The title of my Fulbright research project is Perceptions About Food, Dietary Habits, and Prevention of Cardiovascular Disease in an Urban Slum in Bangalore. I have been working on this since my August 2018 arrival in Bangalore. According to the World Health Organization (WHO), noncommunicable diseases (NCDs) account for 63% of all deaths in India and cardiovascular diseases consist of 27% of this percentage (2016 data published in 2018). There has been little research in regards to the prevalence of NCDs in lower socioeconomic sectors here in India, so it is my goal to contribute to the research, by studying dietary habits and how this modifiable risk factor may be a significant cause of cardiovascular disease in India, specifically Bangalore.

After getting registered in Bangalore as a temporary foreign resident, which took about a week, I met with people who would help me assemble a team to start my research. The neighborhood in which I would recruit my study participants isn’t a community in which one can just show up and start making friends in. The neighborhood is one of the largest slum communities in Bangalore and residents are wary of outsiders, especially foreigners. Fortunately, my host institution has a community clinic here and over the years they have formed positive relationships with the residents. There are community health nurses that visit the homes of many people every week. In order for me to build a relationship with the community, I went to the community almost daily, for many weeks and walked with the nurses to the homes, childcare centers and spent time in the clinic. It was necessary for the community to get to know me, see my face and additionally, it was vital for me to become familiar with the community for myself.

While getting familiar with my research community, I worked on my presentation for the Institutional Review Board (IRB) in regards to my project. The IRB is established to protect the rights, ethics and safety of human participants recruited in a research study; when human partipants are involved and the researcher plans on publishing research findings in scientific journals, the researcher must have approval from a local IRB. After receiving IRB approval for my project in November, I was ready to begin the study.

Working with the community health nurses, we identified 10 families that were interested in participating in this study; eight families from the slum community and two families from a migrant community nearby. The research methodology for this study is Photovoice. It is a realtively new method and is a parcipatory action method – meaning, it gives the participants a voice in the community that perhaps they have never had. I gave each family a digital camera and asked them to photograph anything related to food which their family consumed over a 4-week period. This included food they ate, bevereages they drink, cooking and preparation of food, where they buy food/how they acquire food and any challenges they had regarding food.

During this time I stopped by the participant homes once a week to check in, offer support and help with any challenges they were facing with the project or the camera equipment. For most of the participants, this was the first time they had ever operated a digital camera and I wanted them to feel comfortable using it. The photos they had taken each week amazed me and I sensed they were really enjoying this project. The families were all very kind to me throughout the project. They always offered tea and biscuits (cookies) when I would visit; some even insisted that I have lunch with them. One participant even called me on Christmas morning to wish me a Merry Christmas.

After the photography phase of the project, I had all of their photos printed. They really enjoyed seeing the images they captured. With the assistance of community health nurses who helped to translate the various languages of each participant family, we held discussions with the participants about the photos. During these discussions, I gathered data about dietary habits and nutrition, in addition to personal perceptions of how healthy they feel the food is for their family. The results are intriguing and I am still analyzing the data in order to publish the research.

With Photovoice, the participants choose the photos they want to display at the community exhibit. The community exhibit is held to educate people such as fellow neighbors, community stakeholders, public officials and anyone else with an interest in the community or the topic of the exhibit. The participants not only choose the photos they want to display but they also write captions or stories about each photograph. This allows the viewer of the photographs to better understand what the participant is wanting to communicate through the chosen images.

My participants chose 3-5 of their favorite photos for the community exhibit and gave me stories for each image. I had the first community exhibit in Bangalore on Friday, the 15th of February, at Bangalore Baptist Hospital’s Community Health Department (CHD). I will post information about this exhibit, the CHD and photos of the event in a separate post.

The photos below are the images that the study participants personally selected to exhibit, along with their captions/stories. They selected images of food/beverages that were important to their family, whether it is something they eat everyday or something they rarely eat. The captions are in their words and contain their personal perceptions of the diet. Whether the perceptions are true or not, this is how they view the food that is important to them.

I hope you enjoy the beautiful images and the captivating stories, all created by the participants of this study. I am simply the facilitator of the project – everything else is driven by the participants of this study.

