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A vet in Delhi – day 6: a selection of photos

I've been busy this evening working through my survey results so that I can give a presentation to ASHA about them tomorrow, so I have not had time to write a blog. But to give a sense of the past day here, I've put together a selection of photos. The captions should be enough to tell their stories.... [caption id="attachment_3811" align="aligncenter" width="560"]01-DELHI 828 Local children interacting with a street dog. Excitable, uncontrolled close contact like this carries a high risk of dog bites. Education of the children in dog-human interactions could reduce incidence of dog bites.[/caption] [caption id="attachment_3812" align="aligncenter" width="392"]02-DELHI 826 This street dog seemed friendly, but he has a track record of biting children such as the girl pictured below[/caption] [caption id="attachment_3813" align="aligncenter" width="374"]03-DELHI 825 This girl was bitten on her right forearm a few months ago[/caption] [caption id="attachment_3814" align="aligncenter" width="560"]04-DELHI 824 The scar is hard to see now but at the time she needed hospital treatment with post rabies exposure vaccinations[/caption] [caption id="attachment_3815" align="aligncenter" width="560"]08-DELHI 787 This pup is being comforted by his mother after a frightening incident that I witnessed[/caption] [caption id="attachment_3816" align="aligncenter" width="560"]09-DELHI 784 The pup had been barking ferociously at a local goat[/caption] [caption id="attachment_3817" align="aligncenter" width="560"]10-DELHI 783 The goat was not impressed, giving a demonstration of punishment by butting[/caption] [caption id="attachment_3818" align="aligncenter" width="560"]27-DELHI 646 ASHA works in the community, spreading information via a network of women from all over the area who come to the ASHA centre regularly to meet up and share knowledge[/caption] [caption id="attachment_3819" align="aligncenter" width="560"]30-DELHI 610 The last questionnaires were done today, and the rabies/ street dog survey is now being analysed[/caption]


A vet visits a Delhi slum day 5 – asking about dogs in the world’s biggest motor workshop

