Homeward Bound! With a pit stop at the Taj Mahal

With our time in India winding down, we decided that we needed to see the Taj Mahal before we left for America. After some creative scheduling, our driver, Ram Singh, agreed to drive us to Agra before we flew out on Saturday. We set out bright and early to make the 5 hour drive from Jaipur to Agra.

When we got there, we realized why the Taj Mahal was considered one of the seven wonders of the world... The first view you get of it through the main gate is staggering- The huge structure is made entirely of white marble, and it rises out of extensive gardens complete with fountains. We slowly made our way around and through the Taj, taking time to absorb its beauty. Finally, people had something to stare at other than us!

After wandering around for a while, we were exhausted so Kevin and Josh decided that they were done moving for the day.

At that point, we made the 1km walk back to our car (so much for not moving), hopped back into the car, and started our long journey home. Our flight left Delhi at 3 AM, we had a 4 hour layover in Amsterdam where we met up with the Nepal, Kenya, and Tanzania teams, and then we took off for Washington, D.C. In all, we had a travel time of about 24 hours (ugh, but not as bad as the Nepal team's 36!)

Thanks to all of the Jhpiego, Laerdal, Johns Hopkins, and hospital staff that made this trip a success! And thank you to all of the Hopkins and Jhpiego staff,  friends, and family who kept up with our travels through the blog! 

The Desert and Dessert

To explain the witty title, I will first discuss our trip to the rural desert town of Kolayat on the outskirts of India near the border of Pakistan. Although we reached Kolayat in about an hour, the patchy and sand-covered roads made it seem like we were driving for almost twice that time before we reached our destination. We first met with an award-winning ANM who we spoke to about her skills, training and our device. Once again, there was a mouse running amuck during our meeting, which made the three of us a bit nervous (I was probably the most nervous of us).

Josh in the CHC.

Desert town of Kolayat

More desert in Kolayat, giving a sample of the roads.

After this, we embarked on another lengthy trip through the town to the Kolayat Community Health Center. Before reaching the destination, we encountered a pond full of dazzling lotus flowers adjacent to a row of temples. This was certainly a sight for sore, desert-filled eyes. When we reached the hospital, we spoke to a doctor about ANC screening and our device while receiving cups of the delicious Maaza Mango Juice.

Lotus Pond- a hidden beauty!

On Wednesday, we made a visit to a Primary Health Center just outside of Bikaner where we spoke to Dr. Priti Agharwal who had incredibly good English. Dr. Agharwal was very helpful in providing a potential novel surveillance idea for our device. After visiting the PHC's lab, we drove across Bikaner to a district hospital, thus completing our survey of Rajasthan's health care hierarchy. There, we met with a pathologist and some General Nurse Midwives who were very passionate about our device.

Primary Health Center

Dr. Pankaj and GNMs.

The other half of our title comes from the fact that that afternoon, the three of us were severely craving chocolate. Thus, we drove to the center of Bikaner to try to find some. We ended up buying 5, 4-month overdue chocolate bars that were stored in the refrigerator with drinks. Nevertheless, we bought the chocolates and devoured them.

At night, we met with a block officer, Dr. Anil Verma, and spoke more about our device and surveillance. He was so interested in our device that he wanted to purchase our prototype for 6000 rupees before we informed him that it was just that, a prototype!

Blurry Picture with Dr. Verma

Today, we made the return drive back to Jaipur. We only made one stop on the way back: a break for tea, which Kevin and I owed to our driver Ram for falling asleep during the ride. When we reached our hotel, we said our last goodbye to our beloved driver and hooked him up with a limited edition Johns Hopkins Biomedical Engineering water bottle.

Ram Singh and the Team i.e. the Team

After a quick rest, we headed to a shopping area where we enjoyed some Domino's pizza and some bargaining. One horrifying auto-ricksaw ride later, we were back at our hotel and debriefing on our last few days' experiences in Bikaner. We just want to thank Dr. Pankaj Suthar for being an awesome guide and translating our conversations to the very best of his abilities. We also want to thank Dr. Manish Gehani and Dr. Kailash Saran for helping facilitate our trip in the very beautiful and very rural city of Bikaner.

A Day in the Life

It looks like the other teams are really stepping up their blogging game. As we start the last week of our overseas immersion, it should be a great race for the 2^nd best blog! Jokes aside we were thinking our team’s blogging format has gotten a little repetitive. So today we’ll be switching it up a bit…

Namaste! Yep that’s right, you’re joining the team for a day, WELCOME TO INDIA. Ashley, Josh, and I have been here for 11 days so we’re more or less pros at navigating India (ha!). Car gets here at 8am so catch your bearings, jump in the shower (fair warning: only cold water), pop that malaria pill, and get your boots on. We’ve got a busy morning ahead of us.

