Countryside living, shamans and stomach bugs

My data collection here in Okhaldhunga is progressing fairly nicely I would say. I have now visited the home of, and interviewed, every mother of a 6-23 month-old child in two areas and I will need data from two more areas. Each area is divided into 9 sub-areas that have one or more villages. My research assistant and I go out for about ten days at a time. We cooperate with the female community health volunteers which there are one or two of in each sub-area. They take us to the children and mothers and usually let us stay at their place. Sometimes we stay with other people we find along the way. This fieldwork is challenging for sure, we walk a lot and the conditions here are simple. The only thing there is an excess of is hospitality. The family shares what they have and we live like them. If they live in a shed due to the earthquake, and many do, so do we. We have shared beds with others and slept on floors and one night we shared a blanket that was so small we had to spoon and turn around simultaneously. The toilets are not for the faint of heart, or maybe mostly, not for people with arachnophobia. I struggle with the spiders I have to admit… Also, I struggle with the fleas and other bugs in beds and blankets. They seem to have taken a particular liking to me. The feeling is not mutual.

My data collection has unfortunately been halted now for a little while. We returned prematurely from the last location, me on a stretcher that was carried by twelve men taking turns. The trip was 5 hours of walking through the forest, up and down hillsides. If you think laying on a stretcher being carried in steep terrain is comfortable, think again. I was very happy to be brought to the hospital though. You know when you get a stomach bug and spend the whole night on the bathroom floor next to the toilet? Well, take that only minus the bathroom floor and add cold, rain and an outdoors toilet that is no bigger than just 20 centimeters on each side of the hole. What you end up with then is crawling back and forth to the hole and laying on the muddy path just outside of the toilet for the rest of the time. Not one of my better nights to say the least… My lovely assistant Rikina stood there half the night holding an umbrella over me. That is a true friend!

I was diagnosed with having been attacked by a woman’s soul. She had died while giving birth and we had met a son of hers and her soul was probably with him and angry souls like new people apparently. The grandmother and the 15-year old daughter of the family we were staying with left at 3am to bring the local Dhami, a shaman, to me. The came back at around 5:30am when I had stopped vomiting and was resting in the bamboo and tarpaulin shed we stayed in. With them was the Dhami, a small elderly man. He chanted Buddhist prayers and moved some burning incense around me. He also put a tika with rice on my forehead and threw some rice on my bed. Nonetheless I was taken to the hospital for some western medicine. I arrived at the hospital in the evening, dehydrated and dizzy. A night with some fluids intravenously and I was all better even if a bit weak.

You’ve got to admit I do thorough research of the health care available here though. First I checked out the out-patient clinic with a urinary tract infection, second the traditional methods of healing, then I tested the means of transportation for the sick, and finally got myself admitted to the hospital! That is dedicated participant observation I’d say! Too bad that is not part of my project…

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Finally in Okhaldhunga!

I have finally reached Okhaldhunga district! I’m in a small village 45 minutes from the main hub (another village) in the district. By foot that is, which is sort of how you get around here, even if it takes several days to reach your destination. So far I love it out here. I guess I’m not so much of a city girl, I tend to like the more rural settings regardless of where I am. Here it is quiet and very green and we are surrounded by huge hills and steep hillsides with little houses clinging to them.

So far it is all about meeting people and planning and talking and things take time, which is fine. I mean it’s not like I didn’t want to finish in December, but it is what it is and I’m fine working here longer if that’s what it takes.

Plans have sort of slightly changed (they always do right?) and my research assistant and I will not as planned be based here in the village with the hospital but walk from village to village and only come back here every few weeks. That is quite a change as life here is fairly comfortable. I have even gotten my own desk at the hospital! Almost sad to leave it, a bit attached to the one spot in my new world that is sort of mine!

Few people who come here to do research go into the villages, they are usually based at the hospital. The people who have attempted village stays, well, there are failure stories about them and everyone loves to share those stories with us. Like the young man from Kathmandu who couldn’t take the bugs sucking his blood or the foreign woman who didn’t even last two days in rural poverty. My plan is to not become one of those stories! I’m sure they were equally optimistic when they set out though, my only hope it that I am more stubborn. I am know to be fairly stubborn, cross your fingers it’s enough!

