Today was our first day at Sahara Michael’s Care Home. We got a really good intro to Sahara’s programs (one of which is last Monday’s transgender drop-in center/clinic site visit) and I’m really impressed with all of them. There’s socioeconomic empowerment, emotional counseling, and a host of other details that run the gamut from individual to social-ecological health promotion methods. What was most inspiring to me was the fact that both of the people who gave us the grand tour and briefed us on the care home (Francis and Philip) were former patients themselves—injected-drug users (the clinic caters mostly to IDUs who are HIV positive) who found just what they needed to get their lives back on track at Sahara. Interacting with affected people these past few days, and meeting rehabilitated, dedicated health workers (92% of staff are former clients), it hit me how little separates me from a high-risk, HIV-positive person. Physically and mentally, we’re made of similar stuff. It’s not about how low you go, or how much you mess up. It’s about how you come out of it, how you move on.
Sahara’s programs are truly comprehensive—they reach out to the most marginalized groups of society (IDUs, transgender MSM, street children, trafficked women). And they don’t just offer medical services. They emphasize spirituality, mental health services, family therapy, skills re-training and income generation programs, too. It was interesting to hear Francis and Philip talk about the barriers they face in doing their work….unexpectedly, some important global health issues came up.
Funding is a big issue not just for Sahara but for all health programs in India. As a developing country, it has relied inordinately on donor agencies who are starting to phase out (or actually already have phased out) their financial support for projects like Sahara. One donor agency stopped funding on June 1, just a couple days ago. This means fewer beds, lower salaries (staff at Sahara haven’t been paid for 4 months), and less food—recently, a local donor had to come in to provide meals. Where is the donor agency funding going instead? They see India advancing, health workers everywhere in Delhi tell us. It’s going to Africa now.
Another big challenge is stigma and discrimination, of course. Just yesterday, two people from the care home expired. They died in government hospitals at the ages of 20 and 25. Their bodies were still in the morgue today, because family members didn’t want them. Even in death, when they’re no longer alive to be HIV positive, they are still shunned. They don’t have anyone when they come to Sahara, so staff members don’t have families to partner with in caring for clients. They’re on their own, and it’s up to these ex-addict health workers to provide a little bit of everything that their broken patients need.
Health professionals are one of the most dangerous groups, in terms of perpetuating stigma. Their discrimination does more damage than the rest. Three years ago in the clinic, a patient was dehydrated and needed an IV drip to be started. There was a nearby doctor living in the community so they called him; apparently there were no medical staff on call at that hour . He was asked to wear gloves in the process, but he said no, it’s ok, this is my daily job. Afterward, he was sitting with the staff at Sahara chatting, and came to know the patient he had just treated was HIV positive. He threw a fit, raising his voice, arguing, and washing his hands with urgency. A doctor.
While Sahara provides skills training for clients so that they can eventually reintegrate into society, one of the toughest aspects of this kind of work is that many times the cycle of outreach, detoxification, rehabilitation, skills training and job placement repeats itself. IDUs are a very sensitive bunch, Philip told us. They feel self-stigma because of their life. Even more important, it is really hard for a chronically ill person to hold down a steady job—with treatment and opportunistic infections, a lot of time is taken off work, and the client can’t explain why without facing stigma or being fired…all of this makes successful reintegration a big challenge.
Sahara gets no funding from the government. In fact, government services are so poorly planned in comparison that patients can’t get what they need there and come to the care home instead. The quality of care is so much better. At government-run establishments, HIV testing is a crude process, and HIV positive patients are directed in an assembly-line fashion to the queue for free ARVs (first-line treatment only).
Dr. Deep Gupta, the medical director, also gave us a really informative overview of broad issues in treatment options for HIV/AIDS. While developed countries have 4 or 5 ARVs to work with, fewer are available in countries like India. They also start treatment with ARVs later in India, at a CD4 count of 200 rather than 400. This is because of resistance, viral mutation and of course the Bottom Line: cost. When you have fewer ARVs to work with, they must be started later on in the disease progression to guard against patient resistance, viral mutation, and the cost of being on ARVs. HIV is an RNA virus, which not only has a higher rate of mutation (rendering ARV cocktails less effective) but it also replicates faster. There are positives and negatives to waiting until the CD4 count is so low; on the positive side, ARVs do have toxic side effects so not being on them for a long time is a good thing. Managing the health care problems that arise from being on ARVs is mentally, physically and financially draining. On the negative side, starting ARVs late in the game means that the HIV positive patient is more prone to opportunistic infections which must be constantly managed. This also taxes resources though; we’re talking about a developing country with a billion people in it. This is an interesting debate that points out fundamental differences in how health care systems are run in the US and India.
