Namaste, Baby!

I saw a surgeon perform a circumcision on Tuesday. A four-year-old boy had an infection that was preventing him from urinating properly. That was hard to watch. He was mostly sedated, but before he was given the shots he cried a terrified cry and his whole body shook and he just looked so scared. He was basically out while they did the surgery, and when it was over a man carried him to recover in the ICU. But anyway, on to today’s stories.

I stood about two feet from the male surgeon as he sliced across a mother’s lower abdomen and cut an opening big enough for a baby.  You prepare yourself for viewing a surgery by expecting the blood and the tissue and the fat, but you don’t necessarily think of the sounds. Like the sound of the scalpel opening the skin and the clamps clenching down on the tissue with a little double clicking noise, and you can almost feel your own skin being clamped. It’s not an easy thing to watch.

He cut through the skin and the belly fat and membrane and made an incision in the uterus. The opening in the abdomen isn’t extremely elastic like the vagina is, and the doctor grabbed each side of the incision and pulled it – ripped it – apart to make it wider. As I watched I could almost feel someone tugging my own belly open, feeling the fingers inside the body cavity and the skin tight and stretching further.

During a c-section the baby doesn’t swim out of its mother like during a vaginal birth. The doctor finds the head and takes both palms around it and pulls it out the opening. He takes a second and finds better grip of the neck and gives a little tug and the rest of the baby follows. Yellow liquid gushed out along with the baby.

The first baby was a girl.

She was pulled out and the doctor grabbed her ankles and held her upside down in one hand and clamped the umbilical cord and then cut it, while she dangled there for a second. At first she wasn’t really crying, but she was looking around with a sour little pout on her face. He dropped her into a metal bin held by a nurse, and the nurse carried her over to the other operating table in the room. The baby girl started to whine and the nurse rubbed her face and began to suction out her nose and mouth with a long, thin tube. Another nurse got brought over a green plastic baby bath and filled it with warm water and a few drops of soap. The nurse rubbing the baby looked at me and smiled. She pointed at me and said “bath?”

So I walked over to the other side of the table and stood in front of the green tub. I couldn’t believe it. I was nervous and excited and it was almost surreal. I was wearing a mask over my nose and mouth and my breathing was hot and moist. I think my eyes were probably wide. The nurse picked up the naked baby and put her in my hands inside the tub. I washed the baby.  She was covered in yellow and white and red. I gently rubbed her skin clean. I held her misshapen head with my left hand and cupped water in my right hand and poured it over her tiny body. I washed a newborn baby in a green plastic tub in an operating room in an incredible hospital in a rural town in India. I washed a newborn baby girl.

The nurse swaddled her in a scrap of orange Indian cloth and handed her back to me. I held her and I looked into her dark brown eyes and I felt how her head smushed back into a funny shape. I whispered to her and told her don’t worry, I was born with a funny head, too. I said “namaste, baby. You’re mommy is going to love you so much.” I looked at her little nails and her little white hands and her little white feet. The nurse flicked her feet a few times, fairly hard, and the baby let out a cry. She handed me a green tube connected to an oxygen tank and showed me how to hold it close to the baby’s nostrils. She smiled and me and pointed to the baby’s face and said “good color!” and put her finger on my forehead and said “same color!”

This was the mother’s second child. Her first had been a normal birth, but this baby was in distress for a period of time, which is why the c-section was done. She was knocked out the whole time. You could see her belly fat through the incision, whitish yellow blobs. The doctor first sewed up the uterus and then the tissue and then sewed the skin up with maybe six thick black stitches. Mommy and baby were taken to the ICU to recuperate.

Then the second mother came in. This was also her second child, and her first had also been a c-section. We watched her get the epidural in her spine.

The doctors did the same procedure that they had just completed on the first mother about fifteen minutes before. This mother groaned a bit during the cutting, and slurred some words of pain when the doctor grabbed her skin with his hands and pulled it apart. Her head occasionally rolled on the operating table.

The second baby was also a girl. She came out covered in white. The doctor also held her by her ankles and cut the cord. He plopped her into the tray, and the nurses took her over to the other table. Anna and Laura washed her and held her.

