Departure

Looking down, ever down, calloused hands scout crusty soil for the sole pewli she pirouettes—a habit of anxiety belying pretenses of stoicism. We know so we smile, in these final days readily to temper the tide of our true feelings. We laugh through a last meal, a last song, a last conversation; mashed mango and kofta, Open Your Eyes, an unending commitment to the community. Feigned happiness again buries tears along this string of post-college years knotted with such punishing celebration.

This community—teachers, farmers, cooks—is family we will leave. And in the end we remember the beginning. What brings anyone to APV is misunderstood, though retrospect helps explain groggy 3:45am smiles persisting through each day’s three workdays in the classroom, kitchen, and fields.`

A pause in the flower’s twirl, a tug at the petals, a divulgence:

—When rice, I enjoy many people together. First one family work, then others come, then four, five families together. Everybody taking out and tying and joking, talking, and I like. Plowing the field and water and mix and mud and sowing again and throw mud at each other in mouth and…like Holi, I like.

Muddled mosaic tiles of memory; petals amputated, collected in her hands. Pluck…

—All children went forest together to big stone and are sitting there and eating and sitting. We talk about our home, our school. Women and brothers talk me. They know I don’t tell anybody. Some women hide and they fight and they tell me about. They tell everything. Like secret. They trust me.

…Pluck…

—I have goat and sheep. I like our cow, very nice, no horns. One day leopard attack our cow and I am crying. Evening time, leopard attack and killed. Many people go to forest not find and after two days I saw the cow dead. I am crying. Many days I am crying. My cow has no horns.

…Pluck…

The decent, the diligent, the gentle, and the wise. We are who came here, grown, intellectually and emotionally.

She balls the severed petals and from them crushes fragrance.

—These days I like so much, I learn many things because many volunteers came here. Like, you teach us everything, about other, other, other, other.

Evolution characterizes the APV experience. Investigation through mindfulness focuses life. Too often schools forget the plasticity of inquiry to pursue ordered achievement. We run a school, but we own a methodology, one that begins with introspection and may someday end with awareness and understanding.

—I learn how to live together—most important thing. Here is different places people here. We met and happy. I like home but this time I like home and here both same.

Through ease and ordeal we absorbed the best of each other, daring the other to toil alone. I have never challenged myself so exhaustively for another; every log, stone, and field was hers.

Tracing shapes in her palms, petals drop and hues erode. Her wedding is too soon, as June.

—I want marry; marry important because sometimes some problem and care each other.

Enter society, play its game. We do not reject our fall into urbanity, but balance would be nice. The world jerks us from Garhwal. Detached, we do stir for modernity’s conveniences (electricity! restaurants! ice cream!) but don’t we need so little? Naïve, we anticipate happiness, but aren’t we happy right now?

—I don’t want leave here.

She entrusts me with her sorrow. From afar we will work for APV, comfortable our relationships will tether and retrieve us. But to leave this place is to die a little and in the end all we can do is talk.

Still, things we say leave much unsaid: we are beholden to this community; without it, we would never have met, may never again.

Clouds weep the hillside, dampening her hands, smothering their perfume, shrouding what her shuddering lower lip and clutched brow tell. We mute before an impending storm. All will change—not simply intensify or diminish, but evolve. Our shared, smiling eyes might be aimed—charily—at friends; the salt of our labors may be summoned—painfully—beneath a different sun; and the synchronized, accelerating pulses as one waits for the other (the other hurrying to the one) could repeat— weakly—before our family’s embrace.

A draw from our tumbler suspends water beads from her chin that scatter what rays breaks the clouds. Evolution is perilous. I will remember forest fires, felled trees, and festivals, but those beads? Details—ends devour them and trade the salvage. In new places with new people, we will barter pine for concrete, hugs for salary, smiles for desks.

—He say ‘I can’t get leave.’ That time I not happy, very serious. Now, telling you, I am very happy. He said, ‘if I can’t get leave, what will we do?’ I said, ‘nothing, don’t worry about it, next winter. I can stay at APV for long time, no problem.’ Seriously, then; now, smiling.

She rubs the water from her chin, washing her hands. Her chin rises and eyes into mine she smiles.

—I don’t know what is future.

None do.

Charles Iannuzzi works on curriculum and syllabus development at APV School in Anjanisain, Uttarakhand.

Sixteen ten on my mind

Today had been an unremarkably routine day. Nothing to write home about, as they say. Unremarkably routine day. One down. Sixteen to go. Only ten at Rishi Valley. Frightening calculations for a girl who has grown so fond of the place she’s learned to call home. The Subcontinent. Incredible India. My own Rishi Valley.

