brunch in the hotel. We all had the opportunity to discuss our business plans for our final projects. I came to India with an idea to help the DC community, but have been so struck by the poverty and health disparities in India that I have changed my idea. Mumbai is a city covered in trash, a problem I believe is the underlying issue of the health crisis facing those living in the city, especially in the slums. Factors relating to government corruption and population size make the waste management infrastructure nonexistent. The piles of trash and sewage is an image that has stuck with me the entire trip, it is something I cannot walk away from.

While driving through Delhi the other day we passed by an open area filled with pigs. With a little direction from Dr. Parish, it occurred to me that pigs could be a solution to waste management. The idea will need to start on a small scale, just one slum, and I still have a lot of research ahead, but I think this is an idea worth thinking through. I have a few weeks to work it all out, but I will share my plan with those who are interested once it is done.

India provided me with many struggles. At home, I often feel that everything is my “comfort zone”. Even if something is unfamiliar I adapt quickly. India was an “uncomfort zone” at almost every turn. No one likes feeling uncomfortable, but I was happy to find that I do have boundaries and there are things that make me feel out of place. I am looking forward to getting back home, but India has helped me realize that I can do work in rough areas (just as long as I have a nice place to go back to at night).

Throughout the trip I often thought of how many people would benefit from seeing what I saw. We live in a country of complaints and I am sometimes frustrated by the lack of patience from everyone, myself included. I saw Indians living in worse conditions than any homeless person in the US without complaint. There is a balance. People in slums should be more outraged at their situation, but at home we should stop complaining about everything (and if we do complain being proactive about a solution). I would love to bring groups of Americans to India to see how the rest of the world lives.

For those of you at home, I am excited to show you my limited number of pictures, but it might be a few weeks before I can wrap my mind around everything I saw and put it into a cohesive conversation. It is not to the Taj Mahal for a day then one more day in Mumbai before heading home.

Last Group Day (Elizabeth)

Today was our last day in the field. We visited with two organizations. CARE, one of the largest international organizations, works all over India in areas of health and the underlying issues of poverty, sanitation, food security and capacity building. We met with a number of people in the office and had a wonderful discussion with them about their programs. They shared their challenges and successes while we shared our views on social entrepreneurship and how it might be able to help India’s future.

Next we met with a great organization, Salaam Baalak Trust. They rescue street children in Delhi from train stations, bus stations and street corners. Last year alone they helped over 5,000 children who had left home for any number of reasons. Their main goal is to reunite children with their families, but in the majority of cases this does not happen. Either the family can not be found, the child does not want to go back or the organization does not feel that the home environment is safe. In all of these cases Salaam Baalak tries to place the kids in one of their five shelters. Some children stay for only a few months, but some children stay until they age-out at 18. Salaam Baalak provides the children in their shelters with clothes, food and education.

We walked to their newly formed drop-in center where we met two boys who told us their stories. Both have been with Salaam Baalak for years and are thriving. One of the boys left his home in Bangladesh when he was 6 because his parents died. He walked across the border into India and eventually found himself in Delhi where one of the social workers spotted him. He is over 18, but still comes to the drop-in center to hang out and help. The other boy ran away from Mumbai and is currently completing his high school degree. He left his home at such a young age that he does not know his birthday, so does not know how old he is. His English was very good and he was incredibly bright. He schooled us on US history and politics and asked us about the upcoming election. He wants to go to college and then move to the US.

This is an amazing organization that deserves a lot of credit for the daily struggles they encounter in their work. "Scale" has become the buzz word among NGOs and social enterprises. Can this organization or model be scaled up to impact more people? It seems to be the main method of evaluation for many groups. Salaam Baalak is an organization working against this notion. They work in Delhi and will probably always work in Delhi because that is where they are needed and I do not think they should be devalued because of it.

Who is Kiran Bedi?

We heard early in the morning about a change in the day's schedule. We were going to meeting with a group called India Vision Foundation, and perhaps their founder Kiran Bedi. All we were told was she is famous in India.

After Op ASHA and lunch roulette, we went to Ms. Bedi's offices where an associate gave us an overview of IVF. The foundation provides day care for children of incarcerated women. These children are fed and go to school near the jail and sleep with their mothers in their cells at night. 

Then Kiran walked in. Her office decorated wall-to-wall plaques, trophies, fan letters, photos of her with dignitaries.

Turns out, she's a HUGE deal in India, especially among youth (I later found out a friend who grew up in India would buy clothes to dress more like her!). She first came into the spotlight as the first woman officer in the Indian Police Service in the 1970s. Although she came from a privileged background, she went into the IPS believing the police were there to serve rather than to suppress. She gave Indira Ghandi, the prime minister at the time, a parking ticket! Not everyone thought it was funny. When her enemies tried quash her by reassigning her to oversee Delhi's biggest prison, she responded by completely transforming the prison system.

