Public Health

One of my alma maters – Taylor University in Upland, Indiana – is starting an undergraduate programme in public health.

As they work towards recruiting the director of this programme and getting the word out for the planned start in Fall 2012, the good folks in the University have sent out feelers to the alumni asking for inputs.

One of the questions they asked was simple and stark: why does public health matter?
Here are some thoughts on this that I am writing from the Herbertpur Christian Hospital where Sheba, the kids and I are visiting lots of our old friends – all of whom are practicing public health.
Why does public health matter?

Public health matters because people matter. People who make choices. People whose choice affect both their own lives as well as the lives of others.

Public health looks at the basic human need for wellness. I believe that this comes from a principal expressed in the Bible – that of Shalom – a peace that goes beyond the absence or even management of conflict – but one that is based on having ‘right relationships all around.’ A 360 degree wholeness and harmony where body, mind, spirit, relationships – the whole complex and beautiful web of our experiences are essentially good.

A public health perspective that is based on this set of ideas sees that good decisions on our part result in the well-being not only of us as individuals – but also and necessarily so – that of our families, our communities and our nations.

Even the most cursory look around us shows us that things are hardly geared to well-being. The challenges of ill-health and disease, the crippling effects of poor decisions and systemic evil have generational impacts.

Public health matters because we know that we are not passive spectators of the world around us. We are called to be stewards and managers of our lives and those whom we are given responsibility for acting on behalf of (which includes those who are yet to come of course).

Public health uses a ‘big picture’ systems approach that sees multiple roles in shaping our shared wellness. But as said before public health takes more than just a descriptive approach – it seeks to be actively involved in shaping the outcome of our lives.

What makes a public health approach different from other ways of looking at how we shape our communities? One distinctive lies in some of the tools Public Health uses.

The man or woman on the street may not be familiar with the terms of epidemiology (the science of understanding how diseases spread) and biostatistics, or be aware of health communication and behaviour change inputs, or even appreciate policy initiatives that are informed by public health considerations – but each of these are powerful ways which can help promote shalom in our fallen world.

In our work at Jeevan Sahara Kendra in Thane, for example, we estimate that HIV affects about 21,000 people in a city of 1.8 million people (epidemiology). A look at the numbers suggest that with an average of 4 other members per family we would expect about 100,000 people to be affected by HIV/AIDS since either they or their immediate family member has the disease.

At JSK we have developed a team to work with local families who are affected by the disease. We are not just dealing with a virus – besides the damage to the immunity, the very real, and very deep stigma and shame that people with HIV face in our society mean that many are dying despite services being available – since they are too scared to access them. Our interventions cannot thus be just a few slogans on a wall – we need to change lives one at a time. Towards this we have developed a small core team of JSK staff and volunteers who meet people with HIV in their own homes.

Using the best available medical understanding of the disease – and the wonderful set of interventions now available – our team discretely meets families who have members with HIV. Our efforts are bearing fruit – we see remarkable changes in the lives of many with the counselling and medication interventions that the JSK staff do.

At the same time we know that we as JSK staff cannot bring about change alone. One of the powerful tools we use are support groups for people with HIV – where people with HIV come together to share their stories – and challenges – knowing that they are not alone. We also are convinced that local churches and prayer groups must reach out and bless people with HIV. Since HIV is a life-long condition we need to have people who are committed for the long-haul who can come alongside families and bless them – and be blessed by them – through practical and life-changing help. Involving the community is not a luxury – social networks are vital to see families affected by HIV change and move forward towards the wellness that we seek for them.

At the same time, it is not enough just to set national policies and expect things to change magically. Going back to the level of the individual - each person needs to make responsible choices. Part of our work at JSK is to help our friends with HIV see that they are created by a loving God who left the glories of heaven for their sake. The specific choices they make all have consequences – whether to share their HIV status with their family members (and how to do so when they want to) – how they spend their resources – how effectively they take their medications – what steps they are taking towards reconciliation and care for each other… the list goes on and on. Each set of choices need to be guided by reliable information that empowers the person and their family to make decisions towards wellness.

So does public health matter? Yes it does – and we at Jeevan Sahara Kendra see it in the lives of men and women who are living with HIV/AIDS despite the climate of hostility and fear that still shrouds the disease. We see it in the gradual change in attitudes towards people with HIV in the church and society at large. We see it in the generation who are growing up without a parent or sibling – and the hope that many of them have to make a new life. We see it in the continued challenge of seeing the spread of HIV stopped – and the dream we have of being able to live in a world with HIV is consigned to the dustbin of history.

