Health & Life

lisa haydon kangana ranaut

By Ananya Saha:

Apollonian? Good. Dyonisian? Bad. The mind is a yes, but the body is a big no. Never mind the words in the lexis related to the act of sex; uttering the very names of the sexual/erogenous/reproductive parts of the body, especially female body are still considered to be a taboo in an alarming number of households in the present times. I am aware that there are quite a few demographic factors to be taken into consideration here; such as rural v/s urban, affluent v/s impoverished and so on. But for the sake of sheer convenience and a holistic overview; let us keep those aside for a moment.

The female body has always been a site of polemics in the historiography of social orders. The female desire is a threat to hierarchy, and, therefore, must be curbed or labeled hysteric. A million contributions to this discourse have been made but nothing is ever enough. But this piece is not about female sexual rights par excellence. It is a step before that, the rights to knowledge of the body.

One will be alarmed if they check the number of queries that are generated by the primary search engines (Google and Yahoo as reference here) regarding the anatomy of the vagina from females themselves. Though partially arbitrary, one can common sensibly guess from the approach, attitude, language and even the usernames that many of these are from females belonging to younger age groups of India, if not exclusively so.

One would be alarmed about the lack of knowledge in basic biology, which should be a part of every school curriculum within the tenth grade. There are actually questions such as, ‘How many openings does the female genitals have? Is it two or three?‘ ‘Are the vaginal and the urethral opening the same?‘ Or, ‘I am not a whore to sleep around or something, but when the time comes, would he know what goes where?‘ Which ensued a rough debate about the use of the word ‘whore’. Thus, the original question remained sidetracked. As any reader with knowledge of Biology 101 would know that there are three, and no, the vaginal and the urethral orifices are not the same. But the fault does not lie with them. It is in the predicament that they are brought up in.

Image source: Flickr/Kayla Kandzorra
Image source: Flickr/Kayla Kandzorra

Leave alone indulge in the pleasures of the body; to talk about the body in open, to write about the body, to utter words such as ‘vagina’ and ‘clitoris’ inadvertently invites body or slut shaming. Girls are often taught not to indulge into the knowledge about their sexual organs because it would be ‘immoral’. Hence the aforementioned questions. If one would refer to this article, one would find that the talk about ‘birds and bees’ is still not a common phenomenon in many Indian households. Children usually learn from their peers through debatable sources, which often result into confused half knowledge. I have actually encountered some pre-teen girls who believed a kiss on the mouth would impregnate them.

Yes, it is a rite of passage to talk about the body and share little secrets with same-sex friends as a phase of growing up. But it should also be the duty of the parent to disseminate clear information to the growing child about the anatomy, hygiene and functions of the private part. Especially the female child, as our genitalia is not as outwardly situated as the male one. Ladies, our ‘inner plumbing system is high maintenance’, as Amy Farrah Fowler from The Big Bang Theory would say. Hence, grab a mirror, refer to the online health posts, take the help of the GYN/OBG (An annual visit is a must by the way); but familiarize yourself with your body. In this stage, especially if pre-teens and adolescents are concerned; it does not have to do necessarily with sex. Hence, alarmed parents, there is no need to be alarmed even more. It is essential to encourage a healthy body image without excluding or eliding over any part of it. It is not something dirty. It is completely OK to talk about it as well. One cannot protect their darling girl child from unsafe sex through a lack of knowledge. But a thorough set of information about the pros and cons might do the trick.

Being a scholar of literature, I am reminded of the 20th-century novelist Ford Madox Ford’s work, Parade’s End in this context. Herein, the young Valentine Wannop, the games teacher of a girls’ school in London finds a book about sexual health and knowledge in the changing room. The other teachers are in favour of finding and punishing the owner of the book, as, according to them, it is unsuitable for the students.

Valentine argues with her colleagues that the title suggests that it is for girls who are to be married which some of the students would soon be old enough for. She convinces others that the lack of knowledge would make the soon to be married girls unhappy in matrimony and it is better if they are informed well about both the male and the female body. This is the first half of the twentieth century that we are talking about. And if we peruse through another article, where it has not been clearly mentioned; but a lack of knowledge of the body can still be a prominent reason for divorces caused by sexual dissatisfaction. Some, of course, put up with it still as the ‘good wife’ is supposed to do, which is hardly ideal. The temples of Khajuraho, the caves of Ajanta and such other sites have celebrated the erotic beauty of the female form. One must not praise them and shame the woman curious about her body in the same breath. Know thyself; said Socrates and body need not be alienated from the discourse.

A villager undergoes an eye examination at a camp organised by Aravind Eye Care System in a village outside Madurai, in India's Tamil Nadu state March 3, 2010 to screen for eye problems which will then be treated at one of their hospitals. From a rented house with 11 beds in 1976, Aravind, whose mission is to eliminate needless blindness, has grown into a network of hospitals and clinics that provides eye examinations, surgery by keeping its costs extremely low and by subsidizing care for poor people through fees for paying customers and the sale of eye-care products. Picture taken March 3, 2010.  REUTERS/Reinhard Krause (INDIA - Tags: HEALTH SOCIETY) - RTR2B9T5

By YKA Staff

A woman receives treatment at a free eye-care camp set-up by a voluntary organisation in the eastern Indian city of Siliguri June 14, 2009. According to a World Health Organisation report, 90 percent of the world's blind people live in developing countries with at least 9 million of them in India, where they are often the victims of poverty and lack of access to quality eye care. REUTERS/Rupak De Chowdhuri (INDIA SOCIETY HEALTH) - RTR24NO1
For representation only. Source: REUTERS/Rupak De Chowdhuri

The Madhya Pradesh government has shut down all eye camps, an annual affair in the state, until further orders according to reports after a botched cataract surgery in a district hospital in Badwani. Around 45 patients are reported to have lost vision in the eye camp organised between 16th and 23rd of November. The government has also offered a pension of Rs. 5,000 for the victims and set up a panel for a probe, which may lead to an FIR.

A similar case of negligence had emerged in Ambala earlier this month, where 15 patients had lost vision during eye operations at the Sarvakalyan Eye and Charitable Hospital. In March this year, 14 people had developed infection during cataract operations at Navjeewan Hosptial in Panipat in Haryana.

One is reminded here also of the sterilisation tragedy in Chhattisgarh where about a dozen women had died because guidelines had not been followed. A similar incident in Angul in Odisha, where a bicycle pump was used to dilate the cervix of women, had led to more stringent guidelines in the state according to reports. The state had decided to allow health camps only after permission was sought from authorities a month before the camp.

A villager undergoes an eye examination at a camp organised by Aravind Eye Care System in a village outside Madurai, in India's Tamil Nadu state March 3, 2010 to screen for eye problems which will then be treated at one of their hospitals. From a rented house with 11 beds in 1976, Aravind, whose mission is to eliminate needless blindness, has grown into a network of hospitals and clinics that provides eye examinations, surgery by keeping its costs extremely low and by subsidizing care for poor people through fees for paying customers and the sale of eye-care products. Picture taken March 3, 2010.  REUTERS/Reinhard Krause (INDIA - Tags: HEALTH SOCIETY) - RTR2B9T5
Representation only. Source: REUTERS/Reinhard Krause

However, similar procedures do not seem to have been implemented or considered in other states, despite the sterilisation camp tragedy in Chhattisgarh grabbing the Prime Minister’s attention. What is more appalling about the incident in Madhya Pradesh is that the camp was organised by the authorities and is a regular affair. According to an Indian Express report, the result of the operations was brought to attention only after a report was submitted to the Indore-based Joint Director (Health) Sharad Pandit by the district’s chief medical and health officer. Although there have been suspensions following the incident, the authorities must seek to evolve a method to prevent any more mass scale cases of negligence like this. The loss of vision of 45 people does not speak of negligence but systemic failure and that needs to be addressed with changes in the system.

reuters obesity

By Charu Bahri, IndiaSpend.com:

Broadening girths are expanding India’s battle against malnutrition, a new Indian study has revealed, setting off a host of so-called lifestyle ailments.

This is happening as India fights a losing battle with the bulge, hosting as it does the third-most number of obese people in the world, 61 million and growing.

Malnutrition is commonly associated with emaciated, undernourished people, not with being obese or overweight—or over-nourished, as it is called in dietary parlance.

Actually, the ‘over’ in over-nourished relates only to calories, or energy intake. Getting those excessive calories from fat- and sugar-rich, nutrient-poor foods can lead to significant micronutrient deficiencies in obese people, said Carlyne Remedios, senior nutritionist, Centre for Obesity and Digestive Surgery, Mumbai and co-author of the study published in August 2015 in the journal Obesity Surgery.

Of 2,740 people with a Body Mass Index (BMI) more than 30 kg/m2, the cut off for obesity, forming the study group, 43% suffered from iron deficiency, 56.7% from vitamin B12 deficiency, 11% from calcium deficiency, 35% from vitamin D3 deficiency and 10% from protein deficiency.

Micronutrient Deficiencies In Obese People In India
Micronutrient Deficiency in obese people (%) Deficiency in general population (%)
Iron 43 60-80
Vitamin B12 57 35-75
Calcium 11 8-40.6
Vitamin D3 35 44-90

A new US study has arrived at a similar conclusion as Remedios. One in five obese patients of that study had insufficient levels of three or more of these micronutrients: vitamin A, vitamin B12, vitamin D, vitamin E, iron, folate (vitamin B9) and thiamine (vitamin B1).

Clearly, abundance of food and nutrition are not synonymous.

Overweight Indians: Growing Almost As Fast As Malnourishment Is Contained

India’s new face of malnourishment is likely to belong to the urban and affluent, those who can afford to choose their diet.

Three times more obese and overweight people live in urban areas than in rural areas, as per the National Family Health Survey III. Their numbers are growing almost as fast as the number of undernourished Indians is being contained.

Consider:

  • In 1990, 23.7% of India’s population was undernourished while 15.8% was over-nourished.
    Today, 15.2% of the population is undernourished while 22% is over-nourished.
overweightobese

Source: World Health Organisation Obesity & Overweight data.

 

undernourished

Source: Food and Agriculture Organization

Diets Gone Awry Are Broadening India’s Girth

A 28-year-old man, 5 feet 4 inches tall, weighed 100 kg. His diet was overloaded with bad carbohydrates and bad fats, and low in protein. Severely obese, he complained of persistent body ache and pain in the thighs and around the knees. His vitamin B12 levels were low.

Investigations showed that the patient was suffering from vitamin D deficiency and high uric acid, findings that are “typical of overweight people”, said the consulting doctor Anil Arora, head of unit and lead consultant, Department of Orthopaedics, Max Super Speciality Hospital, Patparganj, Delhi.

A 13 year-old girl, 5 feet 4 inches tall, weighed 114 kg. She consulted a dietician for a weight-loss programme.

“Dietary assessment revealed she ate no vegetables, just high-fat and high-carbohydrate foods and a lot of meat, mostly chicken. Overall, her intake of calcium, iron and other micronutrients was low,” said Sherin Verghese, manager, dietetics, Malabar Institute of Medical Sciences, Kozhikode.

Blood tests showed the young teen to be borderline diabetic, despite her young age.

Research and the experience of dieticians across the country trace a clear correlation between faulty diets and excess weight.

A 2010 study in Gujarat compared the daily diet of overweight people and normal weight people. Overweight people were consuming almost 10% more grams of oil per day and 20% fewer grams of vegetables.

In a 2013 survey focussed on women conducted in Delhi, obese women identified fried food as the leading cause for their condition, while overweight women attributed excess weight to overeating.

Most overweight and obese people consume a surfeit of energy-dense foods rich in saturated fats and simple sugars“, said Karishma Chawla, Mumbai-based nutritionist and founder, Eat Rite 24×7, a nutrition consultancy, “We call them empty calories for being nutrient poor.”

To add to this, metabolic changes associated with obesity can compromise the absorption of micronutrients from food.

Technically, obesity is a kind of inflammation, which research has shown impairs iron absorption or iron utilisation.

A recent Indian study at St. John’s Research Institute in Bengaluru showed that obese women face an increased risk of iron deficiency, and they also absorb less dietary iron.

Research is yet to fully confirm but we believe that adipose (fat) impedes the utilisation of micronutrients—iron and potentially other micronutrients—by the tissues,” said Remedios.