The day had started as most days in Rishi Valley do, with waking up to a screaming Bollywood alarm melody, to close the doors for a hope of privacy. A few hours later, I rubbed my eyes out of bed awoken by the intrusion into privacy, the maid in the window singing a long “Helloooooooo”, intruding into the hideously messy cocoon of my life, fit under and on top of two twin bed cots put together with thin mattresses on top.

Some time after the usual morning routine of brushing teeth and inserting contacts, walking to lunch to the hum of my iPod being overrun with outside sounds: cicadas buzzing, various birds singing various songs, tractors plowing down the road, rickshaws blaring more Bollywood tunes. Rice and dhal consumed, kofta gathered into the folds of warm soft chappati pieces placed gingerly in the mouth. A friend once told me that Bengalis have a saying, “Eating with a fork is like making love through an interpreter.” Makes perfect sense. I dread the cutlery waiting for me back home – shiny spoons and sharpened forks, the interpreters of my love for the Subcontinent. Incredible India. My own Rishi Valley.

Post lunch, heading to the office for browsing the internet, connecting with the outside world. Learning about new status updates, request of technological friendships, news of engagements and breakups, reading articles about sadness drenching our world with old wars, new conflicts, neglect, and somewhere maybe even hope. If only the world was drenched with more rain. I hope the sky turns grey. If only over the Subcontinent. Incredible India. If only the rains would come just to my own Rishi Valley.

The afternoon heat is sticky. Physically disturbing. The cool comes after five, close to six, close to dinner-time. But my room remains hot, everything, each piece of the mess under and on the cots and even the cots themselves, warm and unpleasant to the touch. It used to cool off by the time dinner was over, by the time I had finished licking the rice and sambar off of my fingers and walked in the cooler air down the road in the dark by the faint light of my cell phone, familiar sounds mixing: the tunes from the iPod, the birds still chirping, the relentless cicadas, the honking of rare motorcycles going by. But now, it does not cool off until midnight, technically the next day, ruining the post-dinner plans of comfort and productivity. I lay uncomfortably on the warmth of the sheets, swallow pain-killers for the dehydration headache, sip water mixed with Glucon D, try to read, think if I can afford a cold shower during this drought. Mostly, I am filling my head with thoughts not revolving around the numbers sixteen or ten. One month left to shudder and distract myself.

When relief flows with the wind from the screened windows, it is not immediately noticed. The air cools gradually, like water boils gradually, first becoming lukewarm, then warm, then hot, only finally bubbling. The desire to sleep floats out the window with the hot air. The cool air allows the head to think clearly, to be productive, to be comfortable, to be creative, to be alive. Fully. Even though it is technically the next day, it is time to savor the one just lived, even if unremarkably routine. After all, it is this unremarkable routine that I will miss the most. The annoying Bollywood melody. The screaming cicadas. The green of the palm trees waving as I walk by them on my way to my forced vegetarian diet. A familiar “Helloooooooo” in the window. My whole life fitting under and on top of the two twin bed cots put together with thin mattresses on top. The heat sneaking out of my room when relief quietly spills in. The Subcontinent. Incredible India. My own Rishi Valley.

Posted by Tatiana Rostovtsev

The Faces of AIDS

I don’t think that I could ever forget the first faces that I associated with HIV.  Like anyone else from the developed world, caricatures of wasted AIDS patients in grim, third-world wards have been consistently imprinted by news reports and pictures on checkout-counter donation boxes.   I think we all realize that we become desensitized, but that still doesn’t prevent it from happening.

Even if you work for a specific health cause – HIV/AIDS, TB, parasitic infection – it’s so easy to get lost amidst the statistics and programmatic pigeonholes.  Attending several WHO meetings in recent years has increasingly taught me how easy it is to become removed from the same people that you are trying to help. It’s not through any diminution of altruism that this happens – exactly the opposite.  Finding a niche that needs to be filled – better development of dengue diagnostic tests, for example, or campaigning for increased training for nurses – is both natural and necessary; disaggregation of a problem is the easiest way for an individual actor to make an impact.  All this being said, at the heart of the tables, graphs, and logframe outlines, there is a population that is sick. And each population is made of so many individuals.  People. Stories. Lives.  Faces.

Until this past month, I had become increasingly uncomfortable with this disconnect in my own life.  I have written extensively about “domestic violence victims” and “HIV positive wives” during my time here – but who are they?  Equally important to me – and, in the pragmatic sense, to the program as they approach potential new donors – was interacting with the patients and AIDS-affected population that YRG serves.  Through the kindness of my advisor, Ganesh, and the dynamic medical director at YRG’s hospital, Dr. Kumar, they agreed to let me start attending rounds, counseling sessions, and helping with outpatient care.

