Goodbye, India

It's funny how quickly time flies by. 8 weeks have passed and I'm finally ready to head back home to Portland, Oregon. This summer has been filled with various experiences. I'm leaving Meghalaya

feeling accomplished and am hoping that one day I can return to Shillong and renew my commitment to change. My time here has shown me that working in the health sector requires constant community mobilization and government commitment. I'm also reminded that change takes time. Social behavior is not something that quickly transforms. It takes patience and sympathy to encourage individuals to adopt new health behaviors.

My whole project was surrounding institutional delivery in the state of Meghalaya. I remember that at one of the first National Health Mission meetings I attended, an IAS officer was surprised by the low number of institutional deliveries in a particular district. I distinctly recall him using the word "force" when it came to encouraging women to deliver at facilities rather than at home. I was shocked that he thought forcing individuals could result in positive behavior change. Attitudes like these threaten progress in health behavior. I learned that the government system in India has a very top-down approach. Attitudes of senior officials trickle down through the pyramid of hierarchy. Therefore, I think it's imperative that officials adopt non-abrasive language and take a moment to realize that behind every data point and trend line, there's a human story. Policymakers often tend to take reductionist views when it comes to data and program implementation. But data often needs to be contextualized. Perhaps instead of expressing shock and anger at the low number of institutional deliveries, the IAS officer should have encouraged a study into what barriers to care exist and what systemic issues at hand are leading to a lower delivery rate.

I'm leaving with a sense of hope and a tinge of existentialism. I no longer am confident that research in rich institutions is the key to solving global health problems. Addressing issues like low institutional delivery, poor quality of care, preference of traditional healers, etc. requires the commitment of researchers from the local community.Community based participatory research and equal partnerships are necessary in achieving progress in many of the global health problems we witness. I'm coming back to the U.S. with many thoughts and reflections, and am trying to navigate my role as a researcher in this complicated ecosystem.