evening project

I turned a baggy pair of pants, kind of like these, into a skirt! Ignore the mess behind me - I'm 'cleaning'.


It was surprisingly simple, although the results are imperfect. Just pick apart the inseam on the legs, cut to length, figure out where the new middle seam is, pin, sew, trim.

new favorite terms: upcycling and refashioning.

ah, summer

I think I've found (or rediscovered?) a new love -- sewing! But fancier this time :)

like this flower:


and this shirt - from this:


to this:


I could definitely use some more practice but I think it's wearable? Shouldn't have made it a v-neck, and I wish the top ruffle didn't have to go all the way across, but it's hiding blue letters.

yaay sewing :)

GPI = life.

And I am screwed for my 7.20 test.

John McArthur and Anita Sharma are coming to MIT for Poverty Action Week
(10/13). This year should be the best ever. Go to gpi.mit.edu to learn more about GPI and Poverty Action Week 2009.

That is all.

Goodbye, summer.

The last month of summer has just flown by. Some highlights:

- Date night at Bistro N + Harry Potter 6

- Finally learning something about sales and the restaurant business. I think as a result I'll tip more for good service, even if it's just a bowl of soup. But I'll also be more picky about the quality of my food. And goat cheese = yum.

- Alaska. What a beautiful place, with so much untouched open space. Flightseeing + kayaking among icebergs = totally worth the $7k my family spent on that trip.

- Dinner at Maggiano's. Surprisingly affordable, although the salad was slightly disappointing compared to Nordstrom's. The Lobster Linguini was delicious, as were the sampler-size desserts we got. Macaroni Grill bread is better though.

- Medical school applications. So many essays it's unbelievable. UCSD wants an autobiography.

- GPI has already taken over my life, but this year will (hopefully) rock. I <3 my directors.

Taking a break from rafting on the Klutina River.

My dad practicing qi gong on the glacier.

Larry showing off.

Yoga in the snow!

The view from the airplane window.

Inside an iceberg tunnel. Beat that, National Geographic.

Unlazy summer days.

So my dad thinks i've just been chillin for the past like...7 months since I went to India and while i've definitely been a LOT more relaxed and i've been sleeping a lot, I think i've still been relatively productive?

For instance, med school apps aren't exactly a walk in the park. I haven't been super on top of them because the secondary essays are a drag, but I am still...on time. I'm working like 20 hours/week at nordrstrom and doing a decent amount of reading as well. I've only seen a few movies and a shockingly low amount of scrubs and other tv shows.

It's hard to keep track of where exactly my time goes, though. 20 hours/week isn't exactly a lot, and GPI hasn't really taken over my life yet. I read a lot more news and current events, but it's not like that takes a ton of time. Somehow the hours just don't seem to add up.

9am wake up for work

10am-4pm work

4-4:30 drive home

4:30-5 read/snack/chill

5-6 email/read news

6-7 nap?

7-8 dinner

8-8:45 walk the dog

8:45pm -12:30am randomness/gpi/apps/phone

12:30-12:45 shower

12:45-2:00 read

2am sleep.

not a bad summer vacation. i just wish my job were a little less mind-numbing.

Dear 3rd-year-medical-student-Kathleen-of-the-future,

I just finished reading What I Learned in Medical School, and one of the stories that really stuck out to me was about slowly getting the humanity and sense of self beaten out of you once clinical years start. So I just want to remind you not to let that happen.

You're becoming a doctor to help PEOPLE. Don't forget that. Don't get so caught up in treatments or diagnoses (although those are pretty cool) that you forget there's a patient behind that chart. And I don't know what health care will be like in 3 years, and I know you don't have to worry about who has insurance, etc, as a student, but remember what Nordstrom said during training - treat everyone the same, and don't make assumptions. I think that might apply to patients as well as customers.

More importantly though, don't forget to take time out for yourself. If staying longer at the hospital is "optional", go home at least some of the time. Catch up with old friends, get out of the medical mindset for a bit. Try to maintain some sort of balance, and retain your personal identity. Don't go crazy. Go to a yoga class. Catch up on the news. Watch a movie. Sleep. You can never have too much sleep.

That's it for now. I hope you're having a good time :). Medical school can't be all that bad if you don't let it be, right?

Cheers,

Kathy-as-I'm-applying-to-med-school

Celebrating the Fourth with Lemon Cookies!

