Pre-Trip Training Reflection

For me, India is a country that is at once both close and far. I was born in India, retain a strong connection to Indian culture and cuisine, and still visit relatives there every few years. At the same time, I have spent the majority of my formative years in the United States and have always lived in middle class comfort during my summer trips to India. A big reason I chose this specific country was my desire to get to better know the “real” India outside of my comfort zone. As I embark on my summer project to Delhi, I will be entering the country for the first time on my own. I will be exploring a part of the country that I have never previously been exposed to and interacting with all kinds of people I would usually stay away from. My hope is for this experience to broaden my mind and allow me to see the bare realities of life in my home country. This will go a long way to helping me understand who I am and where I come from. This is the personal reason as to why I chose India for my fellowship placement.

As an aspiring future physician, I am constantly looking to learn about the intricacies of patient interaction and about the roadblocks that prevent effective provider patient interaction. The specific issue of drug rehabilitation in Delhi fits in well with these interests. This is mainly because the cultural stigma associated with drug use in Delhi means patients find it extremely difficult to admit their problem and seek help. The stigma also means many healthcare providers are unwilling to admit rehab patients or unaware of how to work with them. The sheer challenge of navigating this problem will provide me with an incredible opportunity to study provider patient interactions in challenging situations. This kind of in-depth, hands on look will teach me valuable lessons that I can take with me on my path to becoming a physician. This is why I chose the specific policy issue of drug abuse in India.

Overall, my pre-trip training has given me a great look at the background of India and the basics behind the drug addiction problem in Delhi. I feel like I will be going into my summer project with a solid understanding of what I will be facing.

Community Connection

For the community connection part of my pre-trip training, I had to speak with a member of my nonprofit organization who would be able to provide me with advice and context for my upcoming internship. I spoke with Miss Robin Young, who is director of programs at CFHI (Child Family Health International), and was in charge of organizing my Delhi trip in conjunction with my in-country non-profit SPYM (Society for Promotion of Youth and Masses). CFHI is a global health non-profit based in California that works to set up international service programs in a variety of countries worldwide. They have broad areas of focus in Global Health, Clinical Work, and Public Health. At the same time, they try to be flexible when deciding which programs to cover. As an example, if a specific need comes up at a specific time- such as a fight against a certain disease- they will then adjust their programs to meet that need. At any one time, CFHI runs 37 to 40 programs in 10 countries, all centered in Africa, Asia, and Latin America.

In terms of determining social issues/policies to address and finding organizations to connect with, there is a general model that CFHI follows. CFHI has local coordinators and contacts in their 10 countries, and when there is an issue to work on or a program to implement, the local coordinators will get CFHI in touch with the appropriate non-profit, hospital, or family practice. In my case, the issue of drug rehabilitation in India led the local Delhi coordinators to connect CFHI with SPYM, and that is how my project was formed. Miss Young referred to this as a “cadre of pre-receptors”(though in some cases the local coordinators might be part of a non-profit itself). In general, advocacy and policy work is not something CFHI does directly. However, the in-country partners often try and do advocacy work and implement policy change on their own, and an example is a palliative care initiative that was started through a CFHI partner in Trivandrum, India.

In regards to my role at the organization, the structure of CFHI programs is all about nesting short term internships into longer term partnerships and broader goals. I will be coming in with a couple of other interns, and we will all work together this summer. We will be implementing one phase of the project, and when we leave, CFHI’s partnership with SPYM will continue, with new interns and new projects, all working towards the same long-term goal of drug rehabilitation in Delhi. When I leave, I might not a direct worker for CFHI anymore, but I will be an advocate of the issue back in the United States as I share my experiences and lessons with those around me.

Faculty Connection

For the faculty connection part of my pre-trip training, I had to speak with a Rice faculty member with connections to Delhi who would be able to provide me with advice and context for my upcoming internship. I spoke with Dr. Divya Chaudhry, who teaches Hindi at Rice. Dr. Chaudhry was born and raised in Delhi, India, and spent her entire life there until coming to the United States for graduate school. Most of her family still resides in Delhi, and she still regularly visits them.