This baby girl was quieter and sleepy. We tapped her feet every now and then and she’d let out a cry and make the saddest looking frowny face. Her lower lip curled up towards her upper lip and trembled just slightly. Her knees were especially wrinkly and had little rolls of skin around them. Here eyes were shut and the nurse came over with antibacterial ointment. She took two fingers and gently opened the baby’s chubby eyelids just a bit and squeezed the ointment across.

The doctors took the entire uterus out of the woman’s body and rested it on her abdomen. They sewed it up with thick black thread, which will end up dissolving as the body begins to heal itself. He took a full white sack out of her insides and explained that she had an ovarian cyst. He punctured a few holes in it and it spurted clear fluid across the table. He took the scalpel and sliced it open and the assisting surgeon suctioned it up. Then he explained that the mother has had two children now, and expressed interest in tubal ligation to prevent another pregnancy. They tied off the fallopian tubes and then cut them. Then the doctor took her uterus and put it back inside her body, soaked up the extra blood with a white rag, and stitched her up. I looked at the mother. I looked at her tired face and the bangles on her outstretched arms and here feet. Her feet struck me. They were dusty and cracked and callused. Village feet. The village feet of a mother on an operating table in a charity hospital in a rural town in India.

One of the nurses cleaned up the blood around the mother’s legs and the doctors inserted a tube into her vagina and suctioned out a bit of blood. They took a clamp with gauze and also stuck it into her vagina and pulled it out. The nurse took a thin strip of cloth and tied it around the mother’s waist and then took folded cloth and tied one end in the front to the thin strip, and wrapped the cloth between the mothers legs, under the right leg, and tied the other end to the thin strip around her waist in the back.

I held the sleeping baby girl in my arms. She was warm and damp in the cloth and her face was wrinkled up like she knew the real world was too cold and mommy’s uterus was so much nicer and warmer. Anna took her back in her arms and they wheeled the mother to the ICU. A small older woman came in with a bucked and some rags and began to clean up the operating room. We looked around and didn’t know what to do – we still had the baby! The nurse looked at us and smiled and said something in Marathi (the local language here). We asked “should we take her to her mother? To her mother?” and the nurse shook her head yes and laughed.

In the ICU stood some of the family. On the far right the first mother was resting. She had her eyes open but looked quite lethargic. TO the mother’s left was the first baby girl, curled up with a baby IV in a little open incubator with an overhead heater.

To the left of the first baby was the second mother, now resting uncomfortable. A young female doctor in a white sari came over and unsnapped her blouse top and checked her breast for milk. Nothing came out. She walked away and came back with a needle and another woman, from the family I think, held the second baby as the doctor gave an injection. I took a few pictures of the new babies and we left the ICU.

And we came back to the room and I sat down at my computer because I had to write this all down. I washed a newborn baby in a green plastic tub in an operating room in an incredible hospital in a rural town in India.

 Baby Girl #1^

 Baby Girl #1^

            Baby Girl #1^

        Baby Girl #2 ^

Me and baby girl number one :)

Finances at the Comprehensive Rural Health Project

Food for thought...

The CRHP works on a budget of US $500,000 a year. That's a very small amount of money for an NGO to work with, especially when considering the number of programs and services that CRHP runs. Ravi says that ideally they'd like to have a budget of US 1 million.

Many NGOs spend up to 80% of their budget on salaries. CRHP spends 80% of their budget on services and programs, and only 20% on salaries. They have around 40 people working for them. No one makes more than US $300 per month, and average salary is between 3000 Rs and 7000 Rs a month, or between about US $65-$155. Shoba, Ravi's sister, makes the most at US $300 a month.

Ravi, the son of the founders of the organization, takes no salary, and neither does his father (his mother is deceased). He has a business and business partner in the US and 42% of profits from that comes to CRHP. Anything money makes is used for the CRHP.

At the hospital patients who can afford to pay usually pay half the cost of the care. Only 30% of patients pay at all.  

The other half of their funding, US $250,000, comes from donations, from both individuals and large donors.

Why can't they get more money? Ravi says that many people and foundations say that because CRHP spends so little of its budget on salaries that they must not have qualified people working for them. 

