26.04.2010

Nithya Krishnan: Community-Driven Intervention Strategy

Progress Reports

Mid-Year Public Progress Report

Gadchiroli, Maharashtra

Nithya, a graduate in Anthropology, Biochemistry and Global Health, is partnered with Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, Maharashtra. For her project, Nithya is developing and community driven intervention strategy for SEARCH on preventative health, with a focus on hypertension. Apart from her project, Nithya is also very passionate about building leadership in the youth of Gadchiroli through Ultimate Frisbee.

NGO Background

The tenets of SEARCH are built on education, action and research in community health. by Drs. Rani and Abhay Bang, who identified a need in the Gadchrioli district of Maharashtra, the couple committed their lives to addressing the problems in the region. SEARCH was founded in 1985 with the vision to provide immediate health care for the villages in the surrounding area, as well as impact national and global spheres through research. As an institution, SEARCH prioritizes issues of women’s health, newborn, child and maternal health, alcohol and tobacco de-addiction and sexual health education for youth. SEARCH is active in both the rural and tribal areas of the district. Above all, the Ma Danteshwari hospital, is a place that is aesthetically and culturally friendly to those seeking treatment. Since its inception, SEARCH has grown to include treating acute problems such as infant/maternal mortality, infectious diseases such as pneumonia and diarrhea to giving attention to the root of causes such as tobacco/alcohol abuse, behavioral change and nutrition.

On a daily basis I interact with a few different communities. Most immediately, I interact with the community at SEARCH’s headquarters, a village-campus named Shodhgram (meaning: Search Village). The Shodhgram community mostly consists of various members of the SEARCH teams and staff as well as patients staying in the in-patient department. Upon arrival, I felt very safe and comfortable within the community.

There is also a group of young people at SEARCH, some of whom belong to a fellowship called NIRMAN. They are bright, passionate, innovative and energetic. Being around them, especially when discussing projects, sends electricity down my spine. It is truly a source of inspiration for me. I am lucky enough that I see my co-fellow Laxmi Chhaya every day. She is a wonderful team mate and a constant source of support and delight.

The other communities that I see on a daily basis are outside of SEARCH. One of the NIRMAN fellows early on told me that there is no reason to not go to field/community every day. Since November/December, I have been in the field if not every day, at least 4-5 days a week.

Using Frisbee, I have been able to connect with people, and it is irresistibly fun to throw and catch a flying disc. In Kudakwahee, a NIRMAN fellow Pawan and I started a Frisbee team. Within the first week, I realized how easy it would be to go there every day just for a few hours and play Frisbee. Community immersion happens over shared looks, smiles and genuine love. And love that community I do.

Another community that I interact with on a weekly basis is a group of girls in Savargaon. I go to Savargaon at least once or twice a week. The original intention was to form a collective to have conversations and push the potential of a group, specifically, regarding public health interventions. I had cold feet for about one month before I went. One day I just did it. I got on my cycle and I went Savargaon. I spoke to the first young girl I saw and before I knew it I was inside their house, playing Antakshri and our group of two became a group of 21. I stayed there from 2pm-6pm doing nothing but learning names, faces and sharing about myself, and listening to their stories. I couldn’t believe how easy and fun it was. A few days after that, I went back. My roommate Chetna and I made ‘prompts’ for acting out plays or mimes on little sheets of paper. That day, we talked about topics from marriage, skin color, gender relations, women’s rights to land ownership. We used the prompts maybe once. The rest of it was initiated by the girls.

With engagement comes challenge. I think that is one of the most beautiful aspects of relationships. The more intimate you are with people, the more you engage them, the more challenges you face. The line becomes blurry between where one ends and the other begins. Previously, I used to let very few people enter my life in such an open and tangible way. Now, I wish to be connected with so many people.

Challenges that I encounter with people in the villages outside of SEARCH are mostly in the realm of communication. Unfortunately, my Marathi is not good enough for me to always communicate what is on my mind. I want to take “easy” relationships and push them to the next level. I want to search for meaning and fulfillment, but it is tricky to do that without language at my disposal. However, this is the type of challenge that I thrive on. Though I love conversations that are deep and meaningful, I believe that the best relationships come out of shared actions; people bringing the best out of one another in shared purpose. I want to encourage that more in my immediate surroundings.

My current strategy is to be completely natural and genuine. I try to let my face and expressions speak for the words that struggle to make sense from my mouth. I want to push myself though and take these comfortable relationships to something more. That something more remains nebulous and undefined, but I know that it teems with possibility and promise. I think the thing about my relationships that has really changed the most is that there is more congruence between my actions, thoughts and words. I used to understand myself within the confines of the things that I could do or the amount of stuff that I knew. Now I am becoming more comfortable with just being me.

The last challenge is the overarching meaning of this fellowship: The challenge of giving back. I have learned so much in the spaces that I have been offered. In both at the SEARCH campus and in the communities, I have taken so much and learned so much. Sometimes I am at a loss for how I can give back, even if only a little. What is the appropriate way? That is my challenge for this year. To find out how I can contribute for everything that I have taken.

