Meeting the People Where They Are - Part 2 (for fans of Partners in Health)

I arrived safely back into New Delhi on Sunday evening, no problems. The security at Bangalore airport was pretty intense – I had my bags searched multiple times and boarding pass checked many more times than normal. They almost confiscated all of my camera batteries that weren’t already loaded into the camera (I had about 15). All in all, it was smooth and there weren’t any problems.

My time at Swami Vivekananda Youth Movement was one of those experiences where you look back and you say, “That was only one week?” I guess I’d say that because each and every single day that I was there was filled with opportunities and chances to take part in something I had never seen before. Whether it was the hospital rounds or mobile clinics or trips to the ayurvedic hospital, each stop along the way taught me something about the vision of the organization. I’ve been able to see how coming in with the desire to observe public health initiatives, that “public health” is so much more than what can be fit in the confines of a hospital or office.

I mentioned Partners in Health because many people are familiar with Dr. Paul Farmer’s organization and have read Tracy Kidder’s book, Mountains Beyond Mountains. Swami Vivekananda Youth Movement began with the very same vision and reason – tribals living in the rural areas of south Karnataka were flooded out of their homes by the construction of a dam in the areas where they were living. Out of compassion and concern for their healthcare – a group of doctors in the 80’s began SVYM to provide healthcare to these tribals with whatever it took.

But they realized after a couple years that treating the needs of these people with their medical skills could only do so much. What happens if you treat a child for diarrhea and he went back to his village and drank the very same dirty water and got sick again? What if an entire generation of girls grew up and none of them could read? How could you teach people that the polio vaccine was something to save you from a potentially life threatening disease and not a way to make you infertile?

And so they started schools. They began promoting clean sanitation and water practices. They envisioned creative initiatives to teach women about family planning and ante-natal care. For many of the tribals and non-tribals alike, there were many obstacles that needed to be overcome before a sincere trust in SVYM was garnered. But for every obstacle, there was an innovative solution devised that was alongside the vision. People were taught that it was okay and desirable to have a toilet in the vicinity of their house. People were charged a mere 2 rupees to reinforce the value of seeking healthcare even if nothing was wrong with them.

One of the simplest but profound lessons that I learned at my one week at SVYM started even before I got on the plane to Bangalore. I’d once heard a story of a group of aid workers in Africa who decided to bless the tribals they were working with by giving them a huge batch of eggs as a gift. Delighted, the tribals accepted the eggs and consequently killed all of their chickens for food, not realizing that the eggs given to them by the workers would eventually run out. When they finished their eggs, they were left with a huge challenge that the workers were not there to help them through – how were they going to get more eggs? Similarly, I heard a story like this one at SVYM. At one point, the government had allotted a certain amount of money for the construction of toilets in the rural areas. The people were left asking though, “What’s a toilet?” “Why would I want that?” “Where am I going to get the water to flush it?”

The simple lesson to learn here is that development, aid, medical, whatever work to people must meet the needs of the people. It’s not that the intentions of the African workers or the Government of India were bad. They probably meant the best for the people they were serving. But somewhere along the line, there was a mishap in understanding the true needs of the people they intended to help. And that was one of the most valuable take-aways from SVYM. Every initiative, program, and extended arm to the community was created with one purpose: meeting the needs of the people in the surrounding communities.

So what’s next? I’m not really sure. I was having dinner with Sridevi and Seetharam’s family the night before I left and I remember asking the same question. Before I left for India, I got to meet with a professor in Michigan’s School of Social Work and I remember inquiring about any possible work opportunities in the fall. He mentioned the plethora of grassroots initiatives that he was involved in across southeast Michigan and that there were plenty of opportunities for students who wanted to take up a project for themselves. He even pointed to a box of robotics Legos kit that he was hoping to use to start an after school program for kids at a local low-income middle school. Somewhat disappointed that he hadn’t offered a regular eight hour a week job, I nodded and told him I would keep in touch.

But thinking back the lessons taken from SVYM – I’d have to say that I’m seriously reconsidering that box of Legos Robotics for this upcoming fall!

