Please, Madam

We visited Jilledupadu, a tribal village and saw some interesting seeds being dried out. These are called kosam, and they’re gathered from the forest. They grind the seeds for oil because it’s great for an itchy rash that comes in the rainy season. Some of the tribal villagers say that all who knew about the medicinal herbs are dead now, but it seems like there is still a lot of ‘common knowledge’.

The tribal folks are really interesting. Asha likes them a lot. She says they never lie. They have lots of festival days where they honor nature goddesses and gods from the forest (and party pretty hard). One of my favorite things about them is that they generally pay a bride price to the bride’s family, rather than the dowry that everyone else pays.

The dowry phenomenon is mystifying to me, and a huge problem for so many people. Dowry has been outlawed officially, but is still demanded by most families. The women that I see are working all day long to grind food and cook all the meals, haul the water, maintain the home, bear and raise the children. They’re very restricted in what they’re allowed to do outside the home (ie, they’re not allowed to leave it!). In many ways, the wife is essentially a domestic servant for the husband and his family; I can’t imagine why she should pay her husband to take her in! And if she’s educated or has some job of her own, she has to pay an even higher dowry!

Sometimes “dowry harassments” occur. That means, if the whole price isn’t paid to the inlaws, after the wedding they give the bride a hard time, pressuring her and her family. Sometimes this ends in suicide or even murder.

In some of the villages we visited, the rates of consanguinity are as high as 30%. This is because if you marry a cousin, you don’t have to pay a dowry. One woman told me about her 2 grandchildren that had died, and showed me her 3rd grandchild, age 6, developmentally delayed, destined to die within 2 years because of some inherited metabolic disorder.

Families hope for male children because they worry they just won’t be able to pay dowries for their daughters. The practice of abortion because the fetus is female is totally illegal, but it still happens.

Wow, I really wanted this blog entry to be a happy one! Let me end with a nice story: The other day I was attending a meeting – quite boring all in Telegu, so I went for a little walk down the road. Everyone was watching, cause after all, it’s very entertaining watching a foreigner walk down the road! One guy on his motorcycle even slowed down. He had his wife riding sidesaddle like they do, and 2 kids and some packages all packed on there, too. After he passed me, he stopped, I just figured the kids were really getting a kick out of how pale I am. Then he said, “Madam, please...” indicating that I should take a place on the seat, with everyone else! He was so concerned for me! It was so incredibly sweet, and people are doing things like that all the time here.

My Fantasies

My first week in Srikakulam district, over two dozen people died in monsoon flooding. It serves to remind me how marginal survival is for so many people here. For instance, a huge killer of children is – diarrhea. When you’re starting off malnourished, there’s not a lot of buffer. Luckily, it’s not the case for me. I came with plenty of “buffer”.

The villages have all been really consistent in what they site as main health challenges – febrile and diarrheal illnesses. Usually, these come seasonally. Fevers can be caused by so many things: malaria, typhoid, dengue, chicken gunniya. Yes, chicken gunniya! It sounds funny but it really sucks. It’s an arbovirus like dengue (breakback fever), which means you get it from a mosquito bite (the Aedes mosquito, not the Anopheles that spreads malaria). The fever only lasts about 5 days, but the body aches seem to last up to 6 months! It can be so bad that sometimes it’s treated with steroids.

I’m struck by the sanitation in these villages. There are “canals” that are just open sewers with all kinds of foulness just there, in the middle of where the animals and kids are. And the water that people are drinking – it’s all contaminated. There’s agricultural runoff, sewage leaching, people bath and do their laundry just by the wells. The tribal folks hunt, and know that they get sick when they drink stream water, but people don’t seem concerned about the well water.

They’ve been recommended to drink “hot water” – it doesn’t have to be hot, just previously boiled – but they don’t. I asked and they said “lazy fellows”. I don’t really believe that (Geez these people are hard working). I think they don’t like the taste, and they’re just not used to it. Folks keep their own houses very clean (a huge challenge given the mud and dirt and no screens to keep insects out, etc) but have no consciousness of keeping public spaces litter-free. So rotting food in the road brings more bugs, that of course, bring more illness.

