My first 2 weeks of IBD are complete and I am beginning to feel comfortable in my surroundings. Like breaking in a new pair of running shoes – at first it feels awkward and every time you hit the ground you are acutely aware of the shoe rubbing on your heel and the tightness pushing on your arch. It started with an assault on all 5 senses. The colors are vibrant. Beautiful shimmering saris in every color you could dream of. Even the trucks that haul the chickens off to market are painted with bright yellow, red, green and blue. Every morning I wake up and wonder how I possibly slept through the night. The rickshaws, motorcycles and trucks are in a constant battle of the horns. And the streets are filled with constant chattering, upbeat music, and every so often a “moo” from one of the cows lazily sauntering down the street. Mid-afternoon a blanket of hot moist air falls over the city of Mysore. People say that it is “mild” here, but I find myself avoiding touching anything that seems warm and lay there at night fanned out over my bed. Of course there is no AC.
The food has been both wonderful and awful. I do love Indian food, but I don’t think I ever had considered eating it for three meals a day for 3 weeks. It started off a little rough in Bangalore as I found that I do not so much like green curry leaves, nor suspicious looking meat. Yet, the multitude of dishes and spices always make meal time an exciting adventure for both Rooti (yes I named my stomach parasite) and I.
By far the biggest adjustment has been for my olfactory system. It has to compromise constantly throughout the day. Thank goodness it has a special ability to adapt and attenuate over time. I am not going to lie – there are a lot of very bad smelling things here. I will leave it at that.
The amazing thing is that it is all beginning to feel normal. I no longer walk tensely down the street checking to see if I am going to get run over by the next rickshaw, nor do I feel impatient when the interviewee shows up 90 minutes late to our meeting. I am quite enjoying myself and my teammates and learning a lot about the Indian healthcare system.
Oh yeah, did I mention that I am working on a mHealth project? Our two weeks in the field has just concluded. We traveled to many nearby villages interviewing health providers from all different levels, gaining an understanding of the care process, information flow, and understanding the key issues they are encountering. These conversations have been extremely insightful and the people have been so kind and welcoming. It has been quite challenging though as we often hear conflicting descriptions and messages and we are quite sure things are getting lost in translation. Many of our initial assumptions are not as obvious or true as we had expected.
I am starting to doubt mHealth. It is not that I no longer believe there is an opportunity for mHealth in some situations, rather it does not seem to be the most effective investment or efficient way of improving mother and child health in Karnataka. So far all of the ANMs who are using SMS in the field to record information on services provided to mother and children feel that it is extremely inefficient. First, almost none of them speak English so it is very hard for them to write and receive text messages in English. Second, most of these women have never used the SMS function on their cell phone before so it is difficult for them to learn this, especially the older generation. Moreover, I am still confused on the objective of this program as the ANMs still have to record all of this information in the mothers (Thayi) card as well as at the primary health center, so there is a lot of redundant work going on.
Now that our team has a good understanding of the issues involved in providing and tracking care in rural India, we will be able to come up with some helpful improvements to the current system. During this final week in Bangalore we will try to incorporate best practices from other successful mHealth projects as well as our learnings in the field to the new technology that the Foundation for Research on Health systems (FRHS) will be developing. However, we also acknowledge that there are many easy fixes that are not related to technology that would have a huge impact on health. For instance, the ANMs are supposed to receive supply kits with oral contraceptives, broad spectrum antibiotics, and iron a folic acid, but every ANM we spoke with did not receive this in the past 2 years! As a consequence the health of many women and children living below the poverty line is much worse off.
It’s these simple things that we find so frustrating. It is hard to understand investing millions in technology when simple inexpensive solutions exist to combat diarrhea and anemia. Whether expected or not, our team plans to propose both mHealth solutions as well as suggest some very basic non-technology solutions. We hope our work has an impact.