The main point I got out of my discussion with Dr. Chaudhry was a reinforcement of the notion that drug addiction and rehabilitation are extremely taboo subjects in both Delhi and in the majority of India. Dr. Chaudhry noted how the very notion of people using recreational drugs is almost unheard of amongst the middle class and educated population, even though the issue is prevalent in a large number of urban areas. She repeated how the cultural stigma on this subject is simply massive. Even when the concept of drug addiction is accepted, it is primarily viewed as something that affects grown men, with women and children not expected to be associated with the problem at all. The stigma also means there is a general lack of empathy and support for individuals who find themselves addicted. If they openly seek help, their family name will be shamed. This stems from the Indian notion of ‘log kya kahenge’ (what will people say), or the huge weight placed on the opinions of others in society. Due to the stigma, it will be very difficult to speak to others about drug rehabilitation during the course of my internship. I will keep these facts in mind and be sure all efforts to speak about the problem of drug addiction are done so with utmost care and consideration when I conduct my work this summer.

Dr. Chaudhry also gave me very useful tips on traveling and general cultural awareness while in Delhi. She noted how a proper distance must always be maintained between men and women in public, as this is a very important part of traditional Indian culture. A particularly interesting point was that the first coach of most metros in Delhi is specifically reserved for women- men should not enter this area. For other travel tips, she told me how it would be a good idea to use a metro to get from the suburbs to the city, and a rickshaw (a  common small Indian “taxi”) to get from there to the socioeconomically underprivileged areas where I would be working.  She also stated how the poverty and desperation I will witness while working with the low income population is likely to be overwhelming. She told me to stay wary of pickpockets and scammers, and advised me to not show my cell-phone in the open and carry as little money with me as possible. Finally, she mentioned the tendency of those in India to look after themselves and mistrust outsiders, which means I will have to be vigilant and on alert throughout my time in the country. I will be sure to take note of these tips so I can travel safely, work with minimal stress, and adjust to the cultural norms as I begin my project this summer.

Breaking News Articles (Issue)

Issue Article One

This article showcases the increasing severity of drug addiction in Delhi, India. It starts off by describing the struggles of a man who lost his family and business due to his worsening addiction. It then describes how the availability of drugs has increased rapidly in recent years in Delhi, with the substances available in a variety of new forms and concoctions. This is followed by a description of a recent police bust of a drug gang and more accounts from individuals whose lives have been shattered by drug abuse. Finally, the piece focuses on a detailed discussion on different smuggling paths that have been used recently to move drugs into Delhi.

This article relates to my policy issue of drug addiction and rehabilitation in India by describing the overall issue from a “big-picture” point of view. I got to read about the different ways drugs were made and packaged in Delhi, different routes through which they are smuggled, and stories of police crackdowns and personal struggles. By being able to analyze these various aspects of the problem through one article, I got a good look at the present state of the wider drug problem in Delhi.

(Singh, 2017)

Issue Article Two

 This article focuses on a single example of fatal drug abuse and showcases the episode from beginning to end for emotional impact. A female call center employee had come home to find her door locked, and her two friends unresponsive from the inside. She repeatedly tried to get them to open the door, then broke in through a window and saw her friends lying unconscious inside. She called for help and got them to the hospital, but they were both declared dead on arrival. The doctors said it was most likely a case of drug overdose.

This article relates to my policy issue of drug addiction and rehabilitation in India by describing the issue from the specific point of view of one isolated incident. By reading about how one lady instantly lost two of her close friends in the space of one night, I saw how damaging the problem of drug abuse in India can be at the individual level. Overall, this article aptly captures the fear, shock, and helplessness that can stem from a single fatal episode of drug abuse.

 

(Jandial, 2017)

Breaking News Articles (Country)

Country Article One

This country article describes the struggles of being a young African student in modern day India. The article starts off by describing how the death of an Indian teenager in a city on the outskirts of New Delhi caused a local mob to severely beat and injure a Nigerian student who was studying in the same area, even though there was no clear evidence linking the Nigerian to the Indian teenager’s death. The article then describes similar violent attacks against African students that have recently taken place. The discussion then shifts to explaining how African students often come to India in pursuit of affordable higher education, but often struggle to find acceptance within Indian society due to long-standing stereotypes and stigma, which all too often boil over into violence.