Things at work are improving (not that they were ever bad, aside from a sometimes-grumpy coworker). I'm getting the hang of the register and working efficiently. I used to be really impressed by the speed and skill with which tailors and cloth-sellers in india handled cloth, but now I realize that it takes about a week to get pretty good at doing just one thing, and a few weeks to get really fast. I don't really need to think when I work, I just need to pay attention. I guess (and hope) that that's the difference between a real expert like a doctor and a tailor. Although there's not as much of a difference as I once thought - depending on how you look at it, one is just a more complicated skill than the other.

But a good thing that's come out of work is that i now possess the recipe to the amazing lemon cookies we sell. I tried my hand at making them, and they're good, but still not as loose/light as the ones we sell. I have some more dough that I'll bake from frozen (rather than from room temperature) tomorrow for our family bbq. I followed the recipe otherwise, so hopefully that'll make the difference. Pictures from tomorrow...today's are all gone :)

Pulkit's coming to a family event tomorrow for the first time! Took 4 years but we're making progress :)

Goodbye contact lenses :)

LASIK = awesome. June 26 - probably more life-changing than my semester in India (okay not quite true but close). There's not much else to say. Dr. Boothe knows what he's doing. Less than 24 hours after surgery I was seeing like 99% as well as with contacts. And it keeps getting better. Especially after having to wear glasses for 2 weeks prior to LASIK, it feels all the more freeing.

In other news, started work at the Nordstrom Cafe in the Galleria. I had no idea there was even a restaurant there until a week and a half ago, but they have surprisingly good salads and AMAZING lemon cookies. They're like cake cookies (instead of cookie cakes) - suuuper soft with yummy lemony icing. It's a pretty fun place to work, although the cash register still confounds me at times. And having a job makes me appreciate weekends that much more :) I <3 sleeping.

New addiction to reading news from The Daily Beast. Not always the greatest, but it summarizes top news articles from different sources and puts them into a Daily Cheat Sheet that takes 10 minutes to read. So convenient.

Home at last, at least for awhile.

Five days after I got back from India, I left for Boston for a week, then NYC for 2 days, but I'm finally back for a good amount of time!

Cousins photo, taken at one of our traditional family barbecues the day after I got home. Like Karen said, I don't think I've had better chicken wings anywhere else. And the steak isn't bad either :)

Island Hopper in Boston! It was great to see the seniors again before graduation, and making $400 from Tech Reunions wasn't a bad deal either. Seeing alumni who are coming back for their 70th reunion and still talking about how much MIT has done for them is amazing on so many different levels. I'm totaly running for Gift Chair on the Alumni committee so I can choose reunion gifts :) Something to look forward to - for the 25th reunion, each class member gets a paperweight version of the brass rat. It's GINORMOUS. I can't wait (although I totally can't imagine what lives we'll all be living 25 years from now...). I spoke to alumni who majored in computer science in like the 1950's. I didn't even know computers existed back then. And one guy had been with IBM from graduation to retirement. Imagine the evolution of the computer he must have experienced/be experiencing.

Thailand Cafe in NYC! And froyo (did you know that Red Mango had tart froyo before Pinkberry did? Berryline is better though)! And shopping! And pedicures! NYC was definitely the largest shock to my system since coming back from India. Home is calm and clean and kind of boring in a relaxing way, Boston is amazing, but NYC was just like HELLO.

Except there were these super cute sculptures all over this one subway station.


Awww...

But...now I'm home! Things are still moving pretty quickly though. I met with some people from the Earth Institute about doing a summer internship from home while I was in NY. I need to finish my personal statement and get AMCAS submitted ASAP. I need a new laptop because my screen is shot. I'm considering getting LASIK? I might might MIGHT have an internship with the WHO in July if the lady would ever get back to me... If not, we might go to China to visit my grandma and make a stopover in Thailand for a week or so. Yay summer.

Aaand I still need to finish up stuff from India. Updates/pictures on our final few weeks there soon, I hope.

Going home!

:)

It's been an amazing experience, but I can't wait to get on that plane and be back in the good ol' US of A.

Bicilavadora...Indian style

After feeling kind of down about all the intangibilities (if that's a word) and disappointments we're encountering in our health projects, Pulkit and I decided to focus on something more concrete for awhile. We turned our attention to a project that we've been talking about since the first time we had to do laundry by hand - making a pedal-powered washing machine. 

