Citing myself

Another reason doing field research in India is very cool: using my own photos as evidence in our paper. No need to Google pictures of ORS packets in Tamil when I can just snap one in the office!

Nice.

So much things to say

Still working away on the intervention plan...hence, most brain cells capable of producing words have been assigned to that endeavor. Hopefully my teammates appreciate said strategy and Mom and Dad forgive me for not reminding them of my continued mortality on a daily basis.

Yesterday we took over the Ideal River View Resort to pitch our intervention proposals and receive feedback before the final paper and presentation this Thursday. We presented to the ICTPH staff, including one of ICTPH's board members, Dr. Nachiket Mor. Dr. Mor has an extensive background in finance and is closely involved in the non-profit sector as the Chairman of the Boards of Sughavazhvu Health Care, CARE India and IFMR Trust, among other board memberships. Pretty cool.

It was exciting to express what we have been working on for the past four weeks. Also good to share our work with a smart and thoughtful crowd. Although, even though millions of presentations have come and gone throughout academic and Coro settings, I've never really been in a position where my objective was to "sell" an idea to a "client." So experimenting with that approach was a great learning experience for me. Still not sure how I feel about using the corporate language of the man, blah, blah and all of that...but really, I am thinking a lot about the intersections between non-profit and business and how and where the models should adopt pieces from each other. And how and where they should not. But I won't bore with all of that here.

Either way, the Q&A sessions following each presentation were also an interesting illustration of how a presentation like this is different from the traditional academic "let me tell you everything I know about this topic" presentations I've done before. Many of the issues raised to me and the other presenters had been discussed at length with our teams, and, for one reason or another, were not included. Point being, even when you want to be concise and focus on the "selling points," the other stuff will inevitably be pointed out and addressed along the way. Which seems to be productive in that it gives a more comprehensive picture...so should all "pitches" include more info? Do we have attention spans long enough for that? I might venture to say no...

Besides all that, hearing what all the other groups are planning for their interventions raised some important questions for the organization. Like how are we going to expect our community health workers to do ALL this stuff--talk to people about clean water, anemia, salt intake and blood pressure, smoking, etc. That's a huge burden on them. So, it seems that, we, as a large group, need to have a conversation about points for coordination and collaboration to tighten all these ends up. Child and maternal health team look out...the GI folks might be looking to work with you on addressing diarrhea in kids under five...

After the morning presentations we enjoyed and awesome lunch on a beautiful patio overlooking the river. So much food!! Soup, paneer (cheese), eggplant, mushroom, breads, rices, ice cream and fruit. Oh man. I also had the opportunity to chat with Dr. Mor for a bit about some of his different work in micro-lending. Very interesting to hear how some of that implementation was designed and executed around India, where most people are not connected to any bank. Like many counties, the Indian mobile banking sector is growing. However, mobile banking takes away the human advice and guidance of a loan officer (who is more like a counselor in micro-lending settings)...so is something better than nothing? Or do we need the whole package? And if we need the whole package, is it ethical to decide to do nothing if only doing something wont really work so well?

Meep!

So we waiting the mom-recommended 30 minutes and proceeded to dive (ok, only I dove, but my shallow diving skills aren't too rusty) into the coconut tree surrounded pool. Water. Mmmm.

The night wound down with another awesome dinner, complete with...samosa!!! YES.

Ok, back to writing our final draft of the intervention paper. Thursday...so close...

It matters now

...so London bound post-India it is.

Closer and farther

observing the cooking being done for the school children. all very sanitary. no transmission of diarrheal disease here. and the lunch ladies were awesome.
hanging out with the lunch ladies in the kitchen. those big pots are full of rice and sambar (veggie soup to put over the rice. delicious, but kicks my esophagus's butt).
home visit with mother and her 2 and a half year old daughter.
cow hanging out in the busy road. im worried about an inevitable crash with me and motor vehicle, but if the cow can stay alive, maybe there's hope for me and my supposedly more evolved brain yet.
hanging out at school with Subha, one of the ICTPH community health workers who helps us get around town with her expertise of the village.
put the condensed milk and the sugar in the coffee and mix it all together...
coffee making
the school we visited
"money is the root of all evil" is written on the board in this English classroom
monkeys climbing up to our food stash. they broke the water pipe the other day doing so. while i was in the shower. covered in soap. cant make this stuff up.

