How to Dress and Deliver Healthcare “Where there is No Doctor”

Before leaving for India, we were instructed not to pack any Western clothes. I knew I would have to dress in a certain way to respect the local customs, religious views, and gender norms. But in all honesty, it was hard to let go of my cutoff shorts and sun dresses. I could not imagine what it would be like to cover up my arms, legs, and sometimes head, in the summer. I don’t even think I cover up that much of my body in the winter, let alone during the heat of June and July. Of course, I knew Himalaya would be cooler than the rest of India, even Philly, but I still struggled to grasp my head around hiding my legs behind long skirts and pants for three months.

I spent my young childhood living on a beach in Australia, where it was more normal to sun yourself half-nude or even change clothes on the shore. That being said, I was imprinted from an early age with a very different concept of appropriateness and comfort regarding the objective showing of skin–this is more intertwined with my cultural views of the female body, entirely separate from my strong opinions tastes for fashion. Objectively, I would prefer to live my life in a bikini and sarong because that is what I feel most comfortable in, even though I live in Philadelphia. So I prepared myself to spend a summer hidden from the sun, except for my feet, which currently boast a ridiculous chaco sandal tan.
Aside from the pair of skinny jeans I wore on the airplane, I limited my packed articles of clothing to underwear, a few shirts and leggings, and my patagonia fleece. I normally wear wild bohemian prints and strange flowy articles of clothing, a “hippy dippy” look I inherited from my blonde (and once dreadlocked) older sister, so picking out my Indian attire wasn’t a problem. In Delhi I bought enough colorful kurti tops, baggy bright pants, and linen scarves to fill my obnoxiously bright green land’s end suitcase to the brim.

Daily outfit

At the start of our internship, I felt very comfortable in my new attire. In the village, most women wear saris or conservative panjabis every day. But this is technically “the field”. When I am out playing anthropologist, trekking to different houses with health committees, speaking to local healers, or working around the hospital–I feel comfortable. But in the office, and other professional settings with more Westerners and Delhi-ites, I feel strange. Gradually, each day in the office became a reminder of how much I stand out. Anjali and Renu–two other girls working as interns from Haldwani and Delhi–most often wear dark jeans or pants, button up shirts, and maybe a scarf if we’re going out. They look office-appropriate and normal. I completely understand the necessity to be culturally sensitive and “blend in” but at the same time I also recognize that I will never, ever blend in–no matter how authentic my panjabi is or how well my kurti and scarf matches. I am six feet tall and blonde. If anything, I think the Indian clothes make me stand out more, especially with my thick-framed Warby Parker glasses. Sometimes I look like–I feel like–I’m trying too hard.

Outside of my own personal experience with modesty and clothing, an interesting thing I’ve noticed here is the culture surrounding women’s appearance in a rural, mountainous setting. Women women do the majority of outside work with farming, forestry, and animal husbandry. You would expect them to dress in clothes which are more hospitable, or fitting to these jobs, and perhaps save the sari for when the work is over. But this is not the case.
Another intern, who is from India, often remarks that the cultural appropriateness of clothes here and what is expected of your appearance as a woman here is contradictory. Whereas everything is covered in loose layers of fabric from the waist down in addition to the chest and arms–the midriff is usually showing. Essentially, the sari includes a long slip skirt tied with a nada (drawstring) at the waist, a long piece of fabric which is wrapped around the body in a very complicated way, and what we would consider a crop top. No matter how old, overweight, wrinkly, or scarred–most women show a large part of their bellies. And this is still considered “conservative”. I find this fascinating because in American culture, it is typically most appropriate to cover midriff in exchange for some bare leg or arm. I kept asking myself why my ankles were more sensual than my stomach but after a while you just learn to accept the customs and seek to understand, even if it makes absolutely no sense.
I think it is quite fabulous, even empowering–not only the exposed bellies but the fact that women wear these beautiful saris while doing work and pull it off. It’s quite a stunning sight to see a woman carrying fifty pound barrel of hay on her head while draped in layers of carnation pink chiffon delicately beaded with sequins and silk thread patterns. It is also pretty badass–these women are doing hard manual labour, sweating in the Indian sun and trekking for hours, and they look absolutely beautiful while doing it.

