ISP Project: About India and my research

As part of the ISP project, I researched about India’s history and culture as well as the background for my project.

 

Background

India is mainly made up of Hindus (80%), Jains (0.5%), Sikhs (2%), Muslims (14%), and Christians (2%). The population is 1.1 billion, the capital is New Delhi, and it has a democratic government. Further, although the official language is Hindi, there are over 122 major languages and dialects spoken!

India has been taken over by many different groups throughout its history. In 400-300 BC, the Maurya Empire ruled. Then India fragmented into different Muslim and Hindu kingdoms that fought with each other. Eventually in 1500, Persians from Central Asia established the Mughal Empire. Then in 1700-1947, the British took control over India. We can see the influences of these different cultures in India now. Although the British plundered India’s natural resources. India has maintained such central British institutions as democracy, parliamentary government, and the rule of law through the judiciary. My cousins for example speak British English. Now, a lot of people in India can speak English, and mix Hindi/English in daily languages. Most schools teach English as part of its regular curriculum.

And, while many in modern-day India date and marry for love, the most common practice is for families to find spouses for their children in an arranged marriage. Dowry is often given to the husband’s family, even though this is illegal.

Women’s status in India declined starting in 500 BC. Despite this, several prominent women leaders influenced India. For example, Indira Gandhi was the world’s longest serving prime minister. However, lifestyle in rural areas especially has affected women’s role and freedom. Although the legal age of marriage has changed from 12 to 18, but child marriages still happen in rural areas. “Female infanticide and female foeticide have caused a discrepancy in the sex ratio, as of 2005 it was estimated that there were 50 million more males than females in the nation.” The chief barriers to female education in India are insufficient school facilities, lack of female teachers and gender bias in the curriculum.

The caste system, though outlawed, also plays an influential role in Indian society. For example, in arranged marriages, the caste is often considered when choosing candidates. Further, the lower castes have now composed to poorest socioeconomic classes. So the government has reserved government jobs and university seats for the lower caste—however, this type of “affirmative action” has caused many tensions between different castes.

 

It is important to understand the role of women and any other tensions/prejudices in Indian culture, especially for the type of research that I will be participating in.

The objective of my research project is (1) to determine why delays in diagnosis and treatment of breast cancer occur and (2) to help design and evaluate a pilot screening program for cervical cancer.

In India, a popular medical practice is called “Ayurveda,” which is largely based on herbal treatments. However, in scientific medicine, the private healthcare sector is responsible for most of healthcare in India. So most expenses are paid out of pocket rather than through insurance. Further, only 2% of doctors are in rural areas where 68% of the population live. Out of all health workers, 2/3 are men. And, only 6% of health workers in rural areas are women.

India is facing a growing cancer epidemic, with large number of women getting breast cancer. It supports over 1/10 of global burden in cancer. And, oral, breast, and cervical cancer account for a third of this burden.

 

In the news

Recently, the Jats have participated in riots in Haryana, demanding inclusion in caste quotas for jobs and education opportunities available to lower castes. However, India’s Supreme court ruled that the Jats were not a backward community. Therefore, protestors have went on a rampage, even after the army had been deployed to open fire on them in Rohtak and Jhajjar districts. They have sabotaged the Munak canal, causing a water crisis in New Delhi as well. 16 people have been killed and hundreds have been injured.

This event reflects the prejudices and tensions in Indian society. I must consider the cultural and social factors such as these that could perhaps prevent women from seeking medical help.

http://www.bbc.com/news/world-asia-india-35627819

 

Another news event is the savage 2012 New Delhi gang rape case. A medical student was raped and she and her boyfriend later died due to assault. This case caused widespread outrage across India and the world, and people in India started protesting and calling for all people to respect women. This led to more anti-rape laws being passed. For example, new crimes such as stalking were added. Also, the definition of rape was expanded so that assault on a woman who did not physically struggle was also considered rape. However, many of these laws have been criticized as a way for the Indian government to be perceived as cracking down on violence against women—however, in the long run, higher punishments for crimes could lead to a higher rate of acquittal and no real protection for women. It is important to understand how women are treated in Indian society in order to determine what psychological and social pressures they face that could prevent them from accessing proper medical care.

http://www.cnn.com/2015/12/20/asia/india-new-delhi-gang-rape-juvenile-released/

 