So I found myself, face to face, with a family of three being counseled on HIV for the first time.  As the interview was in Telugu (a regional language of Andhra Pradesh), I simply watched and tried to follow the counselor Lakshmi through her interview.  The family was young: the father was 32, the mother 26, and their small boy three.  I played peek-a-boo with the boy as Lakshmi went through her paperwork and preliminary questions, the young couple sitting uncomfortably erect in their chairs.  The boy played with the edge of a window curtain, smiling as he sat quietly in his father’s lap.

Pausing, Lakshmi turned to hand me the carefully-creased diagnostic tests that they had brought with them that morning.  Medical papers in developing countries still always cause me to pause; coming from a culture where everything is digitalized, to see people’s testing strips taped to soft, well-worn papers, diagnoses scribbled by hand, is such a powerful example of an old world adapting to the new, to the extent that’s possible. 

“This is a new family at our clinic,” she explained.  “All three are HIV-positive.”

I tried not to let my face show emotion as I turned toward the family.  I had suspected the husband, possibly the wife- but the boy?  Soft morning light falling on his face, he now slept peacefully in his father’s arms.  Three years old, and already limited to a shorter life and inevitable pain.  I looked at the father, seeking to vilify the face that had brought his entire family so many difficulties.

But I couldn’t.  His face was not the face of a malicious womanizer, nor that defiantly poignant, hardened image of a “truck driver” or “injecting drug user.”  His eyes were kind, and sad, and empty; I could not begin to imagine the guilt that he had to bear as he sat in that room, calmly discussing the death sentence that he had unwittingly given to his family.  I felt such sympathy for him.  Yes, he had had an extramarital affair.  Yes, he hadn’t practiced safe sex, and his partner had been positive. But, in a society where it’s commonly accepted for men to have side partners – was he really so much to blame?  How many things have we all done that we know haven’t been “right,” but were colloquially accepted?  Coupled with an arranged marriage and likely lack of health education – how much could he be blamed, and how much of his situation was simply the unlucky product of circumstance?

As the wife wiped away silent tears, I likewise felt my heart sink for her.  Caring for a positive husband and child, as well as herself….So many burdens added to the burden of who she was: a poor Indian housewife.

The family agreed to undergo further compulsory tests – tests for TB, STDs, co-infections – as per the norm at YRG.  Lakshmi explained that the tests would cost at least Rs 3,000 – about $66, a fortune for a lower-income family here.  This, plus travel expenses to come to Chennai for treatment, missed days of work, the diminished capacity to work as the disease took hold later….YRG significantly subsidizes costs of tests and treatment for poor patients, but even still – how would they make ends meet?  The clinical and public health world vehemently demonizes patients who miss drug regimes and contribute to resistance.  But, faced with the choice between food on the table and a year-long course of TB drugs that cause vomiting and severe liver complications – can you blame anyone for opting out?  They have a second uninfected child – what will happen to him when all of his family members die?

None of these questions have easy answers.  Some may not have answers at all.  But these are the realities that people face, as well as the realities that their caregivers must mitigate.  Treatment.  Care.  Support.  Education.  Livelihood improvement.  Poverty reduction.  All of them are niches to be filled, while not forgetting the connections that must remain between them.

As I come to the second half of my fellowship, I am beginning to better appreciate that health, and the determinants and maintenance of it, is an entire ecosystem.  I recognized that public health was my passion years ago, and decided to forgo a medical degree to treat the source behind the symptoms.  However, I am realizing now that I have been wearing the same focused blinders that I saw and criticized within clinical medicine.  Yes, there must be a focus on prevention, but that education and infrastructural improvement must be contingent with holistic care of those affected by health problems now.

Increasingly, I have been brainstorming the foundation of my own health coalition, focused on public-private collaboration to provide preventative and curative health services in geographically isolated areas.  It must connect with some market interest to be sustainable; it must be scalable; it must be simple; it must be comprehensive.  It is addressing an ecosystem of needs, and likewise needs to build upon a network of symbiotic relationships.  Above all, it needs to strive to find that elusive balance between treating what exists and paving the way for a healthier future.

To do this effectively, I am now weighing options to try and find the most efficient and useful graduate degree that allow me to help on an individual basis, as well as a systemic health level.  I am not sure what medical avenue would be the best route - MD/MPH, NP, PA, etc. - but I am beyond grateful for the valuable insight that numerous doctors, nurses, and fellows at YRG have given me regarding each option.   I’m hopeful that the path I choose will give me at least a good platform to build the core of the coalition, while recognizing that other specialties – environmental, social, business-oriented, economic – must be incorporated as well. 

