Tuesday, January 15, 2013

Public Health in the Developing World

After lunch, we took a bus ride to the north of Delhi where we continued our discussion on air pollution and public health concerns in Delhi. We revisited a number of issues and concepts regarding quality of life indicators, like housing, food security, poverty and public health.

After lunch, we took a bus ride to the north of Delhi where we continued our discussion on air pollution and public health concerns in Delhi. We revisited a number of issues and concepts regarding quality of life indicators, like housing, food security, poverty and public health.

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Caption: Waste cleared from a clogged open drain, left to dry before being discarded elsewhere.

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Caption: Young men working on repairing sewing machines amidst food markets and homes.

Our first stop in the settlement was the Urban Health Resource Center, a neighborhood organization that provides a plethora of information and services to residents on matters ranging from education, nutrition, personal health, and government resources. They also provide specific information catering to the specific needs of pregnant women, widows, and the elderly. The organization appears to be doing great work. However, one barrier to providing the ideal level of services was the fact that many women were unable to access UHRC directly (due to distance, safety concerns, or household obligations) resulting in many of the staff to make home visits.

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Caption: A guide for a daily meal plan for pregnant women. Translation- Breakfast: bread, butter, milk; Lunch: dahl, rice, green veg, wheat chapati; Supper: fruit, sprouted beans/grains, soup, biscuits; Dinner: Mattar Paneer, spinach, potatoes, roti, fish, kheer

One stop in our tour was the home of a student of UHRC. UHRC visits this home regularly to hold classes for 18 local women to teach them how to read and write Hindi, among other skills. The household was a multi-generational family of 14 people, with 4 rooms, each lit by a single florescent bulb. A small kitchen was tucked under a set of stairs - the stairwell to the roof provided the only means for ventilation. The house was quite orderly, and about 20 people (half students, half local women and children) fit snuggly into the largest room in the house.

In our discussion, we spoke with the local women about their daily lives, and what they felt contributed to the instances of poor health in their community. Surprisingly, there was consensus among the women that the stresses of maintaining the home and raising their families was the greatest factor undermining their health, an answer that may have defied our expectations considering our focus on environmental conditions. They also expressed frustration at the lack of cleanliness in their community, but my impression was that it was more of a nuisance than a health concern.

As we spoke further, we discovered that the homeowner we spoke with was in fact her husband's second wife. His first wife had died young, at age 45. Her cause of death was not known for certain, but the women believed that it was respiratory-related. Reflecting on this, while we were surprised that the stressors of daily work were what the women felt compromised their health the most, would they (or could they) understand the extent to which air quality affects ones health. Do we?

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The lasting impression in our tour of the neighborhood was the walk over a bridge that crossed over a "nala", or open drain, whose water flowed slowly in a black, viscous slurry. In the dry season, the only water flowing here was wastewater from homes, businesses, and workshops in the neighborhood. The sight alone was overwhelming, and while the smell was unpleasant, it was certainly subdued by the cooler winter weather, with temps around 60F/15C (summer temperatures easily reach 110F/40C). The banks of this stream were lined with trash, since no formal waste collection system exists here. While we had seen many small, open ditches throughout the city, this was our first glimpse of a major open wastewater channel.

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From the smoky haze that looms over the city through the windless winters, or the open channels that carry wastewater from any variety of origins, India is undergoing a metamorphosis similar to western countries at the time of the Industrial Revolution - pollution, health effects and all. Can India learn the lessons of the West and curb its pollution while continuing its unprecedented growth, or is are these effects simply growing pains required for any country to transition into first-world society?