This article relates to my country because it is a case study showcasing India’s overall problem with a rigid social structure that encourages stigma and leaves very little room for acceptance and growth. The fact that the African students look physically different from the average Indian and come from a completely different culture means they will always struggle to fit into the uncompromising social structure of India. This kind of inflexible mentality is at the root of many other societal problems, including the lack of women’s rights, homophobia, and the increasing rates of drug addiction in urban centers.

(Roy, 2017)

Country Article Two 

This article describes a recent development in the turbulent India-Pakistan relationship. A recent United States offer to help de-escalate tensions between the two nations was rejected by India but welcomed by Pakistan. These decisions have followed a recent trend where Pakistan has welcomed third party international help and mediation on disputes, while India maintains that the issues are solely between the two countries and must be resolved bilaterally. India is also adamant that what it sees as terrorist attacks and violent incursions on Indian soil by Pakistan must stop before any sort of significant negotiations can begin.

This article relates to my country because it showcases the latest development in the India-Pakistan relationship that is such a massive part of India’s history, culture, and foreign policy. It shows how the relationship is still very uneasy and full of tension, and highlights the difficulty in getting both sides to even start to negotiate at the same table, much less actually reach an agreement for peace. This really gives a picture of India’s complicated foreign policy issues, and emphasizes how delicate the India-Pakistan relationship is as a subject.

(Press Trust of India (PTI), 2015)

Policy Issue Background and Analysis

Introduction

            While in Delhi this summer, I will be working for the Society for Promotion of Youth and Masses (SPYM), an Indian non-governmental organization that provides various forms of social support for the underprivileged  in India. For this summer project, I will be helping individuals on the margins of society who are struggling with drug abuse. Accordingly, my policy issue is drug addiction and rehabilitation. The main challenge, both in Delhi and in wider India, is overcoming the cultural stigma associated with this issue. To better understand this stigma, it is useful to take a brief look at other problems in Indian society that stem from similar roots.

Roots of Social Stigma

            Many of these stigmas originate from the rigidly orthodox social set-up that still predominates in most areas of India. This set-up definitely has its benefits, including a strong emphasis on family and group togetherness, a commitment to discipline and purity, and an adherence to tradition and culture. However, it has also bred a large amount of social stigma towards any concepts that do not fit within the rigid structure (Jacobson, 2004). There are countless examples of this, of which one of the worst is an unfortunate lack of respect for women, who are lower on the traditional social hierarchy than men. Women in India thus struggle to be on equal footing with men in the workplace and at home, and are often victims of rape and prostitution (Kumar, 2004). Another example includes the widespread presence of homophobia and lack of LGBT rights in Indian society. These stigmas stretch to the issue of mental health, and that is where we see the main connection with drug addiction and rehabilitation (“India: Events of 2015,” 2015).

(Sharma, 2014)

Mental Health Stigma

            Mental health is a subject that is almost completely taboo in Indian society. Any mental health problem- whether it be anxiety, depression, or, addiction- is often viewed with immediate apprehension and horror. Mental health issues are seen as a sign of weakness, instability, and undesirability in Indian society, and their very mention can rob entire families of respect and honor. This unfortunate stigma means that mental health issues routinely go unreported and untreated in India (Banerjee, 2016). This has resulted in high rates of suicide and the inability to effectively manage mental health-related conditions (Tahseeni, 2015).

