Traditional birth attendants!

When given the option to create a teaching module for the traditional birth attendants, I could not believe how lucky I was to have this project.  Because I am going into Ob/Gyn and am extremely interested in global women's health, this was the perfect project for me.  

The traditional birth attendants (TBAs) are illiterate village women who assist with deliveries.  They are untrained, so Seva Mandir holds teaching sessions for the women to give them more skills.  This includes triaging and teaching them when and where to get more help.  

Seva Mandir provides TBAs with a kit for home deliveries.  When I saw the kit and Dr. Sangeeta explained each tool to me, I could not hold back my excitement!  The TBAs are truly delivering patients with the bare necessities, and it's quite heroic what they are able to do with limited tools and knowledge.  Below you can see the kit contains a fetoscope to listen to the fetal heart beat.  There is a tarp to lay on the ground because most women deliver on dirt floors. There are even very basic tools such as a nail clipper for the TBA to help with hygiene. I was amazed to get to see the kit.

Dr. Sangeeta and Lindsay with TBA kit

TBA kit for labor and delivery

Although Seva Mandir teaches the TBAs, they have no set lesson plan, and instructors mostly go off the top of their heads to teach TBAs.  I created a module on contraception so all TBAs will learn the same information and there are set points which instructors should cover when teaching the TBAs.

Finding a TBA to interview was actually quite difficult, and when we finally interviewed a TBA we required a Wagri to Hindi translator as well as a Hindi to English translator.  The interview was pretty crazy with so many iterations of the same sentences.  During the interview I asked Santa, the TBA, how she liked to be taught.  She actually did not understand the question and after multiple attempts to ask the question in different ways, I realized her education was so minimal that she did not even know of different methods of learning.  Her perspective really made me step back and rethink how to formulate my module.  I had to make it much more simple while still engaging the TBAs.

Santa, the traditional birth attendant in the middle after our interview

Khojawara Hospital

Three times a week Lindsay and I climb into a jeep and drive two hours to a remote rural hospital in Khojawara, which is in the Kherwala district. The road becomes more and more rural until we are surrounded by arid hills dotted with cacti. 

Dr. Salvi is the pediatrician, and Dr. Mahalakshmi is the Ob/Gyn at the clinic.  Sometimes they each see up to sixty patients a day, so the clinic is a very busy place.  After working her whole life as a military physician stationed as far north as Ladakh and as far south as Tamil Nadu, Dr. Mahalakshmi retired and works three days a week in this rural Seva Mandir clinic.  They are both extremely brave for being rural physicians, as there is literally no other help for hours and they are on their own.  

Dr. Mahalakshmi, Nurse (Sister), and me

Dr. Salvi and me

 The patients mostly speak Wagri, which the physicians do not speak.  It can be very challenging to treat patients with a communication barrier, limited resources, and an overwhelming amount of patients.  Even so the physicians are very patient with Lindsay and me, explaining diagnoses and translating for us occasionally. On one of the first days Dr. Mahalakshmi asked me what I came here to learn, and I said rural medicine in a developing country poses completely different problems.  Physicians have to rely more on their physical exam skills and use fewer diagnostic resources.  She replied "You came all the way here to learn that?" I think she feels a large responsibility to help us learn because we traveled so far just to learn from her.

We see completely different pathologies here in rural India than we do in Chicago.  Malnutrition is a huge problem, and may children have shrunken bodies and the characteristic large head and bulging eyes.  Dehydration and sanitation is a huge problem, so much so that even men frequently have UTIs here, which is uncommon in Chicago.  Malaria and typhoid are also common diseases, whereas in Chicago if I saw one of these diseases I would be surprised.

Pharmacy at the clinic

Happy Holi!

I have a new favorite holiday!  On Wednesday we celebrated Holi by smearing colors on each other to show love.  And Udaipur celebrated Holi with the most rigor out of any city!

My favorite part was actually the night before.  All around the center of the city were tall tree-like structures made of hay, and in front of the main temple was the largest of them all.  Every year they burn them to symbolize triumph of good over evil.

Cow minding its own business

My friends and I were told by some old ladies we met at a temple that the night would start with a traditional performance, but it turned out to be more similar to a disco with dance groups dancing to Gangnam Style.  One interesting part was the hijras, who are eunuchs thought to have powers to curse or bless and are marginalized by society.  The hijras would pull men onto stage and dance with them on stage.  All the men were laughing and trying to push each other onto stage.  

