Interviewing the right people

Today I went to run focus groups with women at a place called Kankowli.

Upon arrival I was introduced to 'people who know' about my topic. Having been through this before, I tried my best to shake them off before getting down to the real discussion... with the women of the villages, about the problems that affect them.

It's not that I don't respect 'experts', I do. It's just that without working in the field with people, without living their lives and listening to what they say, lots of 'high-up' people like to pass comment, and even judgement on people they know little about.

My only hope can be that I do not go ahead and do the same.

How do these things keep happening?!

Woke up early this morning... while eating breakfast I got a text from Hannah, returning home after a night out back in Newcastle... gotta love time-difference...

Anyway, I went off to run some focus groups that I'd been promised were organised and ready to go at the end of a 'function' being held in nearby Vengurla.

I'm not sure that I really like these Indian 'functions'.. at this one, there were around 400 women, sitting in rows listening to eminent speakers... they were 15 men and two women. It did seem rather strange that a group of 400 *womens self-help groups* were being lectured to by a group consisting mainly of men. Anyway, people seemed to have a good time, and who am I to complain. Just, I can't help but think that if those women were in groups of 10,20... coming up with ideas, plans for the future... being mentored... that things could work a lot better. Afterward, a leader of one of the groups was asking me about how to market her mango products - me!

Ah yes, the bit I haven't mentioned... the 'how did this happen...again'...

About half way through the 'function' I heard my name mentioned about 3 times in a couple of minutes. Quite alarmed at this, I asked the girl sitting next to me to translate a little faster! She calmed me down, and said they were just using me as an example of outside-people coming to work with the people of Sindhudurg. It turned out she was wrong...

"Sunil Bhopal, please come to the stage" cackled the microphone. I was up, and off... what else could I do?

Arriving on the stage, I was pushed towards a microphone and told to speak, in English, about how women should "make better lives for themselves"... bloody hell.

I thought about concentrating on my research, about sticking to something I knew something roughly about... in those few seconds of decision making, it seemed like the safe thing to do. But then I looked around, spotting those who had spoken before me, and the topics they had spoken on. I disagreed with lots of it, and many who had spoken didn't actually have much backing to what they were saying... so...

I did what I do best. Opened my big fat gob, and gave my take on women, men, gender and power relations in places I'd been to in Sindhudurg. I was uber-respectful, and didn't crticise at all... just giving a few examples of things I'd seen, heard and documented.

Right decision? Well, it doesn't make any different to me - really. Has it harmed anyone? Well - perhaps... I suppose someone could repeat some opinion somewhere it's not welcome - but the probability is rare, and anyway change is happening all around. Have I helped anyone? Probably not.. but I'm pretty resigned to that at this stage...

Not much blogging about research...

It strikes me that most of my blogging has been about funny things that have happened, or general stuff in India... not much about research... so, a few words on what it's like to conduct this type of social research in the field, in a place where I don't know the language...

It's difficult! As I knew all along, the translator really holds the key - if they're interested, it'll work. If they're not, well.. you're struggling.

But that's all standard stuff, that is fairly obvious. What is less obvious is the way in which people constantly have constantly tried to put me off carrying out my work - everyone in India seems to think they know the answer to everything...

..so when I said this morning that I'm researching about nutrition, I was told by an NGO worker

"See, Sunil - for poor women there is financial problem. For not-poor, there is no problem".

Fortunately I have learnt not to be put off/too influenced by these comments... everything is to be heard, then filtered... before being digested. I have also learnt some follow-up questions..

It is beyond doubt that money, and lack of it, is a major source of problems for nutrition in women. But is it a simple lack of money? Yes, they say. So - why is it that when I inspect random Haemoglobin levels of people in Sindhudurg (measurements taken by blood bank outreach workers), that women have much much lower levels than men? Why is it that women are of much lower weight than men? This isn't all about money, elements of distribution of that money... culture... must enter the equation.

How about the 'not-poor' having no problem? For this one, I visited a local private clinic. Speaking to the doctor, he laughed at me... the problems of low birthweight children, or anaemic mothers etc etc, he said, is prevalent throughout Sindhudurg, in all economic groups.

Many people are amused about my interest in the topic... many people find it slightly pointless. It may turn out to be... but I really think I might have some findings, and would love to see them developed further in the future. Having said that, changing behaviour is extremely difficult, and I'm completely aware of that.

Things I forgot.

