Emily Meiring Reflection – Global Health Fieldwork in India

Emily Meiring is a College of Health Professions student at MUSC. She was awarded a Center for Global Health Student & Trainee Travel Grant in early 2023 to pursue a project with Children Family Health International in Delhi, India. View more photos of Emily's time in India in this Flickr photo gallery.

The outline of this experience involved visiting, observing, and engaging with non-governmental organizations throughout Delhi, India. The idea was to understand the public health sector of Delhi and to begin to understand how their healthcare system works for and against individuals in various circumstances. Additionally, my goal was to learn about the experiences of multiple different populations through my lens as an occupational therapy student to understand more about the concepts of complementary health, global health, and cultural humility. My specific learning objectives I identified prior to my trip were:

1. Identify how complementary approaches are implemented in occupational therapy and explore the use of these approaches in mental health settings.
2. Apply global health concepts to clinical experiences with occupational therapy practitioners.
3. Analyze how healthcare professionals in India integrate cultural humility into client/therapist interactions when working with individuals in vulnerable populations.

Because I visited multiple organizations, I want to include my reflections to provide the full scope of my experience in New Delhi, India.

CanSupport: The team of healthcare professionals travel to homes of individuals with cancer who are too sick to travel or don’t have access to consistent transportation to receive care. They address any new symptoms, pain, medication changes, and social support with their patients. I did see an opportunity for occupational therapy in this organization to address mental health troubles, pain management, medication management, and participation in daily activities.

An important takeaway from this experience at CanSupport is that we as healthcare professionals don’t always need to be “go, go, go.” Especially in the United States, it is emphasized that productivity and efficiency are the most important aspects of treating patients to see more people and get the most done. However, with CanSupport, I was able to recognize the value in sitting with the patients, meeting them where they’re at, and socializing with them and their families. Although I didn’t speak the language, I didn’t need to be able to know any vocabulary to see that the provider interactions with the client were not anxiety-inducing, but rather anxiety-reducing, informational, and compassionate. Sometimes slowing down and letting the patients sing to you is the best thing you can do for them.

Genesis Health Foundation: Genesis Health is a medical care center that provides treatments including integrative medicine to treat a patient holistically, nutritional counseling, clinical counseling, dermatology, and internal medicine at schools, in-person clinics, and virtually. Dr. Suman Arvind brings her team with her from Genesis Health to a school in a rural area to help consult with the children and their families about providing a healthy life and proper care. Dr. Suman told me that in this community, it’s common that the mothers of the children at this school only have an elementary school level of education and don’t understand much about health literacy, proper nourishment for their children, when to seek medical treatment, or even what it looks like for their child to be ill. The doctor works with the teachers at the school to provide care to the students and assess their health. Additionally, she provides consultations with the families to help them understand more about child development and help give the parents the knowledge and the support to make a change.

My biggest takeaway from this site is that knowledge is power. Dr. Suman provides information for the families to help empower them to take the first step in providing their children with the care, nutrients, and support they need. All parents have a right to an understanding of their child’s development, behaviors, and how to best support them, they might just need to be told what to look out for first as no one has provided any explanation in the past.

Additionally, I did see an opportunity for occupational therapy in terms of addressing learning disabilities. These often go unnoticed because they can be perceived incorrectly as a child misbehaving if they are not performing as expected. For the children who are supposedly “acting out” or not performing to the expected level, it would be helpful to have additional staff members, such as occupational therapists, to help assess and evaluate the children who are not performing as other children are to see what might be contributing to that.

HIV Testing Center: We visited the HIV Testing Center at Kashmiri Gate, a large bus terminal in New Delhi. The main populations seen at this testing site are migrant workers, sex workers, drug users, and gay men. Although this is a self-reporting site for individuals within these populations, it comes with facing a lot of difficult concepts: stigma of the illness, lack of education, knowledge of access to resources, and denial of reality. What I loved most about this clinic is that it is not a “get in and get out” process to circulate the most people. There are pre-counseling services that can help individuals work through their denial about their circumstances as well as help confront the depression and stigma with which they might be struggling. The clinic keeps track of everyone who comes into the clinic and tests positive so that they can be checked in on physically and mentally. There are even monetary incentives to maintain medication compliance and healthy nutrition, both things necessary to make sure the treatment is most effective. This testing center providing a safe space with an abundancy of information to spread the word about how to prevent the disease as well as encourage supportive relationships.

