Author Archives: Vaidehi

Perceptions of Food in Relation to Illness Narratives

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There are many moments—mostly while studying for two biology exams over
Winter Carnival or going to lab on a Friday afternoon–that I reconsider this
lifelong interest in pursuing medicine. In the depths of Dana or while watching
the sunrise yet another morning, it just doesn’t seem worth it to be pre-med.
However, I find that every time I actually go into a hospital or work with
health issues, the excitement, the interest, and discussion that stems from
those experiences is unparalleled to any other field of study I have ever
pursued.

This past week, I have been working with a volunteer nurse from Canada on
the health coordination for One!’s school in Nallasopara as well as helping
with health check-ups for all the kids in the Khar and Nallasopara schools.
Another volunteer and I created all of the health folders for Nallasopara over
the last couple of weeks since they do not have a medical program there yet.
The children all get quarterly check-ups, but in this case we were triaging
those children that needed the most attention and could be given the care
immediately. For example, although getting a follow-up TB test is important,
the nurse did not have a test kit with her. Therefore, we looked at kids who
had dermatology problems such as fungal infections because that was an ailment
the nurse could immediately take care of with ointment or a prescription. In
rural medicine, you find that what we would think of as the most pressing
issues are not always the first ones attended to by health professionals. A lot
of that has to do with availability of resources, practicality of care, and in
some ways picking and choosing what to “heal.”

In addition, the nurse, Juniper, and I are training a community member with
no prior healthcare experience to be the new medical coordinator for the
families that live in this village (which includes writing down patient names,
deciding who needs to go see a doctor, doing follow-ups, and going with
patients to the doctor and asking questions on their behalf). I have mainly
been creating assessment sheets and questionnaires while the nurse does the
actual check-ups.

It’s been a challenge communication-wise because the nurse speaks English
and the medical coordinator speaks Hindi/Marathi and barely any English.
Because I speak all three and the coordinator feels comfortable speaking with
me, I have been serving as a translator between them.

Having gone on medical brigades and trips before, I am well versed in how to
conduct a check-up. However, I have never served as a translator before so this
task has been challenging for me. On Wednesday, I walked into the make-shift check-up area in the Khar school and immediately had one of the mothers start talking to me about her illness. Part of my research is to speak with families and gather “illness narratives” —-because I have found that the members of
this community start any story or complain about an illness with what they ate
or didn’t eat. Therefore, food has become the crux of any health story I have
ever heard in this community. It’s fascinating for me from a general health
perspective as well as thought-provoking data for my research study. For about
four hours, I sat next to the patients translating between them and the nurse.
These patients speak over three different languages and all of them have
various village dialects that are very hard to understand.

Essentially it was the nurse asking them a question in English, me
translating that into Hindi or Marathi, the patient replying, and then again
translating what they said into English. One of our last patients was a young
mother, about 18 years old with a one year old baby. She spoke Gujarati, which
I do not speak or understand. So this time the translation was from me to her
brother who spoke to her and then translated for me and I told the nurse. If it
sounds confusing—-it was like trying to put together a story from the
viewpoints of three different people. I often had to stop for a minute to make
sure I was making the correct translation and clarifying idiomatic phrases.

This young mother was not eating enough and therefore not producing enough breast milk for her baby. She told me she was eating only once a day so she could save the money her husband made. Her brother, the nurse, and I all tried to explain to her how important it was to eat 2-3 meals a day, if not for her—then for
her baby’s well-being. It was frustrating to see her just smile back blankly. I
felt as if everything was going in one ear and out the other.

And if that was not stressful enough, we had one mother who had sores on her leg from rat bites. She said they hadn’t healed for months and oozed pus every once in a while. When I asked her to show the nurse so we could clean them, she
shied away saying she didn’t “feel good” to let the nurse see her legs.
After some coaxing from me in the sweetest Marathi I could muster, she showed
us and then proceeded to tell me that she took a small butter knife and Dettol
(a brand of antiseptic) and scrubbed her legs raw every week. Upon here the
word knife, I didn’t even translate for the nurse before scolding this woman. I
got flustered and forgot that I was just supposed to be observing. However, imagining someone taking a knife to a wound just made me viscerally react.

And if that wasn’t enough excitement for one day, her son, Saif came in with
white jelly-like material covering both of his eyes. The nurse initially thought it was some bacterial infection, so we gave him a follow-up appointment but we both kept thinking about it after work. That night in our apartment we were going through common eye disorders on the internet and read symptoms on something called xerosis.

