One month and counting.

So it's been awhile since the last update...days here are generally exhausting so the thought of typing everything up after dinner (around 8:30pm) is not too exciting. Time seems to pass very differently here. Each day is relatively slow and long but weeks go by without me even realizing it. The past week or so has mainly been visiting the villages and asking our respective questionnaires to families we come across. We've learned how to become more efficient by being more professional/work-focused and less social with the families we visit, but some days are still unexpectedly slow. One day we'll get 8 surveys in (4 each) and the next we'll only do 3 or 4. Last Friday in Bareyt, we interviewed a family who had just had a boy, and it was the 11th day after his birth or something - naam kaaran - and he was being named, so we had to sit for a couple hours and then have lunch with all the friends and relatives. That slowed us down significantly, and it was pretty awkward (some old men saw me eating with my left hand and were like...eat with the other hand. so i tried...and failed...), but it was pretty cool.

On Saturday, we went to Ramgarh to visit the PHC (Primary Health Center) to get some statistics on maternal/infant mortality and jaundice, check out the facilities, and hopefully talk to the ANM (Auxiliary nurse-midwife). The PHC is currently under construction in order to upgrade to a CHC (community health center), so things were really dusty and generally unclean - not a place I'd want to be treated (it's also common knowledge that the medical officer there is drunk 70% of the time, another reason I wouldn't really want to go there if I was sick). The record-keeper person we talked to was really nice though, and gave us all of the statistics and numbers we asked for, and explained much of how things should be happening in terms of maternal health care. The records are all on paper, but are surprisingly well-organized and up-to-date. There may be underreporting at the ASHA level, but it seems that the reporting system itself is working at least. Maternal mortality in the Ramgarh block for 2008 was nil, but infant mortality was 14 out of 790 live births (April 2008 - Feb 15, 2009), not a great number. Jaundice data is compiled at the district level so we'll have to make a trip to Nainital to get those figures, but I imagine that those will be even more underreported since most people go to traditional healers rather than doctors.

At the PHC, we discussed how the ANMs are supposed to give out information about JSY (government scheme), nutrition, etc. during antenatal checkups and how that normally doesn't happen. Giving information like why it's important to take iron tablets, and how many and when to take them, is solely the ANM's responsibility. If the ANM is 'too busy' to give this information verbally, women often don't take their iron tablets or will experience side effects from taking them at the wrong time. I definitely think verbal communication is a good way to transmit information, but if it's not happening then distributing iron tablets with an explanation/instruction sheet attached is better than giving no information at all. Literacy is pretty high in these areas, around 75%, so simple instructions with pictures should not be difficult for people to understand. I wonder how difficult it would be to create some sort of information sheet with nutrition, medication, and other useful advice and convince the government to give out these sheets to every pregnant woman. At the very least, organizations like CHIRAG can make the sheet and give them out in the areas they work in, but it seems much more sustainable and far-reaching if you can get the government to do it. Definitely a potential future project...

We were supposed to be off to Bageshwar tomorrow (100km away, closer to the Himalayas :)) but we just found out that it's been delayed another day, so I guess we'll be going to Bihalgaon or something tomorrow to finish up some of the last surveys we need to do in this area. 

Pictures!

Only a few since there's limited bandwidth... my favorite is the last one (taken by Pulkit).

Yay snow!

Snow!

I thought Texas weather could change quickly, but the weather here is a new extreme. We went from like 75+ degree and sunny weather to rain, to hail, and then to snow in about 36 hours. It probably snowed a foot in the course of an afternoon. The world was totally transformed. Power was out for about 48 hours, the roads were blocked, and the terraced farmland was absolutely gorgeous as we walked back from the Sargakhet hospital where there was supposed to have been an anemia study that day (no one showed up due to the weather so we sat around singing and playing card games). This morning the sun rose in an almost cloudless sky and the temperatures were again about 60 Fahrenheit. It’s now evening and 90% of the snow is gone; only isolated patches and muddy puddles remain. We finally have power, but the internet connection is down so I’m writing this in MS Word. Who knows how long it’ll be before I can check email and post this.