From Fatness To Disease—Via Micronutrient Deficiencies

Raised BMI is a major risk factor for non-communicable diseases such as heart disease and stroke, the leading cause of death in 2012, diabetes, musculoskeletal disorders and some cancers—endometrial, breast, and colon, according to the World Health Organisation.

Less commonly reported is the association between obesity, nutritional deficiencies and disease.

A US study has traced a link between obesity, diabetes and deficiencies of vitamin D, chromium, vitamin B7 (biotin), vitamin B1 (thiamine) and vitamin C.

A 2012 study of 1,765 North Indians diabetics, pegged the overall vitamin D deficiency rate at 76%. It identified progressively worse deficiency in those with higher BMI: 65% in those with BMI less than 23kg/m, 75% in those with BMI 23-27.5 kg/m and 81% in those with BMI greater than 27.5 kg/m.

This is highly plausible.

Overweight people are at higher risk of developing vitamin D deficiency because the vitamin is fat-soluble, which means it gets stored or ‘locked up’, so to speak, in fat cells, with less available to the body for use,” said Seema Gulati, head of the Nutrition Research Group, Center for Nutrition & Metabolic Research (C-NET).

Conversely, when fat people lose weight, their serum vitamin D level may increase, said Gulati.

Lower vitamin B12 and folic acid levels are characteristic of hypertensive overweight and obese people as compared to hypertensive people of normal weight, according to a 2009 study in Mumbai. Even among people with normal blood pressure, those who were overweight or obese had lower vitamin B12 and folic acid levels than those of normal weight.

Why Watching Your Weight Is The Only Way Out—And Why It Is So Hard

Obesity can shave off up to eight and a half years of an adult male’s lifespan and six years of an adult female’s lifespan. Obese people also lose two to four times more healthy life years than a person of normal weight.

While that is reason enough to lose weight, shedding kilograms isn’t so easy.

In the last 33 years, no country has significantly reduced obesity, according to the Global Burden of Disease Study 2013.

With the prevalence of overweight people in India estimated to increase to 27.8% by 2030, and with the most population growth expected to occur in urban India where obesity is expanding the fastest, experts said public policy should focus on malnutrition at the other end of the spectrum—that presents its own challenges because in India, over- and under-nutrition are not simply a problem of the rich or the poor.

“Often, over- and under-nutrition overlap and coexist in the same household even in rural and periurban areas as a result of ‘urbanicity’,” said Sutapa Agrawal, epidemiologist, Public Health Foundation of India.

Dual burden households make public health interventions tricky.

Strategies to address under-nutrition—such as increasing household food supplies—could contradict obesity curtailment programmes while interventions to address obesity—like recommendations of a low fat diet—may adversely effect any underweight members, said Agrawal.

So what is the best way forward?

Catch them young before the fat creeps on: create awareness in children through school education programmes that simultaneously address both types of malnutrition, she said.

This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.

ellie-620x413

By Shambhavi Saxena for Cake:

It’s a lot like any other doctor’s office. The walls are an unassuming shade. There’s a biggish sofa. And your therapist asks you short questions in an even tone of voice. Except you’re sitting at a screen and the therapist is a finely programmed bit of software. Don’t worry, we didn’t just cast you some odd mash up of Lisa Kudrow Web Therapy and Spike Jonze’s Her. We’re talking about some very real technology. With funding from the DARPA, “Ellie”, the virtual therapist, owes her existence to the University of Southern California’s Institute for Creative Technologies.

Ellie relies on super intense voice and facial scan, as described here in this NPR article. One of the cool things she can do is analyse smiles, comparing them with “a database of soldiers who have returned from combat”, in order to detect depression and post-traumatic stress disorder (PTSD) in her ‘patients’.

One of the major blockages people have with seeking therapy is stigma – it can cling like a pesky bit of toilet paper on the shoe. The medium of the Ellie program itself makes it feel a whole lot more approachable. As a software, it offers distance and anonymity, which can be a comfort requirement for a lot of people. But Ellie is also human enough to draw out responses from the ‘patient’.

The International Medical Corps, which works particularly in the area of humanitarian crises, has said that “mental illness is one of the great invisible burdens on all societies, accounting for 4 of the 10 leading causes of disability worldwide.” But it just isn’t being openly addressed like it needs to.

In this video, Fusion’s digital producer Cleo Stiller looks at this diagnostic tool as a natural progression from other electronic means of therapy – over telephones, or through emojis. The stigma around mental health is gradually being countered, especially with Mental Health Awareness activities on university campuses. But until such time as seeking help can be as easy as buying coffee, maybe a privately accessed, affordable software can make it easier to get the help we need.

This article was originally published here on Cake.

A health worker attends to a patient at the maternity ward in the government hospital in Koidu, Kono district in eastern Sierra Leone, December 20, 2014. Health workers at the hospital are in full protective gear as part of increased precautions since the outbreak of Ebola in West Africa. Sierra Leone, neighbouring Guinea and Liberia are at the heart of the world's worst recorded outbreak of Ebola. Rates of infection are rising fastest in Sierra Leone, which now accounts for more than half of the 18,603 confirmed cases of the virus. REUTERS/Baz Ratner (SIERRA LEONE - Tags: HEALTH DISASTER) - RTR4ISTF

By Alexandra Calmy, Eric Goemaere and Gilles Van Cutsem, Doctors Without Borders:

This article was originally published here

On 6 January 2015, in an Ebola treatment centre run by Doctors Without Borders, a patient was discharged from the so-called ‘triage area’ with a certificate to attest that he was ‘not a case.’ However, he did present clinical signs of advanced HIV disease. When asked about his reaction to the HIV diagnosis, he replied, ‘I am so happy it may just be AIDS.’

We have come a long way from the first days of the AIDS epidemic. Since the beginning of the latest Ebola outbreak, several comparisons have been made between Ebola and HIV. Both viruses jumped species in the West African forest and both have generated panic and discrimination. Twenty-five years ago, with an initial death sentence, HIV caused fear and stigma to an extent that is still difficult to understand, with proposals in some countries to isolate patients in dedicated centres.

Some hypotheses suggest that the first patient became infected through contact with infected bush meat, such as a fruit bat or primate, followed by person-to-person transmission. Isolation and quarantine have been part of the public health response in many countries, including in the latest epidemic. When the first health workers returned from Ebola-affected countries, they were isolated and traced, even those who were asymptomatic, despite no scientific evidence supporting isolation of asymptomatic individuals. AIDS activists and HIV researchers were at the forefront in denouncing the paranoia that led to the isolation of health workers out of fear, having learnt long ago that HIV transmission cannot be limited through health-related discrimination. Nevertheless, there are still many countries that restrict travel for individuals with HIV. Similarly, stigma is affecting also the lives of health workers in West Africa. In Freetown, Sierra Leone, national staff working in the Prince of Wales treatment centres reported in many instances not to be able to tell their families that they were working with Ebola patients. Many convalescent patients volunteering to give plasma did so while hiding from family in Conakry: instead of heroes, they were outcasts. Among several other examples, survivors were unable to find a taxi willing to take them home and extended families were unwilling to care for orphans out of fear that they would bring Ebola back home. As with other infectious diseases, notably plague epidemics in the past centuries or, more recently, drug-resistant tuberculosis, the policy of quarantining patients has the potential to increase stigma and drive the epidemic underground.

ebola adThe mobilization of HIV-related actors in the fight against Ebola disease has been substantial. Many HIV researchers and clinicians have volunteered to work in treatment centres or clinical trial sites. Prominent HIV researchers have also presented on the Ebola response in several HIV conferences. Indeed, the results of the first trial assessing the efficacy of favipiravir were presented during the 2015 edition of the Annual Conference on Retroviruses and Opportunistic Infections whose main objective is to share the latest studies on HIV/AIDS and related infectious diseases. Clearly, the Ebola outbreak has resonated strongly with HIV actors because of numerous similarities and lessons that can potentially be drawn from HIV to support the Ebola response. Even the HIV prevention ABC strategy (Abstinence, Be faithful and use Condom) has been twisted to fit with the Ebola prevention messages (Avoid Body Contact) in Sierra Leone. Interestingly, before a cure for syphilis was available, this type of poster campaign was also used as a weapon in the fight against the illness.

According to the WHO, many health workers have suffered from the epidemic with more than 800 dying from Ebola disease. Although personal protective equipment can prevent accidental exposure, the exact risk assessment for some exposures (e.g. contact of an infectious material with intact skin) is unclear and post-exposure prophylaxis is unavailable for many local health workers in the three affected countries.

By contrast with HIV, Ebola patients with no clinical symptoms do not transmit the virus. The transmission window is also short and the incubation period is no longer than 21 days. Therefore, the ability to contain the spread of the disease would appear to be easier and contact tracing is part of the epidemic fight. But this raises other questions. To what extent will the fight against the epidemic alleviate the need to protect the confidentiality of affected patients and families? How do quarantine measures affect the household? Another lesson learned from HIV is the paramount importance of involving the communities in the fight against the disease. Innovative ways of involving the community and peer educators have proven very effective in the HIV field. As an example, Ebola survivors with a persistent immunity have been involved as caregivers in the care of young children in some Ebola treatment centres and have been critical in providing essential quality healthcare.

An Ebola survivor has been quarantined in India after his semen tested positive for the virus. The latest patient diagnosed with Ebola in Liberia is the wife of a cured patient. There is a theoretical plausibility for sexual transmission of Ebola virus. However, further research is needed to consider if, and if yes, to what extent, sexual activity contributes to the epidemic in order to inform individuals with regards to avoiding acquisition or transmission by those recovering from Ebola virus disease.

Ebola causes a severe, often fatal disease, and timely diagnosis is critical both for individual benefit and public health concerns. For example, the early symptoms of Ebola infection are difficult to distinguish from malaria, influenza or typhoid fever. In August 2014, the US Food and Drug Administration issued an Emergency Use Authorization for an Ebola diagnostic test developed by the Department of Defense, the Ebola Zaire Target 1 (EZ1) real-time reverse transcription PCR (TaqMan) assay. The use of rapid tests should improve the detection of cases and help control the Ebola epidemic in the same way that large-scale HIV testing helps to curb the HIV epidemic by promoting rapid access to prevention and treatment.

Access to antiretroviral drugs has been a 15-year battle and 12 million individuals are now on anti-HIV drugs worldwide. The availability of an effective treatment was a critical factor in increasing the uptake of testing and enhanced health behaviour as evidenced by low test uptake when access to antiretroviral therapy was scarce. Early phase of favipiravir and blood-based therapy (’convalescent’ plasma) trials started recently in Guinea. The admission rate suddenly increased in these sites, possibly because of the changing paradigm of the treatment centres (from isolation to treatment). How is it possible to speed up the access to antiviral drugs in the Ebola setting?

In the case of Ebola disease, the determinant of access to quality care appears to differ from HIV. First, nearly all patients treated in high-income countries had accessed experimental drugs. Despite the WHO declaration stating that it would be ethical to offer unproven interventions as potential treatment or prevention in the current context (11 August 2014), none of these drugs were used in African treatment centres until late 2014. The design of such a clinical trial for an innovative intervention, such as immune blood transfusion or ZMapp (Mapp Biopharmaceutical Inc., San Diego, California, USA) led to debate about whether a placebo-controlled trial in the context of a disease with at best a 50% case fatality rate was ethical. Although the first anti-HIV drugs had been compared with placebo in initial trials, the time taken to approve them was contested by treatment activists who were successful in ensuring fast track approval. Almost all clinical trials since then have tested one drug against another. However, the major difference between the two diseases is the fact that no cure is in sight short term for HIV, but Ebola is a curable disease and several drugs may affect the disease outcome; the reconciliation of scientific fast tracks and ethical concerns is urgent.

syphillis posterThe controversy related to the methodology used for evaluating the efficacy of new drugs can be extended to the evaluation of vaccine efficacy. As the epidemic declines, is it a good use of resources or even ethical to expose volunteers to an experimental vaccine through a large phase III trial as the chance of being exposed to Ebola – and thus determining vaccine efficacy – will become almost zero? On the contrary, is it justifiable to mass vaccinate in a future epidemic based on the sole basis of a phase II trial? Vaccine trials just started now in all three countries will potentially lead to a new Ebola vaccine commercialization, which is still not the case in the HIV setting, despite more than two decades of research.