Woo-hoo, almost finished with our first draft of our intervention plan. Minus the actual intervention...

It seems that every time we go into the field (almost every day this week) we see another aspect of diarrheal disease and a new perspective from different community members. While we are moving closer to narrowing down a specific intervention, we seem to be moving farther away from our original understanding of the issue. In a good way--more pieces of the puzzle are revealing themselves. Still questions on how to fit them all together and which pieces should be weighted more than others, though.

We spent time talking to the village panchayat (village president, like a mayor in the US), a primary health center nurse (nurse from the government run primary health care clinic), parents with young children experiencing diarrheal disease and a school headmistress and the school cooks who prepare lunch for the children.

A few really interesting things:

-the nurse reported that water in the government tanks is chlorinated at the time of cleaning, which is every few months. Furthermore, she reported that two tablets are used for the tank. Two tablets is the appropriate amount for two liters of water, for a 24 hour period. The tank holds tens to hundreds of thousands of liters of water, and is chlorinated every few months. She also reported that the water filling the tank is clean, as it is coming from an underground source that is safe. We are planning on testing the water in the tank on Sunday with the panchayat to see what it really looks like.

-some village residents reported that they are not happy with the water, and suspect that it's possible the water is playing a role in their children's diarrheal disease. They also said that they would need a large scale movement among the village residents to move the panchayat. They didn't think this was viable because many people are happy with the water or even take matters into their own hands (some people break the underground pipes that lead to the taps in order to pipe "clean" water to their own homes...however, this pipe breaking opens more opportunity for water contamination).

-one mother reported taking her young daughter to the doctor several times a year because of diarrhea. The mother reported spending 500 rupees on each visit. That's a lot of money (about $10 US)...makes me wonder if this family is one of the families who reported taking out loans to pay for medical expenses. Despite paying this large fee, the mother reported that the doctor has not once given her daughter ORS treatment...

So, again, there are a few things going on: problems at the government level in terms of politics and policy for supplying clean water, problems at the private practice level (the mother above went to a private provider), problems going on at the community level (people breaking pipes to make their own taps), problems at the household level (people aren't boiling their water or treating it in any other way)...just to name a few...

What was really hard (and yes, I know, this is going to be like one of those save the children announcements, full of feelings and stuff that I generally avoid talking about, but it must be said) was just hanging out with the mom mentioned above and her daughter, knowing that this little girl was sick as a result of preventable disease. She just happened to be born into a place where the conditions allow for diarrheal disease to be prevalent...and according to the research out there, her whole life could potentially be negatively impacted because of her chronic illness. Children who suffer from chronic diarrhea before two years of age have been shown to have impaired cognitive functioning compared to healthy children. In addition, nutritional status is often poor in children who have continuous diarrhea, which is associated with a whole bunch of bad stuff like stunting and wasting. And, in terms of economics and future economic potential, the family's resources are strained when they are constantly taking kids to the doctor, which might influence what opportunities will later be available for school, or social development or starting a business, etc. Bad, bad, bad.

Certainly an incentive to stay on top of our game as we continue to move closer to proposing an intervention...maybe we could actually prevent some of this stuff from happening in the future...

So, yes, on that note...other life happenings.

Foremost, food:

-monkeys everywhere! they have moved on from taking fruit to Nutella and Digestives. Sneaky little bastards.

-we had the most amazing chick pea curry the other night. I can't wait to observe this family who cooks for us. How do they make such wonderful things? Probably helps all the food is local, fresh and naturally organic...

-also, paneer butter masala...mmmmmm. My go to dish on our usual visits to Hotel Sangum's restaurant. Ravi, our co-instructor, and his wife have promised to show us how it's done. I cannot wait!!

-I drank my third cup of coffee ever. It tasted good! Because it was essentially condensed milk and sugar. And the woman who made it was awesome-- she owns one of the other coffee shops in the village where we are doing our field work.

-we visited Arun ice cream shop. So many flavors! And toppings! I was lame and stuck to chocolate stuff, but next visit will include some of the local fruit flavors like guava, jackfruit and lychee.

Other things non-food related (yes food is my first filter for organizing my thoughts):

-GIS (geographic information systems) mapping is awesome. With Ravi's help, we have a nice map of the water tanks, taps, schools and public toilets coming along. From there we can see who where some of the determinants of diarrheal disease are hanging out, who has access to what and is interacting with the determinants where, where good locations would be for point of access filtration...so cool!!

