Dirty Wall Project

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I look across the clinic waiting room and watch the young mother. Her face is held in contempt, her eyes stare straight ahead and her lips are curled down and I can’t help but wonder what she’s thinking.

An hour before, while I was walking through the community, I noticed her youngest daughter wobbling after her older brother towards the school, barefoot and filthy, her stomach protruding prominently over her shorts. I stopped the ragged twosome and asked where their house was. Ashley and I went to their home and found out the family had only recently moved to the community in the past few weeks. This family’s story is a familiar one across India and our community. Meager earnings and six children leave the young mother over-burdened and unable to cope with the numerous medical ailments of the children and she has begun to turn a blind eye to the obvious health problems her youngest daughter faces.

I nudge Ashley and whisper to him to look at the mother and ask why he thinks she looks so angry with us? He’s uncertain as well and we think maybe it’s because she’s unsure of us and might be wondering if we are as well meaning as we say we are. A few more minutes go by but I can’t take it. I ask Ashley if he’ll sit beside her and ask her what’s going on and if she is still OK with us taking her children to the doctor?

Ashley gets up and quietly sits beside her and speaks to her. I watch as his face turns from concerned to frustrated and I fear what she has said. He puts his hand up in frustration and sits beside me. He tells me she wants to know why we are causing her trouble and why we can’t just leave her alone? I look down at her daughter who stands below me gently tugging at my leg hairs, her huge unblinking eyes are dark brown, nearly black. She is unaware of her problems and I’m saddened, not by her mother’s comment, but by the situation so many families find themselves in and the lack of knowledge they possess to pull themselves out. This mother, no doubt, came from a family just like her own, starved of nutrients during her early years which stunted her development both physically and mentally, setting in motion her current situation.

It seems everywhere I look since my return to Mumbai I see insatiable greed that is ruining the lives of those at the bottom of India’s economic pyramid.  Money drives our world and in India’s boomtown, money means everything, including access to proper education and healthcare.

India’s Healthcare system is divided into two parts, municipal (government) or private.  The private healthcare option ranges widely from the mildly affordable to the ridiculously posh with deluxe surgery suites. But the municipal level is even across the board with crumbling buildings, overworked doctors and packed, filthy corridors where the the sick come to get sicker.   The cost of care is low for surgery and medicine at the government hospital but the chance of infection and long waits are guaranteed. India’s upper class often speak highly of these government hospitals speaking frankly, saying that these hospitals are there and free so why do the poor patients still want to come to the private hospitals? I have met with countless cases in Mumbai where adults and children have contracted HIV through blood work at municipal hospitals. (Read my blog post about our friend Ganesh’s final hours at Sion Municipal Hospital last year). I have had the opportunity to work helping poor patients in dozens of hospitals both private and municipal across this city and each time I am no less appalled and embarrassed for a city with immense wealth to house patients in crumbling buildings, with rusted bed tables and stained sheets. Two weeks ago, while funding an angiography for a DWP patient at a municipal hospital in Mumbai, I decided to attach my small Go Pro camera to my backpack as I wandered the halls hoping to show a glimpse of what India’s healthcare system looks like from the bottom up. Two hours later as we still struggled to get the appropriate forms filled to even gain admittance for our patient, I suddenly noticed I was surrounded by tan coloured uniforms and one angry hospital supervisor yelling at me in Marathi. The gig was up and I was quickly escorted out of the hospital for illegally filming and taken to the hospital police headquarters to meet the sergeant. Nervous and ever thankful that Ashley was with me to translate for me, we found ourselves sitting on metal chairs in a dimly lit and dank room. Behind the desk sat a young sergeant with a pleasant demeanor. He was told by his officers what I had been up too and gave me the opportunity to explain. Explaining that I only wished to document our patient’s procedure for our records, I apologized profusely while thinking how Ashley was going to break the news to my parents that I was now in jail?! After a few tense moments he looked at me and thanked me for helping his country and people.  I was shocked and relieved and finally relaxed. He then went on to say that the healthcare system is terrible and sickly and the government does not want any filming or photos making it out of India or to the media. He was embarrassed for his country…but what to do he said??