The Drug Problem

             It has also led to the drug problem in India, and Delhi, spiraling out of control. There are a large number of individuals in urban areas like Delhi, including women and children, who are addicted to varying kinds of mind-altering substances. Most of the addicts are from socioeconomically underprivileged backgrounds, and they have few opportunities to move up the socioeconomic ladder (Murthy, Manjunatha, Subodh, Kumar Chand, & Benegal, 2010). For them, drugs are cheap and easy to come by, and once they are addicted, it is very hard to stop due to both a lack of health knowledge/resources and the social stigma prevalent in Indian society. The subject of drug addiction, like other mental health problems, is basically taboo, and is almost always hushed up and swept under the rug. It is near impossible for an addict on the margins of society to come out and admit his/her illness and then receive the required support and help to overcome it. This is why drug addiction is such a problem in India, particularly among struggling individuals in urban centers like Delhi (“Straight Life,”2015).

(Banerjee, 2016)

Current Policies

            Unfortunately, the policy framework India currently has in place does little to rectify this problem. The current national drug law is the Narcotic Drugs and Psychotropic Substances Act of 1985, which prohibits “the cultivation, production, possession, sale, purchase, trade, import, export, use and consumption of narcotic drugs and psychotropic substances except for medical and scientific purposes in accordance with the law ” (Tandon, 2015, pg. 2).  The implementation of this policy has mainly focused on crackdowns and arrests, with little emphasis on rehabilitation and treatment (Tandon, 2015). This is directly related to the inability of many in India to see addiction and mental health as legitimate problems that require understanding and help. Some progress has been made, such as the set-up of the National Centre for Substance Abuse prevention (NC-DAP) in 1998, but the policies in place today do not do anywhere near enough to break down the stigma and address the problem at its roots (“Drug Abuse Prevention,” 2015).

Fact: Actress Deepika Padukone recently came clean to the media about her struggles with depression, making her one of the few high profile figures in India to speak out about mental health awareness (Banerjee, 2016).

 

Country Background and Analysis

General Facts and History

  • The nation of India is today both the second most populous country and the largest democracy in the world. Located in the heart of South Asia, India’s natural borders include the Indian Ocean, the Bay of Bengal, and the Arabian Sea. Its modern political borders are with China, Pakistan, Nepal, Bhutan, Burma, and Bangladesh (“World Factbook,” n.d.).
  • India has a long and colorful history dating back to ancient times, when the Indus Valley civilization first flourished around 2500 BCE. For centuries thereafter, India came to be ruled by a series of tribes, dynasties, and empires, with some of the most prominent being the Maurya Empire, the Gupta Dynasty, the Delhi Sultanate, and the Mughal Dynasty. A prominent shift in Indian history occurred with the arrival of European explorers in the 16th century, who gradually seized power over the subsequent years. The British Empire eventually controlled much of the country by the 18th century (“Know India,” 2016). Rule under the British crown went on for nearly two centuries, until a non-violent movement championed by revered Indian figures Mahatma Gandhi and Jawaharlal Nehru led to Indian independence on August 15, 1947 (August 15 is now India’s independence day).
  • The empire was replaced with a secular and democratic republic, complete with an executive, legislative, and judicial branch. This modern system has successfully remained in place to this day, and India’s current prime minister is Narendra Modi (“World Factbook,” n.d.).
  • FACT: National Flag Colors- Deep Saffron, White, Dark Green, and a Dark Blue Wheel

    (“World Factbook,” n.d.)

    The India-Pakistan Problem

                India’s transition to independence was anything but clean, as disagreements between different governing factions led to the bloody partition of British India into modern India and Pakistan. This partition displaced millions of individuals, and conflict between Hindus and Muslims led to acts of horrific violence and thousands of deaths (Dalrymple, 2015). In the years since, the India (Hindu majority)—Pakistan (Muslim majority) relationship has been fraught and uneasy. Tensions have come to boiling point over the development of nuclear weapons by both nations and multiple wars disputing the territorial control of the northern Indian region of Kashmir. Even today, India retains a strained relationship with Pakistan, and the years of division and conflict have made it a delicate topic likely to incite passions and fears (“World Factbook,” n.d.).

    FACT: National Bird- Indian Peacock

    (“Know India,” 2016)

    Government/Economy

              Since its creation in 1947, modern democratic India has seen both success and failure. This dual record can be captured by looking at India’s government and economy. The fact that the nation has maintained its democratic setup for almost 70 years is no small feat, especially considering its incredibly large population and its myriad cultures and religions (“Know India,” 2016). Despite this, corruption remains a significant problem in India, with allegations of bribery, laundering, and financial mismanagement ever-present in the news (“Bad boom,” 2014).

