FINALLY!!! some direction

So, a week later, and I still haven't had that meeting. One of the leaders got into an accident, so we kept postponing the it. Finally, I got fed up and so did Hans, so he came up with an idea for me. He decided to combine DISHA and SureStart by using the community health workers from both programs as resources. We want to conduct an HIV/AIDS knowledge assessment in the slums, as well as an assessment on the relationship between pregnant women and the associated stigma and discrimination that comes with being HIV+. So, a working draft of the overall question that would be posed to the women in the slums would look something like this, "Can HIV+ women become pregnant and have children and should they?" The community health workers from both programs will conduct these interviews and the results will be used to create a new HIV/AIDS awareness program for the slum dwellers or to improve the already existing awareness program that SureStart has. The aim is to disprove these myths and to get rid of the stigma and discrimination surrounding HIV+ pregnant women in the slums.
So right now, I'm doing a little bit of background research on programs/ interviews/ questionnaires etc. that have already been done so that I can successfuly obtain data that can will be useful in creating an awareness program. I still need to obtain the report on the survey of women that SureStart has collected in order to determine the population size that I need collect data from, but that may not happen till Monday (at the earliest).

End of the AIDS awareness week and a bit of frustration concerning the rest of my time at DGS

On friday, an AIDS awareness event was held at a bar known as Soul where "Herman Death Willy Tail," a band from Scotland staying with us at the volunteer house, sang their song about HIV/AIDS and performed some of their other songs. Outside of the restaurant, volunteers including Rashmi and I tried to get people to where ribbons to show their support for people living with HIV/AIDS and to introduce them to the Wake Up Pune campaign. We both understood that some people wouldn't wear the ribbons b/c of the silence, ignorance, fear, stigma and therefore the discrimination associated with HIV/AIDS; however, at the same time we were kind of annoyed at those who didn't want the ribbons because we felt that in America and especially at Duke, most people and most students would want to show their support. We were handing out ribbons again at the candlelight vigil on MG road on Sunday night. Most people were willing as they began to see others with the ribbons...especially all of the street children who were wearing at least 3 each. So many people came to our booth, picked up brochures, sheets, bootcamp for volunteers, some took quizzes that tested their general knowledge about HIV/AIDS and how it has affected Pune. On the other hand, there were a few that were unwilling. After we asked them to wear their ribbon, they didn't even reply no, rather they just turned their backs to us as if we weren't alive. Maybe it was because we were wearing "HIV Positive" shirts on to represent the campaign (positive about education, awareness and support), but it was just a ribbon. They acted as if we were aking them to contract HIV. Later on that night, we had a vigil and it was so great to see SO MANY people show up. The walking plaza was completely filled, the crowd was on the sidewalk and in the street as far as the eye could see from the stage watching the program, which consisted of dancing by the DG kids and singing by 3 Indian Idols. It was so great to see that many people "wake up" and realize that if 1% of a population has HIV/AIDS is considered to be an epidemic, then the >12% of people living w/ HIV/AIDS in Pune along is something that simply cannot happen, especially if awareness can help prevent an increase in this percentage.
On Saturday we visited the Intravenous Drug User site in Pimpri which is a slum located in Pune, but it's not associated with DGS, rather with the Sahara and the Shara NGOs. It looked like a tin box and felt like we were in an oven...and that's because it was funded by the government. It's a place where they substitute the injection drugs with an oral substitute known as Addnok. They eventually want to wean them off the injection as well as the oral drug to reduce the presence of opportunistic infections. Two ID users told their success stories and it seemed to deeply affect those that were listening. It was definitely something we'v never experienced before, seeing it first-hand that is.
As far as our project goes, our meeting was cancelled on Saturday and changed to Monday so that Hans could attend. However, we didn't have the meeting today either. Again, I'm frustrated because I feel a little lost in terms of what the rest of my stay here will be like...will I have a long term project that I can be engaged in, or will I be volunteering from day to day on random projects that need to be done. Hopefully tomorrow (Tuesday) I'll have a better idea. Rashmi feels that she could take a greater interest in a project that really needs here, such as DISHA or the IDU site, and it looks like I may be incorporating awareness about HIV/AIDS into the SureStart program.

Chaos....thrust into the organization and the Global AIDS Week of Action in Pune

On Monday, Rashmi and I toured the three slum sites that Deep Griha (DG) caters to as well as their crèches. Their main office building is located on Tadiwala road (about a 20 minute drive from our place at the cultural center) where we met the director, Dr. Neela Onwale, and watched a video that showed us all of the projects that Deep Griha is in charge of, such as the education they provide to children as well as adults, DISHA, the eye clinic, etc. We met our contact and volunteer coordinator from DG, Hans Billimoria on Tuesday who set up a meeting for us to meet and talk with the SureStart leaders that afternoon. This week, the SureStart community health workers are in training sessions from 9am-5pm everyday, so we decided to turn our attention to another project for the week since the sessions were in Marathi and we wouldn’t have been able to understand. Instead, we read the instructional handbook that was in English.

