A Letter Home from students on the IHP Health and Community: Globalization, Culture, and Care Track 1 Spring program:
After beginning IHP Health and Community in the fun and festive atmosphere of New Orleans, the first week in New Delhi, India was overwhelming, stressful, and, at times, scary. Crowds of people, potent smells (both good and bad), masses of trash and stray dogs made us quickly realize that we were far away from home. From the constant honking and crazy traffic to the unabashed staring, being in such a new environment made it challenging for some of us to adjust. Something as simple as crossing the road took our full attention as cars, motorcycles, buses, and rickshaws weaved in and out of traffic. But after a few days, we adjusted to “inDelhible” life, and our view of “normal” began to change.
One of the first, and most important, lessons we learned was that India is full of contradictions; our amazing country coordinator, Abid-Ji, liked to say, “If anyone says anything about India, it is right. And so is the exact opposite.” This statement is a good representation of what we learned through our guest lecturers, discussions, site visits, and homestay experiences. While Delhi is home to hundreds of thousands impoverished laborers, it also supports a booming upper class who populate the well-manicured gardens, high-end markets, beautiful sports complexes, and private hospitals of the city. How can some parts of the city be stuck in time, slowly developing, while others are so westernized? Attempting to understand the unequal distribution of wealth and services continued to plague our community as we assessed and critiqued India’s public healthcare system.
Shortly after arriving, we dove right into our coursework, learning about the preventative versus curative approaches to healthcare and how they play out in the dynamic public sector. The complex, multi-layered system marries the AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) forms with biomedical practices to theoretically provide quality care that honors religious beliefs and cultural norms. Theoretically? Yes, the policies in place are good in nature, but the implementation falls short. Cultural inequalities stemming from the importance of class and caste combined with rampant corruption impede the success of the National Rural Health Mission (NRHM) and other government programs.
Similar to the United States of America, India is a former colony of England. During our brief stay in India, we learned that the country gained independence from England in the mid-20th century and is now working towards establishing political, social, and economic equality in its diverse populations; however, achieving this ideal of equality is much easier said than done due to India’s hierarchical cultural institution known as the caste system. First, we learned briefly about the history of the caste system. Embedded in the teachings of Hinduism, the caste system existed long before the English colonized India. Once the English arrived, they used caste as a systematic way of enumerating the Indian population. In other words, the English used caste as a way of keeping track of national demographics. Every person, excluding the colonists, was counted in this way. Therefore, caste became both a pre-colonial and para-colonial social system.
We also learned of social dynamics within the caste system. Each ranking was traditionally tied to an occupation or title, which was further connected to a last name. For example, someone with the last name “Singh” was known to belong to one of the warrior castes. There are numerous subdivisions within the caste system, which allows for the inclusions of the many different surnames that span the Indian subcontinent. Additionally, people were supposed to marry only within his or her caste. Today, the caste system continues to influence a variety of sectors. Socially, inter-caste marriages are still frowned upon and discouraged, but their numbers are on the rise. Politically, people who are in marginalized caste groups can receive government benefits for food, education, and more. However, those of lower caste groups still tend to live in dangerous areas, have less access to adequate health care, and hold low-paying jobs.
Many of us found this concept hard to grasp, confusing caste with class, not entirely sure how one differed from the other. Nonetheless, as we continued with this knowledge of such a pivotal portion of Indian society, our community began to explore the topics of environmental health, food and nutrition, infectious disease, non-communicable disease, maternal and child health, and indigenous/traditional healing in case study groups. Despite the limited scope of our findings, we were still able to witness and talk with amazing people while putting our Research Methods lectures into practice.
The environmental health group talked with various NGOs and visited Delhi slums; they were stunned to see the lack of basic needs such as clean water and sanitary living conditions. The food and nutrition group saw how a “farmer’s market” serves India, as well as the workings of distribution centers. The infectious disease group interviewed a variety of people from rickshaw drivers to construction workers to health care professionals about their knowledge of tuberculosis (TB) and how that information (or lack thereof) contributes to the associated stigma. The non-communicable disease group narrowed their focus to mental health and talked with a wide spectrum of applicable organizations. The maternal and child health group had the amazing opportunity to observe the full spectrum of rural, urban, private and public maternal wards. They reflected on the poor conditions, which are evident in high rates of both infant and maternal mortality. The indigenous healing group took a deeper look into the Indian AYUSH system of medicine and visited a Sufi Shrine (along with the non-communicable disease group) to witness the traditional healing of ‘possession.’
