Pinkeye and Prospects for International Health Care

Your humble correspondent wasn't in India for more than a 48 hours when he acquired pinkeye. I was itchy, watery, and contagious for about two days. Wikipedia says that pinkeye occurs when bacteria from fecal matter come in contact with your eye. This does not narrow down the source too far, as most of the local population uses their left hand to wipe. The next morning, after prying open my stuck-shut eyes, I walked down to the corner doctor to get a prescription. The doctor was a thin tall man wearing a white lab coat. He called me into his office, shined a light in my eye, wrote the prescription, and ushered me back out, all within about two minutes. I picked up my prescription at the in-house pharmacy and was out the door within ten minutes of arriving. The consultation and treatment cost a total of $4. (In any event, it’s hard to complain about anything at all when there are so many people in Udaipur who are desperately poor. )

I got all of my immunizations growing up and ate well, so my immune system can throw off pinkeye with relative ease. The children in the villages where Seva Mandir works may not be so lucky. The government claims that over 90% of children in rural villages are immunized, when, in fact, a Seva Mandir survey found that less than six percent of the children had all of their immunizations. As a result, many children suffer from preventable diseases.

While the money for immunizations exists, the facilities and training to ensure the regular delivery of immunizations do not. Furthermore, there’s a significant amount of resistance within villages and from parents, most of whom are apprehensive about the idea of outsiders poking needles into their young children. Their fears are understandable and shared by parents in Marin County; the positive effects of immunizations are invisible and occur years in the future.

(And at some level, who are we to think that we should be intervening in other people’s lives? Most villagers are aware of immunizations and the promised effects. We might believe that if the villagers are living longer, with fewer deaths, then we are making a difference. But it’s not at all clear that the people in these towns want these things. I am willing to entertain an argument that it’s not fair to the child to let the parent make a decision that could damage their health, but if that argument’s valid then who is in a better position to make a decision about the child’s health? I do not believe that we should be doing nothing, especially if villagers are seeking help.)

With the help of the Jameel Poverty Action Lab, Seva Mandir has been running experiments to try and encourage more villagers to sign up for immunizations. In 2007, they ran an experiment where parents in some towns received a bag of lentils for bringing their children to an immunization drive, and parents in other towns received nothing. Not only did the treatment group succeed at immunizing more children, but it also was cheaper per-child than the control group because of the high fixed costs of providing immunizations. Maybe if one village has a high rate of immunizations, their children won’t get sick, the other villages will take notice, and the towns in Rajasthan will move to a high-immunization equilibrium. In the meantime, we are reminded that progress and development are slow, and that setbacks are common.