What else happened today: the Gujjars finally got what they want by planting bombs in buses in Delhi. As a result of all the ruckus, we rode home to Vasant Kunj from the care home in an ambulance. But whoever said bombs don’t distinguish between rich or poor was wrong as far as today’s violence goes. The kind of people who take buses in India are of low to middle socioeconomic status; those who are “well-off” have their own vehicles. So the people in the three burning buses today were at a disproportionate risk for terrorist acts. Disparity, disparity, disparity. But it seems that the government has come to an agreement whereby the Gujjars will get what they’re asking for (Scheduled Tribe status)…that means we might be going to Mewat on Thursday, and Jaipur on Saturday! Lesson for other tribes: violent protesting in the capital city might get Parliament to give you what you want...
Monday, June 4, 2007
Sunday, June 3, 2007
Photo Blog--Week 1 in Pictures
Signs outside the Bapu Nature Cure and Yogashram emphasizing preventive care. We were a little reserved when we first got here, but now that we're staying in Vasant Kunj, I miss it! We met some cool people there. We'll be back there for the fourth week of rotations.
Youth peer educators at the St. Stephens Community Outreach Center located in Nandnargh (East Delhi slum) last Tuesday. There was so much enthusiasm in that room.
As part of the Outreach Center's socioeconomic empowerment program, women are trained to make, package, market and sell spices.
Standing water and trash...this is a very mild version of the huge problems India has with standing water and garbage everywhere you look...it's so common to see mountains of trash in every type of area, even the upscale places.
Picture from Reuters: People from the ethnic Gujjar community burn an effigy during a demonstration in New Delhi May 31, 2007. Police in Rajasthan killed two ethnic Gujjars on Thursday during a protest for reserved places in government jobs and colleges, two days after 13 members of the community were shot dead by police.
Picture from India Times: People of Gujjar community take part in a demonstration in a Rajasthan village as they demand reservation for their community.
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Emma, Paul and I in a bike rickshaw (the three of us in 110-degree heat on that bike, poor rickshaw-walla). This was on our way out of the drug de-addiction camp (in an utterly packed neighborhood), on Friday afternoon.
A group photo with the health workers at the SPYM HIV testing/counseling site last Thursday. It was hot, and on the way there we got stuck among all these big trucks (it's a truck stop area) because the borders were blocked due to Gujjar protesting (and now there's the uprising from an opposing tribe, the Meenas).
HIV rapid assay testing at the SPYM HIV testing and counseling site. His name escapes me right now, but the guy in the photo did 6 tests and they all came out negative...very good news. But the health workers there stress that HIV and ignorance about HIV and other STDs, as well as high risk behaviors, continue to be a big problem.
Weekend Sightseeing, Part 2
Today we went to the ISKCON temple and Humayan's tomb. We also drove past Akshardham (which I'm convinced now that I don't need to see except from the outside, after ISKCON). It was an interesting experience, not just for the cultural/historical experience, but just to see where people's money goes and why.
The ISKCON temple was an elaborate affair with really interesting architecture. There were lots of people there to worship their statues in the temple. ISKCON stand for International Society for Krishna Consciousness, and at the entrance to the area (where we had to pass through airport-ish security) an eager man informed us that "You may be conscious but you're not really conscious until you're Krishna conscious," or something to that effect. There were garlands of marigold outside too; I thought they were for us to wear as tourists, but really, they were to buy as offerings for the Hindu gods.
It was amazing to me how much money was spent on this ISKCON temple. I wish I were able to post more pictures here right now to show the disparity between the temple and its surroundings, which were the same dilapidated buildings you see everywhere else in town. And I'm not cracking down on temples alone; there are so many monuments, like Humayan's tomb (below; he was a 1500s Muslim ruler), masjids, etc. that show this vast display of wealth that could be used for much more practical purposes. The juxtaposition of socioeconomic extremes is really striking.
I guess that's just how human beings are. We promote our egos and things that feed our egos, and plan to do the nice stuff later on. The problem is, egos are generally pretty hungry, and life is short.
The ISKCON temple was an elaborate affair with really interesting architecture. There were lots of people there to worship their statues in the temple. ISKCON stand for International Society for Krishna Consciousness, and at the entrance to the area (where we had to pass through airport-ish security) an eager man informed us that "You may be conscious but you're not really conscious until you're Krishna conscious," or something to that effect. There were garlands of marigold outside too; I thought they were for us to wear as tourists, but really, they were to buy as offerings for the Hindu gods.
It was amazing to me how much money was spent on this ISKCON temple. I wish I were able to post more pictures here right now to show the disparity between the temple and its surroundings, which were the same dilapidated buildings you see everywhere else in town. And I'm not cracking down on temples alone; there are so many monuments, like Humayan's tomb (below; he was a 1500s Muslim ruler), masjids, etc. that show this vast display of wealth that could be used for much more practical purposes. The juxtaposition of socioeconomic extremes is really striking.
I guess that's just how human beings are. We promote our egos and things that feed our egos, and plan to do the nice stuff later on. The problem is, egos are generally pretty hungry, and life is short.
On Being a Muslim in Hindu Territory
First off, let's talk abuot what it means (to me) to be Muslim. TO ME (and literally), the word means 'submitter' or 'servant.' Islam is the religion of servitude. Many people refer to religion and spirituality as ways for humans to deal with the fact that we are not in control of what is happening in our world. There is apparently some non-human force controlling everything around us, and we basically have the choice of how to respond to what comes our way. How we respond creates our future path.
