So

There are villages and there are villages. The longer I stay here the more I'm learning about generalisations, about how things are not always as they seem, and how taking a position of relative ignorance is often the first step in gaining understanding. Not all that is rural is idyllic; there's a lot of hardship here too.

Today I went with the paediatrician, the pre-school teacher and another medical student to pick up children from the villages and take them to the pre-school on the CRHP complex. It was a fun day; I enjoyed being a child all morning - in fact the pre-school teacher mistook me for a child when getting off the bus, she gave me her hand to help me out and waved me into the group of children, counting me in like you do children to make sure they're safe and feel secure! We had a good laugh about that. The children also made a nickname for the other medical student, 'Bishi walla baba', they shrieked in that delightful way that only children can, on account of his impressively ginger facial hair (I'm told in good faith that the nickname means something akin to 'bearded guy').

In addition to playing and taking part in the joyful learning program, I got to sit in on the paediatrician's examinations of the children in the school. One of the things that impresses me about the CRHP is how they've managed to build a health service that works around the needs of patients. So often it's the other way around; patients are made to manoeuvre around the complex workings of a health service that penalises them for not understanding how things are operated. For example, they have to cancel other engagements to make an appointment which they are then kept waiting for, while being denigrated if they are late for the appointment or even taken off the books if they miss consecutive appointments for any reason. It sometimes seems like provision of health care is a privilege and the time of professionals more precious than that of patients. Obviously this is not necessarily deliberate and is merely an inevitable consequence of the pressure that hard pressed professionals are under to spread their services very wide, but it's helpful to see another model where communities play an active role in their own health and their participation makes them equal partners and not just passive recipients. I like the fact that rather than having the children skip school to go to the hospital, the doctor goes to school to see the children. This is possible and efficient because of the ready accessibility of the health care facility within the community, not in the form of a (physically and metaphorically) removed hospital that is in some senses a law unto itself. That's the beauty of community based primary health care.

The children themselves come from a diverse range of backgrounds. As an ignorant foreigner it is easy to wonder, 'how can there be such heterogeneity in such a small geographical location?' forgetting that even the most modern cities have gross disparities of wealth and living standards existing side by side. For some of the villages we went to today were extremely poor. Filth was strewn everywhere and pigs swam around in puddles, procreating openly in the rubbish. Every second sow you saw was pregnant. The chickens were scrawny and as for the domestic cattle - well, the one cow I saw in one hovel lay lethargically on the ground, its eyes encrusted with as yet unknown detritus. It is difficult as an outsider to pick up on the subtle structural inequalities that cause such differences in living standards - gender and caste prejudice and discrimination, land ownership, employment differences, and historical factors - but it is my aim to learn more about the stories of the local communities during my time here. Already I have been learning about the influence of agricultural factors and cultural issues (including the caste system) on the face of rural poverty from Dr Raj Arole, one of the founders of the CRHP.

Despite the wide range of backgrounds (and some of the children's stories are heartbreaking - one little girl lost her father to suicide over financial difficulties) the children are all bright, playful and keen in the pre-school. Even the ones who cried when leaving home had fun - and who wouldn't, in a place where you are treated with love and respect by your teachers, and have many friends to play with? They all have two nutritious meals at school, militating against malnutrition. It's inspiring to see such hope for the future.

While we are here on elective we have to write three papers - one on something that has caught our interest at the hospital, one in the community, and one as a personal reflection. I think I might write the second one on sanitation. The contrast between the beauty I have seen in some places and the squalor in others intrigues and disturbs me. I have a feeling that this issue is going to become a hobby horse. Perhaps it's because in childhood I lived in a military dictatorship that decreed every other Saturday environmental sanitation day, or maybe it's the fact that I was health and sanitation prefect in primary school, or it could just be down to personality - whatever it is, I am passionate about the physical environment in which we live: both the built environment and the surrounding landscape. Surely it is one area where collective action is possible, inexpensive, and can make a big difference...we shall see.

I am yet to write about the things I've seen and learnt in the hospital and outpatient clinics and a recent visit to a tribal community up in the hills, but that'll have to go in another post because it's way past bedtime already. Here's a little interesting fact before you go though. Did you know that the entire nation of India, despite being big enough to justify being called a subcontinent in its own right, is just one time zone? That's why the sun rises at different times of the day depending on what part of the country you're in here....