Also present among staff at this location was the concept that knowledge is power. The team was focused on providing information to empower their clients to take charge of their own health and providing incentives and support for these individuals to be able to continue living a healthy life. Slowing down and taking the time to have compassionate interactions and help their clients work through denial, depression, and unwillingness to change addressed the cultural stigma attached to HIV.

Sulabh International: Sulabh International began in 1970 with a sanitation movement to provide affordable and safe toilets to homes, schools, and public places. Then between 1985 and 2003, Dr. Bindeshwar Pathak worked to end the social injustice for the lowest members of the caste system: scavengers. By implementing a vocational training center to teach these women new skills, he dedicated his time to helping them change the trajectory of their life and engage in meaningful activities, find purpose, and rebuild their identity.

What I learned at this organization is that small scale changes can make a big impact. It all starts with an idea, but the actual change takes place when there is a consistent dedication and passion directed towards the idea that makes the difference. If Dr. Bindeshwar Pathak was not actually passionate about the communities of India and helping people have better quality of life, this project would not be sustainable, and it would not have succeeded. Dr. Bindeshwar Pathak leads with cultural humility in that his ideas and action are not stagnant and are in tandem with the ever-changing issues in India. He is dedicated to learning and to identifying new problems that have risen rather than settling with the solutions he has already found.

Having the opportunity to visit Alwar and to listen to the women’s personal stories about how this movement has changed their life was emotional and empowering to see how simple changes have made such an impact on their lives.

Society for Promotion of Youth and Masses (SPYM): The SPYM is a de-addiction center that provides drug treatment and rehabilitation services at multiple centers for children and adults. The treatment at this organization consists of a holistic healthcare team to treat drug addiction as well as other comorbid and co-occurring physical health and mental health issues. I visited the de-addiction center for boys (ages 6-17) and the one for girls (ages 6-17).

What I learned from this organization is that all children deserve a safe environment no matter where they are from, and that a second chance is possible with a dedicated, consistent support team, and established routines. This program provides an environment free of judgement and filled with encouragement. By introducing routines involving various therapies, meaningful activities, and skills training, they are provided an opportunity to practice living a better quality of life among a community of individuals to connect and grow with to later integrate into the real world. Culturally sensitive care within this organization came with the understanding that no shame should be attached to their admittance to the program. Only care and support are provided as the kids are not at fault, but their environment.

In reference to my learning objectives, I did not directly learn how complementary approaches can be implemented into occupational therapy as I was not in a clinical program in India. However, I was able to see how complementary approaches such as yoga, mindfulness, art therapy, and movement therapy can be used to build routines and allow opportunities for children to engage in activities to increase their health outcomes. While I did not see any occupational therapists practicing in India, this concept of finding meaning and purpose in something other than drugs and participating in activities to influence your health and wellbeing is the foundation of occupational therapy.

Additionally, I was able to apply information from global health courses to each non-governmental organization that I visited and every interaction that I observed between clients and healthcare professionals. Again, while I did not see occupational therapy directly, I was able to view these experiences with other healthcare professions through an occupational therapy lens to identify where it could be present or what theories and concepts are already at play.
Lastly, cultural humility is the dedication to the lifelong learning of culture and interactions with people. The humility piece of it is that we will never be fully competent in all cultures or any one culture because the world and the people in it are always changing. The humility piece of it is that it’s okay to make a mistake or to not know something, but that you are respectful and not defensive when it comes to recognizing it and apologizing.

The healthcare professionals I observed during my time employed culturally sensitive care within every interaction with their clients. The doctors were not condescending when giving what may seem like common sense; the counselors did not project shame onto their clients when asking questions about their lives; and the healthcare professionals were not dismissive of detours in conversation and would rather take their time to sit with the clients and explore their thoughts and ideas. Every individual has a story, an experience, and a background that influences the way they see the world. It is our job as healthcare professionals to understand our experiences and how that influences the way we see the world, but then to package up that perspective and hold it to the side while we meet the patient where they are to best understand their perspective so we can provide the best care possible.