I describe myself as a Muslim because I believe in the Quran, a book that is meant for everyone but that happens (and I think, aptly) to describe believers as Muslims--submitters to this aforementioned force (aka 'God'). However, I think many process their religion intellectually, while I wish to process Islam conceptually. To me, this means that the definition of a Muslim is not a brown person who prays in Arabic five times a day and fasts during Ramadan, but rather a monotheist who remembers God often, is charitable and tries sincerely to humble herself. To continue with the whole conceptualizing Islam theme, rather than a tangible God who we refer to as 'He,' I believe God is more of a force. We can humanize this force all we want, but it is more omniscient and all-encompassing than we can fathom. Islam is a monotheist faith (no trinity like in Christianity, no gods and goddesses as in Hinduism, no interceptors of any kind needed), and it makes sense to me on non-scriptural levels as well that there is only one of these all-powerful forces, not several conflicting or conspiratory ones, and that I don't need to talk to a priest/imam/statue to communicate with it.
On to the title of this blog. When I introduce myself as a Muslim, both at home and abroad, it elicits such a stereotypical response that I almost dislike identifying myself as Muslim. Maybe I should say that I'm a submitter, so people don't react so viscerally. Of course it doesn't matter how people react, at the end of the day (so this whole post is somewhat moot...), but it's interesting to think about.
Some people react to the religious/spiritual beliefs of others with indifference or some level of interest, whether or not they truly understand them. What gets me sometimes is the so-called 'enlightened' people who 1) renounce all religion and 2) simultaneously think that their religious/spiritual beliefs are exempt from judgment. In other words, they Have It All Figured Out. But you? You're the fool who believes in God, heaven and hell, and that being nice will get you somewhere (besides life satisfaction).
Of course, intellectually I can understand why people all over the world, and especially those of South Asian and Middle Eastern descent, have a distinctly anti-Muslim sentiment. Given the history of India, and the recent history of the world, Muslims havent't exactly created a sense of global goodwill. But one must distinguish the fanatics, the power-hungry, the agenda-driven, and the hypocrites. These are found in every organized religion. The solution for 'enlightened people' has been to do away with it all and create a new language in which the words 'God' and 'religion' do not exist. Ok. If we do it that way, I will replace God with 'The Overwhelming Force' and religion with 'way of life' (in fact, the Quran refers to Islam as a 'deen', or a way of life...it never uses the term religion).
My conversation with Dr. Raina the other day (a religion-renouncer and fervent proponent of distinctly non-religious enlightenment) sparked this post. But Delhi is overwhelmingly Hindu, and Islam is a minority...so the entire trip has made me reflect on religion, which is a good thing. As I see Hindus prostrating on the floor in front of gilded idols with painted faces, I think about my own beliefs (I also think when I'm around Muslims, Christians, Sikhs, etc...it all makes you think!). I stretch them, hold them up to the light, see if they fit me right and am still convinced that there is only one God, and this God does not marry, or have kids, or appear as a human being, fight with other gods, or engage in petty affairs.
I agree that organized religion has vastly contributed to the corruption, impurity, and desecration of true faith in a higher power. But where I disagree is in judging those who sincerely persist in their faith in God. Hey, I'm New-Agey too, in the sense that I want to continue to evolve, learn, grow, stretch myself, look inward and outward, and reach an inner sense of zen. This path is how I define happiness. But I find that wholly compatible with my belief that God revealed the Quran to Muhammad for the benefit of us humans as we hobble through life. If we could just read the holy scriptures (yep, all three of em) with common sense, trying our best to start over like babies without all those preconceived notions (whether they're positive or negative), I think we'd all come at least a little bit closer to the Truth.
At the end of the day, I think this sums up what I'd say to people who gently accuse believers of perpetuating the societal destruction that organized religion has caused: Live and let live. If we ALL followed that (even you enlightened ones) I think we'd be a much healthier race.
I describe myself as a Muslim because I believe in the Quran, a book that is meant for everyone but that happens (and I think, aptly) to describe believers as Muslims--submitters to this aforementioned force (aka 'God'). However, I think many process their religion intellectually, while I wish to process Islam conceptually. To me, this means that the definition of a Muslim is not a brown person who prays in Arabic five times a day and fasts during Ramadan, but rather a monotheist who remembers God often, is charitable and tries sincerely to humble herself. To continue with the whole conceptualizing Islam theme, rather than a tangible God who we refer to as 'He,' I believe God is more of a force. We can humanize this force all we want, but it is more omniscient and all-encompassing than we can fathom. Islam is a monotheist faith (no trinity like in Christianity, no gods and goddesses as in Hinduism, no interceptors of any kind needed), and it makes sense to me on non-scriptural levels as well that there is only one of these all-powerful forces, not several conflicting or conspiratory ones, and that I don't need to talk to a priest/imam/statue to communicate with it.