Much easier said than done, but 3.5 days and 3300 Rs (not including things like buying soft drinks for the workers or excess/wasted materials) after we decided to do it, we were doing our laundry by foot rather than by hand. The design may not be the sturdiest but hey, it's working and it made it through a nerve-wracking, pothole-filled drive from Bageshwar to Devaldhar while roped to the top of a car.

Irfan welding. notice lack of gloves, real shoes, and face mask. On the plus side, the sunglasses make him look pretty cool.

Irfan making holes in the inner drum, by hand. He was a little strange but a true artisan and very skilled at what he does.

Almost done! 

Test run :)

Having a project that is a product is so nice sometimes. It's such a great feeling to be able to see, touch and use something you have made. Personal satisfaction factor is very high, unlike it is for public health projects...

The future of this bicilavadora? Chirag plans on showcasing it in the villages and promoting it as a labor-saving product. People (mainly women) spend at least 2 hours/day doing laundry, and this should cut the time down to 1 hour (for 2 loads) and they won't have to get their hands wet or wring dry, two other complaints about handwashing. We'll definitely leave behind recommendations for modifications, and hopefully there will be demand from the women since we can probably reduce the cost to 2500 Rs or less (50 USD), and that's a pretty reasonable price around here. The workers at Khetwal Industries where this was made may (hopefully) be able to start a business of their own with this but we'll see... Ideally, someone in Chirag or an intern with an interest in appropriate technology/mechE/business would take up this project and 1) modify the design 2) promote/trial it in villages and get feedback from women 3) work with local welders/artisans to manufacture and sell more of these. Any takers?

"At least we're not quadriplegics"

After a string of rather frustrating days trying to make year-long plans for 6 village health committees,  that is the silver lining we found in our cloud, no offense to quadriplegics intended.

Preventive health work kind of sucks. No one here cares about health, not the villagers, not the health committee members, not really the Chirag staff, and not even the ANMs and ASHAs. Villagers for some reason don’t make enough of a connection between health and livelihood; health committee members aren’t paid so what’s their incentive (their village’s development/improved health is usually not the answer); Chirag staff are just doing their job and doing the minimum to meet their deadlines; ANMs and ASHAs…there’s just no accountability anywhere. And no one has the right information, so even if people are trying to ‘give information’ about preventive health issues, who exactly is going to give it?

Things aren’t always like this, but it’s tough because successes are so small and you have to work so hard for each one. Health is a ‘soft’ development area, meaning its results are hard to measure and it’s not a very tangible issue. Infrastructure, agriculture, forestry – these things can be measured, there are plainly visible outputs for a each input. With health, you talk to 30 families about boiling water and jaundice prevention and are pleasantly surprised when 2 Chirag staff finally decide to start drinking boiled water. Maybe, a year down the line, once Chirag has finally gotten around to translating and printing my jaundice information sheets, a few more families will decide to boil their water. But who can tell what exactly influenced them? Was it my brochure? Did they get jaundice and decide it was something worth preventing? Did their neighbors convince them? Did the husband land a government job that allowed them to get a gas stove? Some combination of these scenarios? I can’t wait until I’m a doctor and have the knowledge to help villagers directly, measurably. Do women here really all suffer from leucorrhea, or is it just the name they give for yeast infections, reproductive tract infections, and other womanly problems? If so, hygiene needs to be the #1 focus. If not, each condition has its own cause and treatment and should be addressed separately. “If you want to change the world, become a doctor or an economist.” I can’t remember who said this to me, but sitting confused and powerless at health committee meetings, knowing Chirag staff are probably giving the wrong information but not knowing exactly what the right information is, it hits me every day how right that person was.

 

No doubt, I have learned SO much here about how things work on the ground, about NGO culture and politics, and about the failures of government health schemes and certain approaches to preventive health. I also didn’t expect to change the world in my 5 months here – I know these things take years. But for some reason, I didn’t expect to feel so frustrated and unaccomplished so often. The entire system is frustrating sometimes – the villagers, Chirag, government bureaucracy – but there’s usually no way to get around it, at least not at this stage. We’re just interns. Who are we to think that Chirag, let alone the state government, will take our projects and ideas seriously? I wish that wasn’t true, but I don’t see how we could make that happen.

