Every winter, HSPH students have the opportunity to travel abroad in courses designed for the special term of WinterSession. HPH NOW has invited students to write about their experiences. In the essay below, Marci Brooks, a master's student in the Department of Health Policy and Management, shares her thoughts on her trip to India. The goal of the trip was to familiarize students with the health problems and health systems in parts of that country. This is Brooks' essay:
It wasn't until we were a few hours into our overnight train ride that the culture shock actually hit. Four HSPH students, including me, and a Brown University undergraduate endured the 10-hour journey down the Kerala coast of India and around the southern tip of the country. We were part of the Winter-Session field trip to India, led by HSPH Senior Lecturer Richard Cash, and we were en route to our field placement in Tamil Nadu.
At back, from left to right, HSPH students Laura Hoffmeister Lindsay Giorgi, Marci Brooks, and Annette Martin in India
We were traveling with the locals, part of a packed train car with no air conditioning, bars on the windows, wood planks stacked three high that served as beds, and an Eastern-style squat toilet that emptied over the tracks. At five in the morning, we arrived at the Madurai train station, disoriented but energized, for our work with the DHAN Foundation.
DHAN, which stands for the Development of Humane Action, is a 10-year-old Indian organization. DHAN empowers communities, specifically women, throughout rural India to develop their own banking, commerce, education, and health care systems. Unlike more conventional microfinance organizations that deliver small business loans, DHAN "enables self-help" by nurturing innovation, scaling up institutions, and assisting with the training of qualified personnel.
The effectiveness of the DHAN model was evident immediately. The first "kalanjiam" (self-help group) that we visited provided a tour of the hospital they built from scratch. The funds for the hospital came from the initiation of an herb cultivation business that continues to generate revenue to support the hospital's operations. The hospital was clean, efficient, and achieved positive health outcomes, especially in the areas of infant and maternal care.
Other DHAN-affiliated kalanjiams boasted similar achievements, including establishing a volunteer corps of "health guides." The guides, trained by DHAN, are charged with educating community members on nutrition, sanitation, and prenatal care. In the face of burgeoning anemia rates, some of the corps had made real strides in altering entrenched behavioral patterns. For example, families accustomed to rice- and potato-based diets increased their intake of locally available iron-rich fruits and vegetables with the encouragement of the guides. Also, despite widespread cultural norms promoting bare feet, the guides persuaded many adolescent girls to wear "chappels" (shoes) to protect their feet from anemia-inducing worms.
When our time in Madurai came to an end, our group embarked on a long trip across the mountains and back to the state of Kerala, and my culture shock reemerged. The Indian landscape was a constant reminder of the dearth of basic health infrastructure for the country's 1+ billion people. Open defecation (despite latrine building costs of only 1,000 rupees, or $22 USD) is commonplace, and lack of access to clean water contributes to health concerns.
In addition to these glaring issues, India contends with many of the same public health problems as the U.S., including health system cost-containment pressures and exploding numbers of people suffering from chronic, non-communicable diseases, especially diabetes. My biggest takeaway lesson was that India is in a uniquely challenged position. The country faces public health difficulties of a grossly underdeveloped and a well-developed nation simultaneously.
Copyright, 2009, President and Fellows of Harvard College