On to the title of this blog. When I introduce myself as a Muslim, both at home and abroad, it elicits such a stereotypical response that I almost dislike identifying myself as Muslim. Maybe I should say that I'm a submitter, so people don't react so viscerally. Of course it doesn't matter how people react, at the end of the day (so this whole post is somewhat moot...), but it's interesting to think about.
Some people react to the religious/spiritual beliefs of others with indifference or some level of interest, whether or not they truly understand them. What gets me sometimes is the so-called 'enlightened' people who 1) renounce all religion and 2) simultaneously think that their religious/spiritual beliefs are exempt from judgment. In other words, they Have It All Figured Out. But you? You're the fool who believes in God, heaven and hell, and that being nice will get you somewhere (besides life satisfaction).
Of course, intellectually I can understand why people all over the world, and especially those of South Asian and Middle Eastern descent, have a distinctly anti-Muslim sentiment. Given the history of India, and the recent history of the world, Muslims havent't exactly created a sense of global goodwill. But one must distinguish the fanatics, the power-hungry, the agenda-driven, and the hypocrites. These are found in every organized religion. The solution for 'enlightened people' has been to do away with it all and create a new language in which the words 'God' and 'religion' do not exist. Ok. If we do it that way, I will replace God with 'The Overwhelming Force' and religion with 'way of life' (in fact, the Quran refers to Islam as a 'deen', or a way of life...it never uses the term religion).
My conversation with Dr. Raina the other day (a religion-renouncer and fervent proponent of distinctly non-religious enlightenment) sparked this post. But Delhi is overwhelmingly Hindu, and Islam is a minority...so the entire trip has made me reflect on religion, which is a good thing. As I see Hindus prostrating on the floor in front of gilded idols with painted faces, I think about my own beliefs (I also think when I'm around Muslims, Christians, Sikhs, etc...it all makes you think!). I stretch them, hold them up to the light, see if they fit me right and am still convinced that there is only one God, and this God does not marry, or have kids, or appear as a human being, fight with other gods, or engage in petty affairs.
I agree that organized religion has vastly contributed to the corruption, impurity, and desecration of true faith in a higher power. But where I disagree is in judging those who sincerely persist in their faith in God. Hey, I'm New-Agey too, in the sense that I want to continue to evolve, learn, grow, stretch myself, look inward and outward, and reach an inner sense of zen. This path is how I define happiness. But I find that wholly compatible with my belief that God revealed the Quran to Muhammad for the benefit of us humans as we hobble through life. If we could just read the holy scriptures (yep, all three of em) with common sense, trying our best to start over like babies without all those preconceived notions (whether they're positive or negative), I think we'd all come at least a little bit closer to the Truth.
At the end of the day, I think this sums up what I'd say to people who gently accuse believers of perpetuating the societal destruction that organized religion has caused: Live and let live. If we ALL followed that (even you enlightened ones) I think we'd be a much healthier race.
Saturday, June 2, 2007
Weekend Sightseeing, Part 1
So today we finally got around to some sightseeing, which included the Parliament buildings and the National Museum. The museum was really interesting. We got to see all these artifacts from as far back as 3000 BC! There was also miniature art from the Mughal period, with beautiful use of colors...really intricate stuff. A lot of the miniature art depicted stories from the Hindu scriptures. Many were of Krishna and Radha. Others showed Shahjahan (creator of the Taj Mahal) and the courts of Muslim rulers several centuries ago. Statues of Buddha, Krishna, and other Hindu gods filled the museum too.
There was also a room dedicated to the history of Indian coins. As Sej pointed out, it was really interesting to see how the appearance of coins changed with each ruler. There was also a series of displays depicting the switch from bartering to using coins as a form of remuneration. While coins are obviously more efficient and businesslike, bartering seems like a much less materialistic way of getting the goods you need to live your life...rather than amassing a bunch of (objectively) meaningless coins.
Last week, we saw the India Gate, the Qutub Minar fort, and the Lotus Temple (a Bahai temple). The Lotus Temple is architecturally beautiful; I wish I could post a photo here but I'll have to do it when I get ahold of flash drive over 512MB! Qutub Minar was fascinating too, because (to be blunt) of how old it is. The architecture is also pretty unique; it is distinctly Muslim and has some intricate carvings on the buildings. The India Gate is just a big gate, but I've always seen crowds there. Maybe because it's summertime.
Tomorrow, we are hoping to visit the Indira Gandhi museum, the Mahatma Gandhi memorial, and the Garden of Five Senses. Hopefully we can go to a marketplace where they sell artifacts and cotton clothes...the only places we've been for shopping have been A/C malls that resemble what you'd find in the U.S.
Updates at the yogashram (Bapu Nature Cure, where we're staying): nothing new. We're leaving for Vasant Kunj tomorrow, which is in South Delhi. It's supposed to be in a better area of Delhi. Bapu is not exactly in a choice area, not that I'm complaining. Now that I've gotten to know people there, I feel like it's home. Except for the fact that the A/C conked out last night and we spent the night like sweating pigs (that ceiling fan doesn't do it for me). But anyway, we'll be back at Bapu in a couple of weeks.
