Steps to Grow – an Interdisciplinary Project

Over the last few weeks I have been working with an interdisciplinary group that included medical students and a physician, a student receiving a Master’s in Graphic Design and a couple of Iowa alumni who now have their own technology start-up company in Iowa City called Mazira.  I contributed as a MPH student and also with my undergraduate studies in Child Development.  The project was to create a website application to enter into a contest called Go Viral to Improve Health held by the Institute of Medicine.  The result, a website called Steps to Grow, I think has the potential to go far beyond this contest. 

 As explained on the website, Steps to Grow is a personalized, interactive timeline that allows parents and caregivers to access important information about their child’s development and milestones.  They can also get timely information from reputable sources about various childcare topics including vaccinations and nutrition.   The amazing Mazira team has even taken some of the CDC’s statistics on child health and created interactive figures specifically for our website. 

 I am equally excited about the potential for Steps to Grow in the future.  We plan to expand the age range and hope that it’s use will make some parent’s lives a little easier.  We also hope that this may allow for earlier identification of children who have developmental delays so that they can begin getting the help they need to be healthy and happy as early as possible. Soon, parents will be able to add more of their own child’s information to the timeline such as pictures and videos. Perhaps this could even become something that will facilitate more effective communication between physicians and families.  For example, a parent might read their child should be saying a certain number of words by a certain time.  Now that they are aware of that they can keep a count before their child’s doctor’s appointment.  If they are worried their child is not eating or sleeping the right amount they can check their child’s timeline, then they are able to link to more information online right away, record the date the events take place and bring all their questions to the doctor’s office.   

 I encourage anyone, and especially parents, to check out the website and the timeline and provide us with your feedback using either the contact us or guestbook options.   I have really enjoyed stepping out of a single-discipline team to work on this and I think it has been a real strength to have multiple mind-sets and skillsets contributing to it. 

Cool Things that Happen at the College of Public Health

Saturday night I attended the keynote portion of the Midwest Outdoor Leadership Conference, which was held in the College of Public Health this weekend and directed by a College of Public Health alumnus who just graduated last semester.  The keynote speaker was Fabrizio Zangrilli, a professional alpine climber and guide on K2.  Following his talk we viewed a documentary called K2 – Siren of the Himalayas.  Now, I have done some normal camping and I generally can at least pretend I know what I am doing in an REI or Land’s End but I really had no idea what this mountain climbing stuff entailed.  This is an example of something really cool you can do and learn about by keeping your eyes open for stuff and getting involved in opportunities at the College of Public Health.  This is something I would never have otherwise known about and I got to learn about it from one of the few people in the world who do this for a living, one of the few people who do it at all actually.   Hearing people talk about something they are so passionate about is a nice reminder of how different people are and of the things each of us is passionate about in our own lives and careers.  Also, good advice is good advice, and even though I will never in a million years be leading a group of people up a mountain, the leadership advice we got last night could apply in a lot of situations whether it is an extreme sport, working with a medical team in a clinic or hospital or forming new delivery systems and better healthcare. 

Our Last Week in Chennai

I arrived home from India last Friday night.  Our final week continued to be a really great experience. We met with an NGO that serves as a support group for the MSM (men who have sex with men) population and a group that provides testing and STI prevention for sex workers.  Both of these visits really added a lot to our trip and shed light on yet another aspect of the culture and the country.  We were also able to visit the National Institute for Research in Tuberculosis.  This is funded largely by the Indian Government but also collaborates with the WHO and the NIH.  It was really cool to hear about the research being done there on improving treatment modalities for those with TB and with HIV and TB co-infection.  

Celebrating Pongal

We also travelled to one of the rural villages.  Villages there are much larger than I had imagined, about 3500 people lived there and they had their own health clinic, school and businesses, such as grinding spices which were sold there and in the city.  Our last days fell on a holiday called Pongal.  This is a Southern Indian, multi-day celebration of the harvest.  Our host in Chennai very kindly invited us all to her home and taught us about the holiday.  One of the traditions is to boil rice and milk in a pot over a fire and when it boils over everyone makes a lot of noise by cheering and using noisemakers. 

We wrapped up the trip by presenting our projects at the American School in Chennai.  Finally we all got packed up and took our long flights home.  Overall this has been a great experience and I would encourage anyone considering doing a Winterim in India to do it.  Coming back and starting the semester right away is a challenge but it was absolutely worth it.  

Palliative Care

The following day was not much easier for any of us emotionally.  We visited the DEAN Foundation, a  palliative care program in the city and we also traveled to their rural center.  DEAN stands for to Dignify and Empower the Ailing and the Needy.  This is the second palliative care center we have visited, last week we went to the RMD Pain and Palliative Care Trust.  My presentation topic has changed and I am now doing it on the Present State of Palliative Care in India.  This is a new field here.  It is relatively new in the US but it is still much smaller here.  Only recently has the Indian Government become involved and it sounds like most of the work is still done by NGOs with some government collaboration.  These NGOs struggle because they do not wish to charge patients, or at least those who cannot afford to pay, but donors prefer to give to a more hopeful cause rather than towards helping people who are already dying.   I was able to interview three physicians who practice palliative care.  Though I know this is far from statistically significant, they told me that it is not a very highly respected specialty and a couple of them have had colleagues try to discourage them from practicing palliative care.  Two of them also work in other specialties and said they could not afford to only practice palliative care.  

