The first months at M.I.B.E. Graduate School for Nurses, Indore, I have been preparing reports on the library and computer lab. I have been waiting to see how my recommendations would be received by the principal. I presented the reports at the judgement-time (or faculty) meeting, this past week.

During the review of the computer lab report, the school decided to make the internet available to students at no cost. Antivirus software for nearly all the school computers (9 out of 11, and don’t ask me why only 9) was purchased as a result. All the school computers were sent out to be cleaned of viruses (thank the heavens).

Printing from the school computers is still being looked into. The principal would like to make printing available to the students on school property.

An LCD projector has finally been purchased with a designated donation. Within twenty-four hours of the purchase of the LCD projector, I was assisting Ms. Singh with her Medical Surgical class, presenting on electro-diagnostic tests (with videos, ooh aah). This gift of the projector has revolutionized the pace of my classes, making them run smoother and more efficiently. Soon the students will be utilizing it for their class presentations. Thank you, Mr. Duncan, for your generosity.

The library assessment and recommendations report was extensive. Mamta, the principal, was pleased with the quality of the assessment, which pleased me. By the end of the four-hour faculty meeting, we had walked through the library after reviewing the report and every recommendation I made for the library was approved. The work was to begin on Monday. And it did. Mr. Matthews and I began investigating computerized library cataloguing software, Matthew and Dillip Beck began sorting through the textbooks (They found a book from 1893), and painting began.

We have since sorted through all the textbooks, a carpenter has started fixing broken bookcases, and the library software is being installed. Mamta has informed me the whole of the Mid-India Board of Examiners General Board will be meeting in the library on December 9^th, 2010. “The library must be done by December 9^th.”  So the work continues.

According to my students, Indians do not hold nurses in high esteem. Community health nurses are looked at as bottom of the barrel, compared to hospital nurses, in some of the under-developed areas these students have come from. The number of students genuinely interested in becoming a community health nurse after they graduate is few. Most are interested in teaching or working in hospitals as ward managers or nursing educators. In my community health class I try to enlighten the students about the vast scope and worth of community health nurses.

This past week the twenty-two 2^nd year nursing students attended their urban community health practical experience in an inner-city slum in Indore, called Shankar Bagh. Along with Ms. Singh to help me with the language barrier, I guided the students through this week of visiting to the slum.

The students’ focus was on families. We met families living in single room (6’ X7’) houses. They cooked, slept, cleaned, and voided within the small space. One of these families had 13 members living in their single room pucca (brick) house with a corrugated tin roof. The rent for these small homes would often be half of the family’s monthly income. Monthly income was 1,000 rupees, and rent 600 rupees. That is approximately $25 Canadian and $15 respectively. Some of these homes had electricity and water was available from the city line for 2 hours every day. India has extreme poverty, but I did not feel we were seeing the extremes in this slum; although many of these families fall very short of the “less than two US Dollars a day” poverty marker.

After thorough assessment of a family, the students provided planned health teaching according to their families’ needs. These topics included environmental health, ventilation in the home, accident prevention, family planning, anaemia, preventing colds, and importance of immunizations. Many students used role plays, demonstrations and practical hands-on teaching as the methods of their education sessions. These methods, not only engage the audience, but they also allow for participation of those who cannot read.

One particular student worked with a pregnant woman who has not been allowed out of the home while her husband was away at work. She has been suffering from morning sickness and general nausea. As a result she was under nourished and showing signs of anaemia. The student provided nutrition education and the following morning helped her to prepare an affordable, nutritious meal. One of the perks of being the instructor included tasting the cooking. I am glad to report the leafy green vegetable drumstick, which grows like a weed and if harvested too late is very bitter, as delicious.

Shankar Bagh had an Anganwadi Centre where the students run many activities. An Anganwadi Centre, is a government-run initiative to decrease infant mortality rates and improve maternal health status. The centre is open to pregnant women, mothers and children under the age of 5 years. One or two daily meals are served here to prevent malnutrition. Educational programs run to help the growth and development of children, and to educate mothers.

