This program allowed me to achieve my goal of expanding my global horizons through an immersive, international internship experience. It expanded my knowledge on international perspectives of sexual and reproductive health, practices used in rural medicine, and operations of international businesses. At the same time, I developed comfort in adapting to unpredictability and gained a deeper appreciation for Indian culture. The diversity of work I was exposed to during my time with FPAI gave me a glimpse into the grassroots approach to allow for the success of sexual and reproductive health education programs and clinic services. I shadowed the organization’s youth education program, sat-in on patient visits to understand common chief complaints and treatment methods, and assisted with developing their English marketing materials. This process allowed me to gain a strong understanding of the four pronged approach FPAI utilizes to ensure a holistic coverage of sexual and reproductive health (SRH) aid from adolescence to post-maternity. By engaging in these programs as an intern, I strenghtened my public speaking skills through initiating discussions about SRH with local college girls. I learned about the resource challenges in rural areas and urban slums. For instance, my team at FPAI cleverly structured patient flow in a small clinic space to maximize space usage and I had let the doctor use my phone flashlight as an alternative to an examination lamp when it was not operating. In addition to the internship, my independent research project to examine the socio-cultural and operational challenges affecting the sustainability of a family planning and reproductive health clinic in India was my first experience with conducting original research. This has helped me build and adapt my critical thinking skills to a different setting. I critically examined my surroundings and analytically thought about the patterns I observed in my personal interactions with locals. Working through the communication barriers with my managers and local women in the clinics taught me patience, how to find common ground through drawing pictures, and how to maintain a positive attitude. Working alongside locals allowed me to develop my cultural competency as I adapted to cultural norms such as the side-to-side head movement and greeting my elders with Namaste each morning. This trip also challenged me to become more comfortable with stepping outside of my comfort zone. Taking the risk to independently travel to another country taught me to be comfortable with unpredictability as my work schedule often shifted according to when programs were scheduled to take place or availability to gain access the location. I look forward to carrying this flexible and curious mindset forward into my future endeavors. Prior to this year, I had never travelled internationally before. As my first solo international trip, I was extremely nervous to embark on the journey to live and work in India for four weeks. My experience abroad came with many challenges including navigating a language barrier and making new connections to adapt to a city without familiar faces. But I could not be more grateful to have had this once-in-a-lifetime opportunity. Through living with the local women in my hostel and interacting with patients and workers in the clinic, I learned and gained a greater appreciation about regional customs. This trip has tremendously influenced my medical career aspirations by opening my eyes to the importance of public health initiatives. In the future, I hope to work with the World Health Organization to assist countries to strengthen local healthcare infrastructure.

I was fortunate to visit India in a period where I could see three holidays take place. With the celebration of India Independence Day, Eid, and Ganesh Chaturthi, I was lucky to see the different public celebrations that occurred for each event including a parade on Independence and a quick visit to the largest Ganesh idol in Hyderabad. My favorite holiday was the 11 days of celebration for Ganesh Chaturthi. This is a Hindu festival that celebrates the god Ganesha, known as the lord of good fortune, wealth, and remover of obstacles. The festival occurs every year to celebrate the birthday of Ganesha. On the last day of the festival, people submerge clay Ganesh idols as a symbol of Ganesha returning to Mount Kailash to his parents Goddess Parvati and Lord Shiva. On my last night in the country, my friend Girisha from my hostel took me on a motorbike ride through the streets of India around midnight when most festivities started for the Ganesh immersion. While driving around our area, I was amazed at the number of people still out enjoy each other's company over a cup of ice cream or a late night drive-in burger. We even took a quick stop to check out a local ice cream shop ourselves. On every street we turned, there were families riding in cars and men enjoying some late night dosas from a street vendor. During the 11 days of Ganesh Chaturthi, each night was filled with energy as different people came into the city to immerse their idol in the local lake. After sunset, the traffic on roads dissipated as office employees settled in their own homes after a long day of work and another group of people took over the street. For miles and miles, the beating of drums and shouts rang throughout the streets as members from different neighborhoods loaded their Ganesh idol onto a truck and prepared for the trek to immerse the idol. Determined to see these processions myself, I convinced my friend to take us towards the highway that connected with Necklace Road (the way to the lake for immersing the idol) where we saw over 5 different groups of people celebrating Ganesh and making their way towards the lake. It was amazing to see the different styles of dance that each group used and the tradition carried on throughout generations as men of all ages participated in the dance. Some groups had a coordinated style of dance, rehearsing over and over again until everyone was in sync with each other and the beat. Others used a freestyle method, people shouting in joy and dancing in any way they could but still moving in the same direction towards the lake. In a way, the structure for the Ganesh idol immersion mirrors the structure of everyday life here in India. Despite the perceived chaos of traffic and the number of people present, there is an order - an unspoken process of getting things done and learned only through experience, observation, and preserved through tradition. That one of the things I learned in my time here was to fully embrace “going with the flow” and that has helped me achieve an unforgettable experience and along the way meeting incredible people.

