Articles by Caitlin McQuilling

On Saturday one of our new HIV positive patients, a tribal woman living below the poverty line in Jhabua , came into our office distraught.  She had just found out that she was accidentally pregnant, and while she and her husband had been trying for a child for a long time before they found out that they were HIV+, she was contemplating terminating the pregnancy because of her HIV+ status.  As she told us her story the sadness in the room was tangible.  She spoke in barely an audible whisper and hung her head low, staring at the ground with utter defeat.

Jimmy and Dr. Toegel counseled the woman and her husband that if she adheres to her ART treatment, taking good care of herself during pregnancy, and has a C-section, there is a 95% chance that her child can be born HIV negative.  They referred her to a friend of ours who is an expert in PPTCT – prevention of parent to child transmission of HIV – at the nearby government hospital in Indore who will manage her case and with regular ANC checkups, will help to ensure that the child will be born HIV-.

As we gave our patient and her husband this counseling, the most beautiful smile I’ve ever seen came over her face.  Her dull eyes became suddenly bright.  Glowing and grinning ear to ear, our patient beamed at her husband.  She and her husband had never heard of PPTCT treatment and had no idea that its possible for their child to be borne HV negative.  The smile of a women who just found out that there is a new chance for life for her unborn child is something beyond words.

Today Setu, one of our volunteers from the US and a physicians assistant, went to Indore with the family to get their first checkup.  While we have a long 6 months ahead of us (our patient is 3 months pregnant already), we will do everything we can to support this family and to ensure that their child is healthy and happy.

To learn more about how you can support us in preventing an HIV positive birth or about our HIV/AIDS programs, please visit our website at:  http://www.realmedicinefoundation.org/initiative/hivaids-prevention-and-care-program-jhabua-district-madhya-pradesh-india

http://www.ndtv.com/news/india/madhya-pradesh-jhabuas-register-of-death-18247.php

Malnutrition is making headlines again in Jhabua.  Real Medicine Foundation has been here long before the district caught national attention for its severe poverty and will continue to work to improve the lives of people in this district.  Our Director of Programs and Regional Program Director both are based in Jhabua so that they can be close to RMF’s superb local field staff in the district.  We’ve also just hired on 11 women from Jhabua district to cover 100 villages here to ensure that whats described in this article doesn’t happen again.

One of RMF’s guiding principles is that we approach our work “one child at a time”, focusing on individuals, real impacts and tangible results even as we implement large-scale, projects affecting millions of people. This approach, while effective, is never easy. We get attached. This past month, I’ve been reminded of how rewarding one child at a time can be and also of how painful.

I met Abishek, aged 7, one night last December at Real Medicine’s office in Jhabua. I was cranky for spending a late-night in the office sorting through expenses when Jimmy, our project coordinator, brought in a boy and his father who had heard about RMF and wanted to see if we could help them. Even in the dim light I could tell that Abishek was not well. His bony hand clung around his father’s neck as his father told me about Abishek’s battle with cancer and hospitals and the family’s battle with debt and mistreatment. Abishek had been diagnosed with a Wilms tumor, a form of cancer not necessarily fatal in the West, if caught early, but which was already in the late stages because of the poor rural medical system in Jhabua. As Abishek started to get really sick and his stomach began to swell drastically, he and his family were bounced around from hospital to hospital, his treatment being ever referred, deferred, by doctors unable to tell the seriousness of his condition. He finally ended up at a private hospital in Indore where the hospital charged his family obscene amounts of money (which they had to borrow from money lenders to cover) and performed a surgery that another later doctor told me was a butcher’s job. It is suspected, and highly probably given this hospital’s reputation, that the surgeon purposely did not remove the entire tumor so that there would be more to remove later, for another surgery fee. Further, we learned that Abishek was only beingadministered 3 of the 5 recommended chemotherapy agents he required. He went through all of the side-effects of chemo, but with little benefit. Sounds unimaginable, but sometimes medicine as a business overrides the Hippocratic Oath.

