S1E3: Parth’s Experience of Volunteering in Rural Uttarakhand

For our third episode, Parth and I sat down to discuss his experience of working with a non-profit in the village of Paty, in district Champavat, in Uttarakhand. He intends to work with this group long-term, especially since he has discovered yet another CMC Vellore connection with the physician leading the NGO’s work in the region. In a short, free-wheeling chat, we discuss about his experience, reflect on the CMC Vellore program of sending postgraduate trainees to different mission hospitals, and how he thinks this experience will mould his ongoing MD training.

As usual, if you are a video person, here’s a video of Parth and me chatting on YouTube!

For this episode, I also tested out a video to transcript program. Here’s the transcript of our chat.

Pranab Chatterjee (PC):

Hello everyone. Welcome to another session of the Global Health Exchange Podcast, or GPHX, as we like to call it. Today’s session is a little special; today Parth and I will hang out for a little bit. Parth has done something really cool. Last week he took time off from work and volunteered in the villages of Uttarakhand, providing health services and health education in liaison with a nonprofit organization that works in that area. So today I met with Parth and we decided to discuss some pointers of what he did, what his experience was like, and see if there are any takers, amongst our listeners on helping him out with similar endeavors in the future. So, okay, Parth over to you. Tell us what it was like, how did you do it? How did you figure it out? What did you do once you were there? Tell us all about it. Over to you.

Parth Sharma (PS):

Hi Pranab, yes, it started like, around three weeks ago when one of my senior residents just told me, you know, there’s this village, uh, this NGO needs people to come and do a health awareness session.

She actually posted a message on the group, and I was the first one to read it. And I, and she, we happened to be in the same room. So, I asked her like, hey, can I go, am I allowed, I am just a first year, can I go for this thing? And then she was like, why not? So that time she had told me they need help with antenatal care. And probably some intrapartum and delivery and teach them regarding all that. And I had some fair experience during my internship days from two years ago, I had delivered maybe around 30 to 40 kids, you know, so I had, I remembered something and then, so I thought, yeah, why not? Let’s just go. And none of my other batchmates had any, uh, major experience in deliveries.

So, I turned out to be like sort of the confident guy who wanted to go and explore this place. So, I reached out to that NGO and Dr. Sushil, who’s running this NGO called Arogya Initiative. He, I think he called me, but I think he called me to tell me that they had already found somebody. So, it was a whole sort of a confusing thing.

So, I, I took leave. I registered for this. I was supposed to go meet, uh, Dr. Soumyadeep in this, uh, conference that was happening in Delhi. So, I had told him, I’ll be coming there, I’ll be meeting him. Then this whole thing happened. So, I told him, I won’t be coming there. I’ll be going for this village thing.

And then the village thing got canceled and I didn’t know, I couldn’t tell him again that I’m coming now. So, there’s whole, juggling thing happening. And, then I, the Dr. Sushil called me, and he told me, uh, there’s somebody already coming. And then he asked me, if I knew that person, cause she was from Maulana Azad, from where I am.

So, I told him, you know, I’ve just been here for a week. I don’t know anybody. So, he is like, oh, where are you from? And, you know, I just told him, okay, I, I am from Dehradun, but I did my UG from CMC Vellore. And for tag, that means a lot; so, he was like you’re from CMC! Oh, we’ll be so excited to have you. Please come. So, I think that the tag helped me get there.

Uh, so yeah, that’s where it all started. And, then I booked my tickets; train was not available, so I just booked an overnight bus. On the day of the journey, the bus guy called me and he’s like, the bus broke down. Uh, so, you know, like, why do you want a refund? Or do you want us to arrange something else for you?

And, you know, I’ve always been sort of a very superstitious guy. I believe the universe is giving some sort of a signal. And, I honestly have been very afraid of, uh, this, this could be one of my phobias of, you know, traveling in hilly areas. Because there’s so many landslides happening all the time, and there’s always that fear go, what if I die this way? You know, I thought if I die in a landslide, and uh, this whole thing happened where the bus broke down and I was like, is the universe telling me not to go to this place and just sit in my room? Well, I like, screw it. Like, you know, I sat in my room for way too long. Why not just get out? Let’s see what whatever happens.