Here are some last pictures from my final days at SVYM:

I decided to extend my stay for one extra day, which turned out to be a pretty good decision because it would’ve been pretty hectic to fly out of Bangalore the day after the bomb attacks. On Saturday, I went on a mobile again, this time into the deep forests of Karnataka, bordering the state of Kerala. I was told that this mobile was almost like a mini-safari, with elephants, tigers, leopards, deer, and water buffalo galore. I saw everything except for tigers and leopards (luck is really on your side if you do). Here are a pack of elephants that we ran into the first fifteen minutes after entering the forest.

A shot of child getting medical treatment. Life for the tribals in the forest is very tough. I was told that many people survive on one meal a day – there are just very few viable economic opportunities around. I noticed throughout the day that there was a pattern of conditions that we were encountering throughout the day. Many of the children were coming to us with fungal and parasitic infections, like scabies. Many of the women were coming with conditions related to ante-natal care. For the children with the fungal and parasitic infections, the reason for developing such conditions is none other than poor sanitation and hygiene. You can see why there is a great need for education and advocacy campaigns to prevent these preventable conditions.

On the way back from the mobile clinic, I asked one of the health facilitators what a tree house (there were many on every field) was doing in the middle of India (I assumed they were for kids to play in). Turns out that these are real tree houses used to protect the crops from animals eating and trampling over their crops. People sleep in the tree houses at night and if any destructive animal were to come around, they would throw noise making devices onto the ground to scare them away.

Shot with all the doctor's kids that lived next to me. On my first day I came to them, asking them to play cricket. I got to hit my first couple of balls ever - and got destroyed by the bowling of the 8 year old standing right next to my right arm.

Final shot with Dr. Sridevi and Dr. Seetharam's family. They have two kids Amritha and Sriram, a housekeeper named Sughita, and Dr. Sridevi's grandma living them as well. Dr. Seetharam is coming to New Delhi this week for a meeting so hopefully we'll get to meet up and talk over dinner!

Design for the Other 90%

About a year ago, I stumbled upon a website called Design For the Other 90%. Intrigued by the uniqueness of its name, I followed the links and discovered a wealth of innovation and ingenuity that were harnessed for serving the poor. The premise was that the majority of designs in today's day and age are created for only 10% of today's population - ignoring the other 90% of the world who are often in greatest need for creativity and craftsmanship for everyday problems. The website showcased products spread across several categories pertinent to everyday issues that the world's poor face: water, energy, shelter, among others.

One of the cool products I read up on was called the Lifestraw. Because clean water is not easily accessed in many parts of the world, the effects of waterborne conditions encountered because of low quality water are vast and wide-ranging. If I remember from my International Health class this past year correctly, diarhea is the number one killer of children around the world. The Lifestraw is designed to turn any body of water into a sufficiently clean water for drinking. It's shaped like a straw and designed to be sturdy and recognizable. Another product I remember reading about was the Big Boda Bicycle - which is designed to allow local merchants to carry a significantly greater load between destinations. Since bicycles are one of the primary mode of transportation in the developing world, one can understand the convenience factor and efficiency advantages to having such a bicycle. The beautiful thing about all the products on Design for the Other 90% is that every item has been specifically designed and engineered for the needs of the poor and the people that are using them. There was a thought process that occurred and took into account the context by which the products would be best utilized.

At SVYM, the Design for the Other 90% idea became real for me. On Friday, I got to visit a school in the rural areas of H.D. Kote. SVYM has been involved in the education of kids in schools all around the rural areas of their headquarters in Saragur. As part of that initiative, they helped donate funds to construct a see-saw that pumps water out of the ground into a large storage tank on the roof of the school while kids are rocking back and forth. Instead of having to hand operate a pump of some sort to store enough water for the school's use, a simple recess session can instead provide enough water for the school to use for its bathrooms, canteen, and other water-related applications. Although these see-saws aren't being built in every school around, I couldn't help but be reminded of the innovation and uniqueness of the idea that represents one step further towards educating people about the importance of the availability and quality of one's water supply.

We were there on Friday for the inauguration of the see-saw, among other things around the school grounds. The kids were loving the new toy, and as we walked around, we saw different areas that SVYM had contributed to for the education of the children in the areas of water and sanitation. During the ceremony, some adults decided to jump on and contribute the pumping of water into the storage tank as well!


The see saw. You can't really see the pump because the plants are blocking it. Kids were jumping all around it having a good time - and pumping water at the same time as well.



