What kind of a public health person am I?

 As I become a little more familiar with the public health ecosystem of India, I am slowly beginning to feel less like a visitor to this field and more aware of the players and the dynamics... it's like getting to know your husband's family after your marriage. Everyone appears amazing and will go to great extents to tell you how close they are to your husband when you first get married, but as you become more and more integrated within your partner's family, you understand history, nuances, dynamics that were glossed over before.

The main organization I have worked with and understood a little bit about public health is an old one based in B'lore with whom I became close during Covid.  Recent experiences with scholarly writing and with consulting for some other public health organisations makes me realise that not all PH organisations are painted from the same brush, even if nearly all have very similar-sounding mission/vision/goal statements. 

Some follow the consultant-model. I think this is the type of job what most new graduates from fancy PH schools assume they want. This model has some degree of field work, but does not involve much actual ground-level implementation. The meetings will be with heads of other bodies, may include a day or two observing the implementers and the work will involve a lot of writing, calling, meetings, reporting, coordinating and organising. For young PH professionals, their identity is not with the work or with building their own brand as much as it is with the organization they have joined. This is different from the PhD style training I am more familiar with. In the PhD route, at least in the US, students are drilled that they are working for themselves, by themselves and towards building a personal cachet. This, of course, has its own drawbacks mainly that most PhD graduates are not organization builders. They plug into existing organisations, such as universities, and are focussed on personal advancement. 

Some PH graduates follow the ground-level management group. These ones tend to be managers of the implementers- they end up being program leads or program managers. They work closely with the implementers but ultimately their day to day lives are similar to the first group's but with a slightly different weightage to the activities. I think that most of their lives are spent chiefly coordinating and organising and then reporting, writing etc. They also sometimes show up in public sector PH projects for leading teams of young researchers for ground-level data collection, household surveys, and the like.

People from both categories tend to move from project-to-project or site-to-site as projects end. So it can be a life with quite a lot of unpredictability or changing jobs or movement.

Very few PH graduates actually end up as ground-level implementers. From what I have seen thus far, implementers tend to be professionals from healthcare, law, social welfare etc. They may have systems on the ground and they bring on PH graduates to help manage things better, conduct certain types of research, assess quality, monitor/evaluate progress etc. I think for the implementers, public health is of course one of their objectives, but it may not be necessarily the most key one. Their core objectives may be far more narrowly focussed, such as providing some kind of service to some kind of community. This also means that they stay put in that community for a long time. 

The people who choose these different categories also tend to be of different socio-economic strata. 

This categorisation helped me understand where I fit in in the PH field: I identify myself first and foremost as an implementer. And maybe a little bit as an observer and scholar. And that's why even though a lot of the work I do these days is actively public health related, I do not intuitively understand the new PH graduate life or their challenges or mandates or priorities. With more thought, curiosity and discussion, the above categories can be honed and polished and I can be better prepared to understand and anticipate the flow and nature of various interactions in this field.

Time loops, age and love

 What might have my parents been doing at my age?

My mom, I think, had her bone TB diagnosis when she was 43... so she must have been worried about dying. This was in Pune. 

My dad at 43 must have been quite excited about his work in Chennai..I don't think we had moved to Pune yet. In Chennai, he had been the Chief Manager or a Branch Manager, I forget which one. He was ambitious and had still a strong sense of his physical appearance- I recall he would exercise every morning and that I would join him for curl ups and jumping around the house. 

I thought about this today because I realised many of my clearest memories of my mom were from when she was younger than I am now. So there is a juxtaposition of feelings- my old ones when she was the all-knowing, wise, kind person who could always make me feel better and my newer ones when I look back and feel warmth towards a younger mother likely juggling many different things.

All these thoughts emerged from the recent stay of my mother's younger sister from the US and her daughter, my cousin, and her family of husband and 3 year old daughter. And I experienced the same feeling of warmth and confidence that things would be ok when my aunt was around that I did with my mom and dad, while also watching her take care of her daughter and granddaughter. They had brought a lot of old pics with them; we spoke about earlier trips and visits; we spoke of me and my cousin when we were younger (same age as my kids now, actually!) and of my mom and aunt as children and teens. 

