BEYOND ILLNESS a reader for women health activists in urban areas
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a reader for women health activists in urban areas - extracted text
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BEYOND ILLNESS
a reader for women health activists in urban areas
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Swatija Manorama
Chayanika Shah
BEYOND ILLNESS
reader for women health activists in urban areas
Swatija Manorama
Chayanika Shah
Comet Media Foundation, Bombay
September 1994
We thank the Bombay Community Public Trust for providing financial support to the writing and publication
of this book
Design and Illustration
Rajashi Ghosh
Editorial Assistance
Chandita Mukherjee
Special Thanks
Geeta Ramakrishnan
V. P. Jacob
Sonia Agashe
Rochelle Pinto
Acknowledgments
Illustrations are reproduced from or based on the following original sources:
Bal Vaigyanik, Class 8, M. P. Pathya Pustak Nigam
Page nos: 1, 2, 5, 7, 8, 12, 16, 19, 41, 44, 50, 55, 59, 79, 83, 87, 88, 93
Sharccr ki Jankari, a book prepared through the collective efforts of 72 women from Rajasthan active
in a health programme, Kali for women, 1989
Page nos". 6, 18, 20, 29, 31, 39, 40, 52, 57, 58, 63, 72, 77, 79, 80, 86, 90, 94
Time Life Publications
Page no. 10
Typesetting
datafriends, Thane
Print Production
Jaina Pandya
Printing
Naaz Electro Prints, Bombay
Canyon Press, Bombay
Copies available at Comet Media Foundation, Topiwala Lane School, Lamington Road, Bombay 400 007
September 1994
We thank the Bombay Community Public Trust for providing financial support to the writing and publication
of this book
Design and Illustration
Rajashi Ghosh
Editorial Assistance
Chandita Mukherjee
Special Thanks
Geeta Ramakrishnan
V. P. Jacob
Sonia Agashe
Rochelle Pinto
Acknowledgments
Illustrations are reproduced from or based on the following original sources:
Bal Vaigyanik, Class 8, M. P. Pathya Pustak Nigam
Page nos: 1, 2, 5, 7, 8, 12, 16, 19, 41, 44, 50, 55, 59, 79, 83, 87, 88, 93
Sharccr ki Jankari, a book prepared through the collective efforts of 72 women from Rajasthan active
in a health programme, Kali for women, 1989
Page nos\ 6, 18, 20, 29, 31, 39, 40, 52, 57, 58, 63, 72, 77, 79, 80, 86, 90, 94
Time Life Publications
Page no. 10
Typesetting
datafriends, Thane
Print Production
Jaina Pandya
Printing
Naaz Electro Prints, Bombay
Canyon Press, Bombay
Copies available at Comet Media Foundation, Topbvala Lane School, Lamington Road, Bombay 400 00 7
FOREWORD
This book has emerged from the concerns oftwo researchers, Swatija Manorama and Chayanika Shah. During
the past several years they have worked on science and society related issues, with particular emphasis on
women's concerns. In the course of their practice as trainers of health workers, they had felt a need for clarity
on the social implications of the biological content of such courses. This is how the idea of working towards
a manual came about. They chose to address this work to the specific problems raised in the urban setting of
Bombay. While some training material addressed to rural workers is available, there is not much made for the
city. It was also felt that with the resources available in a city, voluntary health workers often require orientation
to make use of these, and this work attempts to address this need.
It is hoped that the authors' attempt will add to the efforts by a number of groups to produce training materials
addressed to learners who are seeking to combine health awareness with other projects for community
involvement. We also hope that organisations conducting training of "para-professional" health workers will
find the book useful.
We would like to thank all the friends who joined us for the many discussions that went into the writing ofthis
manual. They are too numerous to mention here, but we know they will recognise their contributions when
they read the text.
Finally we would like to emphasise that this is a first iteration. It is not an end product, but it holds great promise
for further work on these lines.
We are grateful to the Bombay Community Public Trust for a grant which made this initial exploration possible.
Chandita Mukherjee
for COMET MEDIA FOUNDATION
PREFACE
BEYOND ILLNESS is an attempt to begin a process of creating a knowledge base for health activists in the
form of a book. We hope that health workers will be able to place this knowledge base alongside their work
experiences. What we have written can be modified according to the reader's needs. Hints can be taken from
it to make innovations in the daily practice of health workers.
We would like to have prepared the book with a ring binding, so that the reader can go on adding material
wherever she feels like within the book, and a place is created for keeping newspaper cuttings, notes and so
on. It was not possible to bring out this trial version of the book in such a way, but maybe future editions can
be so prepared, and every reader will go on to make this a book of her own, reflecting her own questions and
needs.
This book is an exploration of the much-used term, "the holistic understanding of health". It is also an effort
to look at health not just as absence of ill health, but as a reflection of the overall social, cultural and economic
existence of a person.
The shaping ofour body rhythms and overall pattern ofhealth takes place in the social and physical environment
which makes our existence meaningful. The physical environment provides the direct inputs for the body to
function. We would like to explore the quality of these inputs in a city like Bombay where conditions appear
to be totally beyond the control of its inhabitants.
In looking at human biology, and at the nature offacilities provided by the city, we have emphasised the activity
and struggle of its people. We are interested in exploring the effort put in by individual bodies to be able to
survive and function. In this connection, we also would like to explore the many collective efforts to bring about
change in the quality of life in the city. They relate to a variety of issues which directly or indirectly lead us back
to well-being and health.
From the way we see nature, the usual concepts justifying aggressive competitiveness and survival ofthe fittest
do not seem to ring true. On the contrary, we believe in the continuity of all life, of both the living and non
living forms on this earth, and would like to draw attention to this concept, both for the clarity and for the feeling
of richness that this connectedness gives us.
Our book begins with body physiology, but we try to explore it differently from the way we learned about the
body in school. There we were taught to look at various body systems such as the digestive, the circulatory,
the reproductive, as entities in themselves. However, the emphasis here is on the basic concepts which help
us in understanding the coordinated action of the whole body. This is why we have chosen not to discuss the
functioning of different organs in detail.
We believe that the purpose of the body's existence lies in its ability to work. Our bodies are continuously
working and trying to maintain themselves. How the body manages to survive, faced with all kinds of odds
in a city like Bombay, is also an important aspect of our enquiry. To our minds, these aspects are inseparable
from a discussion of body physiology.
In our daily lives, each of us constantly attempts to cope, to adapt and to meet the physical and psychological
stresses at both the physical and mental levels. Since we believe that our health is determined by physical
parameters, the emotional and human attempts to change these parameters concerns us, and forms part of our
understanding of health.
This understanding also poses a problem. Should we consider health only in the physical realms of body and
environment? We do not think so. We understand health as a biological phenomenon expressed and shaped
in its social, political and natural environment. From this viewpoint, health is seen as a dynamic process, located
in society, not a static state to be achieved and maintained.
And yet there is ill-health and breakdown of the normal systems of the body. To be able to cope with such
situations we need to be equipped not with medicine as much as with knowledge about the disease process
and the 'natural' response of the body to it. Our stress here is not on specific illnesses and their cure, but on
an understanding of disease and strengthening of the self to interact with doctors and others who appear to
take over when a vulnerable person, in ill health, comes to them for help.
We conclude with a section on self-help in an urban context. In a city like Bombay there are a wide variety of
health care delivery and medicine systems. The same is true for Madras, Calcutta and Delhi, as well as fast
growing cities like Pune, Hyderabad, Ahmedabad, Bhopal, Jaipur and so on. How can we strengthen ourselves
as individuals and as a community to make choices among these health care systems? How can the health worker
help in this process?
So in short, this book tries to open up thinking on many inter-related areas. It is not exhaustive, and in trying
to cover the whole we may have missed some major issues or connections. Wehave touched upon many aspects
but have not explored our thoughts to their fullest extent. This is partly because we feel that this work is not
the end of this exploration. It is a starting point to understanding one's body and the surrounding reality. We
hope that every reader will contribute to this process by looking inwards and outwards with some change in
perspective.
■
*
Swatija Manorama
Chayanika Shah
CONTENTS
Foreword
Preface
Chapter I: SARALA'S STORY .........................................................................................
1
Chapter II: OUR OWN SELVES, OUR OWN BODIES..............................................
7
Chapter III -. EXPLORING THE WORKING BODY.................................................. 19
Chapter IV: OUR BODIES AND THE CITY ENVIRONMENT.............................. 41
Chapter V: WHAT HAPPENS WHEN THE BODY BREAKS DOWN?................ 59
Chapter VJ : OUR BODIES IN OUR OWN HANDS................
................................ 87
Appendix..............................................................................................................................95
Chapter I
SARALA’S STORY
While working with health workers we often came across women
who were trying their best to serve the community, and who kept
running into a variety of difficulties in the process. Sarala is typical
of such workers, and to begin the book, we give an account of her
observations and reflections. Sarala's specific tasks are in the area of
women and children's health.
*
I think I am quite deeply involved in my work. Yet I constantly
feel a gap between what I am supposed to do and the reality
around me. Take my neighbour Leelaben. She works very
hard, doing piece-rated sewing jobs to supplement the family's
income. Considering the amount that her husband spends on
himself, it is actually her earnings that support the family.
Besides these worries she has the housework. She has to keep
to the water timing, deliver her work on time—so much so that
there is no time for herself. She has a pain in her knee which
has been bothering her for many months, and yet where is the
time to go and see a doctor? Even if I want to help her, I am
not equipped to deal with her problems.
Leelaben worries about her children constantly. Her daughter
Sharmila is eighteen, and she is being troubled by a group of
boys in the basti. Leelaben wants to marry off Sharrhila, but
she does not have enough money. Leelaben is also nervous
about committing herself to some unknown family about the
marriage. She feels she must be certain that her daughter
would have some guarantee of security and happiness after
her marriage. The marriage issue seems to disturb her
constantly. At times she feels afraid that if she continues to
delay the marriage, her daughter may get allured into something
that would create a scandal. ■
Leelaben's son Ashok is unemployed. He does not want to
work at anyj ob which involves physical hardship. He contributes
to the household expenses occasionally, but Leelaben is not
very sure about the kind of work he is involved in. She prefers
not to ask him.
Leelaben's concern with her children's futures keeps her
awake night after night. Then she has a nagging cough which
bothers her. She keeps complaining about her problems. All
of it makes her sick. And Leelaben is not the only one in our
basti with such worries.
