It’s been only a little after a week since my arrival in Mysore but so many events have happened since arrival that I still feel overwhelmed.
The travel to Mysore was intensely exhausting. I went from San Francisco to Frankfurt Germany and then from Germany to Bangalore. After I arrived at the Bangalore airport, we had another 4 hour drive to PHRII. It was almost 30 hours of traveling. I’m glad that my PI (principal investigator) recommended living in the guest room at the research institute because it has been tremendously convenient. As soon as I arrived around 6 am in India, I spent a couple of hours unpacking and then slept until noon. Saturdays at PHRII are half days so work starts around 10 and ends around 1.
During this day, the accountant at PHRII, Sanjana, a woman who is only a few years older than me spent time showing us the city. She showed me the place to get lunch, where to grocery shop, and other places I would want to see during our visit. My first meal in India was plain dosas that I bought for around 50 rupees (less than 1 USD). I realized that because I am from Bangladesh and my family’s culture , while has its key differences, is similar to the various aspects of Indian culture including food. I’ve had dosas before and they were similar to what my mom has made at home.
Monday was the first day of work! The administrative director, Poornima, welcomed me and I was introduced to the entire staff at PHRII. Everyone was welcoming and kind. I was introduced to my lab mentors and directors, Kavitha and Anisa, and they taught me the different parts of lab. I deeply appreciate how twice a day the housekeeper, Lakshmi, served chai for all the staff. Again, this was not new as my parents always made chai at home so it was very comforting to have it provided twice a day. Lunch made me nervous since everyone eats together and shares their food. I felt bad because I have nothing to provide that anyone would want to eat since I made masala ramen noodles because I do not know how to cook anything complicated. But the staff members were all kind enough to offer me what they were eating. I appreciated this since all the food that the women made was delicious and exposed me to traditional foods found in Southern India. Rice is obviously a staple but the way the food was spiced was different than the Bangladeshi cuisine I’ve had at home. Everyone speaks in Kannada during lunch so my co-fellow, Milani, and I would mostly speak to each other and sometimes answer the questions asked by the staff.
After work, Milani and I went to buy food from the supermarket and came across a huge poster that people were signing. The poster said “I pledge to save the environment and reduce health hazards” because recently Mysore made plastic illegal. I’m surprised that Berkeley, CA, a hub of environmental activism, hasn’t made plastic illegal but Mysore has.
On Tuesday, I traveled with many PHRII staff for approx. and hour and a half to a couple of villages in Mysore district that surround the city of Mysore. One aspect that I will most likely not be used to for my entire time here is the driving! I become intensely anxious during these trips because the road rules are flexible. The majority of people ride on their scooters here and weaves through the cars. No one seems to stay in their lanes. Lane lines seem like a suggestion and not an actual rule. Even in San Francisco, honking a horn is rare but everyone does it often here. I can’t look out the window without being constantly scared. Also, people here drive on the left side.
The point of the education camps is to educate villagers of HIV to address the seriousness of it in addition to de-stigmatizing it. The education camps also intends to include the cultural elements and concerns that the tribal folks have as they are different from the people who live in the city. It seemed the most difficult aspect of this camp was to get the villagers to participate in the camp. I was told by a staff member to say something that sounds like “Picture nori bani” as in “come see the movie” and go from house to house. At first, I felt like a scammer by trying to get the villagers to attend the camp since I am an obvious outsider in every way to them but I felt better since the intention is to provide free HIV education in addition to screening. I think why I felt like a fake at first is that when I was in high school, many students, primarily just white people, went on missionary trips to various parts of Africa to help spread Christianity. Usually what happened is that they would go and provide NO sustainable services like healthcare, clean water, etc and just religion, take a profile picture for their social media like Facebook, and then leave. The worst part of this all is that these people actually felt like they made a difference and did something for the world when really at the root of it all, these people did nothing to help the ones they were tying to help. This is a scam. Not what PHRII does. While this opinion may be debated against, it is in a deep belief of mine that only spreading religion on a trip is not the way to help people who don’t have access to necessary elements to live a healthy life, like healthcare and shelter etc.
I felt nervous and embarrassed to gather the villagers since my accent was different and they were able to detect that I wasn’t from Mysore easily. Many of the adults and children didn’t take me seriously because of this, which was understandable and were more responsive to the PHRII staff calling them to the small house to participate in the education camp.
The HIV education camp included information about HIV but also scenarios when a woman had HIV and was shunned by her family. The point was to showcase the negative impact of her family shunning them because of their stigma and lack of understanding of HIV. My favorite part was when the PHRII staff acted out a skit. I noticed that for the different villages we went to, everyone was engaged in this and found it to be entertaining. One last thing I noticed in both of the villages is that it was the most difficult for the PHRII staff to convince the men to partake in this education camp. Even if the men did participate, many of them would leave during the middle of the session. For both villages, more women participated and stayed.
Milani went to medical camp and I stayed in the lab. There is only room for one of us to go at a time to medical camp so I will be going next week. I stayed in the lab with Anisa, Kavitha, and Smitha. Kavitha taught me how to do PCR and Gel electrophoresis for the blood samples in addition to DNA extraction. It was slightly overwhelming since I haven’t had exposure to these lab procedures since AP Biology of sophomore year of high school (I will be taking Bio 1A this upcoming semester) but I know that they will be assisting me whenever I begin to do these lab procedures on my own after training.