I would be honored to hold as many exhibits as possible for this project, in India or in the United States once I return in May. I am proud of the participants and so grateful for their participation. If you or anyone you know would like to inquire about exhibiting this project, please do not hesistate to reach out to me through this website.

The following images are the property of the research titled: Perceptions About Food, Dietary Habits, and Prevention of Cardiovascular Disease in an Urban Slum in Bangalore and is not to be used without permission.

Wheat Ball – “My husband likes the wheat ball. It is made from wheat flour. It is made with 1 cup of rice and 1 cup of wheat. My husband will eat everyday for dinner. It is very healthy for people with diabetes and high BP.” DJ Halli, Family of 8

Fried Masala Rice – “This is leftover rice. When we are feeling hungry early in the morning, we make this kind of rice with leftover rice from the night. We make with 50 grams of oil, small spoon of salt, chilies, onion and small packet of chicken masala powder. Everyone in the family eats this. If there is chicken, we will add sometimes. We don’t know if it is good or not but we are eating and living with this food.” Rachanahalli, Family of 8

Khichdi – “This is mainly for the children. We put vegetables, semiya, onion and within two minutes, we can prepare. All the children like this. We can make it sweet or spicy. It is made with 50 grams of oil to fry the vegetables and then we add water to boil.” DJ Halli, Family of 8

Paan – “This is paan for one person. We make with betel leaf. Not everyone takes but some do. It is always available. We chew this three times a day but we do not swallow it. This is not healthy but we still like it.” Rachanahalli, Family of 8

Paratha – “In the morning, we make paratha or roti. We will make it all in the morning to eat in the afternoon. We use one kg of wheat flour to make. We put groundnut oil on the skillet so it won’t stick. Ghee is very expensive so we use oil. We will eat these with every meal throughout the day and night. Sometimes we eat with chutney, kheer, and sambar.” Rachanahalli, Family of 6

Egg Curry, Seasoned Rice, and Brinjal – “The rice has been seasoned with oil, onion, garlic, ginger, and little bit of green chili. These are fried and mixed with the rice. The other is brinjal. We eat this two to three days a week, with the chapatti. This is healthy except for a diabetic person. Rice is not healthy for a diabetic person. We eat egg curry weekly, once. It is tasty. It is good for everybody – it doesn’t have side affects. Also, the brinjal is good for health.” DJ Halli, Family of 6

Dosa and Potato Palya – “This is dosa and it is made up of rice. This is potato smash or potato palya. It has to be boiled, then with some oil, mustard, curry leaves, and turmeric, and a little bit of green chilies fried in a pan – then it is mixed and add salt to the taste. It is good for people but not for a diabetic person because both rice and potato has more carbohydrates. In our home, dosa is occasionally made.” DJ Halli, Family of 6

Chicken Kabob – “This is chicken kabob. It is a favorite dish. There is no caste in chicken. It is mixed with ingredients like chili powder, little bit of turmeric, garlic paste, onion, ginger paste, and corn flour. Everything has been mixed and salt according to taste. And it is left to be marinated for two to three hours, and then it is deep-fried in oil. It is good to eat, but not for health because it has been cooked in oil and oil is not good for the health. Oil will grow fat in the body and lead to heart attack and many other problems. Eating chicken everyday is no problem because chicken has no fat but if cooked in oil, it is bad.” DJ Halli, Family of 6

Ragi Ball, Meatballs and Vegetable Curry – “This is a ragi ball, meatballs, and curry with green leaves. Everyone knows the ragi ball is a very good grain. Even it is good for diabetic patients. Moreover it is a very famous food in South India, especially Karnataka. There is a proverb: “Ragi doesn’t have any disease”. It has a lot of fiber and protein and it has been said by the doctors that ragi is good. In every aspect it is a very good grain. For me, I eat ragi everyday. Sometimes my wife and kids eat. Right now ragi is expensive. Before, it used to be 3 rupees per kg. Now it is 40 rupees kg. Because of the diabetic patients, the demand has been increased. Meatballs are easy to make and is affordable. Beef is cheaper than sheep, goat, mutton. Mutton, beef, whatever it is, is good for health – a lot of proteins. Always vegetable is good for health.” DJ Halli, Family of 6