Another good friend is Sakubai. Deserted by her husband,
she brings up her three daughters alone. Working as a parttime cleaning woman, she has access to the houses ofa number
of well to do people. She often shares her experiences with me,
and sometimes we think we are better off than many of her
employers. She feels that despite appearances, many of these
women do not have even a day's happiness in their lives.
Occasionally, when we have some time to chat, I try to tell
Sakubai about my problems also. Sometimes I tell her to keep
her house clean and to keep the food covered. Actually,
Sakubai has the cleanest house in our chawl, but I tell her these
things just to keep talking, and to keep trying to give her some
support.
I stay in the same chawl, so I know how it is. I also get very
tired doing both housework and my job. Lately, it has begun
to bother me that though I work as many hours as my husband
outside the house, I am made responsible for everything to do
with the house and children. I have tried talking it over with
my husband, but he resists taking charge ofanything. According
to him, some things can only be done properly by women.
Even though I know that these are convenient excuses,
beyond a point I cannot insist. He is after all, the man of the
house, and I cannot allow this to become a permanent conflict.
I have begun to feel that these so-called personal problems are
very much part of the chronic health problems that many
people have. Yet there is little I can do to help anyone, least
of all myself.
2
I sometimes wonder whether my neighbours expect me to do
something more for them as a health worker. But what else or
what more can I do? My job definition is very limited. I have
to distribute contraceptives and motivate women for
sterilisation and contraceptive use. I am supposed to take
pregnant women to hospitals and see to it that they take proper
treatment. I have to advise them to breast-feed their babies and
get them vaccinated. Many times, women have to go through
pregnancies without their heart being in it. It is forced on them,
and I cannot do much for them, even though I am the one
supplying contraceptives to them.
The women around me are all very different personalities, but
their situations are very similar. The doctor in the municipal
clinic had tears in her eyes the other day. She wouldn't tell me
what was wrong at first. Then she said that she has had severe
back pain for days. Even though she has a first class pass, she
has to travel standing for almost three hours every day, and do
all the housework morning and evening. Her husband never
even offers to do the shopping for her. I had thought that when
a woman has the same education as her husband, and earns as
much as he does, things would be different.
I enjoy such sharing and discussion. The next day I go to our
weekly meeting with all this on my mind. Perhaps I ask too
many uncomfortable questions. My group leader tells me to
keep quiet. She does not like such bold behavior in front ofour
superiors, and so she scolds me. At such times I feel that this
is a way ofwarning my other friends to keep quiet. I prefer not
to think too much about all this. Looking at the massive task
before all of us, I fed quite alone and unsure about what is
expected of me. 99
What is the health worker's role?
What do policy makers expect of health workers? Can they, or
should they limit themselves just to the simple routine tasks which
Sarala spoke of? What are the specific problems of health work in
a city like Bombay? Much is written about health workers in rural
areas and the difficulties they face in their work. The urban situation
is different in many ways and the dilemmas of the health workers are
of a different nature. Often, the basic problems get more complex
and acquire larger proportions with the strain of city life.
We had a series of discussions with health workers like Sarala, and
these meeting led us to write this book. BEYOND ILLNESS also
represents a dream we have. The book is not a manual in the usual
sense. We offer you some thoughts, and an attempt to redefine
3
health, or verbalise on an evolving perspective about the complex of
things usually labelled as health.
One ofthe first things we began to question is the perspective ofmost
training given to health workers. The usual course contents emphasise
subjects that are considered to be practical, and directly relevant to
health workers' tasks. It is assumed that health workers are generally
not interested in knowing very much, and in any case they cannot
understand complex issues. Thus it is decided that course contents
should be limited to the areas considered to be priority health
problems of society.
In recent years, AIDS has emerged as a priority health issue. Some
years back it was tuberculosis. In those days all the energies of health
workers were spent in identifying possible cases for testing, and
motivating patients to start treatment. Later they followed up with
updating the patient surveys, making frequent visits to persuade
patients to take medicines regularly, and then to ensure that they
continued to do so for the full course.
Some years later, everyone felt disappointed with the outcome,
despite the sincere and intensive inputs. The programmes were
conceived in isolation from the world in which the patient lived and
the conditions at their places of work. The crux of the problem was
reduced to the patient and health system relationship, still further
reduced to taking medicines on time. Even when the patients did
come regularly to collect medicines, a number of their visits were
wasted because there were no tuberculosis drugs at health centres.
Today huge amounts of material resources and personal energy are
going towards raising public awareness about AIDS and its
prevention. Yet it appears as if the valuable experience of the
tuberculosis eradication programme is forgotten here. Besides the
obvious lessons, there must be a greater susceptibility to AIDS
amongst patients suffering from chronic diseases like tuberculosis.
They should form an important target group for AIDS counselling
and testing. But because tuberculosis is not the key word for the
health care system today, even in the context of AIDS no special
attention is paid to tuberculosis patients. The term "target clientele"
is used very often by health administrators, but these obvious
linkages are omitted by the system when locating a target.
Personal hygiene, and creating a healthy environment is a basic part
of community health. In the training of health workers there is great
emphasis on the proneness to disease if personal hygiene is not kept
up. However, the difficulty of keeping oneself clean in a situation
where even drinking water is scarce is totally disregarded. The
problem is not even considered genuine, those bringing it up are
dismissed, theirresponsestakenasproofof "ignorance" and resistance
4
to change. This alleged reluctance to learn becomes identified as the
problem, and the poor are held responsible for their low health
status.
As in the other sciences, the naming of a particular cause is the
crucial way in which the health sciences identify a disease. In the case
of a new fever, for example, research concentrates on finding a
micro-organism and its connection to a specific health condition.
Once it is found, research moves to finding a drug which can destroy
that micro-organism.
The identification ofproblems in terms ofcauses is itselfproblematic
and leads to misdirected courses of action. For example, in the case
of population control, the "cause" identified is women's normal
ability to reproduce, their fertility. This view is totally misleading. It
does not take into consideration the fact that fertility is related to
men and women and it is their inter-relationship that gives rise to new
births.
Research is carried out with women as targets of fertility regulation,
and this "cause" or fertility becomes an important aspect of study.
Fertility and educational level in women, fertility and the age at
marriage of women, fertility and economic status of women,
anything goes. Since the pre-occupation is with women's fertility,
the effects of various conditions on women become points to be
studied as well as acted upon.
Such misdirection of attention is not something unique in the case
of fertility and personal hygiene alone. This is common to most
community health areas. The points of emphasis of the training of
health workers are also determined by the same rationale. It
becomes difficult for an individual to move out of such frameworks
even if they feel that essential points are being missed.
In the case of malaria, the cyclical action of malarial parasites and the
role oft he mosquito bite is not made clear. Eradication ofmosquitoes
is attempted with occasional DDT sprays in the open gutters and
toilets of a slum area. The relationship of malaria to mosquitoes and
the importance of protecting oneself from mosquito bites is never
brought out.
Based on this iationale, it emerges that policy makers create an
understanding that it is not possible for people to protect themselves
from mosquito bites because of their living conditions, so there is
little that can be done in a situation like this. The easy way out is to
occasionally spray DDT in public places. That DDT, which is
banned in many countries is bad for us, that mosquitoes become
resistant to it in time, that it therefore possibly does more harm than
good, are facts which are disregarded totally.
5
In actual fact, health workers have been able to organise united
community action for cleaning the gutters regularly, and to keep the
environment clean. Many have done much more to improve living
conditions in urban slums. But the approach ofmaking the community
responsible, of involving them in health activity, is not emphasised
in the health workers' training, and they are not encouraged to
explore such potentials for action in their communities.
How can the feeling of futility while doing health work be turned
around? We repeatedly heard health workers say that it takes a
woman some time to become comfortable with a contraceptive
method. After spending months guiding and motivating a woman to
accept a particular method, they found it very disturbing to be forced
to give her any contraceptive in stock at the clinic, without regard
for the woman's health and convenience. If the health worker tries
to question this arbitrary situation, and pursue her clients' demands,
she is given no support by the authorities, and months of effort, and
her credibility with the client are lost.
Then there is the problem of an inadequate knowledge base. Where
does Sarala go for answers to her questions? As a health worker she
is supposed to be capable of absorbing a limited number of facts
presented mostly as /Jos and Don 'is. That a person like Sarala would
want to know more about the body, that she would wish she could
understand disease better in the context of people., is a thought never
entertained by those designing training courses. To make it worse,
it is assumed that she as a person is not capable ofunderstanding and
growing through her work.
We would like to address ourselves to to this need of health workers
in the next chapters. We would like to lay the foundations of a
knowledge base for health workers who want to realise the potential
for growth within themselves. A knowledge base that includes a
critical evaluation of existing "scientific" facts and rationale in the
context of our subjective experiences. A knowledge base that also
invites collective and individual action, to make a difference in the
quality of life in our cities.
6
,
Chapter II
OUR OWN SELVES, OUR OWN BODIES
During her talk with us, Sarala often referred to the differences
between a man's life and a woman's life. Having taken the inequality
between men and women for granted all her life, Sarala seems to be
deeply struck by her recent realisations. The common echoes that
Sarala finds between herself, Sakubai, Leelaben, the woman doctor
at the clinic, and the women in whose houses Sakubai works-these
aspects of women's experience as mothers, wage earners and
persons interacting with the world outside the home—have been
experienced by many of us at some time or another. Our primary
relationship and interaction with the world is through our senses,
located within our bodies. We come into this world with cur bodies,
and that is the only asset we can claim as our own throughout our
lives. The body gives us our identities, a sense of the self during our
existence. Yet, many of us are not comfortable with our bodies.
Sometimes, and more often with women, the body become a cause
of embarrassment and gives the self a deep sense of inadequacy.
Kaushalya is a health worker in a small village in Tamilnadu. At one
of our workshops she shared her concerns about her body. "I know
that there is a difference between my body and that of a man. But is
that the only reason why everything is so different between them and
us? 1 too eat like them, walk like them, work like them. Yet why is
it that I do not feel strong and confident like them? My whole
identification ofmyselfwith my body is itself so different from theirsl
Why is it that most of the time I keep feeling that my body is not
normal, weak, in some way not as competent as a man's body?"^
Let us look closely at the common belief that 'women are weak,
incapable ofhard work, and thus need to be looked after by strong
men.
