Blog Post #17: India, Dr. Ravi Chopra 5/17/19

Today we listened to a lecture by Dr. Ravi Chopra, a member of the People’s Science Institute. This institute works to eradicate poverty by empowering the poor in productive, sustainable ways with foci in natural resources management, environmental quality monitoring, disaster mitigation, and river conservation. Dr. Chopra explained the issues of dam construction and its impacts on water in India. Today, a major concept that I was completely ignorant too was the harmfulness of dams in this country. Dams are constructed to develop hydropower, however, states of India rely on very little hydropower, and the impacts of dams on ecosystems and human health outweigh its possible benefits. Such disadvantages include harming life by dumping the remnants from digging dams into rivers, decreasing the purifying ability of rivers by eliminating the number of beneficial bacteria in river, harming land by explosions used to clear the way for dams, land subsidence, collapse of slopes, and protest and social unrest which occurs as a result of these negative factors. 

However, the most interesting discussion during this lecture revolved around the nature of rivers in India. I was unaware that the Ganga had scientifically purifying properties. We have repeatedly discussed it’s believed purifying properties in terms of sin in the Hindu faith, but I was unaware of its biologically purifying potential. The Ganga contains a massive amount of sediment. This is because the young Himalayan mountain range is made up of very soft rock that is easily erodible and breaks off into the water. Then, bacteriophages with the ability to destroy bacteria within the water sit on top of the sediment and multiply. In addition, the rushing of the water incorporates pure oxygen into the water. However, this potential is unseen especially in holy cities in which there is immense pollution of the water, creating areas of black, “dead water” as Dr. Chopra explained. If more people realized this natural purifying ability, this river would have the potential to provide safe water to more people, but the religious implications that influence how people treat the river counteracts this and overwhelms the river to the point of complete pollution.  

The final implication of water that I found extremely telling of the possibility of spirituality and science coming together to make positive influences on the environment pertain to the principles of Kashyapa’s Wisdom. However, since India’s modern managers of water maintenance are unaware of traditional Indian knowledge, this possibility is unseen. The principles are as follows: the source of a river is sacred, there should be minimal disruption to the flow of river water, water and forests have a symbiotic relationship so water is especially important in these regions, we should not pollute rivers, and everyone should contribute to the conservation of rivers. These principles are all very comprehensive and simple, however, those in charge of river management are engineers who have very different viewpoints that consider only the water itself and not the ecosystem around it when making decisions and designing projects. River water is a life source for plants and animals all over India, and spirituality is a major part of human life in India. If those in charge of the care of rivers take into account the principles listed above, making each a priority, not only will rivers become healthier, but so would the land and life within and around it. This made me realize that every environmental choice has impacts on other areas of life, and by realizing this, positive changes can be realized.   

Blog Post #16: India, Dr. Joseph Alter 5/16/19

Today was our discussion on hospitals in India, specifically near Mussoorie, and the different types of institutions and forms of treatment we see within them. I was surprised to learn that Indian government actually instilled a ministry that pluralizes the common medical practices of the country. The ministry of AYUSH not only allows acceptance but support for multiple different health systems which mimics the vast diversity I have recognized in terms of faith, language, and cultural practices within even the limits of Mussoorie. By allocating funding and research to each of these the domains, it would seem that the health care system would be considered nondiscriminatory and open to the citizen’s choice as to what type of care they want to obtain. However, we learned that this is not what we see in the Indian health care system at all. In fact, the matters of access and cost limit the type of care people are able to obtain. In particular, biomedicine, which removes cultural consideration from the treatment of disease, is offered extensively at modern, high-end hospitals such as the Mas Super Specialty Hospital. Biomedicine is also offered in private hospitals as well as government hospitals, but with different calibers of accommodation, privacy, and modernity. When people attempt to receive biomedical care at a private institution such as the Landaur Community Hospital, they often find prices to be listed ambiguously as well as cultural and religious expectations being intimidating. This pushes them to seek alternative care such as Ayurveda, Unani, and yoga which may be less intimidating and more affordable. 

