Action through Participation

As a Research Administrator, my responsibilities include assisting faculty members make grant applications in Public Health research areas and coordinating capacity building workshops for early career researchers in grants writing and manuscript drafting. At one point in my career, it was but natural to pine for a deeper understanding of ‘field work’ to add value to the documents I would prepare. An opportunity to visit two ‘field sites’ to document successful best practices came through and I was happy to commit to them instantly. The first was to document record keeping by front line health workers in Eastern India. The second was to document health promotion in community settings in Western India. Both required engaging with health workers and community in equal measure. Both broadened my thinking and understanding beyond all the research papers and reports I had read.

One of the field site was a small dingy room without a window. About 30 women sat in the room, some mothers, some daughters, some newly weds and some with infants, all cheerful, oblivious to the dark interiors. A henna competition was on, to gauge whose henna bedecked palms were the best in terms of design and colour. Before prizes were announced, the women were asked to speak on what their dream was about their daughters. The henna competition had broken their inhibition and now they all spoke up. One woman said she wanted her daughter to be healthy, one said education and going to school was important, another spoke about financial independence. But they all spoke, and not about challenges they and their daughters face every day, not about the resource limited households they had to go back to, but about their dreams and aspirations for their next generation.

It was then that the Project Manager told the women about family planning methods, about how spacing between children was one way to keep both the mother and her children healthy, about discussing family planning options with their husbands and families and reaching out for resources and medical assistance in the nearby locality, in case they needed further advise.  What I was observing was a participatory action or engagement, where the community is an active lead for any intervention being planned for them. The Project Manager was part of a larger project involving community, private and public medical practitioners and health centers. He was not an MD or a PhD, but was highly skilled in community engagements. There was a level of comfort that he demonstrated especially while handling a taboo subject like family planning methods with women from a very conservative section of the society. Later on he told us that it was important for him to understand what the community wanted first, before he aligned it with what he wanted to tell them about his project.

Six months later, I had an opportunity of being involved with a group of researchers planning to conduct a study on immunization coverage in Eastern India through community intervention. The Intervention specialists, began with a question for the community. Once again the question was about their dreams and aspirations. As per their experience, for any community intervention to be sustainable, it was important to have the community participate in the study, not as a recipient, but equal in status as the researcher conducting the study. Most often, community interventions require social and behavior changes to have positive outcomes and this can be achieved when the community believes that there are substantial gains from the study which align perfectly with roadmaps to their dreams.

In one of our institutional projects on rain water harvesting and storage in several villages, it was seen that when the community participated as equals, there was substantial ownership. At the end of the project, when the research project team pulled out of the community, the residents took up a mechanism to pool in resources and maintain the structures built and the processes for water regulation, as a regular mechanism. The project was renamed as ‘Aapno Yojana’ meaning ‘our/my project’.

Additionally, cultural contexts are often overlooked while designing community interventions. In a country like India, where each region is different from the other, be it in language, religion, tradition, beliefs etc, one intervention will not be replicable in another setting. Participation from the community in devising intervention strategies not only provide ways to conduct the intervention, but also help drawing out indigenous solutions in resource sharing in resource limited countries.

Participatory Action Research can be valuable in sustainable community interventions. Some of the methods use a lot of listening and then devising an intervention plan along with the community. What is required is a strong monitoring and evaluation component to measure progress at every step. The cons include

  • Ethics- Both the researcher and the community have to believe that the intervention will benefit the community. While aligning the community’s goals with research objectives, there should not be a forcing on or manipulation to align research objectives leading to coercion.
  • Choosing community leaders- especially in projects where community is required to openly discuss topics that lead to behavior change, often a few representatives from the community are first addressed who then in turn become a relay team of informing others in the community regarding the intervention. Sometimes, these leaders can become quite dominating and forceful with their ideas and thoughts. In order to maintain balance, adequate monitoring and constant dialogue with the leading team and the community is required.
  • Not connecting with appropriate stakeholders- in addition to the community, the local health governance members have to be a part of the project. Once the project is completed, they would be required to continue to administer, monitor and guide the community.
  • No linkages with national/ state programmes/resource agencies- In order to be sustainable, the community intervention has to have linkages with ongoing national, state programmes. The project team should also be able to forge linkages with resource people who can be sought locally, like front line health workers, medical practitioners, hospitals, healthcare centers, diagnostic agencies and pharmacies. This would be valuable when the project is completed and the community still has people to reach out to.