So I am in this time loop and wondering at it. Will my kids and their cousins have warm memories of me and my cousins now? Will my kids remember me as someone kind and loving or someone harried and irritable? Will my nieces reach out to me for support and help as I reach out to so many of my aunts and uncles for various types of advice, guidance and comfort, or receive the same even when I don't realise I need these?

I realise that all these are possible only when intention, planning, time and effort go into building these relationships and connections. It is easier for me living in Bangalore to do this with my extended family here. But I do wonder how to reach out to those who are not in Bangalore. 

I am so grateful to my cousin and aunt for having coming all the way here and deciding to stay with me, when no doubt there might have been more comfortable abodes they could have chosen from. These are the connections that both my kids and hopefully hers will recall with trust and love when they are my age.

Turahalli Tree Park

 Is the name of the place I decided to go birding at today. It took about 35m by metro and then another 25 mins of walking.

I have been using eBird as a way to keep track of my lists, but I miss my older posts with the pics and the names. I also think the blog is a better way to keep learning so I'll do both. Here's my eBird list. 

Some of the birds of note I saw today were:

The Asian tit or Cinereous tit- spotted it on a roadside shrub on the way to the park. Image from eBird

The Cinereous tit is such a beauty- it's striking, it's small and energetic, and is almost as common as a sparrow in some parts... alas for B'lore city, we have neither anymore.

The spot-breasted fantail... don't you love names that describe the thing perfectly!

The bulbuls  :

Red whiskered

                                                                                           

White browed

Red vented

Each gorgeous and sweet-sounding

There is a bird called the Ashy prinia which I adore- it's noisy, it doesn't give a crap and it's beauty is very subtle- outwardly boring, but in the right light, the way the light catches on the ashy blue and the brown and the pale orange is stunning 

The Ap is truly as noisy and chattering as this pic suggests

Today, I met its cousin, the plain prinia, an unfortunate name for an equally charming bird

Just look at how gorgeously fluffy it is!

You are NOT plain, my lovely... you are adorable, yes you are!

Also saw LOTs of butterflies, many of which I have seen elsewhere in B'lore, but whose names I do not know. I must start learning about butterflies this year...

All in all, a great morning!

Images from eBird.. none are mine.

                                                            

A deep breath, at long last

 I haven't been birding by myself in a few months.... perhaps the last time was in Copenhagen, about 5 months ago. But that was in peak winter, and the pickings were far and few. 

Birding is funny in some ways- depending on who I do it with, I feel differently about it. It is the most meditative, pleasurable and calming activity when I am by myself. I enjoy it when I am with Goose, my younger one. Goose doesn't care so much about birds, but she likes observing nature and staring at flowers and insects and how things interact with each other- she would any day like to observe a bird eating an insect than a bird sitting by itself somewhere.... she takes a Birds Eye view about birding, lol! In my mind, when I am with Goose, I am the person helping her appreciate things around her. It's a very conscious act and role that I take on, though I don't know if that's a good thing or not. 

My older one, Ani, well, I haven't birded with him alone in a very long time, actually, never. It's almost always with others, either his cousins or with RK. He's an excellent intuitive birder, having been taught by RK almost from the time he was a toddler. But he tends to get bored by the same old birds (who doesn't?) and can be a bit lazy. He is at the stage where the diagnosis is all important, not the story.

Birding with RK, I have realised, is neither meditative nor calming. It's educational and energising. But at the end of it, I don't have the sense of deep connection with the earth or the sky or nature as I do when I am by myself. I think it's because of a sense of urgency that he instills in the process- there's no time to stand and stare. Or maybe he's really fast and gets impatient with plodders like me. 

The opportunity to bird by myself comes occasionally, not too often. I like to plan it out- where to go, how, by when and so on. I research the birds I am likely to see by browsing through eBird the night before. Since I depend on public transport or my own two legs, I choose the places I go to very carefully. Twice or thrice, I have booked a cab to reach slightly out-of-the-way places, but these have never been by myself. I think there are two reasons for this: one is that I am careful- no matter how old a woman gets, traipsing by oneself is not wise. And the second is, I am not very comfortable splurging a few thousand rupees just for myself. I would much rather spend it when someone else is with me.

