And the ISP title winner is…

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Dalit Women: Exploring the Social Determinants of Health Access in Rural India through Development

As I promised, the abstract to my paper is below:

Abstract

Dalit women in rural India are discriminated against triply because of intersectionality, the fact that they are Dalit, they are poor and they are women. This community is one of the most marginalized groups in India especially within the rural parts of India where the caste system is particularly important. These women are denied of their basic human rights: life, health and education. India does however have a reservation policy in place but being a Dalit woman is still not easy. There are also many health programs in place but with poor implementation and lack of knowledge, many Dalit women cannot access these health resources. On account of their ‘untouchability’, their health indicators are poor compared to individuals of higher caste. Previous research shows that, “caste, class, and gender discrimination prevents Dalit women from enjoying their basic human rights, particularly to dignity, equality and development” (Ashalatha). These determinants can affect their access to good healthcare and basic education. Many Dalit women and girls in rural Maharashtra have anemia, malnutrition and overall weak structural skeletons. However with the help of organizations such as the Comprehensive Rural Health Project, women begin seeing themselves as leaders and help with mobilizing their community, “women’s health status is basic to their advancement in all fields of endeavor” (Sethi 2006). Dalit women from India are facing what African American women in the United States faced for over 200 years; however these women have faced this discrimination since the Vedic Period. This paper addresses Dalit women’s social determinants and how that has affected their access to good health as well as showing comparisons between villages that have a strong NGO presence and villages without.

Also, HAPPY MOTHER’S DAY TO MY MOMMY AND ALL THE OTHER AMAZING MOMS OUT THERE!

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My Mom and I

Help me choose a ISP title!

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Hello! I am back in Delhi for a couple of hours and then off to Uttarakhand tonight! My ISP presentation is on Monday, but I still need help deciding on a title and that is where you come in! There is a poll below with three different titles, click on your favorite one! Tomorrow at 5PM, I’ll tell you who the winner is and you get to have an exclusive on my abstract!

Seeing Gettysburg Abroad

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Seeing Gettysburg Abroad

I recently found out that Gettysburg College awarded an Honorary Doctorate in Public Service to the founders of the Comprehensive Rural Health Project – Jamkhed, Drs. Rajanikant and Mabelle Arole in 1985. I am currently doing my Independent Study Project at their organization. Small World? I think so!

Whirlwind of a Week! Oh yeah and… See you later Delhi!

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It’s been a while! It has been a busy April so far and there is much to catch up on.

I’ll give you a timeline of my last two weeks. According to my roommate, this timeline might be a little hard to understand, please read up and down while reading it!

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My goal is to update you on everything that is said within my timeline. Wish me luck!

CRHP Workshop

CRHP stands for Comprehensive Rural Health Project and it is the most amazing NGO I’ve been to in India. Here’s a link: jamkhed.org ,  Their entire mission is to help the rural poor and marginalized. The organization was founded in 1970 by Drs. Raj and Mabelle Arole; they were very dedicated to providing healthcare to the poor and underrepresented that in their marriage vows, they vowed to each other to devote their life to the cause. In the founders eyes, to truly help a poor village, one has to follow the Jamkhed Model. They created this model that other organizations and the WHO adopted. The model includes three main aspects of CRHP which is Village Health Worker (VHW), Mobile Health Team (MHT) and Julia Hospital. VHW’s are women selected by their own community that are usually illiterate and low caste. Becoming a VHW gives these women confidence and major leadership roles within their villages. People that once saw them as useless, see them as doctors and healers. This empowers both women and their village.

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Village Health Worker does post-natal care for a women that just gave birth a couple of weeks ago

The Mobile Health Team provides support to the Village Health Workers by traveling weekly to different villages to provide help with formation of community groups (Adolescent Girls and Boys Groups, Women’s Self Help Group and Farmer’s Club) and helps connect CRHP organization to the community. These groups give the community an outlet to speak about their issues and come up with solutions. The MHT includes a physician, a paramedic and a couple of social workers.

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The Mobile Health Team showing us how the dispel myths within the villages using magic tricks

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The Mobile Health Team

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The president of the Women’s Self Help Group showing her entrepreneurship skills (She makes icees and sells them at the village store)

Julia Hospital, which is being run and owned by CRHP, it serves 500,000 people and has 50 beds. It is updated with some of the best machinery. Cost of services are subsidized and based on a person’s income, “CRHP can serve the poorest of the poor”.

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Julia Hospital

There are so many other things CRHP does to help the community, to list a few:

  • Khadkat Farm – is used to demonstrate to local farmers sustainable farming techniques which will help provide continuous income to the farmers.