As far as Jaipur plans go, it looks like the Gujjar conflict has not abated but rather escalated,as a result of conflicting tribes being awakened by the Gujjar uprising. Now, apparently, opposing ethnic groups are arguing against the Gujjars, and the government is trying to find a way to reconcile. Still, things should quiet down and God willing,Jaipur will happen the week after next.
There was also a room dedicated to the history of Indian coins. As Sej pointed out, it was really interesting to see how the appearance of coins changed with each ruler. There was also a series of displays depicting the switch from bartering to using coins as a form of remuneration. While coins are obviously more efficient and businesslike, bartering seems like a much less materialistic way of getting the goods you need to live your life...rather than amassing a bunch of (objectively) meaningless coins.
Last week, we saw the India Gate, the Qutub Minar fort, and the Lotus Temple (a Bahai temple). The Lotus Temple is architecturally beautiful; I wish I could post a photo here but I'll have to do it when I get ahold of flash drive over 512MB! Qutub Minar was fascinating too, because (to be blunt) of how old it is. The architecture is also pretty unique; it is distinctly Muslim and has some intricate carvings on the buildings. The India Gate is just a big gate, but I've always seen crowds there. Maybe because it's summertime.
Tomorrow, we are hoping to visit the Indira Gandhi museum, the Mahatma Gandhi memorial, and the Garden of Five Senses. Hopefully we can go to a marketplace where they sell artifacts and cotton clothes...the only places we've been for shopping have been A/C malls that resemble what you'd find in the U.S.
Updates at the yogashram (Bapu Nature Cure, where we're staying): nothing new. We're leaving for Vasant Kunj tomorrow, which is in South Delhi. It's supposed to be in a better area of Delhi. Bapu is not exactly in a choice area, not that I'm complaining. Now that I've gotten to know people there, I feel like it's home. Except for the fact that the A/C conked out last night and we spent the night like sweating pigs (that ceiling fan doesn't do it for me). But anyway, we'll be back at Bapu in a couple of weeks.
As far as Jaipur plans go, it looks like the Gujjar conflict has not abated but rather escalated,as a result of conflicting tribes being awakened by the Gujjar uprising. Now, apparently, opposing ethnic groups are arguing against the Gujjars, and the government is trying to find a way to reconcile. Still, things should quiet down and God willing,Jaipur will happen the week after next.
Friday, June 1, 2007
Gujjar Protests & Drug De-Addiction Camp
We couldn't go to Mewat today...I was slightly disappointed (okay, very) but after hearing about what's going on in the Gujjar community in northwestern India that disappointment quickly faded! It looks like we can't go to Jaipur either because of the blocked borders. We're waiting for the military to come in, so it's safe to travel again. It shouldn't be more than a few days.
So instead of Mewat, a village that I will post about later on, we went to a drug de-addiction camp today. It's another SPYM site; coincidentally, it's in a Gujjar community area (but we were in no danger). It was really cool to interact with the drug users, many of whom are older (50+), have children, and some of whom are professionals (one of them I chatted with, Ramchander, is a government worker). We played a lot of games, including Bollywood trivia, singing, reciting poetry, Simon Says, etc. It was cool to see them getting lively, kind of like children. One of them just lay in the corner, I think he was having severe withdrawal symptoms (most of them were, they had only been in the center 2-3 days).
The camp lasts 15 days and is completely free. From what I gathered from talking to two of the participants, Ramchander and Pasandsingh, they earnestly want to quit using smack (the most common drug of choice). In Ramchander's case, he has five children, all of them in school. One of his kids keeps telling him that the teacher at school says smack is bad. The little boy bugs his dad to stop, and that's why Ramchander's here. He happens to be an illustrious performer, and recited bits of poetry, speeches, and even sang a whole song (Teri Meri Dosti Hai). Pasandsingh was a little harder to talk to, because he seemed to be more out of it. In the beginning he said he started using drugs late in life, and then continued to say he was only a child when he started. So who knows. Either way, they were bright and responsive. Ramchander was eager to hear and be heard. Towards the end of our visit, he brought me a piece of paper with Hindi words on it. I couldn't read it, so someone translated. It was his personal log of how he was feeling at this point of his detoxification. The sense of brotherhood he felt at the camp seemed to keep him going. He was worried about how he would resist the drug once he resumed his normal life, but knew he had to leave the habit. I admired his straightforwardness.
I asked him if he likes other things besides drugs...movies, ice cream, biryani (hey, he likes Hyderabad!). He said he used to, but now all his money goes to smack. Maybe he can rediscover all the things he used to like. He seemed like a man of many talents!
The greatest thing for me today was when we stood in a circle and each person stepped forward and sang a song, or recited a poem, or did some sort of performance for the group. Some sang sad love songs, others recited philosophical poems, and there were a couple funny stories. There was always a moral. It was heartfelt and made me feel included in these people's lives, even if it was only for a short while. I loved it.