This day was memorable because it was the first time I saw a cervix in real-life. Two women came to the institute because they were having uncomfortable symptoms that resonated with a sexually transmitted infection. The first woman had a yeast infection. It was definitely interesting to see what a yeast infection looked like but there was a significant amount of discharge around the cervix. A vaginal swab was taken and then the nurse performed a cervical cancer screening. The first test was using 5% acetic acid (essentially vinegar acid) and then waited a minute or so and observed if any acetowhite lesions appeared. Observation based on eye only is difficult since testing positive for HPV can look almost essentially the same as testing negative for HPV. The nurse concluded she was HPV negative. After the VIA test, the nurse put iodine on the cervix as a second HPV test and this was a more confident results since the cervix turned orange near the opening and this was a positive HPV test. We will need to perform an HPV DNA test to confirm the results. The second woman had trichomonnas vaginalis and after Kavitha took a vaginal swab, I smelled the swab and it had a clear fishy odor indicating that trich. I also observed the screening and she tested negative for HPV with VIA and Iodine testing.
Spent more time learning lab procedures like testing for HIV and Hep B through this program called “Elisa”. I also found out my blood type through a blood typing kit. While I always hoped that I would AB or O, I ended up being B +. I probably shouldn’t complain considering if I need a blood transfusion, it would be easy to find another person with B +.
This was a great day since Kavitha, Anisa, Smitha, and Milani discussed U.S values, customs, and policies and compared it to India’s. It was amazing talking about policies including feminism and the differences between the two. I thoroughly enjoy talking with women about the issues women face across the world.
Also today was my 20th birthday! First birthday since I was 4 that I haven’t spent in the U.S and without my close friends.
I went the HPV testing camp with Kavitha and a few others in different villages that was an hour and thirty minutes away. This was the highlight of my week since I applied to this fellowship because of my interest in HPV vaccination and cervical cancer. We went to a primary care clinic in a village and it was shocking and unsurprising. I knew that there were going to be many typical “American in an developing country” moments and this was one of them. This was a primary care facility but was very dirty plus had limited supplies. But the point is that PHRII works with these limited resources to provide quality healthcare. We set up the room with equipment and two members of PHRII went to the village to pick women who already tested for HPV from a previous camp. We planned to take a vaginal swab, VIA test, and Pap smear. The point of the Pap smear is to compare in to the VIA test and see if VIA can be just as accurate as Pap smear.
The first patient was a woman in her 20s. She tested positive for HPV but felt uncomfortable with having a pelvic exam. In the native language, Kavitha explained to her the importance of the pelvic exam and that it wouldn’t be as intimidating as she thought. The woman also didn’t want to do her a vaginal swab. She told us that she had her period and Kavitha asked that she do the vaginal swab to confirm this but she didn’t want. We were all upset that she wouldn’t partake in the pelvic exam because there is a chance she could have cervical cancer but obviously, we cannot force her to do anything. We can only inform her of the risks.
I wished I could speak Kannada to try to convince her but then after some contemplating, I don’t think it is a job or right for a health professional to try to over and over again tell a patient that they should do something after they refused even after informing them of the risks and how the pelvic exam is quick and not that intimidating. Even with this, I felt just sad that this woman was so close to perhaps knowing if she had cervical cancer. I do not know her exact reasoning for refusing the pelvic exam, but I wonder if it has do with the general anxiety and discomfort with showing a stranger her vagina. I wonder if this feeling also has to do with a culture that is more conservative and sex-negative in general. While I’m not sure, I’m sure this could have an impact.
The second woman was a woman in her 60s and consented to the pelvic exam. Though she wanted the exam, the test took longer because she felt really embarrassed to show her vagina to the nurse. She kept trying to cover her vagina with her saree many times even during the examination. Again, this makes me think of what if this discomfort transcends just general shyness and falls under sex-negativity? Maybe so.
The last woman was younger, late 30s or 40s. I was able to watch the VIA test performed on her and there were clear acetowhite lesions on her cervix close to transition between the exocervix and endocervix so the nurse and Kavitha felt confident that this was an early stage of cervical cancer but we will perform the Pap smear to find out. This was an important day because I’ve never seen those type of lesions on a cervix before and most likely, the Pap smear will confirm these results.
On the way back to PHRII, we stopped by a farm and the driver brought back a huge bag of mangoes. The nurse started eating it in the car and shared with Kavitha and me and I would have to say this was probably the tastiest mango I’ve ever had.
After this, we stopped by a street food stand selling Puris. I was a little nervous to try street food but tested my luck and it worked. I had Masala Puri and it was delicious. There are many similarities to how this is prepared and how my Bangladeshi parents prepare it. I will definitely be going back as the food cart is close to the institute.
Explored Mysore and went to my favorite restaurant so far called Lemon Tree. I love Indian food in the U.S… but my god, the Indian food here is eons better. Also went to a Chai café and ordered Masala Chai and it reminded me of home.
Lastly, I am thoroughly satisfied that PHRII is run entirely by women. It makes sense for women to run a sexual and reproductive health clinic but it’s wonderful working with women who are all insightful, intelligent, and intensely strong minded and hearted with their work. Working with them only confirms that I believe I have the personality to work in sexual and reproductive health for my career (resilient in character) but also confirms that this work is so meaningful and significant. I’m looking forward to all the future weeks here! It’s been a good week.
-Adiba Khan, Mysore, India