And. Yeah, so they sort arranged another bus for me and I reached that place where another driver was waiting for me from the NGO; he had come to pick me up. So, I traveled from Delhi to this place called Kathgodam, which is around 40 kilometers before Nainital, which is a very famous Hill Station, and from kathgodam is another… So this, this journey was around eight hours, and from Kathgodam it was another four hours to this village called Paty. Which is in the Champavat district, extremely rural, population of around 5,000. And, on the indicators, it’s still performing extremely badly compared to the rest of the country. Maternal mortality is high. Infant mortality is high, women getting education is pretty low. So yeah, it’s pretty backwards. Um, yeah, so that’s where it all started. I landed there on 29th morning, I got around 30 minutes to freshen up. And, uh, then we, the first place you went to was this PHC, so I’ll just…

PC

Do you have picture pictures that you can show us?

PS:

Yeah, yeah. I’ll show you some pictures.

PC:

So it turned out that it was a good decision on your part to sort of ignore, the signals and, and go ahead with the trip.

PS:

Yeah, definitely in hindsight, you know, it all makes sense. It’s all perfect in hindsight. So now when I look back, I’m so glad I did. So, this is a PHC that we went to. It’s actually a health and wellness center, which has sort of, it was supposed to be a CHC, is what they told me, but, because you know, they didn’t have adequate stuff for the CHC, they sort of converted into a PHC, so this was the most grand PHC I’ve seen and, you know, probably you’ll ever see in India.

PC:

It looks amazing to be honest.

PS:

Yeah, it looks amazing. And the view from there, I don’t have the view from there, but it was pretty good. You know, it’s just like snowcapped peaks you can see if you just stand at sort of the balcony there. And this center had the delivery room. It had a DOTS center, it had OPD and just a classroom. So, where I took a class for the ANMs on, contraception use. And it was quite interesting here. There were supposed to be eighteen ANMs, but only ten turned up that day because they had to travel from like 20 kilometers away. Buses are not available. So somehow only 10 could turn up. But they were so eager to learn, you know, they were like taking down notes while I was talking, something I didn’t really expect.

And, they were very eager, they were conversing a lot. They were talking about the misconceptions people had in the villages, you know? So, it was a very nice experience for me because I was trying to understand, you know, like contraception, how we are taught in the textbook is not what is there in the community, and, uh, there’s a huge difference. Like we don’t even read about those things in the textbook, like women taking, contraception just because, you know, some wedding is coming up, so they’ll just take it for two to three days to delay their menses so that they can attend the wedding and they’ll just stop taking it after that.

That’s a very common practice in the village. I tried addressing that. I did a pre-test and a post post-test after the session, so, just to prove that, you know, I had done something useful and the post-test showed some improvement in scores. So that was something I felt good about. And, uh, yeah, so that’s where my day started.

PC

so, um, I have a question, the obvious question. Yeah, of course. Um, as a male physician, how was it, how was the experience of talking about contraception and, these practices, which are often considered taboo to be spoken about in public, in a rural situation with the, women Anganwadi workers. How was, how was the, how was the experience, how did you prepare for it? What were the pitfalls and how did you try to sort of avoid them?

PS:

Yeah, so that’s something I’ve been practicing, you know, where I talk about these sorts of uncomfortable topics in the society. Like I, I’ve been talking about cervical cancer a lot. I’ve been talking about contraception, I’ve been talking about breast cancer things, which are usually surrounded with a lot of stigma. And, the thing what helps me here is, you know, I don’t feel shy when I’m talking about it because I speak as a healthcare professional. And, I just say the words out loud and clear, so that, you know, people understand where I’m coming from, what my intention is.

There’s nothing like, you know, giggling while I say like condom use. Like I’ll just be very frank, you know, like women should know, men should know condom use. There’s tablets that are there for contraception, but I just be very straightforward with it. I feel that’s something helps because they sort of gain trust in you, when you are so open about it, that’s sort of the initial barrier stigma, itself is addressed. That’s something I’ve realized. So overall the experience was, you know, not at all bad. They are very receptive. Like I, I talked about, oral contraceptive pills. I talk about copper Ts. I talked about emergency contraception, condoms. I spoke about, uh, injectable contraception, sterilization, both male and female. So, I sort of covered everything, with, with some community touch, because I had already been told that, you know, these are the misconceptions, so I should be addressing those misconceptions. So, I prepared accordingly, and I went. So I, I personally didn’t feel uncomfortable at all, uh, while I was talking about contraception there.

PC:

Oh, that’s so interesting. So what else did you do? How long were you there?

