Global Health Research Documentary Critique

While cancer is one of the leading causes of death, it affects different countries disproportionately. In India, much like in other developing countries boasts larger rates of cervical cancers; India claims 25% of global cases of cervical cancers. [1] Indian women are have a 1 in 53 chance of a lifetime diagnosis of cancer compared to their developed country counterparts who hold a 1 in 100 likelihood. [2]. And it is unfortunate to have such high incidence rates in India as the CDC claims that it is a preventable disease and as much as 93% of cases could be prevented through screening and vaccination methods. [3]. During our time in India, my classmates and I attended various lectures including: Caste, Gender, & Health in India, Healthcare in India, and Different methods of Cervical Cancer screening. All of which discussed various gender stigmas present in Indian culture and their role in deterring women from seeking care. From a young age, women's bodies are heavily stigmatized and kept 'hidden', and so it is not widely accepted to speak out about various health issues which the women themselves are facing (that, in addition to the limited information available to these women about their bodies). During the Different methods of Cervical Screening, our lecturer informed us how various organizations within India have been advocating for earlier, preventative testing of cervical cancer, but once the patient's learned that they had to undergo a pelvic examination, many would defer and thus they would fail to screen a possible case of cervical cancer. They were forced to be creative and they developed and out of the box solution: self swabbing. They gave the patient clear instructions to follow on how to obtain a clean and non-contaminated sample and thus developed  culturally aware method of obtaining cervical samples. It is important to bring light to culturally issues as being present in healthcare, because as we have seen, gender disparities and bodily stigma were identified as important deterrents in seeking preventative medical attention for women in India. And by the time, these women seek health evaluations, the disease has likely progressed severely making it harder to treat and control. 

After learning about the issues and cultural sentiments which Indian women experienced, a group of 4 students and myself became particularly interested in how their culture impacted their trends in seeking healthcare, and what were the barriers on a microscopic, day to day level which deterred them from evaluation and consistent medical care. We spoke to Dr. Purnima Madhivanan and PhD - candidate Kiranmayee Muralidhar, both members of the The Public Health Research Institute Of India (PHRII) which works on bridging the gap in women's access to medical care in women. They both address cultural, finances, and transportation (among others) as issues deterring women from seeking care and preventative services. And we ask them to elaborate on potential solutions to these issues and that is where PHRII comes in. Dr. Purnima founded this organization to lessen these issues, she elaborates on the Mobile Health Unit of PHRII, where they bring the clinic to the women in rural villages to limit difficulties with transportation. They understand that oftentimes the issue lies beyond the women themselves and can be due to the cultural attitudes women face, and so they often host multiple education and awareness campaigns to the entire community to bring clarity over various health issues and proper steps in seeking care. Although we attempted to get a full understanding of the issue, there were plenty of other perspectives which we would have loved to have heard from. For one, we would have loved to have spoken with the family members or husband of a woman who has been diagnosed with cervical cancer. It would be interesting to hear what their shift in perspective has been (if there was any) before and after the diagnosis, as well as what perceived barriers they believe the women faced and if they felt that they were able to alleviate or support their wife through the process. 

The topic of this documentary may not seem to be involved with my central idea of Ayurveda, but upon landing to India and hearing about the gender disparities which women faced there and how it affected their access to proper care I was shocked, and had to learn more. Luckily, a few other classmates felt the same and we crafted our idea to interview these two intelligent, powerful women. I felt that as an aspiring physician I wanted to understand, from the patient's perspective cultural and other secondary factors which would deter me from seeking care for a condition which could cost me my life. We discovered just how collectivist Indian culture is, and it can be beautiful. However, the wife is encouraged to sacrifice herself for the cost of her family, and she takes pride in doing so. Although we did not include it in the documentary, our lecturers would inform us that the women would eat last and day old food, so their family could have the best and the freshest. And it may be admirable to them to self-sacrifice, but who is helping the silent women. Who is advocating and speaking up for them? One such voice I found was PHRII, and its founder Dr. Purnima Madhivanan, whom we had the pleasure to interview and speak to about possible solutions to the issues pertaining to increasing access to healthcare. As such, GIRLSNEXTDOOR chose to become yet another voice bringing awareness to these issues. And hopeful, as the viewer, you may as well. Thank you!



References:

1. Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M. S., Parkin, D. M., Forman, D., & Bray, F. (2014). Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer, 136(5), E359–E386. https://doi.org/10.1002/ijc.29210

2. Phaswana-Mafuya, N., & Peltzer, K. (2018). Breast and Cervical Cancer Screening Prevalence and Associated Factors among Women Population. PubMed, 19(6), 1465–1470. https://doi.org/10.22034/apjcp.2018.19.6.1465

3. Cervical Cancer is Preventable. (2020, March 16). Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/cervical-cancer/index.html#:~:text=More%20than%204%2C000%20women%20die%20of%20cervical%20cancer%20each%20year.&text=As%20many%20as%2093%25%20of,HPV%20(human%20papillomavirus)%20vaccination.