-One of the schools we visited had "money is the root of all evil" written on the board. Interesting phrase to be teaching, huh?

-I still get a kick out of cows hanging out in the middle of (very) busy roads.

-How about the London School of Hygiene and Tropical Medicine...eh? I'm kicking myself for not staying on the public health track after college...life gets in the way, I guess. Perhaps now would be a good time to re-explore that path...meep!

Thus, recent life happenings in a (rather disorganized) bullet-pointed outline.

This is a jackfruit tree

Aren't they interesting? This was taken outside of a beautiful hotel in downtown Thanjavur where I took a break to go swimming and eat a grilled cheese sandwich this weekend. So good on the sweet bread that's standard around here. Sort of like Hawaiian bread back home.

Oh yes, and we are doing work too. Visual proof of a session with ICTPH staff above.

Mostly lots of writing for our intervention plan. We seemed to have narrowed down our options to a few different intervention ideas:

-point of access purification plus an educational component about the purification device...so some device to put at the water taps where people get their water. Ideally this would be a device that is produced and maintained locally so that the intervention also contributes to local economic growth.

-point of use purification and storage techniques plus an education component about the device and/or techniques ...so some device or storage techniques to keep water clean once it's in the home.

-an education campaign about proper use of oral rehydration solution for children with diarrhea. we learned that while ORS is readily available, there is a gap in the way in which parents are instructed to use it.

Each idea has significant pros and cons. Ideally we would want to focus as high on the delivery system as possible (i.e. at the point of access versus at the point of use). This means less work for people and is more of a structural change. However, it does not guarantee that water will be kept clean once it's in the home. It also relies on an outside actor maintaining the intervention.

Point of use interventions require small, but significant behavior changes. I keep thinking of it in terms of obesity in the US-- people know that they should eat healthier to avoid all kinds of disease, but they don't. I wonder if it's similar with water treatment. People know they should (people report giving sick kids boiled water), but it's an inconvenience, or treated water tastes bad, so they don't do it.

Education campaigns about treatment would seem to be pretty effective, but they are focusing on kids who are already sick. Would be nice to break the cycle to being with.

While this is just a 40,000 foot outline of what we've been talking about, it does illustrate some of the tensions and questions that keep arising. How do you focus limited resources--on an intervention that would most likely be successful but not break the cycle of the problem, or on an intervention that might break the cycle of the problem, but might fail? Is it effective to continue to design and implement piecemeal projects and interventions--would a greater impact be had if we pooled all our resources to fix the cracked pipes that are likely causing contamination (assuming they are)? Then how do we ensure this is sustained when some water also gets contaminated in the home?

And what role do cultural practices play? We've already seen that just building toilets doesn't mean that people will feel comfortable using them (or that the resources are available to keep them nice so that people will want to use them)...so how do you, in a sensitive and effective way, tell people that their behavior is contributing to the occurrence of disease? And how do you build a sustainable way to ensure the benefits of changed behavior become obvious?

We keep coming back to these basic questions, but can't seem to find any ground breaking answers...maybe those questions are outside the scope of building a concrete, simple(ish) intervention that can easily be implemented and measured...

When the red sun sets...in Ambalapattu

fresh coffee after a day in the field
one of the community health worker's coffee shops
some peace
hand washing stations at the school
the school
government water tank
girls getting water out of one of the taps
rice fields on the way to Ambalapattu
the autos lined up to take us out for Dessas birthday dinner
sometimes elephants walk down the side of the road

A few busy days have passed by...

Wednesday we were trained in Basic Life Skills--CPR & AED. Brought me back to my life guarding days...even though the training has since changed a bit. Now I'll be fully up-to-date and qualified to keep your heart beating in the case of an emergency. Or something like that.

Yeah, so yesterday the GI team headed back to Ambalapattu to try out some geo-mapping. The idea is to take pictures of the government water tanks with our iPhones (there's an app for that! for real) and then take pictures of all of the taps the tank feeds. The phone then stores the coordinates of their locations, and we can produce a map of the system. We can also add other relevant sites--schools, homes, open defecation sites, toilet sites, etc.

Then we can test the water at various points and see if/where it is dirty. We know the government tanks are cleaned and chlorinated, but it seems that the water people are drinking is not clean. So where does it get dirty? By the open defecation sites? At a certain point under the road where there's a crack? Luckily our fancy technology can help us figure this out.