We even contributed a little to the performing...to kick it off, we played Sejal's Bollywood trivia game, which livened things up after talking about drug addiction the whole morning. I even sang a couple lines of a song (it's all I know!), it went like this:
Aye dil hai mushkil jeena yahan
Zara hat ke zara bach ke,
yeh hai Dilli (Delhi) meri jaan
It's edited because we're in Delhi, not Bombay! Sej gets snaps for that.
On the domestic front: the crew is ok. Emma has slept some, Sej hasn't run into a flying lizard, and I haven't seen a cockroach. The mouse mystery is unsolved. Paul continues to be a trooper.
So instead of Mewat, a village that I will post about later on, we went to a drug de-addiction camp today. It's another SPYM site; coincidentally, it's in a Gujjar community area (but we were in no danger). It was really cool to interact with the drug users, many of whom are older (50+), have children, and some of whom are professionals (one of them I chatted with, Ramchander, is a government worker). We played a lot of games, including Bollywood trivia, singing, reciting poetry, Simon Says, etc. It was cool to see them getting lively, kind of like children. One of them just lay in the corner, I think he was having severe withdrawal symptoms (most of them were, they had only been in the center 2-3 days).
The camp lasts 15 days and is completely free. From what I gathered from talking to two of the participants, Ramchander and Pasandsingh, they earnestly want to quit using smack (the most common drug of choice). In Ramchander's case, he has five children, all of them in school. One of his kids keeps telling him that the teacher at school says smack is bad. The little boy bugs his dad to stop, and that's why Ramchander's here. He happens to be an illustrious performer, and recited bits of poetry, speeches, and even sang a whole song (Teri Meri Dosti Hai). Pasandsingh was a little harder to talk to, because he seemed to be more out of it. In the beginning he said he started using drugs late in life, and then continued to say he was only a child when he started. So who knows. Either way, they were bright and responsive. Ramchander was eager to hear and be heard. Towards the end of our visit, he brought me a piece of paper with Hindi words on it. I couldn't read it, so someone translated. It was his personal log of how he was feeling at this point of his detoxification. The sense of brotherhood he felt at the camp seemed to keep him going. He was worried about how he would resist the drug once he resumed his normal life, but knew he had to leave the habit. I admired his straightforwardness.
I asked him if he likes other things besides drugs...movies, ice cream, biryani (hey, he likes Hyderabad!). He said he used to, but now all his money goes to smack. Maybe he can rediscover all the things he used to like. He seemed like a man of many talents!
The greatest thing for me today was when we stood in a circle and each person stepped forward and sang a song, or recited a poem, or did some sort of performance for the group. Some sang sad love songs, others recited philosophical poems, and there were a couple funny stories. There was always a moral. It was heartfelt and made me feel included in these people's lives, even if it was only for a short while. I loved it.
We even contributed a little to the performing...to kick it off, we played Sejal's Bollywood trivia game, which livened things up after talking about drug addiction the whole morning. I even sang a couple lines of a song (it's all I know!), it went like this:
Aye dil hai mushkil jeena yahan
Zara hat ke zara bach ke,
yeh hai Dilli (Delhi) meri jaan
It's edited because we're in Delhi, not Bombay! Sej gets snaps for that.
On the domestic front: the crew is ok. Emma has slept some, Sej hasn't run into a flying lizard, and I haven't seen a cockroach. The mouse mystery is unsolved. Paul continues to be a trooper.
Apollo Blood Services & Free HIV Testing Clinic (May 31)
This is a backlog of what we did yesterday--by the end of the day we were so beat we just barely finished dinner before collapsing at around 8:30.
Dr. Raina, an immunologist (and anti-religionist!) gave us a tour of the blood services at the Sarita Villar Apollo. Apollo Hospitals are a corporate group with 40,000 beds in India. It's a paid service, although 10% of the beds are government-sponsored, and the private revenues pay for services for those who can't afford Apollo's "luxury" care.
Interesting what constitutes luxury. This is not a primary care hospital--it's a referral hospital. Got a rare disease? You'll find your superspecialist here. There are 450 doctors in this hospital, and 2,500 staff. They offer the best care you'll find anywhere in the world.
Almost. At first it seemed odd that Dr. Raina would bring us to this posh area (read: central A/C) to tell us about the disease burden of HIV/AIDS and how it's infiltrating the blood supply. I thought we were at Apollo to talk about success in the health care arena for a change.
About 10 years ago, blood donation legislation changed in India. Instead of getting paid donors to donate, lawmakers banned compensation for donation and decided that patients should rely on family members and, in case of no ready family members, voluntary donors. 60-70% of blood donated comes from family members of a patient. The rest comes from unpaid donation.
However, there is a significant black market in India for blood. There is quite a shortage, according to Dr. Raina. The country uses 6-7 billion units, but it only gets about 5 million units each year. This leads to a massive shortage, which fuels a black market that attracts not healthy people's blood, but the blood of drug users and other high risk populations.
