Field Visit

10 days old

Today I went for a field visit to go see a primary health center in one of the villages outside of Nagpur.  It was shocking, even knowing ahead of time that the primary health centers do not have much, to see a medical facility with so little.  It services over 40,000 people and only had a few rooms: one delivery room, an operating room, an inpatient room for females, and one for males and a couple of offices.  It is such a sharp contrast coming from Boston where I’ve seen some of the best health facilities available.  My mother works in the NICU at Mass General so I’ve seen their unit and all of the machines and supplies (not to mention space and sanitation!) that they have, compared to the delivery room I saw today that had a scale and ambu bag and not too much else.  The good thing is that there are auxiliary nurse midwives (ANMs) and medical officers who can identify pregnancy complications and send those women to secondary or tertiary care hospitals for their appointments and deliveries.  The ANMs I met today were really impressive, they each cover 5 or 6 villages and when asked about a specific patient they could list her expected date of delivery, village where she lives, about her family and health, etc. – so it was obvious that they are very dedicated and care about their patients, they are also very skilled and help to deliver many healthy babies, like the adorable baby in the picture above! This picture was taken when I visited some of the homes in the village, they let me hold her - she was very cute and had lots of beautiful dark hair.

Getting the fire started - they used mostly wood and animal dung as fuel

I visited the homes to see the cooking conditions and get a better understanding of the indoor air pollution.  All of the women were so kind and once the people I was with explained what I was studying (they speak Marathi so we had to have someone translate for us to communicate) they took me right into the kitchen and lit the fire to show me how they cook.  Seeing this helped me to understand even more the huge impact indoor air pollution can have on their health.  The women will spend 5-6 hours a day cooking and from standing there I could see that it took only a few minutes for the room to fill with smoke.  There’s no ventilation and the ceilings are generally very low, some of the homes had a window in the kitchen but others didn’t, so these women and often their children and other family members too are exposed for hours each day.  Overall it was a really eye opening day and made me glad to be working on this project.

Another home with a window in the kitchen but
the room still filled with smoke after only a
few minutes

Village Street

Birthday Celebration

Their friend runs a bakery and made this cake -
it was delicious and so rich!

Last Sunday was Mrs. Khanna's birthday.  They were so great to include me in everything, they have really taken me in as a member of their family.  The day was filled with food!  We went down the road for lunch and a drink and at night went out with a couple of their good friends for Chinese food, not to mention the chocolate cake for dessert!  The house was filled with flowers that Mrs. Khanna got from friends and family.  This worked out well because the day before I went to a craft fair and picked up a vase to give to her as a gift.

Perspective

In the past few weeks I feel like I’ve gone from being excited and overwhelmed when I first arrived, to being frustrated and homesick, and now I think I’m adjusting and getting a little bit of perspective.  It’s easy to get frustrated here if I only remember the good things about home.  So, when I wake up sweating even though it’s almost October, I remember that in a few short months I’ll be shoveling.  When I find a trail of hundreds of tiny ants extending across my room or a spider under my pillow I think of the mouse that lived in my apartment.  When the auto driver says he needs to stop at a shop and it’ll only take five minutes and starts turning in the opposite direction of where I’m staying (he eventually turned around when I looked about ready to hop out of his moving vehicle) I remember that cabs at home will take shortcuts that aren’t so short.  Or, when I walk by the beautiful homes of government officials and a family living in a lean-to on the same road, I remember that where I go to school is sandwiched between the South End and Roxbury. 

And no, I won’t pretend that I’m always levelheaded and don’t get frustrated anymore.  But I am learning to appreciate things for what they are.  For all of the times that I get irritated, there are more times that I am impressed or awed by something here, from the elaborate religious traditions to the ease with which women sit sidesaddle on the two-wheelers without holding onto anything (and somehow manage to keep their saris perfect) it really is impressive!   I think I’m also writing this entry for my own benefit, so that in the coming weeks and months I can come back to it and think okay, go back to that way of thinking – we’ll see if it works!

Where are your shoes?

The etiquette in India, from what I’ve seen, is to always take your shoes off when you enter someone’s home.  The Khanna’s house seems to be an exception to this rule because there we all wear our shoes.  But even at work we take our shoes off before coming in.  The first week everyone was walking around barefoot and I did as well.  Friday was a weekly meeting with most people from the office.  As I was sitting there I looked around and noticed that everyone had sandals on.. except for me.  I tucked my bare feet under my chair and hoped nobody noticed, although I had been walking around barefoot all day (and all week) so I’m sure they already had.  When I came in the next morning I realized that there are flip-flops to put on when you take your other shoes off, so I made sure to put a pair on.  I asked one of the women why the first week nobody wore them and she explained that it was because of the Ganesh Festival.  So, I’m still learning the rules around here but now I’m doing it with my shoes on.

