2011 Grant Recipient 
India
MHS Program, Department of International Health, JHSPH
Investigators from Johns Hopkins Bloomberg School of Public Health and the Women and Children’s Health Research Unit, Jawaharlal Nehru Medical College (JNMC) are collaborating on research activities aimed at improving maternal and neonatal health in rural Karnataka State, India. JNMC has an established track record in carrying out large-scale community-based trials and is one of the research centers within NICHD’s Global Network. An example of the type of research being conducted under this collaborative effort is described below: In May/June 2011, we anticipate initiating enrollment of pregnant women in a cluster?randomized trial of the safety and efficacy of oxytocin in Uniject by ANMs to prevent PPH in Bagalkot District, Karnataka. In this study, approximately 3000 babies will be delivered by women attended at Primary Health Centres and Sub-Centres by Auxillary Nurse Midwives (ANMs). These ANMs will be randomized to provide either 10IU of oxytocin in Uniject immediately after delivery of the baby or the current prevailing practice, which currently does not (often) include administration of a prophylactic uterotonic. We are requesting a student position to provide support for various aspects of implementation of this and other ongoing research activities. Examples of other studies that JNMC is conducting as part of their partner status within the NICHD Global Network include (among others): furthering understanding of the relative contribution of components of AMSTL, validation of fundal height measures for estimation of gestational age, and establishment of a Maternal and Newborn Health Registry. Personal Narrative:
My experiences were a bit different from that of a usual GHEFP awardee. My field site was not just in my home country, India, but also my home state, Karnataka. I was immediately at an advantage because I spoke the local language and knew what to expect in terms of living situations, cultural practices, weather, etc. Yet, this experience challenged several of my pre-conceived notions about the urban, city life in India versus the rural, village life. Having grown up in a sprawling metropolis, I had quite a few set ideas about village India, ideas that had little basis, and mere observations made from zipping past these small towns on road trips growing up. My public health experience in India had until this point consisted of working with the urban poor in slum dwellings around Bangalore and Mumbai, and my naivety and protected background had led me to assume that life was similar to this in the rural areas of India as well. The time spent in Belgaum this summer very quickly put my assumptions to rest, for instance, that rural should never always be considered analogous to poor or squalor or illiterate. People living in rural India do face several challenges, once that urban populace takes for a given usually. Main amongst this is the infrastructure challenge – for almost all the study clusters, the nearest hospital was a good distance away, with terrible connectivity offered by public transport. Similarly, the community facilitators who were in many ways the backbone of this project, described the many miles they had to walk to conduct community workshops, simply because the bus that was supposed to arrive, never did. I learnt that adverse outcomes related to pregnancies aren’t just a result of the family not taking action, but about all the different everyday problems that create obstacles, some anticipated but several unforeseen, for a family trying to rush its laboring mother to a proper facility for safe birth. The experience further deepened my conviction for health systems strengthening, but to also include public infrastructure in the dialogue for health systems strengthening, i.e., not just the infrastructure of the hospital or a clinic in question, but also the road leading to these places, the kinds of transport systems in place, the access to cash in times of emergencies, and so forth. This experience has furthered my interest in maternal and child health, but I would like to go further and learn and understand and be involved in situations that look at existing health systems and find ways in which they can be used and improved upon, in order to better deliver the services essential to a community so it has healthy mothers and children.
Photo Album:  | Two community facilitators are demonstrating a scenario using the Home Based Life Saving Skills (HBLSS) modules developed by the American College of Nurse-Midwives. |  | This picture shows a group of community facilitators that work in the same cluster, filling out a table exercise I had created for evaluation purposes. |  | A close-up of the exercise I carried out with the facilitators as part of the evaluation. |  | A picture taken after a focus-group discussion with community members in one of the poorer, more isolated area in the project. |  | A picture taken after a focus-group discussion and community meeting. |  | This picture was taken at my very last interview and day on site; I am in the centre with 5 community facilitators I had just finished interviewing. |
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