Today I caught a glimpse of why this model of health care delivery is so potent. In each of the villages, we set up 2 stations: a desk for chronic morbidities outside and the antenatal care station inside our van, next to the pharmacy. Patients knew to come the same time every month bringing their own health records, and were reminded to keep their appointments by their health aide worker. From the moment we set foot into a village, patients would rapidly appear until they engulfed our table.
One of the most fascinating aspects of today were the few untouched glimpses into the daily village life from which our patients emerged. I was able visit the rice and sugar cane fields where I watched farmers covered with wrinkles from age and sunlight nudging their cows along as they plowed the land. I watched as young children napped on the tiny cement floor of the village preschool, surrounded by swarms of flies brought in from the hot weather. I saw a nomadic family of stone-cutters, who were part of a casteless and outcasted group called the "untouchables" thought to have descended from criminals. The father, thin and gray haired, sat expressionless in front of their cloth tent, their daughter stared at me curiously while she held a stray puppy, and the mother squatted to balance a hot pot on her feet. I watched women walking to their homes as they balanced buckets of water on their or gigantic bales of hay on their back. I listened as a newlywed woman, who did not appear older than 16, explaining the family charms on her gold marriage necklace.
Separated from a schedule and carried only by the drift of the day, I also discovered many simple pleasures such as walking into a grove of beautiful trees and identifying mangos on the verge of ripening (two major Hindu dieties were married under a mango tree, so it is often thought of as a symbol of love). I also greatly enjoyed playing with the children, and watching their improvised singing and dancing performances. Afterwards, they would crowd excitedly around my camcorder to watch themselves in replay. I sat under a plantation of coconut trees and admired how their abundance once provided the idea for iv hydration at CMC when sterile water was scarce. Imagine that--walking into a cutting edge hospital in India to find all the patients hooked up to coconuts. Apparently this provided the idea for the oral rehydration formula. I think it takes moments like these, when our minds are stolen from the whirlwind, to help us truly appreciate our surroundings and the gifts that they give us.
But the beauty of the day could not conceal many realities, many of which were explained to me by Sharon, the community physician who worked in the antenatal care station. For instance, I began to learn more gender disparities. When a newlywed woman gave birth to a girl, the family would mourn rather than throw the usual elaborate celebration for newborn boys. Girls are often thought of as liabilities, as they must be supported until their families somehow scrounge the money for their marriage dowries. We saw many women who claimed to be 18 or older, but were really 14 or 15, as their families attempted to marry them off as soon as possible. Unfortunately, women with any health problems, even with a condition like rheumatic heart disease, are seen as being defective and near impossible to marry off...unless somehow their family can offer a dowry that is unheard of.
After marriage, any inability to concieve, or even to concieve a male, is blamed on the woman who will often suffer consequences--beatings by her husband and his family, and in some cases "bride burning" (is what it sounds like) which can lead to her death. If she attempts to divorce her husband, or if she is somehow widowed, she is denegraded to the level of a prostitute and outcasted from society. Males, on the other hand, can remarry without difficulty. The government makes regulations, but in the end, they truly have little power over these cultural norms that have been ingrained over hundreds of years. It is like trying talk over a stadium full of chattering people who do not care to listen.
There is only so much that CMC's mobile clinics can do for their community's health and wellbeing--which is tremendous, don't misunderstand. But some things are not easily changed--gender roles, cultural chauvinism, care for the elderly and handicapped. I feel that much of my journey in India is an attempt to enrich my understanding and appreciation for different ways of life. However, there are some ideas which are difficult for me to understand outside the context of a natural pursuit for class power and wealth. Is it because I value or percieve freedom and happiness differently? Either way, I believe that greed and chauvinism, which exists anywhere in the world, provide the inequities that lead to maldistribution of education, clean water, and nutrition--staples of health and well-being.
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