Another important point from today’s lecture is that of efficacy and non-biomedical practices. Biomedicine is purely science driven, so it is easy to take a few labs and prove if a treatment is working to cure a person of disease. However, Ayurveda, Unani, and yoga all rely on symptom treatment, comfort, and balance in a way that limits the ability to prove if it is really influencing a person’s health in a positive way. In countries in which biomedicine has dominated for years such as the US, this would be a reason not to practice these alternative systems. However, being in India for two weeks now I have taken note of the inherent spirituality of the community, and find that alternative medicines that rate health on a spectrum may have greater impact on a person’s wellbeing. The interplay between health treatment and religion is dominant and often dictates which forms of care people are more likely to seek. For example, a Muslim is more likely to participate in Unani and a Hindu is more likely to participate in Ayurveda than the other way around. I believe that this relationship can contribute to health in a way that biomedicine may not always be able to. For example, genetic testing in biomedicine is not always beneficial, if you find that your genome holds a gene for a non-curable degenerative disease such as Huntington’s this may only cause distress, however, if you work to cope with the symptoms of Huntington’s a person’s well-being in terms of the physical and the mental are likely to be much better. Overall, India has a vast range of religions, cultures, and health practices, but all are major considerations that need to be taken into account when making life decisions. 

Blog Post #15: India, Dr. George 5/15/19

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Today Dr. George, with major experience as an orthopedic physician in both Northern and Southern India as well as Canada, discussed the general healthcare system of Uttarakhand and the Lower Himalayas in general. As a brief overview of the region, significant figures that stuck out to me were the percentage of institutional births (36%) and vacancy of health care positions, especially for female medical officers (greater than 60%). 

The former, pertaining to giving birth in clinics and hospitals, being such a low number can be attributed to the practice of traditional medicine as well as the major problem of lack of access to health services. Access was repeatedly highlighted by Dr. George. Many of the factors he mentioned that influence health also impact the actual attainment of health care services in the first place. Major factors influencing health, especially in the rural areas in the Lower Himalayas, include: its nature as a disaster-prone area with high seismic activity which leads to land loss, poverty, and migration out of the area, terrain in general which influences transportation, and cultures and attitudes held by the people pertaining to ailments and treatments. The first factor of the land being so sensitive to natural events affects health in the manner of a cascade. Understandably, when a natural disaster such as a landslip occurs, people lose their livelihoods when they lose their homes and land. Not only may this remove a source of food for those who rely on subsistence agriculture, but it creates an economic burden for those who rely on crops as a source of income. This results in less money to spend on health care and other life necessities, so many are forced to leave the area. Dr. George informed us that there has been a corresponding increase in human trafficking with the rise in human migration. The next factor, terrain, can be combined with the matter of transportation. The geography of the Lower Himalayas is diverse and harsh when considering that people need to travel over long distances to receive health care services. Whether traveling by foot or vehicle, roads are often impossible to lay in areas of variable terrain, and roads that are built may lack safety and integrity. This results in extensive travel time that may cause serious implications for a sick individual. The last factor we discussed was the attitude and cultural viewpoint held by people surrounding health care. Whether in terms of spirituality, religion, or biomedicine, personal opinions of the cause of disease especially influences the type of treatment people seek. For example, many people with mental illness are prevented from getting care by family members due to social prejudice as well as religious beliefs involving spirits. 

My second figure mentioned above revolves around the role of women in health care. This was not a major speaking point of Dr. George, but so far throughout my time in India, I have been noticing major gender roles within the community and am especially interested in how these carry over into medicine. The fact that greater than 60% of female physician positions are vacant speaks to the lack of gender equality that remains in this region. However, I was impressed to learn that many of the most effective initiatives going on in the region are majorly led by women. For example, Dr. George discussed the National Rural Health Mission (NRHM) that includes a Reproductive Child Health Program (RCH). The RCH includes accredited health activists that are often women who support a specific number of families, especially those who have recently has a birth in the family. These women then stick with that family for some time to ensure that the child and other family members are healthy by checking in with vaccination status and other important health indicators. I find this to be a perfect example of why more women need to be implemented into the health care system at the clinical level. The NRHM has been proven to be influencing rural health in a major way, so similar initiatives should be put into place. This goes hand in hand with Dr. George’s final remark in response to the question of what the most pressing issue of India’s health care currently is and should most immediately be addressed. His response was that there is an urgent need for health professionals to increase their willingness to reach out to underserved populations, a matter more of the heart than the actual system. Men and women alike must be willing to share their expertise not only in regions that are comfortable and safe to raise families in, but those areas that need the most help. If this is fulfilled, Dr. George believes that India’s health care system will see major improvement, and I find that this is a point that could change the trajectory of country-wide health not only in India but every country of this world. 