It’s so outside the scope of my training, but I feel that addressing these issues is really the only thing that will make this trip truly worthwhile. I think the top 2 health prioritites have to be removing fecal contamination from the environment, especially protecting the water, and controlling the mosquitoes. I’m reading the Humanure Handbook, and wracking my brain to figure out how that concept can be put into practice here. It feels a little hopeless to think about how big a change in daily behavior this would be, but being here would just be a waste without even trying. I guess the main thing I can do is talk about how important this is, talk about some solutions, and hope that people are convinced enough to try to implement some changes.

Years back, the government tried implementing a scheme to place sanitary latrines in every village. Unfortunately, they were an entirely inappropriate technology (required water, for one thing) and culturally inappropriate, too (the only time the ladies get out of the house to gossip is when they trek into the fields together to go squat!). The project failed miserably and if they’re still standing, the loos are used as storage sheds.

I fantasize about appropriate technologies: compressed earth bricks (so much fuel is consumed firing the crumbly bricks that are used produced currently); humanure compost, solar power… I pray to Shiva and Kali and anyone else out there… let these technologies diversify and propagate like grains of sand on the shore!

Soundtrack today: Jennifer Noxon’s Water and Alison Krauss Down to the River to Pray.

Goatherds on the job

Ok, things are definitely picking up now. I’ve started doing field visits with Asha Begum. We’ll be visiting villages in the 3 different geographic areas served by BREDS: the plains area where lots of paddy (rice) is grown, mostly Dalits and some mixed communities live there; the hills where tribal villages are and they grow pineapple, cashew, turmeric, etc; the coast where they also grow cashew, and they fish. The visits are exhausting, with many hours spent driving the horrible roads, lots of smiling and head wobbling formalities to strangers, but this is how I get my juice! Getting a glimpse of these people’s lives, getting to listen to them and see them interact, and especially, getting to see Asha in action. She teaches with humor and charisma and in the photos you can see, the women are just entranced.

The visit generally starts with a drive out the red dirt roads for anywhere from 1 to 3 hours. There seems to be lots of road construction going on all over, which means piles of dirt, rocks or bricks left on the “roadside”, jutting out into the road, really, for us to swerve around. The road workers are generally toothpick thin men and women that carry piles of bricks or dirt on their head from one spot to another. Ramarao honks, and no matter how huge their load, it seems acknowledged that it’s their job to get out of our way. Same with the herds of cows, oxen, buffalo and goats. Same with the smaller vehicles like bicycles and motorcycles and autorickshaws loaded with many many people, and certainly with less suspension than us. Ramarao drives right into them, honking honking honking, getting so close, to get them to move out of the way. Usually, he’s the sweetest guy and he has this ridiculous high pitched giggle, but he’s a relentless driver.

The scenery is incredible. Green rice paddies and water tanks, hills off in the distance with mostly uncultivated forest and huge stones. Oxcarts with huge wheels, the driver bouncing along, and the oxen with the pompoms between their horns. Fields of saris stretched out to dry. My favorite is the goatherds with their parasols, wearing panchi (man-skirt) and not much else. When we arrive in a village, I’m usually greeted by a couple of representatives who put a small mala of flowers around my neck, a dot of red kumkum between my eyebrows, maybe burn some camphor and throw some turmeric rice to give me a blessing and a welcome.

Then we make our way to a community space – either under a tree, or in an angan wari, and talk. I usually start by asking how many of you are doctors? None. How many of you are mothers? Everyone! Well, every mother takes care of the health of her family. By feeding them, taking care when they’re sick. You’re all doctors, I tell them, and this makes them very happy! Then I tell them I’ve come to help them be better doctors for their families.

We talk about what health care resources they have – either public clinics that are free, private docs that charge money, or public hospitals in case of severe illness or delivery of a baby. We talk about what the common health problems are – mostly fever (which can be malaria, arbovirus, etc) or diarrhea (mostly from contaminated water). Also, gynecological complaints like discharge or heavy bleeding. From village to village, at least 20% of the women are getting a hysterectomy for heavy bleeding that they’re told is precancerous!

The visit usually ends with an “Ask the doctor” session – people showing rashes, lab results, asking why their shoulder has hurt for 20 years or why their neck hurts when they carry 5 gallons of water from the well (in a pitcher on top of their head!).

Lastly, I’ve been showing folks a really simple 8 step surya namaskar (yoga sun salutation). It gets everyone moving and smiling (as they struggle with their saris in a lunge!) and it’s a really great indigenous tradition that mobilizes and stretches pretty much every part of the body. It's a great preventative measure for musculoskeletal complaints, and has lots of other health benefits, besides.

