Holy Cow - Jeff's Leaving India

My strengths lie in speeches, acting and drama. But these are not skills I have known my whole life. These skills have been derived from her taking the time to get to know me and understand what I would be good at. She helped me to learn appropriate facial expressions and gestures. She always strived to make me and others as perfect and whole as possible, never leaving things half-finished or incomplete. She made sure that the same person finishes the task whom she assigned it to, correctly. She was fearless.

Even though she is physically not around us anymore, she still guides all of us, so much so that every single morning I cannot start my work until I pay a visit to her memorial site. I have done this every morning for nine years, and my experience is that work goes much smoother with the leadership she still plays in my life.

- Ganpatrao Waibhat (CRHP Worker since 1971)

I remember a story that has since changed my life: Once, we were a little late to Mandli village and there was a leprosy patient sitting under a tree. His fingers were fully deformed and he was not able to break the bread he was trying to eat. She noticed it and went close to him, took his bread, and broke it for him. The patient said “madam, please don’t do this, what if you get leprosy?” She replied “I cannot get leprosy by touching you or your bread. The disease does not spread like that, so you don’t worry about me getting it.” Her love shown for leprosy patients, displayed to the village by cleaning their feet sores, made me very upset that I avoided touching leprosy patients. Yet such a big doctor breaks the bread for him! Slowly, her examples helped me to start to adapt this way. Today, if any leprosy patients come for x-ray, I feel very comfortable to touch them. For the last forty years, I have been working and chatting with them.

People always said good things about those who have passed away, but I genuinely, from the bottom of heart, thank her for what she has taught me professionally and personally.

- Moses Gurram (CRHP Worker since 1972)

As I leave Jamkhed and begin to head home back to the states, I am given the opportunity to look back on my own personal growth and what I have learned. Perhaps more interesting, though, are those I have learned from. One of the most impressive people I have met since I arrived in Jamkhed has been Mabelle Arole. However, Mabelle died in 1999. Over the past five to six months, I have worked with a social worker to interview and collect the stories and memories of Mabelle from those who knew her best - thirty seven village health workers, villagers and staff members.

One of the challenges that CRHP seems to face in the future is to continue to push the organization forward, be innovative and exemplify a sustainable, equitable and integrated mission. This is still done well but it will become more difficult when the original staff, those who knew the initial struggle s faced by CRHP and the dependence on a vision and values, begin to retire. To help keep Mabelle’s stories alive and her spirit active in new staff, the video hopes to capture the original struggle and soul behind CRHP.

But it is not difficult to still feel Mabelle on campus. Every village health worker continues to speak of her. Her memorial site on campus is visited daily by staff. People live their lives based on the teachings she gave them. Through the interviews, I was amazed at how many little things about Mabelle people remember. It is those small things that really seem to touch people, that people remember the most. Mabelle never wore jewelry, her sarees rarely matched, she at times wore her shoes on the wrong feet, she laughed loudly and openly, she would rush out of bed if a patient came or VHW called, and she lived a simple life. She brought life to villages upon arrival and every visit used to be a community event. People would sit and listen to her speak, believing not only in her intellect but in the fact that she was one of them. And that seems to be one of her biggest contributions – she made each person not only feel empowered, but made them believe that others are equally good. She truly believed in the power, goodness and strength in each person and people feel alive by having known and spoken with her.

A common theme to the interviews was the feeling of one large family. “She cared for her family just as she cared for us. The world community seemed to be her family,” Yamunabai said, a VHW in Ghodegaon for 30 years. And she worked to spread primary health care and women’s rights around the world, working with the local, state, and national government. She was regional director to UNICEF for Southeast Asia, working in Kathmandu, Nepal, and she was a member of the Christian Medical Commission and World Council of Churches. Her greatest legacy, however, lives in those she continues to touch and the leadership she continues to play at CRHP, nine years after her death. “She taught us how to care for the problems of others. How to love others. How to participate in the sorrows of others. She guided us throughout our path. She taught us how to struggle in order to achieve something bigger. She gave us the gift of a lifetime-courage. This will help us as long as we live.” - Sofia Bee Shaikh, VHW in Patoda for 32 years. I feel so proud to have completed a fellowship in her name.

My eleven months in Jamkhed have ended and I almost ready to go. I am excited but very sad and I would certainly be able to stay here for one more year if need be. The people I have met, the things I have done and learned, the projects I have worked on, the food that I have eaten have all been much better than I could have asked for.