Point-of-care diagnostics, early antiviral treatment and vaccines will radically change the community approach to Ebola. Ebola has had an impact on both the use of healthcare facilities and specific HIV care. Recent studies have shown that the Ebola epidemic resulted in a major drop in attendance of general outpatient services, in new HIV-positive diagnosis and in new HIV-infected patients entering care. In most affected countries, access to basic care was dramatically impaired by the fear of accepting an Ebola patient in a healthcare facility. Both diseases affect all sectors of society and reach far beyond the healthcare system, ranging from economy to education, but also with an impact on cultural practices, such as circumcision for HIV and burials for Ebola. The fight against HIV has led to a massive increase in resources which have benefited health systems in resource-limited settings beyond vertical programmes. The mobilization of the international community around Ebola has the potential to similarly benefit health systems in West Africa, a region long abandoned after years of civil war. Let us not fail in the opportunity to succeed in post-Ebola recovery.

There are over 2 million Indians who are HIV positive, the key to tackling this is awareness. Here are 11 Facts About HIV/AIDS That You Must Know, If You Don’t Already

Featured image source: Reuters/Baz Ratner

manual scavenging India

By Radha Patankar, IndiaSpend.com: 

Mumbai: Hot water, sanitary pads and bottles are flung at them when they work in filthy, obscure Mumbai gullies (lanes), but although manual scavenging is illegal, Maharashtra employs 35% of 180,657 Indian families whose livelihood depends on unblocking excreta-packed sewers in those dank lanes.

“Aamhi lokancha jeev wachavto ashi kama karun pan aamcha jeev wachwayla konich nahi (We save lives by doing our job but there is nobody to save us),” a worker told IndiaSpend, requesting anonymity for fear of official retribution.

The Indian state does not officially recognise the employment of manual scavengers, almost all of whom are Dalits. They are officially hired as “cleaners” in Maharashtra. The state does, however, acknowledge that thousands make their living doing manual scavenging.

Maharashtra has more than 63,000 households dependent on manual scavenging, followed by Madhya Pradesh, Uttar Pradesh, Tripura and Karnataka, according to a question answered by Minister of State for Social Justice and Empowerment Vijay Sampla in the Lok Sabha.

Railways Largest Employer Of Manual Scavengers

Since they do not have a proper system of disposing excreta, the Indian Railways are the largest employer of manual scavengers, with an unknown number on their rolls.

Most of the ‘sweepers’, as they are called—thus making them hard to identify as scavengers—with the railways are employed through contractors, and they earn around Rs 200 per day. Although the workers get gloves, hygiene awareness is so low that they hardly use them. If they do use protective equipment, a new draft law says such workers can then no longer be classified as manual scavengers.

In September, the Delhi High court ordered a survey in the capital to determine the extent of manual scavenging. The Ministry of Railways told the court that manual scavenging cannot be completely eradicated until stations get washable aprons and sealed toilet systems.

“While the (railway) ministry denies employing manual scavengers officially, the affidavits it has submitted in the court in the past nine years suggest that barring a few trains, the railways does not employ any technology to keep its 80,000 toilets and 115,000 kilometres of tracks clean,” according to Down To Earth magazine.

On The Margins, Now You See Them, Now You Don’t

Progress for a people who come from the lowest castes and whose jobs do not officially exist is slow, and protest is almost impossible.

Brihanmumbai Municipal Corporation (BMC) “conservancy workers”—a euphemism for manual scavengers who clean lanes—told IndiaSpend that they started getting gloves recently. The BMC has also started giving them medical insurance up to Rs 500,000. Since the premium is deducted from their salary, more than half have not signed up.

“There are four to five deaths every month,” a worker told IndiaSpend. “Most of us suffer from tuberculosis. BMC owns a hospital but all we get is Rs 10 case-paper free.” That means they don’t have to pay consultation fees, but they must pay for their own medicines and wait six months for sonography tests, four months for x-rays.

Almost all of Mumbai’s conservancy workers in BMC are Buddhists or neo-Buddhists, converts from Hinduism’s lowest castes. Kept to the margins, it is hard for them to break the status quo.

One contractor told IndiaSpend that machines now cleaned sewers and workers did not descend manholes. However, workers said contractors sent people down manholes almost every night.

Workers take turns entering manholes, lathering bare bodies with coconut oil to keep away the odours of the sewer.

Why do they continue doing what they do?

Housing, Jobs For Families Key Reason To Continue

In Mumbai, one of the main reasons why manual scavengers continue doing their jobs is that they do not have the education to do much else. Working as a scavenger means that they get housing from the BMC and their jobs can be transferred to family members.

Although their “official” income varies from Rs 7,000 to Rs 25,000, what they actually get in hand is Rs 5,000 to Rs 15,000, after deductions for education and marriage loans—some taken from landlords—and insurance premia.

A new law, The Prohibition of Employment of Manual Scavengers and Rehabilitation Act, 2013, talks about rehabilitating conservancy workers by giving them one-time cash assistance of Rs 40,000. After talking to BMC workers, it was clear they had not heard of this.

One-time Cash Assistance For Manual Scavengers, FY 2014-FY 2016
State/UT Manual Scavengers Identified Beneficiaries Expenditure (Rs crore)
Andhra Pradesh 124 45 0.18
Bihar 137 131 0.52
Chhattisgarh 3 3 0.01
Karnataka 302 196 0.78
Uttar Pradesh 10,016 5252 21
Uttarakhand 137 124 0.49
West Bengal 98 95 0.38

Source: Lok Sabha; Note: Data for FY 2016 up to June 30, 2015

The Self Employment Scheme for Rehabilitation of Manual Scavengers (SRMS) was introduced by the Ministry of Social Justice and Empowerment in 2007, and implementation supposedly began in November 2013. Andhra Pradesh, Bihar, Chhattisgarh, Karnataka, Uttar Pradesh, Uttarakhand and West Bengal have received cash assistance to rehabilitate scavengers identified by the government.

Maharashtra has given no cash to manual scavengers it has identified.

(Patankar is a second-year M.A. student in Public Policy at St Xavier’s College, Mumbai, and an intern at IndiaSpend)

This article was originally published on IndiaSpend.com, a data-driven and public-interest journalism non-profit.

mental health illness stigma discrimination

By Jhilmil Breckenridge

For anyone with a mental illness “label”, they know only too well that they are judged with that label forever. Whether they are a functioning individual or not isn’t considered. If she is singing one day, she must be manic. If he is quiet sometimes, oh he must be in depression. It’s as if people are not allowed to have normal moods anymore, and worse is how the stigma attached to mental health diagnoses affects you outside, at work, in relationships, how society views you. I have a friend, who never discloses at work that she has an issue or takes medication for the fear of being judged. Or another who hides his illness from his children. All of these things are done precisely because of the constant judging, the stigma and discrimination that surround anyone with a mental illness label.

mental health illness stigma discrimination
For representation only. Image source: Trauma and Dissociation/Flickr

In simple terms, mental health issues can be caused by life stresses, psychosocial issues, sometimes it may be genetic and some people are more predisposed to being affected. It’s often a temporary condition and recovery is very, very possible in many cases, especially if the person affected wishes to take an active part in his or her healing. In my case, I read extensively on the subject and embarked voluntarily upon a CBT (cognitive behavioural therapy) model of help, also the fact that I had been incorrectly labeled did not help! In other cases, it may be a lifelong management of a condition and there are several ways of dealing with it. But even years after recovery, now that I am a fully functioning and productive person, I am continually judged with the label I had years ago, “oh she is bipolar,” as though that is the only thing that defines me.

Discrimination at the workplace is also widespread. With many employers unwilling to take on people with mental health issues, this is one of the largest groups of any disability that is unemployed. Often people have no option but to resort to hiding the fact that they have any issue just to get work. In many cases, it is discrimination that prevents people from getting help. “I’m not crazy,” they say, when they think that perhaps they should go see a therapist or get help. And it’s precisely the conditioning we have all had growing up, from our parents or society around, “oh, you know, that person is crazy” and talking about what they did in hushed whispers. If we grow up thinking that to have any mental health issue is being crazy and that is the last thing we want, obviously it is hidden for as long as possible. Why can’t it be treated like a medical condition, which is what it is, and be casual? “Oh, I have diabetes, so no sugar, please,” is treated much differently to “I have anxiety disorder.”

In a survey of over 1700 adults in the UK, Crisp et al. (2000) found that: (1) the most commonly held belief was that people with mental health problems were dangerous – especially those with schizophrenia, alcoholism and drug dependence, (2) people believed that some mental health problems such as eating disorders and substance abuse were self-inflicted, and (3) respondents believed that people with mental health problems were generally hard to talk to . People held these beliefs regardless of their background, education or position in society and when questioned about whether they would employ people with mental health problems, the answer was less likely.
Stigmatization comes in many forms, distrust, avoidance, pity, gossip, etc. Stigma is also prevalent in the classroom where teachers expect sufferers to underperform and this may not be the case!

A lot of the common beliefs about ‘mad’ people stem from media. Cinema often portrays schizophrenics in stereotypical and violent roles, which reinforces what people generally believe about people with mental illness. These go a long way in continuing to make people behave in a discriminatory way towards anyone affected.

Worse than the external stigma and discrimination around mental health is the internal stigma. It’s a condition that often affects people’s self esteem and their own beliefs of recovery are linked to the self stigmatization. If they believe they can’t recover, all the medication and therapy in the worlds will not help. There is often increased social isolation, and this is often linked to a self belief that they will not be liked.

In the UK, there has been a huge campaign to end stigma. A similar approach will be needed in India, one of the worst countries in the world when it comes to how it deals with those affected with mental health conditions.

Mental health issues originate in the mind. So does stigma and discrimination. Let’s work hand in hand to eradicate what we can to make recovery faster and make our society more inclusive.

Note: In this article, I speak about mental health illness as that is how the term is commonly understood and referred to. But I am of the firm belief that a lot of these labels are simply wrong, over-diagnosed and cause more problems than they solve. People are people, and just as there are different colours, so do people vary… we cannot all be the same, react the same, and have the same moods. And to simply label someone without any tool for looking into their brain seems wrong. Until there are better diagnostic tools, I think the world needs more love and tolerance!

TRDLOGO1

yp foundation sex and reproductive health study cropped

By Manasa Priya Vasudevan:

sex clinic - yp foundationYou may have spotted posters from train windows, as you enter stations, or at traffic signals that offer to solve your ‘sex problems’. Right from these unremarkable flyers touting unregistered medical practitioners, to over-the-counter (OTC) contraceptives that are dealt, as though, to fugitives, and the dark coloured polyethene bags that seal off sanitary napkins from the outside gaze, the enigma that surrounds transactions of sexual and reproductive health (SRH) services in the country, is only comparable to that which surrounds illicit drug trade. Social and cultural practice is to regulate even the most basic conversation on sexual and reproductive health and rights (SRHR), and bring it within the axes of ‘marriage’ and ‘procreation’, so much so that we have prominent judges of the high courts issuing ‘marriage’ as a sentence for rapists, post-conviction, as if submitting to matrimony is the ultimate atonement. This systemic epidemic of sex-shaming equals to most of us having no information whilst growing up, or being ashamed of our curiosity about our bodies, sex and desire. The utter absence of comprehensive sexuality education (CSE) also contributes to high maternal mortality rates, rampant early and child marriage, a strapping HIV-positive population as well as a significant unmet need for contraception.

It is in this climate that we at The YP Foundation decided to conduct a preliminary audit of government and non-government health centres in and around communities in the National Capital Region, where we impart comprehensive sexuality education. 18 young volunteers and staff from the Know Your Body Know Your Rights Program conceptualised and implemented an audit to assess the quality of SRH services for youth. They took on the role of …well regular young people in need of condoms, birth control, pregnancy kits, HIV counselling etc.

Here is what we found:-

Shame Games

yp foundation sex and reproductive health studyThe National Adolescent Health Programme (Rashtriya Kishor Swasthya Karyakram; RKSK) guidelines 2014, perhaps the most progressive and comprehensive of the Indian policy landscape, stresses on the importance of the presence of 3 components in every centre that provides SRH facilities: information, commodities and services. Now, regardless of the availability of commodities or services, the real challenge that the hospital and staff seemed to struggle with was information disclosure. How does one confide to staff who are uncomfortable to speak on the subject themselves?

We discovered along the way, that hospital staff had two ways of dealing with their unease. In most of our interactions, we encountered either:

Strategic silence – sometimes their limited information on the subject through clipped responses, censored the questions we could have asked or the conversations we could have pursued to build trust and thereof safe spaces.