During the day, Rashmi and I worked with DISHA, another DG project that focuses on HIV/AIDS awareness in Pune. This week is the Global Week of Action concerning AIDS, so in order to prepare for the street rally occurring on Thursday (5/22/08) and the candlelight vigil occurring on Sunday (5/25/08) we created signs, posters, did some inventory calculations etc. on Tuesday and Wednesday. On Thursday, a few other NGOs as well as DG’s DISHA held a street rally which was a few kilometers long that culminated in front of Pune’s municipal court where Hans was successful in persuading them to send a message to the federal government to pass the HIV bill that is supposed to eliminate discrimination and therefore stigma against those with HIV/AIDS in terms of employment, education etc. (more info can be found at http://www.wakeuppune.org/)

The only communication I had with the SureStart leaders before our meeting was through email; unfortunately, they didn’t have very much email access, so I didn’t get very much information on my project. The truth is that I didn’t know what my project would exactly entail before I came to India and that was a mistake. I only knew my general area of interest. This past semester I had done research on SureStart and similar programs that have already been implemented around the world; therefore, I was prepared to work on help design SureStart and improve on what they had already designed. In my emails, I told them that I could understand Hindi and speak a little, so I wasn’t really qualified to do any communicating in Marathi. So it was at this meeting I was hoping that they could give me some more details on my project.

At the meeting, I found out that they had already done most of the designing and that they had not actually thought of a project for us even though they’ve known since mid-March that Rashmi and I were coming to assist them in any way that we could. When talking to them, it sounded like that they hadn’t prepared anything for us to do, in fact they didn’t even know we were students. They told us that we could do some observing at the training sessions and in the slums. When I heard the word “observe,” I got frustrated because I had prepared for this trip by doing a semester of research in my independent study, received DukeEngage money to travel and have the opportunity to obtain a hands-on experience. Right then and there Rashmi and I told them that we didn’t want to just observe, so then they told us that we could do some computer input concerning medical reports and hospital referrals. I understood and knew that this work was necessary, but I didn’t want to spend my days in front of a computer. I came to Pune to do field work with SureStart; however, after that meeting, it seemed like I wasn’t going to be able to. So, we told Hans, and he said he would talk to them. Rashmi and I are awaiting to hear good news from them at our next meeting with them on Saturday morning.

Intro

My name is Sweta Saxena (Duke class of 2009) and I'm participating in the DukeEngage program for the summer of 2008. I'm in Pune, Maharashtra, India with another student from Duke, Rashmi Bhat (class of 2010). We are working with Deep Griha Society (www.deepgriha.org) to implement/improve the SureStart program (see background information below) and to help implement an electronic health record system as a side project. I'll be working with the Deep Griha SureStart leaders from mid-May to mid-July. I'll try and update as much as possible (I don't know how often I'll have internet access) and I will try and put up some pictures soon.Background Info: India’s current healthcare system to deliver newborn care involves both public and private sectors. The public sectors are compromised of primary health centers, community centers, referral units and district hospitals. More than 80% of the qualified doctors work in the private sector leaving those who can’t afford private healthcare to turn to local unqualified practitioners with inadequate training. Without access to skilled birth attendants (SBAs), most newborns die because of infections, low birth weight and birth asphyxia because the first week of life remains the time of lowest coverage of care even though it is the time of greatest risk for the neonates and mothers. Family and community outreach programs have been shown to reduce neonatal mortality rates up to 40%. In Maharashtra India, home based neonatal care with village health workers, counseling, clean delivery, cord care and increasing proper breastfeeding has resulted in a decrease in mortality rates. A report on the state of India’s newborns was prepared in 2004 by the National Neonatology Forum, Department of Family Welfare/Ministry of Health and Family Welfare, the Government of India, UNICEF India, World Bank, Save the Children and Save Newborn Lives. It reported that India has the biggest newborn health challenge than any other country because 20% (about 26 million) of the worlds infants are born in India and more than one third of the deaths that do occur, happen on the first day of life. 1.2 million of these 26 million die in the first four weeks of life, which compromises 30% of the 3.9 million neonatal deaths worldwide. By 2010, the National Population policy calls for a reduction in infant mortality rates to less than 30% per 1000 live births. In order to accomplish this, care at the time of birth is one of the issues that need to be focused on. Save the Children found that attention needs to paid to skilled and clean care at delivery, keeping the newborn warm and dry by wrapping them immediately including the head, early initiation of exclusive breast feeding within one hour of birth, eye care, ability to recognize danger signs and complications, resuscitation of asphyxiated babies, and special care for low birth weight babies. The Bill and Melinda Gates Foundation responded to the call for action on the high neonatal mortality rates and the Millennium Development Goals. The foundation is funding a program known as SureStart through PATH to support care for the newborn in the home and implement preventive healthcare measures for the newborn. Its purpose is to reduce maternal and newborn mortality rates in Uttar Pradesh and Maharashtra through community involvement. There are four main activities that the program will be focusing on: 1) increasing access to SBAs at birth, 2) building community networks of trained health workers to assist the SBAs in providing home-based care and attending to the newborn as well as the mother, 3) developing community savings programs to help cover the cost of potential hospital referrals for the mother and the newborn, and 4) developing links among the communities so that lessons concerning newborn care can be shared.