CRHP utilizes village residents and "uneducated" individuals (perhaps who never had formal education, or finished only up to a certain grade, don't have a degree, etc) in their programs. This makes the wide scope of their reach and services possible, and promotes ownership and leadership within the villages. And the organization manages to provides comprehensive medical services, educational programs, and assistance with setting up sanitation systems and safe water sources, among other projects, to around one million individuals around Jamkhed at the cost of - and this is not an exaggeration - a few cents per family per year. It is an extremely efficient system.

But the people evaluating their spending want to see more money going to salaries, and therefore CRHP has trouble finding funds. Anyone want to try to explain this logic to me?

Not many people want to do the kind of work that Ravi and Shoba and the dedicated social workers and village health workers do at CRHP for the rural communities, especially when the pay is as low as it is. It is not easy work. It is underfunded. It is really hot here. Lots of care is taken to ensure that the communities are made part of the decision making process along the way, and many jobs and leadership positions are given to the residents of these villages. This can make progress slower and decision making a bit more complicated. But the results are beyond incredible. Ravi says you really don't need much to live in Jamkhed. If only more people could understand and accept living a simple lifestyle...and have 100% genuine interest in helping people help themselves to make the world a little bit better every day.

Phase II

This morning I left my home stay in New Delhi. Yesterday Ruby and I printed some photographs and gave the family a framed photo of the six of us, along with some other photographs of Ruby and me and the two of us with Nikita and Jessica. Nilam Ji, our host mother, got teary, and Nikita and Jessica loved the gift. It was not an easy goodbye. We had a great time together and I will miss them all dearly, especially Nikita. We'll see them again on May 15th when we have our final banquet, and then Nikita has promised to invite me to her wedding (in 10 or so years!).

Early this morning I got on a plane at the Indira Gandhi Domestic Airport and took a two hour flight to Pune. In Pune I got in a car and took a ride two hours to a rest stop restaurant. There I spilled paneer tikka masala on my linen pants. Then I got in a car again and drove another two hours to Jamkhed. And now I am here.

It is currently 98 degrees Fahrenheit and will probably be in the low hundreds by later this week. I'm living with three other students from my program; Laura, Caroline, and Anna. We're staying at the Comprehensive Rural Health Project campus. Take a look at the organization's website here. The other three girls spent a week here two weeks ago for their workshop. 

Take a look at this updated map. Most of the places I have been are identified here. I haven't been to Varanasi yet but I have a train ticket to go and spend 3 days there after my program ends, and I haven't been to Mumbai or explored Pune yet, but I put them there as reference points for the location of Jamkhed.

About the workshop...I was in Rishikesh up in the foothills of the Himalayan mountains, on the bank of the Ganga (pronounced Gunga in Hindi, Ganges if you are American) river. I had the incredible opportunity to go rafting on the rapids of the river and then even jump in for a dip! The water was really cold because it's pretty close to the source, and the water comes from the glaciers. Throughout the week we (Ruby, Jordan, Michaela, Hannah, me) started our day with tea at 7am and yoga at 8am. From 11-12 we had class. 1:15-1:45 we had lunch, and then class again from 3:30-4:30. We had daily meditation and pranayam breathing techniques from 4:45-5:30, and then free time in the evenings until dinner at 7. One night we went to the Ganga Arati light ceremony where prayers are sung and candles are lit at the edge of the water. Other nights we went shopping!

I got the chance to learn about naturopathic medicine (including diet therapy, mud therapy, massage therapy, hydrotherapy, color therapy, and magnetotherapy), yoga theory and practice,  pranayama breathing, and a little bit on aruvedic medicine. It was a relaxing week, but we also learned a lot. My favorite part was probably walking along the Ganga. It's fairly clean up in Rishikesh, unlike in Varanasi where there are dead bodies floating in the water...(the group who had their workshop in Varanasi actually witnessed this).

Back to Jamkhed. I'll be studying the CRHP's Adolescent Girls Program. I strongly believe in the Girl Effect (watch this video, and then go on youtube and watch the most recent one! it's powerful). Educating and empowering girls in economically depressed areas (for lack of a better name - call it 'developing' or 'global south' if you want) can have effects that ripple out from the individual girl into the community and beyond. I also very strongly believe that adolescents need reproductive and sexual health education in order for them to fully understand their own bodies and how to protect themselves (and partners). 