PS:

So, so this session lasted for around one, one and a half hours. Following that, there was a DOTS center right there. So, I was just standing and talking to the DOTS in charges there. And you know, you were just discussing, uh, the end TB goal, which is India wants to end TB by 2025 with India has changed the name of the policy from control program to elimination program, but nothing’s happening on ground. It’s, the reality is very shocking. I had been to a couple of DOTS centers in Delhi as well, and, the situation is the same, you know, just that in Delhi, MDR TB was a big issue there.

MDR TB, I wasn’t even expecting MDR to be a big issue there because, you know, it’s, it’s not overcrowded, people were compliant. The only issue there I found, which was again, similar to what issue I saw in Delhi, was that, you know, that Poshan Abhiyan gives you 500 rupees per patient per month for nutrition. That money is not getting deliver. Same thing. People in DOTS center told me in Delhi as well, you know, patients will finish their six months treatment and uh, then they’ll receive that 500, which is pointless. You know, like the whole point of giving that 500 or giving it on papers that, you know, you get good nutrition while you’re getting treated.

But yeah, again, lack of funds, irregular supplier drugs. So that’s something, uh, I, I realize there as well and something, you know, we read on textbook saying DOTS is directly observed treatment short therapy, but it doesn’t happen anymore. That’s something I didn’t know. Like did you know that, that that’s no directly observed treatment anymore.

PC:

So what, what did you see happening?

PS:

No, like in textbooks, I had read, you know, that the patient comes to the center and takes the tablets in front. But here, like even in Delhi, two weeks, uh, like medi medications are prescribed, there also, they told me a month medications are prescribed because people are travel so much.

So, DOTS as such, I don’t think it’s being practiced anymore. So

PC:

So, it’s more like a monitored use rather than directly observed use?

PS:

See, it’s not even monitored, I would say, because DOTS 99 was brought in where you have to sort of, you take the tablet and behind that wrapper will be a number that you’re supposed to call. And, uh, you know, just, the thing that you have taken the medicine, but that’s also not happening. So, I don’t know how they are monitoring. I think that’s a different, conversation altogether. So after this DOTS center visit, we visited, a sub-center, which the NGO is building. I’ll show you a picture of that.

Yeah, so this is a sub-center which the, the NGO is building in the village. So, the problem there is this, PHC does normal deliveries, but again, it’s in a very sort of main city and they’re accessible for the villages. People, like the people living in main Paty, the village Paty, so they sort of, find it very inaccessible to go there and, which is sort of a barrier and which is why home deliveries happen in this village. So, the NGO’s building a center right in the middle of that, uh, residential area. So that any pregnant women can directly go to the sub-center. So this, the, the under construction room that you see is sort of the labor room.

PC:

So this, this sub-center is, um, far from the PHC that we just saw.

PS:

Yeah, yeah. It is far from the PHC area. So, so, because in hill areas, uh, you know, even one kilometer won’t be like one kilometer in a city. Yeah. And the, the problem here is, most of the houses are on the slope, so they have to sort of trek up where they reach a muddy road and then they have trek up the muddy road when they reach the tar road, and the ambulance can reach only the tar road.

PC:

That makes sense. How do the local residents reach this sub-center?

PS:

So this is actually just a walking. Just the market is right there. The school is right next to the sub-center. It’s actually accessible on foot. It, this doesn’t have a, like a road connectivity for ambulance, but it, the, like, around hundred meters to the right of this would be a farm. You’ll cross the farm, and you’ll reach, reach the tar road. So that’s how close it gets. You know, it doesn’t get closer than that. So, we visited this sub-center and, this was still under construction. They just wanted to show this to me. And then there was a, there was a hill right opposite this, uh, which we trekked up and went. Yeah. So, we trekked up the hill, and this is the view from that hill.

PC:

Wow. That looks amazing. Yeah.

PS:

So, this is the Himalayan range, which this is the Indian range. And, yeah, this is the view from that hill. Yeah. So, we stayed there on top. We saw the sunset, the sunset time, and all these, you know, snow cap peaks will turn orange. So that was something really beautiful to witness.

PC:

Yeah. And you got it on a very clear day as well. You can see the sun capped peaks and all their glory.

PS:

Yeah, yeah. Yeah. It, it was the, the sky had been cleared through early. I was really lucky. And, uh, the sunset was the best part actually. You know, this looks white right now, but it turns orange when the sun is setting.

