First Experiences in India

After my arrival Saturday, I took an extended jet-lag nap that prevented me from meeting the people working here at the Public Health Research Institute of India (PHRII). I didn’t want that to happen again on Monday morning, so I set my alarm for 8AM in preparation for the start of the workday at 9:30. Of course an alarm wasn’t really necessary, since the jet lag woke me up promptly at 5. I came downstairs (my room is above the PHRII main office) and sat on the porch trying to make a dent in my fat tome of Indian history. A pack of monkeys appeared on the courtyard wall, so I ran back upstairs to lock my windows. Apparently the monkeys love to steal little knick-knacks like iPhones. At 9:30 I met Poornima, the woman who runs the show here. Like most of the Indian people I’ve met, she wobbles her head side to side enthusiastically as she speaks, which has a way of immediately putting you in a good mood.  She gave me a rapid-fire summary of the projects I would get to work on in the next five months, then introduced me to the twenty-seven sari-clad women who work full-time at PHRII. Everyone was exceedingly friendly, and I feel bad that it will literally take me the entire spring to learn all their names. Flash cards may be in order. The only three men working here are Sedu, the building caretaker, and the two drivers. At 10:30 I was told to pile into a car with ten other workers. Somehow, incredibly, we all fit. I haven’t seen a single police officer since arriving here, and I guess the “rules of the road” are actually just loose suggestions. I was told we were going to the “communities,” although I didn’t really understand what that meant. We started driving through Mysore and out towards the countryside. Unfortunately, I was sitting in the front seat, which is a fairly terrifying experience on an Indian roadway. No one pays attention to such silly formalities as “lanes” or “street signs” or “seat belts”; all is fair game as long as you honk your horn constantly. On many occasions I would just shut my eyes and await my eminent death as a bus travelling the other direction would cross the median and drive straight towards us, finally veering back to his side at the last second. The driver seemed completely unfazed. He would lean down and adjust the radio dial for a minute or two while we sped along, inches from motorcycles, with father driving, mother behind, and two children hanging off the sides, none wearing helmets. Adding to the confusion were the numerous cows that seem to be grazing care free everywhere you look. They would wander into the road and stand there motionless, not to be bothered by passing cars or honking horns.

 After an hour or so we arrived in the “community,” which turns out to be their term for the small rural villages that surround the urban center. Our mission, I now learned, was to provide pre-natal counseling and testing for the pregnant women in the village. We unloaded the gear we had strapped to the roof of the car, and set up in the tiny school-house. One table would be used for blood testing, urine testing, and vaginal swabs, and the other table was used for counseling with the one MD we had among us. Each village has a “self help” committee, a group of women who act as facilitators when PHRII comes to town and continue overseeing the programs once PHRII has left. They also help locate the pregnant women in the area. There were five in this village, each one strikingly skinny and no more than seventeen years old. Apparently there had been three more pregnant women the night before, but two had given birth and one had been aborted, which I’m told is quite common. Each woman would sit down and the PHRII nurse would draw a vial of blood. The microbiologist would then determine the blood type and place the vial in a centrifuge. After spinning for a few minutes, the red blood cells would accumulate at the bottom and we could remove the clear yellow blood serum to bring back to the lab, where it will be used for HIV, Hepatitis B, and syphilis testing. The mother would then be told to go to the restroom to collect a urine sample and a vaginal swab, which some refused to do out of modesty. The urine samples we could analyze immediately using a color-coded dipstick which indicated albumin and sugar levels. High levels of albumin or sugar in the urine signify kidney problems. Finally, we would give each mother a bag of pre-natal vitamins and folic acid pills to take home, and allow them to speak to the clinician if they had any questions or concerns. PHRII is doing education and screening; if they find a medical problem, they refer the mother to the nearest government medical facilities, which are free of cost. It’s already clear to me that the Indian federal government is much more involved than the governments in some other poor regions I’ve visited, such as Morocco, Haiti, and Mexico. It’s simply that the scale of the need is so great. The state I’m living in, Karnataka, is home to some 61 million people, and it’s only the ninth most populous Indian state! After the clinical work was finished, the townspeople cooked us a delicious lunch. We placed a mat on the floor of the school house, and we all took our shoes off and sat cross-legged in a circle. We had rice, a vegetable stew, fresh papaya, and the requisite pickled lime that comes with every meal as a palate cleanser. I still can’t get used to everyone eating with their hands. Admittedly, I have atrocious table manners, but even I am rather put off by eating sticky rice and stew with my fingers. The PHRII women assured me that no one would mind if I carried a spoon with me from now on. I think I’ll take them up on their offer.

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