My Day in the Slums (Elizabeth)

Yesterday was a long day. It felt even longer since it was my first day back from being sick. A lot of people talk about the overwhelming smell in the slums, but for me, the worst part was looking at the ground and seeing what I was stepping in. We were not allowed to take pictures inside the slum areas since it would attract too much attention, but I did manage to take a few from the outside. We first met with an organization called SNEHA (http://www.snehamumbai.org/). This is a group of visionary men and women who work to improve the livelihoods of everyone in the Mumbai slums, but especially women and children. They have it right, you have to work from inside the community. This is something that we still do not quite understand at home. They are also the most patient people in waiting to see results. At home, if an organization does not show progress in a few months their funding supply drops. It has taken SNEHA over ten years to find small successes in such big problems. What I was most impressed with was the optimism of each of the women that spoke to us. They love every minute of their work, even when it is difficult. I just do not see this same kind of attitude in the US.

We split into groups and visited different sites in the Daravi slum. My group went to a day care center which cares for children who are severely or moderately malnourished. There were seven children in a small room. The one boy cried the entire time we were there and the girls sat quietly. They were all so beautiful, but so small. Their heads were normal size, but the rest of their bodies so thin that many of them did not have the energy to do more than sit on the ground. The day care keeps each child for about two months feeding them a special diet until their weight has reached a normal point. They all waved goodbye as we left.

As a group we went with SNEHA to one of the worst places I have ever seen. This slum was not even a slum, it was an open trash and sewage dump that happened to have people living in it. Flies are everywhere and children run around without shoes, although even shoes do not help here. A group of boys started following us around asking our names and even playing music on a phone in hopes that we would dance. 

We ended our day with a trip to the Family Planning Association of India, a partner of the International Planned Parenthood association. India is still a male dominated society, so women do not have a choice in how many children they have or when they have them. In some cases women seek out abortions in unsafe locations leaving them permanently injured. FPA of India works to solve these problems by offering safe abortions, contraceptives and other services free of charge. They work with youth to teach them early about the importance of family planning, as many girls in India are still married before the age of 18. We met a doctor who worked with FPA for 40 years and now works as a volunteer. There are men in India who support women and their rights, but it was nice to hear one in person who is so passionate about making sure women are treated as an equal partner in India. 

I am glad I made myself get up and go yesterday. It was something that I needed to see but hope to never see again. The problems facing India are too big for the government to deal with. The NGO sector is so important to the 

Empowered women

I received the most perfect timing e-mail from my friend Lacey, who I actually met when I was in India the first time four years ago. Her e-mail was about how she is in Vietnam and just drank the water and is hoping she didn’t get sick from it. Then she started to reminisce about how sick we both got together in India before. She ended the email by saying, “I hope you don’t get sick in India this time around”. I about died laughing and all I could think of is if she could have only seen me the past few days with my “Delhi belly” in full effect. Well, with the worst of the Indian sickness hopefully behind me and a determination to not miss anymore of India, I adventured out with the group after being completely down for two days.

We spent the day with the organization SNEHA. We split into groups to go into the slum of Dharavi to see firsthand the work of SNEHA. I choose to go with the domestic violence group because it intrigued me that an organization like SNEHA had even begun to tackle an issue like domestic violence with the huge gender inequalities in India. Just like in every country, domestic violence in India is not just limited to the poor or uneducated. The abuse stems from a multitude of underlying issues like substance abuse, childhood abuse, and a belief that women are the inferior sex. We met with ten women who have become the “peer educators” on domestic abuse in Dharavi. I was humbled by their dedication and passion towards helping women in domestic violence situations and educating them on the importance of speak out against abuse. In public health, we love the term “popular opinion leader”, which refers to the liaison between an organization and the community it is trying to serve. This person acts as a leader in their community and engages those individuals who otherwise may have been hard to reach by an outside influence. Sitting in a circle with these incredible women ranging from early twenties to later fifties, I realized that I was witnessing firsthand what true popular opinion leaders look like. They are people just as involved as the organization itself and want a voice in their own community. India has been such a whirlwind journey that I forget to step back and look at what amazing opportunities I have been given to see public health functioning in the field.

I think one of the most important things about traveling is having your preconceived notions about a country challenged. With gender inequality vastly ingrained within the Indian culture, I assumed that female equality in homes wasn’t a focus area in India. I feel happily embarrassed that I was wrong. Even in the poorest slum in Mumbai there are champions for women’s empowerment and women that have stood up against questions from their own families in order to participate in SNEHA’s programs. One woman smiled and said she told her family, “it’s the right thing to do and brings good karma”. The women in this group may not have years of formal education but are very wise on issues affecting their community. People, myself included at times, do not give these women the credit they deserve in being knowledgeable about solutions that could benefit their community. I had a chance to ask the group what they thought were the greatest problems affecting the slums. A lack, or none for that matter, of sanitary toilets and a high unemployment rate were the two biggest issues the women raised their voices about. I had two thoughts come into my mind: 1) It is always amazing how no matter where people are in the world some issues, like unemployment concerns, are universal; and, 2) How incredibly unfair it is that something as simple as having a toilet is a major concern in India. The things we are able to take for granted in developed countries will never cease to amaze me.

SNEHA Mumbai

Our first stop in Dharavi, one of Mumbai’s largest slums, at the Lokmanya Tilak Municipal General Hospital to meet with SNEHA founder Dr. Armida Fernandez and her program directors. SNEHA, which means “mother’s love” in sanskrit, is a non-profit NGO that addresses the needs of women and children living in slums of the Mumbai. It all started in the 1990s when Dr. Fernandez, a neonatologist of 30 years who eventually became dean of the medical college, became frustrated that the babies she was saving in the hospital were returning to dire conditions back at home in the slums. It was then that she began to build a bridge between the hospital and the community.

SNEHA provides services in four major areas: maternal and neonatal health, prevention of violence against women and children, sexual and reproductive health, and child health and nutrition. [Side note: The NGO also has an enterprising arm where they train women to make and sell quilts from donated fabric scraps. In some cases, a household’s income increased 4-fold! Our group came through like a monsoon and raided their warehouse. I went a little overboard and bought four quilts and three pillow covers.] There’s a strong emphasis on using replicable/sustainable models that focus on family and community units, engaging partners whenever possible, and embedding rigorous (hello, randomized-cluster sampling) research and evaluation. We saw and heard a lot more on the other programs but one of the most passionate, and memorable presentations for me was on PVWC. Here are some startling statistics:

• 52% adolescent girls/57% boys think beating is justified
• Every year, the national crime rate against women increases by 7%.
• In 2011, there were 24,000 rapes and 8,618 dowry deaths (typically burnings of women perpetrated by husbands and in-laws unhappy with the amount of dowry brought into marriage. Why burning? Because it’s difficult to prove homicide. This occurs in the world we live in.)
• 12 million girls were aborted in India in the last 30 years.
• All of the numbers above are likely to be under-reported

SNEHA not only provides legal and counseling services to victimized women and children, it also advocates for the status of women and challenges the community to accept domestic violence as a public issue. Since this is a systems-level problem SNEHA is active in community organization and prevention campaigns and works in partnership with government and social service providers (police, legal, health, education). This work only scratches the surface of the problem, but I believe the approach is right. I hope the women of Dharavi feel just a bit safer, rest just a little easier.