7:12am – The waiter knocks. Josh and I scramble to get to the door and prepare to speak our best Hindi-English. “Breakfast?” There’s two choices for breakfast: Continental or American, both include eggs, cornflakes, apple juice, and toast. Although we both say American, we manage to somehow end up with only tea and a single cup in the room 15 minutes later. Not sure how that order got so mangled in translation, but no worries, we’ll grab some toast on the way out. The language barrier continues to be tough, don’t think that’s changing anytime soon.

7:59am – Meet Ram Singh. He’s been our driver since we arrived in Rajasthan. He speaks Hindi and can also converse in English and French. As we've come to find out, many people in this region are multilingual. Unfortunately he's feeling sick today so we'll have to go with a different driver. We learned early and often to be flexible and go with the flow on this trip. 

8:53am - We're halfway into our 70 km trek northward towards Loonkaransar. Today we'll be visiting a community health center (CHC) in the village. The traffic has been non-existent considering typical Indian roads, but this clip should get your attention. Two weeks ago we all would have considered this a near death experience, now it seems like nothing more than 8:53am on a Monday.

Notice the camels, cows, dogs, and sheep all around and in the road. A surprisingly small number of these animals actually end up as road kill considering the number of TATA trucks 'wreck'-lessly cruising the highways. You'll also see the roadside stands selling just about everything including spices, hats, cell phones, scarfs, and necklaces. The stands are littered with advertisements. Vodaphone, Airtel, Coke, and Pepsi dominate the otherwise all Hindi ad-space.

9:31am - Get ready, we're pulling into the town. Everyone's going to stare. Not the typical make eye contact and look away, but more like we're from a different planet. In their defense we do stand out. Red hair, blonde hair, or being tall and lanky would be enough, but the trio is priceless in this neck of the desert. Oh well, everyone's been friendly and for the most part are just curious why we're here.

 

9:38am - Sit down with Dr. Chabra. He is a gynecologist and one of six physicians at this facility. We'll give the 5 minute Hemoglobe pitch and ask questions about his CHC so that we can get him on board and meet the rest of the staff. Great news, he's stoked and said if the device was on the market tomorrow he'd buy one with his own funds!

10:27am - We're taking a quick tour of the lab facilities. There's 3 lab techs that work here performing tests to screen for everything from anemia to HIV. Tools, disposables, and paperwork are scattered over the counters. The equipment here got recently upgraded and they've even got a complete blood count machine.

 

10:56am - Time to head over to the district block data management building. The 2-man staff is showing us the PCTS (Pregnancy and Child Tracking System). The amount of patient data and the ease of access is nothing short of extraordinary compared to the facilities we've seen. Although there are still issues with the quality of the data and the man hours required for manual entry. 

11:30am - Best part of the day! Meeting with a team of eight ASHA workers. The language barrier is more apparent than ever, but like they say a smile goes a long way. Even so we're having trouble getting answers to questions until Ashley comes up with the brilliant plan to role play the home visit. Using a backpack to simulate the pregnant belly, the women were excited to show us how they currently screen pregnant women for anemia. They even showed us how they keep records of individual patients throughout the pregnancy in their version of a binder full of women (too soon?).

Now that we've got them talking, demonstrating the Hemoglobe device becomes cake. They're all showing their phones ("will it work for me too?") and gathering around to get a glimpse of the app. Everyone takes turns giving feedback on the size, shape, and weight of the device!

12:58pm - An ASHA named Sema (she's in the purple and blue saree in the middle of the group) is thrilled and wants to take us on a home visit, so we drive the 1/4 km to a pregnant woman's house. Our visit is unexpected for the family and the mother seems less excited than Sema about having us there. After a few minutes of Hindi small talk, our host let's us know that its probably best to try for a home visit a different time. Family and friends of the woman follow us out and bid us farewell. They appeared sufficiently confused why 3 white people came unannounced to their home and were trying to ask questions about pregnancy and showing a new device. We'll have to come up with a new strategy to make future home visits more useful. While that didn't quite work out, it's been a very productive morning! All antenatal care duties at the CHC are wrapping up for the day and it's time to head to lunch (Do you want paneer, dal, or aloo gobi? My personal favorite Indian dish is called pizza).

2:23pm - The team is going over what info we've learned on the ride back to Bikaner. Although we hear the horn and feel the swerving, the crazed driving is no longer a consideration. It's amazing how quickly people can adjust to new places. 

Thanks for joining the squad for the morning! We'll meet up around 4pm to debrief, type out the notes we took, meet with Jhpiego staff, and figure out how the hell this whole thing is going to come together. But right now seems like a good time for a nap.

