Saturday, June 8, 2013

First week of the Fellowship

So...I have now been in Delhi a week. After a pretty unexciting weekend (very light sightseeing, figuring out the Metro, doing laundry, grocery shopping, and otherwise getting settled in the apartment), I started in the CARE India office here in Delhi on Monday.

First Impression: Very professional, very smart people doing really meaningful work.

The office itself, as one might hope for a non-profit organization, is in an industrial part of town - mostly factories and a few small shops that have sprung up to support the people working in the neighborhood. CARE has two floors in a factory building - very nice, clean, airconditioned offices (a very good thing given the scorching heat outside!) that could be in New York or pretty much anywhere. It's a mostly-cubicle set-up with a few offices for the President and his direct reports, a couple of pantries, a lunch room, and a few conference rooms.
Outside the CARE India offices

I was given a cubicle, a laptop, and (eventually) a sim for my phone. My first day I met with M. Srinivasan (known as MS - many Indians go by their initials) from HR and went over the history of CARE (quite fascinating as it originated as a purely food-aid related organization in the US, providing "CARE packages" to Europe after WWII) as well as the mission, vision, operating principles and major programs of the India office.

My work station!
I had the opportunity to meet quite a few people in the office, and shared lunch with them - when people get together to eat in the office, they tend to open up all their containers of homemade food and share them with everyone - a great practice! I had bought a tiffin of food from a service that provides them to the office for a minimal cost (40 rupees, less than 80 cents!), and shared what little I had - a daal, or lentil curry, a blackeyed pea curry, some rice and some roti (flat wheat bread).

I finished up the day doing some additional research on kala azar (the parasitic disease that will be the focus of my primary project), went home. A very good, very productive first day!

Tuesday was similar - my "manager" at CARE, Dr. Raj, was still out of the office, but I did get the chance to meet more of my new colleagues, find out more information about CARE's programs, and share another lunch - this time, with food I'd cooked the previous night - a potato and okra curry with roti and a mango.

One of my early attempts at Indian-style cooking:  
Potato and okra curry with roti.

Dr. Raj returned on Wednesday, so I had the chance to meet him, and he gave me an overview of my primary project as well as a great overview of the Indian public health system.

The program I will be focusing upon is called the "Strengthening Kala Azar Elimination Program," or SKAEP. SKAEP is funded by the Bill and Melinda Gates Foundation, and CARE will work over the next two years to implement it.

As mentioned in one of my earlier posts, Kala Azar (KA) is a disease spread by a sand fly, which transmits the protozoan Leishmania donovani from person to person. The "epicenter" of the disease is in the State of Bihar, which will be the site of my field visits over the course of my fellowship. Bihar is the poorest state in India - people living in villages there survive on an average of about one US dollar per day. About 30 million people in this part of India are at risk of contracting KA, along with other conditions like malaria and tuberculosis.

An illness like KA, thanks to time missed from work, mis-diagnoses and ineffective treatments, can cost a patient a significant proportion of their annual wages - some have estimated up to 60-70% on average!

My role with the program will be first to set up a study to truly evaluate the journey of a KA patient in the poorer villages, determining how long they are sick before being properly diagnosed, how they go about getting diagnosed, how the health care system (starting with local community health care workers called ASHAs and going all the way up to District Health Centres) enables them to get diagnosed and treated, and what kind of impact all of this has on the individual. Importantly, we want to focus on the best way to diagnose and treat the patients, and what hurdles there might be in the process. Later, I will help set up the treatment and monitoring program to help evaluate progress against the goal of elimination.

Part of the program will entail indoor spraying with insecticide (DDT) for affected areas, incentives for the local health workers to find potential KA patients, free diagnostic testing, and free treatment for the patients - as well as free transportation, meals and compensation for time missed at work - this will help encourage patients to actually show up to the health center and get treated.

Because KA only persists in the human population, the goal is to find as many patients as possible and cure them, while also reducing the sand fly population enough to eliminate the disease. A huge task, but hopefully one we can accomplish!

CARE produced a series of posters
 geared at dispelling key Myths about
women in India for International Women's
 I finished out the week with several more meetings about the KA program, doing more research on my own, and also learning about another key CARE program, called EMPHASIS, which helps migrant workers from Nepal and Bangladesh to have a more safe and secure life, with a particular focus on HIV/AIDS prevention and treatment. There is another American in the office, Samantha, a grad student at Emory University, who is an intern here at CARE and will be working with the EMPHASIS team. She arrived on Monday, and is only here briefly in New Delhi before heading to a CARE field office on the border of Nepal...but it was good to know I am not the only person learning the ropes this week.

CARE India is doing some great work in other areas besides health, such as food security, education and gender quality. I feel honored to be able to be a small part of it for a few months!

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