A month over here in Sindhudurg - it's not much. But it is enough to get a peek into how people live, what they think, how they act (around me, around others)... it's enough to realise that this is a different world to the one I inhabit back home, but that on the whole human ambitions don't seem to vary that much...

...but in all of this, I seem to have forgotten some basic questions. What do people I meet base their understanding of the world on? TV? Internet? Travel?

Well... yesterday I met a very articulate young man - 20 years old, just a few younger than me. He had a lot to say (as do most, round here) on 'Indian' culture, 'Western' culture - the good and the bad. I would say he was reasonably astute. Anyhow, where did all of this come from - what had he seen?

I asked him if he had ever met a foreigner before? He listed off around 3 or 4 groups of varying nationalities. I couldn't quite believe this - so rephrased the question... it turned out that these were the foreigners who had ever visited his taluka. I was the first person.

What about what he has seen? Has he seen the beautiful beach at Tarkali (20 kilometres away), or the royal palace at Sawantwadi (40 kilometres away). How about the cities of Pune, Mumbai (a few hundred rupees by train).

The answer is no, he has never been out of his district. His trips out of the village are limited to one particular beach at Malvan, that he has visited a few times. Remember - this isn't the poorest of the poor... not even poor at all, really... just a standard rural guy, with parents who work in government jobs.

Why am I so surprised?

Results are coming in...

I've done around 15 interviews with women (I may discard some due to low quality of responses... too much outsider input etc), and 5 with doctors and others working in the healthcare system.

The picture that's been painted makes sense. Too much sense actually. I'm quite suspicious of it, and wonder whether I've been given a picture of 'cultural norms'. However, I've used various techniques (including lots of simple observation, rephrasing of questions -including in the negative) and seem to have some answers that most of the participants, and especially the translators, think is OBVIOUS.

That's all very well, but I haven't found it published in the literature... and more importantly, when I put these findings to people working in the health service - they seem impressed. They seem to feel that there might be some techniques for improving nutrition of pregnant women coming out.

Is it possible?

Trip to the KEM hospital

Today I to the Diabetes unit at KEM Hospital, Pune. My goodness - they are doing a ridiculous amount of incredibly interesting research. Including the massively important Maharashtra Maternal Nutrition study - which is basically following a huge cohert of young women through pregnancy and then following their children as they grow. Incredible stuff.

Can't find a wesite link... but basically they're loving Vitamin B12 - and love to wax lyrical about how great it is... and lots of very scholarly stuff too!

time's on my side...

a little random point... to illustrate that despite the good times, being alone in Sindhudurg leaves much time for contemplation and lying around... in the last 8 days I have read 'Captain Correlli's Mandolin' 'God of small things', Mohammed Younis' autobiography and 'purple hibiscus'...

ridiculous.

The Alma Ata approach - working?!?

It seems mad, indeed it is.. but here in Sindhudurg there seems to be, at least the skeleton, of the PHC approach in action. This, for the uninitiated, is the approach to providing healthcare services using the state, using comprehensive health systems..in a way that provides equity of access.. more here..http://en.wikipedia.org/wiki/Alma_Ata_Declaration

So, the point is - here there is a real referral system, which appears to be in use. There are village workers, then PHC centres, sub-centres, regional health centres, and finally district hospital. It's quite incredible actually.

Now, in terms of a reality check - lots of these facilities don't function as they should, some workers are more motivated than others, and there is a MASSIVE private sector which doesn't have any involvement in the healthcare system...

But - it's definitely a structure, and definitely better than some!

Chilling out a bit

Yesterday evening I "found the new Goa".. really, I did. The beach is absolutely beautiful, there's some great hut/tents to stay in, food's great - and it doesn't suffer the affliction of tourism that Goa has unfortunately succomed to. Not gonna name the place in public, though...

Today I went to visit a project that I'm really interested in - it's called 'homestay' and is all about creating a sustainable alternative to the "build 'em big" model of tourism that is normal. There's quite a few places to stay in Sindhudurg and I went to visit the deluxe one. Absolutely stunning. Apart from a great room in a rural area, you get to eat with an Indian family, be introduced to local cultural activities... basically, a nice way to see the 'real India'...http://www.cultureaangan.com/homestays.htm

"He has COME FROM AMERICA..."

One tip for anyone travelling in India... pop in to peoples houses around meal-times... they're bound to give you food. Think of it as 'skipping' or 'freeganism' today's breakfast was obtained in that way... delicious!

Today was a big day of interviewing... headed off to a village with Prof Hindelekar. When we arrived it turned out to be her village - so we spent the first hour sitting drinking chai and eating mangoes with her family. I like this kind of research.

