First Day on the Job!

Today was our first day of the four week CFHI program in Delhi on HIV/AIDS and Public Health Challenges. It was quite a day!

In the morning we got acquainted with St. Stephens Hospital, a non-governmental hospital that serves citizens regardless of ability to pay. Of course, there are rooms with AC and TV, and those with no advanced amenities. Rooms are about 1500 rupees per night, or roughly $40 (very expensive for the average Indian).

We saw three HIV cases, a typhoid patient, a TB patient, and several other cases, all of which were very interesting and educational. The HIV patients had it the worst, with opportunistic infections and long histories of various health problems. To make it worse, two of them had failing first line treatments. One was on his way to death, and the other had to switch to a second line amid complicated allergies and facing the fact that the government doesn't cover second line treatments. He was a 24 year old boy who had received multiple blood transfusions after a liver abscess as a child, through which he contracted the infection. Another HIV patient, the one nearing death, was a transgender patient with a very low CD4 count, tuberculosis, and a host of other problems including a fractured mandible which could not be operated upon due to his low Hb level and generally precarious situation. The doctor was not hopeful.

The second part of our day was spent at Sahara, a drop-in center for men who have sex with men and transgender individuals. Both groups are commercial sex workers. We got to speak with the health worker who began the program with so much dedication. He had to fight a lot to prove to the population that he was different from the numerous other health workers who drifted in and out of this community's existence without making any beneficial changes. But through dedication and responsiveness, the director, Ajay, was able to win the trust of these individuals, many of whom suffer from HIV and who are injected drug users.

The best part of the afternoon was the question and answer session we were able to have with the MSM and transgender individuals. We sat together and got to ask them questions about their lives and their daily struggles. The transgender population in India is very well-delineated, with hijras (the female role), eunuchs (castrated men), and a host of other culture-specific titles. Transgender men make their money two ways: 1) by dancing at festivals and parties (weddings and baby celebrations) and 2) commercial sex work. Hired dancing can earn them thousands of rupees, whereas commercial sex work, their daily jobs, earn them anywhere from 100-800 rupees.

We asked about harrassment from the police, and found that beatings and other forms of harrassment were common occurrences. As poor marginalized people they have no legal recourse. They are often faced with violence from customers, too; one worker mentioned that a customer may take the worker to a room where five men are waiting to be served. The worker is then subject to violence and forced sexual acts.

There is so much more to write about, even though this is the first day. Yesterday something very eye-opening happened. We had a meeting with all the CFHI students and the cordinators of the program. They are all devoted individuals and we are so lucky to be under their tutelage here in Delhi. The doctor in charge of the program, Dr. Raina, asked us, "Now, I've explained what you will gain. What do you have to give back to the people you will meet?"

Stupidly, I immediately thought of funds. Money that could buy more ARVs, or school books for kids, or whatever else may be needed.

Dr. Raina, on the other hand, was thinking much more simply and much more from the heart. He suggested we put on a skit to teach the community members in our outreach trips to villages and disadvantaged populations how HIV is transmitted (or some other useful topic). He advised us to make it lively and entertaining, but also ifnormative. He suggested we bring toys or little candies for the children, to build a rapport. The word rapport has been used so many times since we started the program that I'm beginning to see just how important it is to use whatever means you can to befriend the population you're hoping to help (or as Dr. Shahi sometimes says, "your victims").

Something as little as a candy or a rubber sling, or a polaroid picture can make the difference between your making a difference, or falling flat on your face as a health professional doing outreach to those who need it most. Seeing how much sincere dedication it took for Ajay, director of the Sahara program, to win the trust of the transgendered population, makes me realize that I have SO much to learn. I'm just glad I have this opportunity to do so, and pray I make the best of it.