Once we have that information, we can figure out where the intervention should be focused. Like should we put filters on the taps disbursing dirty water? Or try to move the open defecation sites? Or is water clean at the taps, indicating that it gets dirty after it's stored in the home? This might indicated that safe storage and hygiene campaigns would be the most important area of focus...

We also had the chance to do a few more home visits, check out a school and the library. Some cool things:

-all the kids in the k-8 program receive hygiene training, like brushing your teeth, hand washing, etc

-people generally feel safe with the tap water because it looks and tastes clean

-people do boil their water before giving it to people who are sick, though

-doesn't seem like people are using the government maintained public toilets (I don't blame them)

-people are aware of ORS treatment for diarrhea, but not everyone uses it

So chatting with people and being so incredibly welcomed has been really awesome. I do wonder about the social desirability bias, though. I mean, people are on to us-- we ask about if and when their kids get sick, where the family gets water, how the use it, how the store it, if they clean it...So it may be the case people are telling us what they think we want to hear-- our kids don't get sick because we keep our water clean. Which could be totally true, but I'm wondering other ways to have these conversations so that we aren't quite so obvious. When it comes down to it, my favorite conversations at the home visits have been the ones about politics and food, anyways. And, somehow, we've learned just as much from those (that's relevant to our project, too!) less structured talks...

We ended the day nicely with some fresh coffee at a shop owned by one of the community health workers. And yes, I drank the coffee. Didn't want to be rude after all of the wonderful hospitality. Luckily it had so much milk and sugar I couldn't really taste the actual coffee. Even more exciting, the shop sold pineapples! I don't know if I've mentioned this--I've been eating at least 2 pineapples a day so far. No joke. They're small here...if that is any excuse. They are just so fresh and sweet. Amazing. And watching the sunset over the rice fields on the road back to Thanjavur isn't so bad either.

Oh, and the last thing, some monkeys gave me some funky looks on my way back from the track today.

One more last thing, we rode the bus with our house mom and house brother the other night. It was awesome. Public transportation is just so great and interesting around the world. Our house mom counted us like little ducklings as we hopped off. Me as the bus started pulling away. Probably wouldn't fly on the 147 down Michigan Ave...

It's the little things

Like Morning Edition, a day late. Woo-hoo! I think NPR might be the only thing I really really miss.

This story from Marketplace is kind of interesting, especially while in a country facing food shortages...

But-- seeing as one of my favorite hobbies is visiting grocery stores and grocery shops--it's sort of interesting to see that the junk food is prominently advertised in shops here too. Great news. Cookies and candies are hung above the counter in most of the shops...and I almost always fall for taking some home with me even when I'm stopping for some fruit or yogurt. Clearly setting the proper example.

http://marketplace.publicradio.org/display/web/2011/06/13/pm-the-supermarket-solution/

PS: This picture is not from my neighborhood...I feel weird taking pictures of people while they're chilling at work, so I stole this from online. Basically the same thing you would see here, though.

When you're here you're family

Today we spent our class time going more in-depth about the ICTPH community health worker model. I know I've mentioned it before, but I'll briefly outline it again. It's pretty cool. So ICTPH hires one doctor and one nurse to work at each RMHC. The doctors and nurses review applications and interview community health worker candidates. This helps to ensure that the doctors, nurses and community health workers work well together, as they will be sharing information. All health workers are women, over the age of 18 and are leaders in their community dedicated to improving health. The health workers visit families in their catchment area, doing preventive health screenings, providing referrals and and providing follow up services. Each worker serves about 200 households, most of whom already are familiar with the health workers. The workers then report their work to the RMHC so it can be recorded in the family's medical records.

Today we got to see home of this in action when we visited Ambalapattu. We had the opportunity to chat with some of the ICTPH community health workers who serve that village. The health workers were all very enthusiastic about their work and said that the villagers highly valued their work. Many of the workers said that villagers would call them to ask questions or take their blood pressures, etc. There is a great amount of trust between the families and the workers. A lot of this is probably due to the fact that the health workers are already familiar with the community members, seeing as they are from the same village. It seems like this really allows for the development of human capital on a lot of fronts. The workers reported that they are eager for more advanced training...

