SIHI2001 Final Report part3 (last)

All alterations and local notes will be made in blue, in addition to the information already researched on the subject which will remain in black.

This information was collected from the manual “Where There Is No Doctor” by David Werner and “First Aid: The Vital Link” by the Canadian Red Cross Society.

A fever is when a person’s body temperature is hotter than normal. It can be dangerous if it is too high or if it rises too rapidly. High fevers may cause fits (convulsions) or even permanent brain damage. High fevers are most dangerous for small children.

§ They should be completely uncovered. For small children, remove all clothing and leave naked until the fever goes down. Never wrap the child in clothing or blankets.

§ Drink lots of water, juices, or other liquids. For small children, the water should be boiled first and then cooled.

4. Pour cool (not cold) water over him, or put cloths soaked in cool water over his chest and forehead. Change the cloths to keep them cool

§ If available, take aspirin to lower the fever (peracitamore for small children)

If the person in unable to swallow the tablets, grind them up, mix with water and administer in the anus, either as an enema or with a syringe without the needle

Feel for fever by feeling the body for excess heat being given off – lack of basic medical supplies including thermometers

As for treatment, there does not seem to be any mention of using water to cool the sick person down. One man described controlling food as a method of controlling fever. He didn’t know how to control the food, and does not seem to be a reliable source. One village preferred to keep the sick under warm blankets.

This is a life-threatening condition that can result from a large burn, losing a lot of blood, severe illnesses, dehydration, or severe allergic reaction (to something the person ate or came in contact with and sometimes due to bites and stings).

§ have him lie down with his feet elevated (higher than his head). If he has a severe head injury, put him in a ‘half-sitting position’ (with his head and back supported)

§ If he looks dehydrated, give a lot of liquid, and Rehydration Drink (see below)

§ If he has vomited, clear his mouth immediately. Keep his head low, tilted back and to one side so that he does not breath vomit into his lungs

1. in 1 liter of water, add half a level teaspoon of salt and 8 level teaspoons of sugar, or

2. in 1 liter of water, add half a level teaspoon of salt and 8 heaping teaspoons (or 2 handfuls) of powdered cereal (powdered rice, ground maize, wheat flour, sorghum, or cooked and mashed potatoes. Give sips of this drink to the person every 5 minutes, day and night.

Rehydration Drink 1) in 1 litre of water, add half a teaspoon of salt and 8 teaspoons of sugar, or

2) in 1 liter of water, half a teaspoon of salt, 8 teaspoons of powdered cereal (rice, ground maize, wheatflour, sorghum, cooked potatoes or

People in the willage admit to having seen shock syptoms as they are descirbed, but they do not associate these symptoms with any one condition. The shock remains untreated.

1. Is he breathing well? Check for rising and falling of the chest. Listen and feel for breathing by putting your face close so you can hear and feel the air coming out of the nose and mouth. If the person is not breathing, tilt his head way back and pull the jaw and tongue forward. If something is stuck in his throat, pull it out. If he is not breathing at all, use mouth-to-mouth breathing at once (see below)

3. Is he in shock (moist, pale skin; weak, rapid pulse)? If so, lay him with his head lower than his feet and loosen his clothing

4. Could it be heat stroke (no sweat, high fever, hot, red skin)? Follow section on heat stroke.

The hurt person is often allowed to sleep after the injury. There is no real concept of concussion or its seriousness. Unconscious people as they are transported are allowed to lie on their backs, they are not deliberately put on their sides.

When food or something else sticks in a person’s throat and he cannot breathe, quickly do this:

§ Make a fist with one hand and place the thumb side of the fist on the middle of the abdomen slightly above the navel and well below the tip of the breastbone.

§ Grasp your fist with the other hand and give quick, upward thrusts into the abdomen to dislodge the object

§ Attempt to dislodge and remove the object by sweeping it out with your finger. Be careful not to push the object deeper into the airway. If the airway is still obstructed,

§ Place the heel of your hand on his bell between the navel and the hips (for fat persons, pregnant women, persons in wheelchairs, place hands on the chest, against the center of his breastbone making sure your fist is centered on the breastbone, not on the ribs. Also make sure your fist is not near the lower tip of the breastbone.)