So that’s something early that, you know, you have to be there. Pictures just don’t describe how, how beautiful that scene is. So that was mostly day one of it. And, nighttime, I just hung out with this one fellow who was running another NGO there, and we were just discussing nutrition and agriculture and you know, something that you, and then he, that was earlier surprising, you know, he took out a Park’s textbook, this NGO guy. He told me, can you just tell me what all I should know from this part textbook? And I was like, how do you have a Park textbook? And he is like, see knowledge is wealth. That you know, I should know everything. I’m in a village. I need to do public health. That was really interesting, you know, that you don’t really need a degree to do public in, you can just

PC:

Yeah, you don’t, you don’t. I’m, I’m so surprised that Park has become the, has remained the standard of care as far as public education is concerned. There’s so many alternative nowadays though.

PS:

Yeah. But it’s just the brand that has continued, you know, Park and Park. So, Yeah. And uh, yeah, then we just had dinner for dinner. He had made something very indigenous to that area. Uh, I had never had it before. It was like extremely healthy and it had like decent good taste as well.

PC:

Healthy and Tasty. That’s, yeah!

PS:

Hmm. Yeah, that was pretty good because this case kind of make dishes which are healthy and can be incorporated and made like famous among the newer generation. And so this guy is really working hard. So, it’s really interesting to, cause I sit and talk to him about all this. So I mentioned to him that, you know, I am interested in oncology, preventive oncology. And he’s like, okay, why don’t you come to a school, where kids are there, till 10th standard and come and talk to them about tobacco use.

So that’s what happened the next day. The next day actually started off with, so we visited an antenatal lady at her home. So, we again, traveled through muddy roads and, and I’ll show you how accessible healthcare is. You know, when you talk about hilly region, this is, this is just a video of us going to that lady’s place.

So, this is still decent road. You know, this is extremely decent road. It gets way worse than this. And you will see there’s no house around. You know this is how you, from the tar road, you have to come down. You reach this place, then you, beyond this, the car also won’t go. So, you have to like park the car on the side and start trekking after that. Another 10 minutes of trek, and then you reach the house. So healthcare is extremely inaccessible. We reached that lady’s house, and this was her third pregnancy. She had had one normal delivery before and one Cesarean section, indication for cesarean section was being told at five months, she was told the baby is in breach position.

So again, you know, highlighting how Cesareans are just done, without any indication. And,yeah, so we spoke, spoke with her about antenatal care, about breastfeeding. She had basically close to no knowledge about good breastfeeding practices, about why she was taking iron, why she was taking calcium. She wasn’t even taking both the correct way, and uh, yeah. So then you know, you sort of realize that anemia problem is going up so much in the country despite there being a full program focusing just on anemia. But if you don’t tell women that, you know, Iron is supposed to be taken on an empty stomach and not along with calcium, or not with milk, or not post meal, like if you don’t convey those messages, the iron tablet is pretty much use. And then you can’t blame who, who do you blame after that? That your hemoglobin is not rising? You can’t blame the patient for sure.

PC:

Oral iron is not the easiest drug to tolerate when taken long term. And I speak from experience gastritis and nausea is the, the feeling is quite real.

PS:

Yeah. And that’s something I have noticed. You know, people see, um, people will see anemic women and they prescribe iron BD. Like twice a day. And that doesn’t make sense to me. And you know, like here also my colleagues in my seniors will be like, why are you prescribing, iron OD, you know, she has anemia. Prescribe it BD and, and like, you know, it’s so difficult to tolerate even once a day, like prescribing that twice a day to a pregnant woman is just torturing her, you know, already the nausea.

PC:

Yes. That’s the, that’s the, that’s the balance. That’s the needle to thread. Right. How do you balance it with, gastroprotective medications or behaviors so that they don’t, suffer the side effects, but are able to, you know, avert the anemia issue as well, because, anemia and iron deficiency are real big problems. Yeah. That was your day two, you went to the school?

PS:

So day two started off with, with visiting this lady, we were there for around, one and a half hours or so. Then I also got to see, smokeless Chulha which this NGO built. So again, you know, the coverage of, natural gas for cooking is only 23% in this Champavat district, Paty village, I don’t have the data, but, so most of the people use firewood and respiratory issues were a huge problem

PC:

Do they prefer cooking indoors?

PS:

Yeah, it’s indoor cooking. It’s indoor cooking with firewood, so, which is worse, you know, the indoor pollution is, it’s a big issue there.So, they built the smokeless Chulha and I sort of went and saw that as well, which is very fascinating on how, you know, with this mud and PVC pipe, they have sort of built a Chulha, which is functioning really well. So that was the initial part of my second day. After that we went to a school, where there were kids from 10th, 7th to 10th standard. And, uh, I taught these kids about tobacco use. I think I’ve missed that picture.

