Vavar-Health Check Ups

The main point of my stay in Vavar was to conduct school health check-ups. I started with the 7th graders as they are more likely to speak Gujarati. First I checked their vision with an eye chart and then I went through a list of questions to asses their health. "Do you have a fever? Does your tummy hurt? etc." The younger kids were really cute with their responses to "Can you see properly at night?" (we ask this to pinpoint Vitamin A deficiency). Many of them said "no, everything is dark at night" I would have to ask other questions to make sure that they could in fact see.

After the last check-up, we were going to play a slideshow to educate the 5th-7th graders on basic primary diseases that are common in their area. Predictably, th projector wouldn't work, so while they fiddled with the equipment, I decided to be brave and entertain the room full of kids. During the health check ups, I was most disturbed by the number of cavities I had seen so I asked the kids to raise their hands if they had tooth pain. About half of their hands went in the air. I asked them how many brushed their teeth everyday. An honest 3 were raised. I tried to ask them what happens when you don't brush, they were too shy to call out, but I could tell by their murmurs they knew the answer. I then asked them how to brush. They all used their finger to demonstrate. I copied and said "thats it? just the front 4?" They all said "NO!" and very diligently proceeded to properly air-brush their teeth with their finger. They covered every angle possible, they knew to use their finger if they didn't own a brush, and what else do you need? "COLGATE!" If you dont have colgate? "WATER!"

In a way, I was disappointed. They had all the information they needed and yet they still just did not make brushing a priority. Something so painful and yet so preventable and they just don't take action. It goes back to what I was saying in my last entry and even my very first entry. This population of people is so isolated that they have trouble with abstract thinking. Seeing is believing for them. If they can see the cause and effect, they can make the necessary change. But otherwise, the concept of preventative health care is lost on them, most specifically in circumstances like cavities, things that take time to develop.

Before I left I asked how many would brush their teeth everyday. All hands went up, but Vinayak Bhai assured me that they were just trying to make me feel good...they weren't actually going to start. And the truth is, why would they? I taught them nothing new.

Vavar

I just spent 3 days in one of the tribal villages outside of Dharampur. It was incredibly green and beautiful! It reminded me of the rainforest..less foresty, but WAY more greener than the rest of Gujarat, which can often be desert looking. Daxa auntie has established a homebase in Vavar , and I stayed with one of her friends Vinayak Bhai. He had a little home with a clinic in the front. There was a kitchen and a proper bathroom (sqatting toliet of course) but no running water. There are hand pumps scattered throughout the village, so before going to bed every night, we would have to go down to the hand pump and stock up for the next day. In a way, I was grateful! It was good physical training for Ladakh!

The children are sweet and generally very well behaved but incredibly shy. They eventually open up, but for the few days I was there it was so frustrating!They refused to ask me my name, and in front of me they keep telling V-bhai to ask me. I even extended my hand a few times but they refused it. What a change from the kids in the Dominican Republic!

In the morning we saw patients. V-Bhai is not a doctor but he can provide basic primary care and knows how to recognize cases that should be sent to a doctor. One patient came in saying that he went to a private hospital for malaria treatment but he only had a few tablets with him. We realized that there wasn't enough so Vinayak Bhai gave him the remainder medication for his course. He told me that many doctors in the rural areas do that (and get away with it) so that patients keep coming back with the same problem, and thus keep paying the medical fees. Clearly, the problem with this is that it is causing serious drug resistance. I'm still having trouble comprehending how they could do such a thing!

The next adventure of the afternoon was a drunk mute man that came in asking for (motioning for) money. I admit, I was a little freaked out--especially when he took a moment to pet my head. I was 1% concerned that things would become violent. Luckily, when V-bhai escorted him out, he did not resist.

After my nap we hiked up the hill to a beautiful viewpoint he calls Little Kashmir. As we hiked up, a whole batch of children joined us. As we sat at the top overlooking the valley, the younger kids played and the older ones sat and talked to v-bhai. Again, out of shyness, they pretty much ignored me. V-bhai sang song with the kids and then we played memory games, going around in a circle trying to remember the chain of fruits and vegetables we were calling out.

