Bageshwar, part 1.

Alrighty, it’s time for my long overdue update on Bageshwar. We went there for a week to sort of scope out the health scene as well as the Chirag culture in that area. We had planned to just conduct more household surveys about jaundice and JSY, but it turned out quite differently than I’d expected.

The first evening we were there, we discovered more about the overall health scene in Bageshwar than we’d found out about the Reetha area in a month and a half. Maybe it was because the office was right next to the living area so all the information and files were right at our fingertips, but I think it was more that Gopika and Ganga di were like 100% focused on our project and what we wanted to know (b/c we were guests), something no one in Reetha really did. Because of that we learned about a lot of other health issues that we later found out also existed in the Reetha area, namely leucorrhea and poor dental health, both of which are caused by lack of hygiene. Gopika and Ganga di also suggested that we try a different approach. Instead of just doing household surveys and giving information one-on-one, why not present what we’d learned and what we know at 1) the primary school and 2) a town meeting? Our initial intentions had been jankari lena and jankari dena (getting and giving information), but we figured it was more efficient to give the information to people all together. You lose a bit of the “personal touch” and the ability to cater it to each family’s concerns, but I think that people’s concerns are similar enough that we’re still able to address the major concerns. Soo, we said sure, let’s call a meeting and go to the primary school in Janoti Paladi, the village we’d decided to work with. The other days, we planned to conduct household surveys and visit the ANM on vaccination day (Wednesday) to see if and how her work was going.

Now, slightly random tangent on the way we chose Janoti Paladi, which also represents basically the way Chirag seems to have chosen to do their health work in Bageshwar. Since it didn’t make sense to work in more than one village during the week we were there, Ganga di recommended that we work with Janoti Paladi because the Gram Pradhan (sort of like the mayor) was most supportive there. Now I see the value in the support of the Gram Pradhan, but Janoti Paladi’s health status is NOT the worst in the Bageshwar area, and that’s kind of what we had wanted to see. Turns out, in the Bageshwar area, Chirag is only working in health in 5 or 6 villages (the grant money limited the # of villages). And these villages were chosen not by their poor health status, but by the quality of the Chirag workers (karikartas) who work with the villages. Ganga di had the best karikartas, so all the villages are under her supervision. But because they are such good karikartas, wouldn’t you expect a better health status? If it were me, I’d either select a group of villages in which you see a range of health conditions, or select them at random, which would probably be the best thing to do. 

Soo, the next day, after we’d made our week’s plan, we met up with the karikarta for Janoti Paladi, Ajay da, as well as his wife Geeta di and the health coordinator for the area, Vikram da, who’s favorite phrase is ‘no tension’ and truly lives up to it. Then for some reason ALL of them as well as Gopika decided to accompany us on our introduction to Janoti Paladi. We were taken around to the old gram pradhan, some random women, the ASHA, and the angenwadi. Because there were so many people talking, it was nearly impossible to conduct our surveys, and strangely there were no pregnant women in a village of 500+ people. That evening we were feeling slightly down about not really getting anything done and not having a strong direction for the next day, so we decided that we’d tell Ajay da that we’d just go into the village alone and do our surveys, since that’s what our usual routine was. If he insisted on coming, fine, but we’d explain that we had a routine and stuff so there was no need for him to come along. And somehow we’d do this without making him feel like he was getting in our way.

So...Saturday morning and Ajay da insists on coming with us, but says he’ll only stay til 12:30 since he’s got a report to finish. We’re slightly more productive – we go to this one guy’s house and like 5 other people drop by and join in on the discussion. At first they think we’re government workers or something and they say ‘man, health is just great in this village. The ASHA does her job and everything!’ Then Ajay da says ‘guys, they’re not from the government, you can tell them the truth’ and we get a different story. They’ve seen the ASHA like twice in 2 years, the ASHA only does things for the women, there’s a new hospital/clinic in the village but there’s no doctor posted there so it’s never open, and on and on…. We asked what they’d like to see done with the 10,000 Rs that each gram panchayat (city council equivalent?) gets to improve the health of the village, and they suggested paying for a doctor to come once every 2 weeks or so for a health camp, which I think is a great idea. Whether it actually happens, whether the money comes, whether the health committee listens to their opinion is a different story…but it was good to hear solutions coming directly from them. We also went to the home of the head of a women’s SHG, and we were able to clarify some things about issues like leucorrhea and why it is such a problem. Leucorrhea, translated as “white water” in Hindi, plagues about half of the women in the villages. It’s caused basically by an infection that you get from improper hygiene, especially when you’re on your period. Women here are treated as “dirty” when they’re on their period, as I think I’ve mentioned before. They were once forced to live with the goats while on their period and they weren’t allowed to touch other people. Those practices and beliefs are changing, but slowly. Most women don’t bathe when they’re on their period, and they don’t properly clean the cloths they use to absorb the blood, a combination which breeds infection. It’s important to disinfect the cloths, and the easiest way is UV disinfection by laying them out in the sun, but women are just so embarrassed by them that they won’t dry them outside. I think one solution may be to suggest that they hang the cloths inside but next to an open window with direct sunlight shining in, but I don’t know if that is possible in all homes. And the bathing factor still remains. It’s sad that something so easily preventable will probably keep on happening for several more years because cultural norms are so hard to change.

While we had lunch at this woman’s house, we had a very interesting discussion on the amount of work women do here. Shafik, the guy who drove us up to Chirag on our very first day, had told us that women do all the work around here, and we’d seen it for ourselves in the villages, but we’d never really discussed it as a problem with a solution until this point. (For some reason or another, we seemed to generate many more ideas while in Bageshwar.) Basically, women work so much and don’t eat or sleep enough that it’s really bad for their health. Some days in a month they just give into exhaustion. They go into the forest to cut wood and leaves for the goats, and they’ll be gone all day with no food. They just drink chai to keep them going. And at night they sleep like 4 or 5 hours and wake up at 5am to start the day again. Their work is undervalued because it’s not income-generating. But there’s so much unemployment around here that the men aren’t really earning that much either, so they just sit around and complain about how they can’t get a job. I’m slightly exaggerating, since we did see one man plowing in the field and another digging a latrine for his home, but you get the general picture. So far, Chirag’s (and many other NGOs’) approach has been to work with the women in self-help groups and such. However, I don’t think that you can effectively change a society’s traditional views without addressing and working with both men and women. We can tell the women they work too much but they can’t work less unless the men agree to take on some of the workload. Also, we can tell the middle-aged men and women about all this until we’re blue in the face, but the truth is we probably won’t change too many of their minds. We need to start talking about these issues with youth, whose minds are still rather pliable and open, who aren’t already set in their ways. That, according to Ajay da, is the most effective way to affect change. And the government would ideally hold these discussions in schools across the country, but until that happens, Ajay da has the idea that Chirag basically starts youth groups that can meet and discuss these issues. I think it may be a viable idea, although it’s not very scalable or necessarily sustainable. Regardless, Pulkit and I are thinking of addressing the issue of gender equality in some form or another, we’re just not sure of a culturally appropriate way yet.

Alrighty this is getting lengthy and it’s getting late, I’ll save the rest for part 2.