Lots of Pets

I have a lot of adopted pets while I'm here.  The Khannas have 2 dogs, 2 ducks, a turtle and a bunch of birds.  The ducks and birds stay outside all of the time and the turtle is usually out there during the day too.

Commander

Happy

Parrot

Ram Ram

Mr. Khanna feeds the ducks a banana every morning, they love it! 

There are also plenty of other animals around town. I met this guy during breakfast one morning.  Commander was going nuts barking, when I looked around I noticed a group of monkeys were climbing around in the trees and along the fence in the yard.

Don't Drink the Water

Downtown Nagpur

Well as careful as I thought I was being, it was not careful enough... I went out with some people after work on Saturday (yes, the work week is Mon-Sat here) and they showed me around Nagpur a bit more.  We got some food at a restaurant and I didn't know at the time but one of the items had water that hadn't been heated.  I luckily haven't been really sick, just some stomach pains - it's a reminder of how careful I need to be about what I eat and drink.  I've also been battling with some of the bugs that have been feasting on my arms.  I came equipped with deet, I'm sure this isn't environmentally friendly but I went to town spraying the floor of a doorway that leads from my room to an outside patio.  When I came home from work today I didn't spot a single bug!

These are some pictures from when I went downtown, they aren't very clear but you can see some of the "two wheelers" (as opposed to four wheelers, one of the girls asked if I owned my own four wheeler) - these are the most common mode of transportation.

A cow navigating traffic

First Days of Work

I've only had a day and a half of going into work but so far it's been great.  This week is a little abnormal because they are being audited by their funders, this happens at all research sites but it means that everyone is on their toes and the schedule is a little different.  It worked out well for me that I came this week because I got to listen to all of the presentations and get a good run through of how everything works and the research projects that are happening.  They have an ongoing Maternal and Newborn Health Registry project that registers all pregnancies in the clusters (regions for the study) and collects information on the birth outcome and survival of the mother in order to better understand the maternal and newborn mortality rates and also causes of mortality.  They are just finishing up an Emergency Obstetric and Neonatal Care (EmONC) study, this involves community mobilization and teaching birth attendants interventions and recognition of problems during pregnancy so the mother can be referred to a health facility.  They have another study starting up that will involve antenatal corticosteroids to help prevent respiratory disease in newborns and then they'll be doing the indoor air pollution study looking at health of mothers and newborns.

Today I worked more on my specific project.  I am using data that has already been collected from countries around the world and will look at if the infant mortality rate varies between homes using high versus low polluting cooking and heating fuels (I explain it more in the post "What I'll be working on").  This is for the upcoming indoor air pollution study.  There are people here very knowledgable in biostatistics and STATA and it was a huge relief to find that they are so willing to answer all of my questions.  I also talked with one of the researchers for a while about what I hope to learn while I'm here in addition to the project I am working on.  I explained how I'd really love to see the practical side of conducting health research.  I've learned for the past year about theories and study designs, but putting these things into practice is a whole different story.  He was great and told me that I'd be able to go into the field to see how things are done, the problems that arise, and how they go about problem-solving.  He also suggested I follow one of the clinicians at the government hospital.  I feel really lucky to have such a great opportunity to work with this group, they are obviously doing a lot to improve the health of mothers and children.

Ganesh Festival

After being here for a few more days I'm starting to appreciate Nagpur more each time I travel around the city.  I don't know if it's the areas I was traveling around on my first day here or just my initial reaction to the city, but now I find that it is a clean city.  I think I initially focused on the shacks or homeless or cows, but those are things that come with most urban areas (well not the cows..) and I wouldn't say there are any more here than in cities I've been to in the US.  I'm especially thankful that I'm here at the end of the monsoon season, everything is green and while it still rains periodically it has mostly been at night.  It is also a very vibrant city, that is probably partly because I came right in middle of the Festival of Ganesh - one of the largest festivals celebrated in India.  Every night there are activities at the community area a couple doors down, music is constantly playing (it's funny because there will be a few Indian songs and then all of a sudden Katy Perry or Jay Z) and kids are always there playing.  Last night there was a comedian, I stopped in for a bit, he spoke all in Hindi so I didn't understand but he'd also do impressions which seemed funny (I'm sure they were funnier if I knew who he was doing impressions of).  In downtown Nagpur there was a fair and large idols of Ganesh and street vendors and lots of lights!

