So what ARE you doing anyway?

Greetings everybody who happened to find your way to this blog post. Just to let you know, the title of this webpage TOTALLY does not apply to Raxaul. Boy would it have been nice to end up close to the Himalayas. While I am on the border of Nepal, there are definitely no mountains to be seen. Apparently you can maybe see them if it rains and the thick clouds of dust, smoke, and pollution clear out, but that isn’t likely to happen. So what am I doing here, halfway around the world? As most of you know I am here doing my public health practicum experience. What I have found is an excellent hospital that is running effective community health programs in one of the most difficult places in the world to live.

Just a little bit about Bihar and Raxaul, if I haven’t mentioned it yet.  Bihar is the poorest state in India. The weather here is a sweltering 115 degrees at times during May and June (looking forward to that for sure) and then down in the 30s and 40s in the winter. In June and July there are yearly floods that drastically affect the life, culture, and economy of this border state. Raxaul in itself is pretty safe, at least from what I can perceive walking around. In Bihar there are known to be several trouble-making factions, both the nationalists Indians that want a very pure, Hindu state and Maoists or communist revolutionaries inspired by Mao Zedong from nearby China to the north. This makes travel a difficult matter if you deviate from safer forms of transportation like public trains, etc and makes road travel quite tumultuous. 

The other night I had a good talk with Dr. Sunil, the hospital director, and was asking him a lot about his life, what it means to be a leader in a large, medical-missions organizations, and thoughts on being a rural physician.  I asked him, “So what is the best thing that Western physicians can do to serve EHA?” I was surprised by his answer. What he didn’t say was “Please come here and work” or “Give us more money.” Instead he said “The best thing you can do is to come and do research and teaching to help us learn how to do what we do better. We are always very encouraged by doctors that take an interest in what we are doing out here. We appreciate the exchange of ideas and being able to show people what we are doing at Duncan…Sure there have been Western doctors that have sold everything and moved here to work with EHA, most of them have helped to set up educational programs, etc.” I was very shocked by his answer. I think the answer, in my limited perspective, would be different in an African vs Indian setting. EHA, and I think Indians in general, are less apt to desire “aid” than maybe some other systems the West has created.

His comment left me thinking about a comment I had made in my Bible, who knows how long ago. It comes from Acts 15, just after the Jerusalem Council decides to let Gentiles be a part of the Church. It says “So when they were sent off, they went down to Antioch, and having gathered the congregation together they delivered the letter. And when they had read it, they rejoiced because of its encouragement. And Judas and Silas, who were themselves prophets, encouraged and strengthened the brothers with many words.” I wrote in the margins that this should be an example of how we are to go about doing short-term missions. Part of the beauty of the body of Christ is that we get the gift of travelling halfway around the world to find believers who are striving for a common purpose, and through the Holy Spirit we are able to encourage them and be “mutually encouraged” as Paul would say in Romans 16. This adds a good bit of humility to our efforts and gives a healthy perspective to goals and sense of accomplishment in our travels. My mind has been racing with a lot of the implications of my conversations here with respect to long-term ventures, but we can save that for a later date.

Getting to the point, since I have been here I have found myself doing precisely what Dr. Sunil described was most helpful. It is really easy, when you are overseas in a drastically different setting like this, to be overwhelmed from the stark contrast to life in the States. I would have to admit that I have experienced more of that than I was expecting. That overwhelming feeling typically leads students to spend their time separated by the language barrier and standing back observing all the crazy stuff that is fun to write home about without ever doing much of anything. I’ve been very frustrated that I haven’t had much awesome stuff to write home about, as if many of you cared about most of the gross/exotic/sad things that I really get excited about. In my 12 days here in Raxaul, I’ve been on rounds with all the teams to get familiar with the hospital, spent some time in the outpatient clinics, been to the OR twice, and haven’t delivered a single baby yet. What I have been doing is spending a TON of time learning.

My goal here as part of my practicum is to create a formalized research study using focus groups to draw out social and cultural barriers that exist in the community that may be impeding the delivery of obstetrical care and, in part, contributing to the high maternal mortality in this state. Whew, that is a mouth full. While I haven’t delivered a baby yet, I’ve spent a lot of time being familiar with who does in the state of Bihar. I’ve been learning how to organize a research project from background literature reviews, to getting institutional approval, to writing out research plans, and organizing the intricacies. All of this is in an effort to leave them with some bonafide information that can help in shaping future programming in the community health department. Additionally, I spent a fare amount of time this weekend working on pulling charts for an internal chart review that Bethany and I will work on once the maternal mortality project gets underway and she finally gets here. We will be looking at all of the neonatal mortality cases and seeking to help them get funding for a neonatal resuscitation grant from the WHO. On top of that I have been trying to do presentations at every opportunity and be a part of all that is going on here.

All in all, things are shaping up nicely. I am really looking forward to getting into the hospital more, but this is my public health practicum so I have to be dedicated to that first. All of this work has been very paper work heavy on the front end, but I am leaving tomorrow to get out in the village and visit the antenatal clinics. I wish that I could keep you posted on everything, but this is already long enough. Thanks for making it this far. Peace.