In case of community interventions where participatory action cannot be utilized, appropriate ways to conduct research dissemination should be explored. Often research dissemination is done at a higher level, involving government functionaries, policy makers, research groups. The people who would benefit most, the community is not informed regarding the research results. Importantly, changes are being driven by some funding agencies who advise for strong dissemination components at proposal stage itself. Medical research involving drug and patient trial results are often not shared due to ethical factors. However, there are many public health research projects where dissemination mechanisms are not explored adequately. As a result, public health research is still conducted in silo and shut down in large cumbersome reports that are not accessible for wider reading.

A few interesting examples of participatory community interventions using different methods are-

  • The Maternal and Perinatal Death Surveillance and Response[1] project initiated by the Ministry of Health and Family Welfare in Bangladesh, which helped make substantial improvements in maternal death indicator. During open discussions with the community on maternal death at childbirth, the project team realized that excessive bleeding during delivery and delay in seeking appropriate medical care, delay in accessing appropriate transport to the nearest hospital, caused an increase in maternal deaths. Interventions were created to address these issues followed by policy level changes that led to better indicators.
  • Community Photovoice project[2], where community members took photos or wrote and spoke stories regarding barriers and promoters of eye care in rural India. Their voice identified a few key barriers such as alcoholism, unregulated blood sugar and hypertension. These can now be adequately addressed by strengthening the healthcare fabric within the locality.
  • Participatory Women’s group addressing maternal and child health[3]– front line health workers used participatory methods to prioritize neonatal and maternal health issues amongst a women’s group that in turn spread the information amongst women through implementation projects that they themselves assessed.
  • Developing smoke free homes in Kerala[4]– Pilot studies suggested that Community participatory action helped substantially reduce second hand smoking in homes. Interestingly, the study showed that husbands, who did not stop smoking on request of their wives, did so when the community together aimed at a ‘smoke free home’ drive.

It is also important for Public Health researchers to obtain information regarding various successful participatory action research methods that have been tried and tested.  A compilation of literature on various approaches to participatory action research is required. This would help researchers understand the implications of community participation and then to design intervention plans that have potential to be scaled up. Perhaps all the major funding agencies working with communities could come forward to collate information on their successful community intervention projects, at one place. Or perhaps scientific publication houses could bring out commissioned papers in this direction.

At a time when Public Health research funding is slumping across the world, it would benefit to test out different methods of participatory action that have scalability and sustainability while being minimally resource intensive. In developing countries where population numbers are high, people are the true strength and the only resource. Bringing them together, learning from them and linking them to the local resources available should be the primary objective of the researcher involved in designing community interventions. Participatory Action Research can help bridge the gap between people and the Sustainable Development Goals we have set for ourselves to a great degree. As researchers, we have to merely facilitate this connection.

 

[1] Biswas, A., Rahman, F., Eriksson, C. and Dalal, K. (2014) Community Notification of Maternal, Neonatal

Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh. Health, 6,

2218-2226. http://dx.doi.org/10.4236/health.2014.616257

[2] Rani PK. et. al. (2017) Envisioning eye care from a rural perspective: A photovoice project from India. Int.Q.Community Health Educ. doi: 10.1177/0272684X17736153

[3] Tripathy, P. et. al. (2016) Effect of participatory women’s groups facilitated by ASHAs on birth outcomes in rural eastern India: a cluster-randomised controlled trial. The Lancet Global Health, Vol 4, No.2, e119-128. DOI: http://dx.doi.org/10.1016/S2214-109X(15)00287-9

[4] Nichter M. et.al. (2015) Developing a smoke free homes initiative in Kerala, India. BMC Public Health. 15:480. doi:  10.1186/s12889-015-1815-1

Advertisements

Gender Views

We received a wedding invitation last week from our professional network. The invitation card mentioned the name of the groom (whom we know) and the bride to be. Her name is ‘Trophy’. Now I know, one can only imagine how she would have gone through school and college with that name, and also of the innumerable puns (intended) that would have surrounded her at all ages. However, I was thinking of the day she was born. She must have made her parents so happy and I can practically visualize the pride and delight her parents would have felt in holding her and showing her off….you know…like a prized possession (almost like Lion King!)

