The Days Are Flying By (Part 1)

It feels very odd to think that almost a month has already passed since my arrival in India. Despite how full of excitement, new experiences, and new memories it has already been, the days left here seem fleeting. Because of the amount of content in the past month, I’ve thought it best to split the happenings into two parts.

ARRIVAL

As the airplane speakers announced our arrival in Delhi, I looked out across the aisle and over the shoulder of the person with a window seat. I saw absolutely nothing as they had decided to keep their window closed. So, instead, I leaned back in my seat to worry about making my way through the airport and customs. Little did I know, I was going to get a guided tour.

Not setting more than a single foot into the airport, I was randomly selected for a Covid RT-PCR test. I was a little worried about the results because I had recovered from covid so recently, but those thoughts were secondary to trying to keep up with the speedwalking officer zooming through the airport. The process was fairly quick but was definitely a little overwhelming as my first experience in India. 

Indira Gandhi International Airport – Delhi: post-covid test 🙂

After this, customs and baggage claim were a breeze, and the Delhi heat hit me and my co-intern in no time. We were very lucky to have my co-intern’s uncle’s family pick us up from the airport and take us to our Airbnb. They were also incredible Gurgaon exploring buddies in our first few days as they acquainted us with the nearby markets, malls, and the holy trinity of apps needed in India: Ola (ride-sharing app popular in India along with Uber), Zomato(food delivery app), & Big Basket (grocery delivery app). We realized the great value of these apps when many vendors would not have change available and the online payment systems (i.e. Paytm, PhonePe) were not available to foreign nationals. It seems urban areas are moving towards a more cashless system. Further, many cash purchases would also suffer rounding up to the nearest rupee. 

Our first trip to Worldmark!

WORK

Our first work day began 3 days after our arrival. The first few meetings were virtual and introduced us to the office and the projects we would be taking part in. One of these is the Let’s Fix our Food Project; its goal is involving adolescents in improving food regulation and literacy in India in hopes of reducing the prevalence of diet-influence non-communicable diseases. The second project we are working with is the “I-Saathiya” or peer educator program which is part of the greater Rashtriya Kishore Swashya Karyakram (RKSK) initiative for the purpose of using peer mentors and guided adolescent meetings to improve access to utilization of adolescent health services as well as increase health literacy. 

Our first day in the office was incredibly exciting. After having Ubers cancel on us about 4 times, we finally arrived about 10 minutes late. Everyone was incredibly kind and we were guided to our neighboring spaces. We then participated in a meeting of the Health Promotions Department where we were able to meet and introduce ourselves to everyone and get assigned a few tasks as well as instructions to help out with a field visit in Madhya Pradesh!

Before this visit, we worked on informational material for adolescents, designed engaging activities, and presented a literature review on scale-up methods as well as sat in on a meeting regarding a public health course PHFI would be beginning in collaboration with a European university. The travels to and from the office also acquainted us with Uber Auto! As it was likely that our “unique” Hindi could get us ripped off by auto drivers, the app gave us a great way to experience autos, pay a fair rate, and track our travel.

A week later, our trip to Madhya Pradesh approached. We would be traveling to the Madhya Pradesh districts of Panna and Damoh as a part of evaluating the “I-Saathiya” and adolescent clinic portions of RKSK. We traveled via train with an amazing PHFI Sr. research assistant. The Gaatiman Express train ride was an amazing experience, although we were definitely confused about where to go at first. It truly is a blessing how most things are written in both Hindi and English in Delhi. The placement of seats was also not the most intuitive, but officials were mostly easy to find and helpful in guiding us to where we needed to go, but there were definitely points where we felt eyes follow us in analysis. After stowing our bags on an overhead shelf, the 4-hour journey began from Delhi to Jhansi. About a half-hour in, soon after our tickets were checked, a tray was laid down in front of us. We were being served a full breakfast of bread, butter, cereal (that later came with a hot bowl of milk), banana, digestive cookies, soan papdi, mango juice, and of course options of tea and coffee. Of note, most coffee in casual settings I’ve come across in India has been instant coffee, giving more liquid pancake energy than brewed roasted beans …just the way I like it😈. This was soon followed by lunch, with options that my frazzled Hindi could barely understand, so the safe choice ended me up with some yummy paranthas I barely had stomach space for. 