The state of the healthcare system does not stop at the hospitals, but spreads deep into each community across the city in small decaying clinics and pharmacies. India’s drug market is also split in two, selling prescription drugs by “branded” (quality) or “generic” (low quality and sometimes completely fake). Prescriptions from government hospitals are often given using the generic names which sell for a fraction of the cost. A branded pack of pills will sell for 100 INR($2 CAD) where their generic counterpart will sell for 20 INR (.40 cents). This is great in theory because generic medicines are somewhat affordable for all sectors of society but…nothing is ever as it sounds. I have filled hundreds of prescriptions over the last few years and finding these generic drugs can sometimes be next to impossible. As a business pharmacies are not interested in selling drugs which are one quarter of the price, as they stand to make less money.

The next major problem in the system comes in the systemic abuse of antibiotics across the city. Small shops turned into “clinics” and “hospitals” hand out cheap antibiotics like candy to nearly every patient through their door. Just yesterday, an article in the Times of India wrote about all the new viruses including a new strain of drug resistant TB which antibiotics and the rampant abuse of them has surely caused. Every slum community has a small clinic nearby where the majority of people go because the cost of drugs is cheap. The clinic near our community is a ten minute walk away and deals with any type of case. Patients complaining of upset stomachs, diarrhea or with open wounds are all given the same generic blue or white pills which sit in the clinic’s only drawer in two separate containers, wrapped loosely in newspaper and cost 50 INR – $1 CAD. The antibiotics clear up the problem quickly, but not forever, and both patient and doctor are happy.

Malnutrition is so rampant throughout India (1 in every 3 malnourished children worldwide live in India) that it is believed to be double that of sub Saharan Africa where massive droughts and food shortages are abundant and pandemic. Yet, 48% of India’s children are malnourished, underweight, under height and developmentally challenged due to poor nutrition and hygiene habits where food is available and within reach for nearly all urban slum dwellers in the city. Perhaps the way to help this next generation of India’s poor is to educate their mothers about nutrition and hygiene, to ensure, despite their economic standing, the improvement of their children’s health and well-being as well as the need for birth control. With no money for birth control and no control over their own bodies, women must endure multiple pregnancies, miscarriages and the premature deaths of their children because of illness and abnormalities.

Eight months ago I briefly came into contact with relatively new NGO in India called the Foundation for Mother and Child Health (FMCH). FMCH has done extensive work through South East Asia and has expanded their field of help to Mumbai, India. I became immediately interested in their work and visited their clinic a few months ago and followed up, bringing several malnutrition cases from our community across the city to see their doctor (Dr. Rupal) and the team of health care providers. The thing that struck me is the care and passion they have to truly bring about change in these young families by nurturing the babies and teaching the mothers practical and useful knowledge. FMCH concentrates their efforts on children 0 – 6 yrs. old, holding daily clinics, cooking demos and awareness campaigns all geared towards the developing child and their mother.

Two days ago I sat in front of our school during our monthly health camp and watched as mother after mother with swinging babies on their hips and children in tow lined up to see a doctor and I realized that these young mothers need help and access to the knowledge to help their children, and not just another blue pill. A few hours later, I travelled across the city to FMCH’s offices in South Mumbai and met with their committee. In our meeting, we took turns discussing our work and what we both had to offer one another all in the hope of fighting the same battle. FMCH is currently looking to expand to other communities and I have pitched for that next community to be ours. This will be a big project and partnership, but one that can truly have a lasting and meaningful impact on hundreds of families and India’s next generation.

FMCH will be visiting our community in a few days to view first hand our centre and projects and with any luck to set in motion a health commitment to an entire community.

Sincerely,

Kane Ryan

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Indu...

The third installment  in our interview series with the women of  the Girls Can Be centre.

