This is part of a recurring series in which we share reports from Harvard students who have traveled to South Asia with support from a SAI grant during the 2016 winter session.
By Hannah Yoo, Doctor of Dental Medicine, Harvard School of Dental Medicine 2018
This winter, I had the opportunity to travel to India to conduct research on the oral and nutritional health of women and children in the slums of Mumbai. I worked with an organization based at UC Berkeley called India Smiles, an innovative and low-cost community-based intervention that utilizes education and prevention methods to improve the oral health and nutrition of children age 0-6 in the greater Mumbai and Tamil Nadu, areas of India. We partnered with two NGOs: Foundation for Mother and Child Health in Dbobi Ghat and Powai and Reality Gives in Dharavi. At each NGO, we trained community health workers on the importance of oral health education and practical preventative measures that Indian mothers could use to improve the health of both themselves and their children. The following day we held all-day oral health camps that consisted of interviewing the mothers on their knowledge of oral and nutritional health, socioeconomic status, and other protective factors. In addition, we conducted oral health exams on children, applied fluoride varnish to children, and provided free toothbrushes and toothpaste. Through this experience, I learned to practice cross-cultural compassionate care, learned about a broken health-care system, and gained an understanding of a complex yet beautiful country.
Prior to this trip, I had never visited a third world country and didn’t know what to expect. What I found most shocking was the huge disparity between rich and poor. It was hard to believe that huge slums and shanty towns could exist next to luxury apartment complexes and extravagant shopping malls. One of the slums we worked in was in Dharavi which is considered to be one of the largest slums in the world. Most of the homes in the slum did not have running water or toilets. Things that I took for granted in America were luxuries here.
Another shocking surprise was the ease of access to unhealthy foods in India. Within slums, it’s hard to find a school or doctor’s office but small snack stands with cheap, unhealthy snacks were everywhere. Healthy food options like fresh fruits and vegetables are nowhere to be seen in slums; outside of the slums, fruits and vegetables cost significantly more. In addition, because of the poor water quality, it is considered safer to purchase pre-packaged snacks. Moreover, betel nut – a carcinogen that causes oral cancer – are commonly sold on the side of streets. Thus, it is apparent how dietary choices like this have led to a global epidemic of tooth decay, or “caries”, and resultant mouth pain and malnutrition. At the oral health camps, we observed a high incidence of caries in children. It was very common to see children at the age of 5 to have over 10 caries who were significantly underweight.
Overall, this experience dramatically changed the way I think about global health. I used to believe global health consisted of a methodological approach to providing health services and education to underserved people. But this project showed me that “global health” is much more complex and requires the commitment and involvement of the people who understand the barriers to healthcare best: the local community. I am immensely grateful for the support of the Harvard South Asia Institute and the winter session research grant for this eye-opening experience.