Blog Post #14: India, Stephen Alter 5/14/19

Today we listened to a lecture on pilgrimage and urbanization in the Himalayas by Stephen Alter. A key point that was reiterated was the major diversity of the region, literally and metaphorically, in terms of cultures, biology, climate, and customs. A major contributor to health in particular is maintaining this biodiversity. However, urbanization and the resulting tourism is decreasing this. Biodiversity mainly depends on the high mountains where moisture accumulates during monsoon season. These reservoirs of ice release water throughout the rest of the year for people to use all over the country. With increased global warming and its resulting increase in rates of glacial melting, this flow of water supply becomes unstable and unpredictable for the people of India and the biodiversity of the land is decreased. In addition, with increasing tourism for religious, leisure, or adventure purposes, the land is heavily influenced in a negative way by increased human interaction. Near temples visited by enormous numbers of people, plants are tread down and diversity decreases. This influences the resources available to local people, especially those in small villages. 

I found the most interesting part of Stephen Alters lecture to be the emphasis in relationship between the environment and religion. In a country of so many religions and a destination of religious tourism, the beliefs of how religion plays into the land influences how people in turn treat the land. The same goes for the stories that people believe in the original formation of landforms and other environmental phenomenon. This deep tie between spirituality and nature can be beneficial as we learned about the Chipko “tree-hugging movement”. However, with increased urbanization and westernization people have begun to lose their tie to spirituality and nature and the results lead to a decrease in compassion and dedication to protecting the land. In summary of this point, I understand that India, a generally spiritual country, the connections between religion and environmental protection can be positive or negative, but the additional tie between health and the environment is also influenced. In essence, one factor cannot be influenced without the other: the environment, religion, and health are inherently linked and co-dependent which makes considerations of each extremely important for the well-being of this country.

In terms of pilgrimage, in his own experience, Stephen Alter traveled with pilgrims into Tibet to get around the restrictions marked by the Chinese government. Pilgrimage is typically a way for people travel to an area that has spiritual or moral significance to their lives. The vast number and diversity of temples and religious sanctuaries in India and China is why we see many people moving between the Chinese and Indian border. Due to the large population sizes of both countries, people will follow the spiritual resources they require for a prosperous life. This sort of movement can also be done into areas that offer more economic, political, and health-related opportunities. Any type of migration introduces changes in each of these areas, so not only do people experience spiritual renewal but possible improvement in other areas of life. 

Blog Post #13: India, Rest Day 5/13/19

Although today was our day off, I reflected on information Akshay shared during his first lecture, covering information on the geography and wildlife of the Himalayas and Lower Himalayas in particular. While discussing plants and natural resources found in the area, he shared that India has made a turn from traditional to Western medicine, but is slowly transforming back into traditional practices. Not only is India seeing increases in practices such as Ayurveda and yoga, but the United States has also seen and increase. In the Himalayas in particular, this is significant because with its rich biodiversity, many medicines come from the land and its natural resources. According to the article on ethnomedical plants, the major route of information exchange between generations about medicinal plants is by word of mouth which may be a contributor to why the practice started to die off. The article also highlighted that villages are the major users of these sorts of practices, likely due to the fact that more modern medicines and treatments are further away and more difficult to maintain due to the isolation of villages and lack of proper transportation. 

During our day off, I went into the town of Mussoorie and noticed that there were many pharmacies and chemists as opposed to traditional medicine shops. This led me to further believe that in more modernized cities, traditional, natural medicines were less common. In comparison, I traveled abroad to Shanghai, China last Spring and I saw traditional Chinese Medicine shops all over the place, even on one of the most modern and commercialized streets in the world, Nanjing road. This comparison highlighted to me that China maintains traditional practices not only in terms of medicine, but acupuncture and massage as well, in even its largest cities, but in current-day India, these sorts of treatments are more prominent in villages and more remote areas. This is likely due to the more direct contact with nature these rural communities have, lack of access to modern technology, and cost of biomedical care. 

