In the Field, Not the Documents: What Rural Bihar Taught Me About Public Health

Sandhya in conversation with group of women and children

Before I entered the field, I thought I understood public health.

I had earned a master’s degree in public health in New Delhi. I studied the frameworks, explored theories of systemic change, and submitted every assignment on time. But when I returned to Bihar (my home state) and started working with communities here, I realised that no textbook had prepared me for what lay ahead.

Three months ago, I joined ZealGrit Foundation, a grassroots organisation based in Supaul, Bihar. We work on addressing malnutrition in communities whose issues rarely appear in headlines or online.

Since then, I have spent more time unlearning than learning. I have discovered that some lessons only come when you sit with the communities, listen and absorb like a sponge, and notice what the books never mention. Here are three lessons I carry with me every day.

Lesson One: Communities Don’t Speak in Frameworks.

They speak in feelings, memories, fears, and silences. I learned that listening matters more than speaking. You will be able to listen only if you provide them the space. Early on, my team gently pointed out that I often avoided eye contact while talking. It wasn’t intentional but a nervous habit. But in the field, that can look like disinterest. I began practising presence, slowing down, making eye contact, offering a smile. And people responded. They listened, asked questions, and welcomed me into their spaces.

Lesson two: Trust doesn’t follow checklists.

You don’t earn it by completing tasks, you build it through connection. That takes time. Sometimes, I explain the same thing ten times. Each time, I do it with the same care, the same tone, the same respect. There’s no shortcut here. It comes with patience, presence, and persistence.

Sandhya engages in a conversation with a woman while taking notes

Lesson three: Local context changes everything.

What sounds like a casual comment often carries a deep belief. In the field, every day feels like live qualitative research. Patterns emerge if we are paying attention. During a recent engagement with young children and their families, I noticed that grandparents hesitated to weigh their grandsons. “Nazar lag jayegi, baccha kamzor ho jayega,” they said. But they had no problem when it came to granddaughters. However, the mothers stayed silent. In that moment, I saw layers of gender bias, fear, and family hierarchies. And no textbook had warned me of that.

In the short span of three months, I feel my work has made me more grounded. I have become careful with my words. More patient with silences. Because in this line of work, one kind sentence can open a door. One careless tone can close it forever.

My biggest takeaway is that public health doesn’t live in glossy reports, PowerPoint presentations, or policy notes. It lives in people’s lived realities, in their doubts, fears, habits, and hopes. If we want to make a difference, we need to meet them there.