Across the street from the Public Health Research Institute of India (PHRII) is a laundry, where laundrymen, women and children undertake their quotidian task of hanging white linen sheets before daybreak. They cover the long ropes that run by the dusty, red road with countless numbers of alabaster white sheets. The sheets spread to cover the walls, wrought-iron fences and wooden posts transforming the city street into effervescent maze that billows under the hot mid-day sun.
Like the white sheets juxtaposed with the heavily lived-in cityscape that is Mysore, India, PHRII is bastion for women in a male-dominated society. In India, a country that has attracted global attention due to not-so-uncommon reports of heinous acts of sexual violence against women, PHRII, a public charitable trust founded by Dr. Purnima Madhivanan in 2007, empowers women of different religious, ethnic and social backgrounds through employment while offering comprehensive medical services to thousands of women in urban, rural and tribal settings. They staff women to conduct research in obstetrics, gynecology and infectious disease, addressing the diseases that affect the most disadvantaged people while collaborating with scholars around the globe.
To provide care, workers travel across their district in white all-terrain vehicles whose doors are emblazoned with a picture of a woman offering a peaceful salutation. The roads in India are treacherous: one weaves into the oncoming lanes dodging trucks, motorcycles and buses to pass the tractors and ox-drawn wagons. The female staff cram in between the free nutrition packets and the equipment needed to provide education, on-site medical testing and sample collection, swaying back and forth on the long drives.
Arriving at a small concrete school on the side of a forest, we cross over a canal carved into the red earth that is flowing with the water from the passing monsoons. We are here to provide a medical camp for a village of tribal people, a group of once forest-dwellers who were relocated when the forest they lived in was deemed a protected national park. Though the tribal people receive government stipends meant to supplement their new lives, interviews indicate that many sell their government allotted land and food to buy liquor, while others work as “coolies” at tobacco and coffee plantations. High rates of anemia and stillbirth are seen in this population.
As I carry the centrifuge that runs on a gas-powered electrical generator toward the school, one of the nurses warns me to not be surprised if an angry husband comes to yell at us. She says, “The men yell because when their pregnant wives are screened, tested and educated, they have no one to wash their clothing, cook their food, clean their houses and care for their children. We show the men the consent forms and explain what we are doing is for the women’s welfare, but they still yell.”
She goes on to say that, “Many of these tribal and rural villages have large rates of hysterectomies, with some villages showing rates up to eighty percent. The villagers are told that the costly procedure for which they mortgage their land, sell their possessions and borrow money will prevent cervical cancer,” which it does, but what they are not told is that it can lead to adverse health outcomes such as urinary incontinence, thyroid dysfunction and depression — diseases that are easily forgotten in rural India. PHRII holds cervical cancer screenings for younger women where they also provide education about the risks of procedures and stress the importance of getting a second opinion when surgery is advised. This service, along with the mobile medical program that has been providing free pre- and post-natal care and education to Mysore district for the better part of a decade, is just one part of those offered by PHRII. PHRII also sustains the Prerana women’s clinic in Mysore City, a rural cervical cancer clinic in the forest, and a laboratory that studies infectious diseases.
Hours pass in the small building while the tribal women are educated about prenatal care under the extended eaves to avoid the intermittent downpours. Afterwards, they enter the building through a low door to have their clinical signs assessed and their blood drawn to test for anemia, HIV and syphilis. They are then instructed to provide urine and vaginal swabs to test for protein, glucose and bacterial vaginosis, which they self-collect in an empty adjacent storehouse. After a full day our vehicle, stained red from the mud, passes by fields of coffee and tobacco, some scattered houses, and then past the sheets that are also stained red by the mud kicked up during the rain.
We carefully unload our precious samples at PHRII’s lab for testing and storage. Today we collected samples from twelve women. The rains start up again and the building goes black. Then, a high-pitched chorus of electronics screeches as the appliances reset. The deep freezer in which we keep our samples starts flashing and beeping; I hit the override.
When I open the minus-eighty, a white mist flows out to cover the floor at my feet; the cold, dry interior is a world away from the muggy place we just were. I place the vaginal and sera samples we collected in boxes that are labeled into the thousands — each one a person, a story and a journey to collect. The fridge is closed and locked.
One of the projects I am conducting here during the summer between my first and second years of medical school is looking for differences in birth outcomes in a retrospective case-control study of the collected frozen vaginal samples testing for chlamydia, gonorrhea and trichomoniasis. Looking back through the tables and samples, I notice we are missing 2,500 samples. I inquire with the lab manager. She tells me they were compromised by a power failure from a storm — five years of samples and five years of trips into the field.
This is an aspect of the field of global health that is often overlooked — that on some days we are but the people hanging sheets on a dusty road before a storm. And when we meet failure as we all will, as researchers, health care providers and global citizens, we must be like the laundrymen, women and children across the street from PHRII and return the next day hoping for sun.