At night we went back to make dinner. Vavar is famous for Agna--big lightning bugs that come out before the rain falls. It's the most amazing thing I've ever seen! There must have been thousands! They lit the trees like little christmas lights!

A note on the education system here...it's ridiculous. The classes are all taught in Gujarati (the state language), the teachers speak only Gujarati, and the students speak only Kokani--a dialect. As result, students have no idea what's going on, and not only do they miss out on crucial academic development, they also just plain loose interest in the concept of education. Their minds remain unstimulated and it only compounded by their minimal exposure. Now to be fair, this is not true EVERYWHERE, but it DOES happen and that makes it enough of a problem. It makes me want to overhaul the entire bloody education system here.

Baroda

I just got back from a relaxing 6 day "vacatoion" in Baroda (a much larger city closer to where I am from). I spent the first two days with my mom and dad's friends from medical school. Uma Auntie is an academic pediatrician and Siddharth Uncle is a pediatric surgeon. I went on rounds with Uma Auntie for the first two days, and again, I was just really impressed. India has really well established medical academics. I hope that progressively, the government will even better utilize their resources. The medical system here is like the education system in America. There are government hospitals (which are the academic hospitals) and there are private hospitals (Western Style hospitals for the rich). Uma Auntie strongly believes that the quality of care is almost on par with the quality elsewhere. The problem is twofold. First, because Gujarat is a wealthier state, it attracts patients from all over the country. Thus, the hospitals are majorly over crowded which obviously reduces the quality of healthcare they can provide. Secondly, the people who come to the hospitals are poor, and often unhygenic which invaribly creates an unhygenic atmosphere. So essentially, the knowledge and machienery is there to provide excellent care, the problem is in the neonatal ICU there are 3 infants to 1 bed.

Now, I'll be totally honest and say that I know very little about the American health care system (I know, that's VERY bad). So that as my disclaimer, I can't help but feel as though India doesn't deserve its bad rep. I mean, true, the care in the government hospitals could be better, but at least we are striving to provide affordable/free care to the poorest and most needy. I can already think of arguments back and forth, but I'm not going to delete what I've typed. I think it could make a very enriching conversation topic :)

After my two days exploring the Indian Academic health care system, I spent two days with my dad's cousin--which was great. Her daughers are my age and I had a great time with them. I was a little frustrated because they hospitality is so overwhelming that they wouldnt let me lift even a finger. They seemed to believe that I wasn't capable of anything (girl from America, what would she know?) It's incredibly frustrating, and I had to yell at them a few times..I think the message barely got through.

The one thing I was thinking on the train ride back is how incredibly lucky I (and my first cousins) am/are. Comparing our lives to my cousins here..it's just so different. We have SO SO SO much freedom education and exposure that I take for granted. Every time I come here I remember how lucky I am. Everytime I come here I try to remind myself not to take it for granted--but I always do. It's incredible to think how far we have come in just 3 generations. I can't wait to see my grandpa next week and give him a huge hug and thank him for all his sacrifices. It's because of him that I am able to travel this much, and its because of him that I have the education that I do.I'm adding this quick tid-bit for my family to read because I know they will understand that I mean. Sorry friends, you might not get what I am talking about I can go into detail later if there is interest.

Humm..thats about it now I'm back ready to hit the villages!!

lots of love!

Dain Ben Trainning

One of the coolest things that Daxa Auntie does is traditional birth attendant training. Given that the villages dont all have great access to hospital facilities, most pregnant women rely on traditional birthing. The problem is, these birth attendants are almost always uneducated, and since I am talking about the very rural areas, they also have little exposure. Their methods are often unhygenic and obviously they don't know what to do in emergency situations.

Daxa auntie does a great job of teaching them when the baby is in a breeched postion and that the mother shuold immediately be sent to the hospital. ok I have to go now oops..I'll add to this later. Basically it was tons of fun, the women are old and spunky and I cant wait to show you all the pictures of today!