In other news, India’s Prime Minister, Narendra Modi has spearheaded a government initiative called Digital India, which is aimed to promote research and development in electronics and IT in India. It invites global firms to invest in India’s electronics sector and connects rural areas with high-speed Internet. It is important to understand how technology can be used in India. Technology is an important tool for people in low-resource settings to access healthcare and learn about it. actually one of RTI’s projects is to investigate how mobile applications and the Internet can be used to promote awareness about diseases like breast cancer.

http://economictimes.indiatimes.com/tech/ites/digital-india-will-be-a-1-trillion-business-opportunity-ravi-shankar-prasad/articleshow/51147683.cms

 

Finally, there is a serious lack of jobs in India. This is due to the dramatically high population. Therefore, most people do not even get into colleges, and those that do are not guaranteed jobs as well. The famous Indian Institute of Technology has an acceptance rate of about 0.2%. Entrance exams into humanities colleges often have a cut-off of 99%. Because of this intense competition, many do not have the opportunity to get good jobs and break out of poverty. This type of social crisis can affect families. We must look at factors like these that can cause people to overlook their health conditions.

http://www.cnn.com/2015/10/05/asia/india-jobs-crisis/

 

Connections

I talked with my research mentor to learn about any tips and advice when approaching research. He said to always make sure my assumptions are valid, and justify them before using them to justify other analyses. In addition, it is important to always communicate with others and read other papers and research in the related field. Research is a collaborative process and always builds on others’ work. Also, it is easy to chase data to support an hypothesis, but much more difficult to keep an open mind to consider other variables that affect results. Research is a long and frustrating process, but rewarding once results are achieved.

 

Although my exact role in the research project has not been confirmed yet, I expect to perform a literature review to identify factors that cause delays in diagnosis. I may also perform statistical analyses to examine the significance of those factors. Further, I will administer and analyze survey results that investigate how people learn about breast cancers. Dr. Krishnan, my mentor, also mentioned that I may sit in on some sessions with women self-help groups for domestic violence, because RTI does research to support victims of domestic violence as well.

 

Reflection

I chose this project because of my personal experience with cancer. My grandpa died from oral cancer because it was detected too late, and my mom and grandma were able to successfully be treated after being diagnosed due to breast cancer because of U.S.’s wonderful health prevention strategies. I learned that we must detect it early and put our best foot forward to treat it when it is too late.
So I became interested in how we can catch it early so that treatment goes well. Also, I am very familiar with the culture in India because my parents grew up there. So I wanted to learn more about my family’s culture by exploring a different part of India and gaining a new perspective of India.

Some questions I still have after doing research are: How do people in rural areas learn about healthcare and disease prevention?

How do family members interact with each other about these issues?

Are there any cultural stigmas/prejudices that prevent women from seeing medical professionals?

Future directions this research can be to investigate:

• How governments and non-profits use civic research results to implement solutions

• Technologies that can improve access of rural communities to health care
• Health care policies in India and U.S. that have addressed health disparities
• What factors causes health disparities within the U.S.
• Analyze the success and failure of screening methods implemented in other settings/countries

Case Study Reflection

This week, I read a case study for class about a research project that tests whether polycultures (growing different vegetables together) are more productive than monocultures. Because at first I saw no obvious ethical issues, I was surprised by the number of ethical concerns after reflecting on the issue.

One of the main concerns is: Who gets to decide what to research? Should the lead ecologist have the authority? Or should the participating farmers have more of a voice because they are collecting the data and work directly with the plants? In addition, this raises the issue of how funding can lead the direction of the research. 4 seed companies provided free seed for the trial–therefore, those seeds were used in the research and influenced the research content.

Another main challenge is: What can we ask the participants to do that is not too demanding but yields results that are meaningful to the participants and to science? Is it ethical to discriminate against people who do not have a proper education level by assuming they wouldn’t be able to follow project instructions? How much science do we ask them to do?

One of the main problems with the project is that there were only 24 farmers spread across the entire UK–subjected to different weather conditions and variations. Therefore, there are confounding variables that can affect the reliability of the project’s results. In addition, ownership was not implicitly stated, which could have become an issue if novel findings were made.