Or, overt moralising, what I like to call the ‘circle of shame’ – shaming us for shaming them by requesting access to improper things, and subsequently bringing shame upon our family and ourselves.

Neither assuaged the experience.

“The chemist shop in the facility premises required doctor’s permission to buy a kit. Firstly, we were sent to three different rooms to get the CMO/doctor’s permission. In the third room, a female assistant lashed out at us saying, ‘Sharam nahi aati? Parents ki izzat mitti me mila di (Aren’t you ashamed of yourself? You are ruining your family’s honour).’ It would have been downright humiliating for any person let alone a distressed young girl. In the end, I wanted to be out of the hospital as soon as possible.”

Health care practitioners should ideally play the role of a facilitator. But increasingly, we began to observe that either consciously or unconsciously, they would slip into the role of a gatekeeper. A moralising ground does not qualify as a safe space, and in fact adversely contributes to mental trauma.

Sticky-Stacky Stigmas

It was also interesting to note that their stigma against talking about, leave alone treating, SRH services piggybacked somewhat comfortably on their stigmas attached to sex outside of the confines of marriage, which in turn piggybacked on their intolerance towards people of a different religion, weak academic performers, independent youth and a host of other seemingly unconnected things.

“The room was empty except for 3-4 doctors who looked like the ‘gossipy neighbourhood aunties’. And as we were about to find out, they behaved exactly in the same manner. What college, they asked. What subjects, what percentage. Do you live with parents? Are you sexually active? With more than one guy- this was not so much as asked as shouted. And then, are you Christian?”

On some occasions, the younger doctors seemed happy enough to treat the patient without passing judgement, but the older doctors and assisting nurses assumed the garb of a disciplinarian.

On other occasions, doctors were found to be selectively empathetic – privileging one SRH service over the other. There was a stark difference in the attitudes of some health care practitioners who were warm and helpful when it came to services such as contraception, HIV and STIs, but haranguing when it came to abortion.

On still other occasions, they were guilty of granting smoother SRH services to boys over girls; and upper middle class, English speaking patients, whilst reserving dispassionate judgement for everyone else – the peer educators would come out with lukewarm reports only to find a disillusioned fellow patient. So despite wielding our English-speaking class privilege, being at the receiving end of such differential treatment based on banal biases, made us sit up and think – what then, would be the treatment meted out to young girls from the communities we work in?

yp foundation sex and reproductive health study 2

Lack Of Signages

Information education and communication (IEC) material was available only partially and sporadically, across all centres!

“GTB Hospital is like a maze. It is a huge hospital and there is no clarity whatsoever as to which building one has to go to as there is a shortage of sign boards. It is not like the services are not available here, just that reaching the right place is a herculean task.”

Proactive disclosure of the gamut of SRH problems and services through intuitive flyers and sign boards that lead the way to counselling rooms and testing labs also can minimise patient-patient or patient-staff interaction, offering the former the benefit of privacy and shrouding them from harsh judgement and scrutiny of community moral police.

Due to the stigma surrounding most SRH services, especially HIV/pregnancy testing or counselling in the case of sexual contraception/abuse/violence, and the larger community’s likelihood to suppress and shame, creating safe spaces by guaranteeing privacy and confidentiality, also becomes doubly important to encourage young people to avail of these services. Unfortunately, there is no escaping nosy neighbours of neighbours anywhere in India, least of all at community health centres!

“It was an open room where all the patients stood in barely a line and just stated their problems in front of everybody. No privacy whatsoever.”

“One of the things that I didn’t like about this centre was that a patient having an upset stomach walked into the room, right in the middle of my abortion counselling session.”

On the whole, the team had mixed feelings on the pilot study. Their preliminary excitement regarding the ‘plain-clothes audit’ was short lived. The volunteers may have been assuming the
guise of young people in need of counselling, contraception or kits, but their masks were fast rendered inconsequential. The slut-shaming and unsparing character assassination that accompanied
the study was but directed at their realities. Such personal assault dampened their spirit and frustrated some of them to the point of tears. Both the government and non-government health centres were ridden with the same-old age-old, patriarchal, sexist and non-secular bigotry transmitted by staff and communities who frequented their corridors. Uninterrupted treatment was accorded only to the PEs who conformed to their narrow ideals.

In the name of patient history, a person’s identity was dissected, its markers scrutinised: starting with gender, sexuality, class, religion, academic merit, and then moving on to an avalanche of micro markers – none of which was their business. Not surprisingly, the tendency to regulate a woman’s sexuality over a man’s was painfully evident, and how. Add to this mix, a trans person, a Dalit or a differently abled person and the experience could well be traumatic. We then wonder if the singular subject of this exclusive public health system is simply – an able-bodied Hindu man.

Illustrations by Vanika Sharma, ‘Know Your Body Know Your Rights’

caste_women_village

By Anya Vohra

Always having been slim I never thought of anaemia as the reason behind it until a few years ago. I recollect being called different names like stick and skinny and that’s the reason I hated being thin. People who met me for the first time asked me my weight instead of my name, I was subjected to name calling and teasing. People say being thin is easy but they are clearly oblivious of the underlying social and emotional cost of being slim. Diagnosed with a mild case of anaemia at an early age motivated me to delve deeper to find out more about its symptoms, causes and prevention.

I invested time researching about this disease and the numbers were a shocker! Although anaemia affects 52% of the female population in India, over 68% of the total Indian females are unaware of the condition! More than half of the pregnant women in our country are mildly anaemic and 42.6% are moderately anaemic. The situation is the worst for adolescent girls, 27.1% of whom are severely anaemic.

Anaemia is most often synonymous with being thin, and often not recognized as a medical condition. It’s almost as if you’re thin you MUST be anaemic; the casual attitude and ignorance of people towards this disease troubled me. My research showed that while many types of anaemia can’t be prevented, the most common of them, caused by iron-deficiency, can be outdone with a vitamin-rich diet. Iron-deficiency anaemia suppresses human productivity, which indirectly hampers national growth and development.

The Food Requirements

anaemia anya vohra
Image source: Anya Vohra

My deep dive into this affliction made me realize that if I, with good nutrition, can be a victim of such a disease then what about those who do not have access to the same level of nutrition as me? Thus started my Youth Anaemia Initiative born out of an incessant motivation to make a difference. My objective is to spread awareness of the disease itself and about the dietary needs to prevent it. I have developed cost effective solutions which could be incorporated by economically weaker sections of society into their daily diet. After doing comprehensive study I came up with a few budget-conscious solutions:

-Vitamin C is effective in preventing anaemia as it helps in increasing iron absorption and sources of vitamin C include lemons, sweet lime, pineapple and guava.

-A good diet must include iron-rich foods which include chickpeas, watermelon, lentils, bajra (millet), jawahar, pumpkin seeds.

-Folate synthesized from folic acid can be found in bananas, cauliflower, legumes and papaya.

-Vitamin B12 is also essential and sources include milk, yoghurt, sweet potato and carrot.

-Vitamin A is also helpful in preventing anaemia. Sources include pumpkin, milk, melon and tomatoes.

Most all of these are affordable and easily available and are a regular part of Indian kitchen menus and India being primarily agrarian a majority of the above is grown by farmers.

How Society Contributes To Anaemia

I also unearthed two unpalatable notions girls often buy into or are passive spectators too.

Firstly, that society places an optic premium on girls that are slim. To conform to these stereotypes, girls often starve themselves which also leads to anaemia due to the low percentage of nutrients and vitamins they consume.

Secondly, and this is important, girls are more often than not, especially in rural areas, fed an inferior diet vis a vis boys based on the premium placed on the boy perceived as an asset and girl as a liability.

A person should never be discriminated on the basis of either their weight or gender. I have visited a number of NGOs and taught girls from classes 6-10 about the symptoms, causes and preventions of anaemia as well the need to place health ahead of beauty and demand the same food as their brothers.

Clearly a lot needs to be done and not just about anaemia. Females at last count (despite infanticide) are over 500 million and it’s unacceptable to have a half a billion disenfranchised citizens. We have to bring about that change and I believe I am doing my small part in catalysing that metamorphosis.

Editor’s note: Feel strongly about health and well being? Email PM Narendra Modi and show your support here!

empathize this headache illustration 2

By Anonymous:

Note: Originally published on Empathize This and republished here with permission.

I woke up one morning with a headache three years ago. It hasn’t gone away.

I have been diagnosed with a condition called New Daily Persistent Headache (NDPH). This means that every day, all the time, I have a headache to some degree. I’ve seen countless doctors and had tests done and tried countless medications and other solutions, and while I have found a couple of things that significantly help, the headache never completely goes away. There are certain things that make my head hurt even worse than normal, including bright or flickering lights, loud noises, certain foods, physical exertion, and stress. As such, sitting in a classroom with fluorescent lighting is difficult. I cannot go to concerts. When my friends run, I must choose between being left behind or running to catch up and cause my headache to get even worse. Looking at a computer screen for too long is painful. There are so many things I would love to do, but I simply can’t.

My friends and family who know me well know about my condition, but very few truly understand it. I know they are trying and that means the world to me, but it’s hard when I have to either correct/remind them about it, or decide to suffer through something that is difficult for me. Some days, I simply can’t cope with the constant pain. In the moments I can cope, I feel like I ought to be working and productive, so instead of living my life, I work until the pain comes back, and spend my free time collapsed and not moving. But I cannot live that way, so I feel like a failure. I’m doing the best I can, but it will never be good enough. Sometimes I wish I had something more serious so people would try to tell me how to fix it. No one tells a cancer patient to “just suck it up,” or “take some Advil, you’re fine.” I know they mean well, but it is tiresome. It is not easy living this way, but the combination of others not knowing and trying to help is even more draining. Some people at church pray every week for me, and I have to tell them every Sunday that no, I’m still not better. Others think I am possessed by some sort of demon or am sinning against the Lord so he is withholding healing. It hurts that my pain doesn’t matter and that people I thought I knew believe I am being punished.

This is real. This is my life. I would get better if I could, I promise…

reshma valliappan

By Reshma Valliappan

We would have heard this ‘NO’ in context to the rape culture that has been going on ever since dinosaurs stopped existing and man and woman sprung up from some strange godly discourse of existence written in some scripture. Again, this scripture was written by a man and not by a woman. If she did, I really wonder what life on this planet would look like.

reshma valliappanThe word sex has been the biggest taboo ever since then. It has been the biggest power tool for repression, oppression and control ever since man realized he could only shoot climatic stars of ecstasy (orgasm) once (or maybe twice for certain gifted ones who have worked out) or several times (for those who know what they are doing in bed) as opposed to the woman who can own the sky of multiplicity. I say ‘man’ because I would agree to the feminist terms of womb and vagina envy that speaks of how men have a natural envy to the biological functions of the female body. However, this term has sprung up from the same psychoanalytic school where Sigmund Freud first coined the term penis envy. But there would be real dangers if we kept our focus on the psychoanalytical theories of gender roles and sexuality given these theories came from individuals born and raised in a different culture, society, religious and spiritual beliefs, language and existential roles but have been put on the same pedestal of gods by you.

Since I am writing this article, I would call everyone else fools for doing so. Why? Because since the birth and rise of psychiatry and psychology in the 1900, it took this one man called Freud followed by Jung and a whole bunch of other baboons to come up with many different intellectually stimulating words and spread it through the economics of mindless fascinations because they couldn’t understand themselves better. They needed to find the ‘mad people’ which mostly comprised of women labelled with hysteria for them to study and experiment upon while some even had sexual bondages with these women they claimed to help. Then this other fellow called Eugen Bleuler coined the disorders and broke them into different branches called schizophrenia, autism, bipolar so on and so forth. This further entered all the psychology books, education and social understanding of what mental illness is. And the whole world believed them and follows them. Coming from being a schizophrenic, I think everyone else are complete fools for doing so because they have no voice of their own. On this note, I am glad I hear voices, many of which are my own. But I have been treated for hearing them. I have been called crazy, lunatic, pagal, mad, insane, unsound and have been completely rejected by society and the same system claiming to help someone like me finding my way back into society.

What society fails to really understand is that mental health issues affect each one of us. No human being is discriminated on the experience of mental health breakdowns yet they choose to discriminate and stigmatize the likes of people like me along with spreading and believing that we can be violent or dangerous to others or ourselves. If they do their research and use their brains, they would find that many of us were ‘victims’ of violence and our spurts of aggression are merely defences for the acts committed on us which live in our minds.