On Hearing

Hearing is a miracle. Nothing less.

That we can perceive the exact vibrations of air – which cross at so many different frequencies – and that we can make sense out of these air-vibrations is amazing.

All the more so when we consider how much of our life takes place through our talk. Our soft murmurs of love. Our short sharp warning shouts. The drip-drip-drip after an early monsoon shower. The whirring of the fan. The click-click of the train bogie hurtling through the dark night. The warm sounds of people talking in the kitchen. The soaring notes of a song of praise.

And how alienating it is if we are excluded from this forest of sound.

Appa has inhabited this land for years.

A few months ago, when he was visiting us he said that we was ready to have his ears checked. We took him to an audiologist – our old friend Santosh Joshi – who performed the tests and found out that Appa was living with severe hearing-loss due to neural degeneration.

Because of the high decibel sound environment that Appa worked in during his days at the Rourkela Steel Plant – and during the days of his working with heavy machinery in the captive mines that feed the RSP – he has suffered neural loss. Certain parts of the sound spectrum are not being picked up by his ears.

When Santosh spoke loudly and on a topic – Appa was able to hear him and respond. When Santosh spoke a bit softer and suddenly changed the topic – Appa was not able to catch the change. He was actually lip reading to compensate for what he was not hearing.

Santosh asked Appa why he wanted to be helped. Appa said that many times he hears sounds but cannot make out what is being said. He would attend church meetings and want to follow along in the Bible – but the sound from the loudspeakers was confusing to him and he is not able to get the main points of the message that is being preached.

The solution to Appa’s hearing loss is two-fold.

The first part of which I was familiar with – the second came as a surprise.

To compensate for the loss of hearing in certain parts of the spectrum – we were advised to get two digital hearing aids.

These tiny machines were programmed to amplify the areas of the spectrum which cannot be heard. We got the machines and inserted them. When Appa started using them, a big change took place immediately. His own voice volume decreased dramatically.

Why? Because now he could hear what he himself was saying without speaking at a semi-shout.

Secondly, he became immediately aware of all the environmental sound. The hum of the air-conditioner in the consulting room. The whirring of a fan in our bedroom. The loud sound of an auto-rickshaw – seven floors down on the street outside our house. These sounds which we routinely filter out were heard again by Appa – and not appreciated.

What surprised me was Santosh’s statement about the need to relearn hearing.

According to him, because Appa was not hearing so many of the sounds over the years – his brain will have forgotten what certain sounds are like. The challenges at this point is not only to increase the volume – which is done immediately when the hearing aids are inserted and turned on.

The real challenge for Appa is to retrain his brain by relearning. Relearning what different sounds are like. Retraining his mind to filter out that which is not important. Rematching sound to meaning.

All of this takes time. Its easier said than done. Santosh said that it would be a matter of at least a month for Appa to get used to the hearing aids.

His words came true. Appa found it very hard to use the hearing aids on the phone – and usually switched off the aids – and resumed his previous high-volume voice when talking on the mobile. Initially he complained about an echoing – which was partially helped by Santosh making a special mould for the plastic parts to fit snugly into Appa’s ear. Later when Appa was back in Vishakapatnam, he developed an ear infection – and had to have some oil and antibiotics to deal with it.

I have had my own small experience with this over the past month. For some reason my mobile phone is stuck in ‘speaker’ mode. I have tried repeatedly to figure out a way to turn it off – but it keeps switching back on to speaker mode when I finish the call. The settings have been scoured for possible reasons for why this is so – all fruitless.

A month ago I took a call. Without thinking I place the handset next to my ear. It was made worse because I was wearing a helmet at the time – and the phone was inserted snugly in-between the helmet foam and my ear – all at speaker volume. The call was over in about 10 seconds – but the ringing pain in my ear did not fade that quickly. For days I had a ringing and echoing.

I felt cut off and aloof because my inner me was not easily hearing what was going on around me – and others were. The pain and ringing eventually have subsided, but what a sobering glimpse into what so many others experience on a day to day basis.

What a miracle hearing is – and what a gift to be able to listen.

Delhi Rellys

Delhi means many things to many people. It is a vast metropolis – a virtual continent to itself.