After talking with the health workers, the GI team interviewed the village president. We learned about how people in the community perceive diarrheal disease in children. Parents take their children to a health care provider, usually the most expensive one that they can afford. We also heard the ORS (oral rehydration therapy, which is the most effective treatment to prevent dehydration and it's complications) isn't widely administered. This may be because parents don't perceive it to be effective.

We also were invited into the home of a couple who was taking care of their grandson. It's been really really humbling how kind people have been to us since we've been here. The family welcomed us and gave us chairs, and told us "when you're in our home you're our family." They even picked some mangoes off their tree and gave them to us.

We spent some time just talking about India and the US and learning a bit about the family. We then asked them some of the same questions about their perceptions of diarrheal disease and sanitation. Surprisingly, the family asked us for our advice on how to prevent disease in their grandson. It was really interesting to have a conversation with them about some of the prevention methods we had been researching and how they thought they might work in their community.

Overall, a few things I'll take with me:

Just chatting with people is great. I mean, go figure, it's important to feel comfortable, and in turn, help people to feel comfortable around you. I'm hoping that I'm going into people's villages with an open mind and open ears, and can just soak up all of the interesting things that we are told. It's really cool too that people are so open and happy to talk with us. And are patient with us. I really couldn't be learning anything like this in a classroom in St. Louis. Props to the ICTPH staff and the villagers who have really taken the time and energy to help this gaggle of Amuricans learn about health and India and maybe a bit about some larger concepts too...

To put this concretely, I found it challenging to frame questions in a way that were open-ended and didn't come across as "ummm so why don't you wash your hands, huh?" I'm here to learn about whatever it is people report, because that's the best evidence for designing an intervention that will work in this environment. But I also know certain things usually work to prevent disease-- hand washing, water treatment, etc. Again, thanks to Sangeetha, our ICTPH team leader, for talking with us about this and helping us ask questions in the most appropriate way...

I look forward to continuing to develop in this area...another thing we certainly wouldn't be doing back on Danforth Campus...

Now, an early bedtime for another early track-date tomorrow morning...

The complicated futility of ignorance

Safe and sound back in Thanjavur. The morning beach think and the four hour car ride back left plenty of time for reflection...

And the following might be boring. Another stream of consciousness rambling session...

Last night we all went to a beautiful rooftop restaurant for Shawns birthday. And had a great time enjoying lots of grilled fruits and veggies (and wonderful meats for the animal eaters out there), cold drinks and the moonlight over the water. We had the opportunity to chat with some other American students taking a weekend break in Pondi. It was really interesting to chat with them and hear about what their experience has been in India.

But I couldn't help but keep thinking about a conversation I had earlier in the day, and the background conversation that's been going on for me since I've been here.

So yesterday while sitting at the beach, a teenager came up and started talking to me. One of the first things he mentioned was the exchange rate between rupees and US dollars. And asked if I've been able to live very nicely here because of it. Yes, we really have...I've been thinking about this from day one and am still not sure what to make of it. We have clean rooms with AC (that uses a ton of electricity in the already strained system) and an abundance of food (which is more plentiful than what many families around the world are enjoying) and all the bottled water we can drink (plastic bottles piling up everywhere!). And I'm at the forefront of doing a lot of these things...because I can just buy clean water when I want it. Wah wah.

And then the traveling, too. Sort of interesting how lots of the foreigners learning about a new place and working with the people who live there (yours truly included) end up in the same swanky bars, buying drinks that the average person could certainly not afford. Or drink, if she happened to be a woman.

I mean, not even a mile away from the beachfront restaurants and air conditioned shopping center is an open sewer ditch where people wash their clothes--see the picture. Because that's what's available (the closed sewer system in the former French quarter doesn't extend out into the rest of the city quite as nicely. Shocking). I mean, just now there is a diarrhea outbreak in the state of Orissa where more than 65 people have died because of unsafe drinking water. I could go on and on about the disparities that are apparent every day, but does that move the conversation forward? It's not like any of these realities are new to you or me. So then, the question I have is, what do I do with this?

Being right at the intersection of observing what's going on and being a part of the reason that some of it is going on has been really... interesting. And challenging. And hard to express without misrepresenting anyone, including myself. No guarantees I accomplished that.

I guess the final question, as it has been throughout these posts, is what are we, as a global community, committed to doing to address such disparities? Anything? Should we be obligated to act, even if we don't want to? What would those actions look like on a person level, community level, policy level? If we don't act, what are the consequences?

