Site Visit

This summer, we interned at Operation ASHA based in New Delhi, India for two months.  Operation ASHA is one of the world’s largest NGOs dedicated to bringing lifesaving tuberculosis (TB) treatment and other forms of health care to underserved communities.  Through working here, we’ve had the opportunity to see how this organization functions and witness the real, positive impact it’s had on people’s lives.

Our internship duties were vast and variable (comprehensive, to say the least).  Research on an array of topics occupied our time. Our initial work centered around fundraising.  We compiled the research gathered about fundraising into a presentation that we gave in the latter half of our time here.  Other research conducted throughout the internship followed these themes: enhancing social media following, reasons for patient default out of TB treatment, nonprofit benefits in programs such as Google AdWords, Amazon Web Services, Facebook Start, and more.  In researching the role of technology in social development, at the recommendation of our supervisor, Sonali Batra, CTO of Operation ASHA, we read Kentaro Toyama’s Geek Heresy and presented our findings. Essentially, we learned the importance of having devoted, human advocates to back any kind of technology implemented in social development work. Without this factor, the technology has a higher risk of failing its purpose.  We realized that Operation ASHA has seen so much success in its treatment program because of the dedicated people working behind it.

During our site visits (we went on three), we witnessed such technology usage in action.  While the tech team of Operation ASHA plays an imperative role in ensuring the maintenance and functioning of eCompliance, it is the Community Health Workers (CHWs) that champion this technology.  They are the ones who go the last mile, journeying to patients’ doorsteps, conducting follow-ups, and earning community respect, which allows the nonprofit’s operations to run as successfully as possible.  This is why OpASHA has achieved an unprecedentedly high treatment success rate of 85% and an unprecedentedly low default rate of 4%. It was during our first site visit that we filmed a short, informational video about OpASHA, the script for which we had prepared ahead of time.  We published this video on our personal fundraising page to inform potential donors about the organization and its mission, and surpassed our $300 fundraising goal.

Something else Operation ASHA prioritizes is the education of these underserved communities revolving around matters of the disease.  Educating populations about tuberculosis serves the purposes of reducing stigma, recognizing symptoms, and knowing when to seek help. OpASHA educates the communities it serves through informative videos on the eCompliance application, TB awareness camps, and, more recently, through a comic book called Knight Wolf.  The comic book contains pages with information about TB so that children in the communities are aware of the disease and can act appropriately. One of our site visits included stopping by a school in an urban slum to distribute these comic books. The primary school was a public school which receives government funding for educational materials, lunch, and uniforms.  Students in the upper classrooms would stand and greet us with a resounding “Hello, Ma’am” and then have a seat. After the book’s contents were explained verbally (in Hindi), we went up and down the aisles to hand them out. Invariably, each student would shyly accept the comic book but eagerly open it to explore the contents therein. Our departures consisted of enthusiastic waves and verbal goodbye’s, and at least one student exclaiming, “Bye bye, diidii” which we learned meant, “Bye bye, elder sister” in Hindi.

Throughout our internship, we also had the opportunity to sit in on meetings between organization founders, headquarters staff, and distinguished guests.  We met inventors looking to distribute a unique medical device that tracks heart activity over time. The device was optimally designed to be as comfortable and as minimally disruptive to daily activities as possible. Through this partnership, Operation ASHA may act as a pipeline to distribute this technology to underserved communities in which they already are established.  Women at risk of preeclampsia and other heart conditions, in particular, would benefit from this intervention. Additionally, we were fortunate to meet a young team of entrepreneurs looking to use drones in the healthcare sector. In this trio, one person designed the drone, another built it, and the third engineered the electrical circuits within. Drones may be used to help supply medicine, carry samples, or deliver the biometric technology itself.  The implementation of this technology remains to be settled. Other intra-organizational meetings included discussing allocation of funds, future grants, auditing, and informative presentations. In these meetings, it was fascinating to consider the vast innovation that goes into accomplishing all of Operation ASHA’s activities. Furthermore, an organization with such scale must make calculated decisions to maximize its impact.

The month of July brought with it a respite from the record-breaking heat wave, along with several opportunities to attend conferences related to international public health and tuberculosis awareness.  In the first half of the month, we dropped in on two conferences. The first was the American India Foundation (AIF) 2018 Fellowship event. Twenty-seven young people from the United States and India were placed at locations all around India for ten months working on a variety of social development projects.  Themes of the projects included public health, education, the arts, and more. The event served to celebrate the culmination of all these projects, and it was eye-opening to learn more about so many different sectors of social development. The second event we attended was all about ECHO, a platform for like-minded people to share information about a unique topic via digital conferencing.  Such a program may be implemented to access experts across disciplines. They may, for example, bring up a particularly interesting patient case study and discuss treatment. Pooling knowledge and resources in this manner helps to disseminate useful information all across the globe.

In the latter half of the month, we attended events hosted by Médicins Sans Frontiéres (MSF) and United Nations Programme on HIV/AIDS (UNAIDS).  The MSF organization, also known as Doctors Without Borders, hosted distinguished speakers knowledgeable about health care and disease in India, AIDS/HIV and TB in particular.  One of the most memorable speeches was that of Nandita Venkatesan, a two-time TB survivor, TEDx speaker, and journalist. Through most of our work at Operation ASHA, we had seen TB from the perspective of the health workers’ side – detecting patients, administering treatment, conducting follow-ups, etc. – but this was a unique chance to hear directly from a TB sufferer about their formidable struggles and hardships.  What was duly impressed upon the audience was the sheer amount of suffering that afflicted TB patients as well as the indisputable necessity of doctor-patient communication. In just one example of where this latter requirement faltered, Venkatesan lost her hearing during treatment without being informed that this was a possible side effect of the drugs. Evidently, there is much to do in improving the way this epidemic is tackled.  Events like this communicating progress and challenges in the field are just one step in bringing about such change.

In our last week with Operation ASHA, we attended a three-day conference hosted by the United States Agency for International Development (USAID), all about healthcare technology in TB care. Representatives from the top nine high-burden TB countries attended to learn about the various technologies implemented worldwide for TB treatment. We listened in on informative sessions with distinguished speakers from South Africa, Ukraine, Myanmar, and more.  During breaks, we helped man Operation ASHA’s booth with CTO Sonali Batra and Deputy Director Operations Manju Bajiyu. After a short introduction about the organization, we would demonstrate OpASHA’s eCompliance technology. One of us would explain the process of treatment while the other showcased the app and biometric fingerprinting device. This event was the perfect way to end our internship, testing our accumulated insight about TB treatment in India and Operation ASHA’s work.  It was a privilege to witness such international cooperation and contribute knowledge in serving vulnerable populations around the world.

Our summer at Operation ASHA has been both informative and transformative.  We’ve learned a great deal about the issues with which the organization works closely to remediate. Furthermore, our perspective on international development issues broadened exponentially.  We are immensely grateful for the opportunity to have spent the summer with OpASHA. Thank you especially to our supervisor, CTO Sonali Batra, the co-founders, Dr. Shelly Batra and Sandeep Ahuja, and everyone else at OpASHA headquarters and beyond, for welcoming us, including us, and giving us a uniquely enriching internship.

–Melanie Rumbel and Marika Dy, Wellesley College

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