India: Brighter and more colorful

Updated: Sep 7, 2019

Jenna Mueller, PhD

My trip to Kolkata began with reading Jhumpa Lahiri’s novel The Lowland, which is the story of two brothers who were born in Kolkata during the 1960s. The novel seamlessly interweaves their personal stories with the historical events in India and paints a picture of an area torn by revolution. I read The Lowland as I flew across the globe trying to start to understand the complexities that awaited in Kolkata.

As we arrived in Kolkata, I realized that nothing could prepare me for the next two weeks. Kolkata was an overload to the senses. Everything was brighter and more colorful than I could have imagined. Cars constantly honked and weaved in and out of traffic. The food was packed with flavor and spice unlike anything I had ever tasted in the United States. The heat and humidity was so intense that it seemed to slow my thinking and enable me to better observe the life that buzzed around me.The history of colonization still pervades many aspects of society in Kolkata. People live among structures and monuments that were built thousands of years ago. The roads are both chaotic and organized. It is a city of contrasts – old and new, colonization and recent independence, order and disorder, linearity and nonlinearity, extreme poverty and extreme wealth.

As program directors our role is to help get the DukeEngage students settled into their new life in Kolkata. As part of this, we did a walking tour of Kolkata, which enabled the students to get an orientation into the city where they will be working for two months.

Additionally, we helped the students get settled with their placements, which are organizations that advocate for the underserved. During the morning, the students worked at one of two placements: 1) Tulipdale public school, which is an elementary and middle school for children who live primarily in the slums outside Kolkata and 2) Julian Day New Mission (JDNM), which is a school that works with children with special needs, particularly autism. In the afternoons all of the students go to Future Hope, which is an orphanage and school for Kolkata’s street children. We helped the student meet with the administrators from the different schools and develop a plan for the first week.

In addition to getting the students settled in their placements, we went on two weekend trips to Delhi/Agra and Murshidabad. In Agra, we saw the Taj Mahal, which represents the culmination of the highpoint of the Mughal empire before it fell to the British. The visit to the monument was critical to the students’ understanding of transition of power in India and how the Taj continues to be an icon of the past that influences everyday life in today’s post- independence India. We also traveled around Delhi and saw the Lotus Temple, which is a Bahá'í House of Worship that represents the spiritual unity of all humankind. In many ways the Lotus temple represents the secular nature of India – there are so many different religions (Hinduism, Islam, Christianity, Sikhism, Buddhism, Jainism) that co-exist in one country.

We also visited Murshidabad, which is the old capital of Bengal on the banks of the Ganges river. Murshidabad is very rural and has a very high poverty rate. This visit enabled the students to experience the dichotomy between urban and rural India, Hindu and Muslim communities, and different socio-economic classes.

During my stay, I also had the opportunity to meet with various physicians to better understand cervical cancer screening and treatment in Kolkata/eastern India, receive feedback on the POCkeT colposcope developed in our lab, and explore potential collaborations. Specifically, I met with:

  • Neerja Bhatla, All India Institute of Medical Sciences (AIIMS), Delhi

  • Jaydip Bhaumik, Tata Medical Center, Kolkata

  • Rahul Roy Chowdhury, Thakurpukur Cancer Hospital, Kolkata

  • Dipanwita Banerjee, Chittaranjan Cancer Hospital, Kolkata

From these meetings, I learned that 140,000 women are diagnosed with cervical cancer in India every year, 50% of whom will die from cervical cancer. Currently no population wide screening program in India; consequently, many of the hospital are trying to start various screening programs, which include HPV testing, followed by colposcopy and biopsy, followed by either cryotherapy of LEEP depending on the extent of the disease. In particular, several physicians mentioned that they would like to see HPV, colposcopy, and cryotherapy at primary level and LEEP and cancer treatment at hospital level. Currently screening is very adhoc in the community and awareness of cervical cancer is a huge hurdle.

To address this challenge, Dr. Banerjee is leading cervical cancer screening days in rural villages where they have several different phases. First, they meet with community leaders and have an orientation program. Next, the have their first camp day where they do VIA and HPV screening. Then, they return to the villages to do a second camp, which included colposcopy and biopsy, immediately followed by cryotherapy in the same visit. They refer to Chittaranjan if LEEP is needed. They have screened 3,000 women with their cervical cancer days in the past 6 months!

The physicians also provided great feedback on the POCkeT colposcope. In particular, they liked that it was small, lightweight, compact, and battery driven. Additionally, they liked the form factor, placement of the buttons, the ability to zoom in on regions of interest, and the ability to use green light. Suggestions for improvement included the ability to store and retrieve pictures from previous visits, enabling the device to be used without a speculum, and thinking about a spray mechanism to apply acetic acid.

In summary, the trip to Kolkata was eye-opening – both in terms of the immense challenges faced by underserved children in Kolkata and the hurdles to preventing 70,000 deaths due to cervical cancer in India every year. But while these huge challenges exist, what struck me more than anything was the resilience of the people who are striving to make a difference in their communities and how much we can learn from them.

#CervicalCancer #India #Kolkata

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