The view outside Victor and Sarah's house in Delhi. Every square foot of land is used!

Delhi is a paradoxical city – studded with money and greenery. This ethereal world inhabited by diplomat and the minister and the teeming masses of newspaper distributors and cooks and taxi drivers and masons and sweepers. This cross–roads of power and hard-scrabbled money – a collision between the aspirational worlds of the upwardly mobile professionals and the seedy-shabby-security-land of the innumerable folks who have got the coveted government jobs. And all around it the amoeba–like massive shanty-towns that fill in the blanks at the city’s ever expanding peripheries.

For me – as I tap this on a sleepy Sunday afternoon – where all the household is catching a nap in the late afternoon heat – the lights all off and the coolers on with fans fluttering in every room – for me Delhi is a place of relationships. We are blessed as a family to have two of our closest Rellys in Delhi.

Enoch on the steps going up to Victor and Sarah's place

It is no surprise then that when we do show up in this land of green autorickshaws and ancient monuments swallowed up in small genteel parks – that we spend the lions share of our time with our Rellys. I am writing from Sheba’s sister Sarah and my co-brother Victor’s place. They are blessed with the lovely Joanna – who with her current age of 9 is nestled neatly in between cousin Asha’s 10 years and cousin Enoch’s 8 spins around the sun.


Last night my brother Stefan and his lovely wife Neeru came over with their brace of kids- Ashish (almost 5) and Anjali – a sprightly 2 year old.

Enoch and Asha playing with Anjali on Joanna's green horse

Being the son of single parents – we had no cousins growing up. Though the extended OM family was there for us – we missed out on having cousin brothers and sisters. We are so glad this is not the case with our kids. They are part of a passel of 8 cousins so far. What fun to see our lovely ones spend these precious hours with each other.


Delhi means many things to many people – but to us it is primarily the place of our lovely Rellys. Delhi is also our gateway – we are scooping up Joanna – and taking her with us for 10 wonderful days in Mussoorie. Stefan and family are going ahead of us and we plan to have all 5 cousins at Shanti Kunj!

Victor and I enjoying the snacks that Asha and Joanna made for us

VBS

Each child is precious.

By God's grace we are in touch with about 150 people in Thane who have HIV/AIDS through the JSK home-based care programme.

Many of our friends have children. Some of our positive friends are children. Each child has their own special needs.

Holidays are a challenge for many - as there just is nothing to do.

The streets beckon.

For a number of years Jeevan Sahara has been organising a Vacation Bible School together with folks from local churches for children who we are in touch with. This year's time was a wonderful one.

The kids who join the JSK VBS are not 'Sunday School' goody-goodies. They are children who have seen their share of sorrow. Many have lost a parent. Some have lost both. Some are HIV positive themselves. Some have HIV positive siblings. Almost all have a parent who is suffering from the disease.

Needless to say - it is unsurprising that many can hardly sit still.

Which is why we worked hard to get teachers who have big hearts. Lots of them. We ended up with 18 different classes taught by 22 different teachers. With 119 kids being there on the final day this meant that almost every class had only 6 kids in them. Some with even less. The attention to each child is vital. Precious.

Over the 5 solid days of the VBS we saw so many blessings. Lives receiving love. Children holding on to their teachers. Much laughter and prayer. Games and joy as well as times of introspection.

The children loved singing. Loved it. To have over 100 kids singing lustily together was an amazing sight. We were so blessed to have a great song-team who poured themselves into the kids.

The premises for this intense 5 day time was provided very very generously to us by the Marthoma Church in Majiwade, Thane. We are so grateful for the beautiful hall and stilt area which we were able to have fully to our use for the whole time! Such a blessing to have a safe, beautiful space for the kids to learn, play and enjoy in.

At the centre of the VBS is the Bible. We are convinced that it is God's word which changes hearts - and know that many of the dear ones will see real fruit in their lives.

We were blessed to have Bro Oliver Ammana and Sheba share with the older children in the special devotional assemblies - and Sis. Sabina Jadav share with the younger children.

I had the joy of telling a daily 'missionary story.' As I was telling the older children about David Livingstone - it struck me that Livingstone left school at the age of 10 to work in a rope factory because his parents were too poor. Instead of giving in to a life of drudgery, however, Livingstone took his books along with him and tried to read and learn in every spare moment - while working 12 to 14 hour days. So many of our children have very poor educational situations - but how any one of them can be a world-changer - and a desitiny-shaper - with God's help!