PC:

That’s okay. Um, so what’s your experience? Did they know about the (PS: Yeah, surprisingly they did!). I mean, my experience in Delhi, I have seen, school kids as early as class 10 and 11, use tobacco products, whether it’s smokeless tobacco or smoking. What did you find there? Like, this is very, anecdotal, so I’m not going to make any public health comments based on this, but. You know, what did you find? Did you see that people were…

PS:

No, so I, yeah, I started the whole talk by asking them, you know, how many people in your family smoke or consume tobacco? All of them raised their hands. When I asked them, how many of you do it? You know, like, obviously nobody raised their hand because their teacher was sitting right next. Yeah. But, uh, you are just a new, new face coming into the school with no rapport. Rapport. It’s difficult to get the, to answer that question.

PC:

No, no, no. I completely understand. I completely understand. It takes a special level of trust. Yeah. Um, before they open up about these things.

PS:

Yeah, definitely. So my aim sort of with this session was to just tell them, you know, if anybody is sort of using tobacco, mainly the, like smoking tobacco, their health is getting affected. So that was my main message I wanted to convey. Surprisingly, these, these kids already knew a lot about, effects of tobacco. You know, they, they, and I asked them, what problems do you think tobacco cause they’re like, it causes heart disease, lung disease, cancer, you know, they were able to tell these three.

PC:

Nice. That covers the bases.

PS:

Yeah. And then I asked them, uh, you know, what type of cancers does it cause? So that also they were able to tell at least four or five cancers. They’re like, oral cancer, throat cancer. Lung cancer. And I was like, surprised for

PC:

Well, the IEC, the information campaign is working clearly.

PS:

Definitely, definitely it is working. But how much is translating the behavior change? I am not really sure.

PC:

Well, that’s, that’s always the know-do gap, right? How many times do we fall prey to that? The temptation of doing something that we know we shouldn’t be doing, but we do anyway.

PS:

Yeah. So the, so I showed them pictures of, you know, the things that have tobacco in it. I showed them few pictures of just like symbolically showing this is how heart attack looks like if you smoke, and, uh, this is the sites of cancer. The, the, the session was pretty interesting. Uh, and then, you know, I, I feel I, I notice a difference between a city kid and a village kid, which is, which is very, very, very, very different.

And I sort of prefer village kids anytime. I’m not even kidding. Like, they were so interactive. I would ask them something, they would answer. They were pin drop silent, like while I was talking. When I walked in, they all stood up like very well mannered.

PC:

And you had a different sort of experience in your, um, Delhi dealings?

PS:

So, I have gone and spoken with kids in Dehradun as well, you know, and schools there as well. I, I like teaching generally, so I have done some health awareness there as well. There kids were very extremely ill mannered, something. When I went to this village, I was so shocked that, you know, kids can’t be like this.

So, yeah, that was, that was really interesting. Uh, after that,

PC:

Just, just to, just to poke the bear here a little bit, do they, do they know about, um, vaping and e-cigarettes and those kinds of things? Or did you not address those issues?

PS:

No, I didn’t address that. I didn’t address that. So I just spoke about tobacco chewable, smoking, tobacco and smoking, smoking tobacco, and that’s all I talked about. And then I, then we offered them help, you know, in. They, they know anybody who’s looking for help. They can come to the school, and they can sort of write down the name and the number in the register and we’ll contact them. So the other NGO that I was telling you about, this guy who’s ProHealth and Pro Nutrition,

PC:

I somehow feel moving the locus away from the school, perhaps would be better to get responses because the school is a place of discipline where you don’t admit to these kinds things or practices. So…

PS:

Yeah, that’s very true. But you know, the limited time, because this whole awareness session plan was made overnight. So, the only place where you find you would find like a group of people will go to school.

PC:

No, which is fine. Which is fine. You gotta start somewhere. I’m just saying like if you ever go back to that village and work with the same group of non-profit organizations, maybe you can, create a, once the sub-center is ready, that could be a place that people could come to seek help.

PS:

Yeah, definitely. Yeah. Next time it could definitely, I, I actually wanted to do it in the community, like next year their houses sort of organized just on the street, organize an awareness camp.But yeah…

PC:

These kinds of, these kinds of settings are very, very ripe for using, um, non-traditional approaches. Like street plays or other forms of, local arts and crafts like puppetry. And all those things. I have a friend who used to have a public health puppet puppetry group, and they, they used to do shows around spreading message about healthy behaviors and not, not smoking, not using tobacco and stuff like that, using puppets. That, that was a pretty cool idea and that that was an attractive proposition for, kids especially.