We really don’t have much choice, walking 4-5 hours to reach a village, then work a full day, just to walk 4-5 hours back, there just aren’t enough hours in a day. Also, we need daylight to walk. This new plan means my blogposts will be few and far between… I’m not bringing the computer hiking all over, and besides, there’s not a lot of electricity anyway…

By the way, I have seen a huge, almost beautiful, spider! Yes you read correctly, I used beautiful and spider in the same sentence, unbelievable huh? The spider is bright yellow and black-striped. I really do hate spiders but if you happen to be such a frightening creature, I find it highly sympathetic of you to be stationary or preferably completely motionless. Mr Yellowback hasn’t moved an inch in a week and though I do not like him, I do appreciate that courtesy.

Waiting…

So how is my fieldwork and data collection coming along? Well, it isn’t… I’m waiting, sort of on stand-by, ready to leave for Okhaldhunga as soon as I can. First I was sick, then the hospital director at Okhaldhunga Community Hospital isn’t currently in Okhaldhunga, and he is my contact person. My only contact person there. So now we wait… I do have some good news though, I have finally acquired a length board, yay! Also, I still don’t have cholera even though the newspaper said 3 days ago that the outbreak had now spread to my neighborhood. Thrilled to not have cholera! (Doing my best to focus on the positive…)

Finding yourself in a new setting sometimes make you see things from a different perspective and ask yourself new questions. I have asked questions I have never asked before. Like is it a good thing to have a gecko in your closet? Does it eat spiders? Will it leave gecko-poo all over my clothes? I have never previously considered the diet or the digestive functions of geckos… My conclusion: The gecko can stay. I really do hate spiders… I am also considering my relationship to time. Should I care less about time or should I take greater care not to waste it? Probably both. I should probably care less about time as something that is running out and something that is working against me, and take more care not to waste the moments that make up time. Since I can’t really do anything about this waiting situation I am currently in, I’ve decided not to be stressed about it, and just go with whatever happens.

So, for now, I’ll just stay here I Kathmandu and continue my new little life here. Getting by in Kathmandu is easy as most people speak English fairly well. I love meeting the schoolchildren on their way home, they are simply adorable and often make use of the chance to talk to a foreigner and the standard is “Hello, how are you?” and then sometimes the follow-up “I’m fine, where do you live?” Then they giggle and move on. One day I walked through a different neighborhood than I usually do and it was right around the time school finishes. A 9-10 year old girl in a school uniform starts to speak and I expect the usual, but out comes “Hello sugarbaby, you beautiful girl”. Well, that was new. She must be learning her English from quite a different source than the majority of the kids… But hey, I don’t get called beautiful that often, and, nearing 40, I don’t get referred to as a girl very often either.

Expect the unexpected

Expect the unexpected was the advice we were given before departing to various locations for fieldwork and data collection. I’m still working on getting there… I definately had a few expectations when I arrived, I had for example heard that getting an approval from the ethical board in Nepal could take a really long time, so I thought it would and that I’d probably be delayed. It only took a month and to my great surprise was the first thing settled when I arrived, I guess I forgot to expect the unexpected… Also, I thought it would be a piece of cake to find and acquire a length/height board (to measure length/height of young children) and it has turned out to be my biggest struggle and is now threatening to delay my departure for Okhaldhunga. Surprises in the other direction are so much nicer…

Nepal is actually a pretty good place I think to practice expecting the unexpected. Several things happen here without giving much notice, like the earthquakes/aftershocks and the political strikes, and you do get used to it pretty fast. The last earthquake, though it wasn’t very big, broke my fridge. I guess it had finally had enough of being shaken… It is missed, it’s really warm here now and I just loved how my fridge would have cold drinks ready for me whenever I came home. The political strikes you do hear about the day before, but they are never completely certain until you get up in the morning and see if the strike is enforced or not. Strike means you stay at home, no work, no vehicles on the road etc.

So, I might not have a length board yet but I do now have a questionnaire in Nepali ready for piloting and I even know what it says! I think… I decided to do a back translation of my questionnaire. When you, as in my case, cannot read your translated questionnaire because you don’t speak that language it is difficult to make sure the questions are really asking what you want them to ask. With the back translation these little, easily overlooked nuances were made visible to me and I could tell my local supervisor specifically what I did NOT want the question to say.