Once I reach the place, I am a meanderer. I don't like rushing about. I take deep breaths, trying to let go of my usual avatar, City Varsha, and to calm myself down. Invariably, there will be no birds seen in the first minutes, though their songs carry in the wind, and occasional glimpses of wings can be caught. This is mostly because Birder Varsha, the patient, observant, curious avatar hasn't yet fully come into being. 

For me, birding is a way to give in to curiosity. I use my binos on a lot of things, even those that I know aren't birds. There will be strange-shaped leaves, the angle of light and shadows creates shapes that capture my attention, there will be nests of various types... I try comparing how things look through my glasses and what I imagine the thing to be, with what the clarity of binos reveal. At times, I collect seeds, leaves, and twigs because in that moment it seems unbearable that I can't take this world back with me. I have given up collecting flowers because they lose their magic so quickly, wilting and browning a few minutes in my little bag. Seeds are the best, because they retain the potential to hope. You can stare at them and imagine the tree they will grow to be, plant them and water them and pray that they sprout and that the sapling survives. There were a set of seeds that I brought back from the Forest Research Institute in Dehradun that are now sturdy little plants at home and I always hope that the other seeds I collect can be at least slightly successful. Most have not, but the hope remains. 

I am neither an intuitive birder nor a very experienced one. It's like a language that you learn in adulthood, needing frequent laborious mental translations and references to dictionaries. I still get confused between birds that look kind of similar like robins and bush chats, still can't entirely tell which ones are the females. Raptors are the chapter I never got to in my studies. What I think I am decent at are small-ish birds that mostly hang out in trees or fly between grasses and trees.  I say small-ish, because warblers are small and hang out in trees and I cannot figure them out at all. 

The sign of a successful birding expedition is if I can see birds under my eyelids after I return home and sleep. 

Normal

"Normal" is entirely subjective. It is person-dependent, society-dependent, culture-dependent and time-dependent.

What seems normal to us today (where to start.... homosexual relationships, divorces, premarital sex, women working, women in government! ... ) would have been extremely shocking at various points of time in history, and if all our texts are right, then in fact not so shocking if one were to go even further back in history.

We get so bogged down by what is normal, we get so scared about not appearing normal, and are so afraid of others telling us so, that we forget that the definition of normal is temporary.  

RK has been spending the last 2 months in Udaipur and will be spending another 2-3 months there. He gets asked this question a lot: but why are you doing this? Isn't this abnormal? What about your wife and kids? Wouldn't this have an adverse effect on the children's emotional state?

To me, this actually feels a bit normal- growing up, my mom and I used to be one of the rare families that would accompany my dad to every city he ever got transferred to. Most other bank officials would leave their families in their home towns and basically spend years in various other cities, occasionally meeting up with wife and kids and parents. We were the abnormal ones at that time and I recall my parents constantly fielding questions about why they were ok with my changing schools every so often, and wouldn't this have an adverse impact on my emotional state and so on. 

I think the things that feel right and give joy are the right choices to pursue. Obviously this will change from person to person, from family to family and from time to time. Then Everything is normal. 

Remembering my dad

 I've had the opportunity these past two days to spend a couple of hours at IITM. My father did his B.Tech and M.Tech there in the late 60s- early 70s. 

For some reason,  when I was doing my B.Tech in Anna Uni opposite IITM, neither he nor I thought about going to the IITM campus to see what he did and where and how things might have changed 30/35 years later. I never went to IITM by myself during those 4 years either.  

He didn't tell me much about his years there (and I didn't ask... most teenagers/ early 20s new adults feel no great curiosity about their parents' lives and I think we have established over the course of this blog that I'm fairly self- absorbed).

 Now that they are both in a different realm,  I wonder a great deal about their early lives and the choices they made and wish I could have the opportunity for easy conversations that I have with my friends.  