Archway into downtown

I also went with the women I am working with to a Ganesh celebration.  It was unlike anything I have ever attended!  It was held at the old residence of the minister to the King of Nagpur (there is no longer a King of Nagpur).  When we walked in there were three men sitting and chanting prayers in front of a shrine and the smell of incense was really strong.  We sat in the center of the room which was a square created by columns and all around the room were wall murals depicting the life of the god Krishna.  Around the top of the wall were tons of old photographs from when the family lived there back in the 19th century.  We got to participate in part of the prayer ceremony which was really interesting, at one point we all stood and walked toward the shrine and were clapping, people who were Hindu and knew the prayers also joined in the chanting.  Then someone brought around flower pedals and rice and put them in the palm of everyones hand, then another person walked around with a candle and you waved your hands over it and then swept your hand up over your head, finally we tossed the flower pedals and rice onto the shrine.  I didn't know the reasoning behind all of it and I'm sure someone who is Hindu would cringe at my explanation of what happened, but it was really fascinating, especially when I think that Hinduism is the oldest religion in the world so these traditions have been around for a very long time. It also showed me how inclusive the people here are, I would have thought that non-Hindus wouldn't be allowed to participate in their prayer service but this wasn't the case at all.

Prayer Service

After the prayers, the idol of Ganesh is in the way back

Murals of Krishna

One woman, who is the great-great granddaughter of the minister, then took us through a tour of the house and then we all sat to eat.  We sat on floor seats with trays of food in front of us, seats surrounded the courtyard and the wall so we faced people and could talk to each other while we ate.  The food was delicious and at one point it started to storm so just in the center of the room rain was falling and flashes of lightening showed through the opening, how cool!

Indoor courtyard dining area

Dinner!

Khanna Household

The Khanna's sitting room

Sati (husband) and Reeti (wife) Khanna are hosting me at their house for the three months that I am here. They are an older couple whose children are grown with families of their own so they host exchange students through the Rotary Club.  Mr. Khanna is so friendly and talkative and has been very helpful.  He went to Harvard Business School about 40 years ago so he spent time in Boston and goes back occasionally to visit.  We spent a while talking about the work I'll be doing here and the places he's traveled to and the parts of India that he says I must see before I leave.  Mrs. Khanna is also very nice and I spent time talking with her about our families, she does not smile or talk as much as Mr. Khanna, but I've realized that this isn't because she's angry or upset, it is just how she is.

Outside patio

We had tea out here, there's a ceiling fan so it's very nice sitting out here and they have a wall that can come down to separate the patio from the lawn for when the rain is heavy

Yard - the statue is of Ganesh, it is currently the Festival of Ganesh

My bedroom and bathroom off to the right

First Days in Nagpur

I finally made it to Nagpur! I arrived Friday morning after traveling for almost two days to get here.  My trip over here was mostly uneventful, I sat next to a man who is Indian but has lived in the US for the past 20 years.  He had never been to Nagpur but what he knew of it was that it was a very relaxed and easygoing city.  I was concerned on my flight from Mumbai to Nagpur, we were already on the plane and the pilot explained that we were 17^th in queue to take off because a plane had skidded off the runway.  A little too cheerfully he said that we could look out the windows on the left as we went by to see it – I didn’t look, I prayed.

I was a little surprised on my first ride through Nagpur from the airport to the hotel.  If this is a relaxed city – I can’t imagine the other cities in India!  There seem to be no rules on the road, the cars are all small and there are tons of scooters and auto rickshaws and bicycles, all weaving in and out of lanes with no signal that they are going to do so.  Red lights seem to be optional.  Everyone beeps their horn a lot but it’s not used like it is in the US – mostly by angry drivers – here it seems to mean “here I come watch out!”

The part of the city I saw when I first arrived was crowded, there weren’t a lot of tall buildings but many buildings all close together.  Closer to the center there are areas where houses and buildings are more spread out but in general the streets are busy.  I also have a new appreciation for street cleaning in Boston – I’ve complained a lot about it this past year because it makes it difficult to find parking – but here there isn’t any street cleaning and some roads get piled up with trash.  There are also animals: goats, dogs, cows all wandering around.  I saw one enormous cow sitting in middle of the road and it didn’t appear to be moving any time soon, cars just maneuvered around it.

I went into the Lata Medical Research Foundation where I’ll be working and met the people there briefly on Friday.  I listened to a couple of presentations they were practicing for the upcoming week.  I was surprised and excited by how many research projects they are involved with, all having to do with maternal and child health.  They are doing a lot of really interesting work and I’m so excited to be involved with it.  I’m staying with a host family, the Khannas, who have been wonderful and so welcoming.  So things are off to a good start and I’m glad to be here and settling in.