Local women meeting at Sitla school

The women were all especially well dressed during my first day at a “health camp” this past Monday. I had been awaiting this day for a long time, because I knew I would finally be immersed in the rural health clinic setting. Essentially, a health camp is a type of “mobile clinic”. The hospital, (which essentially functions as a clinic instead of a hospital) is transported to a very rural, isolated area in order to reach more patients who do not have the means or transportation to visit the Chirag hospital. We packed up the jeep with simple examination instruments, a mini pharmacy, emergency dental supplies, and a water testing kit.

In attendance there was one doctor (Dr. Daya), one nurse, one dental assistant, the NGO health team leader, the pharmacist, and a water specialist. We set up camp in Majera (sp), a small village about 8 km from the hospital–our mobile clinic was in a sort of recreation drumming circle room next to a temple on a quiet bluff just a short trek from the road. It felt like–and looked like–we were in the middle of nowhere, but people showed up. More people in only 3 hours, (18 total) than the number which visits during one entire day at the hospital. There were a few interesting cases–one 92-year old with extreme optimism and high blood pressure, a crazy tooth extraction, and a large-headed toddler with possible hydrocephaly (excess cerebral fluid surrounding brain). I helped record weights, which were shocking low in every single patient, and talked through the different cases with Dr. Daya and Mary, the german nurse.It was a long day, full of whining children and concerned patients–but I learned more about rural healthcare in one day than I could have ever anticipated.

Health camp

The health camp works. This type of rural healthcare delivery model works. The hospital does not “work” in this sense. Even though the health camp was in the middle of nowhere, it still works because “the middle of nowhere” is exactly where people live and work around here–not just off the main road. But most importantly, it works because it’s familiar. We were set up next to a temple on a bluff overlooking the hills on clear, windy day–ideal for walking the paths that led up to our site. Light flooded into the community recreation/drumming center through three massive windows, illuminating the makeshift examination room. There was no harsh glow of artificial whiteness from fluorescent lights–no unmistakable smell of waxed floors, latex gloves, and cold metal instruments (the all too familiar “hospital smell”). There was the sweet fragrance of pines and ripening plums from nearby hillside orchards. Instead of the monotonous humming of an ancient x-ray machine and lab test beeps, the temple bell rang ever so often and there was the faint sound of cows and goats on the farm nextdoor. There was a carpet where women sat in a circle. Shoes off. Just like home.

I just began reading a textbook from the chirag hospital titled “Where There is No Doctor: a village health care handbook”, which has proven to be incredibly insightful. It reflects many of the triumphs and challenges I see in healthcare each day. I think the idea of serving the patient, combining the best of local traditions and modern medicine, and capitalizing on human interaction as a foundation of medical care is too often lost in the art of practical and cost-efficient decision-making. I want to understand how the hospital, which focuses on curative health, can combine their strengths with the local preventive health teams to make up for the deficiencies and under-utilization issues which are so obvious in different modern medical centers in Kumaon. I suppose the best way to learn is to continue to watch and listen. Although this is sometimes quite difficult when there are so many different voices.

Morning reads

 

 

One thought on “How to Dress and Deliver Healthcare “Where there is No Doctor”

  1. You are rocking the kurta!
    I think in both the areas Chirag works and where I teach now in rural Navajo Nation, there’s a long history of “outsiders” coming in to provided services. Around Chirag, people were very used to foreign interns asking questions. Now, my students are used to having non-Native, young teachers because of Teach for America’s presence. It establishes interesting norms and relationships, and at times can be tense. Even so, I was always told that they appreciated when I tried to learn Hindi or now, when I don’t hesitate to try their pesole, mutton stew, and frybread. I think it plays a role in affirming culture and language and that the Western button-down is not the only option for a professional look.

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About Caroline Kee

Located in West Philadelphia, where I attend the College of Arts and Sciences at the University of Pennsylvania. I am a junior in the 2015 graduating class, majoring in global health and minoring in creative writing. This summer I will be an intern at Central Himalayan Rural Action Group (CHIRAG) in the Kumaon Mountain region of Uttarakhand, India.