I did something very silly in that I did not post my last entry written on my laptop when I had the chance. Early last week my work for SEWA Bank was starting to slow down. I mentioned this to Mirai and she invited me to join her in her own field excursion for SEWA health insurance. I wrote all about it and had an almost complete entry but it wasn’t quite done to my satisfaction so I didn’t post it when I was last at work. I went home to finish the entry forgetting that I didn’t actually have wireless at home. The next day I left to do some traveling first in Nepal and eventually around India. I didn’t bring my laptop with me so now that entry will have to wait. This is a placeholder for that entry until I return to my laptop.
July 16, 2009
Two nights ago at dinner Mirai and Binoy were asking me how work at the bank was going. “It’s going well. I am learning so much, it has been such a wonderful experience,” I started to reply automatically. These were of course my very true feelings about the first few weeks I had spent at SEWA. In that time I had received a wonderful introduction to a culture dramatically different from my own. I would never go so far as to say my learning is finished but I cannot help but feel a sense of pride at the radical shift in my understanding of India, SEWA, microfinance, and grass-roots poverty alleviation strategies. However even as I was feeling good about all that I had gotten from my experiences in Ahmedabad so far, I had to admit that the last week was looking pretty slow.
Having gotten a sense of the pension project and its challenges I was no longer doing the field interviews that had opened my eyes to another part of the world. I had also spent some time creating a powerpoint presentation that will be shown at local universities in an attempt to recruit students to help SEWA Bank get in contact with more women. Though I was under the impression that once the powerpoint was done I would be a part of the team that would go and give the presentation, it was not looking like there would be any trips to schools in the next couple weeks. This was something that required further organizing by people higher up and though I do not know what is taking so long, I have accepted this frustration as a part of being an intern for a large NGO. With so little time left to work I could not ask for a new project; however even if I had I am not sure I would have received one seeing as giving out projects to summer interns has not been at the top of anyone’s to-do list.
I confessed that I wasn’t doing much at the bank this week and if Mirai had any small jobs I would be happy to do them. She seemed concerned and as luck would have it she was going into a few villages the next morning to speak with the women about insurance. To my delight I was invited to come along.
The next morning Mirai and I climbed into a car with two other SEWA health insurance workers. We drove out of the inner city and away from the congested streets. As large rice paddys began to replace buildings I was once again struck by how incredibly lucky I am to be here. Mirai pointed out all the workers dotted along the rice paddies. Because the rains had finally come, the fields were full of workers eager to plant and reap the rewards of the land.
We are going to villages where a number of women who previously held SEWA insurance policies have stopped taking them out. The SEWA team is attempting to find out why the women have stopped taking out insurance and how the product can better suit their needs. The first home we arrive at belongs to a midwife in the village. It is very simple but Mirai tells me this family owns 10 bigas of land and is rather well off by village standards.
The midwife tells us that many of the women in the village have stopped taking out insurance because SEWA Vimo, as the insurance program is called, does not pay for claims for one of the hospitals nearby that many people like to go to. Mirai informs me that SEWA only pays for claims from hospitals it has connections with because they found that many were making fraudulent claims. After a somewhat lengthy discussion about insurance and the happenings of the village we leave the midwife’s home with one idea about why the number of people with insurance has gone down.
We walk down the road to get to the next home where three men are sitting around outside and a few women are engaged in household tasks. Mirai and the SEWA team sit down outside and speak with the men. I find it interesting that it is primarily the men who are speaking even though I know the policyholder must be a woman, as per SEWA rules. I make a mental note but realize it is best to wait to bring this up.