Though gender bias exists throughout the world as per scientific literature, I may be one of the fortunate few who is yet to document this from any practical experience. In fact, my family may be quite weird. I am an only child and all my uncles and aunts (5 of them) have only a single girl child. Maybe it’s a genetic predisposition, but we have been a very contended lot with a house full of women. Sometimes I do feel, we have sidelined the male population to a background in our family. We do include them in decision making processes, but just so they don’t feel left out (J).

It is however, extremely important to have different perspectives while making important decisions for the family like health choices, financial choices, education for children, marriage decisions, buying a home etc and a balanced view emerging from all family members irrespective of their sex is valuable. I also think children and adolescents make good decisions too and should not be undermined in the process. More than stressing on gender, I am of the view that each person is valuable and has a lot to contribute. The dynamics of power distribution will change when we start valuing each person, instead of attaching adage of male female, girls boys etc.

The fact is that my family may be part of a very small microcosm. I have women colleagues who have felt domination every day of their lives, I have male colleagues who are constantly overruled by their mothers while making family decisions with their wives for their children. Power has and will always lead human kind through all ages.

There are three delays in obtaining timely healthcare, type 1 delays are those made at the family level, where the decision that the ailing person in the family needs urgent healthcare in a timely manner can lead to survival or death of the person. Type 2 delays are often transportation or means to get to the closest healthcare and can depend on decisions, economic conditions etc of the family or surrounding community, terrain and accessibility in remote areas and the type 3 delays are adequate and timely healthcare provided to the patient in a healthcare facility. All three delays together or individually can lead to survival or death. Gender plays an important role in all these delays and is particularly crucial at the type 1 delay stage. There is a lot of research evidence that type 1 delay causes extensive bleeding at child birth in mothers who deliver at home, especially in low and middle income countries and together with type 2 delay causes the largest portion of maternal death. Same is true for neonatal deaths.

What are the barriers? Gender is only one of them; social, traditions, customs, faith, economics, illiteracy, ignorance make up the rest. What are the solutions? Education of every child, awareness of family and community, more participatory mechanisms to include women, men, community in government health schemes are a few answers, together with greater outreach of front-line health workers into urban and rural communities.  Often in Maternal and Children Health programmes, the men are sidelined, however, they should know the programmes and their views are as important as the women and mothers. Community empowerment and education of all will lead to better understanding of men and women in general and build stronger families. As part of a public health research organization, the best we can do is to include a equal gender lens in all our studies. To be inclusive and create projects that benefit everyone and don’t exclude men and/or boys. Health should be gender free, it is for and by all.

 

 

Organizational Leadership

“Leadership consists of nothing but taking responsibility for everything that goes wrong and giving your subordinates credit for everything that goes well”-Dwight D. Eisenhower

Last week Prof David Peters from Johns Hopkins University (JHU) was in our institute, addressing our faculty members for a short while. As an established public health practitioner, overseeing his division of 140 plus researchers and academicians with research network and collaborations across most countries in the world, he took up an impromptu session on career building with our faculty members at a mere notice of 5 minutes.

Through an informal discussion, Dr Peters examined the current level of research engagement in each faculty, where they wished to see themselves in five years and the opportunities and support they would need to do so including self work. He also helped acknowledge the challenges in our systems and ways to deal with them. These are not aspects that our faculty is unaware of, and given that solutions in the context of JHU may be quite different from our own indigenous solutions, there is always a scope for deeper introspection. However, the leadership quality he demonstrated was impressive. For the two hours, he held everyone’s attention. The engagement was participatory and there was an element of mentorship without being patronizing. Nor did he express his mastery over any particular area. He was more facilitative than overbearing.

The next day, the new Director of our institute (another seasoned public health practitioner) sat down with all faculty members and helped them devise a personal research plan, based on each person’s training and expertise, interests and where they wished to reach in some year’s time. There was an accountability plan as well along with it, each faculty was asked to write milestones, deliverables albeit self assessed and self proposed. I have worked in many organizations, however, this was the first time I came across a true leadership driven activity where a career plan was being devised for individual member with an accountability framework. I certainly hope that a supporting and enabling environment is provided to fulfill these individual goals. Our institute is small with a small team of faculty, hence face to face meetings, individual plans may work. In bigger groups, especially where there are 140 researchers involved, a lot is derived by setting an example that trickles down from top to bottom. More like stewardship that has been explained in a number of journal articles.

