Tuesday, July 28, 2009

First days in India...




After my first one-hundred hours with the Institute for Global Health, I began focusing more on preparing for the diabetes research in India. Beyond working in the IGH office with Dr. Wipfli and Ivette, I worked with Dr. Jaimie Davis and Dr. Mustaq Qureshi of Pardi Hospital on building the questionnaire for the study. After thorough advisement from Dr. Wipfli, Dr. Qureshi, Dr. Davis, and Ivette, the final questionnaire primarily will assess various known risk factors for diabetes (including age, sex, body characteristics, physical activity, diet, and health beliefs/attitudes). Extrapolating from previous questionnaires, the final questionnaire had seven components (including: General Information, Diabetes/Family History, Body Characteristics, Physical Activity, Diet, Health Beliefs/Attitudes, and Additional Comments). In the process of building the questionnaire, I visited Dr. Davis’ office, where I was trained on how to measure waist circumference, calculate waist to hip ratio, and to calculate body mass index, all of which I used for assessing body characteristics. I was also trained on how to take a detailed Food Intake Record, which asked for all food and liquid intake throughout the day. I felt that this detailed record would be too time-consuming and not appropriate for the sample population, which is why I decided not to use it. Instead, diet was assessed by asking simple questions including an open-ended question on a typical meal at home. Overall, the final questionnaire consisted of 37 questions. I had not realized that building a sufficient questionnaire would require numerous drafts and an extensive amount of time. I actually ended up working on it on the plane ride to India and had a final copy of the questionnaire on the first day of the study.
The first part of study was conducted at Pardi Hospital (a privately owned clinic) in the small rural town of Pardi in Valsad, Gujarat. The hospital is owned and operated by Dr. Qureshi, who is also the Chief of Medicine and Surgery. Dr. Quresha Qureshi is the OB-GYN Doctor and Surgeon and lent her expertise during my research at the hospital. Dr. Qureshi and Dr. Quresha have provided their expertise in medicine and clinical research over the course of planning the research study and in-country logistics. With their guidance, I met leading physicians in the field of diabetes, which made my experience in India was amazing.
Since I have visited and worked at Pardi Hospital a few times in the past two years, it was easy for me to assimilate in the daily routine of shadowing Dr. Qureshi during rounds, meeting patients, and conducting one-on-one interviews. After going over my questionnaire in detail with Dr. Qureshi, it was finally time to do what I had been preparing for, conduct an interview with a diabetic patient. Coming from Indian descent and knowing how to fluently communicate in Gujarati and Hindi made it easy for me to talk to the patient and beyond that, build a relationship in the 20-30 minutes it took to fill out a questionnaire. One of my concerns before conducting interviews was any pre-conceptions that patients may have of an Indian American and the possible lack of trust in sharing personal information. However, I was very surprised on how much patients were willing to share about their history with diabetes, their health beliefs and attitudes, and their curiosity in my background and what type of work I was doing. Many people in India think that once people leave their home-country and are raised in a place like America, they forget their language and culture. But because I spoke the language and was willing to learn about the daily lives of patients, I was able to gain trust quickly. Beyond just filling out a questionnaire, I learned so much from the patients that I talked to (as well as their family members) and I had a chance to impart the knowledge that I have gained throughout my undergraduate and graduate careers.
In addition to interviewing diabetic patients, I interviewed respective family members, since they would have similar health behaviors, eating habits, and share a family history. Because it took about a 1-1 ½ hour to interview a diabetic patient and family member, it was difficult to obtain a great number of interviews. However, the interviews that I did conduct proved very informational and extremely qualitative because most of the participants were willing to share their personal information.

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