A question I have been consistently asking myself as an intern at Chirag is how to make my time here worthwhile. My mind will not stop contemplating the ways that people’s living conditions can be made less challenging, particularly from a health standpoint. Narrowing down my research questions has not been easy, but I have decided to let this be more Chirag driven. Since Madhavan, the director, first suggested the idea of exploring how out of pocket health expenditures contributes to a household’s economic status, I have taken this broad topic and begun to delve in further. Even the most basic of questions leads to fascinating responses in this unfamiliar setting. In response to the question of “what is your spouse’s occupation?” one man told me, “she sits at home.” Upon further prodding, he finally revealed that his wife keeps up the farm and milks the cow and goat. Essentially, she does all the tasks that my host mom Bina did. These tasks are far from just sitting at home, and the man’s response is a classic case of gender norms in this region.
My first impression of this region left me with an overwhelming feeling of hopelessness. Government did not seem to exist here, and the community had to keep itself afloat. However, through conversations with ASHA workers (Accredited Social Health Activists, India’s version of Community Health Workers), physicians, and Chirag staff, the rural healthcare system is beginning to make a lot more sense. Villagers are meant to seek out ASHAs as their first point of contact regarding health needs. ASHAs are trained to extend biomedical healthcare services to rural regions, act as cultural barriers between the health system and the local people, and act as social change agents. Seeing this program work on the ground has been quite interesting after learning so much about them through classes. ASHAs can provide free first aid care and free medical supplies, such as antibiotic cream, paracetamol, cough syrup, and even birth control pills, given to them by the closest Primary Health Center. Villagers who live below the poverty line (BPL) receive a BPL health card, and this entitles them to an annual monetary amount for healthcare services. Beyond that, Village Health and Sanitation Committees (VHSC) have formed to advocate for the people’s health needs to the government by reporting incidences of disease and writing letters to the government when they recognize areas for improvement. All in all, health services exist in a clear format, but its implementation, such as adequate training for ASHAs or effectiveness of the VSHCs, could use more technical support from NGOs like Chirag. With this in mind, Chirag’s main drive in the health sector is through education. Some of their initiatives include building the capacity of the VHSCs, teaching villagers effective ways to treat drinking water with chlorine tablets or boiling, and host workshops and school competitions on health themes. Despite this valuable work, water-borne disease incidence remains high and will be a great concern with the upcoming monsoons, and women’s health issues demand much greater attention.
Nearly all the knowledge I know of this area has been gathered through interpreted interviews or conversations in English with Chirag staff. Speaking to a professor from the United States, who is here at Chirag for her own project, helped me recognize that it’s important to let go of the incessant need to Google every new topic. These informal sources of information are even more valuable and pertinent in this rural setting than any article I can uncover online. It’s all about continuously asking questions and engaging in dialogue. With this in mind, I look forward to many more conversations with local residents in order to learn more about their traditional health practices, their out of pocket health expenditures, and their experiences in the healthcare system.
And a few fun highlights from this past week:
· For the first time ever, I was mistaken for Native American by a shopkeeper. So I can now add this to all the other guesses I have gotten so far in India, which includes Northeastern Indian, Nepalese, Filipino, Thai, Laotian, Cambodian, Mongolian, Korean, Japanese, and Chinese. (I am of 100% Chinese origin). It’s been a fun experience for both Shumita and I to see how we are perceived abroad. When we are both thought of as Indian, we secretly give each other a high-five.
· The birds in this area are absolutely marvelous, and their beauty completely compensates for their annoying 5am chirping. My favorite is the Paradise Flycatcher. The male is of a pristine white color and a long ribbon-like tail that flutters as the bird darts around elegantly in pursuit of a mate.
· I finally finally finally got a SIM card for the cellphone and internet stick. Thanks to Indian bureaucracy, we were not able to do so as foreigners, so it took quite a number of steps and various people to contact before a kind coworker agreed to purchase two for us under his name.
· This past Sunday, Shumita and I went to Talla Ramgarh, but I believe she’ll share this personal story of discovering how connected her family is to this region. Beyond hearing stories of her grandfather, we had great fun birding, hiking, and seeing flat land in the valley!
· I went running on these gorgeous roads both today and yesterday. Each new turn paved the way for a completely new and magnificent sight. I received wide-eyed stares from the few people I passed, especially because I was running in the direction where no tourist ever walks through. When I greeted one young boy with “namashkar,” he just dropped his mouth and rotated his head in shock as I ran by. I also made the classic rookie mistake in the hills of going to far downhill, making the return a brutal uphill race against the sunset.
More adventures to come!