As I went around to take pictures of the see-saw from different angles, kids started to follow me. Eventually, they began to stand in front of what I wanted to photograph (the see-saw).


The water tank that water from the see-saw gets pumped into. It holds enough water for everything the school needs for day-to-day functions.


A photo of the bathroom at the school. One of the obstacles that SVYM had to overcome initially in its promotion of toilets over no toilets was convincing the people that it was safe and acceptable to have a bathroom in the vicinity of buildings. The thought of having a bathroom inside of a building was looked upon as undesirable and disgusting. This bathroom was right next to the school - and had a covering as well as a collecting pool (on the left) for water used for flushing.

Situation in Bangalore

If you've read the world news in the past day or two, you might have come across a story on bomb blasts that have been occurring across India over the past couple of days. On Friday, a series of eight low-intensity bombs exploded across Bangalore, killing two people and injuring several others. Today, serial blasts ripped through the western city of Ahmedabad in the state of Gujarat, killing 15. This level of bomb attacks has occurred in India several times in the last couple of years, most recently and prominently in Jaipur a couple of months ago. Apparently, they are designed to cause civil unrest and instability and may have a connection between Hindu and Muslim tensions.

All in all, I am safe. I am not staying anywhere close to the bomb attacks and will take utmost caution when I travel back to New Delhi soon. I decided to extend my stay here at SVYM without prior knowledge to these attacks in Bangalore to check out the Saturday mobile. I'll update on the final wrap-up of my time at SVYM when I return back to Delhi!

Go Blue!

The past couple of days have been great. On Tuesday, I missed the hysterectomy to go on a mobile clinic into the tribal areas. It was a full day experience with a doctor named Dr. Suman, a community health worker, a pharm tech, and myself packed into a van stocked with enough drugs and medical supplies to last us for the day and drove out for hours into the rural villages of Karnataka. We stopped in about 10 villages total, with people coming to our van with anything from acne to infected wounds. Some people came complaining of a particular ailment, but after a quick consultation from Dr. Suman, she would end up prescribing them a placebo drug - a multivitamin! She explained to me that this practice is not simply lying to the patient and tricking them - it reinforces the practice of actively seeking healthcare, something that is not as ingrained in the culture of the tribals. When we drove through the villages - many of the people and especially the children would stare at me. I would wave, and some children would wave back. Others might run and hide. But when I took my camera out and started taking pictures, the children opened up right away and were really excited to see pictures of themselves when I showed them on the screen.

My first picture at the stop. About 8 or so kids.

My second. Twenty or so kids. They went crazy every time I showed them their picture on the screen.

I thought to myself, "What would happen if I showed them the screen and took their picture?!" Unfortunately, after this picture, I started to fear for some of the little kids' saftey (you can see some of the kids in the front are sort of getting crushed by the excited kids on top).

At one point, eight or so guys were lined up next to me on a fence ledge. When I pointed my camera to take the picture of these guys, everyone that was below ran and tried to get in the picture. The line of kids standing in the back was probably ten or so kids.

Typical shot of the mobile clinic. We would normally have a couple patients, and a lot of kids that were curious as to what we were doing there.

On Wednesday, I got to visit the tribal hospital that specializes in Ayurvedic medicine called Kenchnahalli. Ayurveda is another philosophy of medicine that is practiced mainly in India. It is different from typical western styles of allopathic medicine in that it involves a lot of herbal medicines, yoga and meditation, and personalizatio based on your own body type. SVYM uses in Ayurveda in conjunction with allopathic medicine, especially to treat chronic conditions and in situations where ayurveda might be the better solution to the medical condition. Since I was visiting - the people thought it would be a good idea for me to get of ayurveda by going through a round of treatments. I ended up spending the day getting a full body massage, a session in a steam chamber, a hot bath (more on that later), and a yoga lesson. I also had a session called "shiroddhara" where hot oil was poured on my forehead, with the intended effect of raising my intelligence and helping to cure any sort of psychosomatic disorders or conditions around my head that I may have had (didn't have any).

Shot of the hospital. The entire campus was pretty small (you could walk to the other side in 5 minutes). The campus reminded me at times of a spa or resort, with its coconut trees and design of buildings. After all, there were facilities to administer and receive full body massages and steam chamber treatments (as part of Ayurvedic medicine, of course).