§ For an infant under 1, turn him face down on your forearm with the head lower than the body, and with the heel of your hand, give five forceful back blows between the infant’s shoulder blades. Then turn the infant onto its back on your lap and give five chest thrusts with your middle and index fingers on the breastbone between the infant’s nipples.

People in the villages could only think of basic choking treatment. One village said thgy would give a person more food or water while another willage demonstrated how the choking person would lean their head forward while another “karate chopped” the back of their neck. This was the only thing mentioned that resembled back slapping. Some villages simply said they would take the choking person to the doctor. This was discounted as being unreasonable as the doctor lived 1 hour away, this is not seen as an effective treatment.

The next section was not deemed necessary, as of the shortage of water in the Garwhal region. There were no reported cases of drowning in any of the villages.

§ Check if the person is breathing (see section on loss of consciousness). If he is not breathing,

§ If the airway is obstructed and you cannot blow air into his lungs, try to clear his airway using the method described above

2. Start by tilting the head back and lifting the chin (the head-tilt/chin-lift) in order to remove the tongue from the back of the throat and clear the airway

4. Cover his mouth with yours and blow strongly into his lungs and watch for his chest to rise

5. If the air does not enter the lungs, this means that the airway is blocked. Use the head-tilt/chin-lift again and blow into his mouth again. If the air still does not go in, follow methods in the choking section

7. For babies and small children, cover the nose and mouth with your mouth and breath very gently once every 3 seconds

In hot weather, people who work hard and sweat a lot sometimes get painful cramps in their legs, arms or stomach. This occurs because the body lacks salt. In case of heat cramps, message the area and stretch the muscle. Put a teaspoon of salt in a liter of boiled water and drink it. Repeat once every hour until the cramps are gone.

When working hard in the intense heat all day, it is possible to get painful cramps in muscles of the legs, arms or stomach. This is because the body has lost a lot of salt in swat and it must be replaced. The best way to do this is through the rehydration drink (see above)

When asked about heat cramps and exhaustion, the village women reported repeated cases of this. However, they also reported it as being quite normal, and the women would continue to work through the cramps and exhaustion.

Have the person lie down in a cool place, raise his feet, and rub his legs. Give him cool water or salt water to drink

The body temperature must be lowered immediately. Put the person in the shade. Loosen tight clothing. Soak him with cold water (ice water if possible) and fan him. Continue until fever drops

2. With a thick clean cloth (or your hand if there is no cloth, make sure your hand is clean) press directly on the wound. Keep pressing until the bleeding stops

This may take from 15 minutes up to an hour or more. If the bleeding does not stop due to due to the large extent of the wound, the person is in danger of bleeding to death. You must then:

§ Tie the arm or leg between the wound and the body, as close to the wound as possible. Tighten by twisting the bandage enough to control the bleeding. Use a folded cloth or a wide belt; never use a thin rope, string or wire. Make sure it is as clean as possible. Sterilize if possible.

§ Tie the limb only if the bleeding is severe and cannot be stopped by applying pressure.

§ Loosen the tie every half hour to see whether it is still needed and to let the blood circulate to the area.

Bassia grass was used on cuts and abrasions of all kinds. Further research is needed to test effectiveness. This was used in several villages. However, another concern is that the grass is not washed or treated before being applied to the wound. There are animal and human feces everywhere, and the grass could easily be housing pathogens. Some villages reported other methods to heal a wound including rubbing charcoal from the cooking fires directly on the wound.

Nosebleeds may be dangerous as they may drain to the back of the throat and cause choking or vomiting.

2. Pinch the nostrils together for 10-15 minutes, or until the bleeding has stopped. If this doesn’t work,

3. Pack the nostril with a wad of cotton (if possible, treated with hydrogen peroxide, vaseline, cardon cactus juice, or lidocaine with epinephrine (lidocaine anesthetizes the area and epinephrine controls the bleeding)

In older people, bleeding may come from the back of the nose. In this case, have the person hold a cork (or some similar object) between his teeth and lean forward. This will give the blood a chance to clot.

Many local treatments were discovered. Having person drink a mixture of lemon, sugar and water while they sit with their head tilted forward so blood does not drain. Upon further research of “lemonade” treatment, it was discovered to be moderately effective, and a good idea in the long run.