I feel very involved in the peoples’ lives around me. I am also involved in the peoples’ lives that are not around me, such as my family. I remind myself daily not to take for granted the people immediately around me.

Project Vision

At first my project was my reason for being here. Now, my project is the vehicle I intend to use as a small gesture for all that I’ve gained from the community. My initial understanding of my project was that it was going to be a classical anthropological and public health study, like I had done in college. I was seeking large scale impact that unearthed new information. However, as it evolved, it devolved. As I began to take a closer look at the project with my mentors Dr. Abhay and Dr. Anand Bang, we realized that there was a lot of ‘research’ in the way of the final goal which is to introduce a participatory intervention to mitigate the symptoms of hypertension and stroke in villages. I felt a little shortchanged that my big important research project was being cut down. But as I began to think about it, my perspective changed. The research was never about me. The research is intended to get the best information possible to get the best outcome as possible. If that requires that we do less research and leave more time for the actual intervention, that is what needs to be done.

The main benefit of the project is that it will address an important part of SEARCH’s relationship with the villages. It will assess the levels of knowledge, attitude and practices of village people regarding hypertension, nutrition, cardiovascular disease, lifestyle and other related phenomena. As this proceeds to an intervention, the benefits could be as large as a behavioral change/lifestyle change programme that dramatically reduces hypertension, or the effect could be as subtle as a few more people knowing a little about this cluster of illnesses. Either way, in my opinion, the end goal is to add value to communities, to SEARCH and to me.

The part that I take the most pride in is conducting the study. I have experienced what it is like to have people right in front of you, yet not be able to see them. Sometimes when we think we have “the best interests” of people in mind, it invokes a paternalistic mindset, though not always intentional. I want to make this as participatory as possible. I want to engage the people that I’m with. I want to get involved in their lives and give them a part of mine. I think that is the part that I take the most pride in. Healing comes in a lot of different forms. Sometimes it is cut and dry. Other times it is knowing that someone is invested in you. I want to see how I can join both together and improve health using happiness and relationships as a way to get there.

I have faith that my contribution will make a difference whether it is immediately noticed, noticed later, or not noticed at all.

Implementation

My major goals from the beginning have been to improve my Marathi so that I am able to have conversations with people and can more easily build trust. I have come a long way from knowing no marathi, to being able to have simple conversations with people. I still understand Hindi (and think I speak Hindi) better than Marathi, but I am still embarrassed to speak it. Other major goals have been to set the foundation of relationships with the people in the study communities and toe the line between project and personal. I used to worry that introducing my project into my friendships would bring tension. I am finally comfortable enough that I feel that I can combine both.

The past 6 months have been necessary for me to learn about myself, for me to learn how to be in India, and to find balance. I have been taking very small, but sure steps up until now. Now I go headlong into my fieldwork, but I feel comfortable doing so because I have set up a strong foundation of support within and without SEARCH.

The goal by the end of the year is to have put 110% of my effort into the project and accepting and being satisfied with what comes out of it, without expecting anything to see anything in return (as in impact, progress, etc.).

Personal Growth

I have changed radically as a person. Always opinionated and political, activism has played a big part in my life. This is the first year in many years that I have not been politically active. By politically active I don’t mean supporting a political party; I mean standing up for what I believe to be social justice, equality and human rights. I have had to face a lot of things contrary to my values in India and I have experienced the spectrum of emotions in doing so. It gives me an insight to what life is like where people, especially women, have less of a voice.

At first I had no other reason for choosing Indicorps other than being able to come to India. Now, I feel that there are parts of the Indicorps philosophy that will stay with me for a long time coming. I respect the importance given to commitment by the fellowship. I think that’s an important part of any undertaking in life. Passion and commitment drive action and I hope that I can live my life with that kind of intensity.

The fellowship has changed my outlook on life in many ways. I used to always think on a macro scale; about society at large. Now I have put faces to those people that make up the so-called society. When we were first asked to read ‘My Experiments with Truth’ before the start of the fellowship, there was one key message that I didn’t understand at all. The part that change comes from within first, and then comes from without. “Be the Change,” it sounds so simple, yet I could never understand how concentrating on me could address any issues around me. Now I believe I understand, if only just a little more, how important it is to inculcate that change in oneself that we want to see in the world. It reminds me of the Howard Zinn quote, “Small acts, when multiplied by millions of people, can transform the world.”

Challenges that I am still struggling with are being confident in my self-worth. I am generally a confident person, but I have lows where I doubt myself or I judge myself based on what my talents are. This fellowship has given me the chance to be reacquainted myself, rather than my attributes. It is refreshing. One day I hope to completely love the skin I am in, and on that day, I will really learn how to love others wholly.

In five years I don’t know where I will be, either I will be in medical school, or I will have decided that professional life is not for me. Either way, I will make a decision that is not too logical but not too whimsical. I will make sure that I am satisfied, while being cognizant that I do not cause trouble for those around me to whom I am accountable. I want to be a good person; do the right thing and live responsibly. I hope 5 years from now, I live a life that my conscience is fulfilled. And I hope that I never give into complacency.

Nithya Krishnan, August 2009 Indicorps Fellow

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