Day 4: Speechless in Dharavi

Slum (n.) |sləm|

• a squalid and overcrowded urban street or district inhabited by very poor people.
• house or building unfit for human habitation.

· See DHARAVI.

There are few things that make me speechless, there are few things that make me emotional, and there are few things that make me cry. My visit to Dharavi did all of the above. Some of you may be familiar with Mumbai’s largest slum as being the setting for the Oscar winning movie, Slumdog Millionaire. However this is not a mere two-hour Hollywood film for the people living in Dharavi, this is true life. A life filled with sewage, trash, and unkempt houses at every corner. Though my description of Dharavi, a city of Mumbai built on a swamp, sounds unlivable it is now home to around 1.5 million people.

Before arriving to Dharavi, we picked up Vinod Shetty , Director of the ACORN Foundation India. ACORN Foundation is a registered charitable trust that hosts the Dharavi Project initiative. “The Dharavi Project is a multimedia project that utilizes artists and social-impact programs to change the living conditions of over 100,000, 'rag-pickers' who are segregating waste in and around the landfills of Mumbai. Its mission is to increase the welfare of rag-pickers, and give their profession a legitimate and sustainable voice in the recycling and waste-management value chain at Dharavi.”

The rag-pickers of Dharavi, including children, make their living of 100 rupees a day (the equivalent of $2US) by picking up garbage and selling dry waste to scrap dealers. Shetty explained to us that Dharavi is the largest hub for recycling in Asia. Here, nothing is considered garbage and as a result the people of Dharavi create wealth out of what we would call trash. There’s a native intelligence amongst all of the Dharavi citizens, an intelligence that allows them to survive and navigate their streets. Here the equation in everyone’s head is: plastic = rupees, paper = rupees, rupees = survival.

The majority of the people living in Dharavi are content with their living situation, they have jobs, a roof over their head, and a community around them going through the same daily battles. The priorities of the poor are something to be admired. Because when you have close to nothing and don’t have a choice, you have to make do with what you have. They have little to no representation and as a result have to vent for themselves. Consequently, work is essential to their daily lives. Shetty defined their lifestyle as a day-to-day struggle- for electricity, water, food, roads, and schools. The people here struggle for what you and I would call basic needs; needs that we are born with. It breaks your heart to think that this is what they wake up to, and to think that they are fighting for a right to survive, or as Shetty called it a right for their citizenship. The picture is grim, but it’s real, and there’s so much the government could do if they would just recognize what these people are going through.

Work is all they know, and as a result their own health is on the backburner. Those that work in the factories, use no form of protection for any part of their bodies. Children run around barefoot and they use dirty water to cleanse themselves. As an outsider looking in, with my slight background in Health and Communication I found that the people living in Dharavi are in need of health education on the topics of chemical toxins, safety, and monitoring their own health.

But with the help of ACORN Foundation and donations from others at least something is being done…not much but something. On our trip to Dharavi we not only got to see the ACORN office but also got to meet two brothers (both around the age of 10) that work there. We learned about Dharavi Rocks, a “joint project between ACORN Foundation and blueFROG” that brings the world of music to the children of Dharavi. Various artists from all over the world help by performing and putting together workshops. One of my favorite quotes by Shetty was “World music started in the streets, therefore street music must also go to the streets.” Music is that global language understood by all and most importantly music has the power to brighten up anyone’s day. The makers of Dharavi Rocks believe that “that music makes a difference. It educates, improves learning skills, self-discipline, self-confidence, encourages teamwork, improves social skills, temperament and community life.” This could be seen when meeting the two brothers at the ACORN Foundation. They sang for us and played on drums made out of recycled bottles. A moment that I will forever treasure because it just illustrates how family and music can bring sunshine to the darkest of days.

Shetty is a labor lawyer in Mumbai; he explained that he is involved in grade unions and social movements. His primary clients are formal workers. When asked the question ‘How did you get involved with the slums of Dharavi and the ACORN Foundation’ his reply was simple: “I’m a member of the Bleeding Heart Society, just like many of you I want to make the world a better place.” He continued “I found it time to also represent the informal workers and if nothing more, the smiles on children’s faces brings joy to my heart.”

Though Vinod Shetty and the ACORN foundation may not be an example of Social Entrepreneurship it is his passion and dedication to his mission that each social entrepreneur should mirror.

