Week 2 in Mysore — Public Health Research Institute of India
Hello! Welcome back to Week 2!
Monday
Today Dr. Kiran came back which was really exciting as it meant that my project and questionnaire could move forward a lot more.
When it was my turn we discussed my survey in-depth and all the various questions that my survey had. I also got a lot more clarity on how my project would run, as I was unsure on the exact amount of ASHAs/AWW that I would be working with and how I would be meeting them.
I learned that they have a large registry of ASHAs/AWWs that they have contact info about as they often bring them back to PHRII to conduct other studies on as well. So it was relieving to learn that the recruitment part of my project would be relatively easy. However, in spite of having all the contact info of the ASHAs/AWWs, we would have to actually go to the villages they work at rather than requesting they come to our clinic directly as it would be very difficult for them to take time out of their schedule to visit us.
After making a lot of edits, I was able to send a fairly finalized version of my survey to the counselors who would help me with translation purposes. They would go through my survey tomorrow to see whether the questions would be understood in Kannada, and add edits based off of that.
After work, Nikhita and I decided to head to Green Leaf for dinner. We got some masala puri and chole bhatura which were soooo good! The chole bhatura was massive, but somehow we managed to finish it all!
Tuesday
Today, we started off the day by listening in on Nikhita’s mock interview for her project. It was really cool to see the way that Fazila went into character as a diabetes patient, and how prepared they were to act in those roles. I feel like if I had to act in a mock interview, I really wouldn’t do that well!
After lunch, we had a lot of work to do on the survey and I was working a lot with Rashmi to get the Kannada version of all the statements of my survey. She was really patient with me, and we worked on many of the questions together. I also realized the limit of my own knowledge of Kannada, as there were a lot of health terminology that I was completely unaware of. I also felt like the tone that we took on this initial draft of my survey was a lot more formal than I usually speak in Kannada as well.
Dinner that night was really interesting. Nikhita and I were craving pasta so we ordered food from Cubs. We had placed a side order for garlic bread as it was fairly cheap for a lot of pieces. When the food came to us, we were surprised to see a literal loaf of bread. The loaf was our garlic bread which was mainly just bread with a sprinkle of garlic, and it honestly left us really amused. Ika later told us that Cubs was actually a bakery so most of the stuff they sell is baked goods.
Wednesday
Today was a really eventful day.
We started our work by working with Priyanka on her qualitative research project and the IDIs that she had of the male tobacco farmers. She asked to download Atlas.ti, which has a free trial and is a software that allows you to work with qualitative data such as IDIs. Priyanka explained the process of using Atlas.ti to identify codes and themes across the various interview. Codes are a subgroup that appears across the interviews, while themes are a larger group that can encompasses multiple codes. An example would be that a theme is emotion, and that anger, happiness, sadness would be different codes.
In order to identify the codes, we were recommended to first read the IDI in totality and identify some codes as well. We also can use tools like WordCloud and TextSearch to identify any specific words/quotes that stand out, and label them under codes. After identifying some codes, we would be able to also develop some themes that we notice across the interviews.
The coding process enables us to conduct qualitative research that identifies what is similar across the varying interviews. Then you conduct Network Analysis, manually or automatically done by the software, to see the various codes and specific quotes we’ve identified around the codes.
It was a really unique tool that had such immense power to go through so many words across the IDIs, and it was so lovely of Priyanka to explain the whole process to us. It also made me realize how different the qualitative research approach is and some of the work I would have to go through for my own project. As much as I like to read about qualitative research, I’ve never done much work in it so I was completely unaware of the tools and processes to go through it.
After that we had a patient that was supposed to come to the clinic. I hadn’t seen a walk-in patient at the clinic yet, so I was excited. I learned a lot from the whole experience. Rashmi explained to me that this patient is part of a study, and will be a study participant but is coming from a government hospital. The government hospital has a tie up with the clinic where the will send patients over to be a part of the study. This specific patient was actually unaware that they even had cervical cancer.
This struck me and I couldn’t process this information for a long time. The patient had been to multiple clinics, done an MRI, and was even coming in to the cervical cancer study but didn’t know or understand their diagnosis. I couldn’t imagine the levels of fear and uncertainty they might have been currently experiencing when what they believed as stomach pain and vaginal bleeding was culminating into a much more serious diagnosis. Rashmi and Dr. Vijaya later explained that a lot of these government hospitals they don’t describe to the patient what they are going through, and breeze past most patients very quickly. In addition, these patients are often illiterate so even if there is time to provide them with explanations, they may not even understand. For example, the patient that came in mentioned she had never gone to school and was actually married at 12, so she didn’t know how to read or write and thus signed her consent forms with a fingerprint.
I honestly don’t know who is to blame here, and if blame is even the right word to describe my frustration. As much as the government’s hospital’s negligence in telling the patient about their condition is appalling to even hear about, I also have to remember the research I had done on the quality of care at these government hospitals. Most of these hospitals struggle to meet the demand for care, and are often restricted by staff shortages, lack of adequate facilities and resources, and competing private hospitals. Many medical students urge to move on from the government hospitals, disheartened by the lack of facilities and grueling influx of patients, and thus it seems like patients are often just viewed as a number in a larger system.
Regardless of this, Dr. Vijaya and Rashmi explained to the patient multiple times what the study would be involving, what the patient would be undergoing, and also explaining their condition to them. I then was allowed to watch Dr. Vijaya examine the patient’s cervix, and collect swabs and samples for the liquid-based cytology (LBC) as well. Dr. Vijaya explained each step to me and the patient, and she described that the pathology of the disease meant that there was a lot of blood inside the cervix and the lesion, and so it is often difficult to collect a swab as you don’t want blood contamination on swabs.