Since she retired from the IPS, Kiran has become an anti-corruption activist icon exposing corruption and atrocities perpetrated by the government. Giving a voice to the hundreds of millions of people who demand reform and seek a better life. She leads rallies of millions. There's a documentary about her narrated by Helen Mirren. She's been on TED multiple times. And she's sitting there chatting us up.

We asked a lot of questions about corruption in the government, her philosophy, and her background. I particularly liked this about leadership:

Build yourself, not to be a leader. Lead yourself first. Then you'll start influencing others. Practice constant inside-the-boot polish. 

This woman is a symbol for courage, perseverance, and truth. She's emerged through serious personal and professional battles, and continues to confront new challenges as she moves forward. To us, Kiran says she's comfortable with activism and is conflicted with the pull she feels toward politics. She's going to be prime minister of India one day.

12 dancing ladies

This past weekend in Bombay was both relaxing and exhilarating. On Saturday I met up with some friends for brunch. We walked from their apartment to the restaurant and it was an abbreviated way to see Bombay’s two-facedness within a 10-minute timeframe. On our walk, we navigated through traffic, puddles, trash mounds, people and even a family of rats feasting on something in the street. Ick. We arrived flustered, damp and ready for some good food. Walking into the restaurant, the Tasting Room, it was like stepping into a different world. Plush couches lined the walls, sangria flowed freely and it was open, comfortable and pretty much the stark opposite from the world just outside the doors. My friends in Bombay are total foodies and having done some serious traveling in their lives, they have learned how to quickly navigate to the best food a city has to offer. Their restaurant choice did not disappoint! The Tasting Room imports many of its meats and cheeses from Europe. They offer creative dishes that are exquisitely served. We were seated on some purple couches and I felt right at home! We ordered up some incredible tapas: watermelon with feta, fingerling potatoes, vegetable mac and cheese, skewers of chicken, hummus, mushrooms in a divine sauce and so on. Am I really in India, I thought? Unfortunately, my upset stomach from days past hadn’t fully worked its course, so we left after lunch and went back to relax a bit. Given my ailments, they were the best doctors a girl could ask for and set me up with some medication that really helped out. I returned to the hotel with some Indian ramen noodles (totally yummy!) and saltines and took it easy to prepare for the week. I hope we’ll make it back to the Tasting Room once more before I leave Bombay because it was such a diamond in the ruff!

One of our dishes at the Tasting Room 

Eating with Mel and Imran

The following evening, our group was invited to dinner at the home of Netra, the woman who was our right-hand lady in Bombay in scheduling our buses and helping us navigate the city. She lives in a lovely home just on the outskirts of the city. Her mother had prepared a feast for us and it was delicious! We sat out on their balcony and soon became the talk of the neighborhood. What were all these white people doing at Netra’s house? Perhaps what was even better than the food was the pre-dinner performance. Netra’s sister is a minor celebrity here in India because of her dance career. She practices traditional Indian dance and has traveled the world performing. She and a few of her friends performed one of their most famous dances and it was amazing! I mean, amazing. They moved so eloquently and in synch. Even their eye movements were in unison and portrayed with such intensity that you couldn’t help but get chills when watching. Then they invited all of us in a circle and showed us some Bollywood dance moves. Now, I am not much of a dancer, but I sure as heck tried! Dasi girl, anyone?! We danced around laughing and singing as a group. All of the harsh realities we had been trying to process from the week melted away and in that moment we felt like anything was possible – carefree laugher filled the balcony! It was probably one of the happiest moments I’ve had on this trip and a wonderful way to get to know some of my fellow students. I can only hope that if Netra and her family ever make it to DC someday that we could show them half as much fun and hospitality as they showed to us!

Learning some Bollywood moves!

Sanitation, TB and poor environmental health

The staunch scent of hydrogen sulfide from the sewage drains permeate the air in Mumbai and even worse so  in the slums we visited last week where the smell is enough to make you gag with nausea—especially when suffering from the expected bout of your own digestive issues.  As an environmental health student, I am struck by the overcrowded, poor conditions in the slums and the garbage piles on the streets—often wondering why there is such a lack of planning and sanitation services in the slums and the cities.  Simple int

erventions can prevent the number one cause of morbidity in this country—diarrheal disease.  However, sanitation services are not on anyone’s priority list—not the NGOs, the NIH nor the Indian government and frankly, I don’t get why such a necessary public health issue is being overlooked.   

India currently produces some of the brightest engineering minds in the world and there are innovative, cost effective, efficient sanitation systems out there that can recycle methane and reuse bio-solids as fertilizer—however, none are being used in India—to my knowledge.  Today, we met with Dr. Karin Bedi—Delhi’s famous police chief who restructured the prison system and is currently fighting against corruption in the Indian government.  She said many of the sanitation projects fall short of being implemented because the money allocated to them was consistently syphoned off by “politicians.” While I think corruption may play a significant role in the apathy surrounding this issue, I also think funding priorities often prioritize “sexy” diseases over those that are ubiquitous. 

