Final Entry

I’ve told my story a hundred times to a hundred different people. India was crazy, beautiful and life altering. I appreciated every second of it and I would never do it again. It wasn’t India’s fault. Sure the heat, noise, and pollution were pressing but the intensity came from within. I felt trapped in a huge country. The million faces with foreign tongues surrounded me but were wrapped up in their own 9 to 5. I was stuck processing this whole new world with my own thoughts. Oi my thoughts. Were never soothing. But felt like a cracked out energizer bunny on Jerry Springer. It was a manifestation of loneliness. No gaggle of girlfriends to talk me down. Juuuust me. And sometimes some wisdom from old Tom Hanks’ movies. Honestly, India was crazy and beautiful. Crazy and beautiful. Every single aspect and every single day resonated with me. I don’t think I could say that about any other 3 months of my life. There was no vortex of routine. I was living and working things out and growing. I never learned how to cook Mattar Paneer. But I did finally learn how to tie a Saree. And I never found my god. But I’ve started to look more actively now. I’m applying to graduate school. To Public Health programs where I’ll be focusing in International Epidemiology. I absolutely haven’t given up my passion for global health. Working in the slums of Kolkata reinforced it. I just know next time I travel internationally to bring a few friends, or buy a really good internet connection. Below I posted my graduate school personal statement. It’s relevant to my entire stay in India and what I drew from it. Thanks again for everyone who read my blog. And to everyone I didn’t know who read my blog! Reading your emails while I was there was validating and kept me going. I’ll be sure to create a new blog of my adventures in graduate school. Maybe they’ll be called At Africa… Upon my arrival in Kolkata, India in June, I was told if you want to understand India you must first understand the Ganges. It is India’s life force as cyclical and devastating as the monsoon season — feared and worshipped. Life is centered around the great river. People pray along its banks, fill their buckets with the sacred water and carry them back to their families for bathing and drinking. The Ganges’ beauty was lost on me when I first arrived. Armed with my antiseptic-Brita-Filter-mentality, I saw only a contaminated water supply that was transferred to buckets and barrels that created, in turn, vast breeding grounds for disease-carrying mosquitoes. The irony was powerful. The Ganges, the heartbeat of Indian life, is a major contributor to the transmission of cholera, an epidemic that has plagued the nation for decades. Thanks to a research grant I was awarded by the Howard Hughes Medical Institute, I had the opportunity to work for three months at the National Institute of Cholera in Kolkata, India. The award gave me the opportunity to strengthen my research skills and abilities but, more substantially, to grapple with translating research into action and implementation. The entire institute of doctors, researchers, and public health officials worked to answer the question “why is cholera epidemic?” Through my intensive research work in the lab and field work in the “slums” and in the medical outposts, I was introduced to the complexities of the cholera epidemic and the immensity of the challenge to end it. I appreciate the diverse stages involved in the implementation of public health programs. I don’t want to simply treat the symptoms of a disease, but to see it through—from the root of the problem to the realization of the solution, from the lab bench to the vaccine trial, to lobbying for health care reform. My work with cholera was a perfect model of the kind of global health I hope to pursue in my graduate studies. At the Institute, my lab work involved the chitin-binding protein associated with cholera transmission. I studied the promotion of the protein under different environmental conditions such as nutrition, salinity, pH, bile, and temperature. If certain environmental variables are targeted as triggers then perhaps future epidemics can be predicted and prevented. The Institute’s strategies for preventing and treating the disease extended to medical field work and large scale vaccine trials. I had the unique opportunity to shadow doctors in a double-blind randomized phase III trial of the reformulated oral killed bivalent cholera vaccine in an urban slum site in Kolkata. It is manifest that cholera can and should be treated by addressing the issue of the provision of clean water and education related to community hygiene. But until effective prevention strategies can be realistically implemented, the development of a safe, effective, and affordable vaccine is a necessary component in cholera prevention. Just how out of reach prevention strategies like clean water and proper food storage and preparation was brought home to me through my field work. Inexorable poverty, more than the chitin-binding protein, is the host for diseases like cholera. A typical “slums” household consisted of a dozen or more family members sharing a living space of a single room. The household siphons water twice a day from a rusty pipe that comes up through the floor into open barrels. Food is prepared on the floor just a few feet away from the home’s bathroom, which consists largely of a squat toilet. So it is not surprising when conducting a medical history, I found most household members in a typical home have had cholera, and in fact, have had it multiple times. Unfortunately, many children exhibit the long term effects of the disease, including the impairment of physical and cognitive development. Improvements to global public health issues require an understanding of the political, economic, and cultural contexts of diseases such as cholera, in addition to research. The lack of education and economic resources, as well as cultural obstacles, fear, and superstition create awesome barriers to implementation of effective prevention programs. Public health officials who hope to have a positive impact should be competent researchers but they also must have the capacity to interpret, mediate, appreciate, and translate profound cultural obstacles. At the medical outposts, I witnessed firsthand the fear and suspicion people felt for vaccines and most refused to participate. The doctors utilized several strategies for overcoming this, sometimes by paying for the pavement of roads or giving prizes to those who received the vaccine, or even hanging pictures of the Indian goddess Kali on the walls of the outpost. But there were limits to the patience and tolerance of the doctors. When Muslim women with cholera would not have a rectal swab taken by a male doctor, the doctors would give up on her and turn to the long line of other patients. The lack of economic resources was also reflected in conditions and limitations of the Institute’s laboratory facilities. Contrasting sharply with my lab experience at UF, in which aseptic technique is the single overarching rule, I was now working with cholera and carcinogens with no gloves, using toilet paper as Kimwipes and re-using instead of disposing of pipette tips and other lab materials. Water is rationed, even for the labs there are no paper towels or soap. The lack of material resources was also a notable and meaningful new experience. Nothing is ordered from online catalog. If we needed antibodies, we had to raise the mice ourselves. And, when the infant mice we ordered lost their mother (and feeding source), I had to stay up all night to hand feed 19 infant mice with a syringe. I collected pond water leaning over the sides of bamboo suspension bridges, in the rain. When there was a transport strike, I had to walk the 4 hours to work so that I would not lose the work and results of a weeklong experiment. The difficulties I encountered are just the tip of the iceberg for public health researchers and providers. For me, studying Cholera was a compelling experience. Not only is it a research challenge, but its transmission is exemplary of so many of the public health issues facing vulnerable populations in developing nations around the world: limited access to prevention services, inadequate financing of health and prevention programs, and, sadly, a lack of commitment to a basic human right to clean water and sanitation. Studying cholera has allowed me to wed my considerable research skills and experience to my interest in and commitment to furthering social justice issues. My involvement with activism in the university and community has taught me the rewarding complexity of social and political justice which I hope to translate to a career in public health. The work in India was challenging just as I imagine my future work will be. Questioning people’s medical history in the “slums” felt intrusive. The medical outpost barely had enough medicine for colds yet was constantly confronted with every scary disease from drug resistant tuberculosis to leprosy. On the clinical days, it was hard to understand and work with a person who would neither take a vaccine nor give one to their child. An entire day of lab work could be lost from a single power outage. The challenges facing global health are endless and multifaceted. I want my graduate studies to teach me to strengthen the understanding of the major health issues of vulnerable populations. The questions that jump off my lab bench are the questions that confront public health. They are the global questions of culture, class, religion, complicated with history, stories, and a juxtaposition of worlds. But they are relevant and urgent and the questions that I want to be answering for the rest of my life.

Children in the slums