A little perspective with my tea

08.03.11

Wednesday was incredible and really eye-opening. All preconceptions and assumptions destroyed.

Also I should point out that this post will be a little bit more graphic than others, given the reality of the amazing people we interviewed and my area of interest.

The organization met with on Wednesday was Aastha Panivar, a collaborative community organization that focuses on health education and respect for sex workers (prostitutes) in Mumbai. Yes, I was going to meet with actual Indian sex workers. The idea was that our group of 20 students would divide into 2 groups and meet with two separate groups of sex workers. We were asked by the organization to prepare health education materials on menstruation and hygiene, menopause, and breast cancer. These were topics that one of the organization’s directors had told Dr. Vyas that the sex workers wanted to learn about and have more information on.

Photo (1) Sex worker community representatives and GW students

Here’s something that I should point out – a few learned lessons: (1) in health education, be prepared for the unexpected and for things to not go according to plan; and (2) always offer utmost respect and openmindedness towards the population you are serving. I have to admit I had some trepidation about meeting the sex workers. I had seen documentaries, movies, read articles, held class discussions regarding sex workers and the business of sex, but had never actual met someone who has that profession. I was unsure what they would be like, how they would look, what they would say. I’m afraid that I struggled at first with understanding their perspective and why these women did what they did – I had initially ASSUMED that these women were born into brothels or sold to brothels though human and sex trafficking, all devastating human rights issues. However, when I actually had the opportunity to meet these women and sit down and discussion life and health issues, we quickly found out that they were a lot like the incredible women I know and were raised by.

In the end, they all were mothers, daughters, grandmothers, sisters, cousins, and neighbors. One woman shared about her two children, one of whom was just about to get married and all the joy she felt. Another woman shared about how she takes care of her mother and children all by herself. And sex working has become the means of employment for these women. No please do NOT misinterpret my text as thinking that I am condoning sex work, am saying that all of these women chose this occupation or are willingly (100%) continuing sex work by their own volition. My intention is to shine light on the reality of these women, what circumstances led them to their occupation, what sort of life they lead, and what challenges they face.

In the end, like I mentioned, these women are all still mothers, daughters, sisters, etc.

We showed up to the NGO’s main building with our lesson plans in hand and a color print of a uterus to provide visuals for explaining menstruation. How quickly all of our detailed, well-planned itinerary was destroyed. Every conversation and topic – every single spoken word – had to go through the scrutiny of Hindi to English and English to Hindi translation. Dear God, this is going to take forever. We made sure we explained to the ladies meeting with us, who characterized themselves as community leaders and teachers for sex workers in their area. The group we met with never explicitly said that they are or were sex workers, but the idea was implied. More than once. However, we maintained a respectful disposition throughout the entire session and actually learned so much!

To start, we told the women (and some men) in the group that we were there to share some health topics that had been mentioned as important topics for this specific community – ones in which the sex worker community in this part of Mumbai had questions about. Well, within 5 minutes of the start of the lecture on menstruation, we learned that nothing was going to go accordingly to plan. First, a few of the community leaders stopped some of my colleagues in the middle of their “this is a uterus” talk and explained they had the whole reproductive system and menstruation actuality down. Apparently they had been told about sexual and reproductive health by nearly every NGO they’ve encountered. They get it. Well damn, there goes part 1 of the lesson plans. Conversation quickly led into hygiene around menstruation and the use of sponges during their week. Sponges. Yes, sponges. It is becoming more uncommon (old school) with the introduction of maxipads but apparently for a long time, sex workers would use sponges to help with menstruation. Kitchen sponges. They’re cheap and reusable – even though we tried to stress they should only be used once and then thrown away. From this conversation erupted an amazingly vast discussion, dialogue between us public health students and these Indian sex worker community representatives. Within 20 minutes, our lesson plans were shot dead but we opened the forum for conversation and a chance for us to learn from them.

The discussion addressed everything for sanitation and hygiene during menstruation to natural remedies for cramps (apparently the sex workers swear by ibprofin) to symptoms of menopause to breast cancer and self-exams. We had prepared materials on all of these subjects, however, instead of it being a teacher-student setting, we were forced to switch modes into women learning/teaching women; a open dialogue to learn. This seems to be something that arises often in public health: deviations from the plan. But Dean Parrish was there to help guide us towards a cooperative of information. I was still able to share my information on menopause, symptoms, and how older women are still feminine and beautiful, even if they can no longer have children. It provided amazing perspective for me, though, given that the sex worker representatives made note that menopause might mean the end of a sex working career since it was seen as more of an end to femininity. Also, the representatives were hell bent on getting numbers out of us – one woman politely demanded an age when menopause occurs. I explained that it varies woman by women, but she needed a number – so I was forced to settle with the average I found online: age 51 years. When I told her this, she seemed to be satisfied and move the conversation onto the next subject.

After my brief stint in menopause discussion, we entered the very hard topic of breast cancer. Jennifer Mendoza, another GW student, shared her mother’s own battle with breast cancer and how she is going strong because she chose to take care of herself. We asked the representatives if they knew someone who had breast cancer, and most of the women said they did. Some even shared their own personal struggles with finding lumps and getting them tested. They agreed that cancer was bad and you should go see a doctor if you suspect something, however, they did not see it as a health priority. HIV/AIDS, pregnancy, STDs, menstruation – those are the big concerns for these female sex workers, not breast cancer. But that’s where we found purpose and passion – stressing to the women that they should recognize that taking care of yourself is the most important thing you can do for yourself, your family and that by taking control of your health, women can find empowerment over her own life and outcomes. We were trying to stress in our discussion that by these sex workers taking care of their own health, they are helping themselves be independent in the future – their health is in their own hands.

Think about it like this: sex workers do not always have complete control over their lives, their surroundings, their clients, their rights. Some women are born into sex work, some women are sold into sex work, some women are coerced into sex work, and some women chose to do sex work. However, one thing a sex worker could potentially have control over is her health; if she takes every measure she can to take care of herself, to be clean and healthy, use contraceptives whenever possible, to get tested for STDs, visit doctors when possible, AND be aware of her own mental and physical being she can gain some empowerment over her own life and outcomes. We were trying to stress in our discussion that by these sex workers taking care of their own health, they are helping themselves be independent in the future – their health is in their own hands.

In order to makes sure no information was lost in translation, we proceeded to lead a breast cancer self-exam demonstration. Correction: I proceeded to lead a breast cancer self-exam demonstration. Under the instructions and explanations of Mrs. Kelly Healy, I demonstrated how to place pressure on the breast, with your arm lifted, to check for any irregularities each month. The sex worker representatives were fascinated by the idea of checking every month and being aware of their body. We even promised them an illustrated pamphlet on breast cancer self-exams to distribute to the sex workers. I feel like our first year of back-breaking, headache-causing public health graduate school has finally manifested itself into something real! We have the opportunity to prepare materials to be distributed to real people and potentially make a real difference; maybe even save someone’s life. I mean wow. Teaching a woman about self-exams and taking care of her body could literally save her life. Absolutely incredible! I now am starting to see and understand why I am doing what I am doing – helping people help themselves.

Fair to say nothing turned out the way I expected but it was so much greater than I could have imagined. What an amazing experience and what amazing perspective it provided. As a public health professional I need to always be flexible and always enter into a new, unknown population with an open mind. I am not there to judge or assume – I am there to serve and learn. This was a very humbling experience but one much appreciated.