Before arriving in Jamkhed, I did not know what primary health care was, but now I hope to dedicate my life to its principles. I had no understanding of community development, yet now I hope to be a doctor to serve the needs of the community. There are a couple key lessons that CRHP has taught me that I will quickly point out:

One – It doesn’t matter how smart you are, or how much money you have, or how well connected you seem to be. What matters when it comes to success is a die-hard commitment to the community, especially those who are most vulnerable and needy. In fact, I have come to find that money and intellect can serve as barriers to really being able to work with the community.

Two – The work done with the community needs to be based not on finances, not on theory or formulas that have been shown to work, not on great ideas, but on values. Values like love, equity, trust, humility and confidence are the pillars of a successful organization and project. Without them, struggles and uphill battles cannot be overcome. And these values need to be reflected in every staff member.

Three – The true caretakers of the community and the family are women, and that very often they get little of the respect they deserve. The women are the ones who are constantly there for their family, who work their butts off to make their family safe and healthy, and yet who rarely share many of the luxuries that us men share. Even in America, I have come to realize that women are often mistreated and not allotted the full status they deserve.

In Jamkhed, I leave behind cows in the middle of the street, tea stalls at every corner, the extremes of rain and heat, and people defecating on the side of the road. And I have little idea how I will be able to readjust back to life in America. Tea is 100 rupees in America (2 rupees here), haircuts are 750 rupees (25 rupees here), and I can’t be stuffed with delicious Indian food for under 1000 rupees (250 rupees here). I leave Jamkhed happy not because I am leaving, but because of all I have gained.

I encourage you to help Jamkhed in the future, visit if you can, or read the Jamkhed book if you have the time. I also ask that you help CRHP financially, with however much money you can give. Every little bit counts and your money will be well spent at CRHP, as their overhead and staff costs are kept at 20%. If you have read this blog, or if you have spoken with me over the past year, you see the incredible work CRHP has done and continues to do. If you are interested in donating anything from $5 to $500, you can visit www.jamkhed.org.

Finally, I want to say thanks to those who have followed my blog and kept up with me over the past year. The blog has given me an opportunity to write down my thoughts and experiences, as well as keep in touch with friends and family back home. These conversations and posts have played a big part in my hope to fully grasp what I am experiencing here.

So now that we’re in rural India, where’s the poverty?

As you drive from urban Mumbai or Pune into rural Maharashtra, on your way to Jamkhed, the scene changes quite dramatically. Big buildings are traded in for tea stalls and hair cutteries, computer stores for paan and tobacco shops, cars for cows, and traffic five lanes wide for traffic in the game of ‘chicken’ with the opposing driver. Concurrently, the poverty also changes and many might ask where it went. In the city, poverty is in your face – men, women and children sleeping on the streets, claiming a piece of sidewalk as their own, wearing torn clothing and covered in dirt asking you for money. Many have disabilities – no legs, one eye, leprosy, or scars on their face. The concentration of poverty in cities is greater, with slum houses stacked on top of each other and men sleeping in their rickshaws if they can get off the street. For many visitors, urban poverty is overwhelming and leaves you questioning yourself and a system that permits such overt struggle and inequity.

And then you travel to rural areas and that poverty seems to disappear. Sidewalks no longer exist and people do not sleep on the streets. You say that it’s better in rural areas because at least the poorest sleep under a tent made of hay or tarp rather than uncovered on the sidewalk. It is much rarer that someone comes to you asking for money. Twenty years ago, Dr. Arole tells how it was rare to see a village woman without patches in her only saree. Yet today, you’d be hard struck to find a woman who does not own at least two to three sarees, none with patches. Where as twenty years ago people barely had any food, families now have bags of sorghum grain stored for difficult times. Twenty years ago only the rich had goats yet now the majority of families seem to own buffaloes, cows, goats or chickens. Even the poorest of villages can seem better off than the conditions faced by the homeless and poor in the cities. So where is the rural poverty if you cannot see it? How do you explain the statistics of high rural poverty when it is so much more transparent in urban areas?

To understand where poverty exists in rural areas, one must look a little deeper than appearances. One major cause of rural poverty is access – to government services, health facilities, higher education, and transportation. In rural areas, 36.5% of children are immunized and 36.9% of pregnant women receive at least three antenatal care visits, compared to 56.6% and 70.1% in urban areas, respectively. In the public sector there are 1.5 physicians per 10,000 inhabitants. Even when facilities exist in remote or underserved areas, posts often remain unfilled due to the financial draw of private practice, exemplifying why not one caesarean delivery has been done in the Jamkhed government hospital in the past ten years. Doctors, teachers and government officials prefer to live in cities, dragging appropriate health facilities, good educational opportunities and access to government resources away from rural India. The anti-poverty programs that have targeted rural India are ineffective and inadequate, often ending in corruption or mismanagement so that the funds and services meant to assist rarely make it to the needy. No program exemplifies this better than the Anganwadi worker program (established by Integrated Child Development Services) or the National Rural Health Mission and their Accredited Social Health Activist, both of which are meant to combat rural poverty yet are stuck in beaurocracy and inefficiency.