         India’s economy, meanwhile, is also quite varied, with both a strong agricultural component and a rapidly growing service industry focusing on software and telecommunications. The latter has led to an emerging middle class that wields significant power and can enjoy the benefits of urban life (“World Factbook,” n.d.). Indeed, India is today one of the world’s most rapidly growing economies, driven by continued modernization, global integration, and a young workforce. On the flip side, economic inequality remains rampant, with slums and ghettos regularly found near cities and apartments. While those in the higher classes generally enjoy an excellent education, those of lower income often have severely limited educational opportunities. This means India faces significant challenges in the coming years as it attempts to keep up its economic growth and extend the fruits of that growth to those on the lower rungs of the socioeconomic ladder (Agrawal, 2016).

    Link to useful graphs on Indian Economy

FACT: National Animal- The Magnificent Tiger

(“Know India,” 2016)

Culture/Society

             India has a rich culture that remains one of the world’s most vibrant and diverse. The nation has 29 recognized states and 23 recognized official languages, including English (English remains a commonly spoken language throughout India, and the majority of educated Indians know at least some basic English). However, the total number of local languages and dialects spoken could actually number over one thousand! Out of these, the most commonly spoken language is Hindi(“Languages,” n.d.). The most common religion is Hinduism, with Islam, Sikhism, and Christianity all prominent minority religions. Indian culture is likewise a blend of different customs and festivals, with common staples including classical dance and traditional music performances. The largest Indian festival is Diwali, or the Festival of Lights. Another well-known Indian festival is Holi, or the Festival of Colors. Indian cuisine is just as varied and complex as the other aspects of the nation’s culture. Though a large portion of the population is vegetarian, non-vegetarian dishes are also common and well-known. Additionally, India is renowned for its art and architecture, with the Taj Mahal being a prime example. Overall, India’s rich and diverse culture is magnificent to behold and one of the country’s best traits (“Know India,” 2016).

FACT: National Currency: The Rupee

(“Know India,” 2016)

Conclusion

            As I embark on my internship this summer, I will be coming into a dynamic country with a bright culture and plenty of potential for future growth. However, there are also a number of issues that I must be aware of during my travels, such as the India-Pakistan divide and the rampant corruption and economic inequality. Overall, this snapshot of India aptly captures what I will be running into. I will be able to enjoy the cultural diversity and appreciate the fast growth, but I will also need to be on guard against delicate and controversial topics and the realities of corruption and poverty.

FACT:

Bollywood Refers to the Hindi Language Film Industry. Tollywood-Telugu Films. Kollywood- Tamil Films. Mollywood- Malayalam Films.

(“World Factbook,” n.d.)

 

Appendix

Breaking News Articles

Jandial, S. (2017, April 1). Delhi: Call centre employee returns home to dead friends, doctors claim it’s case of drug abuse. India Today. Retrieved from http://indiatoday.intoday.in/story/delhi-drug-abuse-girls-found-dead/1/917948.html

Press Trust of India (PTI). (2017, April 5). Pakistan welcomes US mediation after India rejects. The Economic Times. Retrieved from: http://economictimes.indiatimes.com/news/defence/pakistan-welcomes-us-mediation-after-india-rejects-it/articleshow/58023481.cms

Roy, S. (2017, April 4). The Ugly Side Of Being An African Student In India. NPR Goats and Soda, Stories of Life in a Changing World. Retrieved from http://www.npr.org/sections/goatsandsoda/2017/04/04/522453520/the-ugly-side-of-being-an-african-student-in-india

Singh, A. (2017, March 27). On a high: How Delhi has become a hotbed of drug smuggling. The Indian Express. Retrieved from: http://indianexpress.com/article/cities/delhi/on-a-high-delhi-heroin-addicts-hotspots-of-drug-smuggling-national-capital-4586913/