Try to make a list ofall the tasks thatyou dofrom morning to night.
How does it compare in terms ofphysical exertion to your brother's
or husband's work? What are the comparable timings? What are
you paid compared to what he earns?
Try this exercise with agroup ofwomen, andcompare the experiences
of different people. You could do this with any group of women,
urban or rural, poor or relatively better off. It may reveal how we
women take many things for granted, without valuing them in the
way a man values his labour.
In principle the major difference in the bodies of women and men is
in the structure of their reproductive organs. Women can bear
children and men cannot. Is this basic biological difference alone at
the root of the completely different experiences and expressions
about the body by men and women? Throughout history, various
biological explanations have been put forward to condone the
oppression of women by men. These explanations are often centred'
around women's ability to give birth. Some ofthese theories say that
because of this special character, women are weak, they cannot do
certain kinds of work and need to be protected by men. Other
theories excuse men's violence and aggressive behaviour towards
women on the grounds of insecurity created in them by women's
power of procreation.
Whatever the explanation, women's bodies become the property of
men, their children the possessions of the man's family. This happens
in most societies, and is part ofthe culture most of us have inherited.
It is not surprising therefore, that women's bodies are usually
discussed in terms of beauty and desirability from a man's point of
view. When a marriage is being arranged, we often hear assessments
ofthe bride in terms ofher child-bearing capacities. The family elders
will openly discuss her looks and reproductive organs as an asset or
property coming into the family.
Society largely pays attention to two aspects of women’s bodies.
One is in our role as mothers or procreators. The other is in our
external appearance, especially until we become mothers. This
8
external self is the one that we recognise, and identify with. It is a
part of ourselves with which we are consciously and continuously
in touch. It is also an aspect which we largely model on other people's
opinions and requirements.
After Kaushalya expressed her doubts at the workshop, we made a
list of questions which each one of us tried to answer individually,
and as a group. Beginning with the external appearance, the
questions helped us to start entering into complex concepts relating
to health.
This again can be tried out as an exercise with any group ofwomen
who meet regularly. We begin with a set of questions that each
person thinks over alone, and then everyone takes turns to present
their responses to the group:
•
Do I consider myself average in height and weight?
•
Do I like my skin colour and texture?
•
IfI do not like my ownfeatures and appearance, how do I wish
that I looked?
*
Have I made any postural or any other adjustment to impi ove
my appearance?
*
Have they affected my health?
•
Do I tend to go infor a particular type ofclothing or make-up
to enhance certain features of my body?
•
Do I wear clothes to disguise certain unflatteringfeatures ofmy
body?
After individuals have presented their personal perceptions, the
group could go on to asking themselves:
•
Do we as a group have differing notions about a good height
and weight?
*
Compared to our ideal for women's bodies, what is our
expectation in body structure for a man?
•
What are our notions about skin colour? Can a dark-skinned
woman be considered beautiful?
•
Can a dark-skinned ma.i be considered handsome?
9
•
Are we wearing comfortable clothes?
•
Are they suited to our work and the demands of life in the city?
•
Have ideas of beauty such as good height, ideal skin colour,
proper dress and so on changed since our parents' times? Do
teenagers have different viewsfrom ourselves in these matters?
All of us, perhaps some more than others, mould both our internal
selves and our external appearances according to the trends and
requirements ofsociety. Some aspects ofthis process ofchange take
place relatively rapidly. For example, our taste in dress today may
be completely different from our grandparents. Another kind of
change takes place over lakhs and crores of years. This is the
adaptation of life forms to external conditions, or the process of
biological evolution. The origins of all life on earth, whether plant
- or animal, began with the same sort of one-celled creatures about
175 crores of years ago, when the earth's climate and atmosphere
was nothing like what we know today. Gradually, as the environment
changed, and different life forms emerged, the earth came to have
the lakhs of different animal and plant forms that make up the world
we know.
Of this long and complicated story, the episode of human evolution
perhaps fascinates us the most, concerned as it is with ourselves. It
is probably because we see so much of ourselves in them, that the
monkeys and apes attract the largest crowds at the zoo. While
people watch the tricks of the apes, they enjoy telling their children
that had things turned out differently, we may have been like them.
Certain features specific to humans evolved during the millions of
years of development that preceded us. For example, the human
baby had a much larger head then the creatures who were our
ancestors. To be able to accommodate the child in the womb, and
give birth to it safely, human female bodies evolved to have a wider
pelvis. This in turn slowed down their ability to reach similar speeds
10
as the males when running. Another such development is that people
staying in hotter climates have darker skin colour. This is actually
due to the presence of certain pigments in the skin. These enable the
skin to tan without burning, even with long exposures to the sun.
Those with pale skins bum easily in the sun because they lack these
pigments, and they have to wear protective clothing.
People's muscles reflect the kind ofactivity and exercise they engage
in. If children grow up doing physical exercises they develop more
muscular bodies, which in turn helps them to do intense physical
labour as adults. Although men's bodies are usually thought to be
more muscular, women doing physical labour have much more
pronounced muscular structures than men leading sedentary lives.
In high altitude environments where the available oxygen in the air
is less than that in the plains, we find that people develop barrel
shaped chests. This enables them to hold more air in their lungs, and
thus to take in more oxygen than they could have otherwise.
Within our lifetimes we adopt lifestyles and habits which affect our
bodies in a permanent manner. Social norms ofbeauty or desirability
which may be fashionable at a particular period of time dictate our
actions, and we humans often follow these trends without regard to
our health.
Until about fifty years ago, small feet were considered to be the ideal
of women's beauty in China. So around the time girls' feet reached
about 10 centimetres in length, they were tightly bandaged and put
into iron shoes. The feet were not allowed to grow beyond about 15
centimetres. It did not matter how tall the girl grew to be, she had
to have tiny feet to show that she came from a class where women
were not expected to do much outside the house. It was extremely
painful to move around with tightly bound feet, the feet became
permanently deformed, and the practice resulted in major orthopedic
problems. It also meant that these women became house-bound and
immobile for the rest of their lives.
At the end ofthe nineteenth century, narrow waists were considered
an essential feature of beauty for European upper class women. As
a result women were forced to stuff themselves into tight
undergarments laced and bound in the same way that boots are
laced. Thus women appeared to have tiny waists, but they could
hardly breathe or eat.
At the same time, the ideal projected by that society portrayed the
beautiful woman as being very sensitive, fainting away at the
slightest amount of physical or mental discomfort. This delicate
constitution was considered to be a sign of noble character. Today
people feel that all this display of weakness was at least partially a
11
result of poor blood circulation and suffocation due to restrained
expansion of the chest when breathing.
In many parts of the world, people have to have permanent marks
made on their bodies for the sake of beauty and social acceptance.
Among these are tattoo markings, scars from branding, and scars
from slashing. They may seem painful and torturous to us, but they
also show how much people are prepared to endure for what they
consider the right appearance.
Social pressures often force us to make choices that are not suited
to our bodies. Here in our city, a section ofwomen spend a great deal
of money subjecting their bodies to all kinds of painful treatments,
surgery and diets. They may make themselves physically and
mentally ill doing it, but it becomes a compulsion, to meet society's
requirements of beauty.
The skin and the self
Another example of this is the so-called skin care that is advertised
in the media. A fair skin is a sign ofbeauty and so needs to be obtained
whatever be the cost. Whether it is physically possible or not,
whether we can afford to do it or not, each one of us is trapped into
dreaming of the fair, smooth, glowing skin to be achieved through
bleaches, soaps, creams, powders and bitter syrups.
In all this external beautification we are made to forget that the skin
reflects overall health, and has an important role which goes beyond
making us look good or bad.
The task of the skin is evident in the fact that different parts of the
body are covered with different kinds of skin.
Let us examine ourselvesfrom head tofoot, and list the differences
in the nature of skin on various parts of the body.
•
How does it help to have hard, tough skin on ourfeel? Yet why
are ourfingertips so sensitive?
•
Why doyou think that there is such long and thick hair growing
on the skin of our heads whereas the soles of our feet are
hairless?
The skin is the protective and interactive surface between our bodies
and the environment. It not only wraps and holds the body together
but also prevents unwanted elements from entering the body.
12
However the skin does not work like a waterproof and airtight
plastic sheet. There is constant exchange between the body and the
world outside going on at the skin surface. These exchanges are
important for the overall health of the body. Evaporation from the
pores of the skin in the form of perspiration is one such example. It
helps the body to maintain the internal body temperature. Factors
like fresh air and sunlight falling directly on the skin all are necessary
for maintaining a healthy exchange. There are many women who are
confined indoors because of customs like parda, and they have to
cover themselves fully when stepping out. What would be the effects
on the bodies of women covered from head to toe all the while,
without exposure to sunlight and fresh air?
Sometimes it is not social customs that impose restrictions, but the
circumstances in which people are forced to live. In Bombay and
other urban areas where most families stay in one small room, the
lack of exposure to sunlight is felt most by women who remain at
home. Confined to their dark, unventilated homes, many women like
Leelabai spend their entire days working at home on piece rate jobs
while maintaining the house and family.
What can be the state of the skin of women like Sakubai who spend
many hours working in close contact with detergent, other strong
chemicals and water, washing clothes and vessels in house after
house for ten to twelve hours every day? What could be the state of
the skin of women exposed to dust of all kinds at construction sites?
And what about the health of the skins of men handling hazardous
substances in poorly ventilated surroundings with no protection
whatsoever?
All these do not come into the skin care picture of the ads at all.' And
yet in reality these are the majority who have serious and chronic skin
problems. The ideas about the skin, skin care, and beauty seen in the
ads reflect the dominant attitudes in society. The science that has
been constructed and developed in these circumstances too cannot
escape this partial way of looking at the problem. The outlook of
biology, of medicine, of the overall health care system and their
methodology,, seem to have completely bypassed the world of
Sakubai and Leelabai, and of women in general compared to men.
Conventional science and myths about women's bodies
As Kaushalya said, a normal human body is usually taken to be that
of a man's. A woman's body is considered to be a weaker copy, an
aberration with an additional capacity of being able to reproduce. In
most textbooks, a man's body is shown as a symbolic human body
when talking ofdigestion, circulation or any of the systems common
to all human beings, like the first drawing in the margin. A women's
13
body is usually depicted only while talking specifically ofreproduction.