Xerosis is an abnormal dryness of the eye in which there is less secretion
from the membrane. Often, the cornea’s luster is reduced. If you looked at
Saif’s eyes, they looked like craters because his cornea was sunken in slightly. In addition, you could see small triangular spots near his pupils. You may be wondering what causes xerosis—-severe vitamin A deficiency. And Saif not only had a deficiency, but he had keratomalacia. Keratomalacia is an advanced case in which a kertain layer (white jelly-like layer) covers the eyes. Saif, like all the other children, gets one meal a day at the school. It consists of a lot of calories, but not many nutrients. A typical meal is rice, a little bit of vegetable like onion and potato, and sometimes an egg. However, the meal at the school is probably his only full meal of the day. The nurse consulted with a doctor back in Canada via email. The doctor’s response was that she had learned about xerosis and how severe it could be in the eye—but in all of her training, education, and practice—she had never seen a real case. It was a disease, she said, that medical students only saw in books. In developed countries, we often forget that what we call illnesses or problems of the past still do occur in other parts of the world in great frequency.

To me though, what was more interesting from an anthropological perspective
was what I heard another female teacher tell Saif’s mother as he was heading
out of the check-up area the next day. The nurse had already given Saif some
multi-vitamins and said she would follow-up with supplements to see if it
helped with his eyes in the next week. However, I heard this teacher speaking
in Marathi and chose to eavesdrop on the conversation. She was saying that Saif
should wash his eyes with rose water daily and use triphala lotion. Triphala is
an herb consisting of three different fruits and in Ayurveda is considered to
be a complete body cleanser and detoxifying agent. This teacher also went on to
say that walking on green grass and green hills would be good for Saif’s eyes.
To me, this last bit was the most interesting because vitamin A is known to be
found in green, leafy vegetables. However, this idea of walking on green, leafy
areas is definitely a traditional folklore type remedy.

Nonetheless, I am beginning to find a focus in my research hypothesis
focusing in on illness narratives and their connection with the food and
nutrition available in this community. Often I find myself asking families,
“Tell me about your illness or what happened last night” and being told
something about drinking a cold drink while having a cold or eating ice during
a hot day. Certain foods are only eaten in certain weather due to intrinsic
properties within them. A bad back or heartburn is immediately blamed on eating
some kind of food that causes an imbalance in the body maybe because it was
eaten in the wrong weather or cooked in the wrong way. Health in this community
revolves around food and what food means beyond its typical nutrient value.

Ethnographic Study of Food Perceptions & Nurturance in Mumbai, India

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By Vaidehi Mujumdar

At Dartmouth, so many of us take off-terms that take us all around the world. Many experiences and stories get lost, forgotten or kept within a small group of people. It’s often the little things–the anecdotes, the frustrations, the process of writing itself, and the important aspect of being able to communicate with others—that lead to personal growth within the various societal, community, and even global atmospheres we all take part in.

For the past month, I have been working with the NGO “One!International” in the mainly urban outskirts of Mumbai to gauge changing cultural perspectives towards food and nutrition. The research constitutes a link between traditional small-scale ethnographical studies and macro-oriented studies of development.Throughout my study, I hope to share my experiences and stories in the field.

Mumbai, located in western India, is home to some of the richest people in the world as well the poorest. This fall, I am conducting ethnographic research on perceptions of nutrition and food in an outskirts town of Mumbai called Nallasopara. I am also working in the Khar area slum inside Mumbai. One! International is a Canadian NGO that has been in Mumbai for about 12 years. I am volunteering as a teacher at the two NGO schools in Khar and in Nallasopara teaching classes in English, Math, Exercise, and Health. I am also building relationships with the children and local families to conduct interviews and follow a small group of families in-depth during my three months in India. The dual roles seemed taxing when I first started, but I realized that I am researching twenty-four seven as I interact with the children, their parents, other volunteers, and NGO staff. Part of my project is to look at how perceptions of food and medicine, both traditional and what we call “Western” are changed by the presence of an international NGO.

One thing I have learned over the last month is that plans are made to be broken. The ethnography process is both challenging and low-maintenance in that it is observation: I’m not running an experiment in a scientific, methodological way with instructions. When dealing with people and participant observation, I have found they lead me to a goal or to a question through how they speak, how they behave, and what they tell me.