In addition to lack of sanitation services, there are a number of issues that have some environmental health component to it.  For example, today we also visited Operations ASHA, an NGO providing Tuberculosis medications to identified cases in South Delhi.  OP-ASHA works with community leaders to identify TB cases and uses mobile technology to track and remind patients to take their medication. They receive a portion of their funding from the Indian government to implement the DOTS (Direct Observed Therapy-Short Course) program to reduce transmission of TB.  While OP-ASHA employs a novel strategy for addressing the highest rates of TB in the world and their model is proving to be successful, I felt the problem was not being addressed comprehensively. 

TB is an environmental health problem and when NYC was faced with this very issue in the early 1900s, they created the first public health policy requiring each apartment to contain at least two windows to increase ventilation and light into the dwelling thus reducing the propagation of the TB micro-bacteria.  It was the Light and Air standards that mainly contributed to the decreased in TB rates in NYC.  I am not sure why the Indian government does not try to improve living conditions in the slums—i.e. reduce overcrowded dwellings, increase ventilation and increase sunlight into the dwelling—the very conditions that perpetuate TB.  Even more discouraging is the fact that NGOs typically stay away from addressing sanitation issues because the Indian government is the designated responsible party for providing clean water and sanitation services.  Therefore any funding opportunity for sanitation services is viewed as redundant.    

I can’t pretend to understand the bureaucracy that is the Indian government that is so overburdened it relies on the NGO sector to pick up the slack.  However, it is time to put together the great minds at the various Indian Technical Colleges, some community and urban Planners, civil and chemical engineers and a few public health and health policy professionals to develop an implementation strategy for cleaning up the slums.  For a people that added the zero to the number line, not dealing with the antiquated issues surrounding sanitation only continues to hold India back and that just stinks….literally!

A Mother's Love

Last week in Mumbai we had the opportunity to meet with an amazing organization called SNEHA, the Society for Nutrition Education and Health Action. They work in Dharavi, one of the largest slums in Asia made famous by the movie Slum Dog Millionaire. Their programs center around women and include early childhood education, maternal and child nutrition, family planning services and support for intimate partner violence. SNEHA, which in Hindi, means "mothers love" was started by a pediatrician working in a large hospital near Dharvi who recognized through her patients that there was a lack of adequate services to address the major issues faced by  women and children in the slums. Our group was split up into three, and I had the opportunity to visit one of their programs focused on violence against women. One of the most surprising aspects of this program was the involvement of men in the community. A few were actively involved in the counseling and support groups SNEHA runs which was nice to see considering that violence against women is not seen as a serious issue here and more of just a way or life or cultural norm. The women in the support group were all very passionate and spoke confidently about their work in the community. It was a bit of a challenge to get all of our questions across through a translator, but I could tell by their body language that they were very engaged and excited. These women were so brave to have even come forward and spoken up about the violence going on in their homes, especially given the male dominated society that exists in India.

Another great program that SNEHA operates is a quilt making business that provides women from poorer areas of Mumbai with jobs making blankets, bags, rugs, pillow cases and other home good from donated fabric scraps. These women are trained to sew and provided with a steady source of income that allows them the ability to help provide for their families and seek work outside of the home. We had an opportunity to visit the warehouse, and the products they make are unbelievable, so beautiful and unique! We all scooped up some goodies to take home with us. Overall, I was very impressed with the work that SNEHA does in the community to empower women in the slums and help address vital women's health issues. 

Mumbai is not the real India

I love seeing the stark contrast between urban and rural India. Yesterday we took a three-hour bus ride north of Mumbai to trek through the rural villages with the organization Impact India. Our journey was an example of how India is a clash between two completely different worlds: modern Mumbai vs. rough rural. It was really important for me to get out of the city and see that there is this whole other side to India. Even being here only a week I think it is easy to slip into the mindset that India is all pollution, noise, Bollywood, shopping and becoming more Westernized by the minute. But, then you travel just a few hours outside of the city and realize that India is still a very much developing country where cows rule and stores are far and few between. Going to the rural areas with Impact India made me feel more connected to the country and its people.

I keep thinking about what the women from ATMA said, “Mumbai is not the real India…well it is but it isn’t”. That makes so much sense to me. Yes, Mumbai and city life is an important aspect to see but it doesn’t represent the vast majority. The first time I was in India I spent about six weeks living in various rural villages and it was there that I really got to understand the culture and love its people. Seeing Mumbai the words beautiful and lush do not come to mind and I was starting to question why in my journal last time I kept using those two words. Then yesterday we traveled for hours through the forest and I saw all the green and new life the monsoon season brought and I felt justified in my pervious conviction: India is beautiful.