Behind all the classes and amazing sessions - was a whole lot of work. Cleaning, serving, preparing, cleaning again, purchasing, bringing food, serving food, cleaning again, bringing children to the VBS, taking them back, cleaning again.

We were blessed with a small army of young helpers who made it all possible - and an excellent JSK team who continued to meet people with HIV in their homes - after having dropped off their assigned kids in the morning - and then taking the children back home at the end of the day.

And we were also blessed with a lot of prayer. People across the city (and the world) were praying for this special time. We did too. As teachers and helpers. Many times in preparation and during the whole VBS. Prayers made a huge difference in all of us!

All good things come to an end - and on the last day we had a programme where the children shared what they learned with their parents. What a joy to see all of them wearing their crowns - and each class giving a short presentation on what they had learned.

The theme of the whole VBS was 'Walk in My Ways.' At the end of the time we know that God had helped all of us - kids, teachers, helpers - everyone to walk in His ways a bit more.

Here's to the on-going journey!

Departure

Four beauties lie on the floor. Two black. Two blue.

Square with bulges. Filled with the stuff of dreams.

Our suitcases wait silently - as the family sleeps.

Tomorrow is nigh upon us - 4 minutes away.

The long-hoped for day will tick into being. 13th of May. D-day.

We are leaving on a speeding train. Boarding at Borivali we will whiz north to Delhi.

Tickets checked. Money stored away. Milk and newspaper-wallahs informed of our 2 week departure.

A small mountain of work still lurks between here and our leaving - for the mountains that we desire.

But this too will pass. We are now counting hours - soon this will bleed into minutes - rushing towards the 4 PM taxi arrival that will start our trip to Mussoorie.

The road goes ever on and on
Down from the step where it began
Now far ahead the road has gone
And I must follow if I can
Pursuing it with eager feet
Until it meets some larger way
Where many paths and errands meet
And whither then?
I cannot say

Well - I know where our road leads us (D.v. of course). From here to Delhi on tomorrow's Rajdhani Express where we will be cramming in as many meetings with dear ones as we can in the 48 (apparently roasting) hours that we have there.

Picking up Asha and Enoch's cousing Joanna, we then aim to get the night train that leave Delhi Sunday 23.55 to Dehra Dun - and a taxi jaunt out to the Herbertpur Christian Hospital where lots of remarkable folks are - not the least our amazing Dr. Cherring Tenzing.

We plan to spend 2 days in Herbertpur - and then along with Stefan, Neeru, Ashish and Anjali - we should be winding up the roads to the blessed coolness of Mussoorie on Tuesday evening. And the welcoming hugs of Mum and Dad at Shanti Kunj. And 10 days stuffed with silence and laughter, reading and hiking, conversations and meditations and silly hats and and and....

Pinch me! Its finally happening!

So grateful for God's mercy in our lives.

Chicken curry

Its been a long time since I made chicken curry. Far longer than the long break from this blog (see here for the reason). So long that I had to ask Sheba for a step by step set of instructions.

Here is the recipe for Sheba's lovely coconut chicken curry:

1. Take 2 big onions and slice them fine
2. Cube 4 tomatoes
3. Heat up the oil in the fry pan. Add the onions while hot and fry.
4. When the onions are brown, add the tomatoes and the following:
a. 1 tablespoon ginger garlic paste
b. 1 tsp haldi (tumeric)
c. 2 tsp garam masala or chicken masala
d. 1 tsp 'Amma's special masala'
5. Allow the spices and onions and tomatoes to cook on high flame till the oil separates
6. Add 1 kg chicken and 1 cup of water (I added a watery dahi tonight)
7. Let simmer on low heat until the chicken is cooked (about 1/2 an hour to 40 mins)
8. Add salt to taste and 1/2 a grated coconut
9. Serve with rice or hot chappatis (which is what we are eating tonight).
10. Enjoy

As I type the lovely smell of the curry wafts through the house. Sheba and the kids have come back from the birthday party (we are hosting Oliver and Jaya's daughter Stuthi for the duration of the VBS).

I am just about to add the salt and coconut. Soon after that we should be sitting down at the table to eat. One hungry man and four birthday-party-snacks-full-returned-others. But I have a feeling that the chicken curry won't last long.

Bon appetit!