Even in my entrance into cross-disability, many others with physical disabilities did not want to have anything to do with the ‘crazies’ for we might spread our madness to them or just the very thought of sitting in the same room with me would stigmatize them. The invisibility of the stigma and discrimination is equally proportionate to the invisibility of our pain and condition. And the only way we can bring this forward is by talking about it even if it hurts others in the process for being this honest about it all. The very fact is that mental health issues arise because nobody wants to talk about them. Nobody wants to address what is really happening inside of their heads. It is easier to fit in and brush it all under the carpet. And then it grows and gets bigger and out of proportion leading to breakdowns. It is easier to believe it is a chemical imbalance that needs to be treated and the pills will make it all go away. How can people be so blind to treat human experiences and call them disorders? It is disabling no doubt, but it is disabling since the larger whole does not find the need to able themselves with true empowerment of their experiences and voices.

The questions we must ask ourselves are: What really are the causes of mental health issues? Is it what you think has been written and sold? If people have enough access to reading this article, they should use their discretion to do their own research and really find out because until it happens to them or someone they love they really don’t bother waking up. To me, having schizophrenia or depression or any other so called mental illness is our souls knocking real hard on our doors and telling us to wake up to our purpose because we are nothing but a populated group of consumerist dodos; extinct of our true selves. We have developed false expectations and needs of what success means to us and in the road to gaining these illusionary needs we develop such issues.

But no one is going to believe me when I say this because I have schizophrenia. If I had ‘Dr.’ prefixed to my name, the whole world would clap for me and shove degrees up to me. Then again when doctors are funded for research on how to deal with our voices – it is called a discovery. It is called the new edge of helping schizophrenia sufferers to listen to their voices and have a relationship with them. But isn’t it for the very reason that we hear voices and listen to them and have a relationship with is why we are getting treated and stigmatized? This is the double irony of the system which society does not see.

Why do I bring up this critique and how is it relevant to the topic of sexuality? Let’s be clear of the definition and oppression of independent women. That is, any woman who voices her opinions, her needs, her wants and what she does not want is called a bitch, a slut, a selfish badly influenced person who needs to be taught a lesson and this list goes on, as there are over 300 mental health disorders listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) aka The Psychiatry Bible.

What I really want to point out are the many hats and roles placed on women. Let’s take the schizophrenic woman with alternate sexuality. Both these labels and existences are not born with her but are received when she reaches adulthood. When we remove these labels we get the young adult who is rebellious, opinionated, desiring an endless list of what pleases her, saying no to authority, disliking others or their philosophies. She is actually abled by it. So we remove this label and we get the mother, the daughter, the sister, the wife, the boss, the carer, the girlfriend all of which are about owning her. Even in the attempt of telling her to ask for her rights and educate her about patriarchy, she needs a man to tell her that. This is how strong the hold is.

How is this connected to sexuality? Easy. How many heterosexual able-bodied women can tell their husbands or boyfriends openly ‘Hey, I don’t feel like having sex with you today?’ When we find out how many can say NO – then we have to ask the next question ‘Hey, I’m feeling horny let’s make out’. When we can find out how many are allowed to ASK for what pleases them is where the labels of hypomanic or sexual addiction are placed on women. They’ve classified this as disorders that need to be treated because apparently the woman loses herself to it and stops functioning for her betterment which in turn affects her life. Fair enough a point to call it something that does not allow her to function well. But if she was given the respect and choice from the very beginning to say what pleases her, the disorder won’t have to exist to make up for what she can’t ask consciously.

Therefore, before we even get into the discourse of mental illness, psycho-social disability, sexuality, alternate sexuality, choices and rights, legal privileges and recovery, women as a whole need to begin questioning this simple NO. The day I said NO and listened to the voices in my head was the day I discovered my wants and needs. The voices that told me ‘You’re a slut’ were the voices of authority I have heard before. But since society tells me not to question authority and moral notions by them, my psychosis made up for it.

The voices that told me ‘Watch the movie and go out and have fun’ were my innermost desires becoming so strong that they have to assume the existence of controlling voices to the point of psychosis so that I do it. So that I engage in it and know what I really want and not what I should want according to society.

I hear voices and it connects me to my various selves hence others want to control me or treat me. If others only heard their own true voices, we’ll all know who is taking me out for a date tomorrow.

This article was originally published here on the Sexuality and Disability blog. 

intersex bodies

By Vaagisha Das for Cake:

David Reimer was born biologically male but raised female due to the result of a medical procedure gone wrong. Being ill adjusted to his state, David later transitioned to male at the early age of fifteen. Known as the John/Joan case, this was taken up as an instance of nurture versus nature, and later used to support the argument that gender identity is something that is inherent in an individual, and not something that is necessarily connected to one’s genitalia, i.e., it is unconnected to one’s sex.

Sex And Gender Are Not The Same

Sex and gender are two vastly different things. One’s sex is what an individual is born with – male or female depending on the genitalia, while gender – being a boy or a girl – is what is accordingly assigned to an individual at birth by the social order. In a society that cringes at variance, gender identity is inherently tied to one’s sex, and any deviation is sought to be ‘rectified’ as soon as possible. While some people are slowly recognizing the concept of being transgender, most are still struggling to understand that gender- and that too, unconnected with one’s sex- need not be binary.

‘Intersex’, Not ‘Hermaphrodite’

In all the confusion, the phenomenon of there being a ‘third’ sex is completely overlooked – what is contemporarily known as being intersex, i.e. when a human being has both male and female genitalia, or some variance of the same. Earlier, the term used for such individuals was ‘hermaphrodite’ (meaning fully male and female) which was grossly misleading, as this is not possible in humans. The correct term is ‘intersex’. According to the American Academy of Paediatrics, since intersex individuals are relatively rare (around 1 in 2000 babies), they are rendered ‘medical emergencies’ at the time of birth.

Image source: berlin artparasite's/Facebook
Image source: berlin artparasite’s/Facebook

Why Are Such Individuals Termed ‘Medical Emergencies’?

Society is conventionally divided in two sexes – the male and the female. This division, which exists at the core of every societal institution, also has the power to influence medical procedures, which firmly segregate between the two, and provide the courses of action to be taken, for example, female individual hits puberty at twelve, and a male individual at eighteen: medical treatments are undertaken accordingly. The ‘medical emergency’ situation arises when the sex is undecided, and consequently, the future of the child, both medically and in other areas discussed below, is called into question. In this case, the doctors apply themselves to ‘right a wrong’ – little realizing that there is no inherent error in the individual, rather surgery to alter sexual organs can harm sexual function instead.

Discrimination In Sport

This fear of the unknown seems to haunt major sports associations as well- the Olympic Association has enforced strict regulations on the testing of testosterone levels for women for fear of doping- it seems reasonable at first, until one realises that not all women are subject to it, only the ones ‘falling under suspicion’- i.e., the women who look masculine. Even after testing, if such individuals are found to be intersex, they are banned from competing on the grounds that they are not ‘real women’ and that their increased testosterone levels would give them an unfair advantage in competition- a claim found to be false, as the ‘extra’ hormone naturally present in their body does not give them an ‘extra’ advantage. Hence the controversy caused over the late intersex athlete Dutee Chand, who committed suicide following mass protests on the ground of her ‘not being a real woman’. This is gender discrimination, and in such cases, the only fair ground for testing would be to divide competing categories on the basis of testosterone levels, and this would be unrealistic in terms of costs and efforts involved. The lines between the ‘two’ genders are being blurred, making many uncomfortable.

Fear Of Intersex Bodies As Anomalies

In a bipolar gender paradigm, there is no simple social category for those assigned ‘intersex’- hence the doctors- and parents who think they mean well- increasingly opt for surgical corrections to bring biological sex in line with the assigned gender. This is with a view to firmly reinforce the concept of the duality of the sexes- and hence, the associated gender, according to the rigidly set social norms that strive to create increasing physical differences between men and women to ‘fit’ them into a pre-arranged system. The social order has evolved through careful policing, and anyone who is ‘different’ presents a potential threat- they could shake the entire cultural order of our society, and things would no longer make sense. Any sexual relationship that is non-heteronormative, and therefore untraditional, is often seen as bizarre, with people struggling to normalize the social order. Thus the worry about intersex individuals is this – if a male is supposed to desire a female, where does one place an intersex individual? Further, if a males and females are assigned the gender boy and girl at birth, how do you assign a gender identity to an intersex human being?

‘Hermaphroditism’ Is Natural, Yet We Continue To Shun It

Our anatomy affects our existence in the social order, in terms of how we view as well as interact with others- it even affects our rights and privileges. Our anatomy, and hence the gender identity imposed on us, are reinforced so often that it almost seems natural. However, it is important to note that this rigid ordering is not in fact so. Hermaphroditism in animals is very common – these animals have both reproductive organs and are capable of self-fertilizing, hence ensuring their survival and adapting themselves to live in difficult conditions. Slugs, snails, and a number of invertebrates are capable of ‘normal’ reproduction as well through the aforementioned process. In addition to this, there are a number of animals who are capable of sequentially changing their reproductive organs. When the male in a pack of coral reef fishes dies, the largest female ‘changes’ its genitalia and naturally transforms into male. How then, does one contend that intersex humans are ‘abnormal’ and in need of surgical ‘correction’? In this case, it seems a likely conclusion to draw that we are more concerned about the dictates of human society than we are about what is naturally prevalent in it.

Gender binary is just one way of ordering the world – it is not the only way. When taken into account the spectrum of gender as well as sexualities, it would be difficult to group individuals into any one of two options society makes available to us. Why not just let people be, without trying to label them or ostracise them on the basis of such labels?

This article was originally published here on Cake.

mental health illness depression ocd

By Vidyashree

I trained to be an Expressive Arts Therapist in 2012. Expressive arts therapy is the practice of using imagery, storytelling, dance, music, drama, poetry, movement, dream work, and visual arts together, in an integrated way, to foster human growth, development, and healing. It is about reclaiming our innate capacity as human beings for creative expression of our individual and collective human experience in artistic form. It is also about experiencing the natural capacity of creative expression and creative community for healing. Counseling and talk therapy are an integral part of the work of expressive arts therapists and are used as very strong aids to process the work created by the client.

I4012904148_ddded1b10d_on July 2014, I had my first baby. What followed was postpartum depression. Overwhelming feelings of sadness and unstoppable bouts of crying. When it happened, it took me a few days to realise and to completely accept that this had happened to me, a trained therapist! This was the real test of my training. To be able to apply all my belief in therapy and art. The first step to healing is always acceptance. Acceptance of feelings, acceptance of behavior of self and acceptance of the situation. No healing can take place in the absence of acceptance. I accepted that I was undergoing postpartum depression. I accepted that there were inexplicable feelings and I accepted that I needed to reach out and seek help. I also completely accepted that my ‘symptoms’ were separate than me, the person.

On one such evening of depression, I opened my diary and wrote a journal entry. I wrote about how wanting a daughter had been a childhood dream and how I felt when she was born. I felt better. The next day I wrote some more and I painted. Within the next few days, I also went and consulted my homeopath. She listened to me for close to two hours and just that made me feel a lot better. As a habit, I also shared my everyday feelings with my husband, close friends and my mother. I also cried a lot, without feeling ashamed. A combination of writing, painting, talking, crying and sessions with my doctors ensured that I was on my way to feeling better and feeling healed. It took four months for me to get over my postpartum depression. Some feelings of depression come and go even now, but the deepest feelings of sadness have disappeared.

I share this very personal journey with all of you to bring to light the importance and the beauty of healing. How it is imperative that each one of us recognise feelings that need a way out and then choose a way to let them out. The process of ‘letting out’ needs an anchor. An anchor can be an art form, a close family member, a spouse, a friend or a trained therapist or a clinical psychologist. This is a personal choice and one that has to be made with trust, openness and no judgement.

As a trained therapist and as someone who has herself made this journey of seeking help to ‘let out’, I would always recommend finding an Expressive Arts Therapist or a combination of seeking an art form and going to a therapist.

Please consider the following factors before making a decision about your therapeutic process:

1. Self-Expression: All therapies, by their very nature and purpose, should encourage individuals to engage in self-exploration and self-expression. A platform where this is made possible becomes effective from the beginning.