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    One of the staff showing us how the farmers make fertilizer

  • Mabelle Arole RehabilitationCenter (MARC) – is a farm for women that have survived domestic abuse and those suffering from HIV/AIDS or TB. The women help run the farm and receive a monthly stipend.

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    This womancontracted HIV/AIDS from her now deceased husband and was treated horribly from her family members and community members which led to one of her parents killing her child because of her disease. Throughout all the misery, she still has a smile on her face.

  • Joyful Learning Preschool – educates 50 children (between ages 2 and 5) from the slum across the street. Students are given two healthy meals a day and are taught about “hygiene, health, reading, sharing and creativity in both Marathi and English”.

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    Two kids from the Joyful Learning Preschool playing with my sunglasses and posing for the camera.

  • Artificial Limb Workshop - —CRHP provides subsidized artificiallimbs to people with low incomes and the limbs are made of locally available materials such as wood, plastic, iron, etc.
  • Helping Hands Initiative - provides women from Jamkhed employment and skills training.
  • Adolescent Programs – helps educate the youth of Jamkhed on reproductive health, the environment, gender equality and mental/physical health.
  • Farmers Club – helps educate 40 – 50 farmers on watershed development, organic farming, and changing men’s attitude of women.

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    A farmer from Farmer’s Club

  • Self Help Groups - Speak on health issues, social issues, entrepreneurship. 

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    President of the a Women’s Self Help Group

    Even though we were there for school, we also had some fun. Below are some fun pictures from the week.

 Ellora Caves

On our last day, we visited the Ellora caves which is located in Maharashtra, “Ellora, with its uninterrupted sequence of monuments dating from A.D. 600 to 1000, brings the civilization of ancient India to life. Not only is the Ellora complex a unique artistic creation and a technological exploit but, with its sanctuaries devoted to Buddhism, Hinduism and Jainism, it illustrates the spirit of tolerance that was characteristic of ancient India.” (http://whc.unesco.org/en/list/243).

Below are some pictures of what we saw!

MY 21ST BIRTHDAY

I turned 21 on April 5th, but my birthday celebrations started a couple days before. You only turn 21 once, right? In a nutshell,I had a great birthday: my friends and I traveled to Gurgaon (Cyber City) for this ‘Ladies Night’ thing at this restaurant bar and I went to the movies and saw Captain America, bought my first saree for my presentation in May, got a fruit facial and a full body oil massage and finally my family and I went to this sports bar to see the final cricket game between India and Sri Lanka. Also, I would like to shout my roommate out (Robyn Gibbons) for trying her best to give me the best, most memorable birthday ever. 

Hindi Final Oral and Written Exam plus Hindi Final Project

I studied hard, I think I did well. My little host brother helped me with the project.  It was a whole day affair. I think that’s all I am going to say about Hindi for now (we need some space from each other).

Independent Study Project

Guess What?! I’m currently on my ISP in Maharashtra for the next four weeks. Before I go on, I need to explain what an ISP is. Specifically for SIT Study Abroad Programs, an ISP is basically undergraduate research or field work. In the end, I will produce a 30-40 page paper and presentation to my classmates, staff and academics from India. My ISP will be about Dalit women and their access to health. The “Dalit” communities are looked down upon because of their placement within the caste system.  This community is one of the most marginalized groups in India especially within the rural parts of India where the caste system is still a factor in how individuals are treated.. Caste system is perpetuated because of birth, intermarriage and food sharing. Dalit women are discriminated against doubly because of the intersectionality of being a woman in India as well as being a part of the Dalit or Untouchable community. These determinants can affect their access to good healthcare, hygiene, clean water and etc. I’ll be interviewing Dalit women in rural Maharashtra about discriminatory practices (in the sense of health) and how that has affected themselves and their family.

When I’m done, I’ll post my abstract for everyone to see. I am pretty nervous because this can be a stepping stone for one of my senior thesis or my future career path. However, I have faith that I will be able to get this done.

In conclusion…

Bye Delhi, Hello Maharashtra!

That’s so India! (My adventures in Udaipur)

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Last week we had the opportunity to spend time in Udaipur, one of the most beautiful places in India, also known as the city of lakes. We spent a lot of time exploring the city, meeting the locals and shopping! It was kind of our ‘mini spring break’! We stayed in a beautiful hotel sitting over the lake. I was one of the lucky people in the group to have my own room within our suites. My room was a nook looking over the lakes and palaces. 381 384383 Every night before sunset, we would find a good restaurant and watch the sunset while chatting about life. It was the perfect end to our day! These were the times where I would reflect on how good God has treated me. I realized that I am blessed to be here in India and all these beautiful  views and incredible knowledge I am gaining are all because of God.