Khichdi – “We eat this for lunch every other day. We fry all of this in 100 grams of oil and then water is added. Also we will eat this when nothing else is available. If we are not eating this food, we will not be able to live.” Rachanahalli, Family of 6

Chapatti and Chutney – “This is chapatti, made up of wheat flour and this is groundnut chutney. Both is very good for diabetic patient. As you know, wheat has a lot of fiber and is especially recommended by the doctors to the diabetic persons to use chapatti daily, three times. Because it is rich in protein and fiber is good for digestion. One more thing special about chapatti – it digests late, which is good for diabetic patients. Groundnut chutney is called the Indian almond. For poor people, it is like almond. The chutney is very tasty and is very good.” DJ Halli, Family of 6

Masala – “This is masala for one dinner. It will be enough to feed everyone. We put this in a mortar and grind with pestle to make a paste. Then we fry and add to beef or chicken. We eat this at night everyday. Everyone eats the same food even if health is not good. Some people have high BP but everyone eats the same.” Rachanahalli, Family of 6

Chapatti – “We make chapatti without oil. All will eat. We make chapatti daily and eat it twice a day for breakfast and dinner. Kids have one and adults will have three to four. We will add some oil to the outside for the kids and adults eat chapatti dry. If we eat ragi ball, chapatti and wheat ball, we will be healthy and control sugar.” DJ Halli, Family of 8

Brinjal and Potato – “We make this 2-3 times a week. It can be either for breakfast, lunch or dinner. All will eat this and it is easily available. We make this with potato, brinjal, turmeric, 100 grams oil, green chili, garlic, onion and chili powder. This is tasty and available. We usually consume less amount of salt. When we eat, our stomach is full and healthy. If we eat outside food, our stomach isn’t full and this is not healthy.” Rachanahalli, Family of 6

Pomegranate – “We eat the seeds from this fruit. There is a little for everyone. We only eat once in 10-15 days. It is available but we eat it when we can afford it.” Rachanahalli, Family of 8

Fish – “This is fish. It is good for eyesight and is good for health. Monthly, two times we will have. We make it with chili powder, turmeric powder, salt and then fish fry masala. We mix it in, keep, and deep fry. We either make deep fry or shallow fry. All of us like this. We fry in 150ml refined oil. Fish fry is good for health but fish curry is bad for health.” DJ Halli, Family of 5

Ragi Ball – “This is made from the ragi flour. Three things we can make from flour are ragi ball, ragi dosa, and ragi malt. We make two types. One is plain ragi ball and the others with rice. We can afford it. Ragi is fifty rupees per kilogram and we make ragi flour. Everyone in the family likes this because it decreases the sugar level in the body. It is good for health and easy to make within two minutes. Everyone can eat.” DJ Halli, Family of 8

Falooda – “With china grass, we make this falooda. For a diabetic patient, this is not healthy because it is sweet. Rest of them can eat. Whenever we want, we can make this. We make with 250 grams of milk and the same for sugar.” DJ Halli, Family of 6

Rice, Dry Fish and Curry – “We eat two to three times in a week. It is affordable. We make with salt, fry fish masala powder and deep fry in 250 ml oil. Curry is brinjal and we make once in two weeks. It is made with 50 ml oil and two small spoons of salt. I think it is good for health.” DJ Halli, Family of 6

Manathakkali – “This is manathakkali. It is good for stomach ulcer. Monthly twice we make. We season it with onion, red chili, mustard and then add green leaves. It is good for health and stomach ulcer so it is difficult to get this. It is easy to cook. It is cold food so we will not give for pregnant women and children. I am lactating mother so I don’t have.” DJ Halli, Family of 5

Omlette – “This is for omlette. Everyday we will eat egg. Everyday we get one free egg from anganwadi and we buy the rest. They told me to steam and eat but I can not eat that so I make omlette. I don’t know if this is good for health or not but all family will eat.” DJ Halli, Family of 5