Spoke to lots and lots of women - they are completely baffled at the idea that a man could be interested a) in women's nutrition and b) in anything to do with pregnancy at all. The men, in turn, are apparently quite confused that such a subject even exists...

At lunch time I was guided to a large house near the middle of the village. It has just been built, and so they were having a puja, with prayers, food etc. It was great to sit on the floor with all these people eating beautiful Indian food from leaf plates. However, the most memorable point has to be when an elder gentleman stood up, silencing a portion of the crowd, and boomed out -

"HE HAS COME FROM AMERICA",

to which there were many smiles, and much extra food was doled onto my plate...

Is this on the syllabus?

I hate that phrase... it implies that the only important things are those which are going to be examined, or those which can be questioned through tick boxes...

Yesterday whilst doing interviews, I was stopped half way through. What was this woman saying, I asked the translator? She was saying:

"Okay, I've answered the questions you asked, now look at my child Doctor... he's ill"

She carried on...

"Is it my fault? Because of the foods I ate during pregnancy?"

What have I done? I thought. Thinking on my feet, looking around, assessing the situation. I said, okay got to deal with this... turned off my recorder and explained to her that there are many reasons that a child can get ill - one is nutrition, but there are many reasons... and I explained various of them. I then explained that it wasn't her fault, and that a good thing to do would be to take her to the local primary health centre. Unfortunately, this family refuse to go anywhere but the civil (district) hospital, transportation to which is beyond their means unfortunately. So - that child won't be seeing a health professional.

What was the right thing to do? Should I have pretended to examine the child? It would have given them so much reassurance - but it's not right. What if I'd said that everything was fine, and it wasn't? "Doctor from UK said..." etc.

It's a tough one, being partially medically qualified. The partial bit being the most important. As a medical student I think limits come very very quickly...

"A little bit of knowledge is a bad thing..."?

Florence, and interviews.

Well, that was a day.

It started in the usual way – people not being in the place they were supposed to, at the time they were supposed to be there. Lots of promises of people who can help in the coming days, but nothing immediate.

It was to the civil hospital, where a Florence Nightingale celebration was taking place! Anand and I snuck into the back – we were felicitated with flowers and asked to give a speech. At this we balked, and managed to get away with just flowers and photographs. We were, at this point ‘guests of honour’, and were placed front row, in the middle, with the eyes of 300 nurses piercing into the backs of our skills.
Photographs

Florence Nightingale, it turns out, is a bit loved round here. It was more than a bit amusing to see her picture draped in flower garlands, with haldi and coloured powders scattereda round like a Hindu deity. We left the hospital after a couple of hours – felt bad for leaving, but we had work to do!

We did three interviews – the first of which was not just with a woman, not even just her and her husband… but with a whole extended family sitting and feeding into conversation. Pretty rubbish really – how’m I supposed to ask about the mother-in-law’s influence when she’s sitting right there? Anyway, we carped on for a while about papayas being bad during pregnancy and hit the road. The second was much more interesting, although the baby in the background was a pain. The third was much better and she had lots more to say –including that pregnant women should eat before men – revolutionary.

The assistant, looking tough.

Tired, and fed up?

Feeling quite homesick today, actually. Or maybe just a bit ‘urgh’… want to be somewhere that’s not quite so hot, and where it’s easier to do stuff. Oh well, I suppose I didn’t come into this expecting it to be easy, I should probably just pipe down a bit. It’s just a bit…hmmm, well we’ve even got responsibilities to people here, because, you know, we’ve said that we’ll done stuff, they’re expecting to hear from us etc…

It’s just kind of, getting me down – slightly, I suppose.

We are doing quite well, I suppose. Basically we’ve been here for 5 days – the first was just settling in, then 3 days working and yesterday was random… so it’s only really 3 days.

Meeting interesting people, including a queen!

Met a group of people, including two doctors, who are building a school. Talked lots about sustainability, and heard Sudhir give a minor speech on this subject to an assorted bunch of his gang – brilliant. This included the idea of putting a mother and child centre in the grounds of the school.

It’s a bit of a hive of activity round here. Groups that we’ve met, and are involved with… are really going for it. It reminds of me of some time in British past which I don’t know about… all of these music halls, hospitals, schools etc – that were set up by rich people named after someone, or in memory of someone, I suppose it was the industrial revolution or something. It strikes me that this is the same thing happening in India – but I know not.