    

Once upon a time in Bikaner

Fortunately for us, some time was allotted in our busy schedule to be normal tourists. In that time, it became our mission to find a place to ride a camel. The hotel we are staying at has a partnership with a "camel safari" provider (a.k.a. three kids with small camels that need more training before they can pull carts through the road) to take us on camel rides through the desert. At 5:45 AM, we dragged ourselves out of bed and rushed to the edge of the desert, about 15km from where we were staying. There, we met our guides, hesitantly approached our sitting camels, and got on. We thought the worst was over when we didn't get kicked or spit on, but then the guides told the camels to stand up. When they said hold on they meant it! We all almost rolled forward onto the ground as the camels stood up from a kneeling pose. From then on it was smooth sailing, except for Josh’s camel which did not appreciate the early morning ride.

 

Then we set out through the desert, which was more green than usual because of the good monsoon this year, to see the sun rise from the top of a hill. From atop our camels, we surveyed the local wildlife: cows and the occasional goat. We got to the hill and dismounted the camels, which immediately flopped onto the ground, rolled around, and took a nap… It was too early for them too!

After a many pictures and trying to communicate with our guides through sand drawings, we headed back. On the way, we came across a group of kids who had caught a cobra. Don’t ask me how, but it now lives in a little basket as a pet… They took a little too much pleasure in holding it up and watching us cringe.

Having safely evaded the cobra, we headed back to the hotel to change and see Junagarh Fort, Bikaner’s old palace. We got a tour from the main guide, who was nice enough to give it in Hindi and in English. We happened to be placed with a group from a tribal area who had never seen Western tourists before. Needless to say, we caused a stir.

 

Afterwards, we went to see another Bollywood movie “Once upon a time in Mumbai” with our host, Dr. Pankaj. Though it was still in Hindi, we were able to understand more than the last movie we saw, especially because the plot line was similar to many American movies.

Afterwards, Dr. Pankaj surprised us with dinner at a renovated palace that is still owned by the king of Bikaner. Apparently, many old palaces have been made into the nicer hotels and restaurants in the area. The food was delicious and the grounds were beautiful. Though the day was eventful, the fun left us ready to dive in to another day in the hospital!

Toto, We're Not in Maharastra Anymore

As the title says, the last few days in Rajasthan have been absolutely incredible and completely different from what we experienced in Maharastra. Upon arrival in Bikaner, our first stop was the Bikaner Medical College. Right as we entered the building, we knew that everything had changed. The Bikaner Medical College was extremely crowded and disorienting. The masses of people were being rushed from place to place, seeking any type of care they could obtain. The number of patients was so large that some were forced to wait outside the hospital, lying on carpets that they had spread out with other members of their family. When we got to the hospital, we had a very informative meeting with Dr. Sudesh Agharwal, the hospital’s administrator. We discussed issues with the current ANC system in Rajasthan and learned about the technological changes facing the state and Dr. Agharwal’s hospital.

Then we toured the various wards, talking to nurses and ASHAs along the way. The most notable sights included a newborn that was spontaneously breathing but eventually started crying normally (weighed on the pictured infant scale). There was also an abandoned prenatal ward with mice and a rat in it (all of which made Josh very antsy!). Another funny moment we experienced was when one ASHA took particular interest in our device and followed us through the hospital until we showed it to her. This also drew a sizable audience.

 After this, Dr. Acharya secured a meeting with Ms. Arti  Dogra, the district collector. Despite the fact that there was an employee strike that Ms. Dogra had to deal with, she gave our team a lengthy slot because she said the issue of antenatal screening of anemia hit particularly close to home with her and was a major issue in the district. In fact, when we met with her, her main concern was how soon she could get one. As a sidenote, her office was pretty sweet but we were all too intimidated by the labor strike to take a picture.

 

The next day, the team ventured to Naukar Community Health Center. There, we met with the administrator, visited the lab and spoke to an ASHA about her job and her phone. The ASHAs were very happy to meet with us and were quite keen on taking pictures. We also went to a nearby small village to try to see an Aganawandi Center. As the center was nestled in the center of the village, these two school children were fairly keen on the opportunity to leave class to lead us there.

On the road back, the team visited the famous Karni Mata Temple worshiping the rat goddess Durga. As the temple theme suggests, the place was FILLED with rats roaming freely. Josh had to be coerced by our driver to enter and Kevin appeared terrified, but Ashley apparently had no issues with the little creatures.

At night, we had a very helpful meeting with Dr. Kailash, the Jhpiego State Director of Rajasthan. He was certainly very knowledgeable about the issues our project deals with as well as the various programs and distribution pathways that would be involved with implementing the device. The team went back to the rooms early to rest up for the next day as we had a chance to tour Bikaner starting with a camel ride in the desert at 5:45 am. More on this to come!