The train breakfast before even more food was added

After arriving to Jhansi and wading past the swarm of auto and taxi drivers at the station, we made our way to the driver PHFI always worked with when traveling to/within Panna. Along the way, we stopped at Orchha Fort. It was a beautiful complex built in 1501 by Raja Rudra Pratap. The stairs throughout the fort were a little treacherous especially when it began to rain, but the views were marvelous nonetheless. 

We then traveled through the carefully preserved forestry onward to our hotel in Panna. It was lovely and often served as a wedding venue for the locals with cute gardens, a pool area decked out with animal figurines, and a train-themed food service area adjacent to its restaurant. We perhaps bonded a little more with the hotel staff than intended as we tried to sweep out what seemed like infinitely re-spawning, insanely high jumping grasshoppers/ crickets(??).

In Panna, we observed 2 Adolescent Friendly Club (AFC) meetings and 1 Adolescent Friendly Health Clinic (AFHC). An AFC is where all of the peer educators of the nearby areas come together to meet with their guiding NGO mentors/ trainers. The sister study in Maharastra differs in this aspect as it does not involve NGOs, but uses government employees at every level. We were meant to arrive at these AFCs and watch their function and record our observations of who attends and runs these meetings as well as what happens and is discussed at these meetings. Along with this, it is a chance to get feedback from the most population-level impacts of the intervention up to the implementation designers. We then observed an AFHC in the district. AFHCs tend to run about 2-4 times/ month and are usually located within Primary Health Centres (PHC) that are meant to serve as local clinics for those of all ages and can be staffed with councilors (an implementation from the RKSK program initially intended just for adolescents, but whose roles expanded with the demands of Covid), pharmacists, medical officers (physicians), auxiliary nurse midwives, nurses, and lab technicians. These facilities varied greatly in terms of capacity, but utilization of referrals made for a very efficient system directing more specialized cases to community health centers (CHC) and, if needed, to district hospitals. The facilities at the most local level were also crucial in providing if not direct than indirect access to iron and folic acid tablets and Hemoglobin test (as iron-deficiency anemia is a huge issue in India), pads, anti-parasitic medication, pregnancy tests etc.

Before traveling to Damoh we visited Khajuraho and the temples there. The designs were intricate and explicit and definitely a sight to see. The vibrant green grass really pulled the whole area together. 

Driving in Madhya Pradesh exposed us to wonderful scenery as well. We pass the tiger reserve Panna is famous for and push onward to the twists and hills of Damoh. In Damoh we stay in a “clubhouse” meant primarily for locals to use the gym, pool, and eat at the restaurant but also had exactly two rooms that could be rented. The stay definitely put us through a roller coaster of emotions. However, by night 3 it is safe to say the lizards were our friends, except the one that got crunched when we pulled out the sofa bed to sleep in our supervisor’s room because our initial room had been taken over by a family of 5 lizards and their food.

The AFCs we observed in Damoh were run a little differently and this change allowed us to gain a greater understanding of the implications of NGO trainer/mentor stylistic differences. Along with observing an AFHC we also witnessed an interview with some councilors and a director regarding how the programming is running from their perspective. Overall, it was wonderful to be able to experience and observe interventions and their effects at the local level along with appreciating the kind of effort it takes to maximize scarce resources.

Before we knew it, our 6-day trip was coming to a close and we were headed to Jabalpur to catch our flight back to Delhi. On the way we stopped at Dhuandhar Falls, waterfalls originating from the Narmada River which is known for being the largest river that flows east to west in India. 

In Part 2, I will discuss the local exploring we’ve undertaken!

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About Npatel

My Name is Nikita Patel and I am studying Nursing and minoring in Global Health in Penn’s class of 2024.  This summer, I will be interning with the Public Health Foundation of India (PHFI) in Gurgaon, Haryana this summer! I am studying Nursing and minoring in Global Health in Penn’s class of 2024. My co-intern and I will assist PHFI in “evaluating the implementation of the Peer Educator Intervention for improving adolescent health in India’s National Adolescent Health Programme (i-Saathiya)”!