After a long weekend exploring Bombay, we are digging our heels in and finishing up the home stretch of GROW. Although I consider myself the 2nd slowest reader in our group of 4, I’ve already plowed through some novels; a great mix of Indian trains, Indian Gods, and some Tina Fey of course! I’ve finally settled into my next book – a classic for anyone who knows anything about global health (so clearly, I’m already behind!): “Mountains Beyond Mountains”, by Tracy Kidder. Although Paul Farmer’s experiences as a young pre-health professional in Haiti are not exactly comparable to our experience on GROW, the book has inevitably led me to do some Farmer-esque critical thinking and reflection about our own experiences. With 4 and a half weeks at MINDS under our belt, it’s natural to start to think about some of the difficulties we’ve had while working with MINDS in the context of a culture that for most of us is not our own, and why it is important to let go of our preconceptions in order to support the community need.
At the risk of generalizing, the GROW team has come to understand that everything happens more slowly in India – a phenomenon we like to call IST (Indian Stretchable Time). Leaving at 10? Okay, we’ll be ready by 10 or 10:30. Going to the top of a hill on a Gondola? That’s fine, just realize that if it’s a Sunday, the line to get down will take about 2 hours longer than expected. I was lucky enough to experience what it’s like to go to the general physician in Vadodara. Long lines, short sessions, and lots of random strangers in the room…but about 2 hours later I emerged with the resources needed to get better. I’ve noticed that patients are much more willing to openly talk about their condition in front of anyone, which is sharply contrasted with the confined solitude of the American in a psychiatrist’s pillowy office or in a spacious examination room. Neither way of approaching health care is better than the other, it’s just a matter of culture. Here in India, as Ishani has reminded me, the focus is less on the individual and more on the group. For example, rickshaw drivers will direct us to other drivers, with the knowledge that it will be their turn to pick up a customer eventually. Although some things I notice in India might make no sense when analyzed on their own, when I look at the bigger picture and the collective culture, I understand and appreciate a little bit better why things are the way they are.
On Tuesday, we returned to MS University in Baroda to have an interaction with the students in the equivalent to what would be UW’s school of public health. We talked about GlobeMed, our Public Health curriculum, and the MINDS Foundation, not expecting to be presenting to a crowd that is mainly focused on nutritional sciences. Despite our differences in focus, we were pleased to have a fruitful conversation about the intersection of mental illness and nutrition (particularly undernutrition, which they pointed out was a problem in Vadodara and all of India). One professor presented to us about her interest in geriatric nutrition and mental health. Our passionate attempts to talk about the importance of each of our own areas of interest led to attempts to reconcile our interests and propose some kind of research partnership between MSU nutritional sciences and the MINDS foundation. Despite that, leaving MSU, I still felt like such a partnership might not actually happen. From my perspective, I was ready to talk about what kind of project MINDS and MSU could do together and how they could collaborate to get more local involvement with MINDS while also gathering data for MSU. However, cards were exchanged, and vague claims to get in contact were made. While the passion and the knowledge is there, collaboration doesn’t come as easily. It is not that collaboration doesn’t occur – in fact, people are very open to it here – but that the process seems much slower.
So, despite the great, collective culture that India embraces on a daily basis, why is collective impact so difficult to achieve from my perspective? It is probably because I have a different understanding of efficiency. The U.S. is a very fast paced country with a strong focus on the end goal. It is easy to forget that part of the GROW model is to focus on the journey- the relationship that we make with MINDS staff and collaborators- as a means of achieving goals. It is difficult to remember that perhaps in India, efficiency manifests itself differently, and I should have faith that what they think needs to be done will get done. In India, maybe the act of “doing” is more important than “getting things done”. If I try to speed up the process with my own expectations of how things should be done, I risk doing them incorrectly. As Paul Farmer states in Kidder’s novel, “Living in Haiti, I realized that a minor error in one setting of power and privilege could have an enormous impact on the poor in another”. Coming from a perspective of privilege and fast-paced lifestyles, I can’t expect what works for me at home to work for the MINDS foundation and its counterparts in India. If this means that I will be frustrated and confused at times, so be it. It wouldn’t be grassroots change without it. As Ishani said to me: India is everything that you think it is, and the opposite.