The first stop of my ayurveda experience. I got my massage on this table. You can see the stove and cabinet underneath where a lot of ayurvedic herbs and oils (everything is natural and there are supposedly no side effects to any herbal remedy) where things were heated up and prepared.


The steam treatment chamber. You sit inside and your head pops out of the whole on top. Because your body is covered in oils when you enter, the sweat that starts coming out as you're sitting in the chamber wicks the oil off your skin and when you step out your skin isn't as oily as when you left.

My hot bath. I was totally expecting something on the lines of a bathtub with bubbles and candles and leaves or something of the like, but not this time. I can't complain though - having not had a hot shower in 4 weeks, any hot water in a shower was good enough for me. I had a second one at night too after my shiroddhara.

Perks of being in the rural - monkeys roaming around the campus!

Dinner with the staff of the hospital. Dr. Dennis and Dr. Basaraj are on the right - they are both ayuvedic physicians.

I also got to visit the other school that is tied in with SVYM called the Viveka Tribal Centre for Learning. It's essentially a school that was started about twenty years ago for tribals that reside in the area. It's an amazing story to hear how the school started and how it has evolved to what it is today. Because many of the children over the past twenty years are first generation students, there were many difficulties encountered in acclimating the children and their parents to the idea of learning and attending school. One of objections by the parents was apparently the misconception that schools were "jail-like" for their children. So in order to compensate for this, the buildings were constructed with huge windows in the buildings that made the classrooms look like a gazebo. Starting from the youngest grades, classes are virtually conducted outside, which isn't a problem with the year-round warm temperatures. As the children grow older, the classrooms become more and more closed and what you might think of in a typical classroom, which accomodates their adjustment to school and routine learning everyday. This sort of innovation blew me away and I was left wondering what other sorts of adjustments were made to attract more tribal children over the years. The results are showing - there are families that are producing second generation learners, and children of former students who are now able to attend the very same school. Amazing.

This was the classroom for 1st to 4th graders. It was wide open with huge windows so parents wouldn't think it was a jail.

As you move on up, the classrooms stay relatively open, but more and more closed. This classroom was for 5th - 7th graders. After 7th grade, you move into a normal classroom inside a building.

We walked in around lunchtime. They all sat in perfectly straight rows, cleaned up after themselves, and went to attend to their daily chores.

Today, I took my first bus ride for about 45 minutes to a settlement called Handpost. After making friends with mutton and chicken butchers, an SVYM vehicle came and picked me up and we traveled to Mysore, the biggest city in the area nearby. I got a chance to explore two other educational arms of SVYM, the Viveka Institute of Indian Studies and the

Viveka Institute for Leadership Development. I was particularly excited for this part of the trip because I had heard that there was a group from Michigan that was here at the VIIS for four weeks of classses in South Indian music and dance. I met several of them in the computer lab and had lunch with their group. It was interesting to see where they had all come from and how they ended up in India. I also found out that I have the same class with three of them this upcoming fall!

While waiting for my ride at Handpost, I met these two brothers who were selling mutton. When I drove by in the evening, it was gone!

We ended the day with a trip to visit the antiretroviral clinic in Mysore that SVYM runs in partnership with another medical organization. I got a chance to observe the different arms of HIV/AIDS treatment - namely, the counseling, the labwork and testing that goes into diagnosis of the disease, the administration of anti-retroviral drugs, and the actual doctor to patient interactions and consultation. Because anti-retroviral drugs are very expensive typically, this clinic was unique because it was providing all drugs for free. India has become a world leader in production and distribution of low-cost, generic drugs. Because of that, world drug prices have dropped and thousands to millions have been able to receive therapy for their conditions.

The pharmacist at the ART clinic. Some of those drugs cost eight or nine thousand rupees per box (200 dollars), but since the government is supporting the program, the drugs can be given out for free.

Tomorrow is my last full day at Vivekananda Memorial Hospital, although I am trying to extend my stay one more day so that I can go on the mobile clinic that travels into the forests. Apparently, it's a very different and very exciting experience. On a good day, you might run into animals ranging from elephants, to leopards, to tigers, to wild boar. Hopefully it will all work out.