-Interviewed and written by Cindy Ryan

We don’t remember meeting Indu for the first time two years ago, but since then she has become a friend, a translator and a co-worker despite the issues of culture and language lingering in our Hinglish conversations. Of all of the women we have daily contact with, Indu, who speaks English easily meets us halfway. She refrains from treating us as outsiders in her constrained world by allowing us to treat her as an equal. In India, especially among the poor, foreigners or firangis are treated with the utmost respect. Often when we have helped someone or when we meet someone for the first time, they gently bend at the waist to touch our feet and then they touch their heart. With all due respect to this tradition, it is met with uneasiness on our part to be the one who deserves more respect for simply being foreign and white, but Indu allows us to be friends and it is in this relationship that we have had many conversations and shared many light moments full of mutual teasing, sarcasm, and pranks often with Indu raising her voice while she says, “Hey Bhagwan!!”

Indu has the most beautiful hazel eyes set against copper coloured skin with sharp, defined cheekbones and a grin that stretches from ear to ear. As a 27 year old unmarried woman who has worked at a few jobs and has an education that reached the 14th Standard, she has confidence, ambition and aspirations. When her formal schooling ended she started working for a neighbour making jewelery, and when the neighbour opened a shop, Indu was hired as a sales girl and happily worked there for 3 years gaining skills that she would carry with her to her present job with Janvi Charitable Trust and recently as the manager of the Girls Can Be women’s centre in the Saki Naka slum community. This outside work experience plus her education set her apart from the other women who work at the women’s centre who are mostly illiterate and play traditional roles in their families.

As a young girl Indu lived in a slum in Mumbai with her parents, who are from Uttar Pradesh, and her two brothers until the slum was demolished and they were granted a slum rehabilitation apartment near Saki Naka. After the demolition of their slum home, they lived in a camp for two years until their very basic apartment was built. Her father works as a mechanic at the airport and her older brother works there as a forklift driver. Her other brother, also older than Indu, died 6 years ago of kidney failure and soon after her mother literally cried herself to death, despairing over the death of her son. The other members of her family include her sister-in-law and her 2 year old nephew, Granth, all of them living together in under 500 square feet on the fourth floor of the recently built, but never finished apartment building with a smudgy view of the hazy Mumbai skyline and the international airport a few kilometers away.

While at work at the women’s centre, Indu, who sometimes dares to wear jeans and a t-shirt instead of the traditional outfit of a colourful kurta and leggings, is either singing Bollywood tunes while she works or is cradling her cellphone against her ear while she expertly guides the women in their work. On the other end of the cellphone is her boyfriend. Indu wants a love marriage and she declares that she will marry her boyfriend within a year. At age 27, in her community, she is marrying late. The early death of her mother put the brakes on her family looking for a potential mate for Indu and she found her life partner on her own, causing tension in the home because her father is insisting that she wait until he finds a suitable match who makes more money than her boyfriend. Indu is boldly hoping that her father will come to accept her decision for a love marriage once she is married. Because Indu’s father won’t agree to the marriage, Indu and her boyfriend will not be allowed a traditional Hindu ceremony and they will have to marry at a court, although Indu insists she will wear a sari.  Indu has a curious mix of traditional and modern thinking and is aware that as a poor woman in India her desire  for a more modern way of life will be difficult. A woman is not supposed to work outside the home.  Instead she is to concentrate her energy on her husband and home life, which means cooking, cleaning, having children and obeying her in-laws. Indu sees life differently from her parents and hopes to instill modern values in her children with a link to tradition. “Independence and love marriage will be allowed for my children”, she said sofly. After a moment of quiet contemplation, she remarked, “If I have a daughter I would like her to become a singer because this is what I wanted for myself.” As we watched Indu answer these questions about love marriages and independence, we also noticed she became quiet. She knows that, like a flower that loses its petals in a brisk wind, the gales of tradition might keep her from realizing a more modern way of life.

With marriage to her boyfriend on the near horizon, Indu is saving her wages from the women’s centre and Janvi. Although poor, Indu is somewhat savvy and invests her meagre savings in gold jewelery. With no bank account, this is the way many poor Indians ‘save’ for the future. Gold is king in India and sometimes glitters on the fingers of the poor although most would have to use a money lender to purchase it. Cashing in her few pieces of gold jewelery and using her boyfriend’s savings, the couple plan to buy a 14 foot by 18 foot plot of land in the far northern reaches of Mumbai for 70,000 rupees ($1400 CAD).  Indu has calculated that it will take them months to save enough money to buy the tiny plot of dirt and then it will take a further eighteen months of saving to build a simple brick dwelling.