That is why a diagram like the second one is not a con mon sight in
most books.
The assumptions inherent in such a bias are not confined only to
things like pictures in textbooVs, but have wide ranging reflections
in the very development of biology and medicine.
Clinical research experiments for specific drugs are generally carried
out on male subjects. It is assumed that what would work for men
would work for women. The difference in their bodies because of
reproductive functions, are not considered to be of any significance
while testing any drug or new technique, or even a theory concerned
with the human body. The differences in the overall social cultural
lives of men and women are also not given their due importance.
There is a neglect of a range of complaints and problems which
especially affect women. Even common complaints like backaches
and white discharge or pain during menstruation are not investigated
seriously. These are termed as problems with a psychological basis.
Women are dismissed as being hysterical if they constantly make
complaints which do not fit into the model ofhuman body developed
by medical science with its understanding based on male biology.
Conventional medicine thus feeds a number of socially constructed
myths about women by giving them a "scientific" basis. At one time
there was a theory in biology which said that the brain size
determined the amount of intelligence in the person. Women have
smaller skulls, smaller brains and hence were said to possess less
intelligence!
Interestingly, this theory was later hastily discarded because it was
found that the men of African origin had larger brains than European
men. That would have had disastrous implications for the doctrine
of white racial supremacy. In a way the need to justify the model of
white racial supremacy gained dominance over the urge to prove the
lack of intelligence in women.
Some scientists continue to explain violent and aggressive male
behaviour as an effect of the chemicals within men's bodies, even
today when there is much research showing the contrary In much
the same way, women's submissiveness and docility are also made
out to be biological, a state of being resulting from the proportions
of certain naturally produced chemicals in their bodies.
Many other myths about the strength of men, of their being able to
develop muscle power and hence of their being stronger than
women, are also supported by biology and medicine. I fwe look back
at the lists of work that women and men do, is it possible for us to
14
say that women are not as strong as men? They may not be able to
lift the same loads at one time, but their endurance over a period of
time has been proved to be far greater than that of men.
It has been observed that a female fetus and infant has more
tenacity, and should survive more successfully than the male, ifall
conditions are equal. However the social conditions in countries
like India are so adverse for females, that our census-by-census
figures show a steadily decliningfemale to male sex ratio.
Thesefigures represent an alarming trend directed against women.
Rightfrom childhood girls are discriminated against with regard
to nutrition and health care as compared to their brothers. This
goes on right through life, where the women in the family are
constantly making sacrifices for the good of the others. This is
something all of us know from our own experiences.
Such social pressures and customs also exert an important role in
the overall health picture ofany society. They have to be taken into
account while studying biology and medicine. It is essential to see
all knowledge and so-called natural behaviour in the social context
in which it is taking place. Otherwise we attribute social problems
to biology and vice-versa. Looking at health holistically therefore
requires us to question and make some modifications to accepted
biology.
15
The parts of the body and the whole body.
In spite of all these differences, and variations in all our experiences,
there is a lot that is common to human beings of both genders. As
a species we all have the same structural characteristics. Our
familiarity with the similar features of the body begins very early in
life. A two-year-old starts naming and recognizing the external
organs first. Identifying her hands, legs, eyes, nose, mouth at first,
as she grows older, there is more detailed identification-the lips, the
nails, the nostrils and so on. Identifying each part distinctly is an
indicator of a clearer and greater understanding of the body. It is
considered a sign ofgrowth, of having acquired greater knowledge.
But as in all knowledge, the overall bias of society is visible here too.
Maybe you could check this out for yourselves by looking at the
following aspects:
Begin this exercise in your women's group by asking everyone to
name the different visible external parts of the body such as the
eyes, hands, breasts, feet and so on. Try to collect the names in all
the languages spoken in your area. For example eyes are called
ankh, dola, lochan, chokh, kannu in different languages.
However, ifwe go beyond the eye to the eyelid, eyelashes, pupil and
so on, we may not be able to find specific words denoting or
identifyingparticular parts ofeach organ. When you make a list of
such specific words, you willfind that the extent ofclarity in naming
and differentiating various parts of the body is dependent on
various socio-cultural practices. After making the lists, the group
could think over and discuss the following questions:
•
Is there a difference in the precision with which different parts
are recognised in different languages spoken by the group
members?
•
Is there a difference between written language and commonly
used terms?
•
Are certain parts ofthe body considereddirty, their names used
as abuses? What could be the reason for this?
•
Is there any difference in the treatment of women's bodies as
against those of men in this respect?
The structural similarities between women's and men's bodies
extend to the internal organs also. An exercise like this is possible
16
only with the visible parts of the body. When we try to do it for the
internal parts there is a problem. Those of us who have had some
education are aware of the biological names of the different organs.
However most people use their experience to identify the internal
organs, and thus we have expressions like "bag of food", "bag of
baby" and so on. One of the difficulties we have had in doing health
education work is that when words and concepts commonly accepted
in science do not exist in our everyday speech, the discussion can be
quite confusing for the new learner.
Popular notions about the internal organs are quite different from
ideas about the clearly identified and external organs of the body
which everyone can see. One widespread notion that we have come
across is that the stomach (pet, pot) is a term covering everything in
the abdominal region, be it the organ for digestion of food, for
excretion, or for producing a baby. Some people think that
menstruation, urination, and sexual intercourse all take place through
the same passage.
There is also confusion about the reproductive organs, especially the
uterus. In some places women said that they have one bag to carry
the baby, one for the menstrual blood and a third one from which the
white discharge is produced. The white discharge from the uterus is
sometimes identified as phlegm, the same substance that is thrown
out in coughing.
3 3 3
In the same way as the external, visible parts of the body have been
differently named, all the parts within also have been identified and
their major functions understood by science. In modern biology, the
internal and external organs have been further classified into systems,
based on their major functions.
Hi3i
However, when working within the understanding of modern
biology as most health workers have to, such lack of clarity can cause
a number of difficulties. In order to be a better communicator
between the community and the health care system, it becomes
essential for health workers to understand the basic structure of the
body, and how the parts function. At the end of the chapter you will
find a large chart of the human body. Along with it is a sheet with
various organs printed on it.
m Hi
There are some concepts which represent a person's self, such as the
num, the dil, and the kaleja. Though these do not represent any
specific physical organ, they are recognised as existing within every
person. These can be called floating organs. Some people locate it
in the brain, others in the heart, still others in the liver. No matter
where it resides, the floating organ reflects the personality, mood
and sense of identity of a person.
17
A t the end ofthe bookyou willfind a large chart ofthe human body.
Along with it is a sheet with various organs printed on it.
You can stick the sheets onto stiff paper and then cut out the
illustrations ofthe organs. The organs can then be inserted into the
indicatedplaces in the alphabetical order oftheir labels. In this way
you can become familiar with the location of these organs.
You can also colour the parts and the main body asyou like. Before
cutting up the diagram, you could make photocopies of< it to share
with others.
The names ofthe organs are given in English. You could label them
in all the languages that you are using in your work.
All of us would have learnt about these systems, organs and their
functions in school. Our study of biology in school extends over a
wide range of topics. We study about the cell, we learn about the
plants and animals and we also are told about the human physiology
and anatomy. However there is a problem with the way in which this
teaching and learning is carried out.
While we learn a lot about the various organs, these are like lists of
words we have memorised. Despite our sincerest efforts, we remain
unable to see the connections between them. As a result we are not
able to construct a holistic picture in our minds of how the whole
body works. The body becomes a collection of individual organs,
connected to other organs in the same system. However the overall
connections between the systems, the problems encountered by the
other parts when one part cannot do its work properly, remains
outside our grasp.
We would like to make some of these connections while talking
about the body and its internal mechanisms. We believe that a
holistic approach to health has to begin with making connections
with all life around us, and the socio-cultural milieu within which we
exist. Our emphasis here would be to look at the body as a whole,
multicellular, complex organism interacting with the external
environment. In the next chapter we will look at certain aspects
which are not usually taught, or explained in the same way, in the
conventional textbooks.
%
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Chapter III
EXPLORING THE WORKING BODY
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Sarala told us that some time back she had developed an embarassing
problem--she used to get an urge to pass urine all the time. This made
it difficult for her to move around the bastis freely.The doctor at her
health post had told her to get her blood checked for sugar content.
The problem was identified as an infection and it went away after she
took some medicines, but Sarala was still intrigued.
It is true that I end up drinking tea in almost every household
that I visit, and my sugar intake must be higher than that of
most people. But why testing ofblood, and that too for sugar?
I wanted to ask the girl in the laboratory but everyone around
was so busy. I tried to look this up in a book, but I could not
follow it properly. I also read about it in the health column of
the evening paper and got some explanation there, but I want
to know more about this sugar problem.
The other day Sakubai was complaining about an intense chest
pain which had been coming on from time to time. She was
told to do various blood tests and also get a cardiogram taken.
The experience terrified her and Sakubai kept on asking me
what it was all about. I could guess at something based on an
item in the health column but I could satisfy neither her nor
myself.
/
19
There are other questions that bother me. The body maintains
a constant temperature all the time. Even ifit is very hot or cold
the temperature ofthe body remains constant. How does this
happen and why? When we were taught how to look after ill
persons, it was emphasised that we must keep a temperature
record. That an unusually high or even low temperature is an
indicator of some problem is common knowledge. Why is it
so? How does keeping a detailed record help?
As a health worker looking after women's health lam supposed
to concentrate on childbirth and family planning. I am not told
anything about the other functions ofthe body. Is reproduction
taking place all by itself? Why are we supposed to cut it off
from the rest ofthe body? Take Leelaben's teenaged daughter
Sharmila—she has so much body pain during menstruation—
especially in the back and the legs. In the days before her
period she goes about in a sullen mood, and is veiy rude to her
mother. Why does this happen? Can something be done for it?
Why do some women get regular periods and others don't?
How is the regularity of the periods maintained in the bodies
of women who have no trouble with their periods?
Sarala had kept such questions to herself for a long time. Her school
background in biology had not helped her. She had reasoned out
some logical connections, but she still felt confused. In her training
course they had talked about diseases, but it was more in terms of
identifying problems for referral to a doctor, rather than the causes.