This past week, I was fortunate to accompany the program director at FPAI-Hyderabad to his bi-weekly trips to local slums and villages where outreach clinics have been set up. During both of my trips to Jinnaram and Rasoolpura, I began to gain a better understanding of the difference and similarities of an urban versus rural setting. My first trip was to Jinnaram, a village area located on the outskirts of Hyderabad. The car ride to Jinnaram, passing through acres of rice fields and countless poultry farms, took nearly 1.5 hours to reach our destination from the FPAI office. Upon arrival to the FPAI family planning clinic center, I was surprised to see the overflow of patients lined up in the waiting room to see the doctor. I initially expected the demand for services to be low since it took only 5 minutes to drive through the main road in Jinnaram. Patients ranged from grandmothers and grandfathers in line for routine check-ups to young mothers cradling their newborn babies. The resources of the center were well stocked, with patients receiving free medication at the end of the visit as well. The biggest challenge of all was being able to be creative when simple tools like table stirrups were not available. The doctors at FPAI courteously allowed me to sit-in on screenings and observe a couple of procedures. Patients underwent a visual inspection screening for cancer using acetic acid. Being in a rural region, the accessibility to certain tools could be unreliable. When the examination lamp broke and a flashlight was nowhere to be found, the doctor improvised by using her phone’s flashlight to finish conducting the cervical cancer screenings. To observe a different poverty environment, FPAI led me to their outreach clinic in an urban slum called Rasoolpura.                     On the drive over to the Rasoolpura slum, I  discovered that I was working in the second largest slum in Hyderabad. With a length of  just over 1.37 kilometres, the narrow alleyways and stacked houses push the boundaries for occupancy capacity. Rows of blue barrels lined the sides of homes as families stock up on filtered water, sourcing the water from an NGO donated water tank that is often refilled unpredictably. The conditions of the population living in the urban slum seemed to face more challenges to achieve a high quality of life as I learned about their lack of a filtered water source, cramped living spaces, and low wage amounts that had to cover all food and living expenses. However, people in the rural regions are able to produce their own food, so their living expense are cut down. Many of the patient that visited the Rasoolpura clinic found out about the services through word of mouth and community-based advocacy. Each day, the doctors and nurses walk around the slum to share information with people about sexual and reproductive health after completing their shift at the center. The main operating challenge for the rural slum was having patients become aware of the services, so FPAI tackles this challenge by going door-to-door and distributing contraceptives in this manner as well. Not only was I able to learn about the clinical side of healthcare in these regions, I learned about non-medical factors that directly impacted community members’ quality of life as well. As the living conditions and resources differ in each urban area compared to a rural region, I found that in both communities young women were motivated by similar reasons to sign up for skill training classes. From computer training to embroidery to beautician training, the centers provided a wide variety to satisfy each person’s own interest. Some people did not plan to continue higher education due to restrictions from their father. They wanted to build embroidery work skills to have a source of income to support their siblings and save money by making their clothes themselves. Others have plans to get their Bachelors or Masters degrees and simply took embroidery classes to fill their free time as they transitioned between school years. The wide variety of future aspirations showed evidence of the rapid progression towards further education of young women in India and the resilience of girls to pursue an opportunity of higher education. However, the most distinct progress I observed amongst the young women was the willingness to pass along the information they gained through the sexual and reproductive health seminars. In a partnership with FPAI - Hyderabad, these girls had gotten information about a wide span of sexual and reproductive health topics. When I asked if they passed along the information to anyone else, many said they utilize the knowledge gained through the workshops to help their younger siblings learn about sexual and reproductive health topics (SRH topics). A young mother, with a 5-year-old daughter, said she was willing to discuss SRH topics with her daughter in the future. This confirmation shows a bright future for the next generation of elders to become more comfortable addressing SRH topics with their children. The evolution in SRH topics is rapidly changing within the younger generation and allowing for greater freedom of discussion. Regardless of their positioning as a youth from the rural villages or urban slum, I noticed a positive reception in wanting to pass along SRH information to future generations and reducing the taboo stigma around SRH. The generational shift towards open mindsets about historically unspoken topics is prevalent in both rural and urban settings.

