I keep reminding myself I’m in India, on the other side of the world. I’ve finally branched out from the Americas to the farthest away I’ve ever been from the United States. I definitely felt that distance when traveling here to Guwahati. A six hour flight from LA to New York then a 24 hour layover followed by a 14 hour flight to Dehli and a 2 hour flight the next day to Guwahati. Now that I’ve been stuck on an airport runway on a slab of ice for 6 hours in the middle of a blizzard and only slept a few hours on the airport floor, I can travel anywhere.
When arriving in Guwahati, we drove through the streets on the other side of the road winding through other cars, buses, motorcycles, people, bikes, rick shaws and cowdogs. We call them cowdogs because they are cows that wonder and live like stray dogs! I also noticed the different dress and face/head decorations. The two principal religions are Islam and Hinduism and for the most part these days live peacefully.
So I left LA Wednesday morning and arrived in Guwahati Saturday afternoon just in time for the last bit of screening for the day. We met most of the team and got an overview of the screening process. There are about 8 stations – registration, patient image (photo), plastic surgery, anesthesiology, pediatrics, dentistry, speech therapy and laboratory. The children and their families arrive via bus from the rural districts outside Guwahati, so they are mostly farmers. Then it takes about 1-2 hours to go through all the stations and they find out that day if they are scheduled for surgery or not. For our study, since we are only including those who will get surgery, we won’t be administering our questionnaire until the days of surgery when they come in the day before for hospital admittance. So the past few days we’ve been hanging out and observing. The team asks what Minh and I are doing here and since we have to avoid the word “research”, it’s hard to explain. Our official title is “MPH observer”. “Research” has a negative connotation and the local ministry of health didn’t initially approve our project, so we have to be subtle. Therefore, we call ourselves “comprehensive screeners”. We’ve spent time at the plastic surgeons table and the electronic medical records station. Since we were stranded 24 hours in the Newark airport, the 25 of us on that flight really bonded. So we got to know the plastic surgeons Alan, Nolie and Tatiana (from Colombia). They let us sit with them and explained the form they fill out and let us look at the patients cleft lips and palates. There are 5 priorities for surgery – 1 is cleft lip, 2 is palate under 7 years old to fix speech, 3 is palate over 7 years old, 4 is previous surgery repair and 5 is anything else. Most priorities 1-3 are operable. The top priority of these surgeries are smiles aka aesthetics especially here in India where physical appearance is a matter of survival (marriage-ability, educational/career opportunities, mental health, etc.). It is so interesting and inspiring me to get a clinical degree in surgery.
We were able to also meet with 2 local student volunteer translators – Pompi & Salma – who looked over our questionnaire providing feedback and appropriate answer choices tailored to local culture. We’ve looked over our questionnaire 50 times by now, and are finally going to print the copies today. The student translators range from 19-23 years old so far that we’ve met and are amazing! Not only are they dedicated to the Operation Smile mission, but also very open and nice to Minh and I. They explained their health care system and caste system to us which is different in each state. The caste system is not officially recognized by the government, but is still an important cultural indicator. There are 6 categories – General (Hindus, Muslims), Other Backward Caste, Sechdule Caste (based on last name), Sechdule Tribes (Hills), Sechdule Tribes (plain), Minority Other Backward Caste (used to be called Dalites or “untouchables). One can’t marry down, but can marry up. But they all seem to be friends apart from caste and go to similar universities. The local government has actually reserved seats for lower castes, some type of affirmative action. They also pay ASHAS (rural health advisors) to bring in women to the hospital to give birth. If the woman gives birth to a female, she get paid more money. I guess they are trying to make up for the historical treatment of lower castes and women. Reza (another translator we’ve met) said still to this day in some tribes, they may kill female babies preferring the males. The students have provided such helpful insight and information that you can’t find anywhere else online. I’m so glad that we’ve come early to hang out with them and get to know local culture and society. We still have so much to learn and absorb though!