Though she had often felt the urge to ask, she felt inadequateand was
too shy to speak up. She was also aware that the trainers assumed
that trainee health workers are not interested in knowing more. And
then there were her colleagues — if she asked too many questions the
others would say that she was trying to create an impression with the
senior people at their expense. Sarala's thoughts guided us while
Tackling this chapter on biology.
20
Work and the body
Of all the different aspects of our existence as human beings, work
is possibly the most important aspect. In this chapter, work became
our starting point because the body's labour is what gives each one
of our separate lives a purpose and meaning.
Work is necessary for existence and it is also the primary way society
identifies us. We say "She is a doctor", or "He is an electrician", or
"She is a really good cook". We may refer to a person whose name
we do not know as "Bhajiwali" or "Postman". Our work is also what
others value us by, and if we have a good reputation, it is usually in
relation to our work.
To be able to do any work, be it heavy physical labour in the house,
or something completely involuntary like the act of breathing, we
need energy. Acquiring energy is a major task for the human body.
The whole body functions in such a way that it gets its requirements
of nutrition and rest to produce this energy.
At a wider level, imagine that all our private and individual activities
can be totalled up and put onto one big chart. The whole complex
could be seen as a process of acquiring and processing natural
resources, and equally importantly, knowledge about natural
resources. The outcomes of all these activities can be seen as being
available for the use of everybody. No matter what work a person
does, whether mother or schoolteacher, factory worker or farmer,
processing of natural resources and information about them, are the
major tasks performed by all of us.
From this point of view, it could be said that society as a whole is
engaged in the act of fulfilling the basic needs of human beings; food,
water, shelter, clothing, sanitation, education. The trouble is that
society does not ensure that the needs of all are met equitably. Often
much harm is caused to nature itself in the process of gathering its
resources for enriching a small section.
Is the body a machine?
Right from the early years of school we learnt that the basic
requirements of the body are air, food and water. These inputs enter
into the body, are processed, utilised and stored, and then all that is
not needed is thrown out of the body.
With this kind of simple explanation, it may appear as if there is an
overall input-output mechanism at work here, checking entries and
exits, and watching over the whole body. But is it really so?
21
In an industrialised metropolis like Bombay it is not surprising that
people have a tendency to look at the body's activity in this
mechanistic way. Often in everyday speech, in books, in radio and
TV programmes, there are instances in which the body is looked
upon as a kind of constantly working machine.
We have a problem with this kind of an analogy. No doubt, it is only
an analogy, no-one seriously thinks the body is an engine or the brain
a computer or the stomach a furnace. But such language leads us into
a certain way cf thinking which gives us a narrow and superficial
perspective. This outlook fails to understand the vitality of the body
and also limits or negates the responsive capacities of every part of
the body. While praising the body's so-called clockwork precision,
it misses out on its complex reactions to the unexpected situations
we meet in the course of our lives.
The body is a living organism
We would like to look at the body in a way that emphasises that the
human species has a historical continuity and link with all life on the
earth. We would like to take into account that the body is a collection
of hundred trillion cells -- each of which is a living organism in its
own right.
The body that we see, feel and live within throughout our lives is an
outcome of a long, historical process. All life on this earth evolved
from a single cell. It has been a process of billions ofyears which has
resulted in the present coexistence of a multitude of life forms,
ranging from a single-celled organism like the amoeba, to more
complex multicellular organisms like the human body. However
there is a continuity from the single cell to the present state. This
common root shows us the relationship that we have with all existing
life forms today.
This continuum oflife within which we exist is an important concept.
It enriches us emotionally. It helps us to realise the one-ness of all
life on this earth. At the same time the recognition that each of the
trillion cells in our bodies carries within it the knowledge of billions
of years of existence is extremely empowering.
It is difficult to make the journey from our small and private
perceptions of the external self to the vast, and intricate reality of
each of the hundred trillion cells that coexist to give us human
existence. Yet once this connection is made, the body itself becomes
a fascinating entity, completely in our own hands.
22
(adapted from Human Physiology, the Mechanisms of Body Function,
Vander et al, McGraw Hill International Editions, 1986.)
It is not easy to understand what a cell is because it is usually ofa
size that is invisible to the eye. Try to borrow a microscope and
actually see the size, shape, structure of various cells. You could
take the skin ofan onion and see the arrangement of the cells in it,
take a drop ofwaterfrom the gutter, and see many live one-celled
creatures.
Most interestingly you could see your own cells. Gently scrape the
inside ofyour cheek with the wooden end ofa match stick, and put
the scrapings on a slide under the microscope and see.
Human life begins with a single cell—the fertilised ovum. Sexual
intercourse between a man and a woman allows for the meeting of
an egg and sperm. This leads to fertilisation of the ovum, to the
formation of a cell that would develop into a new human being,
different from both its parents. An apparently simple process .in
which a single cell leads to a complex multicellular organism, also
gives rise to a host of complex social interactions, between two
individuals, their two families, and society as a whole.
Discuss the different implications of pregnancy for women as
compared to men inyour women's group andput these down inyour
notebook. The similarities of the experiences of women from
different economic and family circumstances and cultural
backgrounds has struck us sharply every time we have done this
exercise in women's groups.
23
c cc
Cell multiplication is just one of the processes that take place during
the early days of life. As the whole organism develops, some cells
begin to exhibit specialised functions. In fact, as development
■
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Since the mother does not have the Y chromosome, her contribution
will always be the same X chromosome. It is thefather who has the
possibility ofcontributing either aXoraY chromosome which will
determine the sex of the child. Ofcourse these combinations are a
matter of chance, and nobody can be held responsible for the sex
of the child.
( ( (
Amongst the many things that these chromosome pairs will
determine, is the sex of the child. One of the 23 pairs is unique in
that it differs in the male and the female cell. The female cell has
two identical components called the X-chromosomes in this*pair
while the male has two disparate components called the X and the
Y chromosomes.
c
Every human cell contains some material inheritedfrom its parents
which are called chromosomes. These small bundles of chemicals
come in pairs, and there are 23 such pairs in every cell. These are
formed right at the time ofconception with the egg contributing 23
chromosomes and the sperm contributing the other 23 thus making
23 pairs.
cu ( ( cc
When exactly is the gender ofa child determined, and how does it
take place ?
( '(
One of the questions that seems to concern everyone connected to
an impending birth is the gender ofthe child. How much people are
bothered about whether it is going to be a boy or not, andhow easily
they blame the mother if it is a girl! Sarala is often asked how the
gender of a child is determined, and if science has found any
medicines that could ensure the birth ofa son. Sometimes the people
in the community come under the influence of charlatans who
promise them a boy in return for huge fees to perform some
complicated rituals.
a (
What determines the gender of a child?
C C C C C C C C
The single cell divides into two, each of which further divide into
two, resulting in a rapid multiplication of the total number of cells
which form the fetus. As the weeks and months go on, the new life
begins to look more and more recognisably human.
24
( (
proceeds, each cell acquires a specific function. Some examples of
such specialisation are the development offeree and movement, in
muscle cells and thegeneration ofelectric signals, in nerve cells. This
process is called cell differentiation. The cells also migrate to
different parts of the body, sometimes join with other similar cells
to form tissues and these tissues in turn further organise themselves
to form organs carrying out their specific tasks.
Th< human body is thus a society of cells of many different types
which are combined structurally and functionally, and they interrelate
in many different ways. All this happens in such a way that the
functions of the organism as a whole are carried out. Despite this,
each of these cells individually continues to exhibit the fundamental
activities common to all life.
As a living organism, each cell also carries out the tasks of
processing the inputs to create energy which it needs for its own
functioning and maintenance. These requirements come from its
surroundings, the external environmentals. A cell in a multicellular
organism is most of the time isolated from the external environment
in which thecell survives. These cells however draw their requirements
from the internal environment within the organism, which is
immediately external to the cell. It is the function of all cells in the
organism to maintain this internal environment in such a way that it
remains stable.
The activities of every cell in the organism then fall into two basic
categories: firstly, each cell performs all the basic cellular processes
like an exchange of materials across the membrane covering it,
extraction ofenergy, synthesis ofproteins and so on. These processes
are vital for the cell and represent the minimal needs for maintaining
its own individual integrity and life.
Secondly, a cell simultaneously performs one or more specialised
activities in consonance with the other cells in the organism as a
whole. Every cell continually helps maintain the internal environment
of the body according to the requirements of all the other cells.
As much as the cell is a part ofthe body, we human beings are in many
similar ways a part of the external natural and social environment in
which we survive. Without wanting to make the analogy absolutely
literal, we find that it somewhere reminds us of the need for us, as
part of this environment, to do something to take care of it.
The environment, within the body or outside is a dynamic entity. It
is constantly undergoing changes. We are regularly taking things
from it and giving it something else in return. Such processes which
restore the state in which optimal behaviour goes on continually.
25
(adapted from Human Physiology, the Mechanisms of Body Function,
Vander et al, McGraw Hill International Editions, 1986.)
What keeps the cells together?
If each cell is capable of surviving on its own, then what is it that
keeps them together?
A major actor in this task is the blood. It is the carrier of essential
nutrients to all parts of the body. It is also the medium via which
waste is collected from all over and excreted. Blood consequently
forms an important factor in connecting the whole multicellular
organism.
In society, however, blood is what seems to divide people. What are
some common connotations of blood for us? Hamara khun, royal
blood, blood relationships, somewhere blood is linked to heredity
and lineage.
As women we have yet another association with blood through our
monthly menstrual flows. Menstrual blood is considered dirty and
polluting. For a few days every month, women are subjected to a
strange rejection by their own family because of the fears and
associations related to menstrual bleeding.
In fact menstrual flow is actually an indicator of the fact that blood
is the supplier of the body's requirements. Every month the uterus
is internally prepared for a possible conception. The lining of the
uterus is made ready with an increased blood supply to meet the
needs of the fetus that may implant itself on this lining. Ifconception
takes place, the fetus will derive all that it needs to survive and grow
from the blood supply to the uterus.
When conception does not take place, and there is no need for the
lining, and it is shed. At this time a large number of blood vessels are
ruptured. The consequence of these torn blood vessels is the blood
flow seen during menstruation. It is the same blood which would
26
have given the basic requirements to the newly created life in the
womb. Can such blood possibly be polluting and foul?
bi early 1994 there was a controversy about hysterectomies being
carried out on mentally retardedwomen who were living under the
protection of the government in a home near Pune. These were
defended as a birth control and menstrual hygiene measure by the
authorities.