A different view of India

"To initiate, augment and intensify action against those causes of massively prevalent disablement for which there exists a potential for prevention and control, which can be delivered through existing delivery systems and available infrastructure." -mission statement, Impact India Foundation

We left early Friday morning for our first visit to a rural area. As soon as the bus was out of the city, I felt a huge relief. For the first time we were able to witness the beauty of nature in India. I was starting to get a bit emotionally wound up observing so much poverty among the city communities, but going out to a more rural area seemed much more familiar to me. In January I had the opportunity to do a service project with Global Brigades in Panama. We spent 9 days building justa stoves and slow sand water filters for a small community three hours from Panama City. That was my first real experience with poverty as we spent 9 days sleeping on the concrete floor of the school with little running water. The people in the community lived without electricity and most did not have access to running water let alone clean water. A lot of those experiences came back to me as we made our way to the Thane District of Maharashtra.

The Community Health Initiative (CHI) is a Project of the Government of Maharashtra in association with the Impact India Foundation. The CHI mainly focuses on reduction of future incidence of disablement and eradication of existing disabilities via prevention and curative measures, as well as health communication. Prevention programs focus on immunization, nutrition, maternal and child health education, and water management for the empowerment of the community.

We first visited an ashramshala, a tribal residential school, to meet with the government physician working in the community. The school children were so excited to greet us, and a select group of girls in the class known as “health monitors” presented each of us with a red rose. The health monitors have the responsibility of recording BMI measurements, and keeping track of illnesses that their classmates report to them. We watched the girls record weight and height entirely on their own. With each health monitor responsible for 10 of her classmates, this is an incredible method of empowering young girls. I was actually really surprised to learn of this model and think it is a great way to engage the schoolgirls and teach them to take an active role in not just their own health, but the health of their peers. While at the ashramashala, we also assisted the physician in distributing vitamin A and folic acid supplements. The girls let us know that they really enjoyed taking the supplements because of the taste, and they all knew why it was important to take their supplements every day.

Our next stop was a visit to a government auxiliary nurse midwife at the women and children center. We listened to the nurse give a talk to the women about the importance of breastfeeding and best practices. She spoke about how important the first feeding is, and ensuring the baby is strictly breastfed for at least the first 6 months of life. Much of what the nurse had to say included things that we learn about in class and it was very positive for all of us to see these points being reinforced in exactly the way we are taught. The nurse also performed a hemoglobin test for anemia on one of the schoolchildren. We watched her administer the test right outside the center in front of our entire class and several of her classmates. The girl ended up testing positive for anemia, and what I found most interesting was her reaction to what the nurse was telling her. A group of us spent a few minutes discussing how in the US, there would never be so many people listening to the interaction between a patient and a nurse. Most of us would feel uncomfortable with so many people having access to our health information, and might not want others to know of our health status related to any disease. The little girl didn’t seem to think anything of it, and it seemed very normal for members of community to be aware of other’s health status. When the nurse asked the little girl what she was going to do about testing positive for anemia, she said she would eat more green leafy vegetables and take her supplements. It was fulfilling to hear that she had learned something from the educational sessions that the CHI has been providing for the children.

Next we visited the primary health center in Saiwan where the government physicians are primarily based. We received a tour of the facilities and discussed how the clinic is operated. The patient exam rooms and delivery room did not contain the modern amenities that we are used to, but I was impressed with how well kept they were. The way the clinic is run is not much different than the way community health centers are run in the US, but facilities like this one are decades behind the ones we are used to as far as equipment and staffing. Our last stop was a visit to another ashramshala where the lifeline express mobile clinic was conducting eye exams. The mobile clinic had performed over 80 eye exams by the time we got to the school late afternoon.

I was really inspired by our visits to all of the sites where the Community Health Initiative is working. Their services have reached hundreds of thousands of people and continue to have a positive impact on the health of people living in tribals in rural Thane District. The model that they have created is efficient in utilizing existing available delivery systems and existing infrastructure, and will ultimately provide the government with a successful blueprint to implement similar models in rural areas throughout India.

Making an IMPACT

We wrapped up a whirlwind week with a whirlwind day in several rural villages with IMPACT India. It felt wonderful to get out of the city, and we were able to observe some of the activities IMPACT does in the rural areas working with tribal people, including an ashramshala (residential school), a breastfeeding education session, a primary care center, and a mobile eye clinic. One thing we did not get to see was the Lifeline Express, a train the visits approximately 10 rural locations a year delivering life-saving surgeries free of cost to patients. The train, which is sponsored by members of Parliament and corporations, has nearly eliminated cataracts and has transformed people’s lives by, for example, fixing cleft lips. IMPACT India seems to be an example of public-private partnership that actually works.