Shankar Bagh’s Anganwadi Centre was not very active. The walls were blank and the twice daily meals tended to be the only regular activities which occurred. The Anganwadi (a woman running the centre) was interested in running more activities but the assistants were not proactive people. Our students taught a hand-washing action-song and began the ritual of hand washing with the children before every meal. For three consecutive days we ran health clinics for children under the age of 5 years.  The students purchased posters for the centre and added two measuring tapes to the wall so the centre could monitor the growth and development of the children.

During the evaluation process the students reflected on their time in the slum. Most were pleased with the opportunity to do practical community health nursing. They spoke about the value of the relationships Community Health Nurses have to nurture with families and the extensive array of knowledge they must utilize in a day of home visiting. My students are starting to see community health nursing in a new light. I eagerly wait for the rural practical experience in the New Year, when I will have another chance to show the richness and diversity a community health nurse in India gets to enjoy.

During ‘unofficial time’ in the monitoring visit in Jobat and Mendha areas, I experienced too many joys to count. The many “Namastes” followed by embraces of friends I have not seen in a year or more put me over the moon.

We attended church in Mendha. The congregation at the Christian church has been growing, and was literately bursting out the doors of this church just a few years ago. Last year, I had the opportunity to attend the ground breaking for an extension on the church. Together with the support of a Presbyterian church in Canada, the congregation began extending the sanctuary out behind the pulpit. During construction they decided they required more room, and started building wings on both sides of the sanctuary.

The excitement of the congregation on the progress and for the delight of the congregation in Canada supporting this renovation, has lead me to post these “in-progress” pictures. A new minister has just started preaching at this church, three months prior to our visiting.

Another joy, I have to admit a more devious one, came when the Sunday school children in Mendha recognized me. “Namaste Deedee!!” I was greeted with the affectionate term for big sister (which I much prefer to be called rather than ‘auntie’ for obvious reasons). The kids made me a basket out of newspaper and began bringing me flowers one by one. They were pleased to meet my parents and entertained my mother, excessively, with songs.

My first visit to this area I gave the children bookmarks. They were not able to conceal their crust-fallen expressions. I guess they were hoping for candy. The second visit, I did not bring a little gift, but I and an 8 year old boy from Canada played games with the children. This year, after all the buttering up the kids did, I figured I found the right place to distribute a particular gift I had.

The mothers my never let me back to Mendha for teaching their children a new word: Whoopee-Cushion! Laughter ripped through about 25 children as they learned to play with their new toys. The orchestrated group whoopee performances made my day.

During another part of the monitoring visit, we (Laura, Guy, I and my parents) went to Jobat and Mendha. This part of the trip we visited the various facilities such as the Jobat Christian School, Hospital, Nursing School, Community Health Centres and so on. We also visited several villages.

The community health network in this area is robust and much more established that the community health network near Ratlam.

The Jobat and area network began in the 1970s and began with training of Dais (or Traditional Birth Attendants) to be community health volunteers. The root of this network is made of women and concern for alarmingly high infant mortality rates (IMR) and maternal mortality rates (MMR). This has grown over the years, increasing the number of villages covered and the scope of health and social issues tackled.

The villages covered in this network share a story of many successes. This story reached our group through observing the increased standard of living; hearing stories about determined mothers who sent their children to school all the way through to post-secondary, even though they themselves had not attended school; and discussing how most villages could not recall how many years back it was when a woman or infant died during childbirth. What a joy it must be for the hard-working Community Health Nurses in this network to see the fruits of their labour.

Many people here are eagerly asking “How can we reach those whose tribal areas which remain impoverished?” With their experience, and ingenuity guiding this community health network the future looks toward many more success stories.

