The more you learn, the more questions you have

Today officially concludes my third week in Jamkhed and my second of the training course. The training course will last for 2 months and so far has given a great introduction and perspective on Primary Health Care and what holistic health means and looks like, at least in rural communities. I am taking the course with eleven other people, all working in developing countries – Nepal, India, Sierra Leone and Liberia. Most are nurses but others are community workers, specialists (like TB, leprosy or HIV), or hospital staff. It’s great because they bring very practical experience and expertise that I more or less lack, where as I bring youthful enthusiasm and the perspective from a developed country (with its many undeveloped areas). But even my youth cannot keep up with most of the Africans, who are incredibly playful and bring a sort of excitement and optimism to every discussion – even though they’ve seen and worked with so much hardship and war. Similar to other Western Africans I have met, there’s never a dull moment when they are in a good mood and they bring a sense of purpose and life to each conversation. They also wear their emotions on their sleeves, which has been both good and ‘interesting’, in that you don’t have to look much past the expression on their faces to understand that the session isn’t too interesting.

Over the past three weeks I have been able to also visit the hospital and observe some operations, many of which have been cesarean sections. And I can say there is no more awesome feeling than seeing a baby come out of a person (usually a woman) and seeing how the doctors here work with such limited resources and finances. Over two days last week, I was able to see 5 deliveries, so that when the Africans arrived, the doctor asked me take to the operating room and explain what was going on during the procedure. It was rather ironic, though, as I have never delivered a baby in my life and these Africans had delivered over one thousand babies combined. But if that was empowerment, I did feel it, even though the Africans ended up educating me much more than I did them.

A key principle to CRHP and to primary health care in general is demystification of medicine. Health has been too often defined as the absence of disease, so that being unhealthy means you have disease or an illness and, thus, you can be cured of this disease with the proper diagnosis and prescription. In this way, we have become so dependant on doctors and on medications to make us free of disease and healthy, which puts all the power away from the average person and into the hands of professionals in medicine and the drug industry. Health, though, is not the absence of disease but is rather the complete state of mental, physical, spiritual and social well-being. CRHP works on the basis of Comprehensive Primary Health Care, where equity, integration and empowerment are the essential components to proper health. Equity (rather than equality) in that those who are most marginalized must be identified first and reached at their doorstep. Integration in that care is provided to the person, not the illness, and that all activities that promote health should be integrated into one service. Empowerment in the realization that even the most illiterate can treat illness and cure poor health as well as (if not better than) any doctor, and knowledge should teach people to care for themselves and not create vertical dependency. Poverty is the biggest reason for ill health and treating tuberculosis with medications while ignoring access to clean water and proper nutrition is doing more harm than good. The problems villagers deal with run much deeper than illness and it is those root causes (such as poor nutrition, lack of income, dirty and static water, discrimination and status of women, hygiene, unhealthy traditions and beliefs) that need to be addressed.

And what’s incredible is that CRHP has put the health of the village on the shoulders of the villagers, so that those who are illiterate, cured of leprosy or in the untouchable caste are taking out loans from banks, fighting for their rights, diagnosing illness & prescribing or referring out, taking care of their own nutrition, creating soak-pits to keep water running and creating watersheds. Primary health care is a very simple concept that takes a lot of time and a lot of dedicated people but the results are there, such as in Jamkhed where there is access to clean water and education and zero TB, diarrhea, infant/maternal mortality, and malaria.

In other news, the food is good here, full of daal (lentils), chapatti (chewy naan), and rice, although I presently have a huge craving for some barbeque and spare ribs which will probably not be served for lunch. They also killed a 5 foot snake two nights ago on the path outside my room. It was a python (but I thought it was a cobra… due to my extensive snake experience) and had huge fangs. Regardless of the fact, it is actually relieving to actually have seen one and thus remove the fear of uncertainty, as it certainly will not be the last snake to cross the path.