Works Cited

Agrawal, N. (2016, Oct 4). Inequality in India: what’s the real story? World Economic Forum: India Economic Summit 2016. Retrieved from https://www.weforum.org/agenda/2016/10/inequality-in-india-oxfam-explainer/

Bad boom: Graft in India is damaging the economy. (2014, March 15). The Economist: Fighting Corruption in India. Retrieved from http://www.economist.com/news/briefing/21598967-graft-india-damaging-economy-country-needs-get-serious-about-dealing-it

Banerjee, P. (2016, Dec 28). Voices in their heads: How India deals with mental disorders. Hindustan Times. Retrieved from http://www.hindustantimes.com/health-and-fitness/voices-in-their-heads-how-india-deals-with-mental-disorders/story-a64Jhyk4o72k6SV1Ke7WdJ.html

Dalrymple, W. (2015, June 29). THE GREAT DIVIDE The violent legacy of Indian Partition. The New Yorker. Retrieved from http://www.newyorker.com/magazine/2015/06/29/the-great-divide-books-dalrymple

Drug Abuse Prevention. (2015). In National Institute of Social Defense, Ministry of Social Justice and Empowerment. Retrieved from http://www.nisd.gov.in/content/127_1_DrugAbusePrevention.aspx

India: Events of 2015. (2015). In Human Rights Watch, World Report 2016. Retrieved from https://www.hrw.org/world-report/2016/country-chapters/india

Jacobson, D. (2004). Indian Society and Ways of Living.  Asia Society, Center for Global Education. Retrieved from http://asiasociety.org/education/indian-society-and-ways-living

Know India- India at a Glance. (2016, Aug 22). In india.gov.in, National Portal of India. Retrieved from https://india.gov.in/india-glance.

Languages of India. (n.d.). In New World Encyclopedia. Retrieved from http://www.newworldencyclopedia.org/entry/Languages_of_India

Murthy, P, Manjunatha N., Subodh B. N., Kumar Chand P., & Benegal V. (2010 January). Substance use and addiction research in India. Indian J Psychiatry, 52, S189–S199. doi:  10.4103/0019-5545.69232

Straight Life: India’s recovering drug addicts. (2015, August 10). In BBC World News. Retrieved from http://www.bbc.com/news/world-asia-india-33647423

Tahseeni, I. (2015, April 4). Social stigma hinders real understanding of autism. The Times of India. Retrieved from http://timesofindia.indiatimes.com/life-style/health-fitness/health-news/Social-stigma-hinders-real-understanding-of-autism/articleshow/46794054.cms

Tandon, T. (2015 February). Drug policy in India. International Drug Policy Consortium Publication 2015, ‘Asia Action on Harm Reduction’ project (2013-2015). Retrieved from http://idhdp.com/media/400258/idpc-briefing-paper_drug-policy-in-india.pdf

The World Factbook: India. (n.d.). In Central Intelligence Agency Online. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/in.html

Other Sources

Hutt, R. (2016, Oct 7). India’s economy in numbers. World Economic Forum: India Economic Summit 2016. Retrieved from https://www.weforum.org/agenda/2016/10/india-economy-in-numbers/

India’s Mental Health Crisis. (2014, Dec 30). The New York Times Opinion Pages. Retrieved from https://www.nytimes.com/2014/12/31/opinion/indias-mental-health-crisis.html?_r=1

Kumar, S. (2014, June 6). India’s Shame: Women’s Rights. The Diplomat. Retrieved from http://thediplomat.com/2014/06/indias-shame-womens-rights/

Sharma, K. (2014, August 28). Two lakh street children lured into substance abuse in Delhi. The Hindu. Retrieved from http://www.thehindu.com/news/cities/Delhi/two-lakh-street-children-lured-into-substance-abuse-in-delhi/article6327831.ece

The World Bank. (2016). India [Data file]. Retrieved from http://data.worldbank.org/country/india

Udas, S. (2013, January 12). Challenges of being a woman in India. CNN. Retrieved from http://www.cnn.com/2013/01/12/world/asia/india-women-challenge/