Also went to the Palace and met the Maharani of Sindhudurg! I don’t know much(anything?!) about Indian royal history, but she had some great tales to tell, and was certainly very ‘royal-like’! She was introduced to me as a “real queen – her family have ruled for 20 generations… unlike your pesky one” – what do you say to that? She’s really into maternal health, and sustainability. She’s obviously really on board – she’s a lovely, well educated women, need to think about ways to interview her!

Villages and silver...

Since then we’ve been to Deepak Sawant’s house – we told him we were thinking of moving from the guest house because we wanted to see the villages more. Whether he took this on board, or what, I don’t know. But we said we were going for a walk, his eyes lit up…all of a sudden he grabbed us and off we went. It was brilliant actually, the sun was going down, we walked through this beautiful village. Met loads of smiling village people, even met the head of the panchayat – pretty good! This place is called Ram Bamboli, there’s so many people to interview there, I mean this whole rigmarole of going here there and everywhere is starting to get a bit tiresome given that there are just women women everywhere. I mean, I can see that it’s important to get women from lots of different places – but I could easily carry out 10 interviews right here just off the college where I’m staying – so gotta do that really.
I was asked to tie a piece of silver to a child’s ankle! Basically, there’s a hospital policy that says that girl-children get a gift of silver from the hospital… it feels like some kind of recompense for having a girl, but I think the idea is to make having a girl more palatable. There is a photo of this, but I forgot to flick the AutoFocus button on, so it’s a ridiculous blur.

The first interview... 3 days early!

Today was a really excellent day – we made a massive to-do list, and managed to cross off most of it.

In the morning we met our Professor, who’s looking after us. She came quite late – but this is India, this is Sindhudurg, and it’s really quite hot so no-one moves faster than snails place.

After a few hours running around doing various things we were at the civil hospital. From there we bombed it back to the college via a couple of cups of tea and a packet of biscuits, and met Prof Hindelekar who took us out to Kankavli. Here we met a doctor who works in maternal health and is particularly interested in the wider-determinants. She took us to a school, where her kids were playing some traditional sports – which have been reintroduced. She’s a bit of a legend, and it would be lovely to meet up again. Anyway, we got a half-hour interview – it was a bit off the cuff, and not particulary well explained etc. But I kind of feel that I just need to take my chances as they emerge.

Met another doctor there as well, the sun was going down – all rather beautiful really. Got back to the room via dinner and I think I might have lost my mobile – which is a pain, but I’m not going to cry about it… not worth it.

So – a really excellent day, I look forward to more of the same. Thanks to Anand as always – legend…

Things Progress, but not as expected (although that, too, was expected)

Anand and I awoke an hour and a half after the alarm first sounded. But hey, it was only 7:30am – so plenty of day to go yet. Wolfing down Indian-style omelettes & frothy, sugary chai we phoned our new-found Rickshaw-wallah. He arrived in record time and we were off to Sindhudurg Civil Hospital.

After being assured on the telephone that Dr Kulkarni, the Civil Surgeon (big shot, basically) was on site and waiting for us, we arrived to find that “Dr Kulkarni is in Kohlapur”. Argh. No worries though, the morning ended up supremely. We met the RMO (Regional Medical Officer?), along with various other specialists who popped in. They seemed mostly unimpressed – although the link that Anand had formed with Dr Kulkarni was to be our saviour. At the mention of his name, things happened. The letter Zafar had sent also proved to be essential in the fight to win over this group.

After an hour in an office we were led out by a junior doctor, another Dr Kulkarni – he showed us round the hospital, and this is where the medical knowledge came in handy. Although I am not really here in a capacity as a medic, these people were keen to see that I wasn’t just a “social-minded” person.

They were quite interested in my interest as a medic in nutrition and information. I explained that one ‘strand’ of my six-year course is in social, preventative and public medicine. This satisfied them.

The RMO talked about how ‘prevention is best’, but that they can’t prevent everything because of three factors:

1) Ignorance 2) Poverty 3) Illiteracy

He described cases where people couldn’t afford the Rs30 bus fare to receive top-class free medical treatment. He also described 3rd trimester bleeding that goes un-seen to due to people thinking that it’s normal.

We discussed the healthcare system setup – it seems that there is a strong referral system and that most stuff is dealt with at the primary level. I’ve been promised introductions to the MCH officer and to the PHC centres & Anganwadi centres.

