Lessons learned from India

Everything takes longer One of the biggest things we noticed while in India was that it takes large amounts of time even to accomplish fairly routine tasks relative to trying to do them in Canada. This no doubt was in part due to our unfamiliarity with the country, but based on what we saw, we think this could also be true even for natives, though to a lesser extent. For example, basic tasks like getting a vaccine or getting a cell phone set up were far cheaper but took far longer than doing the equivalent task in Canada. For example, getting a vaccine required considerable time and many different small steps for payments and waits (getting the appointment, for getting the consultation, prescription, getting prescription filled, getting injection, paying for each step).

Mobility is really important One thing we noticed was that mobility was far more important in the locations we visited in India than almost anywhere in Canada. Sidewalks were narrow and paved inconsistently. It was hard for even the most able bodied individuals to cross many streets. Whenever we considered the impact of a health problem that impaired mobility it seemed like it would have a far greater impact in India than in Canada. Cellphones get a lot of texts Our cellphones got a very large and consistent number of advertising texts (5-10 a day) starting from the first day we got local cellphones. We could not find good data on whether this was average or abnormal but it made us more cautious about SMS interventions than we were originally. If we do any intervention based on SMS, we’d have to find a way to establish authority and make it clear that any health messages sent were not merely advertising. People mostly hang out in their own wealth brackets Unsurprising like in most countries there are pretty large deviations between different wealth brackets. When we talked to most individuals about their connections to others it was very often in the same wealth bracket and general socio-economic status. Pollution is really bad The pollution was shockingly bad. We had a sense of this from the statistics going in, but it was a whole different experience to feel it in person. At nighttime burning garbage and wood cook stoves made the air extremely polluted. Even far outside of large cities there was still the feel of some pollution in the air. There were many different languages spoken There was a huge variety of languages spoken in India that we encountered. Some of the people we met were trilingual and said they still had major translation problems in some places. The ability to speak fluent English was extremely correlated with wealth, although most people we encountered could speak a few English sentences. A surprisingly large number of signs and written language that we encountered were in English. This helped remind us that we would really need to have a good sense of what specific area we are working in before hiring staff or we would risk having major language problems. Different newborn health practices We learned there’s a tradition in many parts of India to not take a newborn or the mom out of the house until months after birth. This can cause problems because this holds true even if the newborn is sick and needs care. We found quite a few differences like this that could affect different programs we were considering. People self reported money and jobs as more important than health Quite a few times we asked impoverished people what they most desired or what they thought would improve their happiness most. The most common answer we got was the desire for employment or a better job. People's happiness seemed to vary a lot depending on their job and it also came up a lot in general conversations. The second and third most common things we heard were money and food. We almost never heard about health issues or loss of family members due to health concerns. We are not sure what causes this or if it would be different in different areas. The smallest city we stayed in was still over 100,000 people and we suspect this could affect the answers quite a bit. People we talked to seemed to think life was getting better Many different people we talked to commented about how their personal life was getting better or mentioned that life in India is generally improving. India has experienced huge income and health gains historically, but it was interesting to see how many people had actively noticed and appreciated the improvements.