Blog Post #12: India, Trek Day 3 5/11/19

Today was the final day of our trek before heading back to Mussoorie. We discussed the temple at our campsite whose well was a water source for our time there. Akshay shared that this was majorly a Hindu temple honoring Shiva. Shiva, the god of destruction and creation, is often depicted with a snake around his neck which represents the king of serpents. Together this symbol represents fertility of humans, the land, and animals, so people come here to worship those values. When discussing the temple, we learned that it was originally made of the nearby timber and wood from trees, resources that required no transportation into the area. Since the nearby resources were used, those in charge of the temple’s construction were aware of how much destruction was done and used the materials in a way that was sustainable and minimal. However, now with the push for modernization, the temple was reconstructed out of materials from a nearby town and the wood was replaced with cement and stone with bright colored paint. Although this change made the temple more durable, it required transportation to the site and introduction of unnatural products into the ecosystem. 

This highlights the issue of utilizing forest resources appropriately and transportation of resources. Since this is a relatively remote location up a steep mountain, mules and human power was needed to carry in the products. However, with the development of roads and paths as well as an increased awareness of the lay of the land in this area, this reconstruction plan became possible. In the beginning of the temple’s construction with local trees and resources, this was not a thought since access to resources was limited and trees were available so nearby. Both methods require thought in terms of health impacts. By using the trees and natural products nearby, it must be ensured that resources are not depleted and only minimal amounts of products are taken whereas the transport of products into the area requires dynamic thinking in the logistics of transport and the possible toxicity and impact of these products on the environment. Anytime a structure is built in nature there will be influences on the land itself which affects wildlife and eventually humans, so it requires a lot of consideration when it it done. 

Blog Post #11: India, Trek Day 2 5/10/19

Today was the second day of the trek in which we traveled to our second camp site and hiked to the peak of Nag Tibba. Our discussion mainly pertained to controlling and maintaining the health of the forests as this impacts the health of the surrounding community. Akshay discussed the idea of controlled burning today. Controlled burning, also called hazard reduction burning. works to intentionally set a fire that will clear away an area of forest to reveal soil that can support farming. People in charge of initiating this type of burning often feel that the land where forests now stand could be used in a more productive way, and is thought to be a form of restoration that works to manage the forests in a way that makes them useful to the communities around them. 

In a specific case, we discussed how there are negative impacts from controlled burning in that the plants that come back after the burning are not as nutrient dense. The plants that come back are the hardier, less nutritious varieties that don’t support the livestock to the level necessary to yield products the community needs. For example, the cows that feed on these grasses do not produce enough milk. With this deficit in milk content, the communities have less milk to incorporate into their diets and those who own the cows do not have enough milk to sell to collect income. These negative impacts with once positive intentions are often overseen in the beginning. Since the people in the community rely so heavily on nearby forests and natural resources, these consequences must be heavily considered when making decisions such as whether or not to instill controlled burning. From my personal viewpoint, sitting at the top of Nag Tibba, and seeing literal proof of forest fires in the singed tree trunks, it is hard to imagine that any type of burning of forests would be productive. Although utilization of land is important, it must be insured that that land will be fertile and healthy enough to actually result the intended positive impact. 

Blog Post #10: India, Trek Day 1 5/9/19

Today we began our trek which began in a very tiny village made up of only a few buildings. The size and remoteness of this village had me thinking about the influences of construction of roads on these people living in the Himalayas and the downfalls and benefits of road development. We took a three-hour drive to this location where we began our trek and I observed that there were few additional roads in sight. This led me to believe that the road we took was the major avenue of transportation for people living in the villages we passed through to get to larger towns with more resources. We also discussed the influence of natural weather events and the nature of the land impacting existing and further development of roads. Due to the youngness of the mountain range and its continuous rising, it is difficult to develop roads that would make travel for villagers easier. Just as well, the seismic activity of the land and its active nature in general cause constant changes in land formation that can destroy existing roads or prevent the proper construction of new, safe roads. Examples of this include the risk of landslips by the gradual movement of tectonic plates. 

