Nikilesh Eswarapu ’12 arrived at Brown with big ambitions. Inspired by a community service trip to Mexico during winter break, Eswarapu spent the summer of 2009 in India, laying the groundwork for his own nonprofit organization, the Milana Foundation. Today, a handful of Brown students work for the organization, spending the academic year discussing plans to improve health care in India and using their summers to implement their projects.
Eswarapu brought Milana, which only originally comprised him and Susan Kuruvilla, a friend from New York University, to Brown when he transferred in his sophomore year. His first project with the organization was to build a health care clinic in the Medak district of the Indian state of Andhra Pradesh that provides free service and medication to patients. Before Milana’s clinic was built, the closest clinic with a doctor was 17-20 kilometers away from the group of villages, Eswarapu said, adding that the majority of trained medical professionals in India practice only in urban areas.
While 70 percent of India’s population live in rural areas, only 30 percent of trained medical practitioners work in rural areas, said Karishma Bhatia ’15, who started working as an intern for the foundation this year.
Though the clinic has been very successful, serving 80 to 85 patients each day, Eswarapu said the group does not plan on establishing more clinics. The clinic in Medak is self-sustaining and no longer demands much of the group’s attention, but it works well as a way to learn about the area, he said. Now, Milana will devote its time primarily to education and research.
Fifth world problems
“Rather than being a health care provider, we want Milana to be a health care educator,” Eswarapu said. “We think that a more effective way to improve the outcome on a large scale is to focus on existing practitioners rather than on bringing in new practitioners.”
Most health care in rural areas is performed by Registered Medical Practitioners – health care workers who are largely untrained and unregulated. They are often more a liability than an asset to their patients, said Nihaal Mehta ’14, another intern. The misuse of needles by these medical practitioners has led to a rise in HIV cases, he said.
The group spent this year planning a program focused on providing health education to practitioners. Bhatia and Mehta will implement the program in India this summer and have received a C.V. Starr Fellowship from the Swearer Center for Public Service for their project.
“Nothing like this has been done before in India, and the model itself is robust enough to work in any rural area,” Mehta said, adding that if the project is successful, they will expand it to other areas within India.
“India’s got the health problems of a fifth world country, but it’s trying to be a first world country,” he said. “You can create a health care system from scratch.”
Examining dynamics and metrics
Eswarapu said he is also proud of the success of the group’s research projects that examine the economic cost of health care in rural India. The research shows the positive impact of their clinic in the area. The group has also implemented health education programs in primary schools and performed ethnographic research to understand the dynamics between the clinic and the village.
“It’s not just about doing something but having good metrics and constantly improving and measuring yourself to make sure what you’re doing is still effective,” Eswarapu said.
One of the group’s biggest challenges has been simply communicating between its two branches, located on opposite ends of the world. Since the organization is so young, a lot of its recent work has focused on outlining its goals and mission statement.
“The mission changes a lot,” said Laura Ucik ’13, who works for the foundation. “What we’re really trying to do is create change in a community rather than just provide a service.”