PS:

So, yeah. Yeah. Yeah. Like we had, we are trying to do that in our college as well. Now. We have been doing skits and stuff, like to spread awareness because just holding a chart paper and talking to people doesn’t really, you know, get their attention.

PC:

I remember, I remember when I was doing my MD in UCMS, they had this, street play group called Manchayan and we would, uh, they would do these, um, short skits about, um,  empowerment and women’s education and all those things. And a couple of them were also held in our, um, urban health center, like the practice area. People came in droves and they really enjoyed it, and they sort of got into it. They would chant with the actors, and it was, it was pretty amazing. That was my first exposure to street theater as a public health tool. And I found that in, in the right settings it can, it can go down very well.

PS:

Yeah, definitely that, that’s something, uh, we used to do in CMC as well, where we used to, we used to write songs actually, like, you know, we used to compose songs with public health information. Like few of us used to bring plates and spoons from college, from hostel, bang them, call people, come to the street, bang the plates, and then sort of make a tune out of it and sing a song. But definitely that works much better than just talking. Like, no doubt. And yeah, next time I could, uh, I could plan it better. Now that I know what the community is like and what the terrain is like, I’ve seen the places around. Maybe I can plan it better next time.

PC:

So what did you do the second day, afternoon or evening? How’d that go?

PS:

After this, I went to an Anganwadi center, uh, in the Anganwadi Center I spoke with the Anganwadi worker and, we were sort of discussing nutrition, digital health needs of the community. Like, like different topic. And, uh, starting off with, you know, I asked her the nutrition of the kids, like how it’s, because anemia and children, also anemia in general has been bothering me a lot. And I wanted to sort of figure out what’s happening at the ground level. And she told me that she hadn’t received the funds for the meals for the kids for the past, more than more than a month. And she was paying out of her own pocket to get the kids a meal, which again, you know, it’s, it’s the, the funds are there allocated for the policy, but if it doesn’t reach the, the main people, the main beneficiary, that it’s pointless. So that’s something I found very disappointing. How she had to sort of get a loan to make sure the kids are pulled.

But she sort of never complained about it. You know, I asked her, like, she had been working there for 16 years and I asked her over 16 years, you know, what has your experience been? Are kids healthier now? Or what healthier usually. And she said kids’ nutrition has definitely improved they are healthier now. So that’s something she pointed out.

And, I also noticed her that, you know, that noticed that she was, filling data on her mobile phone at the same time. So then inevitably that conversation of digital health came up and, she told me that the workload has actually gone up now that they have to fill the register along with, mobile app as well. And, the, the hilly areas, you know, I, I barely had network there and she had the same issue as well. The past four days, she was not able to upload the data that she had. And similar news was there, came out from Karnataka a few months ago when ASHA Workers Anganwadi Workers  lost their incentives because they were not able to upload their data for the day. So that’s something, again, which is a huge barrier, you know, at the implementation level.

And lastly, I just sort of ended the conversation asking her, you know, if there was something that you would want in this village, uh, what would it. So, her, her answer was pretty straightforward. You know, like if anybody falls sick, they have to go to this center called Haldwani, which is around 130 kilometers away and 130 kilometers in the Himalayas is a lot, you know, like, you can’t imagine how far 130 kilometers is. So, she is like, I would like to have a hospital here, which is like, it was a very basic need, you know, it’s nothing fancy. She didn’t ask for like a huge hotel or a car or a helipad, right? She just said, just make me a hospital here. So that’s the next step that NGO’s gonna take. I think they’re planning on building a hospital in that, village now. That’s something they’re planning on.

PC:

That was interesting. So, yeah. So that was your second day. What did you…

PS:

Yeah, after that I visited a postnatal lady and, yeah, so I, I talked to her about her delivery. And, so out of pocket expenditure is a big issue there, you know, for healthcare because they, they barely have any constant source of income, people in the village and they have to spend nearly 8,000 rupees to take a taxi and get, get to the district hospital. And 8,000 rupees is a lot, you know, like the, the kilometers and the monetary value is just something you can’t compare with the plains. So that was mostly day two. Yeah. Uh, nighttime. We sort of had a get together in one person’s place where we had a dinner party. I made Pakoras for the first time ever in my Pretty good. They were pretty good. I, all my fake confidence actually worked.