The Dirty Details-- UPDATED

This experience is unique from most of my travels because there is so much to tell and explain, but there is also a lot that I take for granted. Being here is not NEW to me. When I was in Spain I wrote about every Cafe-con Leche and european plaza I saw. Here, I take the cafe-con-leche for granted. I'll walk you through a day so you get a picutre! Ok, so up until a few days ago I was sleeping on the rooftop terrace (now for fear of rain I sleep downstairs in Daxa Auntie's room). Everynight I would take my futon-like matress upstairs and a fan to ward off mosqitoes. I would usually wake up a little after sunrise (6, 6:30) and go down and make my breakfast. Unfortunately here it's like europe. They don't eat much in the morning. I have resorted to biscuts and milk with Bournvita (similar to ovaltine). Daxa auntie would usually wake up an hour or so later. We'd get ready and go to the clinic. The first few weeks I was out doing the surveys I mentioned before. Did I mention our findings? I will next time if I haven't already. I was working with two other guys, Sharad and Vinnay. I think Sharad is around 30 and Vinnay is 25. They're both older, but within my age range enough that we've become friends. They spent most of the day teasing me and I spent most of the day thinking of as many clever responses as I could in Gujarati.

By week three I was starting to get antsy and annoyed. I was sick of the surveys and I was tired of being a spectator. I was in conflict as to what to do, but I talked to Daxa Auntie and she was great about it! Starting next week I am going to go to the village schools and perform health check ups. There are so many schools that she can't go everywhere. She is going to teach me how to look in eyes, ears, throats and noses. If I find any problems I can refer them to the hospital or to her clinic. I will also play health education games with the children. We try to get simple messages across like how infection spreads etc. Daxa Auntie even wants me to give the kids a lecture on the digestive system. THAT makes me nervous, I have to learn all the relevant vocab, but I'm up for the challenge!

So now I am taking a mini vacation and visiting some friends and family in the city. I'm going to do some shopping etc. Then I'll go back to Dharampur. As soon as we are ready to start the health projects, I will move out into the villages and stay in guest houses. It will be easier than having to commute from the town every day.

Ok so I forgot to add the dirty details component of this entry! Let's see...dirty..well, I use a squating toilet. It's porcelin, in case you haven't seen one, and frankly, I have come to like it better! Squatting is much more conducive for well, the related bodily functions!

I actually don't wash my hair that often. You'd think in all the sweat and heat I would, but actually its the oppoiste. I keep my hair tied back all the time so if its greasy it doesn't really matter. I try to go at least 3 days without washing it. It's been glorious because now my hair is soft and shiny!

For lunch, I eat Gujarati made vegetbles with a lentil soup, rice, and rotis made from wheat. When I was littled I HATED this diet but right now I am loving the ready made food. My only compliant is that they only eat 2 main meals a day and its hard for me to stuff myself in one sitting.

Humm ok, that's all I think! Hope that's dirty enough..I keep checking for posts so let me know if there are questions!! :)

Monsoon

Last night we had our first monsoon rain! Some of you know exactly what that means and all the senses that are invoked. For the rest of you, I’ll tell you—it’s just an amazing phenomena. The weather since I’ve arrived has been hot, very hot but bearable. The past 24 hours, however, have been miserable. The air felt thick and stale, almost like wearing a body tight leather suit or something. Peacocks were calling out all day, and apparently even the snakes came out. Everyone, (everyone meaning every living plant and creature) seemed to know that the rain was coming. Usually I sleep out on the roof terrace. Last night I put out my bed and tucked myself in. Something felt unusually peculiar. I starred up at the sky and realized that for the first time since I’ve been here, the moon and stars were not to be seen. It was close to a full moon last night and still, I could barely see its outlining glow. I lied there staring at the sky just mesmerized by the ancient ritual migration of these massive clouds of rain. Like clockwork, (well almost like clockwork, apparently we are 10 days early this year), these clouds come rolling off over the ocean, and sorry to be cheesy, but they truly bring along life. There is literally not a drop of water in the rivers here. They are carved out gorges just waiting to be filled.