It’s not always about salary increments and benefits. Sometimes employees stay back in an organization because of self and career development plans that override benefits. Leadership involves looking outside oneself, creating an atmosphere for team members to rise and also be accountable for their actions, while mentoring them throughout. Most importantly, a leader understands the practical realities of their team members, resources, limitations and designs future plans accordingly.

  • How important is it for organization leaders to have social interactions with their colleagues?

“Sometimes you have to take a break from being the kind of boss that’s always trying to teach people things. Sometimes you just have to be the boss of dancing”.-Michael Scott, The Office

The answer to some extent lies in a mutual attitude. From my personal experience, Directors of institutes who had a regular faculty and staff meeting with their colleagues over a cup of tea had greater commitment from employees to solve organizational issues in a collective way. Not just issues, but volunteering in organizational activities also rose.

  • How important is it to reiterate organization values amongst the employees?

“Ten soldiers wisely led will beat a hundred without a head”.- Euripedes

There is no harm in reiterating organizational values like quality, accountability and trust at employee meetings. However, the leadership should also demonstrate these values amply before harping about them. Sometimes honesty goes a long way, real life stories also help where the leadership may explain that they set out to achieve something and were unable to, however they learnt something more important in that process. Being a leader doesn’t mean 100% success rate, it just means that one is able to cope with life in a much better way.

  • People management vs time management

“The best executive is the one who has sense enough to pick good men to do what he wants done, and self-restraint to keep from meddling with them while they do it.” –Theodore Roosevelt

The answer is in making an impact. Organizational leaders are hard pressed for time between internal, external engagements, overseeing all the activities within organization, making decisions and also traveling around the world. Yes there is a need for balance in everything, however, making an impact in everything one does, adding value to meetings, however small these are, would be one way to leave a lasting impression. While delegation is a part of management, even more important is to know who can accomplish what in the given time.

  • Being able to take risks

“You miss 100% of the shots you don’t take”. –Michael Scott, The Office

In spite of having a deep understanding of whether a team can accomplish a task, the leader is still open to taking risks and challenging the norms. Yes there is a line between taking an intelligent risk and stupidity, but the leader has a sixth sense in terms of understanding that their team would rise above their own comfort zones to achieve a certain goal. Sometimes trust and confidence go a long way. For the first time, our new Director is moving the academic section from paper copies of books to kindle/tab versions. This is not a new aspect in India. Most Indian Institutes of Technology’s have moved to e-books a long time ago. But someone had to come to our institute of 10 years and make that move.

Leaders are perhaps not born, but made through their experiences, ambitions and will to work hard. Mostly importantly leaders are made through their undying faith in others and their undying faith in their own strengths.

Mother’s day- How do we save our mothers?

We have recently celebrated the woman who has helped us cope with life not only during our childhood, but also adulthood. We showed our appreciation to the superwoman, who shields us from everything that could cause us pain, and sometimes, to our embarrassment and sometimes joy, tries to guard us even when we are supposed to have found our own footing in the big world outside home. She is universally revered across cultures, religions, countries or the n number of divisions we have made to segregate ourselves.

But something isn’t right. Why are our mothers dying and why haven’t we been able to curtail this, even in 2017?  Maternal death is a serious issue especially in developing countries. Although we have brought down global maternal mortality by 47% since the 90s, as per the World Health Organization (WHO), about 830 women die due to pregnancy/delivery related problems around the world each day. These are mostly preventable. 99% of these deaths occur in the developing countries.  The odds of a 15 year old dying due to pregnancy/delivery related issue in developed countries is 1 in 4,990. In the developing nations, it is 1 in 180. Sadly most of these deaths occur due to reasons that are within our control.

Severe blood loss during pregnancy and post delivery is the main reason, followed closely by infections. In most cases of severe hemorrhage, injections of Oxytocin are enough to slow down blood loss. The many reasons for maternal death are health inequities, aka, basic services are not available to those who cannot pay for care. Distance to the nearest health care facility, availability of medicines in the facility, inadequate services are also key reasons adding up to the issue. A UNICEF led project in 6 states in India based on verbal autopsy of family members and community members of mothers who had lost their lives during child delivery, showed that cost for transport to the nearest health facility, literacy level of the mother, community awareness were leading cause of maternal deaths.