2. Active Participation: The experience of doing, making, and creating can actually energize individuals, redirect attention and focus, and alleviate emotional stress, allowing one to fully concentrate on issues, goals, and behaviors. How will a process of active participation be facilitated?

3. Safe-Space: The space where therapeutic work happens has to feel safe. The concept of safety can be relative and its notion is as much psychological as physical. Aspects like trust, rapport with the therapist, confidentiality, a non-threatening and a nonjudgmental environment, all of these contribute to safety. It is important that you ask questions related to the physicality of the space which will be used for your sessions. A neutral space is always a good idea – neither your house nor the therapist’s.

4. Affordability: You have to decide what works for you. There are clinical psychologists associated with every hospital, there are expressive arts therapists- difficult to find but they exist and there are therapists running their independent practice. There is also a lot of pro-bono work happening in the field of therapy and while individual therapists may not offer these services, there are organisations and NGOs and online channels which provide free services.

5. Stigma-Shame-Marginalisation: There is NO shame in seeking help. There is NO shame in going through depression, battling mental illness, fighting feelings of suicide. There is no shame in accepting that maybe your mental health is affected and it needs healing. Each one of us goes through cycles of a low tide in our mental health. Marginalisation begins with oneself. When you choose to go into a shell because you are ashamed of what is happening in your mind, you initiate the process of stepping away. It is crucial to remind ourselves every day that each of our journeys are sacred and precious and difficult. When there is no shame, stigma and marginalisation affect us less.

paint-328676_19206. The Person You Are: Who you are and what you want is the most important. How you want to heal is of primary concern while making this decision. How much time you want to take before seeking help, is your decision. A dear friend I know doesn’t take medication for her schizophrenia. Another friend I know takes medication for her depression and goes to a psychologist.What works for another person may or may not work for you. Rely on your intuition and your own understanding of yourself.

7. Seek Therapist Information:

a) Ask for information about where the therapist is trained from and what the body of work is like. This is important because when you make an effort to do research and seek information, you also take the responsibility for your therapeutic process.
b) Ask if the therapist is registered and works independently or is attached to a therapeutic establishment.
c) How will goals be identified for your therapy sessions? You may go with a set of goals you want to achieve, but as you make this journey, you will realise that the goals might change. For e.g. you may decide that you want to do seek therapy to improve your self-esteem. But in the process you will discover stored up anger from childhood experiences. The goal of the sessions will then switch to the theme of ‘anger’. And will eventually lead to enhanced emotional expression and self-esteem.

Mental health is imperative for a healthy society. I have witnessed some fantastic work that is being done in this field and I have also witnessed the evolution of people from ignorance to awareness to healing and then to empowerment.

And NO, therapy is not just for ‘the not normal’. We are all normal neurotics.

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Image source: Sami Siva/Medecins Sans Frontieres

By Doctors Without Borders:

Kisto Devi likes to sing. For more than ten years now, Kisto has been using her voice to spread health messages in her community. She is an Accredited Social Health Activist or ASHA, tirelessly reaching out to hundreds of villagers through her songs.

Image source: Sami Siva/Medecins Sans Frontieres
Image source: Sami Siva/Medecins Sans Frontieres

ASHAs, meaning hope in Hindi, are women who are identified, trained and accredited by India’s Ministry of Health and Family Welfare to conduct health screenings and referrals of sick patients to the nearest government health facility at the community level. Their role is to detect and refer those who need immunisations, a health check-up or treatment and are at the forefront of community health service on behalf of the government. Typically, there is one ASHA per 1,000 inhabitants.

We are not medical technicians or specialists, but we know a little about the diseases of this region; for instance we know everything about kala azar,” says Kisto.

Kala Azar, A Forgotten Tropical Disease

Virtually unknown in the developed world, leishmaniasis is a vector-borne parasitic disease that affects more than 12 million people throughout the world today. Visceral leishmaniasis or kala azar is one form of leishmaniasis that is most prevalent in six countries: Bangladesh, Brazil, Ethiopia, India, South Sudan and Sudan. Transmitted by the bite of an infected sand fly, kala azar mainly affects populations with the least resources. The disease weakens the immune system making the patients more susceptible to opportunistic infections. And it’s almost always fatal, if left untreated.

Vaishali is one of the most endemic districts in Bihar, a state known to contribute around 80-90% of the kala azar cases in India. Bihar is also one of the poorest states with a population of more than 100 million.
With the highest endemicity and concentration of people with poor resources, Bihar set the stage for Medecins Sans Frontieres (MSF) to intervene and start a kala azar treatment programme in 2007. MSF successfully ran a 50-bed kala azar ward, supported five Primary Health Centres (PHCs) in Vaishali and has treated more than 12,000 kala azar patients, free of cost. From conducting awareness sessions to ensuring rapid diagnosis and treatment for the patients, MSF has partnered with government agencies to ensure that treatment is not only effective, but free for all.

Songs To Remember

To support MSF’s work, Kisto Devi does what she knows best: she scripts songs on kala azar; melodies that are set to popular Bollywood tunes from the 80s and 90s. She tells everything there is to know about the disease – its symptoms, transmission and treatment. When Kisto Devi sings she points to the mud walls, to the buffalos and the dirt around the cowsheds to inform and educate people about the habitat of sand flies.

It is a very practical way to generate awareness about kala azar – without relying on posters, writing, or anything else that are sometimes difficult to understand,” says Chhavi Kumar, a health promoter with MSF.

Kisto has devoted her life to community work. She was trained by MSF and knows all too well the work the organisation has done in Bihar for the past eight years. ASHAs like Kisto not only focus on kala azar but also conduct a range of screenings and referrals. They help pregnant women seek facility-based deliveries, ensure timely vaccinations for infants, screen patients suffering from infectious disease such as tuberculosis, and assist in awareness-building around public health issues, hygiene and sanitation, and ways to access proper treatment and care.

I have known many people who have suffered from kala azar but didn’t know they had the disease. Some thought it was malaria. I help people identify the symptoms correctly and tell them what to do,” says Kisto. “I like singing for them,” she adds with a smile.

Below is MSF’s video that throws light on the kala azar disease and the challenges in treating the same:

leela khabar lahariya (2)

By Khabar Lahariya

KL Logo 2 (1)Editor’s Note: As part of Youth Ki Awaaz and Khabar Lahariya‘s collaboration, the following is the story of Leela, an 18-year-old from Banda. Having suffered a tragic accident, she is unable to afford treatment while the state authorities claim that she never came to them for help, highlighting the major structural problems of healthcare for the poor in India.

Zila Banda, Block Mahua, Village Kanjipur. Leela, 18, has been struggling to stay alive for a year. She has multiple wounds all over her body. She has been hooked up to a catheter for the entire year. Poverty-stricken, her mother and father cannot get treatment for Leela. Her mother has gone to many administrators, big and small, to plead with them to help Leela.

Leela’s mother Ranno told the KL Banda team that last year, 19th September, Leela went out with her friends to get mud for the whitewashing of the house. Leela and three other girls fell down into the quarry when a mound of earth they were walking on collapsed.

leela khabar lahariya (2)

Quarries are part of the landscape in Bundelkhand, and are often leased to powerful locals, known as the sand mafia. There are many mining projects going on in this region, given the abundance of minerals available in the ground, and often, people who live in the area find informal work in these quarries. However, there are multiple safety risks to the people who live and work where these large mining projects are going on. The risk of falling into the quarry because of improper safety precautions is one, but there are also other risks.

Recently, an explosion in a quarry killed seven and injured eight in Sonbhadra, which is about seven hours from Banda. In addition, mine workers are likely to be exposed to chemicals and suspended particulate matter all day, and get respiratory and eye diseases – and since mining creates air and water pollution, the health of non-mine-working locals also suffers. Development work in these regions, therefore, often makes the lives of the locals very difficult – as in the case of Leela and her family.

The zila administration came to get Leela out after she had fallen into the quarry. They even had to get a JCB machine to get the girls out of the quarry. The other three girls didn’t get hurt very badly. Leela, however, broke both legs, a hip, and some rib bones. When she was admitted to a government hospital in Banda, the doctors referred her to Kanpur. She remained admitted at the Kanpur hospital for two months.

“We didn’t have money for the treatment. We sold our land and gave the hospital 2.5 lakhs, but that only covered the treatment of one leg. One leg, the hip, and the rib bones still remain untreated.” Lying in bed for months on end, Leela ended up getting genital bedsores.

What Do District Administrators Have To Say About This?

DM Suresh Kumar says that if Leela’s family had come to him about this, he doesn’t remember. If they come again, the government can help in Leela’s treatment.

There are some major structural problems when it comes to healthcare for the poor in India. A 2014 study revealed that India spends less on public health than some much less developed sub-Saharan African countries. Household expenditure, and other private expenditure – that is, money coming out of the patient’s pocket – is, in India, 71% of the total expenditure on health. The government needs to seriously invest in healthcare to change this alarming ratio.

Large healthcare expenses, in the wake of an accident like Leela suffered, can often push relatively stable households below the poverty line. In January this year, Times of India reported that according to the draft of the National Health Policy, 18% of all households faced catastrophic healthcare expenditure in India, and over 63 million people face poverty because of this expenditure. This turns into a vicious cycle – poverty creates living conditions that encourage communicable diseases, which then cannot be treated because of exorbitant healthcare costs.

The government has multiple health insurance schemes. One of these is the Rashtriya Swasthya Bima Yojana (RSBY) launched in 2008, which covers all of India and is one of the first insurance schemes that includes informal sector workers. It covers hospital care up to Rs. 30,000 for Below Poverty Line (BPL) people.

However, there are multiple problems with it. People need to be enrolled in this program to be eligible for benefits, which involves paying an enrollment fee of Rs. 30, which may seem like a lot to a household that does not have the ability to save and lives off everyday earnings. There is also a lack of information about RSBY in these areas, according to a study done on neighbouring states like Bihar and Uttarakhand. To build such awareness is entirely the responsibility of governmental entities – why did no one alert Leela’s mother about this scheme, or any similar ones, when she went to various government offices? Another barrier is frequent migration and travel among the poor (likely in search of work), which prevents them from registering when enrollment stations are open – a reality that a scheme to benefit informal labourers must acknowledge. Another, of course, is the lack of technical implementation – the scheme depends on “smartcards” which need to be scanned to deliver healthcare, and all empanelled hospitals or enrollment stations do not have the smartcard machines yet. Finally, another barrier is discrimination and indifference.

According to the RSBY website, in Banda district, RSBY is in its 5th year of implementation. Their goal is to enroll about 120,000 people. So far, 32,296 have been enrolled – about a fourth of the goal – and about 555 hospitalizations have occurred under the scheme, as of March this year.

Treatment Is Impossible Because Of Poverty

Leela’s parents don’t even have enough money to eat. Leela’s mother leaves her, lying in bed in her wounded state, to walk 13 kilometres into the jungle every day to collect wood which she sells for 20-30 rupees in the market. This is how the family sustains itself. Her mother says, “I’ve gone to everyone, from the Pradhan to the DM, to request them to get Leela’s treatment done. Nobody has agreed to help.”

Brought to you in collaboration with Khabar Lahariya.

Image source: WordPress

By Tabu Agarwal:

At a time when banning is considered the only solution to a problem, the Modi Government has done it yet again. The Supreme Court, with support from the ruling government is all set to ban commercial surrogacy in India, an industry that is worth $2.3 billion.

Image source: WordPress
Image source: WordPress

The curious case of baby Manji’s birth in July 2008, that made headlines, was possibly responsible for the amendments made in 2010 to India’s Assisted Reproductive Technology (ART) (Regulation) Bill.

However, in a shocking move, the Supreme Court has again brought out a revised Assisted Reproductive Technologies (ART) Bill to the table that is both a cause of debate and conflict. The proposed new law will allow surrogacy only for Indian couples and not foreigners. Moreover, only ‘altruistic surrogacy’ to infertile, needy married Indian couples would be provided after thorough investigation by competent authorities.

Altruistic surrogacy is when a surrogate is given no financial gain for carrying a child and only realistic out of pocket expenses are covered by the intended parents. Whereas, commercial surrogacy, which is the process in which a person or couple pays a woman to carry and deliver a baby, was always in controversy due to a host of complex medical, economic, ethical and legal issues that were open to abuse.