My particular delight during this morning visit, second to the walk through the bountiful fields of tall corn and cotton (see pictures), was the time in Mendha and a village adjacent to the Mendha Community Health Centre. My parents were able to come to the small town to see the community health centre. And the village visit was typical, but my father was able to come to a village and see the work that has me hooked on this tribal area in India.

After walking up to the village from the road, we learned how the villagers have been encouraged and linked to government schemes, such as the building of latrines. We saw kitchen gardens being kept to improve families’ nutritional status. We attended a maternal and child health clinic where children and mothers were weighed before an educational session. You’ll find pictures below, including ones of my parents to prove they were there.

Disputed site is Ram birthplace: HC (Hindustantimes, Friday October 1, 2010).

Thursday at 3:25pm I was, like many others, indoors turning the television on. The hotel’s televisions were blacked out during the time of the verdict (I was in Delhi with Presbyterian World Service & Development for two days). After the verdict was announced the televisions were no longer blacked out and I could watch the news stations’ take on the Ayodhya verdict.

Verdict: The High Court claimed to be basing their ruling on evidence dating back to ancient times. The court ruled the disputed land was the birthplace of the Hindu deity Lord Ram Shri. It ruled that both Hindus and Muslims have both prayed in this site historically. The land has not been awarded to one party. Of the 28 parties to the suit, three parties will receive a third of the land. The three parties are the Sunni Central Wakf Board, a Muslim group; the Nirmohi Akhara, a Hindu group; and Ram Lalla Virajman, the Hindu idol which was installed in the place of worship on Dec 6^th, 1992 when the Babri Mosque was demolished. “According to Hindu Law, an idol is a juristic entity, meaning it has all the legal rights of an independent entity” explains the Hindustantimes. The High Court has designated the place of worship, under the central dome, will be awarded to Ram Lalla. It is expected that the parties involved will go to the Supreme Court to challenge the verdict.

Reaction: In Indore on September 30^th and October 1^st the city was shut down; schools were closed, government offices were closed and the streets were quiet. The headline “Only Soldiers on Ayodhya Streets” describes the situation in Ayodhya on these days. In Delhi, there were soldiers and police everywhere, in groups of no less than 4 it seemed. We saw about 12 soldiers with full riot gear on a back street near the railway station. Tourists seemed quite unaware that the police/military presence could be for any other reason besides the Commonwealth Games.

These precautions and pleads for peace have helped to maintain calm across the country it seems. I suspect newspapers and news stations are restricted from announcing any clashes. I see how broadcasting events of unrest could easily ignite others into violence in under educated areas and fundamentalist areas of the country.

If the Ayodhya goes to the Supreme Court, I wonder how much longer the country will be waiting on edge for a verdict.

Check out the Hindustan photo gallery of India on day of the verdict.

International news is a-buzz about the Commonwealth Games in Delhi. Tragedies, ballooning costs, claims of corruption, and unusual stories, such as the increased military langur monkey forces in Delhi. National news in India also is covering the Games with a critical eye, and some tongue and cheek. But the news headlines which are drawing much attention and tension here are regarding the Ayodhya Verdict.

Suspense as D-Day dawns

TIGHT SECURITY India’s response to ruling will shape its future (source Hindustantimes Thursday, September 30th, 2010).

I have very limited knowledge on this long standing debate which seems to have roots back to 1527. This is my narrow understanding of the situation. Ayodhya is considered a holy city for Hindus, because it is believed to be the birth place of a Hindu deity, Lord Shri Rama. It is unclear to me how long Ayodhya has been considered a holy city by the Hindus. In the year 1527 a mosque was built in Ayodhya, the Babri Mosque. It is claimed by some that this mosque is built on the ruins of a Hindu temple. If the temple was destroyed in order to build the mosque is under debate.

On December 22, 1949, Bahri Mosque was broken into and Hindu idols were installed in the place of worship. In 1992, the mosque was burnt down, which lead to the loss of approximately 2,000 lives, because of the religious groups rioting. Since this time a court case has been ongoing to determine which group has the rightful ownership of this land.