As I explored the campus, shrouded in a thin mist but not particularly cold,  early today morning,  I marveled at the giant banyans, the blackbucks and the white spotted deer. These trees must be a few hundred years old... my dad must have walked past them.  Some buildings, including Chemical Engineering, his major,  look to be the squat old buildings of the 70s..I wonder if he too, like so many students today,  cycled back and forth between his hostel and dept, or if he preferred to walk,  as he did in his later years.

He must have mentioned the name of his hostel at some point,  especially during the single reunion he attended a year or so before his death,  but in the long list of hostel names on the road signs, I couldn't recall it.  

He had told me about how, for his M.Tech thesis,  he had to use a computer, which in those days was as long as a room and would be housed across the main road in the Uni of Madras campus.  He would use punch cards. It would take him a few hours to punch holes in the card in IITM, then he would go to Uni of Madras (would have to reserve the computer ahead of time), and then feed the punch card into the machine and return the next day for his computations.  

Huh.

I also found out, the hard way,  that the distance between his likely dept at IITM and the likely dept at Uni of Madras (where the computer must have been) is not exactly an easy walk... must have been at least 3km one way 

My mom and grandmother had told me that he never actually wanted to become an engineer.  He was interested in medicine.  And my uncle,  Sampath, who did Medicine actually wanted to be an engineer.  Ani,  who resembles my father a great deal in looks and personality,  likes neither.  He likes cooking and food.  My father also used to like cooking. He would make the same elaborate plans for menus and ways of cooking that I see Ani make these days.  

This rather unexpected trip made me reflect on my father's life and choices. It also underscored to me that while our kids may have very different preferences to us,  there is still a familiarity to them.  Ani's desires for his life may seem unusual on the surface, but weirdly makes me feel closer to my dad.  

Growth as a public health researcher

Today I did something quite brilliant and I want to crow about it a bit. 

In a particular coalition project on dengue prevention,  one of the coalition partners left rather abruptly and in an unpleasant manner.  This partner was our main community link,  having been embedded in that community for years and years. With their departure,  a lot of the other work,  including ours, was adversely impacted. 

To complete the requirements of the project,  I need to get the data of 100 people in about a week. This is not just surveys, but also blood tests.  With our access to apartments,  community leaders,  labour unions etc completely cut off, I was getting really jittery about being about to finish this thing. I had done a lot of nifty Googling and found other community partners, but things were moving too slowly. 

Last night I decided that the only way to solve this was to go to the community and walk around the area a bit and I hoped that once I saw things with my own eyes and talked to a few people, I would get some ideas.  Well,  long and short of it is,  I did and I got :)

First,  there was a police station as soon as one enters the ward.  I spoke to the constables and the inspector and they agreed to have us come by next week for the surveys and tests! I think i should get atleast 20 -25 ppl here during the 90m they have given us.  

Next,  I realized that places of worship could be other potential areas and tracked down some mosques, temples and churches.  However, when today was Fri, and the mosques were busy; the temples were all closed in the afternoon and my personal bet of churches working out (since a lot of laborers in the area are from Tamil Nadu and most of them tend to be Christians) didn't really materialize. 

I then checked out the banks and have another appointment for testing next week...I hope to get atleast 30-40 there.  Here's a funny thing- one may not have access to the large apartment complexes for such surveillance work, but one can catch the same people at the public institutions (like banks) where most of them conduct their business... of course, nobody goes to a physical bank anymore. Shopping malls or neighborhood supermarkets might work even better, but I don't think it's a good idea to mix up blood collection with food.  

Finally, I spoke to shopkeepers, telling them about what we are doing and have the phone number of one of the owners of a most promising place to request permission- the shop faces a slum with a lot of foot and vehicular traffic, it has the Indian postal service branch above it and the fire brigade a few feet away.  I think I should be able to get the remainder of ppl, if the owner allows us.  

I walked around for nearly 3 hours.  Spoke to a lot of people.  My key learnings have been:

A) nothing can beat the sheer efficiency of personally going to a place and meeting people face to face when one wants to do community engagement projects. 

B) my title helped :)

C) the name of BBMP was like magic- this project is supported by the municipality and so leading the conversation with that really opened a lot of doors... it does indicate a level of trust with the govt that is good to observe. 

I hope next week by this time,  I should have not only met but exceeded the expectations of the project!