We began the day with a yoga session led by our private yoga instructor Ritu Sethi. I’ve never enjoyed yoga because I remember having to go to sessions with my assistant coach after practice when I was in undergrad and it was always painful forcing myself to stretch. At the beginning of class, Ritu taught us about Ashtanga Yoga, otherwise known as “The Eight Fold Path”. This approach to yoga consists of systematic and definite steps towards the realization of the soul’s oneness with spirit. The first step is “Yama” or the ‘don’ts’ that focus on social behavior and how one treats others and the world around them. The second is “Niyama” or the ‘do’s’ which focuses on inner discipline and responsibility, and how we treat ourselves. The remaining steps focus on the practice of yoga until “Samadhi”, or trans-consciousness. Thinking about yoga in this way is a completely new experience for me, and I’m really thankful that we have the opportunity to take this time to reflect in the morning. Each time I took a moment to close my eyes and focus on the here and now I was able to better process the emotion I have been feeling since we arrived. I can’t quite differentiate any of my thoughts right now as we have immersed ourselves in the culture. I am looking forward to the 90 minute session tomorrow and hope that I leave with a clearer head.
After a brief class session with Dr. Parrish and Dr. Vyas around noon, we headed to Girgaon in South Mumbai. It took us over an hour to arrive at our destination, and the city looked completely different from yesterday. The parts of the city we drove through very much resembled big westernized cities we are used to.
The class split into two groups and each went to a different site. We initially thought that we would be educating sex workers, but the group that attended our session ended up being women that work with the community based organization known as the Women Welfare Society (WWS). The WWS is supported by the Social Activities Integration (SAI) and was formed under the Aastha Project. SAI is funded by the Family Planning Association of India, which is funded by Family Health International, who receives their support from the Bill Gates Foundation. SAI works with 350 brothel based sex workers in the Worli district.
We began our session with introductions. First, we went around and introduced ourselves by talking about what we were studying in school and some background on our family. Then, each of the session attendees introduced themselves. In total, 11 women and 7 men attended our session. We crowded around a long table in a room in building that appeared to house several organizations. Among the attendees was the Vice President, secretary, and treasurer of WWS, a peer nurse, a staff nurse, and several other WWS workers.
The women informed us that one of their biggest concerns is PLHIV, or people living with HIV, health services. As soon as a woman becomes HIV+ she is rejected from her family so the WWS provides support to these women. Their intent is to establish a unified front to assist the women in gaining back their respect. SAI provides clothing, nutrition, medicine, and admission fees for children to attend school. In addition, they network with government hospitals, and educate sex workers on where the safest roads are for them to take. To generate revenue, WWS sells Agarbattis (incense sticks), compacts, pancakes, and perfumes among other things, which they showed to us and were eager to sell.
The presentation we prepared for the group consisted of three parts; 1) Menstruation and Hygiene, 2) Menopause, and 3) Breast Cancer. Courtnay and I planned to present part 1. Our session began with a basic diagram of the Female Reproductive System, which I asked the group if they had ever seen the diagram before. All of the women were quick to let us know that they had seen the diagram and they knew what it meant. We immediately realized that the group we were speaking to was quite different than the group we intended our presentation for. We thought we would be presenting to the sex workers themselves like the other group in our class, but instead we were presenting to the women that work on the Aastha project and they are the ones in the community facilitating the educating.
As is the situation in much of international public health, we had to improvise. Because the group immediately seemed disinterested in the diagrams and what we had to say, we knew we had to shift the focus of our discussion. Dr. Parrish suggested that we ask them if we could present our initial training program to them, and propose that they could provide us with criticism and feedback for how to make it better so that ultimately we can provide the women that work for WWS with training materials to then bring back to the sex workers community. They liked the idea very much, and we went on to give our presentation with some adjustments. After going through the menstrual cycle and female anatomy diagram briefly, Courtnay went on to discuss symptoms associated with the menstrual cycle. It was easy to relate to the women because they too could commiserate with feelings of low back pain, cramps, and other symptoms associated with menstruation. It was a great feeling to see Courtnay point to her lower back and another women smile and respond to feeling that same pain associated with her menstrual cycle. As women, we were all one, bonding over the same exact feeling. I don’t know why something so simple brought so much clarity to me, but it made me feel like there were very little differences between all of us sitting around the table.
