Matters of the heart

This week has brought about some new insights into cardiovascular disease in southern India, specifically in Karambayam. The nuances of everyday life in a village are returning to me from my experiences in Botswana- I feel at home just getting to know people in the village, exploring small shops and even looking at garbage to get a sense of what impacts peoples' health in Karambayam. Although I know that life is far more complicated than several weeks of observation and interactions can illustrate, I am hopeful that I'll be able to contribute something useful to the people I'm working with. Yesterday's field visit was both fun and informative- we visited two households and several small shops. The first family we spoke with consisted of a husband and wife- the husband surprised us with his English-speaking abilities and the wife helped us understand how she dealt with her high blood pressure. It was really interesting to hear about her experiences interacting with the healthcare system- she travels to another town to see a doctor because she doesn't know enough about the clinics nearby; when she was diagnosed with hypertension she didn't receive any information about the condition or how she could deal with the condition except for taking the pills she was prescribed, which she claimed she didn't take regularly. She revealed that she did not know if eating differently or exercising would impact her health, but she said that if her doctor told her it would she would be willing to adjust her cooking accordingly. This story seemed to resonate with the other people we spoke to in the village- knowledge about how to manage cardiovascular risk factors by means other than medication was minimal, and willingness to adjust cooking practices for health purposes was strong. Through this information our team was able to get a better idea of what we might wish to do for our proposed intervention.

As we walked away from the first house, an elderly woman with few teeth approached us, unable to speak but making sounds and motions to indicate that she requested our company at her home. It was very sweet and we consented, taking a seat on the front stoop and greeting her middle-aged daughter who emerged from the house. The two of them were very friendly, and the older woman continuously patted my back- her daughter told me she thought I was pretty- it made my day. Sitting on the stoop having a casual conversation with complete strangers brought back so many fond memories of my experiences in Botswana- the way that life takes its own trajectory and time becomes a meaningless construct. We were able to speak with the women about their health experiences as well and received similar information to indicate that healthcare was being sought elsewhere, that doctors rarely recommended lifestyle changes but primarily prescribed medication with little explanation, and that people would be willing to make small changes to their diets for overall health.
Following this encounter, we visited a line of small shops along the main road where people can purchase a variety of foods, toys, school supplies, and tobacco. We spoke with a few of the shopkeepers and learned that the most commonly sold items were cigarettes, and that even children bought them (they were sure to change out of their school uniforms in an effort for people to not notice their ages). A variety of vegetables and grains were available, including tomatoes, garlic, onions, "drumstick" (a tube-shaped stalk with a hard outer shell and soft inside), eggplant, radishes, chillies, potatoes, okra, rice, pasta- considering the size of the shops, it was surprising to see such variety. I looked at some small packets for sale and bought one to investigate- I was told it was used in Chinese-Indian food and that it wasn't very popular- I was happy to hear it since this substance was straight-up MSG. Sold in a packet in crystals like salt, recommended for a variety of foods and said to "make food taste better." I recalled my migraine headaches and nausea resulting from food with large amounts of MSG in it- not an experience I would wish on anyone else.

There was a small bar down the road called a Tasmac- a small shop without chairs where only men can go to purchase hard liquor and beer (it is generally unacceptable for women to drink here). There were a handful of men hovering around it, and one of my instructors went to check out the scene. While there he witnessed a small boy purchasing and running off with bottles of beer, although when asked the bartender said he did not sell to children.

I tried to absorb everything from the day, but it was hard to let it all sink in- so many intricacies and complicated webs of issues surrounding health, it is hard to imagine how to even address a small part of it. And yet I am still hopeful.