[caption id="attachment_3778" align="aligncenter" width="614"]Mayapuri is like a thousand garage workshops lined up end-to-end, in the open air Mayapuri is like a thousand garage workshops lined up end-to-end, in the open air[/caption] When I return to the slum each morning, I'm repeatedly reminded of a type of hell: there is mud, grime, and two other aspects that are difficult to convey via a blog - a strong “workshop” smell (oil, fumes, solvents etc), and most of all, NOISE. Maypuri is known as the biggest motor workshop in the world, and wherever you go, there are deafening sounds of metal beating against metal, metal drilling through metal and engines roaring. Unemployment here is not the highest in the world, at 20%: there is work, but it's tough, noisy, dirty work. Beat-up vehicles litter the streets, where they are picked at by people with spanners, screwdrivers and sledge hammers. I saw a dumper truck being reduced from a slightly bashed but otherwise perfect vehicle to absolutely nothing at all after being picked at all day by a small army of hard working labourers. [caption id="attachment_3794" align="aligncenter" width="323"]This child has a magnet on the end of a stick: instead of going to school she spends her days collecting metal This child has a magnet on the end of a stick: instead of going to school she spends her days collecting metal[/caption] Nothing is wasted. People collect 5cm lengths of wire, random nuts and bolts, springs and anything at all. Children as young as five are sent by their parents to search for bits of metal, using wooden sticks with big magnets on the end. The oily grime on their skin is permanent: hot showers or baths don't exist here. I have found myself questioning my priorities as I walk through them holding a questionnaire to ask about the stray dogs. Many of them seem bemused: nobody has ever asked them about dogs before. Why dogs, when people are clearly suffering? My answer to myself is that why not dogs as well as people? For a small amount of extra effort, animals can be looked after too, and where animal welfare is good, there is a positive feedback loop, with people feeling better about themselves, dogs being friendlier, and the whole atmosphere improved. [caption id="attachment_3789" align="aligncenter" width="800"]Interviewing people in a different language is time consuming and difficult Interviewing people in a different language is time consuming and difficult[/caption] I had a female interpreter with me today, which made it possible for me to talk to women in a much more relaxed way. It still takes a long time to complete this type of survey: there are strict rules about gaining informed consent by explaining it all in detail, with signed forms in duplicate, one to be left with the person. Then the questions are rarely “yes” or “no” - there's always a few minutes of chat before the interpreter passes on the condensed version of the answer. I had imagined I might complete a hundred questionnaires a day: the reality is more like ten or twenty. I'm just gathering in results just now: I'll need to analyse the data and come up with some sort of conclusion before I'm done here. One interesting side effect of doing the survey is that I've spent considerable periods out and about in different parts of the slum, and I've seen aspects that I'd have missed otherwise. Some of it is predictable – the poverty, the lack of infrastructure (many of the drains are open, and there's no rubbish collection system), and the dangers people suffer every day (that railway...) I previously mentioned a woman who had lost her legs to the train as a child. Today I wasn't surprised to meet a dog with a hind leg missing: neatly sliced off by a train last year. It's a small miracle that he survived, with no veterinary treatment at all. [caption id="attachment_3786" align="aligncenter" width="480"]This dog is missing a hind leg after being hit by a train This dog was missing a hind leg after being hit by a train[/caption] There have been other unexpected surprises – the open friendly nature of the folk here – you'd think they might resent this wealthy foreigner with his fancy camera asking strange questions about worthless street dogs. There's not much  negativity: smiles and welcomes are the upfront response (although who knows what's said or thought privately?) And there have been some bizarre sights too: a man with a Pug on a leash, walking the dog along the railtracks. Where did he come from? What's going on there? [caption id="attachment_3782" align="aligncenter" width="347"]A man with a Pug in the slum A man with a Pug in the slum[/caption] And I was astonished to see a pet white rabbit hopping around: when I commented on it, a boy came out and picked it up – it's his pet.  [caption id="attachment_3784" align="aligncenter" width="300"]10-DELHI 503 This rabbit was hopping close to the rail tracks[/caption] [caption id="attachment_3783" align="aligncenter" width="160"]09-DELHI 504 The rabbit's owner[/caption] The most astonishing encounter that I had today was nothing to do with animals: I met an eight year old girl, who's called Poonja. There's a clue to her story in her name: she's called after the Poonja Express, an early morning train that whizzes past every day. Eight years ago, somebody on that train gave birth to a baby girl, and in this land of high dowries and even higher expectations, she was not wanted, so she was flushed down the train toilet. Somehow, the baby was still alive after landing on the train tracks, and some people from the slum found her as they went about their morning ablutions. They brought her into their home, kept her warm, fed her and loved her. [caption id="attachment_3787" align="aligncenter" width="320"]Poonja with her adopted father Poonja with her adopted father[/caption] The charity that I'm here with, ASHA, heard about this, and realising that the couple who'd rescued her didn't even have enough funds to feed themselves, helped them financially. Poonja is now going to primary school, and she visits the ASHA community centre every afternoon for an after-school club. With luck, she'll even end up going to university. ASHA is the Hindi word for “hope”, and Poonja is a living emblem of the value of their work. I just have one or two more days of data collection to do here, then I'll be sitting down to input it into a spreadsheet to try to produce some sort of analysis. I'll be sharing this with ASHA, Mission Rabies, AAP and others. What happens after that is still an open question but one thing is certain: Mayapuri has become a part of my consciousness which will never go away.

A vet visits a Delhi slum day 4: getting down and dirty with the questionnaire

[caption id="attachment_3773" align="aligncenter" width="480"]Rubbish tips form the basis of most street dogs' nutrition here Rubbish tips form the basis of most street dogs' nutrition here[/caption] We are staying in the YWCA close to Delhi city centre, so every morning we are collected by a minibus and dropped at the slum. I was faced with the first shock of the day as soon as I stepped out of the minibus. Most street dogs lift their heads to look at you as you walk past: this young one didn't, so I stopped to get a better look. I called to him, then I gently touched him but he didn't move. I picked up his hind foot, aware that I could be bitten if he was frightened, but he remained motionless. He was still breathing, but he was unconscious: he was dying.

