Posted by: lilyhamburger | December 7, 2009

Peeling back layers


1. getting peed on by a baby at a health worker meeting

2. car rides to and from villages through rice and sugar cane fields with my awesome co-workers

3. playing simon says (sans simon, that was way too comlicated)

4. one of the kitchen women asking me what the TP in my room was. "tissue" i replied. then she wanted to know what it was for…

5. field trip to giant temple with huge statues and a cave that made it feel like a hindu mini-golf course

The big event in Dharampur this week is a gas line being laid along the main road to town. I think the villagers are doing the labor themselves…it’s quite the operation!

Every day of the last 2 weeks has been packed with new words, sights, people, concepts and experiences that I feel like I’ve been here way longer than only 2 weeks. I have settled into my little perch above the offices, and my co-workers and I have grown accustomed to smiling at each other through the language barrier, and helping each other along. It still feels like a thrill to wake up every morning in India, but the more time goes by the more layers of India I peel back to reveal the complexities of Gujarat, southern Gujarat, Dharampur, and each of the three areas of villages that ARCH works in.

I cannot describe how exciting and inspiring it is to be observing the health education programs that ARCH is performing in these villages. In order to prepare myself to create an effective health education program of my own – that I will design with the directors of the organization – I am observing all the activities that ARCH conducts. I have seen direct health education sessions, where we drive out to a village and give a presentation to a group of gathered villagers on topics such as hygiene and preventing illnesses, menstruation, and the reproductive cycle. I have seen health worker meetings where the supervisors check in with the workers regarding what they are seeing in the villages, their treatment procedures and questions they have. It’s amazing – the health workers have high school education only and they are the primary health care providers in these extremely remote hamlets. ARCH is struggling to keep them on top of correct diagnoses, treatments, and record-keeping, as well as convincing people WHY they should wash their hands and vaccinate their children. One important health issue is anemia, especially dangerous to pregnant women, and its caused by nutrient deficiency. One ARCH staff member told me that the iron tablets they give to treat anemia is the best solution to this common deficiency disease since its cheap for ARCH to provide, and patients can’t afford the necessary fruits and vegetables to prevent the illness.

Finally, I have to tell you about the training I attended for daiyen, the traditional birth attendants. About 20-25 old women showed up to the home of one of the health workers in a village in Mancunia, an area where ARCH is partnering with the government and some other NGOs to improve mother and child health. These women were such a hoot. Their broad smiles were often toothless and their skin was leathery and weathered. They jingled with jewelry and they were dressed in a rainbow of saris and traditional Maharathi sari-tied-into-pants get-up. Many had tattoos on their faces and bright red bindis on their foreheads, and their silvery hair was braided, sometimes with a bit of cloth weaved in. They were super chit-chatty and smiley, and Sarad Bhai, who was conducting the training, had to shush them repeatedly. The session felt like a Baptist church service at times because women were constantly shouting out affirmative responses or repeated Sarad’s words as he showed posters of babies in utero and held up models to explain birth. The dayen speak only Kognii, their tribal dialect, but through broken Gujarati I was able to communicate to a health worker who then translated so I could have a little conversation with a few of them. Because of the visual aids I could get what Sarad was telling them, and I learned how to deliver a baby in a village hut! Who needs med school?!

These old ladies conduct births with zero knowledge of anatomy or what’s goin on in there, so there are many misconceptions about things that lead to unhealthy outcomes for mothers or children. For example, they think lower birth weights are better because delivery is easier. They think a mother shouldn’t eat many things while pregnant because the baby will get too big, or turn the color of the food she eats. So no milk or curd (yogurt). The delivery process is definitely not sanitary – no hand washing, etc – and there are different beliefs about when the proper time to bathe a new-born is. ARCH is working on convincing mothers to use the hospitals for deliveries, or at least get a trained dai to attend the home-births. But changing practices like these that are so rooted in habit and in culture are hard to change.

One of the things I think I am going to be able to contribute to ARCH is some ideas for reaching people based on my experiences doing educational campaigns and community organizing stuff at home. I realize more and more every day things I take for granted about my education – critical thinking skills, confidence in speaking in front of a group, the ability to analyze a situation and draw conclusions, etc. Even motivational strategies from coaching are going to come in to play I think. The process of teaching people these basic health things is complicated – we are replacing old practices with new ones, and who are we to be telling people what to do? Many of the health issues they face are accepted as a part of life, God’s will, etc., so why should they now become concerned about them? There is a moral question constantly in the background of this work, I think, about respecting tribal people while simultaneously trying to change them. In the face of people’s “misconceptions” about health, and sometimes a strong aversion to adopting new practices or beliefs, we have to be sure of our fundamental mission that basic health is necessary and good, and that learning basic science of the human body and reproduction is something people should have to improve their lives.



  1. Lily, I love reading about your year. The experiences are amazing, and the best part is reading your thoughts and reactions and questions about it all. Miss you! Love,

  2. Lily you are an inspiration. I miss you, I love reading all this. All my love. xo M

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