Once Indu’s  work day ay the Girl’s Can Be centre is finished she makes her way home, stopping to talk to friends in the chaotic, garbage strewn streets of her neighbourhood which is where her social life starts and stops. Her relationship with her boyfriend is carried out for the most part on her cellphone as she is not allowed out in the evening without her brother as a chaperone. She looks forward to her evenings in her tiny apartment where she helps her sister-in-law cook and clean, and then she settles in to watch Hindi movies on television.

Ending our Indu ‘interview’ with a philosophical question, we asked her, “If you could have anything or do anything, what would it be?” She stopped sewing and took a minute to think, her eyes moving slowly back and forth, pondering the question. Her answer was inspiring and passionate. “I would want to be a politician and change the corruption in India. I want India’s money to be for the people”, she declared. Although it is unlikely that Indu will become a politician, her attitude towards education, jobs for women, the right to choose one’s own path, and her declaration of raising independent children who will be allowed to choose for themselves, we are hopeful that her children may have that opportunity.

Inviting us for dinner at her familiy’s apartment a few weeks ago, Indu excitedly showed us the view from the end of the common beige hallway dotted with doorways every ten feet with a cluster of footwear outside each door. In the near distance an airplane was landing at the airport. Saddened that we were about to leave from that airport in a few days the moment was met with shuffled feet and sideways glances and fortunately interrupted by Indu’s nephew who wanted some adult attention. A few days before, our departure bearing down on us, we held an impromptu geography lesson in the Girls Can Be room. Using our laptop and Google Earth we showed the women where Canada was and told them how long it takes to fly to Canada from Mumbai. They weren’t impressed because it takes longer to get to their native villages in northern India by train. We tried to tell them how many kilometers a plane flies in one hour giving weight to our argument that Canada is indeed very far away. This was met with suspicion and loud chatter. What they agreed on, is that although we disappear in the airplanes they see flying overhead, we will come back the same way, all of us anxious to see each other again.  In the meantime, Indu will keep singing Bollywood tunes and planning her love marriage and the children she wants to have, who she hopes one day will have the chance to fly in one of those airplanes.

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Shashi & Seema

Shashi and Seema 

This is the second installment in our interview series with the women of the “Girls Can Be” centre.

Interviewed and written by : Cindy Ryan

Shashi, a striking beauty with high cheekbones, large eyes with lush lashes and a wide generous smile, was 18 when she started working with Ashley in the community as an assistant in the kindergarten. Her sweet presence in the kindergarten charms the children into listening to Usha Teacher.  Rarely speaking in voice above a whisper when we first came to know her, two years later and now twenty years old, she has blossomed into a chattering, excitable young woman who charms not only children, but us as well. She is second in command to Indu at the womens’ centre teaching women much older than her basic sewing skills.

Her father who is a private car driver and her mother, who takes in sewing for money,are anxious to arrange a marriage for Shashi. Although busy with the upcoming Hindu nuptials of Shashi’s older brother, they are keen to find Shashi a suitable husband. Shashi has two brothers and one sister, all living together in a chawl house. ( A chawl is a neighbourood of permanent, legal brick two story homes of about 500 sq. ft., with meandering lane ways connecting the chawl to the busy city streets).

Educated up to the 12th Standard, Shashi is literate, confident and exhuberant but her life experiences have been limited to her parent’s home and her job with Ashley. When we asked Shashi if she wants an arranged marriage, her eyes popped open wide and she exclaimed, “No, I want a love marriage!” Then her eyes narrowed and her smile dissolved quickly as she reminded herself that her parents will not allow her to make this kind of choice for herself so she must be confident that they will find her a good husband who has an education and a good job. Her brother, who can advocate for Shashi in the family structure, can tell the parents if Shashi doesn’t agree with their choice of husband for her but this is just a formality in a traditional household and her parent’s will ultimately decide for Shashi who she will spend her life with.