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I couldn't do anything to help him. I called back an hour later, and as I 'd expected, he was dead. At the end of the day, I looked again, and his body was gone. This type of incident must be a daily occurrence out here, but for a newcomer like myself, it's hard to get used to. I met Deepak, who is my interpreter for the rabies/street dog survey. He is a young man from Mayapuri who has been helped by ASHA and is now studying at university, a remarkable feat for a slum boy. He speaks good English, and equipped with the questionnaire and consent forms, we began to stroll around the slum area together, pausing to ask people if they will answer our questions. It was a learning experience for me: much slower and much more difficult. [caption id="attachment_3772" align="aligncenter" width="480"]07-DELHI 361 The slum parallels the railway line, so we walked along it, pausing to interview people[/caption] First, there is the cultural gender issue: Deepak believes that women are illiterate (true here) and ignorant (not true anywhere!) and so he did not feel it was worth talking to them. I tried to dissuade him at first, but there was an obvious discomfort in talking with women, and after emailing Mission Rabies (who designed the questionnaire) about this, I decided that I should only interview men when there is a male interpreter. If I can track down a female interpreter, we will include women. Second, I found it difficult to use an interpreter. How do I know if he is telling me what they tell him, or if he is just giving me the “right answers”? Sometimes the person being interviewed gave a great long answer, and Deepak translated that into two or three words. A great deal of trust is needed and that's difficult when you've just met a new interpreter. I found it tricky at first but as the day progressed, we began to communicate better and his translations began to seem more in line with the person's comments. Third, it takes ages to complete questionnaires like this, and it is tiring. We only did twelve questionnaires on day one: I had hoped to do fifty. What have I learned so far? It's early days, but I'm shocked that most people don't seem to know that dog bites can be fatal, and have never heard of rabies. Yet I also heard from a couple of people that they have known of two or three men who have died of rabies in recent years. I have many more questionnaires to get through and I need to put the data into a proper spreadsheet and carry out formal analysis at the end, but certainly my early impression is that there is a desperate need for community education on street dogs and rabies. My day in the slums was dotted with shocking experiences of life here. Facts from the quesionnaire include the ultra-basic living conditions: up to eight people living in one small room. How pampered we all are in Ireland and the UK: we just don't realise it. [caption id="attachment_3771" align="aligncenter" width="480"]Dogs and children are exposed to continual risk of being hit by trains Dogs and children are exposed to continual risk of being hit by trains[/caption] A train swooshes by at speed, every half hour or so, just a couple of metres from dogs and human children. How many must die every year? An impromptu rubbish tip is topped up every now and again by someone chucking a bag of household garbage on top: when this happens, both humans in rags and street dogs descend on it, picking out anything of remote value. Yet bizarrely, the community workers here are shocked to hear about the high suicide rate in the West – despite the appalling living conditions here, suicide is unheard of. I'm not sure what the message is, but it certainly makes you pause to reflect.  