Please remember this is my understanding of the situation. It is all put very simply and is missing many important details. At this time I find it difficult to determine which information sources are non-bias.  I also have difficulty understanding the complexities of this long-standing conflict. I do understand that many people in India feel strongly bonded to this because one’s religion does not just lay close to one’s heart, but often is what one’s heart is rooted in. The historical bloodshed between these two groups has been devastating and is not forgotten.

Awaiting the verdict (which has been repeatedly postponed) has the country holding its breath. Many public figures are pleading to Hindu and Muslim groups to accept the outcome of the trial and not begin violence as seen in the past. In areas considered risk areas Article 144 has been instituted. Meaning no more than 5 people are allowed to gather in public places. An increased police and military presence is felt in many areas, certainly in Delhi as the count-down to the Commonwealth Games continues. A curfew is anticipated in some regions in the country.

The verdict is to be announced today at 3:30pm.

Guy Smagghe, the Government Relations Officer from Presbyterian World Service and Development (PWS&D), and Rev. Laura Kavanagh came to India on September 20^th for a monitoring visit of the community health networks in Madhya Pradesh supported by PWS&D. Fortunately (for me anyways) I was invited along on the monitoring visit. My experience has only been the Jobat, Mendhya and Amkut community health network, and Hatpiplia community health programme. PWS&D also supports community health programmes around Ratlam and Badwani.

The first project we visited was the Ratlam Community Health Programme. Ratlam use to be a large trading city famous for opium, tobacco and salt. Today it is known for the gold sales. The surrounding villages are populated predominately Bhil tribals. The community health programme is running in 10 villages since 1998. The villages are among the hills and the soil is not suited for productive farming. These villages depend on migration for income. There are no public transport facilities in this area.

Bhildi Village

The first village we visited was Bhildi village, with a population of 1200. It is 35km out of Ratlam. The Community Health Volunteer (CHV), Mr. Navin Bhuriaya, has been described as an energetic youth which works towards social change. Prior to the Community Health Programme, the Bhildi villagers were unaware of many government schemes to improve health and support livelihood. Since the programme started immunization rate in the community has increased, Infant Mortality Rate and Maternal Mortality Rate has decreased, and the community eagerly participates in government schemes.

When we arrived we were greeted in a traditional manner, receiving bindis and blessings with rice and flowers. Approximately 50 villagers were waiting for our arrival so they could tell us of the changes in the village. We were told more people were waiting but they had to leave because it was time to milk the cows. Following discussion, we were given a tour to see some of the changes in Bhildi.

The CHV had attended a workshop on planting fruit trees. The government currently has a scheme, which provides free fruit trees to below poverty line individuals. The villagers of Bhildi would not have been aware of this scheme without their CHV. This is one of many mango trees planted in this village. A demonstration of how the villagers rigged up drip-irrigation on their own to conserve water. They hang a bottle with a single hole in the bottom over the tree to water the tree over several days, instead of having the water poured on the tree and quickly disappearing in the porous rocky earth.

A fish farming incoming generating project was started this year. We also saw their kitchen gardens and the road which was funded through the lobbying of the community under the Prime Minister Village Road Scheme. Support was rallied for the CHV during the last campaign period for the Local Self Government (the Panchayat Raj System) and for the first time these villagers participated in elections and Mr. Bhuriaya won.

Bhighapatan Village

We arrived the next morning at Bhighapatan with some difficulty because there is no road to the village. In fact, it was the first time 4-wheelers have ever made it to the village, which is 45km outside of Ratlam. This village of 400 people has active self-help groups and an active CHV. A major accomplishment achieved through the efforts of this community was the sanction of a government Primary School, an Anganwadi Centre (Maternal and Child Health centre with programmes for mothers and children under 5 years), and construction of wells. One hundred percent of mothers are now immunized, 80% of children are reported immunized, and 100% of the village is participating in the pulse polio programme.