So, as I lied there, staring at these amazing clouds, wondering when they would drop their goodies, I felt a drop on my forehead. Before I had a chance to process what I felt, it began pouring! I leapt up and executed my previously thought out escape strategy. I rolled up my bed, slung my purse over my shoulder and ran downstairs. I told Daxa auntie it was raining and she went running outside—it’s good luck to “bathe” in the first rain. I personally, was not keen on soaking myself to the bone. She blasts the air-conditioning in her room, and I knew I would freeze. I just stood there in the corner, allowing the rain to hit my face. The smell is similar to the smell in the U.S. It’s a little different because there is much more rain, and much more dirt than concrete. For the most part, the smell is just much stronger, but generally the same idea. I have experienced many more rainfalls in the U.S. but for some reason, rain always reminds me of my grandparents’ home, and my grandmother. When I was little, teeny frogs used to come out when it rained. Of course I thought they would make great pets and would catch them in old Tupperware containers. My grandma pretended to be mad, but I knew she was proud of me. Ok, for those of you who have never experienced Monsoon, I hope I’ve painted a picture for you, and for those of you who grew up with it, I hope I’ve done it some justice!! Masis, kaka, kaki, foi and fua, comment on the blog with your experiences if you want. It would be fun for everyone to read!!

Arrival

Hello! I’ve been in India for over two weeks now. When I first arrived, I spent a day with Ach’s family in a city called Valsaad. I think it’s comparable to a city like Daytona or something like that. It’s not quite a town—definitely a larger city, but definitely more of hick mentality. The next day they dropped me off in Dharampur—a town about 45 minutes away. The doctor I am working with lives in the town, but her office and clinic is 2 kilometers away in a much more rural area on a river. There are villages that surround her clinic and this town, but given their proximity to Dharampur, they don’t quite qualify as rural. If you were plopped right into the middle of the village, you would want to classify them as rural villages, however, these people have easy access to the town resources and are thus classified as “semi-urban” even though there is nothing urban looking about them.

Since the day I arrived, I’ve been working in these villages conducing a Maternal and Child Health survey. The questions are centered around maternal health seeking behavior. In other words, the survey looks at illnesses in the household and where they went for treatment. Aside from illness, we look closely at reproductive issues, including everything from menstruation, to pregnancy, to delivery, to menopause. This is where it becomes evident that these villages are semi-urban. Most households seek medical care for any illness. A good number are even able to afford private health care. Most of the households were poor, but from my perspective, I would say that very few would have qualified as below the global poverty line (below the World Bank’s Dollar a Day standard). Majority of the homes were huts, but most were well equipped with furniture, televisions, farm animals, fans and running water. Honestly, I would prefer them to my cockroach infested NYC apartment!

About half of the people we surveyed had heard of AIDS and knew what it was. I think the number might even be higher but women may have been shy to respond. Still, there is much to be done, but I was pretty satisfied with what I saw. The important thing is that these villages have access.

Once a week we do a mobile clinic. These clinics extend health care to the truly rural areas. The people on these lands are generally oppressed tribal groups that have been pushed off onto unfarmable land, and in many cases, can be geographically isolated. There are villages, for example, that are completely cut off during heavy monsoon due to lack of proper roads and bridges. The difference between the villages I have been surveying, and the one for the mobile clinic is just outstanding. These people are not only poorly educated, but also have little world exposure. Their understanding of their body, health, and therefore healthcare, is extremely limited. One example of what mean by world exposure is that, Daxa Auntie (the doctor I work with) took tribal children on a field trip to the beach. Two boys emptied their water bottles and filled them with seawater. When she asked them what they were doing, they told her they were so amazed that water could taste so salty without needed to put salt in it, that they wanted to take some home to show their families.