For all the cases below, if possible, replace boiled water and soap with rubbing alcohol

§ Wash the wound itself with cool, boiled water (and soap if the wound has a lot of dirt on it

§ Make sure all the dirt on the wound has been removed, because any bit of dirt left on a wound can cause an infection

Closing a large cut will speed healing, decrease the chances of an infection, and help prevent scarring.

1. Either use ‘butterfly’ bandages of adhesive tape to keep the edges of the cut together so the cut stays closed

2. Or use stitches. Stitches are required when the edges of the skin do not fall together or for any wound longer than 1 to 2 cm (1/2 to 1 inch). To stitch a wound:

§ Boil a sewing needle and a thin thread (nylon or silk is best) for 20 minutes

§ Sew the wound by making the first stitch in the middle of the cut and tying it closed.

§ To remove, cut the thread on one side of the knot and pull the knot until the thread comes out

Never close old, dirty, or infected wounds, or wounds from bites. Closing these wounds could lead to an infection.

To make your own sterile gauze or cloth, wrap it in thick paper, seal it with tape, and bake it for 20 minutes in an oven. Putting a pan of water in the oven under the cloth will keep it from charring.

It is really important to stress the importance of handwashing and hygeine. There is no real concern for pathogens, which leads quite frequently to serious infection. The skin around the wound should be washed with boiled and cooled water, or at least water from a reputable source.

§ Or if the lymph nodes become swollen and tender. Lymph nodes –or ‘glands’- are little traps for germs that form small lumps under the skin when they get infected. Most commonly, swollen lymph nodes are located behind the ear, beloww the ear and neck, below the jaw, in the armpit, or the groin.

§ Put hot compresses over the wound for 20 minutes 4 times a day. Or hold an infected hand or foot in a bucket of hot water

§ Keep the infected part at rest and elevated (raised above the level of the heart).

§ If the infection is severe or if the person has not been vaccinated against tetanus, use an antibiotic like penicillin –beware that some people are allergic to penicillin. If the person develops itchy rashes, discontinue use. If a severe reaction –called an allergic shock- develops, epinephrine must be injected at once.

Huldi is often used (paste of tumeric and water) as an antiinflamatory and antibiotic. It has been proven to be quite effective. Are there other such spices used for mediaction?

§ Wash the wound well with boiled water and soap. Remove all pieces of dirt, blood clots, and dead or badly damaged flesh. Squirt out the dirt using a syringe or suction bulb

§ If the wound is very deep, if it is a bite, or if there is a chance that it still has dirt in it, use an antibiotic. The best is penicillin. If you do not have penicillin, use ampicillin, erythromycin, tetracycline, co-trimoxazole, or a sulfa.

Do not use Tetracycline for children under 8. Use co-trimoxazole or erythromycin instead.

5. Do not push back into the abdomen any organs that may be protruding from the wound

7. Apply moist, sterile dressings loosely over an open wound (warm boiled water may be used)

This only damages the top layer of the skin. The skin is red and dry, and the burn is usually painful. The area may swell. The burns usually heal in 5 to 6 days.

Treatment: You need to cool any burned area right away with large amounts of cool water. Do not use ice or ice water. You can apply soaked towels, sheet or other wet cloths to an area that cannot be immersed. You must also wash it with soap and water and keep it clean. Watch for symptoms of infection.

These burns generally cause blisters. Do not break the blisters. Watch for signs of infection.

These burns destroy the skin and expose raw or charred flesh and are always serious. Take the person to a health care center at once.

§ Pay close attention to the airway. Burns around the mouth or nose may indicate that the air passages or lungs have been burned. If you suspect a burned airway or burned lungs, keep checking breathing. Air passages may swell, making it difficult for the person to breathe.

§ Cool the burned area with water but do not try to clean it. If the burn involves a large part of the body, do not try to cool it because this may lower the casualty’s body temperature. Do not put any kind of grease or ointment on serious burns because these seal in heat and do not relieve the pain well and may cause infection.

§ Cover the burned area to keep out air, help reduce pain, and prevent infection. Use moist, or dry non-stick sterile dressings and loosely bandage them in place.

§ Give the burned person plenty of liquid. If the burned area is large (more than twice the size of his hand) make up the following drink: to a liter of water, add half a teaspoon of salt and half a teaspoon of bicarbonate of soda. Also put in 2 or 3 tablespoons of sugar or honey and some orange or lemon juice if possible.