To end on a bright note, as unpromising as our health committee meetings were, the first event in the year-long plan for Aagar gram panchayat’s health committee was scheduled for today, and it actually happened. About 10 people showed up in Banyatal at 8 in the morning to clear the main path of trash, pine needles, dirt, and overgrown shrubbery. It was a small group, but hey, it happened. 

Lazy...

Some photos I took of my field journal because I was too lazy to update, and then I was too lazy to post them until now... hope they are legible.

Hello from an internet cafe.

So we are going to be in Bageshwar for the next month and a half or so, for our new project. Got here on Monday and am finding a routine. Came into Bageshwar today to meet with the Chief Medical Officer to ask him some questions about some of the things outlined in the NRHM. Of course no one told us yesterday that today is a holiday, so the hospital was open for like 2 hours (I have no idea what people do when the hospital is closed...I didn't even know that was allowed) in the morning, and the CMO wasn't even there. We did manage to catch the deputy CMO but he wasn't very helpful and told us to come back another day for the information we wanted. Great start, huh. Since we're in the city, though, I think I'm going to take advantage of the tailors here and get some clothes made. I think we're going to be coming here every Sunday because it's the only place we can get an internet connection...I really don't understand how people in Chirag can get all their work done without the internet. It is completely beyond me. I guess given that they don't know English, the internet wouldn't be too useful to them, but there are a good number that know how to read English, and it's just so useful (and a little overwhelming) when you don't have a public health expert to turn to.

In other news, I need major help with my personal statement, and I have no idea what I'm doing this summer, nor do I have the means to look for a job at the moment...

More next week...

Bageshwar part 2

The power’s out so I can’t do any online research, and I’ve already typed up my weekly update to Alison, so there’s no more being lazy about this…

On Sunday of our stay in Bageshwar, we mainly lazed around and did a little bit of planning for our primary school preventive health presentation - a pretty cool meeting, if you ask me. We made it interactive and then had a game in the end. [Side note, you know how people normally prepare for meetings or presentations with like…an agenda, a slideshow, who’s saying what when, a couple run-throughs to make sure it’s smooth? I don’t think I’ve ever seen Chirag do that, one of my major disagreements with how they work, the other major disagreement being the fact that they have no experts. Anyways, without preparation, each meeting is slightly different, they might not get through all the material, and there’s just no consistency in a lot of it. So us preparing a presentation and everything was kind of different I think.  Then again I could be wrong since I’ve only been here for 2 months and could easily have missed the behind-the-scenes action that takes place before each meeting – that’s not my gut feeling though.]

Monday morning the Chirag worker who deals with education finds out we want to go to the Janoti Paladi school and says, “You should have told me yesterday, that way I can tell the teacher to make sure all the kids are in school.” Maybe not the greatest planning on our part, but given that we had no idea who we were supposed to tell and other people did, I don’t feel too bad. She makes a call to the teacher who says..yea, not a lot of kids are here but there’s enough for you to come do a presentation. We’re thinking 20 kids, 25 max. We go pick up some soap and candy and a nail clipper for our demonstrations, and when we get to the school there’s at least 40 kids sitting on blankets on the ground - a bit overwhelming. Our presentation went smooth-ish and the kids seemed to pay attention (REALLY well-behaved kids). Highlights were 1) live “how to wash your hands with soap” demonstration 2) “how to brush your teeth” 3) having like all the kids standing at the end of “who has had diarrhea? Vomiting? Typhoid? Jaundice? Stomachache?” and 4) one kid saying “you only washed 3 of your fingers” when they were guessing what I’d done right and wrong in our skit, and another one who said “you didn’t wear a school uniform to school.” That was probably one of the more satisfying things we’d done, knowing that they’d paid attention and learned something and probably wouldn’t forget it (even if they didn’t actually implement it). I may have to change my mind about not liking to work with kids. Adults are sometimes so stubborn and set in their ways that they’re hard to talk with and even harder to convince.  Kids are so willing to learn and be influenced…

After extensive confusion and disagreement among the local Chirag staff  (including the health director, Vikram da) regarding the location of the PHC (primary health center), we headed to the Bageshwar district hospital to get some information on maternal and infant mortality and ASHA/ANM information. Turns out ANMs report to the district hospital instead of the PHCs in the Bageshwar block, so they had all the information we were looking for and were actually very helpful. At the end, they even took us out for chai.