As far as hygiene and sanitation regarding sanitary napkins, there were fundamental differences between best practices in the US and in India. We learned a lot from the group about how women in India often use sponges, or pads, reusing the sponges from day to day or even saving them for the following month. Female sex workers usually have 3 days off from work when they are on their period because the customers don’t enjoy it. It was difficult trying to communicate with the women how important it is to not reuse the sponge because they seemed to think it was sanitary after rinsing with hot water and/or detergent. In our proposed revised training module, Dr. Parrish suggested that we create a day by day diagram of best practices for women to maintain cleanliness and properly dispose of sanitation products. The group told us that they usual tell women to manage menstrual symptoms with medicine, putting their feet up, massage, or hot water bottles; all very similar remedies to those used in the US. The women also suggested that our training materials include descriptions next to each part of the female reproductive system, and list out the consequences of not taking care of the female body.
Charlotte did a great job speaking to the women about menopause. They didn’t seem to understand menopause as well as menstruation, and were definitely eager to learn from our presentation. A great conversation was had about common symptoms associated with onset, and we talked at great length about how it is very normal for women to undergo the process. The women felt very strongly that menopause is viewed as a natural and normal part of life for women, and didn’t note any stigma associated with onset amongst the population. The women did let us know that they women appreciate some training materials to have on hand at their office so that they can better educate themselves on the process and further distribute the knowledge to the community.
The breast cancer lecture given by Gen and Kelly was also one that the women really enjoyed. Some of the women were willing to share their personal experiences with the disease; one with a sister diagnosed with breast cancer, another gave an account of a women that uses Aastha Parivaar and how they raised funds for her to have treatment. When we asked the women if they knew how to check for breast cancer, none of them knew how. This definitely hit close to home for my fellow classmates and I Conducting a breast self exam seems second nature to most of us. We are taught how to do them and of their importance in basic health classes. Charlotte gave a great demonstration of how to conduct a breast self exam, and we made sure to highlight the importance to the women that not all lumps are cancerous, but if one is found, they should have it checked by a physician. It became very clear to us that this was a topic we needed to provide more information on. While breast cancer is not at the forefront of their areas of special interest, they acknowledged their desire for us to help them learn more about their body so in the future they are equipped with the self-knowledge to protect themselves.
The entire experience of interacting with the women was a lot different than what I expected. They were so attentive, and open to discuss any topic that we brought up. I know they learned a lot from us, but I really think we learned a lot more from them. They dedicate so much of their time to educating a population of women that is often looked down upon by their family and several members of the community, and it was comforting to know that organizations do exist to assist sex workers with the necessary resources to lead an informed and healthy life.
After the educational sessions, we headed out to a shopping area in South Mumbai known as Colaba. I think I was feeling a bit overwhelmed with emotion by the time we got there because I was not in the mood to purchase anything at all. However, I had a great experience wandering around with Courtnay. Someone walked up to us and said “Bollywood?” which has quickly become an inside joke amongst the group. Courtnay and I were talking about how walking around shopping with me the prices seem to be a bit higher, kind of amusing if you think about it.
We had dinner at vegetarian Indian food restaurant that served food in small dishes on a huge circular plate. The food was delicious, and a great end to the day. The group surprised Courtnay with a birthday cake to celebrate her 21st birthday India style! The restaurant staff were absolutely wonderful, playing a Happy Birthday song over the speakers in the back room.
Heading back through South Mumbai to the hotel, we went over the sealink bridge. It was a beautiful site to see all of Mumbai. The picture painted in my head of India before this trip is starting to look vastly different than the one I see now.
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