Legal age of marriage in India is 18 for girls and 21 for boys, but frequently girls are married at age 12, 13, 14 - sometimes as young as 3 or 4. They don't necessarily move in with their husband right away. They may live with their parents and spend festivals or weekends with the parents-in-law and husband, and then when they get into their late teens and early 20s they may finally make the official move. Village health workers - when they're available - try to convince parents to hold off marriages and convince girls to hold off sex and having babies until their bodies are mature enough to safely reproduce. Many times girls don't know their exact ages. Menarche (first menstruation) commonly happens around age 13, so the village health workers calculate the girl's approximate age by asking her how long she has had her period for, and adding that amount of time to 13. I think usually they suggest she wait to have babies until she is around 18 years old, and longer if she can help it. Especially in rural communities, girls' rights are infringed upon because of longstanding gender discrimination in an extremely patriarchal society. So sometimes her parents-in-law or husband gets to decide when she has children and how many children she has.

If girls and young women are educated about their rights and given the tools to be able to stand up for themselves, this world could be a very different place. It could be healthier and less hungry, more educated, and safer from violence (As Greg Mortenson describes in his most recent book, Stones into Schools, “In Muslim societies, a person who has been manipulated into believing in extremist violence or terrorism often seeks the permission of his mother before he may join a militant jihad – and educated women, as a rule, tend to withhold their blessing for such things…” Mortenson p. 13).

Here is the description of the program I will be studying (from the CRHP website):

The Adolescent Girls Program (AGP) is one of the latest of the community groups to have been organized. This program owes its existence to the presence and strength of the Mahila Mandals and VHWs. These women have been empowered to realize the need to educate, build up the self-esteem and confidence in their daughters. In effect the entire community benefits as health and development are promoted by a new generation of knowledgeable, competent, and socially-minded women. The AGP has helped organize adolescent girls groups in 54 villages with an average of 25 girls/village participating.

The need for an adolescent girls program is to address the extreme gender inequity and the low status of women in Indian society, particularly in the rural areas. Girl children are given far less opportunities than boys and are considered a burden on the family due to the eventual need for dowry and their marriage out of the family. They are consequently disadvantaged in such areas as education, nutrition, health care, employment and social mobility. The practice of sex-selective abortions and female infanticide is another manifestation of women’s poor social standing and has resulted in highly skewed gender ratios throughout India, particularly in the North. Early marriage, sometimes prior to puberty, often results in early sexual initiation and teenage pregnancy thereby compromising education and livelihood choices. Such are the factors that are being addressed and even reversed through the participation of girls in the AGP

In the project areas of CRHP female adolescence is culturally understood as the time between menarche and marriage (regardless of age) known as Kishorvain muli. This criterion is used by CRHP to identify participants for the AGP. Related activities take place in either of two locations – individual villages and the CRHP compound. 

 

In the villages VHWs and women’s group members organize groups of girls, which meet weekly or biweekly. During these meetings the girls participate in health education classes as well as being given the rare opportunity to socialize. Organized groups are given some books for a library and provided with high-protein and nutritious food for their meal as a nutrition demonstration. The health of these girls is consistently monitored by the respective VHWs and mobile health team, addressing problems as needed.

Groups from several villages occasionally come to the CRHP compound where they stay overnight. The groups are accompanied by the VHW from their villages.

The CRHP is also working on implementing an adolescent boys program, which I'm interested in learning more about. They have also worked with some matriarchal communities (more tribal) and I'm really curious about as well. 

It's definitely going to be an interesting month. It's going to be hot. The work is going to be hard. But the Comprehensive Rural Health Project is a renowned program and has served as the model for not only the Indian government's own National Rural Health Mission but also for health programs in other parts of the world. I'm lucky to be able to spend 4 weeks here - it's a chance of a lifetime, and as Caroline put it (when convincing me to come to Jamkhed despite the heat and middle-of-nowhere location), it's THE public health Mecca. 

Here is a photo of my room here:

 This is my dresser... haha

and this is Laura on the other side of the half wall.   

Also, if you haven't seen this yet...my photo is on the front page of the school website, on a rotating collection of photos. Lolz.

 I think I'll be able to blog more here, since I won't be going site seeing or going to cafes or shopping or hanging out with my host family :/ kind of bittersweet, I guess.