What is the consequence of having a population with a higher burden of HIV/AIDS, Hepatitis B, HPV and other STDs regularly donating blood? The consequence is that the transmission risk for HIV/AIDS in India is 202-50 fold higher than in other countries. This is NOT because of bad testing (1 of every 40,000 will transmit HIV AFTER standard screening, which translates into a profound number in a country with 1 billion people), but because of the population load of the virus. And to get more specific, it's because of the sort of people who are donating. Dr. Raina pointed out that this problem would be solved not by focusing on the black market, but by encouraging healthy people to do their part and donate their good blood.
This is not the only issue. There are two types of screening tests: testing for antibody presence, and testing for viral load. The nucleic acid testing (NAT) is very expensive and new. It is neither required by the Indian government, nor affordable to the general population (at Apollo, however, it is required). Thus, the vast majority of screening relies on ELISA--the antibody test. Antibodies are bigger than nucleic acids, so the test is easier, cheaper, and older. However, it is not so sensitive as doing the two in combination. In the United States, of course, both antibody and viral testing is done. Dr. Raina stressed that if this precaution is needed anywhere, it is needed in India. The situation is compounded by the fact that a high percentage of donors are repeat donors, so if the tests do not detect their seropositivity the first time, they will continue to be cleared for donation again and again. Their donated unit of blood will infect not only one other person, but three or four. Dr. Raina says that the fact that there is no national ID system in India, and no HIV registry, make it much harder to keep the blood supply clean. In the clinics, we have met two patients, both young, who contracted HIV through blood transfusions.
The second part of our day was spent near a huge truck stop at a free HIV testing clinic run by SPYM (correction from the previous blog: SPYM stands for society for the promotion of youth and MASSES!). We met with health workers who do outreach work serving 1,000 people in the community, including female sex workers, MSM, injected-drug users, and truck drivers. The health workers there indicated that MSM were the most at-risk for HIV due to their sexual practices and risky use of condoms that has a higher rate of breakage. The center gives free HIV testing (antibody testing, rapid assay--25 minutes). Many people don't come back for their results. The clinic gets government funding for all its laboratory equipment, and also receives NGO funding that trickles down from larger national anti-AIDS programs.
We gained some insight into the lives of MSM there. For instance, they may be married and have kids. Some are openly MSM and have no other life, others live a normal life (they may have been pressured to get married despite their desire for a different lifestyle). Many who test HIV positive don't tell their wives about their status. They often don't know how it is spread. One of the health workers, Narendra, said that many think having sex with a donkey or a virgin will actually cure them (this was hard to believe, but he was serious). It's hard for health workers to spread awareness because many of their target populations think that having sex is the only way to get the disease; therefore, from the beginning, they are aware of the stigma associated with it and are not open to discussing it. Many are more worried about STDs, and Narendra said that his biggest challenge was convincing them that STDs were not a bigger threat than HIV, but the other way around.
Another highlight of our HOT afternoon was talking to Ammaji, a peer educator for female sex workers. She is a peer not because she herself is a sex worker but because she lives among them. She is older, and has a very strong spirit. She is committed to the women she serves. She said she has sat outside while sex workers are meeting with clients, in order to track them down and educate them. If a client refuses to wear a condom, she openly counsels/scolds/stands up to him, and has empowered the community to say no to clients who bully them not to use condoms. It was interesting; she was able to do what she does successfully because of her position as a strong, wise, older woman.
Trafficking is a big problem in Delhi. Not across borders, but within the country. Women are trafficked from other states into the capital city to work in the sex trade. Men come to Delhi looking for work, and fall into MSM as work because it pays more than other jobs. One of the men we met on Monday afternoon at the Sahara transgender clinic was an example of this. He came to Delhi looking for work, and is an MSM sex worker. He has a girlfriend, and plans to go back to his village and live out the rest of his life there once he's made enough money. This was interesting too.
Ammaji had more insight into the life of the female sex worker: there's drugs, alcohol, and husbands to cover, too. Some husbands of female CSWs accept their work because it brings in much-needed income; others don't even know what their wives do for a living. Some husbands are addicted to smack, or alcohol, and waste away money needed to feed, clothe and school their children. Children of CSWs who live on the street are likely to follow their parent into the trade; those that live in houses have a better chance at a normal life.
A typical CSW has about 10 clients a day (according to Ammaji) and makes anywhere from 50 to 4,000 rupees.
Dr. Raina, an immunologist (and anti-religionist!) gave us a tour of the blood services at the Sarita Villar Apollo. Apollo Hospitals are a corporate group with 40,000 beds in India. It's a paid service, although 10% of the beds are government-sponsored, and the private revenues pay for services for those who can't afford Apollo's "luxury" care.
Interesting what constitutes luxury. This is not a primary care hospital--it's a referral hospital. Got a rare disease? You'll find your superspecialist here. There are 450 doctors in this hospital, and 2,500 staff. They offer the best care you'll find anywhere in the world.
Almost. At first it seemed odd that Dr. Raina would bring us to this posh area (read: central A/C) to tell us about the disease burden of HIV/AIDS and how it's infiltrating the blood supply. I thought we were at Apollo to talk about success in the health care arena for a change.