The goal of the visits is for me to get a sense of what the issues are, so that I can develop some training modules for the BREDS staff. This will increase their knowledge, and make them more effective community health workers. I’m already excited about some ideas…

Su Jok in Vizag

After so much anticipation and planning for this trip, my transition was much harder than expected. I’ve very homesick! I arrived at the Delhi airport in a huge monsoon downpour. I got soaked trying to get to the domestic terminal so I could fly to Bhubaneswar. My luggage, of course, did not arrive from London. I finally made it to Bhubaneswar, was picked up by a very nice stranger who spoke no English and drove me 8 hours to Vizag. I laid down on the back seat but kept falling off because he would slam on the brakes at every pothole, cow, pedestrian and overpacked vehicle on the road. Eventually I managed to hold onto the seatback even in my sleep.

From Vizag we drove about 5 hours on even worse roads to the BREDS office. In the middle of many rice paddies, not much else in sight. BREDS staff were so nice, concerned for my well-being (they communicated this by watching every move I made, every morsel of food I ate, etc), but nobody really spoke English, so I was left to battle the ants on my own. They ruined the snack food I brought with me, even though I packed nuts in 3 layers of freezer-strength ziplock bags. These ants are little guys, but when they bite, it hurts!

After a few days, I was driven back to Vizag (Vishakapatnam). It’s a coastal port city. Typical levels of air, noise and trash pollution. Added to this is incredible humidity. No amount of ‘product’ could control the frizz! The worst part has been my isolation. There’s very little access to telephone or internet. But at least there was Asha Begum. Asha is a BREDS field staffer and we hit it off right away. She is Muslim (Begum means Mrs. in Erdu, the language of Muslims in India), but still believes we were sisters in a former life. I agree.

Together we attended a 10 day training in Su Jok. This is an acupuncture variant that uses hands and feet. It’s based on the same principles as acupuncture so it was a good opportunity to review the 12 meridians, 5 element theory, etc. The exciting thing about it is that the basics can be practiced by anyone, without cost or risk of side effects. We plan to conduct a training for BREDS field staff, who can teach it to villagers.

Here are some photos of my arrival at BREDS, the Su Jok class, Asha and me in Vizag, Asha with Prabhas, our favorite Telegu movie star.

BREDS of India

No, not the East Bay restaurant serving chapati, puri and naan. BREDS is a non- governmental organization (NGO) based in Srikakulam District, in the southeastern state of Andhra Pradesh, India. The name stands for Bapuji Rural Enlightenment and Development Society. Bapuji is a nickname for Ghandi (Bapu means father, and –ji is a term of respect).

Ghandi’s vision was for national independence which was achieved August 15, 1947 – I’m looking forward to Independence Day celebrations! But Ghandi also promoted his vision of self-sufficiency for individuals and communities, and in that area much work remains to be done. In the spirit of Ghandi, BREDS works to empower the poorest and most vulnerable people in India. These are people from the ‘untouchable’ caste (Dalits) and the tribal people (Adivasi).

Tribal people have been living for thousands of years in the more remote areas of India – in the hilltops mostly, and densely wooded regions. They speak tribal languages and have unique religious beliefs, although they have integrated many Hindu gods into their nature pantheon. They have unique cultural customs and dress, and in the past have not had significant conflict with Hindu villagers. In the past 50 years though, there has been increasing competition for resources – land, government support, etc. – and the Adivasis face dispossession from ancestral lands, exploitation, and lack of skills for survival in modern, commercial society.

BREDS staff members are usually from the communities themselves, and their work focuses on building the capacity of the communities, developing their internal resources and ‘human capital’. This can be through the development of livelihood projects like improved agricultural practices and marketing for tribal products. Another area of focus is support for angan wari centers where all children up to age 6 can get basic education, a meal, growth monitoring, nutritional supplementation and immunizations, no matter how small or remote their village.

The Dalits and Adivasis suffer from a very high rate of infectious disease and malnutrition. The infant and maternal mortality rates are particularly high, and that area will be my focus. The plan is for me to join the BREDS staff for 6 months, spend time learning what they do, and hold trainings for the staff on relevant health issue to increase their capacity to serve as change agents, motivators and community health workers. Likely there will be some direct clinical work as well.

Hopefully I’ll have interesting stories and pictures to post soon!