My favorites changes through the two translations are “food insecurity access scale” becoming “instrument to measure access to unsafe food” and “our house was somewhat damaged but we believe it safe to live in” becoming “our house had a little loss but less than half”. Half a house..? Not quite what I had in mind for “safe to live in”. I should mention I have more than 90 questions and both my translators did an excellent job, there will always be some things that are lost in translation and when you do two consecutive translations, well, you have all played the whispering game right?

I’ll do my best to expect the unexpected, or maybe just not expect at all. Though even if the surprises do take you by surprise, I guess what really matters is how you handle it.

On finding a research assistant

So, all of us who go to a country where we do not speak the language to do our data collection, will inevitably be very dependent on a good assistant. We see our respondents and surroundings through that assistant and equally important, our respondents see us through that assistant.

I’m going to Okhaldhunga in Nepal. Okhaldhunga I feel is a fitting name for a place in the middle of nowhere or as we say in Norway “gokk”. Let’s just say people in the capital Kathmandu are in general not the least bit excited by the prospect of wandering from house to house in the mountains in Okhaldhunga/gokk. So, the line of research assistant applicants outside my little office in Kathmandu Medical College Hospital is not very long. On the first day it consists of two girls. The first one quickly decides Okhaldhunga is not for her after all, she doesn’t say so, but I can tell. I have not heard from her since. The second one enters the room dressed in a very nice purple dress, something you might see at an evening dinner party. The dress is matched by ample jewelry and of course, high heels. I can’t help but wonder if this is her normal every day attire? She has never visited the countryside and I am wondering if she realizes how incompatible high heels and Okhaldhunga will be? Purple princess, as I call her, sits in her chair nervously giggling and her eyes are getting bigger and bigger for every sentence she hears about the job I am offering. She keeps saying that she wants to do it, but by the end of the interview her eyes are the size of saucers. Needless to say I haven’t heard back from her either.

The next day there is only one girl coming for an interview. I only need to hear a few sentences to know that she is the research assistant I am looking for. I feel it all comes down to attitude, personality and communication skills, qualifications are of comparatively less interest to me. The other girls may be entirely right for another researcher but they were not a good match with me and my project. What you need mostly in the search for a research assistant I guess is luck, it’s as simple and as difficult as that. I really am excited and happy to have found an assistant, slightly against the odds.

MPhil One Year On: Some Reflections

Time really flies by very fast and it is hard to believe that it has been exactly one year since I embarked on the journey of MPhil in International Community Health.

It has been a year full of learning, challenges and thought-provoking ideas. I thought what a better way to start my blog posts than with some reflections from the past year at the University of Oslo (UiO).

I just came from a trip in Bangladesh a month ago and on my ride from the airport to my friend’s place’s house, I noticed an ad on a bus that immediately took me to the class lectures and group discussions at UiO. Bellow is a picture of the ad.

A campaign ad in Bangladesh: “Motherhood is Unique: Let’s make it safe”

In a very old and rusty bus with a picture of a modern couple the ad says: “Motherhood is Unique: Let’s Make it safe.” I immediately started to ponder who is the target of this ad/campaign? Is it the policy-makers who will never take public transport in a country torn by economic hierarchy? Or is it the general population of a country that barely 70% of its people can read? It also made me wonder whether this campaign ad has actually been pre-tested on the target population. What would a woman in the village where she does not have access to basic health care think of the couple in the ad? Would she understand that this is to safe her life? How much of change will an ad like this change to the maternal mortality in Bangladesh?

It was what seems like a simple ad on a bus that made me appreciate all the long discussions I had with my classmates during the past year. I do believe that I may not have been able to notice this ad altogether hadn’t I taken a health communication course where we talked at length about different strategies for health awareness. It also made me realize how much I have actually gained from the course and how reflective I have become about things around me; things that I would otherwise take for granted.

Yes there were many grueling days before deadlines for the exams, but when you go outside the classroom and into the real world; you do understand the value of a setting that teaches you critical thinking. My first year of the MPhil has certainly given the tools necessary to think critically on health and society.

The past year has truly ignited a passion in me to study and observe the many complex ways of interactions between illness, health and social contexts. I never thought that medicine could ever venture into the realm of social and cultural codes. But I was totally wrong; I learned that the two are tied to the hip.

After one year of learning so much in this program, I can only imagine how more I will gain in the coming year especially being in the field to do research on my own.