Personally I find the lack of awareness and non adherence to hygienic practices during childbirth and subsequent death of mothers due to infections, is most unsettling. Sepsis is a major problem, both in maternal as well as neonatal death. These defy all norms for extent of negligence. Additionally, through our incessant use of antibiotics we have successfully created microbes which are now resistant to most drugs, hence can easily compromise an infected mother and her newborn.

The WHO has recently adopted a resolution on sepsis that urges member nations to be more cognizant regarding causes, prevention and treatment of sepsis and tighten policies and regulations of activities leading to Antimicrobial resistance (AMR), to develop AMR stewardship activities and strengthen hygienic practices, clean childbirth practices and improvement in sanitation and nutrition.

Some of the basic things that we could do at our levels would be to create awareness amongst everyone we come in contact with. Every time we visit a clinic or a hospital, we could inquire about guidelines followed in infection management, waste management and AMR. We could also remind the health practitioners about hand hygiene and seek their advice in ways to prevent infections at our homes.

Every family needs a mother and every mother deserves a good healthy life, especially one that can be met by a few prevention steps

 

.

Summer or Simmer!

It is hot in my city, absolutely scorching and I miss my walks through the office garden. I feel my skin burn everytime I have to be in the open and the tap waters are perpetually hot, be it early morning or late evening. This dry kind of heat penetrates my soul and dehydrates it to the core. I am snappy and irritating to be around and always dreaming of ice creams and popsicles, so yes, when I am in office meetings, I am really not listening, my notes are usually full of doodles of ice cream cones and faces transform to chocolaty glaciers. I am not used to extreme temperatures and every summer, I suffer a heat stroke. My family members have gently advised me that it’s only a state of mind; that I need to shut myself off to the surrounding heat. Is that really possible? Would imagining myself in an igloo solve the problem? I don’t think so. The constant ice cream images dont help either.

And I am humbled by everyone who has to work outdoors during this peak heat, especially those indulging in physical labor. Yesterday, my daughter’s homework (she is in grade III) was on interviewing the person who cooks at home and find out their struggles and how she could support them in their work.

I had tried pushing myself as the cook at home, as a potential interviewee, which she quickly ‘shooed’ away as ‘you are not the official cook, only the weekender experimenter’ and I clearly heard the Thank God! in her expressions that the household did not have to bear my recipes during most of the week. Instead she interviewed Manju who makes dinner for us at home every night. Manju is the representative of a quintessential Indian support system for working mothers like me. I am only blessed to give her full independence of my kitchen on weekdays, so that I don’t have another ‘to do’ item on my never ending list. And gratefully, my daughter likes Manju’s culinary skills, so I am fine with it too.

Manju was very amused with my daugther’s questions and it came as no surprise that her main struggle was to tolerate the kitchen heat, the hot stoves in the several households she sustains with the food she makes everyday. As to the support she requires from my daughter, it was a measly glass of cold drinking water after her chore at our home. Even though Manju and I share ups and downs in our otherwise healthy relationship, my appreciation and respect for her and for all those champion support system reps like her, did increase after yesterday. It also helped my daughter be more cognizant about everyone around. Though she is a better and far more empathetic person than I am and I hope this trait stays with her as she grows older.

As a public health research enthusiast, I am glad that several cities have a ‘heat action plan’ this year and are attempting to generate awareness amongst community on ways to beat the heat, in addition to capacity build care givers on responding to heat related illness.

Temperature tolerating clothing based on chemical and electrical principals is also in the market. These can bear extreme temperature shifts and are suitable both for cold and hot weather. Some of these are being tested in soldiers who are posted at extreme weather conditions. I look forward to a day when cheaper versions can be worn by construction workers, road repair men, community care givers and the Manjus at every home. Here’s to innovations for community health and to a safe summer everyone!

Ship of Theseus

ship-of-theseus

If a ship is replaced part by part up to a point where not a single original part remains in it, is it still the same ship?

This is a central theme of the philosophical paradox and has been reflected in the 2012 movie of the same name (which I happened to watch yesterday….yes I know, I am late by a mere 5 years!). The film depicts the journey of three people who have had an organ transplantation, cornea, liver and kidney respectively. I wish the filmmaker would have delved a bit more on how the transplantation changed the recipients. Especially since the corneal transplant was done on a blind woman who was a talented photographer and would rely on sounds to capture pictures, before the surgery. After the surgery, I wonder if there was a difference on how she would perceive photography, now that she had both sight and sound to rely on.