In the report I am doing on this I am providing some information on the history of palliative care and the challenges it faces.  I am also going to try to add some perspective by giving an overview of palliative care in the United States.   I was interested in the question of whether boys or men are more likely than women to receive palliative treatment – because they are more likely to receive all other types of life-preserving therapy.  I am still working on this but I don’t think the statistics are available to make any conclusions.   A few of us in our group discussed that we  think that there is an opportunity here for those practicing or learning palliative care in the US who want to do global work.  This organization said they would love to have people come and work with them.  They struggle to keep all but one truly dedicated volunteer and despite their enormous efforts they know millions of people in India could be benefiting from this service if it were more available.  If any Iowa students are especially interested in learning more about this, one of the Winterim courses offered is actually entirely on Pain, Palliative care and Hospice as well. 

WHO Definition of Palliative Care: 

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Visit to a Domestic Violence Program

Tuesday we went to a couple places.  One of these was a domestic violence shelter.  We have seen a lot and heard a lot of things that are pretty hard to deal with since being here but this meeting was particularly difficult.  I am not even close to an expert in domestic violence in our own country but I was able to conclude that violence against women in this country is very different from that in the US, though there were some sad similarities as well.  For example, we learned of the negative impacts of a system of dowry and how this may affect domestic violence.  We also learned that violence against a women may be a matter the whole family is involved in and not only the spouse.  The leader of the organization we met with described how they work to help women experiencing violence in their homes, including women who have been victims of burning.  We spent at least a couple hours just sitting and listening to the leader of this organization describe the problems they deal with and how each were being addressed.  It is so important that organizations like this exist and impressive that faced with a problem so large, so prevalent,  they continue to operate and to help everyone that they can.   I won’t go into this further here but if anyone reading this is particularly interested I can share my notes with you; there is also a great deal of information available at this website. 

Monday January 7th

We began our second week of classes by visiting the Center for Women's Development and Research - an organization dedicated to women’s rights .  After learning about the organization we went to visit a group of women who were a part of this program.  We were told the women lived in a slum but when we arrived their living conditions were far better than I had expected.  We all squeezed into a small space and the women told us about how their lives had changed.  Their children are going to school and domestic violence has dropped because the women defend each other.  The leader of the group told us “I may not have had education but I can change the world. “  Once again we found ourselves humbled by the strength and determination of the women of India.

A Traditional Indian Dance 

Later in the day we visited a microfinance organization – this is a government program that offers women the chance to learn sewing for a few hours a day over the course of a couple months.  They then loan them the money to buy a sewing machine.  Many of the women work from home sewing while their children are young but some have gotten together to form small businesses.   In addition to being excellent at sewing, the women here also sing and dance and they put on a brief show for us - shown here. 

Our Weekend in Pondicherry

Saturday we loaded into the van and drove about 3 hours away to the City of Pondicherry.  Pondicherry, or Puducherry in the local language of Tamil, was a French colony on the Indian Ocean.  The city still has a lot of French architecture and culture.   We visited Gratitude Heritage Home there, which works to restore and preserve some of these old buildings.  I encourage anyone reading this to visit the website just to see some pictures.

We also visited the Aravind Eye Hospital, one of 5 centers in India founded by Dr. G. Venkataswamy to eliminate unnecessary blindness.  This hospital has won the Gates Award forGlobal Health earning the title of the most productive eye care facility in the world.  I really enjoyed learning about this hospital.  They have figured out how to provide high quality care to a very large population with their surgeons performing about 2000 cataract surgeries per year (the national average is 200).  By offering more expensive options to their private paying patient the system generates an income that it uses to provide free care and surgeries to those who could otherwise not afford it.  I was very excited to see this system in place because it was an idea I had explored for one of my projects last semester.  If I have time later I may dedicate another whole post to this hospital and everything I learned there. 

We spent the night in Pondicherry and the next day we went to a few tourist places including a place called Auroville.  Auroville is a township where people from all over the world come to live and engage I community living with the purpose to “realize human unity.”  I cannot do Auroville or the philosophy behind it justice here but it was a neat place to visit and there is a lot of information about this online if anyone wants to learn more about it. 

After Auroville we made a few more stops and then returned to Chennai to begin another week. 

Aravind Campus in Pondicherry

Inside Aravind

Architecture in Pondicherry

Architecture in Pondicherry

At Auroville

A Stop at a Salt Mine

Prof. Raj Teaching About Salt in India

Stopped for A Coconut on the Highway

Tourist Stop on the Way Home