Go Blue!

First Day at Vivekananda Memorial Hospital

Today was my first working day at Vivekananda Memorial Hospital. Since I'm only here for a week, I only have enough time get a glimpse of what sorts of programs and initiatives they have here and don't have any sort of opportunity to get involved in projects of my own. That, and I'm not a medical student so I wouldn't be able to treat patients. Aside from that, I would say that the first day as a good glimpse into some of the heart of what the Swami Vivekananda Youth Movement is all about.

I started off my day going on inpatient rounds with Dr. Seetharam, husband of my contact person here at SVYM. We went through all the wards the hospital has and talked to each patient, going through what they were hospitalized for, and what treatment was being done to get them discharged. It was cool bouncing medical terminology back and forth with Dr. Seetharam - those "Trauma, Life in the ER" episodes I used to watch on TLC were coming to life. Since the organization exists to serve the poor and underprivileged, there were a plethora of services that were being offered for free.

For the next section of the day, I met with a man named Shivappa and the man who works in the Water and Sanitation division of SVYM. They took me on a simple tour of the Sanitation Park behind the hospital, which was essentially a "showroom" of 10 different kinds of toilets with different configurations of building material, type of pit the "matter" empties into, and methods of flushing. We had a good time joking about the toilet that had a roof, but no barrier around the person. Because sanitation promotion and fecal matter are both important issues in rural public health, the Sanitation Park serves as an important pillar by which SVYM can promote awareness about hygiene to people in the surrounding area who might otherwise discount its importance.

Next, I got to visit the Vivekananda School of Excellence. It's a school that was started about eight years ago when the leaders of the organization realized that education was a crucial means by which development needed to be undertaken. With thousands of children in the surrounding rural areas, reaching these kids became a prime objective for long term development of the area. All of the doctors' children attend the school, along with hundreds of other children and kids from the local tribes in the area. From the looks and stares and pointed fingers that I got when I walked into different classrooms, it might have been one of the few times that these kids (especially the ones from local tribes) had seen a Westerner, let alone an Asian westerner.

The last half of the afternoon was occupied by an advocacy clinic that was held for women who had just delivered babies or were somewhere in the child birthing age. Because there are certain stigmas and fears of delivering children in a hospital, especially in the rural areas where myths and rumors abound through word of mouth and not necessarily from any credible source, many women will often times avert going to the hospital to deliver their baby at home, risking a whole bunch of mother and baby problems. This clinic was held to distribute "Baby Packs' filled with blankets, clothes, and other misc. items for new borns while taking the opportunity to educate women about the importance of hospital care for pregnant women. The last part of my day going on another set of outpatient and inpatient rounds with an OBGYN doctor (obstetrics/gynecologist) and learning about many of the issues that women face. It was definitely pretty enlightening and interesting.

I rounded up my day with a game of cricket with some of the doctor's kids and am about to eat dinner (9:16pm). Tomorrow I'm supposed to go on a mobile clinic out into the tribal areas, but if that doesn't work out, I have an open invitation from the OBGYN doctor to come and witness a hysterectomy!

Follow Your Gut Instinct

I was reading through my Frommer's Guide to India one day and as I flipped through the "General Tips" section of the book, there was a part about safety that read through. The one line that stuck out to me was "in any situation, follow your gut instinct, because you are probably right." Storing that into my memory, I was set on reminding myself to always be aware of my surroundings so as not to put myself in any sort of compromising situations while I'm here.

Fast forward to last Friday evening, my last day before heading off to Swami Vivekananda Youth Movement. I finished official work at 6pm and started reading Meren's final chapter on the Israeli-Palestinian conflict. I wanted to finish the entire thesis for him because I wasn't sure if I would have internet/computers here (which is the complete opposite) so I resolved to stay a little later on Friday night to help him out. Some people usually stay in the office till around 7-7:30, so I had company until then. Around 8pm, while I was alone, playing some music aloud from my laptop to pump me up while editing the paper, the security guard from upstairs scared me when he came down and went to the bathroom. I just didn't hear him come in. We greeted each other and he proceeded to tell me that he would be on shift for the next 12 hours and I didn't need to leave anytime soon, which was a relief because it takes a couple hours to read through each chapter.