We would ask why this particular discharge of the body is seen as
particularly unhygienic. The same patients have difficulty in
controlling their other bodily excretions and in any case require
special care.
While the authorities kept talking about menstrual hygiene, they
were ignoring the role of the uterus as part of a system. Major
surgeries such as the removal ofan organ cause trauma to the body
and create their own health problems in the future. The known ill
effects of hysterectomies have been early ovarian dysfunction,
depressions and increased risk of heart problems.
Particularly in the case of these women, parts of whose brains do
notfunction in the "normal" manner, the after effects may manifest
themselves in other unexpected ways. By subjecting these women
who are not equipped to cope with any long term problems created
by such an operation, who were the authorities trying to help?
Lastly, just because these women are mentally.retarded, have they
no rights over their own fertility? Would we tolerate it if the
government were to forcibly carry out hysterectomies on people
like ourselves without consent?
Blood is only one ofthe carriers meeting the requirements ofthe cells
within the body. What maintains a stable environment is the co
ordinated action of the whole body. For example we have often
experienced how the body maintains its own temperature even when
there are drastic changes in the external atmospheric temperature.
Why are we not in a constant state of fever?
While we go about our everyday routines of eating, sleeping,
working, running, there are constant chemical changes and reactions (adapted from Human Physiology, the
taking place inside the body. These generate a great deal of heat. Mechanisms of Body Eunction, l ander et al.
How is it that we are not constantly in a state of fever as a result? McGraw Hill International Editions, 1986.)
27
In normal circumstances, compensatory mechanisms ensure a
simultaneous heat loss from the body. This results in a nearly
constant internal temperature within the body. This steady body
temperature has to be maintained, because most chemical reactions
important for sustaining life can only take place at a balanced rate
at these temperatures. This is why we do not feel that we are
functioning properly when we are overheated in the sun, or if a
sudden cold wave comes in winter.
Even ifthere are drastic changes like these in the external temperature,
the body tries to maintain the internal body temperature at a constant
level. Suppose there is a sudden fall in the outside temperature, as
may happen to people living in a Himalayan village in winter, or
perhaps a woman working in a frozen fish factory who has to spend
time inside a room-size freezer.
The immediate response would be in the form of an increased heat
loss from the body, to achieve equilibrium with the external
environment. This extra heat loss however, reduces the temperature
of the body. At this point some involuntary actions are generated in
the body which decrease the heat loss and increase the heat
production. The person would start shivering. This would lead to the
return of the body temperature back to the optimum for proper
functioning.
The change in temperature initiates responses which oppose or
negate this change. In this example, a decrease in body temperature
results in processes that would tend to increase the temperature thus
bringing it back to normal. This is an important mechanism that the
body adopts to maintain a stable equilibrium. It is called a negative
feedback system.
It is important to note here that if the external temperature is below
body temperature, the steady state temperature achieved by the
body is a little below its normal temperature, so that the feedback
processes are maintained. If the temperature came back to normal,
Homeostatic system for maintaining
the constriction of blood vessels to the skin would relax, and
relatively constant body temperature on
shivering would stop. This would lead once again to greater heat loss
decrease ofroom temperature
and reduced temperature. To avoid these reactions, which consume
(adapted from Human Physiology, the a great deal of energy, the steady body temperature in a cold
Mechanisms of Body Function, Fonder et al, situation is maintained slightly below the usual body temperature in
McGraw Hill International Editions, 1986.)
a comfortable environment.
That a slight variation in temperature is normal, or allows the body
to function normally, gives rise to an important generalisation. If a
range of temperatures have to be considered to decide what is
"normal" for an individual, how do you arrive at a figure that is
supposed to be normal for all persons at all times? The norm not only
28
varies from person to person, but also has a range for that person
herseif.
If we were to measure our temperatures at regular intervals over a
period of twenty four hours, we would find some variation arising
from different levels of activity of the body throughout the day and
night.
It has been well established that in every monthly cycle there is
temperature variation in women. After ovulation, when the egg is
mature and released from the ovary, there is a rise in temperature to
the extent of about one degree-which is kept up until menstruation
occurs. In fact, this rise in temperature is a good indicator of
ovulation having taken place. If you were to observe your own body
over one menstrual cycle, you would see a number of overall
changes in the body in accordance with the menstrual rhythm.
Besides temperature there are many other cyclical changes going on
in the body. Each of these has a rhythm of its own. The rhythm could
be diurnal, that is changing with night and day, as with sleeping and
waking. It could be of twenty four hours duration, as with our daily
expulsion of solid wastes, or longer as in the case of the menstrual
cycle, or even longer as with the aging process. There are specific
bodily changes associated with these rhythms, and the overall
responses of the body to situations around us are also affected by
these rhythms. The capacity to take physical and mental stress also
varies within a given period because of the interplay ofsuch rhythms.
Keeping up the balance while constantly changing
The emphasis of all body processes is on maintaining balance.
However this is a special kind of balan -e, that keeps on rebalancing
as the factors contributing to it go on changing. Nothing remains the
way it seems for very long in the human body. This ever-moving
process of equalisation is called dynamic equilibrium. The balance
could be in terms of a physical parameter, in the way we looked at
temperature earlier. Or it could be concerned with the quantity of a
component such as water in the body.
The most important component in the body is water, taking up
almost sixty per cent of a person's total body weight. Present as fluid
in the cells, outside of them and in the blood, water is important in
the maintenance of the body's equilibrium. The absolute quantity of
water at any given time in the body is not important, it is the
concentration of it at specific points that matters.
It is the same with other chemical substances, whose concentrations
are crucial to health. The figure shows a sketch of the system of
29
balance of any chemical in the body. The overall distribution of the
chemical in the internal environment of the body is called the pool.
The pathways to the left indicate the sources from which there could
be a net gain in the body and those to the right show the sources of
net loss.
The picture makes it clear that the input from the gastro-intestinal
tract or through the respiratory tract could also be synthesised
within the body. The loss could be through metabolic processing
during which the substance gets converted into something entirely
different, or it could be excreted out of the body through the lungs,
the gastro-intestinal tract, the kidneys or the skin on the body
surface. Each substance has its own specific pathway.
You may have noticed how when you are tired, a cup of tea can
immediately make you feel revived. The sugar in the tea or even in
a sweet makes a change in the body's energy level. It seems obvious
that sugar is an important component in our diet. It is involved in the
process of providing the body with energy to function.
When speaking of sugar here we are talking about the chemical
sugar, not only the crystal sugar that we put in tea. Sugar is also
present in all foods that give a sweet taste. The chemical sugar that
helps produce energy is synthesised in the body from these foods.
There cannot however be unlimited amounts of sugar present at any
one time in the body. Once the sugar exceeds the body's own limit,
the excess is either excreted or converted to other substances which
are stored in the body in the form of fat. Thus the fat stored at various
parts of our bodies is not only made up of the fat consumed directly
as oil, ghee and so on, but is a product originating in the sugars and
starches that we eat.
Balance diagram for the path taken by a
chemical substance
(adaptedfrom Human Physiology, the Mecha
nisms ofBody Function, Vander et al, McGraw
Hill International Editions, 1986)
This sugar is extracted from the fat as and when required by the body.
Sugar is only one example of a substance which could exist in the
body's storage depots. There are many other such chemicals which
go through similar continuous processes of intake and loss, both
sides of which have to be in a balance.
The most significant aspect of this process is the dynamic character
of the equilibrium that is constantly being sought by the system. Any
input that body has to have must be in a sufficient quantity, and of
a quality that would ensure a balance of all chemical components.
How achievable this is for many ofus, and to what extent these needs
do get fulfilled, are questions that we will go into in the next chapters.
30 ?
How do (lie parts communicate with each other?
We would now like to explore how this balance is achieved at the
level of each cell, as well as for the whole complex multicellular
human body. Obviously means of communication between cells
have to be evolved. Cells placed at long distances from each other
manage to function in coordination, for themselves, for each other
and for the body as a whole. The two most important pathways for
such contact are the nervous system and the hormones secreted by
various glands in the body.
Human bodies are said to have a very evolved system of internal
communication. This is attributed to the brain, the spinal cord and
the nerves spreading from it to every part of the body. The credit for
its efficient functioning usually goes to the brain. It is called the
master of the body.
We have a problem with such representations, where one part of the
body is portrayed as the master, leaving the rest of the body looking
like a limp puppet in its control. This concept gives unnecessary
importance to the role of the brain. More significantly, it undermines
the mutual contributions made at every level within the body.
The nervous system including the brain works at two levels: it
regulates body responses to external stimuli and it regulates internal
mechanisms. There are endless examples of our responses to
external stimuli. The skin—its ability to feel and touch, the nose the
eyes, the ears, the tongue—all of these sensory organs play an
important role in shaping our responses.
In a way, these senses are the body's medium of expression and
communication with the external world. Every stimulus reported by
the senses, be it a disgusting smell, a painful cut in the finger, a
delicious taste in the mouth, a noisy environment or an enchanting
sight, elicits a response from the body. In fact, identifying the
stimulus as disgusting, delicious, noisy, enchanting or hurting is
itself a response in accordance with which the whole body would
react.
At this time, the nerve cells and the spinal cord communicate the
message experienced by the receptor cells on the sensory organs to
the brain. Reacting on the basis of past memory and experience, the
brain sends back a signal through the spinal cord and the nerve cells
to the body. This process is achieved by chemical exchanges
between different cells.
The nature of the stimulus determines where the signal for any
response or action would come from at this time. This is an active
interplay of the whole body, responding participatively to the
stimulus. The widespread idea of the brain as master is an
oversimplification which prevents us from understanding this.
■ '■)
Tastes change with circumstances
Another important aspect which tends to get lost in this understanding
of the nervous system is the way in which stimuli are identified.
There is individual variation in how people would identify any
stimulus. The smell of frying fish could be disgusting for some and
most attractive for some others. Certain music could be noise to
some ears and a most fulfilling experience for others.
Such personal responses emerge from our memories and upbringing.
There is no "normal" or "abnormal" here. These are totally subjective
responses to stimuli, acquired through a process of exposure as we
grow up.
Sometimes it is quite disturbing when people start judging others by
their own typical tastes, and forming conclusions about those other
people which are quite untrue. A characteristic example is the way
vegetarians start seeing non-vegetarians as somehow immoral or
prone to violence.