Bageshwar city is probably the nicest city I’ve been to in Uttarakhand (or India, for that matter). It’s got 2 rivers going through it and they’re relatively clean, not too much touristy hassle, and a nice ambiance overall. I’m excited to be going back there for our next project.

The last day of our visit was the big meeting, and we stayed up til 1AM the night before preparing for it. We spent a really long time discussing how to talk about gender equality and women’s rights. Do we split people up? Is that even logistically possible? Should we let only women talk and then only men talk? What if women say that men do the same amount of work as women (which we’ve seen is not true at all)? An excerpt from our notes...

            Women’s Rights

-          Must address this from a health and productivity perspective. Since the meeting is held to talk about health, that will be our approach to women’s rights as well. First, open up a general discussion about men and women’s roles in the community.

-          Ask women what they believe the role of women is in the community. Then ask women what the role of men is. Then ask the men the same questions.

-          Ask the men and women how much money the man earns in a service related job.

-          Create a list of all the responsibilities of the women including:

o        Going to the jungle

o        Working in the field

o        Taking care of the children

o        Making food for the family

o        Washing the clothes

-          Put monetary values on each of these activities and see how much money the women actually earn for the family

-          Now begin talking about how important it is to equalize the workload of men and women from a health and productivity perspective

We didn’t actually get through everything we wanted to talk about. There had been a meeting right before ours so people started getting antsy about halfway through our talk on jaundice. Covering everything would have taken a good 2 or 3 hours I think, so in the future it would be a much better idea to have separate meetings for each topic, both to avoid information overload and possibly to cater to more specific audiences.

Take a look at the expression on these women’s faces as they listened to Pulkit talk about the NRHM and jaundice though:

I think I learned a lot more from this ‘exposure visit’ in Bageshwar than I’d expected to. I value the importance of being able to get an expert’s opinion, something that is sorely lacking. I realize that, unfortunately, to many Chirag workers, working for an NGO is just a job, not something they do because they believe in it. Sexism within Chirag still exists to a large extent, which is to be expected since they are often from the villages they are helping. I’ve learned that it’s easy for people to get into a rut, into a routine, when they’re in the NGO for a long time. Also, I’ve come to value those that welcome and encourage fresh ideas, those who believe that interns aren’t just a waste of time. I hope that when, if, I am ever in a position in which I deal with interns, I will take the time to sit with them to exchange opinions, experiences, and ideas. 

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.

Delhi vs. Kumaon

We have just arrived in Delhi this morning on the overnight bus from Haldwani, and the contrast is ridiculous.  The hills are peaceful, beautiful, full of fresh air - wholesome. Delhi, and even Haldwani, is chaotic, rather dirty, and definitely lacking in fresh air. But Delhi also has a refrigerator, a washing machine, meat shops, SOY SAUCE, and an immense variety of food and snacks. In Kumaon, grapes and non-masala flavored chips are a luxury, and  snickers bars are extremely rare. It's not even a question whether or not your laundry is done by hand. The bus we took was a "Deluxe AC" bus, a step down from Greyhound, but it was the fanciest, most high-tech thing I'd seen in ages (aside from my laptop). Even the "cities" in the hills like Almora, Bageshwar, and even Nainital are tiny in comparison to Haldwani and even smaller compared to Delhi. The buses we normally take have no AC, no fans, and definitely no shock absorbance systems (enhanced by the fact that the roads are often full of potholes and undergoing construction of some sort). The tradeoff, I suppose, of crappy bus rides is that your destination is usually quite beautiful. There's a view of the Himalayas, gorgeous terraced farms, and greenery all around. While the ride to Delhi was quite nice, and Delhi has many facilities that I miss while we're in the hills, the view isn't what you would call great. 

But... food plays such an important role in my happiness that I'm not sure which place is better. Variety is sorely sorely lacking in rural india, so our trip so far has been a food quest. Today's breakfast at Pulkit's uncle's house had more variety in it than I've had maybe in the last month. Omelettes, meusli, milk, kebab thingies, toast, tomato spread, bananas, mmm.... Then there was lamburgers and grilled fish for lunch, Baskin Robbins ice cream, fresh fruit/vegetable juice, and a quest for soy sauce - first at the Tibetan market and then more successfully at some import shops near Khan market. 

Tomorrow I'll have some pictures and another post about what all we're actually doing besides longing for food. I'm set to wrap up this jaundice project within the next week, after spending Holi in Delhi, and I need to identify what I want to work on next.

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 :)