The construction of roads would positively impact those living in the Himalayas by providing faster, more direct routes to different regions where doctors and products that they need access to can be found. Not to mention, job prospects may lie far from their homes, so roads are a great way to enhance the possibility of transportation for these people to experience economic and health improvement. However, the actual construction of these roads can be both destructive to the environment and to daily functioning of people that need to work around the actual construction of the roads. The building of roads in this type of environment requires extra care and engineering to make them safe, but since there are limited roads at this point, traffic will increase making transportation more difficult until the construction is actually completed. 

Another factor is that of governmental concern in road construction. There is a ridge on the mountain between China and India that the Indian government wants to build a road on to establish a border. However, the tectonic activity at this area prevents this as it would be very unstable. This presents a conflict in the threat of China inching over onto the Indian side, but the land does not allow for safe construction of such a structure. Not only is citizen-level health and livelihood influence by road-construction, but international relations are affected in certain situations of road establishment.

Journal #9: India, Crash Course on Camping 5/8/19

Today we began the day with a crash-source on the basics of camping including the idea of leaving no trace and impacting the environment as little as possible. Later in the day we went into the town of Mussoorie. Today’s discussion helped to answer what factors influence health for people living in Himalayan villages. Tourism, especially those visitors camping in a way that negatively impacts the land on which they are staying, can cause problems for people in villages that rely on this land for their livelihoods. When we went over how to camp in an environmentally cognizant way, we learned to avoid leaving any trash or even introducing unnatural products such as foods that were prepared for humans. Additionally, in terms of human waste, it is necessary to dig a whole 6 inches deep to avoid animals from consuming it which would also cause them negative health consequences. Any sort of unnatural substance introduction can cause illness in the animals and lead to negative impacts within the food chain that will eventually influence humans. In total, tourism heavily influences the animals in the environment, thereby influencing the entire ecosystem. People in rural villages or those within the mountains where treks are popular will resultantly have less wildlife they are able to rely on, and what is available may not be up to the health standards necessary to produce proper resources humans need economically and physically. 

Later, while in the town of Mussoorie and walking these busy, urban streets, it was easy to make comparisons to the Himalayan villages we have discussed. This separation of wealth and resources between the main areas of town and the more rural areas makes it more difficult for rural people to seek care and medications. In the town, we saw multiple pharmacies and doctor’s offices, but the issue of cost and transportation do not make this easily accessible to those in remote villages. This influence on village health is less in relation to natural resources and wildlife and more with the physical layout of Himalayan land and location of health clinics and pharmacies.  

Journal #8: India, 10 Mile Hike 5/7/19

Today we went on a long hike that passed through the Jabarkhet Nature Reserve. In our discussion of geology and geography along the way, we were able to draw relationships between ecology and health in the Himalayas. Specifically, we discussed the concept that forests are protected by the government to the point that even if you “own” or live on that plot of land, you are prohibited from cutting down or planting trees. The forests are protected as a way to ensure that it is unchanged by humans which is necessary during this time in which the environment seems to be under increasing threat due to degradation by human actions. However, this creates a problem in that there is little place for people to move when things such as natural disasters occur, displacing those people. This serves as a double-edged sword in that although we want to keep the biodiversity, health, and nourishment of the land, people also need places to turn that support their own health. By protecting the forests, human health becomes more difficult to obtain because they are pushed into already highly populated towns and cities. In urban areas, health issues are more common such of lack of sanitation, increased infectious disease, high amounts of pollution, and increased poverty. These factors lead to increased rates of disease, especially those that are chronic and difficult to cope with throughout life. There needs to be a way to protect both the land and humans living on those lands. 

Additionally, during this hike we visited the water supply of the area. Having a water supply in the mountains proves that proper utilization of geography can allow cost-effective and efficient delivery of safe water from water sources throughout the mountain range into villages. In this way, the geographic features of the land dictates how water is delivered to people. In addition, an important part of living in this area is ensuring that water sources are clean and adequate for use. Sanitation of water sources, especially when used by visitors from outside of India, must be mindfully considered and monitored. Mountains and its glacial peaks are major sources of water for much of India, so water delivery systems such as the one we saw must be of major priority, especially with the encroaching threats of global warming that will disrupt the swift delivery of safe water to people.