But on a deeper level, we have all gone through periods of breaking down, learning and then moving on in life. At each of these ‘episodes’ we have given up a part of ourselves as in our beliefs, and gained some qualities to face life, become stronger. So even if we may not remain our ‘original’ factory setting self, the constant learning, re-learning has made us the person we are. Hence, by the Theseus paradox, we may not be how we started, but we are still our own unique self.

I believe that life’s constant motion of shaping our thoughts takes us on our path to spiritualism and our higher selves; however, we have made a mess of everything with soul, re birth, immortality etc. in this mix.  It would be simpler to just focus on the process of creating and re creating ourselves and getting through life, while being ethical with our surroundings.

However, ethics for me can be different from for instance, the monk in the film, who would walk miles and miles without footwear so that he doesn’t hurt insects on his path. A part of the monk did change though, as he was shown advocating against using animals in research at the beginning of his story and finally made peace and went through a liver transplant and medication regime, to survive liver cirrhosis. Both transplant technology and pharmaceutical industry use research on animals at some point in their development, and that was something the monk had to come to terms with.

It’s very difficult to go through the metamorphosis of having our principles crumble and regain our strengths, but that is exactly what makes life interesting as well. And perhaps we should not tag it with whether it was the right thing to do or wrong, since it was for that moment in our lives, we chose the best thing for ourselves.

One health- isn’t it a bit late for that?

While discussing a school assignment on different birds with my second grader, we watched videos of humming bird drawing out honey from flowers and weaver birds weaving artful nests. I also told her about the first time I had seen green pigeons. A pair of these green birds had made a nest close to my window and I had watched over them for a couple of months, till two young little birds were added on their family and then the four had flown away together… on their onward journey. There is something satisfying in bird watching and the way they conduct themselves. Unlike any other member of the animal kingdom, birds are perhaps the most sober and dignified and sometimes great entertainment!

The assignment also had a question regarding which birds had her parents seen when they were young and were rarely seen nowadays. When I was growing up in my grandmother’s house, we were often surrounded by sparrows and sometimes a couple of cawing crows. I don’t see sparrows anymore, especially in the cities I have lived as an adult. I tried finding some data on sparrows, unfortunately there is not a lot of research done on them. Their numbers are low and the ones who made it have migrated to greener, less polluted suburbs and villages. Two things caught my eye in the past week. The term ‘one health’ which really means to have everyone who deals with human, animal and environment health on one platform. Since 60% of diseases in man have some sort of origin in animals and since in turn, man has contributed to effectively denude the environment off more than 60% of its resources, now man has decided that we should all work together if we are to save ourselves from animals and the depleting environment. This is the big health jargon of 2017 that will be used over and over on all research applications, debates and talks this year and perhaps till we move on to something more ‘in’.

The CDC page on One Health, mentions “One health recognizes that the health of people is connected to the health of animals and the environment (www.cdc.gov/onehealth/)”. Isn’t it funny that it took us till 2017 to recognize that our health is connected to other beings around us? The real reason is perhaps that as researchers, we have all built our silos of working with our own folks with our own perceptions, like a medical professional may not be seen as a talented basic researcher, a  PhD is seen to be focused only on their bench work and not understand diseases, and veterinarians, well they have been completely dismissed from participating in any ‘serious research’ related platforms. As researchers, we have let our insecurities and sometimes dire selfishness keep us from sharing our results, collaborating and even talking openly about our interesting findings. When we cannot build bridges across our own fraternity, how will we come together on an unified ‘one health’ platform and work together to better our environment?

And why veterinarians alone? We should also partner with anthropologists who learn from living with communities who are closer to nature. The indigenous tribesmen of any country have been practicing living in harmony with nature for as long as the human civilization. We should perhaps seek our ‘one health’ answers from them.

The other item that I found interesting was that telomeres seem to grow longer in space. Isn’t it interesting that telomere which dictate ageing in an individual, grow longer in space? Was the incident a one off, or was it due to space being untouched by pollution, untouched by man as yet? Anyways, since we haven’t been able to find another earth to call our home yet, we should like our own spiritual growth, ‘look inwards’.

Would one health change our perceptions about working with each other for a better world?….only time will tell. Till then, I hope someone somewhere works on sparrows and  brings them back to my neighborhood!