Sugarcane – “Sugarcane is good for jaundice. When we eat this, it will be excreted in the urine. It is cold food so I do not give my children. But sometimes they will eat it.” DJ Halli, Family of 5

Fish – “This is fish. It is good for eyesight and is good for health. Monthly, two times we will have. We make it with chili powder, turmeric powder, salt and then fish fry masala. We mix it in, keep, and deep fry. We either make deep fry or shallow fry. All of us like this. We fry in 150ml refined oil. Fish fry is good for health but fish curry is bad for health.” DJ Halli, Family of 5

Dry Fish – “This is dry fish. Lactating mothers should eat this fish so that they get good secretion of milk. I have to clean the fish and then smash the fish. Then I mix with chili powder, turmeric powder then deep fry in oil. Whenever my milk is not secreted well, I eat this. It gives a good milk production. It is easy to make and affordable. All in the family will eat.” DJ Halli, Family of 5

Eggs – “Weekly twice, we eat egg. Half-boiled, steamed. For children, two days, once they will have. Everyday six people will take one to school or work. Egg is healthy for all.” DJ Halli, Family of 8

Biscuits and Tea – “Everyday in the morning, all family members have tea with biscuits. Children have milk with biscuits. Everyone gets two biscuits each and also we have in afternoon. We make tea with tea powder, half liter of milk, 100 grams sugar and half glass water. This food is good but only good with no sugar if there is diabetes.” DJ Halli, Family of 8

Milk – “Everyday the children drink milk. Whether it is affordable, somehow we have to buy for the children. It is easy to get. The child who is one year will drink two bottles a day. The other two children have small cups, two times a day.” DJ Halli, Family of 8

Dosa and Potato Curry – “Dosa we eat daily. We feel this is healthy. The children eat three dosas but small ones will eat half of one. Also potato curry we eat everyday with every meal. We make with 50 grams of oil and one tablespoon of salt. Both curry and dosa are healthy for everyone and is available to us.” DJ Halli, Family of 8

Fried Noodle Snacks – “Noodles are twice daily. It is tasty. Kids will eat. I know I should not give noodles to the children, but they are crying so I give to them everyday. We are tired. I do not think this is going affect their health when the children are grown.” DJ Halli, Family of 8

Idly, Dosa and Chutney – “Idly and dosa is breakfast, with chutney. It is for breakfast everyday. Everyone likes dosa and idly. Dosa is very easy to make. Dosa is healthy because it is rice and it is light food.” DJ Halli, Family of 9

Vada – “This is two vada. One is masala vada and one is plain. This is dal – chana dal the other is uddina. You have to soak, night only, then morning we can prepare. Otherwise, minimum two hours. Then we add onion, green chili, coriander leaves, curry leaves, then mix it and put in oil and deep fry. Sometimes we prepare inside but sometimes we buy outside for evening snacks. It is fry and fry is not good. Most of steamed food is good for health. Fry – most people will avoid. If the vada is tasty, we will have four. If it is not tasty, we will have two.” DJ Halli, Family of 9

Rice, Cauliflower Masala, Sambar and Fry Bananas – “Bananas are too easy to make. The cauliflower will take time. You have to cut and put in warm saltwater. This is how you clean the cauliflower so the worms will come out. It takes time. The cauliflower masala is good because it is vegetable. The deep fry banana, some people will like, some people will not touch. Sambar is dal and is good for people.” DJ Halli, Family of 9

Rice and Brinjal Curry – “Everyday we prepare vegetables. Sometimes we get bored so we make different food like sambar, brinjal curry, other vegetables. We like this and is easy to make. We make for lunch. Brinjal is good iron and it is healthy. Rice is not good for health but we will have every day for lunch.” DJ Halli, Family of 9

Chapatti and Omlette – “Chapatti is very good for health because of the wheat flour. Everyday we all eat three chapatti. The omlette is made with 2 eggs. Only oil is used to keep the omlette from sticking to the pan. Once a week, we make the omlette. Everyday, everyone in the family will eat one hard-boiled egg. If boiled the egg is healthy. If the egg is made into omlette, it is not healthy for people with high BP and diabetes.” DJ Halli, Family of 5