As soon as the performance was over and the focus turned to the big hay-tree in the center, I started to get really worried. Isn't that thing going to burn and fall on all these people? I fidgeted with my hands while I waited for the burning to start. I don't want to be incinerated!  Suddenly I heard a pop of a firecracker and it was silent.  Then more pops and an escalation. POPPOPPOPPOPPOPPOPPOP!!!! Everyone was backing up away from the tree and I was on the stairs of the temple walking backwards as fast as I could while keeping my eyes on the tree. 

There was smoke everywhere and the cracking of firecrackers was so loud it filled my whole head and even if there had been a sonic boom it would have just blended in!  OhNoOhNoOhNoOhNo! And then the whole hay-tree was on fire!  I felt the heat of the fire on my face.

AHHH!!!!

The fire didn't actually last too long, and I was so happy to be alive and unburned!  Then I was surprised by my friend shouting Happy Holi! and a big smear of bright purple paint on both my cheeks.  Everyone started throwing color on everyone else and everyone was laughing.  

A reporter came up to my friends who are mostly non-Indian and interviewed them. When my friend Lindsay said she had a good time, the reporter turned off the camera and said, "No, you have to say it is the best time of your life!" Here is all of us with the reporter.

The next day people celebrated both in the streets and privately at home by sprinkling colorful Holi powder on each other. Here's some pictures of the day. 

I'm covered in Holi powder!

Tourist on the street

Happy Holi!

Day 5- Sick already!

I ate something I was specifically told not to eat, a little dough pouch that the vendor poked a hole in and filled with sauce. The sauce is supposedly made with tap water, my bad!

So I've been in bed all day. The other volunteers have been really nice and made me tea. :)

Day 4- Exploring the City!
I did get to do some awesome stuff yesterday right before I got violently ill. In the morning an American girl named Hannah took the other medical student Lindsay and me us to the touristy area of Udaipur! Here is me in a tempo on the way there, which is like a rickshaw that can fit more people. It was only 7 rupees, about 15 cents!

Once we got off the tempo we walked around some winding streets to find a coffee shop. I don't know how Hannah figured out where we were going, I felt disoriented with all the people and shops and cows on the street. 

Lovely mural

So many boxes!

We had a beautiful lakefront view in the cafe. In the distance you can see the hotel where the James Bond movie "Octopussy" was filmed.

The three men in the picture below were remodeling the fascade of this arch facing the lake. One guy was slathering red clay on the wall very slowly, while the other two men watched. It took them about an hour to cover three square feet. 

I'm in India!

I love love love this place!

I arrived in Udaipur, Rajasthan yesterday to work for an NGO called Seva Mandir. On the drive there, I passed by cows and goats roaming the streets, women in colorful saris with baskets of produce on their heads, and dilapidated but charming shacks and houses. The taxi driver honked all 20 minutes of the drive, and car honking was the first thing I noticed here in India. It's everywhere! Apparently you can't drive without a horn here. Trucks have handpainted signs on their bumpers saying "Please Horn." I even saw one that said "Horn is our Motto" (hehe!). I think they find it safer to honk, so other drivers/cyclists/pedestrians/moped riders know you're there.

I'm staying in a dorm at Seva Mandir with other foreign volunteers.  The first thing one of the volunteers asked me was "How are you finding the dorm?" with a wry face.  I take it he finds it lacking, and maybe I would too if I had already been here five months. The lodgings are basic, but I think it is whimsical and romantic. Here is a picture of the staircase leading up to the room, as well as the girls' room.

One half of the girls room

When I walked up these stairs the first time, a pigeon flew right by my head with a red thread in its mouth. It landed on a cabinet in the hall across from this staircase. So there are pigeons nesting here, which is incredibly amusing!

Another example of why the other volunteer probably doesn't like the lodgings is the bathroom. Fortunately for me I don't mind squatty toilets or bathing from a bucket.

On the right is the squatty toilet. The little blue pitcher is how you flush. And the left side is the shower, where you can see the bucket which you fill with water and then douse yourself with a dipper.

The other volunteers took me to this ridiculously authentic dinner last night where I was too shy to take pictures but in my head I kept thinking "This is awesome!!" over and over again. We walked behind some stores where there was a little straw shack with no door. The roof was held up by blue-painted wooden sticks the owner probably found somewhere, and the shack was leading against a blue outer wall of a building. We were served piping hot curries with chapatis (kind of like a tortilla) on a steel plate, and the server kept refilling our plates until we couldn't eat anymore. And it only cost 50 rupees (US$1)! We ate only with our right hand, and there is an outdoor sink to wash up. I definitely need to learn to eat properly, no one else's hand was dirty afterwards except for me.

I'm super excited to start work though! I want to work with a traditional birth attendant program here, more on that to come later.