Eight year-old Sangeeta spoke breathlessly in a quick strand of Hindi, releasing her words frantically, like air from a balloon. After every few seconds she paused, looked up at me meaningfully and then continued on – our faces only inches apart. After five minutes or so, her rambling slowed into one final discernable word, Mami, at which point she closed her eyes, and then cast her gaze upward, tracing her finger gradually above as if watching a bird fly overhead. After another slight pause she shook her head – “ne”. A single tear fell from her eye, as she turned quickly to shield her face from view. I didn’t need to speak Hindi to understand. Sangeeta’s mom had died only 20 days before.
It’s not to say that my experience working with HIV positive children hasn’t had its fair share of sadness, but Sangeeta’s heartfelt words were the first that tore at my soul like a blunt knife. Each day as I work to compose detailed case files for all of the children living at Bal Basera Child Care Home (for children infected or affected by HIV in Jodhpur, India), I find myself tearing up. With stories of child marriages, tragic accidents, fatal blood transfusions and inherent societal inequality, it is often hard to ignore the seriousness of each child’s situation. Not only are all 36 of the children living at Bal Basera HIV positive, but a sizable majority of the children have lost parents and a considerable number are orphans. Spanning 4 to 15 years of age, before their arrival at Bal Basera these children are often malnourished or plagued by other medical conditions which have caused their childhoods to be fraught with unparalleled hardship.
And yet such realities are often concealed within the foundation of the home itself, muffled by the upbeat sounds of children arguing over cricket lineups, playing card games or chasing each other from room to room. In this place, debilitating hardship is offset by a degree of fortune: the opportunity to receive proper daily nutrition morning, noon and night, the company of others in a welcoming environment, and access to necessary medical treatment such as Anti Retroviral Therapy (ART). It is rare to hear the children bring up their individual histories, for in this home the focus is on the present, not the past. Perhaps this is why Sangeeta’s story struck me with such weight.
Too often the tendency in India, and the global health field itself, is to measure success quantitatively, based upon survival. Analytically speaking, we often measure effectiveness through the number of lives saved, as opposed to the quality of lives lived (the number of children adopted, compared to the number of children who have experienced success living with their new families). And yet, over the past couple of weeks I have come to firmly believe that this quantitative measurement has little merit. There’s no doubt that every life that can be saved, should – that goes without saying – however, through this lens, quality of life takes a backseat, something that ultimately deprives those, who have been saved, of their livelihoods. Sangeeta is a life saved and a life lived, a struggling semi-orphan who has been bestowed with not only the medicine she needs to survive, but also the support she needs to grow. Regardless of her current struggles, she has remained resilient at Bal Basera, partly because of the safety nets in place to catch her when she falls – she has a home, she has a family, she has the material support she needs and a little extra loving to keep her going even on the hard days. And yet, I would hate to think where she would be without this network.
So much of my experience thus far has taught me that while my day to day tasks at work are important, perhaps the most resounding effects can be felt through my interactions with others. Preserving the safety net through promoting confidence may be the most effective mode of eradicating further illness and despair. If that means leaning in by befriending the most timid and least confident boy in the corner from a low caste, so be it – sometimes the most minute actions spark the most inspiring transformations. I sure know that I have witnessed a few.
Over the past several months I have been telling both others and myself that I would like to pursue a future in global health. While this is true to a certain extent, over the past few weeks I have learned that this does not really cover it. One can never truly enact sustainable change in the hospitals and health clinics alone. The most critical transformations result from a heavy degree of trust and cohabitation that can only occur within the realm of a home, religious organization or intimate neighborhood. To claim understanding of physical health, it is necessary to recognize the roots of the problem that occur alongside any physical ailments. Culture, emotional stability and environmental health are often omitted from the conversation and yet they are perhaps the main cause of most health concerns. In the field of medicine the human should take center stage but not without an understanding of the components by which they have been shaped. So while originally while I set my heart upon the study of global health, today I have revised that statement. Regardless of my studies or degree, first and foremost I will pursue a future in humanity. Only then, will my hopes for improved healthcare ensue.