A lesson in flexibility

Yesterday our training session with Aastha Parivaar was a lesson in flexibility. We arrived at the drop-in center to find a small meeting room with several women already gathering around the table. We found out quickly that we did not have a translator per se but that two of the program staff understand English enough to translate, but Pavitra and Rashi jumped right in and ended up doing most of the translating.

Next, our well thought out plans of having all of the participants sit intermixed with us in the circle were quickly changed when we realized we did not have enough chairs and the staff continually urged us to sit while others stood. Then, in the biggest change to our plans we discovered that the group was not in fact sex workers but community outreach volunteers and staff who work with sex workers. There were even several men in the group, which we thought would reduce the women’s openness to discuss sensitive topics, but they assured us it was fine. This was an ironic realization, that we – a bunch of Americans – were actually being too concerned about cultural sensitivities!

But at last we began our introductions, which lead into incredibly insightful introductions from all of the participants and staff about their organizations and what they do. We had board members and representatives from several organizations affiliated with Aastha Parivaar including Social Activities Integration (SAI) and Women Welfare Society. We learned that Aastha Parivaar means a sympathetic family, which is not only a beautiful phrase but actually what the organization becomes for the sex workers, or Didis, who in some cases might be ostracized from their own families. In addition to outreach with sex workers, the organizations present also provide community-based and mobile healthcare, HIV awareness through street plays, education for children of sex workers, prevention efforts with men who have sex with men and transgendered communities, and prevention of mother to child transmission of HIV, among other efforts. And they have a social enterprise side, which includes selling makeup, incense, and perfume to support the social programs. It was heartwarming to see how the women were so eager and proud to show us their products.

When we started the training session we quickly realized that the women already knew all about menstruation and menopause – two of the topics the program staff had requested we cover. So, with Dr. Parrish’s suggestion, we flipped the session around to ask them to review our training materials and give us suggestions on how they might be more culturally relevant. Having just finished a course in global health communication and done some background reading in preparation for this session about participatory resource creation, I was pleased to get the opportunity to conduct this kind of a session. Despite a few stops and starts as we adjusted to the new format, the women who were so warm and open, and I just felt honored to spend time with them.

When it came time for Jenn and I to talk about breast cancer, we found that the women were not as informed, so we were able to educate them a bit about the importance of self breast exams and when and how they should do them. Although two women shared stories of family members and friends who had suffered from breast cancer and one woman had herself recently found a lump, the women as a whole did not feel the topic was terribly important, compared to the more widespread and immediate threat of HIV among sex workers. However, by the end of the session we were able to help them see the growing risk for breast cancer and the importance of being familiar with their breasts in order to proactively manage their health. Dr. Parrish made the very good point that breast self exams are an empowering activity because, unlike most health activities that require a third-party such as a doctor or a nurse, women can do these themselves. It is also a good way to teach women to be proactive about their health in general. In the end, the women agreed that they would find training materials on breast cancer useful.

I am excited to work with the group and Dr. Parrish to create these materials and then get feedback from Aastha Parivaar about their effectiveness. And, I know that throughout my career I will look back at this experience as a perfect example of how no matter how much preparation you do, or how many stakeholders you speak with to try to understand their expectations, you might have to completely switch on the spot. You just have to pause, readjust your thinking, keep on smiling, and see the value in the unplanned.

Confronting the Rich-Poor Divide of Globalization

Our third day in India had us conducting a site visit to an Aastha Parivar (“Family of Support”) site that centered to helping and empowering individuals working in the Mumbai sex trade. The visit to the Women’s Welfare Society, a community based organization (CBO) that provided educational, clinical, and social support to the sex workers was interesting in that it challenged many of our conceptions of the community and our role as public health experts and educators. Shortly after we arrived for our service project (to help train the CBO leaders and volunteers, we quickly realized the shoe was quite literally on the other foot. It was they who had much to teach us and our role was to listen and learn about what were the actual ground conditions. In sharing our training materials and seeking feedback to improve them, we learned how the women in the trade dealt with health issues and how they already negotiated respite to conserve their health and support one and other.

Ultimately we left with several excellent ideas to improve upon the training materials and a lot of exchange of good will on the part of both sides. Some of the key lessons include the age old need to survey real-time ground conditions in developing public health training materials, really listening to the target audience to learn what their concerns are, and realizing that in the end everyone is part of the human family and that all women around the world share the same concerns, stories and ways of coping.

From the depths of Byculla and Grant Road, our team proceeded to the heights of cosmopolitan Mumbai and the Colaba area with its fancy shopping, hotels, monuments and skyscrapers. Although, somewhat disorienting, it nevertheless provided an interesting contrast to the earlier experience and added to our understanding of the multifaceted nature of the city and country.