Things were not looking good for Abishek when we met him, but every child deserves a chance. I called on a friend whose father is the chief of surgery at the best pediatric hospital in Ahmadabad, 10 hours away and he immediately agreed to see Abishek, free of cost. The doctors, while warning us of the worst, said Abishek had a small chance of surviving and started him right away on the correct chemo. We took Abishek and his family back and forth to the hospital in Ahmadabad, pestering doctors for quicker results, bothering nurses for extra blankets, and even donating blood to Abishek.
While most of the Abishek’s doctors, neighbors, and family members had given up hope of his survival, we stubbornly, continued to consult with experts, continued to look for better chemotherapy agents, and showered Abishek with his favorite chocolates and juice boxes. Ever y visit to Abishek’s house was heartbreaking as we watched Abishek waste away, cancer ravaging his body, and imagining that this all could have been avoided if Abishek’s cancer was detected earlier and if this criminal hospital in Indore hadn’t put greed over medicine.

While going through the heartbreaking journey with Abishek, my spirits and hopes were also lifted by another one of our special cases, Sachini, in Sri Lanka.

Martina met Sachini two years ago and diagnosed her with Turner’s syndrome, a growth hormone imbalance. RMF has supported her treatment ever since, with Sachini’s condition improving drastically, even allowing her to start attending school again, until I saw her in Sri Lanka in November. Sachini had started getting severe headaches, and since she was under RMF’s care, she was quickly referred from the clinic near her town, to a government hospital in Colombo where she was seen by experts. Sachini was diagnosed with a tumor on her pituitary gland, requiring urgent surgery. This is where her family ran into problems. There is only one doctor capable of performing the surgery Sachini needed, but dismissed as a villager from a far-off town, Sachini was placed at #184 on the government waitlist. At the rate surgeries were being performed, Sachini wouldn’t have made it until her number was called.

This is where RMF called in our network. We made dozens of phone calls around the world, reaching out to everyone from a former US Ambassador to Sri Lanka to cricket players to businessmen to Sri Lankan politicians. Suddenly this family from Sri Lanka’s interior was being paid attention to. Sachini’s surgery was scheduled in rapid time and now, post-surgery, Sachini is making a full recovery. She has her vision back, no more headaches, and is looking forward to getting back to her passion, dancing the Tango.

Yesterday, Abishek passed away. With the confidence that’s he’s in a better place, we can only think about how, in his honor, we can help the next child. Hopefully next time we’ll find the child at an earlier stage, we’ll stop this hospital from harming more families; we’ll have a success story.

“One child at a time” in practice isn’t always the feel good motto placed in slogans and in PSAs. It involves sleepless nights, passing out after giving blood, fighting with doctors, politicians, and money lenders, and finding extra hours in the day. But when a tragedy like Abishek’s begins to erode hope, a triumph like Sachini’s gives light. We’ll battle on, fighting for one child at a time, inspired by those we’ve helped and in honor of those we couldn’t.

Sachini, healthy and happy

While the following news coverage is all in Hindi, it translates to a recognition of our work along with partner JJHSS in Madhya Pradesh, to raise awareness about and to prevent and treat HIV/AIDS in Jhabua.   We’ve been getting phone calls all week from across the states from people who were shocked to hear our stats – that 197 HIV+ people have been identified so far in Jhabua.  People are stunned to learn that HIV is affecting rural India and not just the cities.  Hopefully by raising visibility of HIV in rural areas of India, people here will be more cautious and aware of the dangers of the disease.

Yesterday RMF commemorated World AIDS Day by participating in 3 simultaneous events to educate young adults on HIV/AIDS awareness and prevention throughout Jhabua and Alirajpur.

In Jhabua, Jimmy, Caitlin and Rajpal took part in an event organized by Jhabua College.  The event, which was standing room only with over 200 people, was attended by college students and the district Chief Medical Officer.   Rajpal, President of the Jhabua Network for People Living with HIV/AIDS (an organization which RMF supports) was the key note speaker, making all of us proud as he stood up in front of the crowd and said “I’m HIV positive and look at me, I’m living a good life.”  He went on to candidly tell the students how he contracted HIV and how after being diagnosed and starting ART treatment, he’s turned his life around.  He wanted to make the students aware that HIV is not a death sentence and that HIV+ individuals can live healthy, happy productive lives.  He also warned the students, that just because someone doesn’t look sick, it doesn’t mean they’re not HIV+, so that everyone should take precautions every time they have a sexual encounter, emphasizing condom use and treatment of STIs.  Rajpal patiently answered questions during the question and answer session and even after the talk when students lined up to shake his hand and ask more questions.