391 394 405 I also visited a gorgeous palace and temple. The palace was huge with amazing views. The temple was intricately designed. The temple caretaker explained to us that the designs showed life. At the top were gods and goddesses, the second level were people, the third level were the animals and the lowest level were the devils. This temple prayed to Shiva.

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022 025 028 Udaipur was not only filled with impeccable views, lakes and palaces but also progressive ways of health care including a mobile medical unit, Balwadi , Bal Sakhi, Seva Mandir and a Mother Milk bank.

Mobile Medical Unit

The mobile medical unit seemed like a sustainable idea that connected communities with health workers. The mobile unit travels everyday to 20 villages per month, a village a day. Many people miss out on seeing doctors and nurses because of how far the nearest health center is. Each medical mobile unit ideally has two medical officers (one male and one female), one lab technician, one x-ray technician, one social worker, one pharmacist, one GNM, and one nurse.

We were able to see a Balwadi which takes care of children from about 60 families within the mountain villages. The idea behind preschool childhood centers is great because it gives a chance for mothers to work and generate income and/or fulfill their household duties. Also it gives children a chance to interact with other kids their age. Programs like this show that even in the mountains that children and women still have a chance to overcome determinants like distance from others. Also I ate a ton of chickpeas, I could not stop.

My absolute favorite part of the excursion was visiting the Mother Milk Bank and Malnutrition Center. It is great that families have a place to drop their unwanted infants instead of abandoning them in the streets or simply killing them. The great part about this drop off location, the person’s identity is unknown and their child is safe. The mother milk bank is also known for asking mothers to donate their extra breast milk and giving it to mothers that are unable to lactate. The Malnutrition Center was located in a tertiary hospital and I had the chance to meet this seven month infant that had the body of a one month old but he was the happiest baby of all despite his shortcomings.

I would definitely recommend Udaipur as a place to visit to other people. We all ended up wanting to stay longer.

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Next week I am off again to another part of India, more south. I am going to Jahmkhed, in the state of Maharashtra which will be a 20 hour train ride and a two hour drive to our destination. Wish me luck!

Also…

HAPPY HOLI EVERYONE!

“Health inequit…

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“Health inequities are the differences in health that are not only unnecessary and avoidable, but in addition unfair and unjust.” – Margaret Whitehead

Last week in Bahraich we visited four different institutionalized health centers, a school for disabled children, an NGO, and two villages. We compared and contrasted the different hospitals as well as the two villages. The two villages we visited were the Tharu village and the Risia village. Both of these villages were different within their infrastructure. The Tharu village had establish sustainability within their community,like having more stable homes than the people in the Risia village. However both villages had a great sense of community. We also visited the services that D.E.H.A.T offered to the people in the forest. D.E.H.A.T provides children in villages a place to attend school (especially for girls that have dropped out originally or have never went) as well as a place to learn about their rights as children. It was impressive to meet the young girls and boys that were in a Children Rights Group because they were knowledgeable on the issues within their community and their country. After meeting these amazing children, one starts to think of their own country. In the United States, children are worried about the next technological device or the next video game but they don’t realize that as children they have their own duty.

Children Rights Group in the forest citing their rights from the CRC

Children Rights Group in the forest citing their rights from the CRC

Healthcare Delivery

The World Health Organization suggests that four percent of a country’s GDP should be used to provide the minimum amount of health care; however India uses about two percent of their GDP for healthcare within in their country. Altogether, India supports 1.2 billion people and has a GDP of 1.8 trillion (USD) but only two percent is used for healthcare. All of the centers we visited had poor infrastructure, shortage of health workers, and the least possible support from the government.However, India provides absolute free healthcare to their citizens that live “below the poverty line (BPL)”. Citizens that are above the poverty line only have to pay small fees for hospital services. Also, the government is using monetary incentive to convince women to have institutional births by giving women 1400 rupees after every birth at a health center. We visited four types of public hospitals within the rural area: District Hospital, Community Health Center, Primary Health Center and Sub Center.

District Hospital

A secondary level hospital, it serves about three to five million people and has a total of 201 beds. The district hospital had two different hospitals, a main one and a woman hospital. This type of hospital has both an Emergency Room and ODP (outdoor patient) which people see before they are treated on a specialized floor. Compared to the hospitals in the United States, the district hospital had sex segregated surgery wards. However, it was the only type of hospital we saw in Bahraich that was gender separated. The “Sister of the Ward” which is the head nurse was taking care of 30 patients although one nurse should only be taking care of ten patients. Also another thing we noticed is that a patient can choose between three different levels of beds within the hospital: Private, Paying and General Ward. I valued that there were two different hospitals and one was specifically for women’s needs. The services they offer include delivery, post/anti-natal, family planning services, and immunizations.

