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…