3 Right Turns. 4.5 Miles. 15 Minutes. This is the furthest I have ever lived away from my parents’ home in the past 19 years. As a born and bred Ann Arbor townie, I became familiar with the winding, hilly streets of North Campus as a high school cross-country runner training for 5Ks. My summers were spent laying in the grass by the League, listening to live music from local bands during the annual Ann Arbor Summer Festival. Making my way through the never-ending cycle of new restaurants on Main Street was a favorite family pastime. On the day University of Michigan released their admission decisions, I saw my email preview read “CONGRATULATIONS Coleen—You're IN!”. In that moment, I cried, which was a rare occasion. I felt two things - relief and anxiety. I knew that I was going to accept the decision, it was inevitable. The draw of Michigan was too strong - the combination of football Saturdays, world-renowned academics, and the challenging atmosphere embodied by the term “The Leaders and The Best” was a siren call. However, I knew that this agreement would mean that I would stay in Ann Arbor for another four years. While I loved my hometown and was thrilled to explore it through a new lens, I always wondered what my life would be like had I chosen to attend University somewhere further from home. With a strong curiosity to learn more about the world outside of these familiar streets and to have my viewpoints challenged, I discovered the Summer in South Asia fellowship after meeting a mutual friend during welcome week of sophomore year. After just arriving home from a month-long volunteer trip around India, my friend spoke of his adventures working on a train and traveling to remote parts of India to help provide medical treatment for those with transportation issues. The fellowship sounded like the perfect opportunity for me to combine both my eagerness to see the world through an independent, immersive, and introspective lens. Having never traveled abroad before in my life, I was unaware of the magnitude of this endeavor when I was applying to the fellowship. On the day I found out I was awarded the fellowship, for the first time in a long time, I cried again. The countless hours of working on my application and staying up until 2AM to speak with directors of non-governmental organizations in India will result in a tangible ending. I discovered the organization I will be working with this summer through doing online research about reproductive health clinics in India. I am excited to say that I will be interning with the Family Planning Association (FPA) of India in Hyderabad. FPA India is an organization dedicated to providing quality reproductive health information and services to men, women, and children through educational and clinical services. My curiosity about the reproductive health sector stemmed from taking a global health equities class at Michigan. I learned about fistulas that new mothers from remote villages in Africa developed as a result of giving birth. After hearing about the difficulty of maintaining steady access to maternal health treatment for people with limited financial resources and living in remote locations, I want to work with an organization that focused on equitable reproductive health. Through this fellowship, I will focus on examining the socio-cultural and operational challenges affecting the sustainability of a family planning and reproductive health clinic in India. By conducting this research, I hope to ideate solutions for overcoming observed challenges and establish a basic framework for enhancing the current management of reproductive health organizations in developing nations. For the month of August, I will be living in Hyderabad, India. With over six million people, the city is always hustling and bustling with activity every minute. As a fast-developing metropolitan area, the city is a melting pot between traditional styles and modern developments. I am excited to spend four weeks this summer to uncover the hidden quirks of Hyderabad and journey throughout the state of Telangana. Throughout this application process, I moved through many phases of emotion. First, I was curious to learn more about India. Then, I was anxious as I awaited to hear my final decision. Lastly, I became excited after hearing that I will have this opportunity to explore an unfamiliar neighborhood and challenge myself in new ways. With less than three months until my flight takes off, I still have much to learn in order to prep for my trip but I can’t wait to see where this summer takes me and the other fellows. 🙂