PC:

We don’t, we don’t have, we don’t have testimonials to prove that, but, so we’ll just take your word for it for now.

PS:

Sure. You have no option. Yeah, so that was pretty good. We had a small get together and then I had heard, heard about this tiger that’s there, and I was told not to travel at night because this tiger will attack you. But that really, I never, I never witnessed anything like that. Yeah. So that was day two. Then I left the third day in the morning at, uh, nine o’clock and I reached my room at nine o’clock in the evening. It was a 12 hour journey. And yeah, then I had to get back to work next day.

PC:

So, um, this sounds like a, like an, like an incredibly fulfilling experience for you.

PS:

Oh, definitely.

PC:

Yes. So again, like, um, coming back to the same old drum that I keep beating, you are in training in MD right now, right? So, how different was this experience from all your RHTC, the Rural Health Training Center Experience, or Urban Health Training Center experience. And, why was this different? Was this a good different, a bad different? If it’s a good different then how can the current programs learn from these experiences to make the experiences, the learning experiences for the MD students a better one, a more enriching one. Sorry. It’s a long and complex question. Basically, the question is…

PS:

It’s very relevant, you know, that’s something I’ve been pondering on as well.

PC:

What, what do the MD programs learn, or what would you want the MD programs to learn from your, the exposure in, in, in the villages of Uttarakhand?

PS:

So, I, I feel your health is not the same everywhere in India. You know that you can’t have the textbook definition of health being applied everywhere. And everybody has a different understanding of health.

PC:

Well, honestly, honestly, I don’t think, we can apply the definition of health, the textbook definition or the WHO definition of health to anyone. Anywhere. We are all unhealthy by that definition.

PS:

Yeah, definitely. But that’s something I realize, you know, like challenges, uh, you face in Delhi are very different from challenges you face in, in Uttarakhand or in Tamil Nadu. You know, like, but as a public health professional or a MD Community Medicine trainee, you need to expose yourself to these, you know, these variety of issues because you can’t be sitting in a place like Delhi and, think that you know, you know, public health because this, these things textbooks can’t teach you.

PC:

I almost wonder if there’s like room to sort of have Public Health training retreat for like five days where we collaborate with the nonprofits in, in, in diverse terrains like the Sundarbans or the hilly regions of the Himalayas or the deserts of Thar and have every year here we go to a different location and have five days of retreat. We collaborate with local nonprofits. We have MD trainees come over and we just look at the social determinants of health, the economic determinants of health, the political determinants of health, and how they play out in that setting. Okay. It’s a pipe dream. It’s not gonna happen.

PS:

No, it’s not a dream. You know, like I keep saying this, but like CMC has always been way ahead of its time. Like there’s a huge bias coming in. You know, CMC has been doing this in its training, and it’s not just for community medicine trainees, it’s for all like MS surgery, OG pediatrics. All of them have a posting called a Secondary Hospital Posting where they’re posted in this rural hospital for two weeks, which will be like far away from Vellore. It’ll be in Chattisgarh, Jharkhand; it’ll be in Assam.

PC:

Really? I did not know that it would be in some other state.

PS:

It’ll be different states. So, we had these posting undergraduates also. We had three SHPs, SHP, one, two, and three.

PC:

What is an SHP?

PS:

Secondary hospital post.

PC:

Okay. And where did, where did people go?

PS:

So first year I went to this place in, Chattisgarh called Rajnandgaon. And second year I went to this place called Leprosy Mission Hospital in Naini in Uttar Pradesh. So yeah, they had, so basically, it’s a mission network and they keep sending doctors to these mission hospitals to sort of see, you know, how healthcare early is because you can’t be sitting in CMC ultimately that’s what connects you with the people, you know, that’s what connects you with the reality, like when you go to these rural areas. So, yeah, it’s not a dream. CMC has been doing it.

PC:

No, I think. I think it expanding it to the other, um, other institutes, other postgraduates trainees around the country. That is the dream. And I think, um, I’ve had, so this is a good, interesting segue because, um, Archisman Mahapatra and I, we have talked about this kind of a public health training retreat for years. I mean, we were very close to sort of planning something out before the pandemic struck, and then everything, you know, went topsy turvy. But I am, I’m, I’m strongly confident that if there was such a program, we wouldn’t need it to be like, you know, we, we wouldn’t need it to be expensive or we wouldn’t have to post 500 students to make it viable. Cause almost all of these places, if we have the right network and right connections, we can create a didactic program that is hands-on learning, where you, where you actually do shoe leather epidemiology or you know, on the ground, public health, global, um, sort of and learn by doing,

PS:

um, you know, GPHX can actually do this. 