There are differing treatments varying from village to village including repeated scalding with a hot spoon, “slapping” of wound, and many others. The mechanics or treatment of swelling is not well understood in correlation with the education level of the populations studied.

When a bone is broken, the most important thing to do is to keep the bone in a fixed position. Help the person find the most comfortable position. If you suspect head, neck, or back injuries, do not move the person.

§ With all injuries except open fractures, apply ice or a cold pack. Cold helps ease pain and reduce swelling by constricting blood vessels. Place gauze or cloth between the cold pack and the skin to prevent damage to the skin. You can make an ice pack with ice in a plastic bag wrapped with a cloth.

§ If possible, raise the injured area above the level of the heart. This will help slow the flow of blood and reduce swelling

There is no special concern showed towards those with spinal injuries. These people are often transported in chairs to the road head, and skull injuries are often left untreated.

Local Observations for First Aid

Fever:

Fever is dealt with by feeling the body for excess heat being given off. There is a lack of basic medical supplies including thermometers. The villages do not seem to use water to cool the person down. However, some have believed to restrict food as a method of controlling fever. Some villages keep the sick under warm blankets.

Shock:

A person would be given a special drink for shock. In 1 litre of water, half a teaspoon of salt, 8 teaspoons of powdered cereal (rice, ground maize, wheatflour, sorghum, or cooked potatoes. In addition, a maand drink was given to the casualty. Both drinks were administered as sips for a person every five minutes. People in the village admit to having seen shock symptoms as they are described, but they do not associate these symptoms with any one condition. The shock remains untreated.

Loss of Consciousness:

A casualty who has loss conscious is often allowed to sleep after the injury. There is no real concept of concussion or its seriousness. Unconscious people as they are transported are allowed to lie on their backs, they are not deliberately put on their sides (in the recovery position). The concept of the recovery position is a westernized concept, however, has proven affective against the causality choking on their own vomit; allows for the airway to be open.

Choking:

People in villages could only think of basic choking treatment. One village said they would give a casualty more food or water while another village demonstrated how the choking person would lean their head forward while another ‘karate chopped’ the back of their neck. This was the only thing mentioned the resembled back slapping, although back slapping is considered a dangerous procedure when undertaking choking prevention. Some villages simply said they would take the choking person to the doctor. This was discounted as being unreasonable as the doctor lived an hour away. This is not seen as an effective treatment.

Heat Cramps and Exhaustion:

There were repeated cases of this throughout the villages. Heat cramps, however, is quite normal and is not considered a threat or a treatable illness. The women would continue to work through the cramps and exhaustion.

Bleeding:

Bassia grass was used on cuts and abrasions of all kinds. Further research is needed to test effectiveness. This was not used in several villages. However, another concern is that the grass is not washed or treated before being applied to the wound. There are human and other animal feces everywhere, thus the grass could be housing pathogens. Some villages reported other methods to heal bleeding wounds including rubbing charcoal from the cooking fires directly on the wound. This is possibly a way to cauterize capillaries.

When someone would get a nosebleed, many local treatments were discovered. Having a person drink a mixture of lemon, sugar and water while they sit with their head tilted forward so blood does not drain. Upon further research of “lemonade” treatment, it was discovered to be moderately effective, and a good idea in the long run. With wounds, little or no hygiene procedures are used. Often times, there is no real concern for pathogens, which leads quite frequently to serious infection.

Infection:

Huldi (a paste of tumeric and water) is often used as an anti-inflammatory and an antibiotic. It has proven to be quite effective. There is a major need for education about infection and hygiene.

Burns:

There are different treatments varying from village to village including repeated scalding with a hot spoon, ‘slapping’ of the wound, and many others. The mechanics or treatment of swelling is not well understood in correlation with the education level of the populations studied.

C-Spinal Injuries:

There is little concern with regards to spinal injuries. People with suspected c-spine injuries are often transported in chairs to the road head, and skull injuries are left untreated. Pain medication is a rarity.

Concluding Extrapolations:

It is evident that more education is needed in these villages. Even primary first aid procedures do not require billion dollars of technology but can immediately improve health services to people in all areas. The more people who are qualified to teach first aid, the more people will be able to know it. I suggest maybe trying to include a crash first aid course for some of the women in the villages. This will allow them to pick up some fundamental skills in first aid and allow them to become familiar with the concepts. Infection and hygiene are obvious themes that should be stressed with starting first aid. These skills are essential when trying to improve the overall health of individuals within these villages.