Jimmy also left the students wide-eyed as he gave them an impassioned talk about how HIV can happen to anyone if we do not take the right precautions.  By giving the students examples from real-life cases of people their age contracting HIV, Jimmy certainly woke up the audience and then hit home with practical advice on how they can take precautions against HIV and where to go get testing.

Our event in Jhabua was a complete success, with a room full of young adults leaving with information on HIV/AIDS prevention and testing and with many stigmas shattered as they met the charismatic, HIV+ Rajpal.

Simultaneously Shalindra and a handful of members of the Jhabua Network for People Living with HIV/AIDS traveled to Alirajpur to attend a rally with over 200 students and the district collector.  They were impressed by the students desire to learn more about HIV and the lack of stigma present towards HIV+ individuals.

Ajana was also busy meeting with a group of high school girls in Thandla block.  Here, with just girls present, Ajana was able to speak openly to the girls and receive questions that they may have been to shy to ask in front of a large group of boys and girls.

Our World’s AIDS Day activities were extensively covered by local press, articles which we’ll scan and post as soon as there’s electricity!

All RMF fans in New York are invited to come to Columbia University tomorrow to attend Caitlin McQuilling’s talk on about RMF’s malnutrition program in India.  Please see the information below:

Title: Childhood Malnutrition in India – on the ground and on the horizon in Madhya Pradesh

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Speaker: Caitlin McQuilling, Program Director the Real Medicine Foundation’s Malnutrition Eradication Initiative in Madhya Pradesh, India.

Time: 1:00pm to 2:00pm, Tuesday, 20th October, 2009

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Venue: 306 Russell Hall, 3rd Floor Library, Teachers College, Columbia University

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Organizer: Development in South Asia (DISHA)

India is currently facing its worst drought in 37 years, a drought that is just beginning to have its detrimental effects on those living in rural areas across the country.  While the national average for malnutrition in children under 5 is 47%, the rate gets as high as 90% in tribal pockets in MP.  Malnutrition has been a chronic problem for years but is now only exacerbated by drought and economic depression. I’d like to talk about the stark ground realities, but also offer some solutions and examples of actions that groups like ours can take and how individuals, even in the US, can help out.

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Bio:

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Caitlin is the Program Director the Real Medicine Foundation’s Malnutrition Eradication Initiative in Madhya Pradesh, India. A native of New York, Caitlin has been living in New Delhi since August 2007 working first for the Clinton Foundation HIV/AIDS Initiative on diagnostics and treatment. She has worked with the national government on supply chain, forecasting, quality assurance testing, trainings, and advocacy for new technologies and best practices. Caitlin has also spent time living, studying and working as a researcher and translator for an economic think tank in Sao Paulo, Brazil. Caitlin graduated from Georgetown University’s School of Foreign Service and speaks Spanish and Portuguese and is determined to master Hindi. Caitlin enjoys cruising the streets of New Delhi on her scooter, experimenting with Indian cooking, and snowboarding in Kashmir

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But imagine if the anganwadi center was bright and colorful and full of stimulating posters, toys for kids to play with, educating games, and a cheer that would entice mothers to bring their kids and for kids to ask their mothers to go. In these “child-friendly” anganwadi centers, mothers are more likely to bring their kids, who are more likely going to want to stay, where they will be more likely to learn, and the anganwadi worker will be more likely to assess their height and weight.

a child friendly anganwadi started by Spandaan

I’ve seen examples of child-friendly anganwadi centers set up by the Spandan Organization in Khandwa, Madhya Pradesh. They started with donated toys, stuffed animals, posters, and games and then got the people from the village to donate paints and building materials from their homes. The whole village got involved in making the anganwadi center cheerful and child friendly, adding a covered area outside the main room where kids could sit outdoors and painting the place with colorful decorations. The anganwadi center was transformed into a place only the poorest people go to when they’re sick (and often didn’t get care) to a community location centered around maternal and child health. At Spandan’s three child friendly anganwadis nutrition outcomes are noticably better than the neighboring centers.

I would encourage everyone in Bhopal to support this effort! Clean out the clutter from your homes and transform an anganwadi center!  If you’re not in Bhopal, I still encourage you to give to other organizations who do similar type of drives such as the Salvation Army in the US (http://www.salvationarmyusa.org

) and Goonj in most Indian metros (www.goonj.org

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Thank you to Spandan and Ahah Bhumika for organizing this!

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