We asked her what kind of wedding she envisions when the time comes. When Indu translated our question, Shashi, just like most young women of marriagable age, became animated and the two of them chattered on about the details of her impending wedding. She wants to wear a yellow saree for the wedding ceremony, but during the course of the 5 days of festivities, she will change in to three or four different, equally beautiful sarees. Regardless of the exhuberant festivities involved in a Hindu wedding ceremony, the young bride is usually tearful, frightened and pensive because after the last marigold garland comes down she must begin a new life with strangers, leaving her family behind. Visits to her parents and siblings will be dictated by her in-laws and her husband. Shashi, like all brides in arranged marriages must endure and adjust to her new life and never complain.

We asked Shashi about what she would want for her future children and she answered, “I want them to have an education”. Regarding arranged marriages for her children she replied, “No, they could have a love marriage, even to someone of a different caste.” We take note that although women who are in the circumstance of having an arranged marriage, they boldly assert that their children will have choices. For the next generation, perhaps the roots of ‘modern’ India will take hold among those who toil at the bottom of the caste system.

While Shashi is educated, beautiful, and confident, she is also an obedient daughter and will be an obedient wife. Her job skills will be shelved, replaced by the routine of caring for children, her husband and his parents. She must give her mother her full salary from Janvi and Girls Can Be to help offset the cost of her dowry. She is not allowed to socialize in the evenings, occasionally seeing her friends on Sunday. Instead she must cook and clean for her parents and brothers while she awaits her arranged marriage. While this is what life has in store for Shashi, she is not unhappy and when asked if she could do anything she wants, what would it be, she looked up from her sewing, thought a minute and replied, “I would like to work in an office on a computer.” While Shashi will unlikely ever work in an office, or touch a computer, her education, her work experience before marriage and her beautiful confidence and sweet, sensible nature may ensure her children get to realize their ambitions beyond arranged marriages and the confines of tradition.

Seema

Seema, Shashi’s 18 year old sister, is lovely, bright, funny, energetic and deaf. Born with only the ability to hear faint noise when she wears a hearing aid, Seema lives with her disability with all the grace she can muster.  Her parents took her to doctors when she was young, trying to find meaning and answers to her deafness. Hearing aids were tried, but Seema couldn’t bear wearing them, finding they did very little good. Sign language was never offered as a way to communicate, probably due to the cost of a teacher. Regardless of her disability, Seema is capable and confident. She was hired by us to work at Girls Can Be alongside Shashi, who would help her if needed. Watching Seema take her place among the women of Girls Can Be has been a joyful experience for all of us. Although she can’t hear, she makes herself heard with her cheerful grunts and high pitched exclamations. This is Seema’s first job and she is always early, excited to push the thread through the needle and create little works of art.

Seema was born in Uttar Pradesh and like Shashi, was brought to Mumbai by her parents when she was young. Her parents allowed her an education up to the 9th Standard. When the conversation turned to what Seema’s future would hold, Shashi, who was answering our questions about Seema, became upset. Her eyes were suddenly wet with tears, and she  stopped to compose herself. Wiping her tears with a piece of fabric, Shashi said it was unlikely that Seema would ever marry. Although her parents would look for a husband for her, because of her disability, she wouldn’t fetch the kind of husband she deserves. Finding a boy who would agree to marry a deaf girl would be almost impossible, a match only likely if her parents find a boy who also has a disability. Shashi explained, while tears dropped into her lap, that Seema would live with her once their parents can no longer care for her. Looking at Seema watching Shashi talk, although she couldn’t hear what was being said, the closeness she shares with Shashi was palpable.

Seema’s intelligence transcends her disability and her cheerful squeals enliven a long day of sewing in the Girls Can Be room. She is loved dearly by Shashi who will take her by the hand into the next phase of their lives, allowing both of them a sister to lean on. In the few months we have spent working with Seema at the women’s centre, we have been witness to the extreme joy Seema is capable of.

It is bigger than all of us.

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