Nutrition – Summary Report

In this village we found that pregnant women do not eat rice, and sweets although they continue to eat spicy food. After lactation, families recommend that women eat a lot of ghee(butter). During the lactation period, foods that a women should not eat are wheat, yogurt, eggs, milk and salt because they believe that the child will get sick. Also women are given no green vegetables during this period of time.

The infant diet consists of breast feeding the child. Children are breast fed for up to 8-9 months, but if another child is born breast-feeding will stop. Breast-feeding is usually done 4-5 times a day primarily depending on the number of children that are born. The mothers will usually breast-feed their babies after they come back from their day's work in the forest. Although if the mother is unable to breast-feed her baby than someone else in the family provides the milk for the children through bottle feeding the baby. Within these region of Garwhal there are many children suffering through malnutrition. Whereby children from the age of 6 can be expected to weigh only 12kg. We found out that women do not recognize a food distribution problem between genders.

The number of servings of food for children aged 6 and up is approximately 2-4 rotis(bread) or 5-6 rotis(bread) depending on their appetite. The family diet depends on the amount of the money the family has. If they do not have money they will usually not eat. Most families in this village eat two times a day. Usually salt and (bread)roti with daal(lentils) is a common simple meal that is eaten by most families. It is not a common practice to eat sabji(vegetable) for lunch. Either roti and daal or rice(chawal) and daal are common meals for lunch. In this village which was a relatively low civil cast village, goat meat at times was plenty within the area. As a result families could eat goat curry as a meal. Dinner was usually daal and roti.

Usually families can get food from the markets or sometimes families within the villages share vegetables amongst one another that grow within the fields. Although one main problem was that since land was limited for these people they would have to get a lot of food from the market. Daal(lentils) was something that was of plenty to the families.

Families also did not eat much fruit as they did not grow any fruit within the village, as well as it would quite costly to purchase fruits from the market.

This village did not provide us much information, as we were not able to speak to any women about their diet during the stages of pregnancy

Although men were able to provide us with some information. Men said that they did not really recognize the problem between food distribution and geneder. What ever the children chose to eat, they usually ate.

In this village because we did not speak to any women who were going through the stages of pregnancy we were unable to find out information on the diet of pregnancy.

Women spoke to us about the family diet in general. They said that the number of servings of a meal would be the amount of a normal person's diet. Sabji would be made for dinner, with servings being a little bowl per person. Adults will usually have 5-7 servings of roti with their sabji(vegetable), and children will have 2 servings with their sabji.

Some of the spices these women used in their cooking were haldi, namak(salt), mirch(chilli peppers), laung, jira, dama, pias(onions) etc.

In the villages, palak(spinach) is grown but women will usually get vegetables from the market as it was near by.

In this village, the men provided all of the information about nutrition. Therefore, we were not able to obtain sufficient information on issues faced by women such as anemia or even food distribution for women. It was rather interesting to get a male perspective on nutrition and agriculture since it seemed that they saw things from a different perspective than the women. This could partially be due to the fact that while the women take care of most of the duties within the household the men go to work in different cities. It was also found that many of their concerns on nutrition were directly related to water and other environmental problems since the Saujal Project had been taking place.

On average, a family will eat roti with an occasional serving of some sort of vegetable for breakfast complemented with chai(tea) or even milk. Lunch will usually include daal(lentils) or vegetables of some sort, plus a small serving of rice. It was mentioned that ghee(butter) is rarely used for cooking because it is expensive. Dinner is usually more or less the same as lunch if there are any left overs. Each individual eats an average serving of 200-250 grams of rice or vegetables a day. A male individual reported to us that on average males eat 8-10 rotis(bread) per/meal. We were not able to get comments from women on their average number of servings.

From our visits to previous villages we became interested in learning about the different summer and winter vegetables that are often home grown throughout the year.. In the summer people will usually grow bindi(okra), rice, gehun(wheat), choochai(green vegetable) etc. Since there is a shortage of water in the village, vegetables are normally brought from the nearby market due to limited agriculture experienced within mountainous regions. Winter vegetables that are grown in the field normally support a family for one week. For the rest of the weeks the vegetables come from the market. Winter vegetables primarily consist of spinach and rye. The villages also complained of the limited water available for cooking.