The business of commercial surrogacy in India is not unknown. Also known as ‘wombs for rent‘, India remains one of the few countries that still allows the practice, along with Russia, Ukraine, Thailand and so on. In India, about 25,000 children are born through in-vitro fertilization or the IVF technique. It is also the world’s no. 1 destination for surrogacy, but the sector goes unchecked and unregulated. The reason why this industry bloomed so rapidly in the country was because India became a cheap destination for foreigners wanting to use assisted reproductive technology. Poor women often used the opportunity as a means to earn their living. Also, local clinics promoted surrogacy arrangements because they were seen as profitable ventures. What is a cause of serious concern is the fact that can the ramifications that the ban would have on surrogate females and the industry prove to be counterproductive?

With the ban’s provision to keep gays and single people out of the surrogacy loop, paving way only for heterosexual married couples to avail the benefits of surrogacy, the entire law poses a serious threat to personal liberty and raises a question of gross discrimination.

Impoverished women who rent out their wombs in return for a handsome amount of money are generally the victims of an untold and unheard behaviour where they face exploitation, misery at the hands of unscrupulous clinics who cheat them and do not pay them the decided amount. They also run the risk of being physically exploited. Banning the practice will only result in it being carried out in a clandestine manner. Surrogacy as a reproductive technology is now too widely used and deeply entrenched to simply wither away in the face of a ‘ban’. In India, where there are no proper rights to protect the surrogates with the presence of an unregulated market, a ban will further encourage degrading treatment of the surrogate females.

Further, many women ‘choose’ to rent their wombs and consider the whole act and procedure as honourable and an opportunity to support themselves financially. The question that arises henceforth, is whether the government which was unable to lift them up from their present economic state is depriving them of this possible act?

The government, instead of banning commercial surrogacy should put in place proper measures that plug the regulatory gaps allowing surrogates to be exploited and fertility clinics to indulge in unethical medical practices. More stringent regulations should be introduced to stream out corruption and malpractices in the industry. Only couples who really need surrogacy after failed attempts at using other methods should be allowed to avail its benefit, in short, surrogacy must not be overused or abused. With a long history in India, challenging commercial surrogacy with a ban would be most certainly unwise and counter-productive.

Image source: LinkedIn

By Bhavna Sultana:

Get up!
Heavy traffic
Work
Heavy traffic
Sleep
Repeat

Most of us are victims of this infinite loop. Long commutes, extensive working hours, traffic jams; they all take a heavy toll on our health and also affect our level of happiness. Many experts will tell you that there’s a way out, that work-life balance is not really a myth. But, is it?

Image source: LinkedIn
Image source: LinkedIn

Deep down in our hearts we are all guilty of ignoring our personal relationships for the sake of fulfilling our work-related goals. Work is worship. But if you’re overdoing it to the point that you forget about your personal life, then it is a huge mistake.

I’ve come across many articles that point out the dark side of intense work culture. Most people overshoot their working hours, ignore their personal lives, health and even compromise on their safety. We exceed our limits despite knowing that it won’t bring us anything good. Many people are not even appreciated for the work they put in. In many instances, one doesn’t get good appraisals, salary hikes, but they keep on working. We are very much aware that what we do is not right, but we do it anyway.

What can be done? There are a few countries that have very flexible work laws. Sweden has recently trimmed down its working hours to 6 a day. The same level of productivity that was earlier achieved in 9 hours can be achieved in this time. The German labour ministry has banned out-of-hours working, which means one is not under any obligation to receive work-related calls after their normal shifts are over, except in the case of emergencies. I believe that this is a brilliant move.

If, however, big changes cannot be brought and the scenario remains the same, one can deal with such issues on a personal level. Here are a few tricks:

1) Utilize the long commutes

Long commutes result in a waste of time. If you travel by bus, metro or cab, you can utilise that time by listening to good music, watching educational videos, or you can even write. Nowadays one doesn’t even need a pen and paper, Google Keep or Notes will suffice for writing. You can also read.

2) Exercise

A desk job and daily commute takes a very bad toll on your overall health. Taking my own case, I started to feel pain in my back and legs mainly because of a daily four-hour commute. So, I joined a sports club nearby and started walking. It helped keep my creative juice flowing.

3) Try to avoid working on weekends/overshooting work hours

As much as possible, try to finish your work in the shift timings you have. Also, keep your weekends free, it is very important to recharge your batteries, otherwise your thinking capacity also drops down. If your shift doesn’t suit you, try negotiating with your seniors and if possible, take another shift if it helps you avoid long traffic jams.

4) Inculcate a hobby

We all let go of our hobbies because of a hectic lifestyle. I would suggest that you don’t do it. Find time for your hobbies. They will be the best companions throughout your life.

5) Spend more time with your family

We all know we’ve ignored them long enough. It reduces happiness, creates tensions in the relationship. Spend more time with them. Catch up with your old friends. Just don’t be too busy.

If all of this works out for you, then maybe work-life balance can still be achieved. As once quoted in Star Wars, “Be mindful of the future but not at the expense of the moment”.

artist-paints-art

By Janhavi:

I was some 6 years old when my family shifted to a new apartment. The idea of having neighbours was totally new to me and I loved it instantly. The first house I remember visiting was on the floor above our house. When we rang the bell, a saree clad woman opened the door and let me in with a huge smile. Her eyes were deep and her touch was as soft as my mother’s. I ran all over the house and saw a girl sitting on a chair. She was dark in complexion. Her neck was as if permanently positioned on the right shoulder. She emitted a profound odour which I noticed when I went closer to say hello. She kept staring at me and I stared back at her for a long time. After a while, she gave a huge smile with brightened eyes and I smiled at her as well.

artist-paints-art

“You can call her Tai. Her name is Sneha and she is my elder daughter,” the woman who opened the door told me from behind. While returning home, I told my parents that I would go and play with her every day after school. They agreed but told me to be extremely sensitive towards her as she was not a normal child. I asked them what exactly was her problem and they told me that she was ‘mentally retarded’. They made an honest effort to explain what exactly that means. At a tender age of 6 I could only see a potential friend in her. As I grew up, I came across many such children as if I was meant to meet them and befriend them. These encounters helped me deepen my understanding about various physical and mental conditions. Yet, Tai holds a special position in my life. Not just for the special bond we shared but because she introduced me to the empathy within me.

Now when I look back I realise that these were not mere associations, as I ended up choosing a profession where I keep meeting people with mental illnesses. But is that really a ‘mental illness’? I prefer to call it a mental condition. I realised this especially when I went to Brazil for a small internship in Dance Movement Therapy.

I worked at a place called casa dos sonhons (house of dreams). This was a government aided center where people came in for counseling as well as alternative therapies such as art, craft, movement, music and so on, free of cost.

One day when I went to the center, I found Miris, one of the therapists, sorting out boxes full of postcard art. I asked him what they were and what he was going to do with them. He seemed very enthusiastic to share the entire story. The postcards came from different mental rehabilitation centers across the world, made by patients having some or the other mental condition. On a closer look, I realised that I was looking at some intense artwork. My brain simply refused to accept the fact that it was made by people who we consider as ‘mentally ill’. I felt inadequate for flaunting myself as an art-based therapist.

Miris asked me to make a postcard on the theme of ‘How big is your madness?’ Without even giving it a second thought I picked up a piece of paper and a few colours to paint whatever came to my mind. I handed over that piece of paper and told him that I was no painter, but this is what came to me. He asked me to further describe and talk about the ‘mad one’ hidden within me. When I finished talking he said, “This is what it is! Madness is important. We as art based therapists here do nothing but help people find a direction for their madness. In this way they can make it big in their own possible way.”

Looking at my keen interest in arts and therapy, one of the psychologists, Cami Jacob, decided to take me on a tour of the main mental rehabilitation center in the city of Campinas. The first thing I noticed were the sign boards made of mosaic work which had been made by the patients who stayed there. Since she knew that I have worked with people with paranoid schizophrenia, the first place Cami took me to was the extreme trauma center. It came to me as a cultural shock to see a group of schizophrenics sitting under a tree sharing smokes and calmly talking to each other. I enquired about the type of treatment they received and she took me to the arts and crafts section. I saw people engrossed in some or the other artwork. I was surprised to know that this was a part of their core treatment. They utilise art to tell the most intimate stories of their life which otherwise becomes difficult for them to verbalise in a one-on-one counseling session. The walls of the room were filled with jaw-dropping creations.

We further went to the wood and metal workshop where I met a 15-year-old autistic girl who held my hand and took me to show her creations. My eyes could not believe that she was working with welding machines to make metal flowers. She wanted to give one to me but since it was freshly made it was hot and I could not hold it. I told her that I would collect it after some time. But she did not agree and went straight towards the water tap and held it under cold water.

The whole experience of visiting the mental rehabilitation center acted as an eye opener for me. The walls were painted with amazing graffiti works; patients were freely wandering around in the premise; the lawn was well maintained. The whole space was calm, peaceful and energizing. While returning home, Jacob said, “We take art very seriously. It is like one of the inseparable activities that we do in our day to day life. Hence, art becomes an important component when it comes to healing and therapy for people having a special mental condition.”

When I returned to India I felt like a complete alien. I realised that even though we say that India is one of richest countries when it comes to art and culture; we are not able to see the power that art holds. It has so much more to offer than just being a mere tool of entertainment. Many people like Tai might just find a way to make their lives meaningful as art would help them find their own way of expression.

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Abortion_protest_-_Barcelona,_Spain_(8133579204)

By Meera Vijayann:

Republican Presidential nominee Ben Carson came close to declaring a war on women’s health in America on Sunday. On NBC’s show ‘Meet The Press’, Carson defended outlawing abortion even in cases of rape and incest saying: “I will not be in favour of killing a baby because the baby came about in that way.” And just when you thought he could stoop no lower, he went so far as to compare abortion to slavery.

Abortion_protest_-_Barcelona,_Spain_(8133579204)
Image source: Wikipedia commons

But Carson’s regressive views are not uncommon. Back in India, abortion is, similarly, a sensitive issue. Despite Indian law allowing abortion up to a period of twenty weeks, women’s lives are still in danger. Women in large parts of rural India cannot afford abortion services, let alone primary care, when they are pregnant. In cities, social stigma still weighs heavily on women who wish to undergo abortions. The topic of abortion, in short, continues to be controversial, even in light of more open discussions among Indian youth about men and women’s health issues. Recently, a campaign on abortion stigma run by CREA and Youth Ki Awaaz invited a flurry of responses from young people across the country. These responses ranged from positive, encouraging messages to extremely negative accusations that abortion is “murder” and it is a “sin”.

So why don’t we set the record straight and dig deeper into those questions that people both in the US and India are currently debating about:

“Abortion Is A Sin” So I Won’t Support It

That’s fine. What’s important is that it is your choice for your body. In many religions, abortion is considered a sin. It is likely that if your views on abortion are weighed against the values that your religion dictates, it is hard to fathom. However, as citizens in a democracy, we are protected by fundamental civil rights.

Think about this: In many countries across the world, abortions have been refused to women on the basis of religious beliefs. In Paraguay, an 11-year old rape survivor was not allowed to undergo an abortion because of the country’s deep catholic faith. In the United States, House Republicans recently moved to defund Planned Parenthood, a national non-profit network of clinics that provides reproductive and maternal healthcare services for women, after a controversial video made by anti-abortion activists was leaked to the media. The video was proven to be false, yet Planned Parenthood came under intense attack with its Washington office damaged by arson. All this, despite the fact that a large number of beneficiaries of its services are women from low-income backgrounds who have little or no other alternative for care.

In the Philippines, which is predominantly Catholic, abortion is illegal and as a result, many women are shamed and forced to opt for clandestine and often dangerous means to end an unwanted pregnancy. There are nearly 500,000 cases of abortion and 1000 deaths in the country every year. Let’s not forget the tragic death of Savita Halappanavar, an Indian mother who died in Ireland because the State didn’t provide her an abortion on religious grounds. By opposing abortion based on your beliefs, you are placing your personal beliefs above a woman’s life and health.

“Abortion Is Murder” So I Won’t Support It

There are deep emotional, moral and social sensibilities associated with abortion. Primarily, there is a moral (personal reasoning) and an ethical (social reasoning) dilemma involved. Sex-selective abortion is a crime in India, but let’s get this straight — if a woman legally wishes to terminate an unwanted pregnancy, it is her sovereign right.