It was a really unique experience to be able to see the swab collection as it felt like another side of my project within the cervical cancer screening program, and I was actually able to see some of the methods for diagnosis and collection of samples, but in this case the patient was already a confirmed case.
After work, Nikhita and I went to a local gym that’s very close to our clinic and we signed up for a membership for a month! I’m excited to see how my experience at this gym goes. After signing up we went to dinner at A2B, which has a branch in San Jose as well. We came in and we were hoping we could have a thali, but unfortunately it seems that all thalis here are lunch only. Instead we ordered some chaat food that was alright.
Thursday
Today, Ms. Jay, Rashmi, Fazilla, and I went through my survey as Ms. Jay was gone for a week. She had a lot of questions, suggestions, and edits to make to the survey. She also felt that the tone of the survey was a little too formal, as there were a lot of words that she herself didn’t know when we were speaking. Another thing that Ms. Jay suggested was that I also write a bare bones script of the introduction to the survey, the scale that I would be using, and the introductions to each section. I had completely forgotten about those parts so I’m grateful for catching it before my mock!
My lunch break was sweetly interrupted by the cute retrievers at the house next to my relatives! We fed them some bananas!
That afternoon was the painful process of nitpicking my pronunciation of Kannada for the survey. What I landed on doing was having the statement in English, and then below that having my own version written in English of the Kannada pronunciation to help me remember what to say. As we went through it, Rashmi said that I was getting a lot better at it and that I was picking it up fairly quickly. Personally I felt like I was stuttering a little as I felt bound to the script written, and I would get stressed if I missed or mispronounced a word.
That evening we wanted to try out this restaurant suggested by Divya that was supposed to a have good Mumbai street food options. We ordered our food, but not only was the food delivery super late due to the restaurant they also messed up our order! We ended up calling the restaurant and told them about our missing food, and they offered us 2 extra Pav Bhaji for free and we told them to deliver it. This worked to our benefit as our original food order was not enough food, and the extra Pav Bhajis were very delicious, and so so SPICY!! Bombay Kitchen was delicious and I want to go to the actual store another time.
Friday
What a day! Nikhita and I woke up very early to watch Game 6 of the NBA Finals and it was SO worth it! It’s really shocking that I met a fellow crazed DubNation fan across the world, and that we were actually able to watch the game on our little TV. The Warriors won against all the odds and comments that people had to say, and victory felt so so so sweet! I wish I was back in the Bay, and I know that if we were there I would have probably gone to the parade like last time, but alas instead we have PM Modi coming in next week. That is bound to be interesting for logistics in Mysore…
Today was also my first mock interview! I was so nervous as I was really worried that I would not do well, especially in front of a larger group. Fazila, Rashmi, Kiran, Dr. Vijaya, Ms. Jay, and Nagaveni were all there for my mock, and I was asked to interview Nagaveni who would act as an ASHA. The entire process was really long as we went slowly through each section and question and stopped for direct feedback on both the survey questions and delivery. It was a little overwhelming as since there was a large group, multiple people would talk over each other for feedback. I changed some of my statements to a more casual way of speaking as I got feedback that the survey as is sounded like a news report! Kiran said the the formal version of the survey was still important as it would allow the survey to be published in the future or used elsewhere.
That afternoon, Rashmi and I sat together once again to work on my delivery of the survey and we re-edited the questions to sound a lot more natural and casual. This made me a lot more comfortable with delivering the survey as I felt less stressed about the pronunciation of things. I felt like I finally had the hang of things and I felt proud of my flow finally. Since I was going to be gone this weekend, Rashmi suggested I practice my survey at home a bit.
Weekend
This weekend I headed back to Bangalore!! My cousin and I decided to take the train to avoid the traffic that is to be expected to get into Bangalore on the weekends. This was an experience of its own, as I hadn’t been on a train in India since I was 3 years old when we visited my cousins in Chandigarh. We were supposed to leave on a 8:10 train, but my cousin who was arriving from a separate trip was delayed so we ended up taking the 10:30 express train which would take us to Bangalore in 2 hours!
The journey was fairly comfortable and I felt like the two hours flew by, and instead of getting off at the KSR/Majestic station in the heart of Bangalore we got off at Kengeri which is closer to my house anyway. We were really lucky the train stopped at Kengeri as it usually doesn’t, and from Kengeri we took an auto back home. That evening there was a very sudden and intense bout of rain so we couldn’t play the pickup basketball game that we had initially wanted, but instead we all just caught up on our last few weeks apart.
I was able to reunite with two of my aunts after years, and we all went for dinner at my uncle’s home. After that, my cousins and I had a sleepover and we watched Ratsasan, a famous Malayalam movie. Unfortunately we only found the dubbed version in Hindi, so I felt the plot line was less captivating for us.
The next morning, we all went paint balling! I had never done this before, but I remember Appa being destroyed for a week after he did it in the US with his colleagues. I was a little nervous, but I was excited for some competition between our little group. When we got to the place, we saw the impacts of the previous night’s rain. The entire terrain was muddy, and my cousin who had done it before here said that it would make winning more challenging. We then put on our gear, and I felt like an Oompa Loompa. It still hurts my soul that almost all my cousins on my mom’s side are taller than me.
The owner told us that we would play 3 rounds, but that we were playing for elimination. This meant that even if we got hit and splattered with pain once, we were out that round. While the stakes were a lot higher now, it also meant we were less likely to have a lot of bruises. I’m happy to report that my team won (as expected)!! After the game we were exhausted, but my cousin and I had to head back that evening to Mysore as we both had work/school the next day.
It was a tiring week, but so rewarding :)
For other updates, check out my previous blog posts!