Mirai is engaged in what appears to be a heated conversation with one of the men who has sat outside to talk to us. When we leave this house Mirai tells me briefly that this family has also said they were upset with SEWA Vimo because it did not cover claims for a particular hospital. Later, in the car ride back into the city, Mirai says they know for a fact that this man had been involved in making a fraudulent claim to SEWA. He has colluded with his doctor to try to get SEWA to pay out for an illness he didn’t have. SEWA had called the doctor and asked some follow up questions when they got the claim. The doctor had admitted that the patient (the man currently arguing with Mirai) had asked him to fill out the forms so that he could collect money from SEWA. Though Mirai knows this, she chooses to avoid an unnecessary confrontation and simply explained that SEWA insurance can only support claims from certain hospitals but they will look into the other hospital.
The next home we go to is a ways down a dirt road and past other houses. When we get there I quickly notice a young girl sitting off to one side doing bead and sequin appliqué work on a piece of fabric. She is 16 and when Mirai asks her grandmother why she is not in school the grandmother replies that she had to drop out to work because her father was a drunk and is now very sick. Later however a grandson of 17 walks by and we find out that he is finishing school and there will be money for him to continue on to learn computer work. “If there is money it will always go to the boy’s education first,” Mirai tells me as I digest this news.
We sit down and speak with the lively grandmother. She has SEWA insurance but, as we have heard before, she notes that many people are unhappy that they cannot go to the hospital that they like. After a few more stops in the first village we came away knowing that the two main reasons people said they had stopped taking out SEWA Vimo were a) they wanted to be able to use another hospital or b) they hadn’t been sick or collected from a claim for a couple years so they figured there was no point in having insurance.
We leave the first village and climb back into the car to see another village where many people used to have insurance and now do not. Our first stop is the home of another midwife. She has SEWA Vimo and was a promoter for the insurance in her village. However she too went to a hospital not approved by SEWA and thus did not get money for her claim. She says she understands why but it makes it harder to promote it when she didn’t even have her claim taken care of. I find it suspicious that she would choose to go to an unapproved hospital but Mirai later tells me that she has a family connection at this other hospital.
The more we speak with people, the more it is becoming clear that many individuals have connections with doctors at some of the unapproved hospitals and the doctors and patients feel they have insurance so there is no reason to control costs. Inevitably my mind turns to parallels with the abysmal US health care system.
We make a few more stops in the second village. When we are confronted by women who tell us that they have stopped taking out insurance because they haven’t been sick one of the SEWA workers I am with gathers a number of women together to explain the nature of insurance. She explains to them even if they become ill only once in ten years it is still financially better to have insurance and they begin to come around to the idea. The women say that it wasn’t explained well enough before but now they are more willing to take out insurance; whether or not they will remains to be seen.
In a couple of instances we do not go into the homes because all the women are out working in the rice paddy. In one case the woman of the house tells us that her husband is out and he is the one that makes all the decisions so we must come back another time to talk to him. I am reminded again of one of the first houses we went to where we spoke to the men only; I cannot help but be disappointed that this is the situation but I have been here long enough to not be entirely surprised.
At the end of the day we get back into the car and I again watch the landscape change from rice paddies to buildings. A short ways out of the villages we pass a building that Mirai points out as the hospital the people are saying they prefer. I comment that I would never have guessed the building was a hospital from its exterior. Another kilometer or so down the road we pass the hospital that is approved by SEWA and I notice it is much better kept and even has a shiny ambulance outside.
On the ride back Mirai talks with her coworkers about the findings from the field visit. She periodically updates me on the conversation, “we are going to try approaching some of the doctors at the other hospitals that the people have said they like and see if we can try to get them to abide by some basic rules,” is one big thing that has come out of today.
I find it interesting that I am listening to debates on how to provide health care for informal workers in India while at home we can’t seem to get it right either. Here the major problems seem to be corruption (well that seems to be everywhere) and getting people to put money into healthcare when they haven’t been sick in awhile and they would rather use the money for other things (a parallel can be drawn to individuals in their 20s in the US). Otherwise, I don’t know whether it is wise to draw too many parallels because it seems to me that the US should be much more advanced when it comes to providing for its citizens. Suffice it to say for now that I feel very lucky that I was able to tag along with Mirai on this health care mission for SEWA and it has given me some very interesting things to think about.