The weird thing that happened is that later on, around 9pm (after I had spent 30 minutes talking to my brother on Skype), he came down again, presumably to use the bathroom. Except this time, he lingered around and carried a conversation. I was trying to be nice, but 25 minutes had passed and it was definitely getting late. He was Nepalese so sort of resembled each other in terms of physical appearance and so I think he was very overjoyed to have met me, so overjoyed that he started saying things like "I want to take you back to West Bengal with me" and, "you're my favorite in this office." Looking back, I think he was just trying to be nice and embrace me as a "brother," but at the time, I was definitely a little scared out of my boots. I finally ended the conversation, telling him we would talk later, and he went back to his post upstairs.

At that point, I was a little uncomfortable but determined to finish the chapter and email it off to Meren before I left for the weekend. It was approaching 10pm and it was definitely the latest I had ever stayed in the office. I was trying to think of ways I might be able to do it at home, but nothing seemed better than to stay and finish up asap. I read the last 7 pages as quickly as possible and began to pack up. All of a sudden, the power went out. Pitch black. By then I was definitely freaked out, and tried my best to lock my laptop into the cabinet (I wasn't bringing it to the south) and pick up all of my things that were scattered on my desk (boarding pass for flight, headphones, journal). I called Meren and stayed on the line with him as the security guard was waiting to leave with me in the dark and proceeded to walk home as quickly as possible.

When I got home, I layed down on my bed and looked at the ceiling for 15 minutes, thanking God for a safe journey home. For some reason, I was sufficiently scared from the situation even though looking back, it was just a matter of staying at the office later than I should have, an overly friendly security guard, and a random power outage at a not-so-convenient time. If anything, from here on out, it was a good reminder to take seriously any feelings of reservation I might have for a particular situation. I don't know if there really was anything to be worried about that night, but all I know is that my gut instinct was definitely jumping up and down, telling me to leave the office asap!

I'll probably take it more seriously next time.

"Fly the Good Times"

I've arrived safely into Vivekanada Memorial Hospital in Saragur, India. It took about 12 hours in total transit to make it, but overall it was a pretty smooth journey. Upon landing in Bangalore, I met my taxi driver and he nonchalantly told me we were about to make a six hour drive to our destination. After a flat tire, a stop to get masala dosas, 1.5 million (I'm serious) passed Airtel, Tata Mobile, and Vodafone cell phone ads, and way too many near collisions for comfort with tourist buses that were hogging the road, we pulled into the hospital sound and safe. I'm going to have to find a way to dig out the seatbelts that are buried under the seats for my ride back a week from now.

But let me tell you about Kingfisher Airlines. Back in March, when I was planning this trip, I hadn't the slightest idea of what airline to take for a domestic flight to Bangalore from Delhi. Unfortunately, Continental and Northwest don't operate within India so I knew I would have to take an Indian airline. I randomly googled "airline rankings" and stumbled upon skytrax at airlinequality.com. For fun, I clicked on the 5 star airlines and came across an airline called Kingfisher. It was a domestic airline that served destinations across India. With a name like "Kingfisher" and a website called airlinequality.com, I was a little skeptical. The only two airlines that I ever knew, Continental and Northwest, weren't even ranked that high. I decided to give it a shot, even though I hadn't the slightest idea of what a five star airline could offer in terms of a flying experience.

I was totally blown away today for my two and a half hour flight. From boarding the plane, you sit down in a special neck recliner, personal video monitor (with a channel that is a camera that lets you see the pilot's viewpoint), and soothing music in the background. In flight, the flight attendants served miniature bottles of Kingfisher premium water, the personal video monitors played quality in flight programming including a Bollywood movie, cricket matches, and the TV show "Friends," and as our "snack" (I was expecting peanuts so I ate McDonalds before boarding), we got a full course meal with chocolate cake and a mini-dosa. All for a two and a half hour flight that I would normally sleep away, waiting the time out until we reached our destination. I almost felt like I would have wasted my ticket if I had slept!

It was awesome. It's too bad Kingfisher doesn't fly internationally, because it would probably be the most comfortable flying experience I would ever have in economy. Then again, they'd probably be broke. And from now on, I will definitely trust airlinequality.com and its 5-star airline ratings.

On a more serious note, I will try to update on things here at the hospital throughout the week!