If this logic is taken further, one could convince oneself to think that
killing such cruel people is perfectly justified! In fact something like
this does take place when neighbours who have lived together for
years start killing each other during a riot. People of one community
are aroused against another group in such ways, on the basis of
prejudices which actually represent their different upbringing and
tastes.
Human beings also use the threads of common upbringing and tastes
as a way of finding people with whom they can relate and identify.
It is a source of strength and warmth in relationships. It is only when
we use the fact of differentness to exclude others that we create
problems.
However, tastes and preferences also change with experience.
When a person comes to Bombay from a distant part of the country,
she may come to know of a whole range of foods that she had never
heard of before. Though she may not care for something like paobhaji or vada-pao at first, she may later develop a taste for these, and
miss them if she leaves Bombay for a time.
There is another kind of individual change in a person's responses. ,!
It is the way the body gets used to being in an environment which
is clearly not optimal for well-being. We see instances of this in
Bombay life all the time. Have you seen how sitting in a fish market
all day makes the vendors used to a smell which is too strong even
32
for daily fish eaters? Living on a busy road might make the person
so used to the noise that she no longer feels disturbed by it.
Constantly walking barefoot could lead to a situation where the
person would not respond to sharp objects on a footpath in the same
way as someone else, who is not used to it, may.
Effector muscle in arm
If one looks back, the body may have protested at first against the
unpleasant situation with strong negative reactions. However if this
is the adjustment a person has to make in order to get work, or a place
to live, the body does make it.
While accepting and acknowledging this subjectivity, we also have
to realise that it is very difficult to ascertain or determine what
"getting used to" something means. In extreme cases, it could mean
permanent damage to the receptor cells of particular organs,
resulting in failure to respond to situations which could be lifetheatening. An example could be the deafness induced by working
with heavy machinery—the same person could cross a road and not
be aware of a truck that is about to run over him.
Most of the time "getting used to it" shows as individual variations
within the limits of tolerance. A mother may be able to handle hot
vessels with greater ease than her daughter. However, she will not
allow her hand to get burnt, despite her ability to endure heat. Once
again, we have to be clear that individual limits of tolerance are
subjective, very much defined within the social context.
In most instances it is also very difficult to distinguish whether the
body has "got used to" something, or if there is a change in the nature
and character of the body, at the level of the receptor cells. In the
absence of being able to make this distinction it is important to
remember that our response to external stimuli is not just in the form
ofchemical exchanges, but also our own historicity and subjectivity.
Secret messages on unseen pathways
We must also look at the other aspect of the nervous system—the
internal message communicated across the body in the attempt to
keep the organism functioning with a stable internal environment.
Here each cell contributes in initiating, receiving and acting on
signals that actually make the whole central nervous system work.
It is this co-operative effect on the part of the whole body that is
significant. It is also important to know that a feedback system
functions within the body. Certain changes in some part of the body
initiate processes elsewhere which in turn further accentuate or
extend the initial process.
(adaptedfrom Oxford Illustrated Encyclopedia,
Vol. 2, The Natural World, Oxford University
Press, 1985)
33
Hormones are specific chemicals produced by certain glands in the
body. These are released directly into the bloodstream and are
carried by the blood to all parts of the body. An important aspect of
these chemicals is that they are produced by glands which may be
located in one part of the body, but act on organs placed at some
distance. Every hormone initiates certain processes, each of them
have different life cycles, actions and sites of action.
The feedback mechanism reflects the active participation of the
entire body in regulation and control within the body as a whole. Be
it the control exerted by the nervous system, or the control achieved
chemically by the secretion of hormones, the feedback mechanism
is also significant in its control over production and action of
hormones.
The feedback or signal could return to the brain because of the
concentration of some other hormone at a particular spot, or it could
come because of the stimulus from a nerve cell or because of some
other chemical balances. Usually it is a stimulus of some such kind
that starts or stops the production and action ofthe hormone. A very
interesting example of hormone production and its regulation by
varying concentrations of other hormones is the menstrual cycle.
The rhythm of fertility and its control
Every woman's body produces an egg during each menstrual cycle.
The cycle itself is the preparation for growth and nurturance of the
egg in case the egg is fertilised. In fact, menstruation signals the end
of one cycle which has ended without conception, and the beginning
of yet another series of preparations.
Ask the women inyour group to keep a record oftheir cycleforfour
months. This will allow the group to study the length ofabout three
consecutive cycles. Take down everyone's dales on one sheet of
paper to see the range and variability within the group.
Every time we have done this exercise, we have found that most
women would have been having a regular cycle, except when they
may have had some variation due to emotional stress, tension,
fasting, illness or some such immediate causes.
Some women will even boast about how regular they are, naming a
date or a phase of the moon. This means that each woman would
have almost a fixed number of days in which her cycle is completed.
There is no ideal or standard length for the cycle. As long as the
34
periodicity is more or less maintained, the woman can be said to have
a regular cycle
Obviously specific mechanisms enabling us to maintain this periodicityand regularity exist. This is achieved through hormones produced by
the hypothalamus (a part of the brain), the pituitary gland (a gland
attached to 'he brain) and the ovaries themselves.
It is vital to look at this whole delicate system in detail for one more
reason that has important implications for women, that is, family
planning. In the last few years certain contraceptives, working
mainly on the principle of intervening in this cyclical balanced
system, have been introduced on a large scale. While traditional
contraception used some device to block the path of the male sperm
to the woman's egg, such as the condom, these new methods rely on
chemicals which are either taken as pills or are injected or implanted
within the body
Many new long acting methods, with effects lasting from 3-6 months
to 5 years are recently becoming available in public hospitals and
clinics These contraceptives, aimed at women mainly, are totally
under the control of the providers, and once the chemical has been
introduced into her body, the user can do very little to stop the
effects. One has to be very careful not to be persuaded to take
something which has long lasting side effects, or to recommend it to
others. Olfen, t he person providing the drug only mentions menstrual
disturbance as a side effect and the user remains ignorant of cases
of severe damage to the health of women using some of these drugs.
To be able to appreciate the extent of damage that such methods
could induce, let us go over the operation of the hormone cycle.
BARRIER METHOD - diaphragm
INTRAUTERINE DEI It 'E - Copper T
How does the hormone cycle operate?
Let us begin just alfer menstruation takes place. The concentrations
of all hormones related to the cycle are at a minimum at this time.
This is an indication for the hypothalamus to release a hormone
FSH-RF whose task is to stimulate the pituitary to start secretion of
the hormone FSH. Once a certain concentration of FSH-RF is
present in the blood, the pituitary gland starts production of FSH.
Increasing concentration of FSH gives two signals to the ovaries.
One is to start the process of maturing the follicles and the other is
to produce another hormone, estrogen. Estrogen mainly helps the
follicles to mature further and release a egg while also preparing the
uterus lining forembeddingoftheembryoiffertilisation wereto take
place. Rising concentration of estrogen in the blood gives a signal
to the hypothalamus to stop FSH-RF production. This is the
negative feedback mechanism.
o o ° o o O Os
e o o o o o Oj
o o o o O o ol
o o o o • e «-
*—--------- 5
HORMONAL METHOD - pill
TERMINAL METHOD - tubectomy
35
The stoppage of FSH-RF production- results in a reduced
concentration of FSH-RF. Low concentration of FSH-RF means
that the pituitary ceases to receive a signal to produce FS11. Reduced
FSH concentration stops production of estrogen in the ovary.
Thus these two hormones, FSH and estrogen balance each other's
production and presence in the blood by interacting with each other.
We are calling it a negative feedback because rise of concentration
ofone gives a signal for the production ofthe other to begin, but the
rise in concentration of the other gives a signal for stopping the
production of the first.
The cycle does not end with the actions of these three hormones. As
FSH-RF concentration decreasesthe hypothalamusstarts producing
another hormone, LH-RF which also primarily acts on the pituitary,
beginning production of LH. LH helps in bringing the process of
maturing a follicle in the ovary to completion till the release ofthe
eggSTART
When estrogen reaches a certain level the hypothalamus gets a message to slop production ofFSH-RF
I------------------------- —----------hypothalamus
---- ----------------------------------------------------------------------------------- (vary
When hSH reaches a ceria in level, it indue estrogen pi >duction.
h87 ROt. HiN
A similar negative Feedback system operates between l.JI-Rh\ IJI and progesterone
(Rasetl on drawing *» /* •'a Mohunly, in Rrajanan, Chayanika, Swatija,
Kamtai, 1993)
The follicle left behind after the egg has left the ovary starts
producing another hormone called progesterone. The main action
36
of progesterone is on the uterus. It helps the uterus lining to develop
and prepare for the embryo, in case the released egg gets fertilised.
The progesterone also has another vital task, to give a negative
feedback signal to the hypothalamus to stop production of LH-RF.
Ifthe egg does not get fertilised, there are no other signals and as the
feedback stops progesterone production, the fresh lining is shed
away as in the form of menstruation.
This types of feedback mechanisms are dependent on a range of
variable factors. What then are the norms according to which we
decide when the body is not functioning properly? One method used
to determine normalcy in biological functioning can be the calculation
of the average of many persons' responses. Behaviour which moves
away from these averages can be said to be abnormal. Another way
is to list certain basic criteria to determine normalcy, based on the
study of many persons both healthy and ill.
Upsetting the imbalance to create balance
However the "normal" functioning of a body takes place in a variety
of situations. It is also something that varies from person to person.
The nutritional and environmental conditions are different for each
of us, in quantity and quality. The amount of emotional support and
psychological security differs in every family. The opportunities to
explore one's own potential and to fulfil one's desires may be
available to some and completely absent from the lives of others.
Social and cultural factors may put a number of restrictions on some
people's existence—and yet most people's bodies function and
behave "normally". And within the many and varied circumstances
that we live in, the human body performs the same basic tasks,
reproduces and sustains life.
Internally, the body tries its be; t to adapt itself to a host of
unexpected situations. It could be initiating processes that would
upset an imbalance and thus create a balance. It could be making
responses which would force us to take certain actions consciously,
to meet the body's need at that particular moment of time. A
prolonged exposure to some kind of difficult environment could
lead to a permanent change in the basic structure of the body so that
its smooth functioning is retained. There could be temporary and
immediate ways of relieving the body of build-ups of stress.