PC:

Yeah. Hopefully someday. Someday. That’s, that’s, that’s the value of, you know, chatting with you and all the other folks that we get to meet because, um, that’s how we start. I didn’t know, for example, I didn’t know about this SHP thing that CMC Vellore does. So that, that means there’s a model of success that’s been running, for a while. And if they can do it, why not the others? Or why not GPHX, why can’t we do it? So yeah, definitely we can. Yeah. Any messages for folks who are interested in working in, um, these kinds of settings?

PS:

Yeah, so I, I meant the

PC:

Wait. First question is, are you, are you going to go back? Are you going to go back?

PS:

No, definitely, definitely. I’m going back. Okay. I’m trying to go back once every, at least three to four months. But this time with more planning, not just,

PC:

…not, not just because you are a C M C fellow.

PS:

Yeah, yeah. Now, now I think they call me back now.Yeah. Cause I give them a long report of my visit and my recommendations. So I think…

PC:

What will you be telling your colleagues or, co-MD trainees, co PG trainees? What will you tell them that Yeah, go ahead, do this. How, how do you do this? Like what is your message for them?

PS:

Yeah, so what happened was like three days before I, I was going to leave for this assignment, Dr. Yogesh Kalkonde from, SEARCH Gadchiroli. And, we were talking in, you know, he’s a neurologist who did clinical immunology, he did lab research. He went to US and neurology, and now he’s working in public health in Gadchiroli. So, I asked him, you know, how do you know it’s the right. And like, how do you figure it out? So, like, see you are doing your MD training doesn’t mean you can’t leave and experience all these things.

You know, because I had, I had this strong urge, I have this strong thing that I believe, I don’t know, I’m not sure if I need this MD training because I feel my MBBS clinical skills are good enough to work in a primary healthcare center. And why not just leave and you know, settle down in a place like Uttarakhand just work there. But yeah, he told me, you know, MD will give you that leverage. It will help you get some grants and things like that. And he told me during your training, why don’t you just go to these places and explore? You can’t be sitting in Delhi and learning public health. And I was glad I had had this opportunity just, you know, three days after that talk with him.

So my advice would be, you know, you get, at least in my college, you get 30 days off in a year. Consider you take 15 off to visit home. You still have 15 days. Take three, three days. You can visit five places. And, you know, five places worth of experience is something like, not even like a thousand-page textbook can teach you. So, uh, I would totally recommend and, uh, you know, feel free to reach out to me if you need contacts to go to these places because I’m still in touch with the missions department from CMC because they actually sponsored me to come back to CMC, but I sort of didn’t go back. But, uh, I am still on good terms there. So if anybody wants to within a mission hospital, I can definitely ask them if they can arrange. So that’s something I can definitely do…

PC:

That is incredible. I will post Parth’s email, and Twitter handle with the episode notes. So, anybody who’s interested in, sort of visiting a different setting and see how healthcare is done and what are the healthcare public health challenges being, mitigated in those settings, feel free to reach out to Parth and I’m sure he’ll work something out. On that note, thank you so much. I know it’s close to midnight for you part, so thank you for staying up so late and chatting with us and, sharing your wonderful experience of visiting the Uttarakhand village of Paty and spending some time learning public health by doing it. Yeah. Yeah. Nothing, nothing better than that. Learning on the job. Yeah. On that note, thank you for your time as always. We will come back and chat again in a couple of days.

PS:

Yeah. My next trip is gonna be in Ladakh soon. Uh, I’m gonna meet Dr. Norden Odzer. Yeah, I will meet him.

PC:

That’s, um, make sure that you, you take better videos, you know?

PS:

Yeah, definitely.

PC:

That’s, that’s going to be one of the TORs for you when you’re visiting Ladakh. You are going to visit Ladakh next March or April, I believe. Yeah. Okay, here’s something. I hope I am in India at that point of time, and if I am, I’d love to join you and yeah, definitely. Let’s tag along.

Yeah. Alright. On that optimistic note. Thank you for tuning in to our, special episode of GPHX, listening in on Parth’s experience of spending a couple of days in the beautiful hilly terrains of Uttarakhand, learning public health by doing it, which is, in my opinion, the best way to do so. Alright, thank you for hanging out with us and listening to us. I hope to catch you again on another episode. Till then, keep listening and writing in. Stay in touch. Bye.

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