The monsoons have been living up to their name this past week.  When the rain has come stating that it pours is nowhere near the reality.  High humidity and grey clouds harold the coming of the monsoon rains. Cracks of thunder, one Mississippi, two Mississippi… Flash.  Speedy drops of water rush down from the sky, in a density which nearly fills all airspace.  Everything quickly floods.  Garbage sails along the streets in the currents made by the traffic. Most streets do not have drainage.

A few days in a row of this sort of rain had me feeling shut in. Normally I walk to the gym 4 days a week. Even though the school campus is about 1.5 acres, it can feel cramped when you live with your students and co-workers. Feeling restless, I recalled that I am a West-Coaster! What’s a little rain? I dug out my hiking boots, gortex jacket and umbrella.

All suited up I left the campus for the gym, fully aware I would be damp when I got to the gym. I reiterated to myself What’s a little rain?  On most streets there was 1 to 3 inches of water rushing along the street. But then there were the hidden pot holes and cars rushing by sending arches of brown water may way. But where’s my sense of adventure?

Just a little farther to go; up the block and around the corner. SPLASH! I fell into an open swage system! Right up to mid-thigh. I stood while the bystanders under the awning of the closest shop laughed. Lifting one foot at a time from the sluggy bottom I crawled out of the hole.

Laughing at myself I kept walking to my destination. Thank goodness my gym has hot showers (maybe the main reason I joined the gym).  The West-Coaster did, however, take an auto-rickshaw home.

30% Indians totally corrupt: Outgoing CVC chief

This headline comes from the September 9^th, 2010 Free Press. The outgoing Central Vigilance Commissioner, Pratyush Sinha, said in an interview that 20 percent of Indians were “honest, regardless of the temptations, because this is how they are. They have a conscience”. He says “around 30%” are “utterly corrupt. But the rest of the people are on the borderline.”

“Transparency International, the global anti-graft body, puts India 84^th on its corruption perception index with a 3.4-point rating, out of a best possible score of 10. New Zealand ranks first with 9.4 points and Somalia last on 1.1 points.”

Corruption has been on the raise as the country modernizes and has become more materialistic. Sinha stated “if someone has a lot of money, he is respectable. Nobody questions by what means he has got the money.”

An interesting fact I learnt this week is in the Guinness Book of World Records India’s financial auditor exams are ranked the toughest exam in the world. It is not uncommon for hopefuls to write the exam 4 to 7 times before passing. It is very uncommon for someone to pass the exam on the first or second try. Indian financial auditors are said to be international experts. However, I will venture the guess that this only holds true of the auditor falls within the 20% of the Indian population who are honest.

Sinha added corruption in India is “palpable”.

I have begun assessing the library, using community nursing process and Ruth Freeman’s many tools for each of the five steps (assessment, diagnosis, planning, implementation and evaluation). It is proving to be a good teaching aid for my community health class. Through observation, record review, focus groups, surveys, and interviews I am gathering information on many aspects of the library.

Yesterday, with the help of the library committee, I ran focus groups around the issues of book quality, book usage, physical space, and user’s needs with all the students. There is plenty of feedback to work with. Next I will compile and analyze this data.

I must back track. I have not mentioned Mamta’s vision for the library. The principal was awarded her master’s from Edinburgh, Scotland. The high quality of the library she studied at had a great impression on her. Since that time, I believe she has been nursing the idea of MIBE Graduate School for Nurses to house such as library. She sees electronic resources seamlessly integrated in with orderly rows of current books and academic journals. This library will be one which draws teachers from all 28 MIBE schools of nursing and other health care professionals to come for educational development. Her dream is ambitious and will take efforts of many, resources-of-plenty, and time.

I hope to provide recommendations in my report which are ambitious, with Mamta’s vision as the target. However, I intend to also provide realistic steps the school can take in the direction of this target. At present my head is floating in gallons of ideas. I hope they will translate to paper.