Sunday, July 19, 2015

Week 5: Into the Village

Community Visits (Monday, July 13th –Wednesday, July 14th 2015):
I went with about 21 IDDS participants and design facilitators to a village called Uttiramerur. The IDDS participant teams were there to gather more information about their healthcare related topic from the local community by interviewing the local people. I went to interview pregnant women and women who recently had a baby for a mini-study for ayzh to understand how the kits change the perception of women’s care.

The Adventures of Rooming with your Boss:

We stayed in a small collection of guest houses and I shared a cabin with Zubaida. Zubaida traveled to the village separately and soon after she settled into the cabin, she claimed, “Kelly, do you like frogs? There is a frog in the commode.” I gave a puzzled look. Really? We went and checked it out. I don’t particularly like frogs. Luckily Aspen and Kendra (two of the female design facilitators) were outside the cabin. I told them about the frog in the commode and Aspen exclaimed, “I love frogs!” Whoo! I was saved! Aspen and Kendra were really into the situation. They snapped photos of frog in the commode and Zubaida cried, “why are you taking pictures of the frog?! I want to go pee!” I was dying on the bed in laughter. Kendra and Aspen managed to get the frog out with a bucket and peebuddy!

Out in the Villages:
Life in India’s villages is far different from the city. I really enjoyed walking around in the villages. The thatched wooden and palm leave houses were simple and beautiful. The animals roamed and children played. In the evening, I swear I could hear consistent laughter or music in the background at all times.

Kelly and her cohort of pregnant women and new mothers (aka. The mini-study):
One baby reaches for my notebook as I talk with the mother 
As I previously mentioned, I was on my mission to find mothers with young babies and pregnant women in the third trimester who were willing to tell me about their thoughts and feelings of their delivery. The women who recently had a baby were my control group and I asked them about how their labor experience (what happened? Who were you with? How did you feel? Did it go as you expected? How do you think the quality of your care could be improved?). For the pregnant women, I asked about their hopes for their delivery, how they expect it to go, and how they hoped to be cared for by the healthcare workers. Then, I explained ayzh’s clean birth kit and gave them one to bring with them to the health institution for the healthcare workers to during their delivery. I received their contact information to hopefully follow-up in a couple months to discuss how their delivery actually went with the clean birth kit. Although the mini-study is not scientific, it will hopefully be helping in gauging the women’s perceptions of the clean birth kit. During this community visit I found 3 pregnant women and 2 new mothers who were willing to talk with me.

Interviewing women about their labor and delivery experience through a translator is challenging, especially because I was sharing a translator with the IDDS participants and sometimes even had a local IDDS participant as a translator. I found it difficult to connect with the women and get the information I wanted with indirect communication. Here is an example from the interview I transcribed:

KB: “… And, how do you hope to be cared for by the institution?”
KB: “How does she hope the healthcare workers will care for her? Like how does she hope they will treat her?”
--Translator and Woman talking— …
Translator: “She… She hopes from the best of the [mumble]” [woman continues to talk] “She hopes for a normal delivery”
KB: “Okay, Okay. For normal delivery. But how does she want to be cared for by the healthcare workers”
--Pregnant woman talking—
KB: “how does she hope that they treat her?”
Translator: “She wants to be good…” [woman continues to talk] “She is saying that [mumble](she has good care) in the PHC.”
KB: “uhuh”
Translator: “They take good care, so she hopes for the same care.”

I reiterate: It was really challenging and could be frustrating at times. Sometimes, I never know if they understand what I am asking.

In all of my interviews, the mothers wanted to have a normal delivery. All of them want good care and many, as shown in the interview above, believe that they receive good care. However, this is not necessarily the case. One of the IDDS participants did her medical residency in Chengalpet, a local district hospital and she told me about having to do many procedures without the proper supplies or equipment, sometimes not even having tape to hold an IV in. In many ways ayzh is ahead of its time by providing tools for healthcare workers to provide quality care for women who don’t know what quality care means. The village women don’t seem to know about infection in the same way I do, even though it is common and many healthcare providers have expressed concern about it. As I continue my work, I hope to figure out the context of infection that resonates with them (puss in a wound?) to better understand their perspective. 

Wednesday, July 15th 2015:. Imagine going into the OR with a second person in the room having the same procedure. The doctor is going to use the same tools for both procedures. We visited another health clinic, where this is the reality for many patients.
OR with two tables
Thursday, July 16th 2015: Fasting. I’ve always been curious about what it would be like to fast for Ramadan. Given that there are about 5-10 Muslims here (some fasting every day, others fasting when they feel like it), I decided that this is a good time. I woke around 3:20 am to eat before 4:15am. Because I felt set on carbohydrates from all the Indian sweets, Ghana chocolate and mango I ate the night before, I ate a ton of eggs for protein in hopes that it would keep me full throughout the day. It worked till about mid-morning. During lunch I just read and took a nap because I didn’t get much sleep anyway from waking at 3am. I admire my Muslim peers not only in the immense self-discipline required to sit at a table with people eating around you, but also the capacity to deal with the sleep deprivation that comes with waking in the middle of the night to eat and then functioning throughout the day without caffeine.

Friday, July 17th 2015: I was debating about fasting again because it was the last day of Ramadan, but after feeling unproductive yesterday, I determined that I should have some food to (A) feel better during the day & (B) focus better when working. I think it was a good decision for me, as I was definitely more focused. After dinner, the IDDS organizers and I went south to Pondicherry, India.

Saturday, July 18th 2015:
We went to Sri Aurobindo Ashram. It was pretty touristy, but lovely. It’s the place that has been closest to my “normal”. There was a wonderful little cafĂ© where I had a delicious salad (first one in more than a month!). After lunch, I went biking to the meditation center with Sanjukta and Karl. We biked on a small dirt biking path through the incredible gardens!
Biking on the garden trails!
Afterwards, we all went to the beach. The beach scene is quite different. It is essentially all men in the water, but I jumped in with a couple friends!

Upcoming Week:
I am going back into the village for Monday, Tuesday and Wednesday (no internet)! I plan to continue interviewing women and hope to probe their understanding of infection.

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