The Role of Primary Care Centers and NGO's

“Since 1955 till 2004, our country had a vertical leprosy program, which has been merged with the GHC system”

One of the debates that my GPP 105 Literature Review tried to address was the role of Leprosy NGOs, along with the role of the government clinics.  Many of the articles I read stated that integrating Leprosy treatment into Public health centers was effective, and there was no need for NGOs to treat Leprosy patients.  As a result, I concluded that the role of the public health centers was to detect and treat Leprosy, while the NGO’s role was to diagnose and treat complicated cases of Leprosy and have disability prevention programs.

However, everything I have witnessed so far has shown me otherwise.  My experience in the Bombay Leprosy Project has shown me that Leprosy is an extremely complicated disease, and is very difficult to diagnose.  There were several cases that I have witnessed in which the patient went to see a general practitioner and the general practitioner was unable to correctly diagnose the patient.  For one case, the patient was undiagnosed for several years, resulting in him infecting many of the people close with him.  Instead of referring him to BLP or a dermatologist, the general practitioner tried to treat the patient by giving him injections.  As a result of the patient being left untreated, not only was his bacteriological index extremely high, but his sister displayed hypopigmented patches, one of the signs of Leprosy.

This is one of many cases in which the patient was left untreated because of misdiagnosis.  Another patient visited not only a general practitioner, but many other physicians before he was lucky enough to have an orthopedic test him for Leprosy to rule it out.  There is no proper way as to how Leprosy should be treated.  By integrating Leprosy into the General Health System, there has been less of a stigma towards the disease.  However, general practitioners need to be aware of the signs of Leprosy and when they should send the patient to a Leprosy NGO.  In order to aid in Leprosy eradication efforts, Leprosy must be caught early in order to reduce the chance of disability and infection to others.  People diagnosed with Leprosy should be sent to Leprosy NGOs in order to be treated, manage reactions, and start disability prevention programs.   

Homeless Visit

Homeless encampment at Mumbai Central

Today, I went to visit a homeless camp as part of my Friday St. Xavier’s College class.  The first part of my visit consisted of a visit to Pehchan in Mumbai Central.  Pehchan is an organization dedicated to the empowerment of homeless individuals.  In order to do this, Pehchan teaches them their rights, provides and creates employment opportunities, creates awareness about homelessness, and fights to give them their identities and rights.  In Pehchan’s office, I learned that many of the homeless are workers who either do not have proof of citizenship or cannot afford to live in Mumbai.  These individuals have been repetitively harassed by the police, evicted from their place of stay and have had their belongings confiscated, robbing them of their dignity.  Some are even sent to beggar camps for periods of time in order to “clean” the streets of Mumbai.  Unlike America, there are no government programs to help the homeless. 

Image taken from Pehchan

For the second part of my visit, we went to visit a homeless encampment in Mumbai Central.  The homeless encampment was surrounded by two luxurious golf courses, showing the juxtaposition between the two.  As we entered, even though we were intruding on their space, the community welcomed with open arms.  As the women started telling us about their story and struggles, I thought about one word—resilience.  Even though they’ve been neglected and pushed away, they still had hope.  This is shown as the women walked up to us to tell us about her community’s situation.  Not only that, but they embraced Brijesh, the director of Pehchan, like he was family.  They talked about how grateful they were to him and everything that he had done for them.  

Uncomfortable Moments

During my time in India, I realized that there is no such thing as space and privacy.  So far, I’ve had four uncomfortable moments in India.   

Moment #1

On July 25, 2014, a group of us decided to visit Elphanta Island before the monsoons arrived.  The journey to Elephanta consists of a 1 hour ferry ride to the island, costing Rs. 150.  When we tried to go upstairs on the ferry, the crew requested a fee of Rs. 10 per person.  We thought that the group before us was able to get on the top for free, so we started to argue with the crew.  However, a group of men paid for us, and we were able to go up.  Nevertheless, I learned that nothing is free.  While we tried to enjoy the view, the men were constantly bothering us to take pictures with them.  We felt extremely uncomfortable and violated.  One of the men kept harassing my roommate, trying to force her to take a picture with him.  When that failed, he tried to take a picture with only me, trying to coax me into sitting on his lap or kissing him on the cheek.  That incident made all of us extremely uncomfortable for the rest of the trip, especially since we kept seeing that group of men around the island.      

Moment #2                    

While my friends and I were visiting the Elephanta caves, many people also kept taking pictures of us without asking for our permission. 

Moment #3

                On the morning of July 10, when I got off my stop, I was immediately greeted with whistles and cat-calls from the men in the train. 

