Ding Dong! The Witch is Dead...

Okay, well maybe not dead, but gone at the very least! Neema Masi is no longer at Goraj (for those that weren’t reading this blog when I was on hiatus in 2004, Neema Masi was the caretaker at the orphanage I worked at in India – long story short, she used to beat the kids). I visited the Ashram where I spent a month volunteering at the daycare (taking care of 50 – yes 50 – kids under the age of five) and the girls’ orphanage. I looked around not really recognizing any of the faces till I heard “Reshma Didi” from Moxy. The younger girls (Usha, Varsha, Gangu) were still there, but so grown up now! The middle girls (Moxy, Mangu et al) remembered me though. All of the older girls are now staying at a hostel in Anklewar now (Sonal, Anita, Rashmi, Pinki et al) which was so disappointing – was really looking forward to seeing them. The best part of my visit? When I asked where Neema Masi was, Usha got this mischievous grin on her face before saying “She’s gone!!!”. Classic.

That was all yesterday – spent most of the day visiting random family in random cities all over Gujarat which was completely exhausting. I never want to drink tea again. Visited my ba (grandma) in Karamsad – was nice to see her.

Last week I went with Falguniben to Mehsana – a (very) rural district about a three hours journey (by foot, rickshaw, jeep, and bus) from SEWA’s headquarters. I have never been in such a jammed pack vehicle in my life; seriously, I thought I was going to fall outside the jeep (there were no doors). In any case, we finally arrived and the women in the district gathered along with the Agewaan (literally, “leader” – the Agewaan is sort of the organizer for VimoSEWA for the district and takes care of getting the premiums, filing claims, etc.). Falguniben explained what insurance is, what VimoSEWA is doing, why it’s important, etc. She even went into great detail (the words “pre-existing condition” did leave her mouth and we spent some time explaining what qualifies and what doesn’t, when and how a claim is filed, etc.). This is part of VimoSEWA’s annual campaign to obtain members. They do this quarterly, but this campaign right before the start of the calendar year is the main one and traditionally enlists the most members. The office staff goes to all of these far-away districts, meet with the Agewaans, find out if there are any causes for concerns, and then go out into various villages in the districts.

Oh, and you know those commercials that always show little Indian and African children with flies all over their faces which don’t appear to be causing them any irritation whatsoever. It always looked like the World Vision people superimposed the flies afterwards – but I stand corrected. I’ve never in all my life seen so many flies in such a condensed space. I tried to blend in and pretend they didn’t bother me, but really, they were crawling into people’s eyes! Ew.

The area we visited was a tough sell, in terms of insurance. There had just been an instance where a woman filed a claim that was rejected by the insurance company due to a pre-existing condition, and well – bad news travels faster than good news does. The Agewaans have a tough job trying to mediate between providing care and sticking to the “rules”. There’s a lot of insurance fraud, especially in the areas that are more urbanized.

The rest of the week I spent mostly in the office scrubbing and analyzing the data (F-U-N!). VimoSEWA offers two insurance schemes with one providing substantially better coverage with a higher premium. We’re finding that there’s a ton of adverse selection with the higher coverage that’s making it somewhat unstable. In addition, areas that are more urbanized have a higher claims rate in general (variety of reasons – mostly due to easier access to medical care). So what ends up happening is that rural areas are essentially subsidizing their coverage. One solution is to have higher rates for more urban areas, but VimoSEWA is considering other (more desirable) options.

On Friday, there were a ton of meetings going on – the main one being that about 70 Agewaans from a few districts came to the centre for some training and for general discussions. I have to admit, I didn’t understand all the conversations – some words in Gujarati I just don’t know the translation for. But one of the main topics that came up was the use sonograms in private vs public hospitals. The problem is that while public hospitals are prohibited, private hospitals usually do give sonograms. And what SEWA is noticing is an 11%+ discrepancy in the birth rates of boys and girls – indicating that a fairly large number of people are going to private hospitals, getting sonograms, and aborting the child if its female. This all seems reminiscent of what I had heard at Sewa Rural when I volunteered there back in 2004. And even worse, there were instances where they found private doctors were telling patients they were carrying girls (even if they were carrying boys) so that they could also collect the fee for the abortion. I don’t even know what the solution to this is. The idea that a son is more desirable than a daughter is so ingrained in Indian culture, customs, and history that it’s going to take a lot of work to take it out. Beyond that, daughters still mean dowries, weddings, and extra expenses for most families. SEWA tries to educate (and so did Sewa Rural) while the government tries to intervene by disallowing sonograms in public hospitals. I don’t agree at all with the latter, but the former is slow-going and an uphill battle.

In all the things I love about India – there are some things that I just can’t stand. Most irritating for me, this trip, has been the desire of both friends and family to show me things that are “just like in America”. Schools, hospitals, hotels, bathrooms, air conditioning, internet – everyone wants to give me a tour of their town and point out everything American. It upsets me not because I hate America and think no one should want to be like it – but because I didn’t come to India to see all the ways it is just like America. I want to see what sets it apart. I want to see what is different.

That’s all I have for now – unless of course you want me to go into great detail on how it’s kind of cool that you can cross-section the data I have by urban/rural, sickness, district, etc. and find all sorts of neat patterns.

I know.

I’m a nerd.

:)