Melissa’s Musings: Bihar is creating a future worthy of its past

The Northeastern state of Bihar has a long and proud history. Some time during the 6th century BC, Buddha attained enlightenment under a Bodhi tree in Bodh Gaya. In the same century, Mahavira, the 24th and final savior of Jainism, codified the Jain religion. Not far from Bodh Gaya is the site of one of the world’s first universities, founded in Nalanda in 450 CE. The countryside is beautiful with endless fields and colorful buildings, and the Ganges River runs the length of the state from East to West. Bihar is the largest producer of vegetables in India and the second largest producer of fruit. This emphasis on agriculture is emphasized by the fact that only about 11% of its population lives in urban areas.

And yet, even with all of these reasons for pride, Bihar is a troubled region with one of the highest rates of poverty in India, the highest rate of domestic violence (60% of married women are abused), and one of the lowest literacy rates in India (64% overall, 53% for women).

Typical dwellings seen from the road

Bundled up against the morning cold (59 F)

When you tell someone in India that you’ll be going to Bihar, you’re likely to get wide eyes and stern admonitions to be careful. It has a reputation for petty crime (“Keep your car windows closed, no matter how hot it is, or people will reach in the window to steal your purse!”) and mistreatment of women (“Don’t go anywhere by your self and don’t make eye contact with anyone!”). It all seems a bit heightened and hysterical, especially after you’ve been there and had a lovely time interacting with warm, smart, friendly people who have only the best of intentions.

I am incredibly privileged to be working with the Institute for Healthcare Improvement supporting a joint effort between CARE India and the Government of Bihar to reduce

Tejal Gandhi drops in on a meeting at the CARE office!

maternal and neonatal mortality across the state. WHO estimates that Nigeria and India combined accounted for one third of all maternal deaths in 2015. With one of the highest rates of  maternal, neonatal, and infant mortality in India, Bihar is determined to improve. Our current focus is on 10 government hospitals spread across the state, where we are working with teams to cultivate improvement skills so they have the capacity to implement best practices for prevention. Once these initial hospitals have early successes and lessons to share, we will begin to spread to the other 28 government hospitals in the state, engaging outpatient facilities within each district as well. It is a huge project with immense potential.

I say “we,” but my role is relatively small and loosely defined. Still, this is a mission that I can’t help but embrace, and I will support it in whatever way I can. Last week, I was able to travel to Bihar for an Improvement Coach Workshop, where I helped present some of the content (on the fly when a speaker was delayed), and provided table coaching during exercises. It was a great meeting, with the director of the Improvement Coach program coming over from the states, the regional director for the IHI initiative there to co-present with her and translate into Hindi, and a skilled Improvement Coach from Ghana there to begin her 3-month residency in Bihar. In addition, we were joined by many members of the CARE team who are very involved in the initiative, and representatives from state government who were lending strong support. Despite language differences (sure, people speak some English, but it’s really not their chosen tongue) and cultural surprises (people casually wander in up to an hour late for meetings, and once given an exercise, will not stop until they are done, even when the time is up), it went well and concluded with great enthusiasm from participants.

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I look forward to returning a few more times this Spring, to provide support for new improvement coaches, and to run a collaborative learning session. It feels great to participating in something so important and learning so much.