Moment #4

                During the weekend of July 12, I decided to visit Ellora and Ajanta caves.  There, I was swarmed with many Indians asking to take a photo with me, or taking photos of me without my consent.  It got to the point that I could not walk a couple steps without being asked to take pictures with people.  Even refusing was difficult because I would feel bad when kids asked and it did not stop others from approaching me.      

Moment #5
                 After getting off at CST train station, I flagged down a taxi.  The driver and I began to argue how much the taxi fare should be--the driver wanted 50 rupees, and I was requesting the meter price.  After settling on the meter price, he began to try to talk to me, I felt uncomfortable so I tried not to talk to him as much.  Near where I usually got off, he parked the car in a dark corner between two buses.  Immediately feeling unsafe, I told him I wanted to get off and paid him.  As I began to get out, he reached out to shake my hand.  When I shook his, he used him index finger to stroke my palm.  After that, I immediately got out.   

                To me, all five of these moments violated my privacy and made me feel extremely uncomfortable.  It reminded me about the article by the girl from Chicago, about how uncomfortable she felt in India.

  

The ferry ride to Elephanta could have been avoided.  If we paid the fee instead of letting the men pay, then we would not have felt that we had to take a couple of photos with them.  I noticed that if we were back in the US, we would have snapped at the men and threatened to report them for sexual harassment; however, since India was not our home country, we all felt that we needed to be respectful and not cause a scene.  Nevertheless, even though the men were clearly in the wrong, we should have made an effort to at least scare them away from harassing us.

When I talked about the ferry ride with someone at my internship, he told me that there was no reason in trying to be respectful towards the men since they were clearly in the wrong.  He told me that they probably treated us like that because of the common misconception that foreigners were “easy.”  He said that if they kept on harassing us even when we said no, we could have yelled at them or even slapped them. 

The photo-taking was extremely overwhelming for me.  When I tried to think about it, I realized that with America, there is a diverse group of people and cultures, and such a thing does not exist in India.  Although the stares and the photography made me uncomfortable, they did not mean any harm.  Many have probably never seen an Asian or Caucasian woman before, so seeing people from other countries is a huge thing.  Also, to us, it seems like we’re overwhelmed by the amount of people asking for photos, but to them, it is only a couple of photos since they cannot tell how many people are asking for photos. 

I’ve also learned that one’s initial impression may not necessarily be correct.  One pair of guys followed me around the temple of Ellora caves, and I was extremely freaked out.  When I took a picture with a family, I was nervous and I tried to stay close to my friends.  Finally, one approached me, and merely asked me for a picture.  After taking pictures with the guys, both left immediately.  Turns out that the two guys were too shy and nervous to approach me until they saw the family ask me.     

 The thing I must stress is that these moments could have happened anywhere in the world, even in your own neighborhood.  I've documented these moments to let people know that even while traveling, one must always still be cautious of his or her surroundings and interactions.

Although I've posted these uncomfortable moments, they should not be used to make any generalizations about India being an unsafe place.  To me, Mumbai is still an amazing city with such a rich culture and amazing people.  These five incidents are only a few of a tremendous amount of different experiences I've had in India.  

Vimala Centre

Today I went to Vimala Centre in Versova, a Leprosy Hospital specializing in inpatient care.  This hospital was an example of vertical integration, as the care given was Leprosy-specific and patients with ulcers or disabilities stayed in the hospital for continuous treatment.  This visit made me even more grateful for choosing to intern at Bombay Leprosy Project, and showed me the difference between Leprosy NGOs. 

Vimala’s facilities were a lot nicer, as the complex was huge compared to BLP’s facilities.  Most of the patients in Vimala had Grade II deformities, significantly more than those at BLP.  When I asked about ulcer and disability care, the employees told me that they were only offered as part of inpatient care.  This showed me the emphasis that BLP put on preventative and self-care. 

The second part of my visit consisted of visiting the inpatient rooms.  This visit made me extremely solemn, as I saw at least five beds crammed in one room.  Many of the patients were missing limbs and had deep ulcers.  While some were grateful for the care they were getting, others were extremely sad.  One moment that I remember extremely well was when I entered a room and I noticed a patient curled up and shaking.  While all the others seemed to welcome our visit, the man was curled up on his bed shaking.  Because at BLP, I am able to interact with patients, even with a communication barrier, I tried to approach the man.  However, the man turned away whimpering.  This interaction prompted me to ask the employee about psychological services, in which she told me that there were none. 

The inpatient rooms seemed very lonely, as none of the patients I saw had visitors.  Instead, they were surrounded by reminders of the disease they had.  This made me realize that the integration of Leprosy care into the General Health System was a good thing, as it helped get rid of the stigma towards the disease. 

Overall, my visit to Vimala Centre was an informative one, as it showed me another approach towards the treatment of Leprosy.  Vimala Centre stressed immediate care of the patient, while BLP stressed both immediate and preventative care of the patient.