Oh what a world.

Watchin the tide roll away...

Ashrams are pretty cool--ashrams are places of spiritual hermitage. People go to stay and practice religion or yoga or meditation or basically whatever they are focusing on for the time.

Along with a gaggle of other tourists I walked silently through the beautiful gardens, shaded by giant trees. I stopped for some time and meditated with the group of people sitting on the ground. It was wonderfully peaceful and energizing. Quite a contrast from the bustle of the city streets. I wonder if the awareness that many people have for internal balance and the discipline that many people have for meditation plays any role in they way they are un-phased with the lightning fast pace of city life? Could be making a huge generalization here...perhaps worth considering though.

I definitely hope to learn more about some of the philosophy and practices of the ashram communities. I mean, sure I do yoga here and there at home and meditate off and on. But to really be committed to being healthy in the mind and spirit and making time to balance out life...wow that could be pretty powerful.

A good place to start was taking some quite time on the beach...just wastin time...

Pondi

Kingfisher Blue?

Mmmmm...beach...

Lunch!

Saw lots of these chalk drawings on doorsteps for homes and businesses
European feel
Mediterranean feel
A Tree Grows in Brooklyn...or over the open sewer in Pondi...
One of the beaches we visited with sand
The new lighthouse

A cozy bunch of 10 TPS students are spending a long weekend in the vacation town of Pondicherry. Pondi is located on the Bay of Bengal, and the wonderful sea breeze and peace of the water has just been fantastic!

The town has a really interesting history-- in short it was controlled by the French, who controlled a pretty large amount of land for some time. As such, Pndicherry is divided into the Ville Blanhce and Ville Noir-- the white town being the French quarters and the black town being the rest (...). The Ville Blanche has an obvious Southern European feel. The streets are quite (they are blocked to most traffic and the use of horns is prohibited). Many of the beautiful old buildings are hidden behind massive gates, unlike the open storefronts that characterize the places we've seen so far. I thought a bit about St. Louis (as we walked down Rue de Saint Louis) and how closed, gated communities have been a part of the city's development and character. I wonder if it's similar here, although the colonial aspect is, of course, far more intense? Either way, the streets are shady, canopied by beautiful old trees. The restaurant we ate lunch at was re-built around a 200 year old mango tree! It's beautiful and quaint, but totally not representative of the rest of the area or India in general...

We spent the morning exploring the city center and the Ville Blanche. The city center is vibrant, full of sound and smell and bustle. I have a great video of a sign that says "no horn use." The background noise, is, of course, all horns. Which I get-- horns here are how people alert each other something is coming. It's a courtesy. I'm getting used to it, but it can still be very overwhelming when you are trying to cross a street in one piece. We also saw tourists! There are lots of Indian families here for the summer holidays and lots of Europeans, too. By lots of Europeans, I mean maybe 5 or 10. Still the most we've seen so far, which was kind of fun.

We stopped for lunch at the beautiful French hotel. The building was incredible--the outside was plastered with a traditional method where eggshells and yogurt are mixed together and layered to create the smooth, white finish. The inside was all hand carved wood, on the walls and ceilings. And the food!! The choices were a great mix of French and Indian food. I tried a local curry, which was perfectly spiced. A few other classmates took advantage of the French meats and pastas, which were also delicious.

After feeling full, Sonia and Leslie and I went to be lazy at the beach. The main beach here is rocky--like big rocks that you can sit on-- so you can't really get into the water. Perching on a warm rock and being mesmerized by the waves crashing in was just perfect. There's something about being so close to the edge of the ocean and thinking about how all of these different worlds are connected so far away that can be so peaceful. Needless to say, I love the water and miss it dearly in good old Missouri.

After returning for a nap, the group headed out for happy hour at a beachside pub. We had a wonderful view of the palm trees, light house and the water. We then headed to dinner at Bamboo Gardens where we, obviously, ate under a bamboo hut. Not a bad way to spend an evening.

Today we're going to head back to the city center to visit the market. And I definitely am going to make a stop at the local asharam. And of course, the beach again :)

Expressions

One thing I haven't seen a lot of (probably because I've been looking in the wrong places or maybe even because I've just been looking for the wrong types) is art. Like the kind someone would put on a canvas. I feel like most places I've traveled in Europe and Africa displayed all types of drawings and paintings in the markets and on the streets...hmm.

