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M.P.H. Summer Internship Program |
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Gabriel ForreyHealth Policy and Administration Setting–Upper Assam: Set squarely between the countries of Bangladesh, Myanmar, China, and Bhutan and connected to the rest of India by a narrow 20–km strip of land, Assam is truly a unique location. The backbone of Assam in many senses is the Brahmaputra River—one of the world’s largest. The river bisects the state’s fertile floodplains across which countless tea gardens, villages, and a pastoral life abound. As the Brahmaputra enters India and flows through upper Assam, it forms a highly braided channel. This braided channel gives rise to numerous sand bars and islands, also known as chars or chaporis, of which fourteen are located in the Dibrugarh District. Additionally, the Brahmaputra’s ecologic profile exhibits three characteristics that promote a rapid process of erosion of the chaporis—a fragile geologic base, active seismicity, and yearly flooding during monsoons. Thus, the tens of thousands of riverine inhabitants are annually susceptible to loss of land and home. Program Duration: The program commenced with an opening workshop in Delhi that began May 28 and concluded May 30. There were 84 interns from five continents who were grouped into four and five person teams and sent to 18 different states of India. I was part of a team of four that was sent to upper Assam to the town of Dibrugarh. We lived in Assam from May 31st until Aug. 3 when we returned to Delhi for the closing workshop. Back in Delhi, the 18 teams formally presented their results, conclusions, and recommendations to UNICEF directors, scholars and government officials. Overview: The team wrote a case study about an intervention that works toward ensuring improved access to health and basic education on those 14 river islands in the Brahmaputra River. We conducted background research on the selected case study topic, developed our own methodology, created research tools, collected primary data on 512 individuals and produced an in–depth case study with a framework set forth by UNICEF. The case study examined health and education access through the lens of social exclusion and the ways in which social exclusion leads to diminished or missing health services. The study also sought to elucidate the correlation between a lack of education regarding health awareness and health seeking behaviors with increased rates of mortality and morbidity. Also, the purpose of the study was to identify, document, and analyze the approach and extent by which the “Akha: Boat of Hope” is a socially inclusive intervention for the chapori populations residing on the Brahmaputra River islands. Accomplishments: One of the major accomplishments of the group was that this was the first time any literature or body of work has been produced on the island populations of the upper Brahmaputra. Despite over a million Assamese people residing there, more research exists on the evolution of the porcine population than does that of literature about them. Another accomplishment was simply producing the case study. Due to daily power outages, transportation issues, lack of computers, and monsoon rains, it became extremely difficult to collect data, analyze it, and finally produce the case study by the deadline. Lastly, we were asked to make recommendations to UNICEF about how to improve the public–private partnership that has made health service delivery possible. Amazingly, these recommendations are in the process of being implemented thereby demonstrating a tangible and lasting impact of the case study. Thoughts and reflections: This experience entirely changed my life. I went to India expecting essentially nothing and anything. I left anxious to experience a culture totally unknown to me, yet I looked forward to catching my first glimpse of how fundamental needs of human existence such as health and education are afforded to poor rural populations. During my journey to discover the answers to the questions posed to me by UNICEF, I also found the answers to numerous personal questions I never knew existed. Essentially, that meant that I now understand more about what it means to have literally nothing except one’s health and happiness. Those villagers who live in mud homes that are entirely washed away each year by monsoon flooding remained energetically optimistic and unceasingly welcoming during our 90–minute long interviews, subsequent visits and even when they didn’t think we were watching. I came away from this experience not only highly recommending UNICEF as an organization with which to do an internship and learning volumes about basic health service delivery but also a new perspective on what it means to be human and humane, what it means to be honest and open, and what it means to genuinely care about public health.
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