While conducting our interviews, we discovered how important the wording of a simple question is – the voice, the language, and the content can alter the answer drastically. We also realized how crucial the role positionality plays in research. It not only affects what information is absorbed, but also the information released. As we move forward to Argentina, we know that we must take into account our lessons in methodology and improve on them so that we can perform sound research.
Outside of the classroom, we enriched our experiences further by exploring (and navigating) India. Although we lived the majority of our time with homestay families in Delhi, we also had the opportunity to travel outside of the city. Our stay in Bahraich, Uttar Pradesh (an over-night train ride away from Delhi) allowed us to see how healthcare differs from urban to rural regions, visiting several different levels of government healthcare facilities, which truly embodied IHP’s experiential learning model. Each visit humbled us greatly, changing our perspective not only of the world, but also our place in it. We spoke with inspiring providers who struggle to meet demand with supply, ASHAS who work for almost no pay in assisting childbirth and vaccinations, and traditional healers who use herbs and incense to treat their patients. While it was shocking and difficult to tour these hospitals, and difficult for us to comprehend the immense lack of necessary healthcare, we found it a valuable, deeply moving experience. It was a unique opportunity to see, first hand, the reality of the healthcare issues our guest lecturers and readings had addressed.
Twenty-eight of us also enjoyed a magical day in Agra, learning about and admiring the splendid architecture of the Taj Mahal. We all learned that traveling as a large group is not easy, and it takes a concerted effort to make it work. Our first weekend in Delhi, we all split up and visited either the Golden Temple and the Pakistani border in Amritsar, the yoga capital of the world in Rishikesh, the Tibetan Buddhist monastery in Dharamsala, or the holy white city set by the lake in the middle of the Rajasthan desert in Pushkar. Everyone had great weekends getting away from the city, but being able to come back “home,” to Delhi, was a great feeling.
As a part of the IHP experience, we learned not only in the classroom, but also in the city of Delhi. Excursions throughout Delhi were constantly filling our post-it calendar that hung on the wall of the SIT program center. The beautiful Lodhi Gardens provided a peaceful escape from the bustling city on any given afternoon. Visiting the Red Fort, Qutab Minar, the Bahai Lotus Temple and Humayan’s Tomb filled others’ free time. Market shopping (and bargaining!) proposed a challenge to us all. By the end of our month in India, we all (well, most) had tried and mastered this art.
Now the best for the last – homestays! Wow, living in India was tough for a variety of reasons, but our homestay families really helped smooth over the transition. Tilly Story reflects on her experience:
After a month of rickshaw rides, dahl, and traffic, I was finally getting used to life in Delhi. My homestay treated me like family and expected me to blend in as well as I could. Each night, around 10 pm my homestay partner and I would have dinner with our ‘parents’ and two younger ‘sisters’. We shared stories from our day, talked about our studies, and asked questions about daily life in Delhi, which were usually accompanied by a thorough answer and another scoop of rice. I had heard that Indian families love to feed their guests but nothing could have prepared me for the 3rd and 4th servings that were put on my plate. Needless to say, I do not think there was a single moment in India where I thought to myself, “I’m soooo hungry!” To top it off, a sweet dessert always accompanied my meals, each better than the last. After dinner, my homestay partner and I rolled away from the table to play with our two sisters before bed. It was interesting to see that they were just as interested to learn about our culture as we were about theirs. We drew pictures, played cards, and taught them how to play Connect Four. No matter what we did, they were always so excited. As the date of our departure came closer, I utilized the time I had left to the best of my abilities, but there was no escaping the inevitable. Saying goodbye to my new family was more challenging than I expected. We had a final breakfast together, reflecting on the month and making jokes about how confused we were on the first day of our stay. When the cab finally arrived, we said our final ‘good bye!!’ and the cab began to drive away. I waited until I could no longer see the home, knowing in the back of my mind that I may never be back there again. The ride back to the SIT center was full of mixed emotions, but, above all, joy for everything I had experienced.
Looking back on the past month, India was more than we ever expected. While it was so upsetting to see people suffering from easily curable diseases and to be incapable of doing anything to fix it, Abid-Ji always said, “It is not your job to fix India, but to learn!” and to humbly learn, at that. As we continue to explore and live in different countries, we are confident that our paradigm will be challenged once again. We hope to move forward, to Argentina, South Africa, and beyond, ready and willing to use these experiences to help improve the health of another community.
Allison Roberts, Sarah Gleason, Bess Butler, Richard Eboka, Sarah Glass, Tilly Story, Maggie Stroud, Emily Regan