About 10 years ago, blood donation legislation changed in India. Instead of getting paid donors to donate, lawmakers banned compensation for donation and decided that patients should rely on family members and, in case of no ready family members, voluntary donors. 60-70% of blood donated comes from family members of a patient. The rest comes from unpaid donation.
However, there is a significant black market in India for blood. There is quite a shortage, according to Dr. Raina. The country uses 6-7 billion units, but it only gets about 5 million units each year. This leads to a massive shortage, which fuels a black market that attracts not healthy people's blood, but the blood of drug users and other high risk populations.
What is the consequence of having a population with a higher burden of HIV/AIDS, Hepatitis B, HPV and other STDs regularly donating blood? The consequence is that the transmission risk for HIV/AIDS in India is 202-50 fold higher than in other countries. This is NOT because of bad testing (1 of every 40,000 will transmit HIV AFTER standard screening, which translates into a profound number in a country with 1 billion people), but because of the population load of the virus. And to get more specific, it's because of the sort of people who are donating. Dr. Raina pointed out that this problem would be solved not by focusing on the black market, but by encouraging healthy people to do their part and donate their good blood.
This is not the only issue. There are two types of screening tests: testing for antibody presence, and testing for viral load. The nucleic acid testing (NAT) is very expensive and new. It is neither required by the Indian government, nor affordable to the general population (at Apollo, however, it is required). Thus, the vast majority of screening relies on ELISA--the antibody test. Antibodies are bigger than nucleic acids, so the test is easier, cheaper, and older. However, it is not so sensitive as doing the two in combination. In the United States, of course, both antibody and viral testing is done. Dr. Raina stressed that if this precaution is needed anywhere, it is needed in India. The situation is compounded by the fact that a high percentage of donors are repeat donors, so if the tests do not detect their seropositivity the first time, they will continue to be cleared for donation again and again. Their donated unit of blood will infect not only one other person, but three or four. Dr. Raina says that the fact that there is no national ID system in India, and no HIV registry, make it much harder to keep the blood supply clean. In the clinics, we have met two patients, both young, who contracted HIV through blood transfusions.
The second part of our day was spent near a huge truck stop at a free HIV testing clinic run by SPYM (correction from the previous blog: SPYM stands for society for the promotion of youth and MASSES!). We met with health workers who do outreach work serving 1,000 people in the community, including female sex workers, MSM, injected-drug users, and truck drivers. The health workers there indicated that MSM were the most at-risk for HIV due to their sexual practices and risky use of condoms that has a higher rate of breakage. The center gives free HIV testing (antibody testing, rapid assay--25 minutes). Many people don't come back for their results. The clinic gets government funding for all its laboratory equipment, and also receives NGO funding that trickles down from larger national anti-AIDS programs.
We gained some insight into the lives of MSM there. For instance, they may be married and have kids. Some are openly MSM and have no other life, others live a normal life (they may have been pressured to get married despite their desire for a different lifestyle). Many who test HIV positive don't tell their wives about their status. They often don't know how it is spread. One of the health workers, Narendra, said that many think having sex with a donkey or a virgin will actually cure them (this was hard to believe, but he was serious). It's hard for health workers to spread awareness because many of their target populations think that having sex is the only way to get the disease; therefore, from the beginning, they are aware of the stigma associated with it and are not open to discussing it. Many are more worried about STDs, and Narendra said that his biggest challenge was convincing them that STDs were not a bigger threat than HIV, but the other way around.
Another highlight of our HOT afternoon was talking to Ammaji, a peer educator for female sex workers. She is a peer not because she herself is a sex worker but because she lives among them. She is older, and has a very strong spirit. She is committed to the women she serves. She said she has sat outside while sex workers are meeting with clients, in order to track them down and educate them. If a client refuses to wear a condom, she openly counsels/scolds/stands up to him, and has empowered the community to say no to clients who bully them not to use condoms. It was interesting; she was able to do what she does successfully because of her position as a strong, wise, older woman.
Trafficking is a big problem in Delhi. Not across borders, but within the country. Women are trafficked from other states into the capital city to work in the sex trade. Men come to Delhi looking for work, and fall into MSM as work because it pays more than other jobs. One of the men we met on Monday afternoon at the Sahara transgender clinic was an example of this. He came to Delhi looking for work, and is an MSM sex worker. He has a girlfriend, and plans to go back to his village and live out the rest of his life there once he's made enough money. This was interesting too.
Ammaji had more insight into the life of the female sex worker: there's drugs, alcohol, and husbands to cover, too. Some husbands of female CSWs accept their work because it brings in much-needed income; others don't even know what their wives do for a living. Some husbands are addicted to smack, or alcohol, and waste away money needed to feed, clothe and school their children. Children of CSWs who live on the street are likely to follow their parent into the trade; those that live in houses have a better chance at a normal life.
A typical CSW has about 10 clients a day (according to Ammaji) and makes anywhere from 50 to 4,000 rupees.
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