Padu – “This is dosa batter. We take onion, green chilly, coriander leaves, mustard and oil. We season this together and put in the dosa batter. It is thick and not thin like the batter used to make dosas. A drop of oil is added to the pan and the batter cooks over the gas fire. We will have this once a week. This is healthy for people to eat.” DJ Halli, Family of 5

Upma – “This is upma and we will make two times every week for breakfast. Only one person will eat this because only they like it. 50 grams of vegetables are fried with sunflower oil before mixing it all together. Salt is used, but it is per taste and maybe the amount of one small spoon. I am not sure if upma is healthy for a person. Also, there is instant chutney powder. Sometimes oil will get added to the powder. We will eat this if we have not made chutney.” DJ Halli, Family of 5

Tea and Biscuits – “Twice a day, everyone will have tea. Tea is made with half liter of milk, two spoons of sugar and one package of tea powder. We also have biscuits twice a day with the tea, as a snack. I do not know if the tea and biscuits are good or bad for health but if children have high BP or diabetes, the biscuits are not good for them.” DJ Halli, Family of 5

Rice, Papad and Methi Dal – “Three times a week, my family will eat methi dal. Sometimes spinach is added. It is cooked with one small spoon of oil and is healthy for people with high BP and diabetes. The papad is fried and we eat two times a week. I do not know if it is good or bad for health. The rice is good for people if it is eaten one time a day but if eaten more than that, it is not healthy.” DJ Halli, Family of 5

Biryani – “Weekly twice, we make this. I like this food. This has vegetables. Sometimes we make with prawns, mutton or chicken. We deep-fry in 125 ml oil. If we make with mutton, we use 1 kg mutton and 1 kg rice. This food is not healthy. For BP patient it’s not good but others its good.” DJ Halli, Family of 6

Bean Dal – “Only when the season comes, we make this dal. Weekly two times or once we cook this. We cook with 250 ml oil and 4 spoons salt. This is healthy food. All are eating it so it is healthy.” DJ Halli, Family of 6

Chicken/Mutton Curry – “Once we cook in the week. This amount is for one day. For BP patient, it is not good. It is not good for diabetes patients.” DJ Halli, Family of 6

Rice, Sambar, Rasam and Potato Fry – “On Saturdays, we eat only veg. The family likes this and is easy to make. This is good only the sambar, rice. Potatoes – bad to fry because cholesterol, some people with sugar can not eat. Some people will avoid anything potato.” DJ Halli, Family of 9

Chapatti, Vegetables and Snacks – “This is for dinner. Chapatti and side of vegetables and snacks we also eat. All will eat for dinner. Chapatti is compulsory; everyone eats everyday. Chapatti is good – wheat. For sides, sometimes we make non-veg, sometimes we make beans, carrots and snacks also. Chapatti is too easy to make. Beans and carrots, also easy to make. Snacks is bad for health but vegetables, this is good. This is enough for one or two people.” DJ Halli, Family of 9

Shawarma Roll – “This is outside food. Weekly, one time is compulsory. Two people can eat this but one per person. This food is bad but is really tasty. The children love. I also love shawarma but it’s not good. That is full of oil only. Oil is not good to eat. This roti also. My dad cannot eat everyday. He can eat wheat chapatti. This is bad.” DJ Halli, Family of 9

Rice, Sambar and Papad – “Also, compulsory we have rice, sambar, papad, some vegetables. Everyday we eat. Rice is boiled. Papad is fried in oil. Some people will put in the fire to cook but we fry. All my family love this for lunch. It’s easy to make. In the photo, is meal for one person. This is good for health.” DJ Halli, Family of 9

Biryani – “Twenty members minimum can eat. We cannot cook for twenty members with gas, so we will cook outside. When we have a lot of guests, we will make. It will take time to make but the family likes it. This is good only because it is tasty and yummy.” DJ Halli, Family of 9

Chicken – “We eat, compulsory, chicken. Everyday but we make different. Sometimes we make deep-fried, sometimes gravy. All love chicken. It is easy to make. This is one kg chicken and five or six will eat. Chicken is mostly bad for health because it is hot food but it is tasty.” DJ Halli, Family of 9