The average cost of one meal for a family of 5-6 individuals is approximately 12 rupees. Some vegetables can tend to get very expensive. For example, cabbage can cost 70 rupees per kilograms and as a result the poor cannot afford to spend this much money on just vegetables. As a result whatever is grown is what is ate, and is not really bought by the villagers. Also we were told that very few of the families can actually afford to buy goat meat collectively for a festival.

During pregnancy, women do less work. Women might go to the forest for the first five months, after which they stop until delivery. A pregnant woman does not eat eggs before delivery due to the fear of abortion. After delivery, she is denied spicy meals, raw meat fried in oil, ghee(butter), and vegetables for a few weeks due to the negative affects that it may have on a baby's health. They also explained that this is a tradition. Salty foods during the period of lactation are also limited.

During the first 6 months, the baby is primarily breast fed. If the milk from the mother is limited then the baby is fed corn milk. On average the baby is fed three times a day, usually after the mother comes home from the forest. After 6 months, a baby is usually fed rice up to one year. Then gradually the baby begins to eat pieces of the normal food that is eaten by the whole family. At this point the mother might breasts feed periodically depending on how much milk the mother produces. A baby may be fed more than 3 times a day if possible. When a child is older than one year, then the milk primarily goes into making chai(tea) rather than to the children. A child of 3 years of age will eat four times a day. Occasionally food is fried with common spices such as bay leaves, pepper etc.

We also tried to start a conversation on anemia by asking how often a woman eats or fasts. The only information that we received was that during the summer months the women tend to fast everyday. We could not ask more questions due to the limited time that we had at this village.

The village of Mauhad consisted of three different castes: The Rajputs, Civil caste, and the Shatriyas. We were not able to speak to every member. Therefore we found that some of the answers we got were a somewhat biased due to small differences within the caste system.

On an average day, a man gets up early in the morning to go to work at his nearby job from 7am to 7pm. On his days off he will normally work at the field. In Mauhad about 8-10 men work for the government doing some sort of construction work. After coming back from work, they have dinner and then they go to sleep. The women wake up at 4am to feed the cows and make breakfast. They work on the fields from 7 am to 2pm after which they have to prepare for lunch for the family. They return to the fields around 3pm and finish there at around 7pm. These long strenuous days will alternate between agriculture and foresting duties.

Pregnant women in the village have more or less the same diet. They usually will tend to eat more rice. If they have problems with indigestion they stop eating sour curry, meat and fish. A pregnant women also works a little less if she has a mother or a sister in the house. However, if she only lives with her husband that she is expected to carry out all the normal duties.

A family normally has vegetables (sabji) for breakfast once a week with bread (roti) and tea. Lunch consists of rice, with lentils(daal) or sabji. For dinner the main food items include roti, with sabji and daal. Basically the diet alternates between daal and vegetables. Like in other villages meb and children are fed first. Women will only get food if there are left overs.

Agriculture within the village is rather limited due to scarcity of land. The field supports people for one to two months. The rest of the food is bought at the market, which is at the top of the villages. Villagers complained that it was also very expensive. Vegetables from agriculture include rice(chawal), alu(potatoes), onions(pias), and mandua(wheat).

Aside from agriculture, milk is limited in supply as well as due to the few available cows. Often, one kilogram of milk is sold in the market to earn some money. The other kilogram is used to make butter or ghee. Fruit consumption is very rare because they are found only in the market for a high price.

Keeping Culture and Country in mind

The mainstream language in Northern India is Hindi and Garhwali (in the mountains), although you can find many individuals who speak and understand English. But, generally you will have an interpreter with you, especially during interview sessions.

India is known for it’s rich heritage of spiritual and religious practices. Everything can be found here including Buddhism, Jainism, Christianity and Islam being the largest minority religion. Hinduism is the major religion practiced; “approximately 80% of the population” is Hindu (Lonely planet).

During your visit you will mainly encounter Hindu’s but there will be some Muslim villages that you will visit

While in India it is important to exercise discretion in your behavior especially when in public areas, at the NGO and amongst villagers. Open displays of affection between members of the opposite sex is very uncommon where you are heading so please refrain from holding hands, hugging, dancing, or cuddling as these things are frowned upon. Always remember that how you behave can have a lasting affect on the NGO you represent and the way people will receive you.

