Conclusion of our Public Health Work in India
Trip Start
Oct 20, 2005
1
7
31
Trip End
Nov 04, 2006
Mumbai,
India
Saturday, December 31, 2005
Before designing the questionnaires needed to survey the "affected" and "infected", I (Justin) had to learn quite a bit about the subtlies of the epidemic amongst the elderly in India. After talking with leaders of HIV/AIDS relief organizations, he learned that there are quite a number of stigmas and barriers faced by Indian seniors affected/infected by HIV, which would be in addition to those faced by familes with HIV/AIDS in Western countries
01 Last Day of Work Lunch with Prema and Chhaya
. For instance, in addition to the stigma of being HIV-positive, there is the additional shame of being older than 50 and HIV-positive since, I'm told, Indian society has great respect for seniors and doesn't think they should "do those things." In addition, blunt, straightforward questions about sexual practice are seen as derogetory to the interviewee. Apparently, it is better to write questions euphamistically (though clearly this could be at the expense of accuracy!). Nonetheless, I wrote up three separate survey instruments for the groups we will survey - the "infected", the "affected", and the "key informants" who are in the trenches with HIV/AIDS prevention and treatment.
In addition, I set up an Institutional Review Board (IRB) for AVNI (what they call an "Ethics Panel" here). This is a relatively new concept in India for public health and social-service organizations; however, having one is required in order to get funding from most international agencies. The first task, for the panel of seven members, was to review my survey instruments as well as an informed consent form that I had adapted for AVNI, to see that they a met a pre-determined standard of ethics. We'll have the interviewees sign this kind of "permission slip" document prior to being surveyed. Both were approved though I think being on an IRB was a new thing for each member.
Through the IRB members, I learned that literarcy levels in rural areas may not be high enough to read the informed consent document, even if the document is written using basic language in Marati - the mother tongue of this state. It was advised that we tape the document being read in Marati. The tape would then be played for somebody as they examine the document.
Unfortunetely, the physician who was suppose to take over my project in January unexpectedly reneged on taking the job, so project is currently frozen in place with the surveying yet to be done until somebody else can take it over.
Jamie worked on two different projects. For the first one, she created a course session on public health leadership and management which will be taught during a certificate course for medical professionals interested in public health. The other project brought her to the Dhavari slums (the largest slums in Asia) and the medical college, to evaluate a female adolescent health education and vocational training project. This project targets girls, 15-19 years who are mostly from conservative Muslim homes and are pulled out of school before graduation and often times are married before India's legal marriage age of 18. Interestingly, the legal age of marriage for a boy is 21, as they tend to mature slower than girls. The project provides them with knolwedge about their bodies and gives them negotiation and vocational skills to empower them and help them become more independent.
For both of us, doing public health work in India was interesting yet frustrating. On one hand, we enjoyed the challenge of applying our skills in a new setting; we certainly learned quite a bit about the nuances needed to do this effectively. On the other hand, we were often frustrated by the amount of protocal and formalities needed to get things done: one couldn't just call a hospital representative up and ask for assistance; one needed to be "introduced" by one's superior in a separete phone call. Because of this and other inefficiencies, it took a lot of effort and time to get things done. Nonetheless, it was enlightening experience.