Poverty can also be understood in the dependence on agriculture for income and how unforeseen occurrences in weather and crops can disable a family for years. If there is a famine, or if there is too much rain, or if the cost for machinery is too high, then the crop is disabled or ruined and there is little to sell in the market and thereby no daily wage. For farmers without land, drought or insect infestation can mean no work for two to three weeks. For a typical family with little savings, a bad year or crop can mean taking out money from a bank or money lender and paying it back over one, five, ten or even more years. At times this dependence on the farm for income leads to women or children working on the land. For rural women, this is particularly hard due to their requirements also inside the house and raising children, or if they are pregnant. For children, working often replaces education.

When I asked Dr. Arole why the poverty numbers are so high in rural areas when it seems to have changed so much from twenty years back, he explains that it has much to do with the inequality between rich and poor. In the past twenty years, rural women wear more sarees and eat more consistent grains, yet their growth out of poverty has been much slower than urban growth into wealth. And compared with 20 years ago, the gap between the rich and the poor, even in rural areas, is growing. 21.1% of the rural population lives on less than 356 rupees ($7.5 – rural poverty line) per month, and 15% of the urban population lives on less than 538 rupees ($11 – urban poverty line) per month. And with poor health facilities in rural areas, 77% of outpatient cases in rural areas are seen by private doctors who have bills in the range that only the rich can pay. When a family earns 50 to 60 rupees per day, a medical bill from a private doctor can put you in debt for months to years, considering the average expenditure per hospitalization in rural government hospitals is 3238 rupees ($67) compared to 7408 rupees ($154) in rural private hospitals. Given the low level of services in remote areas, it is little surprise that the infant mortality rate for rural areas is 79.7 per 1000 compared with 49.2 in urban areas.

In addition to debt from unanticipated occurrences such as a medical bill or drought, financial strain also arises from rural families spending for marriages, feasts, or other social ceremonies. If the daughter is due for marriage, her family not only pays for the wedding ceremony but also for the dowry which can range from 10,000 to 500,000 rupees. And considering the fertility in rural areas is 3.07 compared with 2.27 in urban areas, the chance of having to arrange the marriage of two daughters is higher in rural India.

Finally, it is essential to recognize that statistics are just that – numbers. Poverty can be just as debilitating when it is taken as a mindset. For example, I lived with a family in a village for two days and during conversation they said they were poor and wondered how I could live with them. I was surprised to hear this as they ate three meals a day, all the men were employed and their babies looked healthy. They have plenty of space in their concrete house and even had many goats. Over time, I came to find that their lifestyle met basic needs and they had little to no luxuries. One of these luxuries very much includes freedom, something that they see as effervescent in cities.

For women, this freedom and escape is even more evident. While housing and meals are consistent, their life is still very much subservient to that of the husband. Her life outside the house is limited and there was little to take her away from the duties of daily life (the daughter-in-law I observed left the house twice the whole day – once to clean the clothes and the other to fetch water). She never eats outside the house nor travels to cities because of the money associated with a vacation, where as for a man it could be work-related. Yet men very much view their freedoms as limited in villages as well. So while the appearance of poverty may have been reduced, there is still very much the feeling of mental impoverishment. And this mental poverty becomes even more entrenched with debt, unexpected occurrences, and the Hindu philosophy of karma and accepting the circumstances of your life.

Where the average daily laborer makes 50-100 rupees per day working on a farm, the idea that in the cities they can make over 500 rupees per day is always in their mind. If given the opportunity, many men migrate to cities, at times alone and at other times with their families. These migrants tend to make up the urban poverty, as they eventually find their home in slums or on the sidewalk. However, if they get a job as a rickshaw driver or helping to construct a hotel, that brings in more money in three months than would one year of village work. The ambition and dream of many rural boys and girls is to work and live in the cities.

The message I hope to come across is twofold. First, I hope to give a better understanding of the causes of rural poverty and why you may wonder where it is when you come to visit villages. Second, I hope to explain the differences between what poverty is like in rural areas versus in urban settings, and why so many prefer to live in an urban setting, where to us it may seem dramatically worse.