A vet visits a Delhi slum: day three- a different slum, different problems

[caption id="attachment_3756" align="aligncenter" width="480"]07-DELHI 230 The Mayapuri slum is a collection of ramshackle buildings immediately adjacent to the main railway out of Delhi[/caption] Today (Monday) was the first official day of our pre-organised slum project: I am one of a team of nine volunteers from Ireland hosted by an inspiring human health/education charity called ASHA. I'm the only vet: the rest are from a varied background, including a doctor, nurses, educational workers and members of the public from our local church. If you'd like to read my summary of the background to ASHA, I've written another blog entry which you can read by clicking here. The deal was straightforward: we committed to raising a certain amount of funds per team member to give to ASHA as a donation (and we paid our own airfares and costs out of our own pockets). ASHA then agreed to use us for a week as volunteers in one of the slums that they're based in. Most of our team are doing work in the ASHA community centre in the slum. With my particular interest in animals, I've chosen to take time away from these activities to investigate the street dog/rabies issues. After our briefing at ASHA HQ, we travelled by minibus into the slum that will be our base this week: Mayapuri. Situated in West Delhi, this slum occupies a narrow strip of land immediately adjacent to the main railway line out of Delhi. Measuring around 3km long and only 50m wide, this strip of land has been a landing pad for immigrants arriving in Delhi from other parts of India for over forty years. [caption id="attachment_3757" align="aligncenter" width="480"]The muddy road leading in to the Mayapuri slum The muddy road leading in to the Mayapuri slum[/caption] Mayapuri is an industrial zone, known as a massive car scrap yard where you can buy any spare part for any vehicle. As we walked into the area, we were surrounded by noise: metal banging against metal, drills, engines and shouting. There was grime everywhere, from ankle-deep mud underfoot to men with oil stained clothes, hands and faces. The ASHA community centre is an oasis in the centre of this mayhem: a high-walled courtyard of relative peace. [caption id="attachment_3759" align="aligncenter" width="480"]I saw many street dogs like this one in Mayapuri I saw many street dogs like this one in Mayapuri[/caption] To date, animals  haven't featured in ASHA's work: there have been so many issues with humans in need. As a vet and as a person with a passion for animal welfare, I've persuaded ASHA to allow me to look into the subject of street dogs and rabies in the Mayapuri slum during my week here. They're giving me an interpreter, and Mission Rabies have devised a questionnaire for me to use. The plan is to tour the slum, interviewing residents to find out more about what's going on with dogs and rabies. Is there any need for extra intervention here at all? Many of the people I've spoken to so far don't seem to believe that there is. ASHA's medical people can't remember a single case of human rabies in their slums over the past fifteen years, and they feel that people already know that if they're bitten by a dog, they need to clean the wound carefully and visit the local government hospital for post-exposure vaccination. My survey this week will ask the people directly, and perhaps opinions may change, but to date, it seems as if ASHA areas may not be nearly as bad as the India national average. Given the India incidence rate of rabies of around 3 cases per 100000 people, you might expect a case of rabies once every three years in an area like Mayapuri with 12000 people. From what I can gather so far, this is not the case. But rabies is not yet a notifiable disease in India, which makes it impossible to track its true incidence. My questionnaire will find out from the people on the ground if they have been aware of any cases of rabies in humans.   [caption id="attachment_3760" align="aligncenter" width="480"]This lady lost both her legs after being hit by a train, but with ASHA's help, she is living a full life This lady lost both her legs after being hit by a train, but with ASHA's help, she is living a full life[/caption] Today was my first day in Mayapuri: I just walked around and took in first impressions. Much of it was shocking: one woman lost both her legs when hit by a train at the age of eight – this is an obvious hazard in a slum that's ten yards away from a busy railway line. Her story of survival is inspiring: she is married with four children, and thanks to ASHA's support, she runs a business, baking and selling pakora from a stall. She travels to and from work in a specially adapted bicycle-wheelchair.   [caption id="attachment_3764" align="aligncenter" width="461"]A street dog enjoying a naan bread A street dog enjoying a naan bread[/caption] What about the animals in Mayapuri? There are plenty of street dogs, but they seem to have a different type of life to the animals that I met in Bondi's slum on Day Two. They have a frightened, haunted look about them, and when I went close to them, they raised a lip to snarl at me, and backed away growling. Several dogs were so lame that they were carrying one leg, as if it's broken. Could these be dogs that have had bad experiences with some humans? If a team like Bondi's taught children in these areas to grow up with respect and love for dogs, would this change the way that humans interact with dogs, and would that in turn change the quality of life and attitude to humans of future generations of Mayapuri street dogs? At the moment, I have more questions that answers. My real work starts tomorrow, when I meet my interpreter, and we set out to visit the slum dwellers to try to learn their side of the story of street dogs and rabies awareness.