As usual, language was brought up as a barrier. How will you communicate? Well – I answered – I hadn’t thought of that…

Met Colonel Sudhir Sawant, local politician, hero and my friend. I told him exactly what I need to get my research done – two people have been assigned to do the job. I think it might just work. This includes links to womens self-help groups. Our scabby guestroom is also going to be done up, well – if we have time to pick some furniture!

In the afternoon we met Dr Kantak, an ajurvedic gynae consultant. He was very interesting and talked about the interactions between the allopathic and ayurvedic hospitals. Apparently women aren’t using their hospital for ANC services at the moment because the government hospital, under the NRHM has reduced its prices drastically.

People are being receptive to us, which is nice. Lots of people speak English, which is surprising and nice… There’s lots to do tomorrow – but before then, an essay to write (uh oh)!

First day in Sindhudurg

6am. Waking up with a splitting headache, and the sounds of the Konkan-Kanya Express ringing in my ears, I washed my face and became positioned standing over an open train door – looking over rural Maharashtra.

Suddenly remembering why I am in India, the excitement rose and my finger-tips tingled – I’m about to go out into rural India! This is why I chose to come back to the Subcontinent, only four months after leaving last…

The plan is for the first formal interviews to take place starting on Monday. That gives me two days in Mumbai and 5 days in Sindhudurg as preparation time – all part of the process, and very important, but not as formal and structured.

Today involved being fed and watered (& mangoed! – fresh, local and delicious!) at Col. Salwant’s house – then meeting and chatting with lots of students, teachers etc from the Agricultural college here. These guys do seriously amazing work around sustainable farming, living etc.

In the afternoon, Anand and I had a failed mission to find Dr Kulkarni, our contact and District Civil Surgeon. Maybe tomorrow will treat us better.

There’s so much to do, before interviewing starts – so really need to get a move on. Basic things like getting our accommodation sorted. At the moment we’re staying in a guest room at the Agricultural college. It’s pretty basic, but ok. But I don’t think it’ll be possible or desirable to stay here the entire time.

More to follow…S

The Best Day... ever?!

Billing something as such, before it has started, may seem a recipe for disaster. It wasn’t disasterous but it did end with me refusing to speak to my own mother on the ‘phone, because I felt ‘dead’…

Now lets start at the start.

I fell asleep at half past midnight. At half four I woke, picked up my camera and a wad of cash and skipped merrily out of Sangrajka – Today I would see the sun rise.

Bombing up the highway in a taxi, I reflected on how many taxi rides I’d taken recently and how un-ecofriendly this is compared with my usual ‘I do not drive’ stance…

I ran into Sahar aiport to find Nedah, Sarah and Olivia sitting in a circle on the floor (how Indian) – apparently they’d been there an hour - oops. I grabbed the first two and stole them back to Five Gardens. What a great place for people to first see in India – large old houses, lots of greenery – kind of like Jo’burg gated villas… but a really nice version!

We watched it get light and then I let them get some rest. I had breakfast to eat, Roabin had bubbles to blow and and I had to do my first interview whilst all this was going on. Chomping on ‘Bhurji’ I was told that

“What you are doing is at best useless, and at worse harmful”

Having said that, this very person is the one who’s giving me access to Sindhudurg. I think what he actually meant was

If you don’t do what I tell you to do… THEN – What you do will be at best…

The interview continued in the park as it got light – there’s some great photos, and it’s all recorded on my shiny new Dictaphone.

PIC OF BLOWING BUBBLES

In the afternoon I went to get some hints and tips on researching, and on rural India, from my old pals at the Mumbai-based NGO, Saathi. They're a great bunch and were very happy to help, and during the course of this it dawned on me that this is something that Ned, Sarah and all other International Health students should get before they go off. So – there might be possibilities of a little earner for Saathi here!
By evening, I felt dead. I dozed in my favourite place in the world – the balcony of Sangrajka house. At 11, we reached the train station where I tried to force Anand onto the wrong train as it started moving. Fortunately he was too clever for me, so we got on the right one – sleepy time!

Introductions...

So,
I am introduced elsewhere... other important people in this story are:

Anand - my younger brother, chief 'scout' of research locations, and now I like to refer to him as my assistant!

Roabin - my mother's cousin, mentor, and general nuisance. He's also my way into researching in India.
Lygia - wife of Roabin, the lady who keeps it together when others are going mad. Key player in Inheritance India, a sustainable development organisation working in Sindhudurg where I'm going.

Col. Sudhir Sawant - Sindhudurg politician, very interesting person with lots of contacts in the distict. He's keen on my project and has offered to help. Also friend/associate(!) of all 3 above.