Our day was like a smorgasbord of public health interventions in action. At the Bapugaon Ashramshala, we were welcomed by the girls of the school and participated in a Vitamin A and Iron/Folic Acid supplement distribution. We learned that the school has health monitors, girls who are elected by their peers to BMI and report any illness (eye infection, lice, etc.) among the groups of 10 they each represent (see picture below). I was really moved by this empowering role for the young girls, and the potential long-term impact in can have on their ability to recognize illness in their children someday.


Later that day we saw a hemoglobin testing to identify anemia, a mobile van performing eye exams (picture below), and a primary care center that serves 50,000 people, providing everything from antenatal care to snakebite treatment.

The most interesting part of the day for me was listening in on the breastfeeding counseling provided to a group of 10 or so women by a nurse midwife. The messages the midwife delivered were spot-on. It almost seemed like she was following Dr. Ramiah’s bullet points from the Maternal and Child Nutrition course I took earlier this summer. It was so refreshing to hear that accurate health messages from WHO and others are making it to women in rural areas.

An inspiring day, filled with hundreds of adorable children, but we also had to face reality. What I found most disheartening was when we talked about how most of the girls in the school will be married off at age 18, if not before, and few will have the opportunity to chase their dreams, like one girl who told us she wants to be a doctor. IMPACT’s general director stressed that the most practical intervention for these girls is keeping them in school until 10^th grade and then providing vocational education so they might be able to learn tailoring, weaving, and so on, to earn a living and provide for their families. This is where social entrepreneurship can come in, but it takes time and may not drastically change lives. Thus I felt like today was a good example of the potential of social entrepreneurship, as well as public-private partnerships, but also its limitations.

Inspired by Sex Workers

Day 2: Yoga, Sex Workers, and Indian Celebrations…

“Because of my work, my daughter is getting her Bcomm and my other daughter now works at the bank” – Sex Worker

“Because of the work I do, I was able to provide a computer for my children so they can learn” – Sex Worker

“I hope in my next life, I am as educated as you” - Sex worker

Today, we began our day with an hour of Ashtanga Yoga, or eight-fold path. We then enjoyed a nice mix of Indian and Continental breakfast at the hotel.

Our assignment for today was to prepare a training protocol on reproductive health for commercial sex workers who also work with community based organizations (CBOs) empowering sex workers to better understand their bodies and use protection. Our group of 20 was divided into two groups so we could train two CBO sites. Our group went to the Kranti Mahila Sanstha (KMS) community based organization. We met with approximately a dozen sex workers who were excited to learn from us. We focused mainly on the menstrual cycle, hygiene, menopause, and breast cancer.

I was in awe of how much they understood what we taught them. At the same time, they were eager to listen so they could be assured that what we were teaching them is what they also knew. They needed the assurance. They mimicked our demonstration so they could then later teach their peers.

What I was most amazed by was their curiosity in wanting to know if there were other sex workers in Washington, DC and if these sex workers were also illiterate as them. They wanted to feel that they weren’t alone.

Once the group left – we had to wait for our bus for approximately 20 minutes. During this time we met with three sex workers that were also waiting for a ride. We used this opportunity to learn more from them – how their families felt; how their husbands felt; How much money they make; and if they want to leave the business.

The women shared with us that they met their husbands as clients first. They do have children but have put their children in boarding schools, as they do not want their children to know or understand their line of work. The women want to leave this work for many reasons – violence, drunk men, harassment; however, they receive approximately Rs 15,000 a month which allows them to provide for their families. The conversation was so humble and frank. They were proud of the fact they were able to do so much for their families. Though they wanted to live this line of work, they have learned a lot about society, themselves, and used the opportunity to empower other sex workers to be safe. It was inspiring to watch these women take advantage of an opportunity that many do not. The quotes I mentioned above, are exact quotations from the women we met today. They taught me that no matter the situation, I too should be better about taking the best opportunity I can.

After spending a few hours with them, we went to dinner to have a traditional thali meal. The women in our group loved it. One of the women had turned 21 so we celebrated with a cake (which was actually good) and the Indian version of Happy Birthday. It was the perfect way to end such a fascinating day.

So factual Information about Sex workers:

• The Largest Red Light Districts in India are in Mumbai and Kolkota
• There are many organizations in India that promote sex sexual practices and educate them on HIV and other STI preventions but very limited NGOs that actually help sex workers leave this line of work
• 50% of Sex workers have HIV.