health for the public

as you all know, i’ve recently completed a masters in public health. however, i haven’t had a whole lot of experience in actually practicing public health; whether in research, implementation, or advocacy. in the beginning of my studies i was gung-ho about wanting to be a field worker and a manager of a public health program. but during my very last term i took a class in public health policy – which is basically advocacy to the government, and i realized that this too is a way that an individual or group can make changes that impact a lot of people’s health.

while i’m in india, i’m hoping to get some kind of experience here, while still having plenty of time to spend with my family. not an easy prospect, since most of the NGOs (non-governmental organizations) i’ve found are quite far-off and i’d have to do a lot of traveling which would eat up my day. however, through a contact at Johns Hopkins, i came to know of an NGO in Pune whose director has agreed to give me work that i could mostly do from home – writing and documentation. however, he first wanted me to come visit their office and see their organization in action.

so last sunday i called up my husband’s masi (maternal aunt) in pune and asked if i could stay at her place for a few days. she not only graciously agreed, but really took care of me while i was there - cooking me wonderful dishes, taking me out for my birthday, and spending a lot of time just chatting with me. half the fun of the visit was spending time with her! when satyajit and i first decided to get married, i hardly realized that i’d be getting much more than just a husband. i’d be getting - along with another set of parents and siblings - a wide array of aunts, uncles, cousins and even a grandmother. considering that i barely knew my own grandparents, having one now is really wonderful.

so monday morning i nervously walked into the office of IHMP and met with the director and about half of the people who work with him. IHMP was first a rural-based NGO, working primarily in the villages of Maharasthra. they have several projects they work on, including women’s reproductive health, sanitation in villages, and also, because they are such a well-established organization, training and empowering other NGOs in the state. now they also have an urban center in Pune where they work in the slum areas (vastis) of the city. i think most of their staff are still in the rural areas, but there are quite a few in Pune as well.

one of their biggest projects is a program they have developed in both the urban and rural areas. in each of the villages or slum districts, they have a community health worker – someone who lives in the community and has been trained by IHMP, to do surveillance and education on both reproductive health and HIV/AIDS among the women in their communities. for example, there are 29 slums in Pune – so 29 health workers (all women) who live in and work in their own communities. they conduct home visits, educate women about proper prenatal care (sometimes just encouraging the women to eat three meals a day!) , recording health data about the women, checking each pregnant woman for infections or anemia (and referring them to primary care if any health issues come up). they also educate each woman about HIV and provide practical guidance and advice about getting tested. (IHMP has testing centers and counselors as well.)

these health workers keep track of all the women in their communities, but also have a special focus on MAGs – married adolescent girls. while the legal age for marriage in India is 18, many women in poorer/less educated areas (such as the villages and urban slums) get married much younger – as young as 13! of course these girls have much higher risks for adverse reproductive health outcomes. overall the goal of IHMP is to increase the age at marriage and the age at first pregnancy of these women, thereby preventing low birth weight infants and maternal complications. the community health workers serve as health educators, advocates and role models to the other women in their communities.

i visited one slum area of Pune, Sharadnagar, while i was visiting IHMP. i walked around with the health worker of this district, Sangeeta Pardhe, as she conducted several home visits. i saw her speaking to several MAGs, checking for anemia, encouraging them to eat properly, and recording their health information in her register. i also watched as she sat with one woman and conducted a mini-course on what HIV: what it is, how it is transmitted, how it is not transmitted, and how and where to get tested. all this in very simple language and clear language. (even me being an absolute novice in Marathi could follow what she was saying.) i was really impressed with the program overall and with the dedication of these health workers. in fact, Sangeeta had received the National Woman Exemplar of the Year Award in 2006, handed to her by Prime Minister Manmohan Singh. when i visited her house, she showed me the award and the newspaper clippings of this story. it's women like her who are the true leaders of public health.