But we're at a good place to start figuring some of this out. We have some of the basics down and I have navigated my most important cultural institution, food (and will happily continue to do so every day). It's time to explore some more traditional (and non-traditional!) forms of cultural expression....

In the meantime I've found a few interesting things about contemporary Indian art:

http://www.bbc.co.uk/news/world-south-asia-13672223

http://www.thehindu.com/opinion/op-ed/article2091291.ece

Sunsets on the road

Yesterday ended up being quite the late night followed by another busy day. We spent our class time talking about my topic area, GI disease. Something that we might not think about here in the US is diarrheal disease, which actually is one of the main killers of children around the world. This is the result of fecal to oral transmission of bad stuff-- through unsafe drinking water, contaminated food, or kids just playing and crawling in unsanitary places, among other things. And, to state the obvious, addressing these issues is hard. We want to tackle the problem before it becomes a problem...but how do you effectively change behavior? Some of the things we've been talking about are school-based interventions where children are taught hygiene skills and can them bring them home. And using the ICTPH guides to educate parents about sanitation and safe drinking water. While a lot of these ideas aren't necessarily addressing the systemic issue (dirty water and practices that dirty it), I'm not sure how to tackle those issues at this point. It seems like the government would have to be involved, and, as discussed, that's not an option at this point. So what's the balance between at least fixing a piece or two of the issue and focusing your efforts and getting the underlying issues figured out??

Later we celebrated some birthdays with our class and the ICTPH staff. It's been great to get to know some of the staff better. They have really enriched our learning and also become friends here. It's really cool to hear about what they have been working on here and before they came to ICTPH. I'm getting more ideas about all the great opportunities out there through their work...maybe crafting a plan for next year...but I'm sort of convinced that having some master plan isn't really the way to go...

More interesting than these thoughts though--we got to have one of my favorite dishes, paneer tikka masala. I know I keep saying this, but the food is just so amazing!! I seriously have not eating so much in a long time. I mean, I'm exempt from the healthy thing as a social worker, right...?

And today...

We spent the morning talking about oral cancer. We learned how to perform a basic exam to detect irregularities on the head and neck. As in the US, tobacco is a leading determinant of oral cancers. Yuckkkkkky. But the other big thing is that, in rural areas, many people use tobacco to suppress hunger while working in the fields. This poses an interesting question about how to address this problem in addition to actual tobacco awareness and cessation...

After class we hopped into the vans and made our way to Ponducherry. Driving through the Indian countryside was wonderful. We got to observe the entire sunset. It was a great time to just watch the landscape and little villages we passed through for hours. Popped in some of my favorite music and thought about how some of the social change being expressed might be similar to the changes India is currently going through...population growth, class struggles, food shortages, environmental degradation, political corruption and lots of educated, engaged young people...

the times they are a changing...

(sorry, cliche. couldn't resist.)

Blessings

Oral health day! Today in class we learned how to conduct an oral exam. Complete with tongue depressers and all. I did my best to make my patient, Audra, feel at ease. Thanks to her impeccable oral hygiene habits, she passed with flying colors. But let's just say there are many reasons why I would make a terrible doctor. I stole some pictures from Audra...my scary face in a mask is just one of the top contenders.

Later in the day Ravi arranged for some of us to have a tour of the temple. Going back at night and with a guide was a whole different and beautiful experience. We observed and participated in a few different blessings by the priests and received both white dust and red dust. The two dusts represent sort of the circle of life--destruction and life. The idea, as I understood it, was to be a reminder that life doesn't last forever, so remember to live while you can. It was really interesting to watch the rituals and think about the symbolism behind them. So many things were similar to the Christian ceremonies I've been to-- inscents, fire, chanting...sort of seems like, when it comes down to it, all religions are probably based on the same things...and perhaps I should just leave that there.

The most interesting thing for me was the elephant who blessed temple-goers. Including yours truly. The elephant put her trunk on my head and breathed on me. Now, I'm used to feeling short, but standing under an elephant is a whole other thing. She was so wonderfully gentle and graceful, though. It was a really spiritual thing to watch her with people. So there, Mom, I finally went to church and was blessed. How's that?

Other than that the night ended with an unsuccessful hunt for more pineapple. It would have been my third whole pineapple today (in addition to a sweet lime, an orange and a pomegranate), so perhaps that was for the better...