Rebuilding trust in communities

Our research assistant and I left to the far off village in our project area on his bike after the clinic on Sunday. The weather was pleasant. The wind blowing on my face, vast swathes of green fields on either side of the narrow cement road, and huge trees standing on either side of the road at periodic intervals as though watching over us as we rode towards the village, created a sense of warmth and happiness. 

The bike did not have one footrest and so my left foot was cramping as I rode pillion. Other than that, it was a beautiful ride and when we reached the centre of the village, it was very quiet. 2.00 PM on a Sunday afternoon, with most people enjoying their post meal siesta, the two of us stood just outside the temple waiting for the people with diabetes to arrive. A peer support group meeting for men with diabetes had been scheduled and I had gone there to participate and interact with the participants in the meeting. 

The community health worker for the village arrived shortly after us and went about to call and remind the participants and gather them. We went inside the temple and sat down discussing briefly about our research study and its progress. There was such a beautiful and pin drop silence all around. As I sit in my room in Chennai typing this blog, bikes, autorickshaws and cars are rushing past my window blaring their horns. What a contrast! 

Five men belonging to different age groups, one in his thirties and others in their 50s and 60s arrived by 2.30 PM and we started the meeting. 

"Good afternoon! I am Vijay. I work as a doctor in the Karumarapakkam hospital. Thank you for having me in your peer support group meeting" 

"I know you doctor. I have come to see you once long ago in the hospital" said a friendly elderly man. 

After these introductions and pleasantries, our community health worker said that in this meeting they will be discussing about tablets and insulin for the treatment of diabetes and the challenges and difficulties they face in taking the medicines. 

"Yesterday I saw this video on Facebook that they have brought some herbs from Amazon forests and prepared a powder. If we mix this powder in milk and drink it for 1 month, we will be cured of diabetes. Doctor, what do you think about this powder?" the man in his thirties asked. 

I had grossly underestimated the magnitude of the infodemic spread by social media in this far off village and was unprepared to tackle this question. I am not sure if commercial interests, profiteering, and exploitation of the unaware vulnerable population were the right points to address to tackle the question, but I went ahead and laid them all out. 

"The person who did that video is trying to prey on the vulnerability of people who have diabetes and are looking for some solution for it. The cost of one of those boxes of the powder will be very high and after spending all the money, the outcome will be nothing. Nowadays anyone with a mobile phone can shoot any video like this and make profits out of it....blah blah blah..." I went on. 

The man in his thirties did not seem convinced. He got agitated. "How are you saying that this guy's video is wrong? What proof do you have? So many people are trusting and buying this. The government is taking strict legal action on other YouTubers who are spreading misinformation like this. We are reading about it in the newspapers. The government must be watching this video also. So if the government has not stopped or banned them, then it must be good."

Again without much clarity on how to handle this question I said, "The government cannot see and monitor everything that ever goes on social media. This video that you are showing is too small for the government to notice." 

He was still not convinced. "You are saying this video is motivated by profit making and commercial interests. Who in this world is not motivated by money? How can you make such an argument? You are here today on a Sunday afternoon. Have you come here without any personal benefit?" 

Things were getting personal and heated. I could not tell him that I am volunteering and have come out of my own interest. I was not convinced about it myself. My brain was throwing random questions at me. I was asking myself whether that man was right. Would I have come all this way to this remote village, if there was no peer support group research project? What is motivating me? - the thrill of sitting and talking to the men, or the anticipation of a good research publication that would come out of this project? Now how could I tell him that I am here without any benefits for me? 

"Your peer support group project is supported by a trust. They have given money to understand how peer support groups work. There is no profit making involved in this. The findings of this study will benefit the society at large. I have come here as part of that project. I don't get any monetary benefits for coming here this afternoon. At the end of all these meetings, some knowledge may emerge that may benefit the larger society. I will also reap that benefit." I said this, but was not too convinced myself. 

The man in his thirties got more agitated. "Two months ago I had severe low back pain. I went to this woman (mentions the name of a doctor in the nearby town) for treatment. She gave me an orange coloured injection and charged me 1400 rupees for it. I know that injection very well because it is the Neurobion injection and I have taken it many times for energy and strength. I got furious because that injection I can have for 15 rupees in a local clinic. I yelled and shouted at her and came away. I even swore to run her down in my van on the street!" 

Now the friendly man in the group who had told me initially that he knew me spoke up, "Doctor, don't think we are accusing you of being commercial. But most doctors today are like this. They are bothered more about money. They charge 300-500 rupees per patient. So if they see 10 patients per day, it is enough. But they sometimes see even 100 patients per day. There is a doctor in the nearby town who sits inside a plastic dome. He makes the patients sit outside the dome. He even puts his stethoscope on the patients only through the plastic sheet. He does not even touch us. How can we trust doctors like this?" 

I could clearly sense the stale feel of mistrust and dissatisfaction. I needed time to address all this. So I politely diffused the discussion and said, "Let us watch the video we have prepared for you about tablets and insulin for treatment of diabetes and then we will resume this discussion." 

Everyone went quiet after that and we played the video that one of my colleagues had prepared explaining the various common tablets for diabetes and their action, side effects, dose and effectiveness. Then she also demonstrated the method of taking insulin injections in the video. All the participants watched with rapt attention. As soon as the video got over, I sat individually with each of them and spoke to them about their tablets, showing them how they should take them, what the tablets do to their sugar levels, what are their side effects and how to overcome them. At this point the friendly elderly man started asking doubts and questions. I answered them. Then two other elderly men started asking doubts about their tablets. A passerby on the road dropped in to check on what is happening. He joined the group and asked me about hypertension and low blood pressure. I explained those concepts to him. The discussions were building up organically. What started as a small 5 member meeting had now expanded into a 10 member crowded discussion inside the cramped temple courtyard! 

The 30 something man then opened up and said, "Doctor, it has now already been one hour since you are talking to us so patiently about each one of our problems. You are answering all our questions. I have never understood my tablets this well before you explained now. I can now go and explain to everyone I know. I am now only starting to trust your ingenuity. I can now say that even if you had come here for money, it is ok. That is because you have done your job well and we all are feeling that we have gained some knowledge from today's session." It was a pleasant shock for me to hear him say all this. This was the same angry man who had asked me how he can trust me about an hour ago. An hour's meaningful engagement and interactions had changed his perception. 

When the meeting got over, I even got invitations from three of the members of the group to their homes for tea and snacks. I had to politely refuse as we had to get back to the clinic, lock up and leave back to Chennai. But this afternoon's session was a transformative episode for me personally. I witnessed first hand the process of gradual rebuilding of trust. When these men met me during the start of the meeting, I was representing the bunch of doctors whom they had met and felt disappointed with. It took them time to witness my efforts to democratize medical knowledge and make it accessible to them in a manner that was easy for them to understand. They experienced the feeling of control and power when they knew about their tablets. This empowered them and made them see my efforts in a positive light. It was just one visit and an hour's work. Rebuilding trust in communities must happen like this, one angry young man at a time, one remote village at a time! I went back home with a lot of positivity and responsibility to do this trust building through empowerment again and again.