A lot of people who are anti-abortion have brought up the issue of a foetus’ right to life. They demand action against the mother for not executing her “duty” and want to take away the right to “murder”. Unfortunately, it isn’t that simple. In some countries, a foetus is not considered a human being until its birth. Recently, when House Republicans made a point to stress that abortion is ‘murder’, there were several debates around what constituted murder.

If you define murder as “the intentional killing of a human being” — would you also be willing to be held responsible every time a mother dies because she is unable to access reproductive health services? That immediately makes the debate lopsided.

Abortion is an intentional termination of a “pregnancy”. Many argue that for an abortion to be termed as murder, a foetus will have to first fulfil all the ethical points of what constitutes ‘personhood’. It will have to have a beating heart, a brain, a fully formed, functioning body – which it isn’t in the first few months.

“Abortion Is Against My Values” So I Won’t Support It

Ask yourself this: if I were to force you to risk your health simply because I believed in something and wanted you to act the way I would, would you consider that fair? The simple answer is no. While you have every right to choose against undergoing an abortion, it isn’t your right to dictate what a woman does with her body. Fundamentally, a woman’s reproductive choices are her own and it is a civic right for her to make a decision on her own. If you are asking why a woman wouldn’t choose to give birth and give the baby up for adoption, mull over this fact: adoption is NOT an easy alternative. In the US, there is 1 adoption for every 140 abortions. Children in state custody do not have an easy life either.

Second, if your family or community ‘honour’ solely depends on your impeding a woman’s right to an abortion or wellbeing, it’s seriously time for a reality check.

Globally, the reproductive health and well-being of women has become highly politicised around issues such as abortion, birth control and sexual health related treatments. Sadly, the people these decisions tend to impact are women alone. Whether rich or poor, in the east or west, millions of women are still struggling for a basic right to have control of their own bodies. I’ve personally seen so many women who are close to me undergo traumatic, secretive abortions and handle it on their own. In each case, it was different; an unplanned pregnancy, a marital rape, an abandonment. Today, their decision to terminate a pregnancy has allowed them to move forward with their lives.

Before we take a staunch position to oppose abortion based on our personal beliefs, take into account that, despite it being legal, one woman dies every two hours in India due to an unsafe abortion and nearly 20 million risks their lives walking into a clinic which has little or no resources to help them. If we put an unborn foetus’ life over a mother’s, it is nothing but a travesty.

maternal instincts

By Mark Elgar:

Many women hear an ominous ticking of their “biological clock” when they reach their 30’s, while others never hear it at all.

maternal instincts
Image source: Nagarjun Kandukuru/Flickr

Some believe the compulsion to bear babies is biologically inbuilt – even suggesting women who refuse their supposed evolutionary duty are being selfish.

Others hold the view that this so-called “maternal instinct”, also referred to as “baby fever”, has nothing to do with biology and is a social construct.

It’s unhelpful to explore this debate through a strictly dichotomous “nature vs nurture” prism. Both biology and culture likely contribute to our reproductive behaviour.

Reproduction doesn’t require any “inherited” preference to have children, since natural selection already favours mechanisms that result in reproduction, most significantly through the sexual urge.

But that version of the maternal instinct that relates to a mother’s ability and need to nurture and protect her child may indeed be hardwired, facilitated by the release of certain hormones and other necessary biological changes.

Sexual Urge

The exquisite diversity of past and present life-forms comes from a single critical feature – reproduction.

Individuals genetically disposed to be indifferent to sex will theoretically be selected out of the population, in favour of those with a greater commitment.

Sharon Sperry Bloom/Flickr, CC BY
Image source: Sharon Sperry Bloom/Flickr

It remains unclear whether the strong longing for a child, otherwise known as ‘baby fever’, is driven by our genes or is a social construction.

This is a self-evident feature of the evolutionary process.

Imagine a population of people or animals who enjoy sex, where that enjoyment has a genetic basis. This would determine their reproductive success. Now introduce into this population those genetically predisposed to be sexually inactive.

These sexually inactive individuals will not produce offspring, so there will be no sexually inactive individuals in the next generation.

In other words, a genetic disposition to avoid sex will neither become established nor maintained.

Some argue the so-called “biological clock”, triggering an enhanced awareness of reproduction among childless women in their 30s, is natural selection at work. Maybe.

There is some evidence that fertility decisions may have a genetic basis. For instance, studies that looked at the age of first attempt to have a child in Finnish populations showed children had similar patterns to those of their parents.

But these only proved there is a genetic influence for when women decided to have a child, rather than whether they decided to at all.

We are notoriously susceptible to the influence of others (witness the broad success of advertising and, one hopes, education).

So, like many other aspects of human behaviour, it remains unclear whether the strong longing for a child – “baby fever” – is driven by our genes or is a social construction.

Defying Biology

Until recently, sex and reproduction were inextricably entwined in all organisms. The discovery of contraceptive technology severed that nexus for one species.

With varying reliability, humans can now have sex without having babies. So in terms of biological evolution, a genetic preference for sexual activity is no longer equivalent to a maternal (or paternal) instinct to have offspring.

Amber McNamara/Flickr, CC BY
Amber McNamara/Flickr, CC BY

Through the contraceptive pill, humans have defied biology. There are many women in our society who aren’t interested in having children.

For instance, the number of US women between 34 and 44 who have never had children has increased by around 10% since 1976. And a survey of more than 7,000 Australian women between 22 and 27 years found nearly 10% didn’t want children.

My guess is that childless women aren’t necessarily sexually inactive – as natural selection likely dictates. But there may be little opportunity for selection to act on their personal choice.

It’s an impressive example of human behaviour defying biological evolution. But culture and technology have immunised humans from many selection pressures. Clothing, for example, allows us to inhabit cold environments unsuitable even for naturists.

Sex isn’t one of them though. Indeed, most cultures express more than a passing interest in sex – from the widespread inclusion of fertility rites in ancient societies to the almost unseemly obsession with sex in contemporary television advertising campaigns.

Nurturing Instinct

In many cases, successful reproduction requires care of the developing offspring. This is often, but not exclusively, undertaken by the mother.

Nurturing offspring is then a form of “maternal instinct”, as distinct from “baby fever”. And nature has built in biological mechanisms to ensure this.

Nurturing offspring is then a form of ‘maternal instinct’, as distinct from ‘baby fever’. For mammalian mothers, a demanding infant stimulates the release of the hormone oxytocin, which in turn triggers a flow of milk.

Oxytocin is also implicated in a suite of maternal behaviours throughout pregnancy, strengthening a mother’s bond to her foetus, which impacts on the foetus’ development.

The crucial, instinctive, nurturing response to feed the child, through the release of oxytocin, occurs only during pregnancy and after birth – otherwise the hormones don’t kick in.

For instance, virgin mice given oxytocin injections could learn to hear and respond to distressed calls of pups, something they were unable to do before the injections.

So it could be argued that the “urge” to have and nurture children is only ensured biologically through the urge to have sex, while the nurturing instinct is biologically inbuilt.

The so-called “biological clock”, then, may be ticking to a social key.

Mark Elgar is Professor of Evolutionary Biology, University of Melbourne.

This article was originally published here on The Conversation.

depression

By Rosanna Rodrigues

“I want to die,” she said. I couldn’t believe it. She was one of the most popular, most beautiful girls on campus. Full of promise. And yet she was serious.

Her chocolate almond eyes looked deep into mine, searching for judgment, shock, fear. She wouldn’t find it. This was a mantra I’d grown up with, repeating it to myself at several points in my life. It was the only thing that made sense some days. The abject insanity and palpable loneliness I sensed in my future was what drove me. I wasn’t, nor will I ever be, normal- and I knew it. I had acted on this mantra in the past. Had she?

Wordpress woman silhouetter

I asked her. She realized she was talking to someone who knew, who understood – a sister. Her words tumbled out, and I felt their weight, like a rock under a waterfall. Yet they brought healing for us both; for me, because the words were familiar – they were often my own. The song of abuse, betrayal and pain was not a new one for me. Fake smiles, forced laughter, forged strength –all things I know.

The Self

This is what it used to be like:

What’s the point, my mind screams at me. Pain washes over me in waves that radiate from my chest, left of centre. I’m paying close attention because I cannot understand it. And I feel like I should try. I’ve been living this for years now, this hell of insecurity, wrapped in layers and layers of pain that I cannot explain to anyone. I’m digging and digging for love, for I feel like it’s the cure. It must mean solace! That’s what all the books and movies say. But it’s elusive, and not constant and every time I’m alone, the pain is more apparent. And the voices in my head crescendo along with the crashing waves of pain, louder than ever – there’s no point, there’s no point, it will never change, no one will love you noonecanloveyou,youmustdie,youmustdieyoumustdieyoumustdie. It’s an unending torrent of abuse. It’s what I hear even when I’m smiling, and everyone thinks that all is right – all is as it should be. No one knows. And when they know, they do not understand, do not accept me. Buck up, it’s life, deal with it. Everyone goes through these feelings, these things. Learn to let go, to turn it off. BUT I CANNOT. Then the barrage starts anew – seeitsjustyoujustyou.there’s no point youmustdieyoumustdieyoumustdie. It’s the only way.

And then I drive people insane, you see. I push them away. And when they leave, I collapse. And this has been the last 25 years. I cannot work. I cannot smile. I cannot read. Life has eroded at my exteriors and defences completely, and left me blank, numb. Life has lost meaning for me. There’s no hope, not even the faintest glimmer. My eyes go damp as I type this. The waves of pain are concentrated in my jaw, my throat. It constricts. I swallow through it. I’m never happy, I’ve never been happy. Everyone says so. I’m always sad. Anyone reading this will say its self-pitying garbage. I’ve heard it before. But they probably haven’t felt this pain.

They probably haven’t burned themselves to escape it. Cut themselves shallow, because though you wanna die, you’re scared. And you cannot be sure, that on the other side there are no horrors. So you hurt yourself, because the red looks pretty. Because it’s the only way you have control. Because physical pain can be borne. Not the black death within me. I cannot bear that. And the black death speaks. It speaks. Constantly mocking me. Constantly telling me what I am. What a failure. In everything. Constant reminders. Imagine living that, can you? Imagine a bad dream that you cannot wake up from, except it’s not a dream. Not at all.

Imagine living life so that every venture you embark on makes you look for horrors, because you just know that they’re there. You expect pain. You cannot escape. Every smile, a lie. Every reflection of yourself fills you with loathing till you want to cut through it all, till you’re slashing at bone. Imagine wanting nothing more than to curl into a ball and die, because death is the only release from a hell you’ve been born in, it seems. Imagine that you cannot turn this off. Then what? I don’t want your pity. I want you to understand. So that you can be sensitive to someone else like me. So think twice before you say get over it. So that you measure your well-intentioned advice. Not everyone is as lucky as you. Some need help, to speak, to read, to learn. Some need understanding, time, so much more than a copy-pasted response that works in other situations. .

Today, I have moved somewhere beyond the space of self-loathing and deep depression. For me, I found that morbid poetry (which I absolutely love to write), meditation, yoga, creating some semblance of structure, creating positive spaces, expectations, they go a long way to help me stay afloat. I have a support system of loved ones, who are my safety nets, and are not responsible for me. I’m responsible for me. I realise that when I talk to you, I’m not coming from a space of diagnosis. See, I’m terrified of labels and all that they signify. I’d rather be undefined by DSM – VI, V (Diagnostic and Statistical Manual of Mental Disorders) or whatever it is. So I never went to the label makers. I wanted to talk about, share fragments of an experience that would enable you to maybe rethink some of the relationships in your life, and your reactions to them.

TRDLOGO1

breast-cancer

October is Breast Cancer Awareness Month.

Each year, approximately 1.5 lakh cases of the disease are diagnosed in India.
Breast Cancer has now overtaken cervical cancer as the most common cancer affecting women in India. Recent studies show one in 30 women in Urban India will develop the disease.
Breast Cancer itself is a curable and highly treatable disease when detected early. However, in India, 50% of the cases are diagnosed at advanced stages of the disease.
The reason we (Tarun Cotra, Deepak Thomas and Anthony Karbhari) decided to make this film, is to highlight these alarming statistics. By juxtaposing the probability of other events actually occurring in one’s life with the probability of developing breast cancer, we aim to jolt women into action.

Early detection is the key to survival and we would like the women in the country to know that although the statistics are unfavourable, we can definitely fight the odds by taking action.

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