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Discovering rural India’s health through stories
Posted in: News & Updates by Susan Phung on April 12, 2010
Hamilton, ON—Why travel to rural India? A legitimate question for those inundated with the bright lights of Bollywood. Even citizens who have spent their whole lives carrying an Indian passport are unaware of the silent life of their rural counterparts. For the trained eye, the fascinating aspect of India is the dichotomy that exists within the country. Arguably both a developing and developed country, the former is easily forgotten with the glamour of metropolitan India. The appeal to some travelers is the coexistence of these two livelihoods with little middle ground.
One cannot meaningfully travel to a country without engaging with the people. Travel agents tend to downplay the local population in favour of promises of grand architectural wonders and natural splendour. Most think of India as the “place with the Taj Mahal”. This perspective, however, is not acceptable for a person interested in seeing something more than tourist sites. For those interested in engaging with the people, I would advise excursions that incorporate opportunities to live the life of the people to some extent.
McMaster’s Student International Health Initiative trip allowed such an opportunity. Through conducting a wide range of interviews, I was given the invaluable opportunity to understand Indian life through the words of its people. In particular, I gained a greater understanding of health in the rural northern province of Uttarakhand. In this article, I hope to share a few stories I gained from the interviews I conducted. Moreover, I hope this article encourages you to understand a country’s people as well as the culture on your next travel.
Standing in the hot crowded ophthalmology clinic, we patiently waited for the doctor to finish diagnosing a patient’s cataract. Sitting in on a patient consultation felt wrong, but then again, the previous week we had walked in on an operation with only the instruction to take off our shoes. Upon closing the consultation, the doctor acknowledged our awkward sentiments. Community was a huge component of Indian life, thus the possibility of concerned strangers barging into personal consultations did not perturb patients.
What was most curious about the clinic was the presence of the doctor himself. Why an allopathic doctor had decided to venture into the rural villages of Uttarakhand was beyond our comprehension. “There is not much enticement to work in the villages. Who would travel forty kilometres with their medical supplies on their back with no roads? Healthcare is easily practiced in the city. The irony, however, is that 80% of Indians are in the village but 80% of healthcare facilities are in the city. Even if a doctor did go there, there is no funding or facilities.”
Such a perspective was reflected by the previous week’s observations in the public hospital; it was poorly serviced by physicians and had long waiting lines. The nearest blood bank was in the major city of Dehradun, 41 kilometers away. Such a journey would take at least an hour by car; a time that would not save a critical patient. If family members could not donate blood on the scene, staff members were required to donate blood since it was in their job description. These conditions contrast with the pristine clinics of Delhi, comparable to the hospitals we see here in Canada. The disparity in healthcare access and quality for those in rural India only exacerbates the existing poverty.
Later that month, a few of the girls on the trip travelled to a rural special needs school to meet with some women. The purpose of the journey was to speak to some women about raising children with disabilities. This of course was not all that was revealed. The field centre lay at the end of a dirt path, periodically obstructed by sickly cows. Children were playing cricket nearby, with an old hose pipe providing them with a murky replenishment. After refusing the kind gestures of water, we sat around a small table in one of the educational rooms.
“My baby cried an hour after she was born. She was the fourth child after three girls. I desperately wanted a boy. At the beginning of my pregnancy, my local Ayurveda doctor prescribed me a medication that would ensure that my child would be a boy. I took the medicine immediately. The pregnancy was fine, but three months after the girl was born, she had a seizure and now the right side of her body is paralysed. I think the mistake I made with having a girl was that I took the medicine at the beginning of the pregnancy. With my fifth child, I took the medicine at the end of the pregnancy and that’s how I got my first son. The trouble is that government practices don’t tell you if a child is female or male. Only private practices do. The government now gives money if you have a girl, because there are so few girls in our country. Nobody wants girls because of the dowry. When my sister’s daughter was born, her birth was mourned instead of celebrated”.
Another woman then commented on the number of deaths during childbirth. We conversed for a long time, sharing stories and discussing the importance of women in contemporary Indian society. The women acknowledged the importance for equality but also stressed that a patriarchal society challenged such progress.
What is disturbing is how openly female feticide is discussed in rural India. Girls are seen as an economic burden by parents since they will need to provide a dowry for marriage. Patriarchal society sees women similar to what one fellow aeroplane traveller described: a vehicle for reproduction. Furthermore, they are also seen as a potential embarrassment because they are vulnerable to sexual harassment.
Improvements to women’s health require a paradigm shift from the patriarchal mindset. Only by valuing half its country’s resources can progress be made to boost women’s health and the health of their children.
Intrigued by the discussions at the special needs school, we were given the pleasure to meet the director of the NGO group funding the site. Our inquiry this time led us to discuss the aftermath of a burnt village in the isolated countryside. Working with the people there, the director was able to give us a better understanding of the immunization protocol in this small village.