Again you need to keep in mind the setting your in and the people around you. Please refrain from using foul language when in public. Although, even within your group settings you must keep in mind the group and the need to be respectful to your members. Not everyone is used to or comfortable with course or obscene language. Be sensitive to each others mood and needs.

Wearing North American style clothes in cities (ie.Dehra Dun) is fine, but one needs to be conscientious of the local norms, which generally stays away from any tight fitting clothes, and shorts. Loose fitting pants or long skirts are advised over jeans. Although, I do recommend wearing the traditional salwar kameez with dupatta (women) or kurta pyjama (men) to avoid unwanted attention. Usually cottons or linens are great materials because they allow air to pass freely, and are easy to clean. Footwear is to your discretion but keep in mind the high temperatures and the kind of terrain you will be traveling.

During your stay in Garhwal traditional attire is a must as you will be visiting villagers who generally are less exposed to North American culture. Your appearance is important for the output of your experience. A minimum of two Salwar kameez or kurtas is advised. Having a dupatta becomes very convenient in Muslim areas as well useful for many other things during your travel.

During your trekking experience keeping clothes to a minimal becomes very important, as you will easily get tired with excess baggage. You will probably only need 1 pant, 1-2 short sleeved shirts, 1 long sleeved sweater, a rain coat (water proof, remember monsoon rains!) and a good pair of running /trekking shoes, and 2 pairs of socks. As well for added warmth at night bring a winter hat and gloves.

Women travelers:

Being foreign women will naturally cause attention to be drawn towards you, especially those who are blond and blue eyed. You may even experience inappropriate gestures directed at you but please try remaining calm and indifferent of them. Unfortunately, there are misconceptions filtered through media and other influences of what foreign women are like. Therefore ladies, be conscious of the impression you’re giving others (especially men on the road) and as such behave accordingly. Your presentation is important so try to follow the traditional dress and customs of the women, salwar kameez and hair pulled back if possible. While in your group you have much more freedom but still remember that even when at the NGO setting there are local men all around who generally are very respectful but you don’t want to give any misconceptions. Remember that what is commonplace here may not be there.

As well an important point to note is that women in Northern India generally do not bath in bathing suits so when going to Kampti falls for instance wear a t-shirt with shorts/or pants.

Think of the impact you may have on the environment. Try to preserve the beauty and glow of the Himalayas as you discover them. Bring with you environmentally friendly products ie biodegradable soap, and minimize waste. Try to carry with you a small plastic bag that you can bring back with you, where you can place garbage and poor decomposers ie sanitary napkins and wrappers.

Walk confidently in the street as though you are going somewhere. Try not to seem lost or confused, but if for some reason you are in need of help or advise, ask another women or a well dressed man who generally are happy to help. I advise you always stay alert for the sneaky rickshaw drivers who want to help but generally make things seem much more difficult or farther, in order to get your business. It’s always best to ask a few people before proceeding any where unfamiliar as you will encounter varying answers for almost everything, especially the length of time things take.

Conclusion

There were several motivations behind compiling this report. Firstly, the report provided a means for the SIHI 2001 India group to reflect upon their experiences. This is well evidenced in the personal reflections sections and the summary report sections. Secondly, this report is a method to pass on the information and knowledge accumulated by members of the group during their stay in India. This information can be useful to future SIHI groups visiting India for similar learning experiences. Hopefully future SIHI groups can build upon this knowledge base and work towards a more comprehensive understanding of International Health and Development in Garhwal Region of the Uttaranchal, India.

Acknowledgements

Special thanks goes to a great number of individuals who contributed to this experience and this summary report.

Vikas Bhagirath, Jon Chang, Neilesh Soneji, Shaheen Bhaloo, Syma Merchant, Cindy Escobar, Ayesha Laldin, Vanessa (lastname), Farah Ramji, Meredith (lastname), Kristine Hales, Matthew Choi, Adnan Piirbhai and David Ng

Dr. Satyendra Srivastava, Saji Kumar, Manthan Associates, SBMA, Dr. Karen Trollope Kumar, Dr. Pradeep Kumar and all our dear friends in India

Contents

FIRST AID – Summary Report