There are so many niches that I could fill; whichever I do, I hope that I find a balance between making large-scale change and connecting, face to face, with the people that those changes affect. 

Nicole Fox is based in Chennai, Tamil Nadu with YRG Care

Do It Yourself: Curd in the Kitchen

Do it yourself: Curd in the Kitchen from Kirsten Anderson on Vimeo.

Yogurt: A Public Health Service Announcement

Service work at grassroots level NGOs in India requires fit and able bodies. It can often entail spending long hours on buses without bathroom breaks, walking in the sun from village to village, eating potentially hazardous street food or unknown foods offered by a generous host, and using bathrooms without soap to wash your hands (or anyone else’s for that matter). If you are sick in bed with a fever, puking your guts out or running to the toilet every five minutes, clearly you will not be able to serve your NGO or the community you are working with. Therefore, maintaining a healthy body during the fellowship is of serious importance. The two most important ways to stay healthy, according to yours truly, a 12-year India travel veteran, are to:

1) Stay hydrated. Drink lots of clean water. It’s always good for you but is absolutely essential in the summer heat and it helps your system flush out the bad stuff. Always carry a water bottle with you.

2) Eat plenty of yogurt! Make it at home and consume a little everyday.

While water has an obvious link to maintaining general health, the need for a daily dose of yogurt probably requires a bit more explanation. Please read below for more information on the benefits of including yogurt in your diet and watch the video to find out how easy it to make at home; it simply requires a little help from a nearby aunty and spoon(ful) of starter.

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yo-gurt [yoh-gert] -noun: a custard like food made from milk curdled by the cultures of probiotic bacteria.

Top 10 benefits of making your own yogurt:

10) Probiotics, the GOOD bacteria: It helps to maintain a healthy balance of micro-organisms in your digestive system. There are hundreds of micro-organisms in your intestinal track and its important to keep them all healthy. The largest group of probiotic bacteria in the body's intestines is lactic acid bacteria, or Lactobacillus acidophilus, which is in probiotic yogurt. It’s the lactic acid that gives curd the tart/sour taste.

9) The anti-antibiotic: If you get Delhi-belly and it lasts for more than 2-3 days, you may need antibiotics to kill the infection. Unfortunately, many antibiotics actually kill the good bacteria along with the illness, causing bad bacteria in the body to multiply and resulting in even more diarrhea. If you need to take antibiotics keep your system healthy by eating an extra helping of yogurt. It’ll help replace good healthy bacteria back into the body, giving relief to the diarrhea.

8) Increase your body’s immunity: Eating probiotic natural yogurt can boost your body’s overall immunity. Not only will your intestines be healthier and more capable of fighting future infections, aids in digestion and can reduce yeast infections in women.

7) Fresh and natural: When you make your own yogurt, the milk needs to be bought fresh, there are no chemical additives or preservatives and you’ll need to make more once it goes sour. Not all store bought yogurt contains the healthy probiotics you need. If you make it at home, you know it has all the good stuff.

6) Even lactarts can enjoy: Many people have difficulty digesting milk or are lactose intolerant. However, the yogurt fermentation process actually produces an enzyme that makes digestion easier.

5) Cheap: You just need to buy the milk.

4) You’ll be the talk of the town: It’s a true sign you have adapted to your local environment, your neighbors and co-workers will be very impressed.

3) Cooling in the heat: You can keep your yogurt in the fridge for up to a week and it tastes great on those hot summer days.

2) So many uses: You can add it to your favorite fruit, put it in the mixie and you have a delicious smoothie, or if you prefer, lassi. Eat it with dahl and rice. Put it on pancakes. Eat it at the end of your South Indian thali. Make raita to eat with biriyani.

(Ladies only: don’t get disgusted, but in the case of a yeast infection, you can apply yogurt directly. It is cool and soothing, and it gets all the GOOD bacteria just where it needs to be. Google search the various ways of application.)

1) Easy. All you need is an aunty and a spoon. Watch the Do It Yourself video above to find out how you too can make yogurt at home in just a few simple steps.

Enjoy your homemade yogurt!

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Kirsten Anderson has extended her AIF fellowship at Aid India’s Eureka Child, a Tamil Nadu based education initiative working to improve the quality of education for all children across the state. Kirsten has been developing the content and printed materials for the primary English reading curriculum, Ready to Read, as well as working on the production of an educational English DVD series. She has also been making her own yogurt for 2 years and is now experimenting with kombucha.