“Immunization is offered free but the people never came forward. Sometimes, even, there were not enough supplies from the government. My team wanted to make sure we have a sustainable project so we decided to do some groundwork. We found that some vaccines that were meant to be given at birth were either out of stock or not funded. BCG vaccines were often out of stock and nobody takes MMR vaccines since they are not under government funding.”
The challenge with immunizing rural communities is not simply a result of poor access to these remote areas. Unfamiliarity with Western medicine does not attract people most vulnerable to contagious diseases. Moreover, people are frightened to come forward with their conditions for fear of losing their loved ones. “People view disease as a result of karma. People don’t want friends and family knowing that they have committed a bad deed. If someone has TB, you say that he just have a cough. People don’t want physicians barging into their homes; they feel safer with the Ayurveda doctors,” said one local teacher. Such an attitude prevents contagious disease from being controlled immediately. A fine balance between maintaining traditional values and introducing medicine must be found to elevate the health of rural India.
One can see from these quick stories that a shift in resources, values and attention are required for progress to be made in India’s rural health arena. Governments must attend to their majority by introducing adequate supplies of new medicine but still maintaining and valuing traditional methods. Moreover, the importance of women must be acknowledged for the sakes of equality. Awareness programs would most likely serve as the best method to marry tradition and modernity.
At times, conducting interviews was incredibly challenging. Men would dismiss my words simply because I was a woman. Women would speak of horrific stories beyond our privileged Western comprehension. In spite of these difficulties, I have never been so glad to have participated in this type of excursion. I saw the people of India, not just the glamour of the Delhi lights. Hopefully this type of insight into a country’s health situation has served as a reminder that so many stories are hidden behind the faces of a country’s people. I encourage you to discover these stories on your next travel. I promise they will stay with you forever.
Anasuiya Surendran
Research Assistant, Empowerment Squared
a.surendran@empowermentsquared.org
Comments
Your article did a great job of delving into the complexities of the issues without trying to come up with simple solutions. I also liked how wove together statistical information with moving personal accounts, giving the story academic integrity as well as journalistic flare.
Great work!
Will
Comment by Will van Engen on April 12, 2010 at 1:54 pm
Very well-written and insightful. These are not topics that are often discussed, and your search past the glittering facade of Delhi is commendable.
Well done.
-Jason
Comment by Jason Binder on April 13, 2010 at 12:41 pm
I found your article very meaningful. I spent the earliest years of my childhood in a village in rural Assam in India, where my father decided to work as a general practitioner for six years right after medical school. His reflections on his work and time there are similar to the many problems you have mentioned. I spent the next ten years of my life growing up in the medical quarters of India’s and South Asia’s largest public hospital (AIIMS), which attracts both rural and urban populations. The dichotomy you have mentioned is very apparent and disheartening. I get the sense that at the end of the six years, my father left rural India cynical and disheartened (although the hospital flourished during those years) because he realized he was a powerless player against the politics and governance of health in the region. Interestingly enough, the Health Minister of Assam at the time was a fellow classmate of my father and I still do not quite understand how people with the same educational background can have such differing practices on core human values.
Given this, I really appreciate belonging to a community of students who share the same core values as I do and I think you have done a great job with this eloquent and informative article to foster these values further.
Comment by Shohinee Sarma on April 13, 2010 at 6:56 pm
I found this piece to have an interesting reflection on India, through the eyes of poorer women living there. Often tourists are not able to experience the “true” aspects of society there due to language barriers, and also because touring usually focuses on the more glamorous elements of the country. I also thought it interesting that the government gives women money to have female children; it seems that this is a simple but necessary step in alleviating the gender gap. I was able to relate to this article very well, as I also attended the SIHI trip and enjoyed the cultural exchange with men and women in the rural areas of Uttaranchal, a province in the North.
- Raman
Comment by Raman Kumar on April 14, 2010 at 3:23 pm
Anasuiya, I found this piece an excellent narration of your experiences. As someone who traveled with you on this trip, your piece echos sentiments I can definitely relate to. You insight into this trip and your experiences speak a lot about your thorough engagement with the people you encountered. You have touched upon some very key topics that I can say affect women globally. We in the west, fortunately, have the freedom to be aware of our rights and thus have an opportunity to fight for them. I often find that the key issue is not fetocide, dowry, or even harassment. The underlying issue is that women need to be considered as more than simply a means to an end, but an end on their own.
Great piece !
-Siddhi
Comment by Siddhi on April 16, 2010 at 9:32 pm
Wonderful piece of work Anasuiya. I think it is very important to look beyond media coverage to the personal stories that often go uncovered and which have the capacity to teach us the most. Your article shows the meaningful discoveries we can make from listening and questionning, not just in health care but really in all aspects of our travels and lives. I also appreciated how you managed to bring up these sensitive cultural topics without imposing a certain point of view. There are definitely aspects of the rural health care that need to be addressed but you discussed this issues of female fetocide for example in its broader social context. Nicely done
Comment by Resham E. on April 29, 2010 at 10:43 pm