Many times I feel as if participant observation, especially in India, is a similar experience to being in a movie.I can just sit outside, overlooking a street, and hear a thousand different conversations in several different languages, see BMWs driving next to bicycles and smell both the fish market and Dominos from the same street. Ethnographic research is overwhelming at times because I want to capture what I hear, see, smell, touch—but I know that a picture, video, or even the most descriptive of words will never do justice to what it feels like walking through the inner mazes of some of the biggest slums in India. Field work is often frustrating for that reason and I find myself contacting my anthropology professor with questions and concerns on how and what and who I should be looking at, asking questions about—and his answer, although guiding, is always vague for which he just says is the nature of this work.

Fortunately, today we finally received good word about a student who had been in a kerosene fire accident about three weeks ago. One of the girls at the Khar school, Kolkila, had been cooking and something went wrong with the stove and she got burned. The flames engulfed her face and went all the way down to her waist. This incident occurred at 5 pm October 6— 35% of her body was burned. Her family immediately tried to get her to a hospital, but was turned down. They went to three different government hospitals, one being a hospital for prisoners and convicts. All of them refused to admit her. Her family immediately contacted One! Teachers, staff, and the director all banded together to see if they could drive her or get her into another hospital.

The wounds Kokila suffered continued to burn from 5 pm until midnight when one of the teachers made a phone call to his uncle. His uncle happens to be the MLA* of the district and because this uncle called the third hospital, Kokila was finally admitted–seven hours later. It took them another hour to take her into the ICU. By then, the percentage of her body burned had increased to 50%. Meanwhile, this girl was conscious and talking. When I heard that she had been waiting for seven hours, I almost hoped that she had lost consciousness so at least the pain would not be unbearable. At 1 am, Kokila was finally in the burn unit where an intern took care of six burn patients. There was no staff—no nurses, ward boys, or attending physicians. The intern had to change all of the dressings for each patient. Each dressing took two hours. He was working non-stop for 12 hours just to provide clean dressings, on top of all of his other responsibilities as a physician.

Walking into a government hospital can be compared to walking into a train station. The only difference is that the hospital has chairs. The school staff that was present when Kokila was admitted pushed her through the wards, transferred her onto the gurney, and wheeled her to her room. A burn patient is generally put into a sterile room, with little to no contact with others because of the risk of infection. Kokila had a possibility of sepsis, organ failure, and several internal infections. Her
entire family, the teachers, and friends were all allowed to walk in without
having to wash their hands or put on surgical clothes. On top of that, there was no air conditioning in her room. The place was unhygienic for a normal, healthy person, let alone a burn victim.

While all of this was going on, I couldn’t help but fixate on the fact that a
government hospital, whose purpose is to provide treatment and health-care for those that cannot afford it, turned away a 14 year old girl who has third degree burns. Although government hospitals are technically free, bribes are basically expected for admittance. Kokila, whose family lives in the slum, obviously does not have money for a hospital stay, let alone an additional bribe. Corruption is present everywhere in India: to refuse to admit a patient because they are too much of a liability is to say that the hospital doesn’t value human life. I know it’s a naive thought and I do not know what kind of pressures these doctors face, however, I just could not and still can not get over the fact that a doctor saw this little girl in excruciating pain, still burning, and refused to treat her. Money is always an issue, but there are also ethics that come along with being a medical professional. Kokila traveled to three different hospitals and if she had not been admitted when she was, she would have died that night.

Kokila fortunately received many donations from One! and this funding allowed for her to be moved to a private hospital, which is more like the hospitals people in the West are used to seeing. She has a full-time nurse, 2 doctors, and is doing well so far. For the last couple of weeks, the doctors continued to say that the next two weeks are crucial and she has a 50 percent chance of survival. Over the last couple of weeks, Kokila has received skin grafts from both of her legs. Now, she only needs a graft from the back of a leg transferred to her shoulders and back. The doctors say she no longer has any internal infections. With the success of this last surgery, she should be back home next week.

The kids at the school all made “Get Well Soon” cards even though they don’t know what that phrase means. They wrote messages that only children can write such as “Kokila, come back soon. I will never fight with you again over the red eraser” or “Kokila, I will share my lunch with you on Mondays.” The slum-area in Khar is a small community, so even the littlest children knew by word of mouth what had happened to Kokila. It really shook the school and getting updates is something that makes everyone feel that they still have contact with Kokila, especially since they have not been allowed to see her. Although we are all grateful Kokila is doing well, I still question how this situation was ethically handled by the healthcare system in India. In the next couple of weeks, the medical coordinator for One! and I will be touring area hospitals and hopefully that will help me better understand how government and private hospitals are structured and operated—shedding light on Kokila’s experiences.

*An MLA is a “Member of the Legislative Assembly.” He or she is elected by voters of a particular district to represent them in the state legislature.