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.