rouleka, sundergargh

Hunker down folks, this is going to be a long one…I spent the past week in Rourkela, a small town built up around a steel factory which is where the majority of the population earns a living, but also where there’s a national malaria research centre. I’m sure it will prove to be my most memorable week in India and I’ll do my best to describe what it’s been like.

So, first things first, why did I go to a malaria research centre? If you go to the project’s website, that’ll give you a head start. Basically, our study is a randomized intervention where we chose 150 villages in rural Orissa in 2007 and randomly assigned them into one of three groups. The first group was merely interviewed with no intervention (our control group). The second group of villages were given mosquito bednets for free to cover their entire family…they were also interviewed. The third group of villages were offered to purchase nets either with cash, or on credit through a local microfinance institution. Everyone was tested for malaria using our field test kits in 2007 and again during the pat 6 months to see whether being in one of the treatment groups caused a decline in the rate of malaria. Logically, you would expect villages with access to the bednets (even if some people didn’t use them) would have relatively lower malaria 2 years later. Unfortunately, using preliminary data (I say preliminary because I’m not done cleaning it yet!!! yuck!!) we have not found this expected result.

Instead of scrapping all the results we’re doing additional research about the validity of our malaria field kits. So, we went to a malaria research centre in Rourkela where the head doctor there agreed to let us come and double test his patients for a few days. They test for malaria using blood slides and analyzing them under a microscope, a more accurate way to detecting the malaria parasite. So, we tested the same patients, and are now comparing our results to the clinic’s results to see if our tests yield accurate results.

The journey started with an 11 hour overnight bus ride from Bhubaneswar to Rourkela. It sounds awful, but it’s really not that bad.

You can see from this picture that there’s a tv where they play bollywood movies, and also a little shrine to Lord Jagganath. Here’s a picture of the staff.

Deepak’s in the middle and Jitesh is on the left, and Jujesti on the right. We had a short questionnaire (mainly about symptoms) that Deepak would ask the patients, and then Jitesh and Jujesti were in charge of actually taking the blood and preparing the tests. They all worked so fast, I was really impressed that we were able to get as many tests done as we did.
Being at the malaria clinic was a rollercoaster of emotions. The only people that come to the clinic are those who suspect they have malaria, which means a lot of really sick people. Fortunately at this time of the year it’s mostly not malaria, but they’re really sick all the same. It was particularly hard to watch the kids who were so sick, and also so scared of getting pricked for the blood test. They screamed and screamed, it was really hard to watch. On the other and though, I was there with Deepak when the doctor (behind the desk in the next picture) was telling people that they didn’t have malaria. Some people just said thank you and walked out, but some people you could tell were so relieved and left just thanking the doctor almost in tears. It was such a good feeling to watch these patients so happy, and also to see what a wonderful clinic it is. The clinic is entirely sponsored by the government of India and is completely free for patients. While a government doctor position is desirable, you often find government doctors that hold an office in the government clinic or hospital, but that actually work at their own private facility for much more money. This leaves the government facilities without a doctor, and so the quality of care that most ultra-poor people receive is sub-standard. The doctor and staff at the clinic we visited were the exact opposite of this scenario. They have almost all been working there for 10-15 years and are completely dedicated to serving the needs of the poor.
Here’s a picture of the little room where all the patients are seen. You can see Jitesh and Jujesti in the background preparing our tests while the clinic’s technician is in the foreground collecting the blood slides.
We spent 2 days in the clinic and also 2 days in the field. We visited 2 villages about an hour outside of Rourkela where the clinic has small field offices that they visit every couple of weeks. Here’s a picture of a tea shop that we stopped at along the way. It doesn’t look like much, but had damn good chai!






Here’s Deepak “interviewing” one of the village children after being tested. We had to ask everyone about their symptoms and if they’ve had malaria in the past 30 days, etc. Unfortunately, the answers provided by the children weren’t very accurate. They would just kind of nod their head this way or that way at each question. It was very amusing to watch.



The roads were not good.


These next pictures I took at a school on the second day in the field. I just fell in love with these little boys. They took a while to warm up to me, but once they did they were all smiles. The first one was very wary of the blood tests and crying, but he ended up being one of the happiest ones after he got to see his picture in the review on my camera (that's his teacher coaxing him).












After a full work week, we took some time to see the only real tourist site in Rourkela - the river where 2 separate rivers joint to become one. This is me with the guys...you can see I'm wearing the Salwar Kameez I had tailored when I first arrived in India. Don't I look like a local? - ha!

On the way back from Rourkela we stopped in Sambalpur, one of the study districts in our project and also where the project headquarters were located before I arrived. We went to the village of Kilasama, which was a village where we gave away nets for free. This woman in the next picture is working to roll beetels - like cigarettes made of dried leaves that they roll with tobacco. She told us that she gets paid about 33 rupees when she makes 1000 of them. That's about 85 cents and takes her 2 days.

She took out the nets that we gave her 2 years ago to show us. One of the remarkable things about these villages is information disemmination. For instance, in one house the family told us that they use the mosquito nets every night because there are many mosquitos. In this house, the woman told us that she doesn't use the net because there aren't any mosquitos...the houses are right next door to each other. Deepak is taking the net out of the plastic bag that she keeps it in. This is an example of a woman who, instead of sleeping under the net, keeps it tucked away in the corner of her house to protect it like an asset. They say that the nets are so nice that they want to keep them in good condition and since they are worth so much (relatively speaking) they treat them like a valuable possession and do not use them to sleep under. (Maybe another reason why there was little difference in malaria prevelance between control and treatment villages...?)







Here is another woman in the village who was eager to show us that her net was hung up in working condition.


Our last stop on the way back to Bhubaneswar was to the damn in Sambalpur. We climbed to the top of the tower that looks from one side of the damn to the other. It was so beautiful and quiet. Very peaceful...a nice change from the rest of life in India.

And that is what I've been up to for the past week. Like I said, it was a wonderful week, and one that I will remember above all the rest I've had here in India so far. I have many many more pictures that I'll try to post on the link to the right in case you're interested. This week will be FULL of hard work and then I'm off to Bombay for the weekend to visit Esha - I can't wait!