After reading this study, I realized that communication is key for research to be successful. It ensures everyone on the research team is on the same page, how people will be compensated for the project, how the balance of power between those who drive the project is fair, and allows results to be accurate and reliable.

I plan to improve upon my communication skills and not be afraid to ask questions during my time in India.

SMART goals

As I look forward to my stay abroad, I hope to accomplish these SMART goals for my research project and international experience.

Language: I plan to practice my Hindi speaking skills by attempting to speak Hindi during any interview I conduct related to the project. I also plan to pay attention to any Kannada words spoken–and learn at least 2 new words every day.

Country: I plan to continue to learn about India by talking with my parents and relatives, as well as family friends who are staying at Bangalore. I plan to ask about what traditions, cultural events, and any local practices that are in Bangalore.

Social Issue: I plan to read all of the articles that my mentor has assigned me. In addition, for the ISP final project, I will read at least 4 articles related to the social issue. During my stay, I plan to have a discussion with my mentor about the issue at least once a week.

Research: I plan to keep a record of everything I accomplished every day and send a weekly update to my mentor. I also will try to do at least one extra research task every week to take initiative and learn as much as possible about the projects.

Personal: I plan to keep in contact with my relatives more often–speaking or messaging them at least once a week. I also will contact my parents and sister every 2 days.

Pre-Trip: I will learn what actions I should take in any emergency situation. I will contact the Berkeley intern I am working with and introduce myself through email. I will research at least 5 fun activities to do that are unique to Bangalore.

In-Country: I hope to engage in a fun cultural activity every weekend. I also hope to interact with the population we are studying at least 10 times when we are meeting them.

Post-Trip: I will spread word about my experience and the Loewenstern program to let other students know about this opportunity by giving a presentation, talking to all my friends, and completing any other recruitment tasks the CCL would like me to do. I plan to incorporate my experiences with cancer screening in low resource settings when doing bioengineering device projects. Currently, for my Systems Physiology class, we are designing a mobile application and sensor that would allow cancer patients to monitor their immune levels. I hope to draw on my Loewenstern experience to improve this design if we continue to work on this project. I also hope to become involved with women’s issues by attending at least 2 events each semester hosted by organizations like WomenLEAD and Society of Women Engineers.

My introduction to community-based research

This past week, I learned about the importance of involving the community in any social research conducted by outsiders.

I was especially impacted by Ivan Illich’s “To Hell with Good Intentions.” This article helped me think about whether the volunteer work we do actually helps people or makes the problem worse. If we blindly going into a community without understanding their lifestyle and values, we may propose projects and solutions that end up not being used by the community. Furthermore, our very different background from that of the locals’ can create a barrier that makes it more difficult to connect with the community. However, unlike Illich, I believe that once we do overcome this cultural/language barrier, our different backgrounds become an asset–we can combine our different ideas to create a more innovative, creative one that helps the community.

The class discussion of this article also reminded me that we tend to overgeneralize and label groups of people. For example, all Americans are labelled as “rich” and all Mexicans are labelled as “poor” by Illich. When I volunteer and serve the community I become a part of, I hope to push past any prejudice I may have about the locals so that I do not just see them as poor people in need, but as people who have a different way of life and a vibrant culture. This class reminded me of a discussion when I participated in Urban Immersion program. We learned that the right attitude when serving is empathy, not sympathy. Sympathy puts the people you serve at a lower level and establishes a paternalistic relationship, while empathy allows you to connect with people and establishes an equal partnership. When we travel to volunteer in other communities, it becomes important for these communities to see themselves as independent change-makers rather than dependents on outsiders, so that they can continue to grow and be self-sufficient without anyone’s help.

This idea was proposed in Bergdall’s “Reflections on the Catalystic Role of an Outsider,” a paper that I really enjoyed reading. I especially found the idea of creating a “self-image” interesting–this is based on the idea that people live out of images, and when you gain a new self-image and self-understanding, your behavior changes. Therefore, if we change the community members’ perception of itself from victims to active agents, locals will become more motivated to take a stance and get involved with improving their community. The role of the catalyst to initiate community discussions without imposing any ideas seems to me to be very challenging but rewarding, because the community is helping itself.

Although I was aware about the importance of the community’s involvement in research, I am now more conscious about how we can connect to the community without imposing our own ideas. I’m looking forward to learning more about how the community and outsiders can work better together!