Community Health Center 

The second center we visited was the Community Health Center (CHC); they serve about 150,000 people and have a total of 40 beds. They have a small surgical facility and they have a “24 hour delivery person”. The provide immunizations two days out of the week.

Primary Health Center

The third center we visited was the Primary Health Center (PHC), which serves 50,000 people and have four beds in total, however there is no “in-patients” because the center has a closing time.

Sub Center

The fourth center we visited was the Sub Center, which serves 5,000 people and has no beds; it is the lowest health care delivery in India. Both the PHC and the Sub Center provide immunizations once a month. All these centers run a medicine room.

Risia Village

We also visited our Academic Director’s home village as well as the school he created, The Global School of Learning. We arrived on the day where they celebrated their 1st Annual Day of Celebration which included performances from all of the classes. During the performance we were served a typical Indian snack, dessert and bottled water. After the performances, we walked around his village and made conversation to women about their lives and their access to basic healthcare. It was surprising to see that many of the women do not have bathrooms within their homes so they are only able to use the bathroom twice a day out in the field before and after dark. However, what I loved about the women of this village is that they were proud of everything they had and they wanted to show us their lives. Also the women of the village performed for us folk music and we performed the Jackson 5, ABC 123 song.

Kasturba Gandhi Vidhayalay for Disabled Kids

I personally had an emotional time at this institution because of the injustice that disable kids receive. Many families with special needs children do not support them and leave them to either fend for themselves or keep them hidden within the home. In India, schools for special needs kids are rare to find. The school we visited was the only school out of four districts that helped kids with special needs. Disabled kids in India are more likely to have accidental deaths and fall into poverty. While at this school, we danced and learned with these kids and they were just like the rest of us! I had the best of time but it was hard to realize that I was that ignorant person a few years back that was afraid to understand disabled kids. It definitely was a great learning experience.

Tourist Side of Uttar Pradesh 

Not only did we observe hospitals, NGO’s and villages, we also saw the “touristy” side of one of the largest populated states of India. We visited the border of Nepal, drove through a safari, we went gator hunting, we went to Shravasti, the famous Buddhist pilgrimage site and visited the Bodhi tree and we had bonfires EVERY SINGLE NIGHT.

Next week I am off to the state of Rajasthan. Phir Milenge!

D.I.E Exercise with the Okhla slum

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D-I-E is a tool or system for discerning among the facts, interpretation of such facts within specific socio-cultural contexts, and subjective evaluations of such information from passionate and opinionated positions. D-I-E stands for Description, Interpretation and Evaluation. Below is my D-I-E for the Okhla slums which is supported by the Hope Foundation who are supported by the Indian government.

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Description:

A young woman, 21 years old, joined the slum in July 2013 after marrying her husband in May. She is currently six months pregnant and is enrolled in the Mothers’ Group. The mother’s group teaches women about the right food to eat while pregnant, how to clean their home and basic things they should know. With the help of the Hope Foundation, every month, the people in this specific slum celebrate Nutrition and Health Day and after attending she told her family she was pregnant to receive the most influential vitamins for her baby’s growth such as iron and follicle. Traditionally, women keep their pregnancy a secret, but with NHD, women learn the positives of telling their families’ as soon as they know they are pregnant.

Interpretation:

Having the support system of the Hope Foundation is helping many women in this community. Women are using the resources to help their family and their newborns. Many more women are having successful births because of this organization. There are high infant and maternal mortality rates in India and the Mothers’ group is decreasing the rates by educating new mothers on their bodies and their growth. Women like the 21 year old, that are unknowledgeable on much needed vitamins and lactating are benefiting from this group as well as their children and husbands. It seems as if there are a lot more success stories than disaster stories.

Evaluation:

Overall, I think this foundation is helping the people of the Okhla slums. They seem to be benefiting from programs like the Mothers’ Group and Street to School. The good thing about this organization is they are not intruding on the slum families they are basically integrated within the community. I think if the slum wants to continue to develop they should continue to follow Hope Worldwide initiatives.  However I have only been in India for almost two weeks and only visited one slum, I cannot really make strong judgments based on one slum without being able to compare it to others and other organizations that are trying to help. Nonetheless, I am hopeful for the future of this slum and the young people within it.