Time has been passing so quickly – it’s been almost a month since I left the US. Hopefully I’ll be able to wrap up the jaundice information stuff in the next couple of weeks, although the bigger picture of education about water treatment/purification will take much longer. In a meeting with another organization in the area, Aarohi (whom I had also contacted about working with during my time in India), we were finally able to get a sense of the bigger picture problems and what approaches have been taken/attempted thus far. Unfortunately, Pulkit and I seem to be much more on the same wavelength as the Aarohi people than with the majority of Chirag. This may very well be due to the fact that, at least within this meeting, we were able to communicate our ideas and ask questions in English, but regardless we were able to answer several questions that had been bugging us (for example, have solar cookers been tried? [yes, but people in the area have a resistance to new technology due to previous bad experiences]; what about various water filtration? [proper maintenance has been difficult to achieve]; what other approaches have been tried with respect to water purification? What is probably the most promising/fruitful approach to take at this point?)

 

Aarohi’s approach is also quite different from Chirag’s. In Chirag, each staff member will have a relative focus, but will basically be responsible for all aspects of Chirag’s work within 2-3 villages. This is an advantage in that people in a given village will become very familiar and comfortable with their Chirag worker, but this also prevents Chirag workers from delving deeply into a specific problem. Even if his relative focus is health, there’s no time to seek out solutions to a specific health problem like jaundice or to have uniform records of health across all locations. Basically, creativity feels very limited. In Aarohi, I believe it is the exact opposite: health workers will focus only on health in all of the villages Aarohi works in. Less personal relationships (theoretically), but more room for depth, problem-solving, and creativity. Which is better? My scientifically-inclined reasoning says Aarohi’s may be more effective, but maybe I don’t really know just how great the value of tighter personal relationships is in these situations.

Anddd power is back! Pictures of snow shortly :)

Gopuli

It’s my new nickname. A family in the village of Simayal decided Kathleen was either too hard to say or not pretty enough, so they decided I should henceforth be called Gopuli, Gopu for short. Now, at every family we visit I am introduced as Kathleen and as Gopuli, and people only ever seem to remember the nickname. I don’t mind, it’s a nice name, but whether I like it or not I think it’s stuck. It’s extra funny to me because to me it sounds like someone is saying ‘Go poo, Li’ all the time :P. Also...if anyone could tell me what Gopuli means, that would be great. It might be Kumaoni or Hindi, I’m not sure which.

The families we meet in the villages are incredibly welcoming and kind to us, complete strangers who are affiliated with Chirag and are doing ‘health work’. Something I’ve noticed both in Tibet and here is that although many of these families are relatively poor, they are so, so generous and hospitable. They insist on going through the trouble of making us chai, giving us oranges (the only fruits besides lemons that are in season) to take back with us, and offering us all sorts of snacks like crackers and guguta. Rural life is such a quiet, peaceful (albeit slow) life. People are patient, helpful, sincere. These qualities stood out even more in light of our trip to Nainital today, a very touristy town. There, people hounded us to take taxis and rickshaws, or to get our pictures taken by the lake. People tried to rip us off left and right, charging 800 Rs to get back to Sitla when it had taken us only 100 Rs to get there. It was good to get a meal with meat and to buy some grapes (I miss fruit more than I miss meat, I think), but I agree with many of the other people who have worked in the area that Nainital is definitely not the greatest place to be. If you want to visit rural India in an enjoyable way, drive (or be driven) an hour out from Nainital, pull over, and walk down to the nearest home you see. They’ll definitely invite you to sit and have some chai, even if you can hardly put 2 words together in Hindi. 

Speaking of Hindi, that brings me to a significant obstacle I’m facing. I have a pretty decent (usable) vocabulary of Hindi but for the life of me I can't figure out how to conjugate verbs. I could probably pick up conversational Hindi in a couple months, but by then I'd have wasted half my time here just learning the language. My options are a) use a translator and b) find a Hindi tutor and study intensively 2x/week for a month. Basically right now if I don't go somewhere with Pulkit I can't have a conversation with people. This wouldn't be a problem except we're working on different projects and I hate being dependent on someone. With a translator, I'd be 'freed', but I'd still be trying to communicate through someone else. Some people have told me that even the translators around here don't speak great English, so how much would I really be gaining? Also, the rate at which I learn Hindi would slow b/c there's less necessity for it. Ideally I think I'd like the Hindi tutor option but the problem is finding someone who speaks English and can give structured Hindi lessons around here. 

Dinner time! (I miss the variety of foods you can find in the US...variety is such a luxury...)