The Prepared Mind: Reflections on Project RISHI’s Summer in Charnia

Recently, the Global Health Portal spoke to members of Project RISHI (Varshini Cherukupalli, Chintan Pathak, Devashish Singal, Akansha Singh, and Pooja Avula) who spent their summer in Charnia, Haryana studying the effect of community health worker systems in encouraging adherence and reducing the prevalence of anemia in Charnia. 

Tell us about your project.  What inspired your work? (Varshini)

AKMOur project was inspired by the needs assessments and hemoglobin assessments we collected last year in the rural brick manufacturing community of Charnia, Haryana. The data demonstrated a need for an anemia intervention. In addition, we conducted extensive research on anemia in rural India, and we learned that it was a significant issue. Anemia can lead to severe health consequences; therefore, we decided we would target it for our intervention. In order to sustainably mitigate rates of anemia, it is essential to promote community awareness for compliance of the Iron/Folic-Acid (IFA) medications. Thus, our study examines the effect of community health worker systems in encouraging adherence and reducing the prevalence of anemia in Charnia. In August, we collected baseline hemoglobin assessments and selected three motivated health promoters. IFA programs are typically 90-100 days in length, so we will return to Charnia in December to evaluate the efficacy of the program. We are collaborating with the local government and the Postgraduate Institute of Medical Education and Research (Chandigarh, India) to execute this research.

How did your experience on the ground vary from your expectations? (Akansha)

IMG_2369Field study provides the experience that even an immense amount of theoretical work cannot completely substitute. Prior to the trip, we spent our quarters at NU thoroughly thinking about every possibility and preparing an intervention that, from our standards, we considered to be a perfect home run. However, when we went to the site, we realized that statistical data isn’t really an accurate representation of people because people are compositions of emotions rather than facts. Thus, convincing people to test for anemia, which we earlier thought to be a seamless process, turned out to be a test of persuasion. With mistrust prevailing in the community due to prior failed government programs and inadequate support from local hospitals, we had to switch this emotion within people who didn’t have the educational background to understand our claims and who had experienced years of neglect from the government. This field experience definitely changed our perception on how we need to foster the desire within the community members to participate in our program. Moreover, our concept of sustainability also underwent a 180o change. Earlier, we envisioned that we would expand this project in the future by continually identifying and providing supplements for those communities where women and children have IDA. However, at our site, we learned of an existing government program that did provide IFA supplements but wasn’t able to reach the migrant and poorest populations. We quickly adapted and decided that our long-run goal would be to continually expand this government program by identifying communities, procuring the supplies from this government program, and augmenting its effectiveness by designating health promoters, and garnering trust in each community that we work with.

What was your most meaningful experience abroad, and what did it teach you? (Devashish)

20130831_051022 Interacting with the people of Charnia, trying to convince them to get the hemoglobin tests done and mobilizing resources to give them access to the Iron Folic Supplementation are some of the experiences that helped me learn a lot. It was interesting to see that neither convincing people to get tests done nor getting them to take medicines was easy even though it was for their own benefit. Their past experiences with the region’s government hospitals compelled them to lose their faith in the entire system. Mobilizing resources was not an easy task as it involved meeting various government representatives and getting several written permissions. Overall, the most important thing I learned during this trip is that in projects related to social health issues, there is no one right approach.

What was your most challenging moment, and how did you cope? (Pooja)

Throughout the entire trip, there were many challenging moments. The most challenging of them all was definitely trying to convince some of the villagers that they were in desperate need of iron injections due to their incredibly low hemoglobin (Hb) levels. Although we transported them to the local primary health center, who then referred them to the government hospital for these injectable medications, most women refused due to deep mistrust in the government and its programs. However, it was imperative that they received the medication. When we tried to explain that anemia causes fatigue and weakness, she proclaimed that we should not comment on her strength because she could easily carry one hundred pounds. But we could not let that stop us! The next day we, along with the doctor at the primary health clinic, went to each village and personally called upon each person who we previously identified as anemic and handed them iron and folic acid supplements. Even though we couldn’t quite convince the women to go to the hospital to get injections we were at least able to persuade them into take these supplements! By implementing a health promoter, who will check up on the villagers to ensure that they are taking the pills, we hope that we were able to make an impactful difference in the lives of these villagers.

Did you encounter any cultural differences that required getting used to? (Chintan)

20130831_051254India is a land of many different languages, customs, and traditions, and this means that there are many cultural differences that take getting used to. One difference that we had to get used to was a more relaxed and casual approach to conducting business than in the US. This made it especially difficult to create formal partnerships with organizations in the area and made coordinating the anemia study difficult. Agreements and contracts are often not something that lawyers draft using precise legal language. Rather, they are done more informally as basically a handshake promises that both parties will keep up their end of the deal. Most smaller NGOs and trusts are not willing to put forth the effort and time required to draft legal documents. This means that any partnerships would have to be based solely on trust. Coming from the US, where even the smallest agreements are written up into contracts, this style of business can take some time getting used to and you learn the necessity and importance of building trust between organizations and people you want to partner with.

Has your summer experience impacted your future goals and interests at Northwestern? (Varshini)

This summer significantly impacted my future career goals.  Because of this study and my experience with Project RISHI overall, I plan to continue global health research throughout medical school and as a physician.  Moreover, in the future, I hope to collaborate with people like my RISHI team members to innovate solutions for improving healthcare access in developing countries. Although some of my team members do not plan to enter the medical profession, I know that all of us will apply the skills we learned this past summer to provide service for underserved communities.

Do you have any advice for students wishing to conduct research in an unfamiliar location? (Akansha)

“Chance only favors the prepared mind” – Louis Pasteur

The above quote aptly summarizes the advice Project RISHI would have for students who wish to pursue conducting research in unfamiliar locations. Having a prepared and adaptable mind are key to exploiting new opportunities that may come your way when you set out in an unknown terrain.

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