We can see examples of this happening to our bodies all the time. It
is just that most of these actions are so involuntary and the body is
so used to responding specifically to particular situations, that we do
not recognise this as a process of adaptation adopted by it.
37
On the other hand in summer, especially in dry climates, there is a
constant feeling of thirst and we have a comparatively high intake
of water and fluids. At this time there is a lot of heat loss through
sweating, and evaporation of water from the skin pores. This helps
to keep the body cool, and an increased thirst helps maintain the
internal balance of water.
As we said earlier, the body has a certain rhythm and pace at which
it needs its essential inputs and rest. If the person's work is such that
this rhythm is constantly broken, the body finds ways to adapt to it.
Within the family, one must also be sensitive to the tension created
by forcing certain habits and adaptations on others. When frustrated
parents forcibly feed children large amounts at mealtimes, and scold
them for wanting snacks in between, they may be unwittingly
interfering with the children's own body requirements and rhythm.
The children may require to eat small amounts throughout the day,
and their unwillingness to eat big meals like adults, may be reflecting
their inability to adapt to the adult rhythm.
One common response learned early in life by the body is the ability
to control the urge to defecate until a suitable place is found. The
necessary muscular control is retained all through the years from
infancy to adulthood. It is another example of the body's adaptation
to social existence, especially in surroundings like metropolitan
cities, which do not have open spaces for these functions. Similarly
the body adapts to long hours of work during which it receives no
food. Or the body learns to make do with the minimum rest possible.
Actually, all our responses, of hunger, thirst, feeling hot or cold,
sleepiness, pain are all ways by which body demands some action
which would help to restore the imbalance created in the body at that
moment of time. In that sense, it is a means of adaptation of the body
to a changed internal equilibrium and balance—this change itself
occurring as a result of activity on part of the body or changed
external conditions.
38
0 0 0 0 0 0 0 3 O O O O O O O O 3 O O <3 O 0 O 3 O O O O O O O O □ O ' ;
In winter we wear more insulated clothing compared to summer
This is an active and conscious act to protect our bodies. But the
body itself has its own mechanisms to deal with fluctuations in
external temperature. Because the body expends more energy to
maintain internal temperature at that time, the requirement of food
goes up. At the same time heat loss is minimised by constricting the
pores of the skin. This is why, though we feel more hungry, we are
less thirsty in winter.
Some common responses of the body to restore balance
Hunger
Hunger often gives rise to drowsiness. This is a temporary coping
mechanism by which minimum energy loss takes place at a time
until the next meal. All the energy that is available is utilised
sparingly by the body tillfresh nutrition arrives.
Pain and pressure
In case the body or any part ofit is exposed to some pressure, which
could represent danger, there is a response ofpain which helps us
to realise that something needs to be done to alter the situation. We
immediately realise that we have to move ourselves or change our
posture. Thus pain is also a response that helps the body to respond
in a way that allows it to continue normal functioning. It is a
manifestation of the process of adaption.
Feeling dull
We yawn in a variety of situations—be it boredom, tiredness,
hunger, sleepiness. Yawning involves taking in a deep breath and
with it a generous supply ofoxygen. The body goes on doing this till
it gets the requiredfood or rest or relieffrom the boring activity
because of which it had started switching offandfeeling lethargic.
Yawning is usually a response to a situation where for various
reasons, the body needs an extra supply ofoxygen to get revitalised
and activated. More than average work needs to be done in these
.particular situations. So the body responds by asking for more
oxygen until the cause of its dullness is attended to.
Blood clotting
When blood vessels are broken, clotting of blood is another
temporary response to check unlimited blood loss. A chemical
which helps the blood to form clots is produced, stopping the
draining out of bloodfrom the point where the blood vessels have
been cut.
Indigestion
In a sense this is a method ofadapting to harmful situations arising
in the body. When there is some kind of indigestion or upset in the
bowels, the body responds with a poor appetite, and the person
expresses no urge to eat despite hunger. This allows the bowels to
rest and recover.
39
In Bombay, we live in an extremely crowded and fast moving
environment. This affects our overall senses and alertness. This
situation is bound to change some of our faculties, and make them
more active. Otherwise people would not be able to cope with the
pace ofthe life here. Without such adaptationsit would be impossible
to travel everyday for hours in packed trains, and to be able to sleep,
rest, and even relax in them. Or to spend a lifetime sharing an 8 by
10 room with five to six other persons. Or to live one's life matched
to a rhythm set by water timings, work timings, and school timings.
In the end we would, however, like to state that adaptation also has
a limit. Its possibilities are dependent on the environment in which
one is living, and on its allowing the body to adapt. Again is it
possible to determine a conducive environment as against a harmful
one?
Social practices and norms have already put limitations on the body's
ability to adapt. As women we know that it is not possible to get all
the nutrition we need when we are eating the leftovers of the
menfolk. Is it possible to glow with health while coping with the
mental tensions and nagging sense of fear experienced by us at all
times? Yet, the fact that our internal environment is in constant
interaction with the external environment makes it necessary to talk
about it, and the efforts to make it healthier for more people. This
is the theme of the next chapter.
40
Chapkr IV
OUR BODIES AND THE CITY
ENVIRONMENT
During our lifetimes, our bodies have to adapt to many changes in
the external physical and social environment. We may be born in one
situat ion, then our parents move, and we grow up elsewhere. Later,
we may find work, or a married home in some completely different
environment, and later in life too, we may continue to migrate. Even
if we remain at the place where we were born, it could happen that
the environment there changes beyond recognition over the years.
Our bodies have to make all kinds of efforts to adapt to such
modifications in the external environment. At the same time it is also
true that there is a limit to the capacity for such adaptations.
Once again we would like to look at Sarala's story. Sarala had been
brought up in a village where the way of life made certain specific
physical demands. Walking long distances, fetching water, fuel and
fodder every day, she had been used to a certain pattern of living.
Today everything--even Sarala's style of dressing, has changed. She
does walk a lot even now, but the distances are not the same, and she
is unused to carrying heavy loads. At the same time she is able to do
many things, like managing to get in and out oftrains during the rush
hour, that she could have never imagined possible when she first
came to Bombay.
41
Lately Sarala has been feeling that the demands of the city on her
body are becoming more and more difficult to meet. The crowds, the
nagging tensions, the increasing violence and insecurity as well as
her advancing age are all putting a strain on her. Even simple tasks
like filling up the water for the house, going to the toilet, crossing
roads, getting in and out of buses and trains, have begun to require
conscious effort.
Over the past two hundred years there have been many changes in
the environment of the area covered by the city. A quiet corner of
India made up of seven small islands, where a handful of village
people lived mostly on fishing and farming, grew to become the
industrial and trading metropolis that we know today. Over the
years, the pace of change has kept increasing steadily. One of the
biggest periods of growth in both the population and physical size
of the city has taken place during our own lifetimes.
If one studies the last hundred years alone, industrial locations,
traditionally placed outside the elite areas ofthe city have continuously
shifted outwards. In their peak periods, each of these have been
pockets ofintense activity. Even in ourown times, we can remember
the crowds at railway stations near the textile mills, such as
Elphinstone Road and Currey Road, during shift change hours.
As the city kept spreading, the residents had to be mobile. Unlike
other Indian cities, an efficient and easily accessible transport system
came into being here in Bombay. Of course with it also came the
hazards of movement of heavy vehicles and human beings.
The sctnt outside Victoria Terminus station,
Bombay, a century ago and at present
To add to this is the necessity of transporting vast amount of goods
and materials. In addition to the trains and buses, there are over
4,00,000 heavy and light vehicles plying on the streets of Bombay.
With the movement of so many vehicles and human beings on the
roads, came the resultant hazards of traffic and pollution.
These are somefigures about urban basic services which reflect the
conditions of life of the urban poor:
• 40% of urban residents in India live in Just one room.
• 75% of the one room tenements in India have no windows.
• 27% do not have access to drinkingwater and the 73%whodo,
do not have access to a safe water supply.
(Figures courtesy UNICEF, 1989)
42
The call of the city
With such a large number of people coming to the city, looking for
work, housing has always been a major problem. Cross-ventilation,
sufficient light, good sanitation, clean water, open spaces are only
suggestions for good living restricted to text books. Getting even a
space to live in is a struggle of a lifetime for most.
Within the available space arrangements are made for as many as
possible. Pavements are used to build houses. Scrap materials
become walls and roofs. New marshy lands are reclaimed and areas
considered unfit for human occupation become homes of large
numbers of people.
Behrampada in Bandra East is a basti settled during the last fifty
years Initially the area was a marsh that was filled up with soil by
the early settlers themselves. Today some builders see the area as
being suitable for developing as a commercial centre. This has
created undue stress on this predominantly Muslim basti made up
mainly of artisans engaged in traditional crafts, and piece-rated hand
work. They feel that it is they who developed the area and will not
hand*it over. All kinds of pressures are being put on the residents to
move out. Many have been living here for decades and cannot afford
to go elsewhere. In a communally charged atmosphere all kinds of
criminal charges are being levelled against the locality people to
frighten them into leaving.
At the same time that such attacks are made, the vast expanse of the
city also provides spaces for all those who are shunned by society.
For example, leprosy patients undergoing treatment and recovering
from the effects of the disease have often been seen to be living
together in self-organised bastis. At other places eunuchs are seen
living similarly. Such spaces are carved out of the anonymity that
such a large city offers. They do not emerge from a generosity and
liberal outlook on the part of the other citizens of Bombay.
Who are your neighbours in the basti?
Despite migration from every part of the country there is a lot of
segregated living in the city. Where we might expect completely
mixed localities we find that the ghettoisation of particular castes
and communities continues. It can be seen in the form of lanes and
clusters inhabited by particular castes in the bastis. Entire buildings
are reserved for particular communities in the Housing Board
colonies. Entire areas like Kasaiwada and Meghnagar are so named
because of the particular community living there.
43
You could do a survey to establish the correlation between regional
or caste identity and the choice of residence in a particular basti.
You can do it by asking questions like thefollowing of the adults in
the families:
• What is the occupation of different members in the family?
• When did they come to Bombay?
• What is their religion/caste?
• What was the occupation of their parents and where do they
live?
• How long have they been living in that area?
• How did they come to know of the availability of the house?
• In whose name is the house?
• In case the person is a married woman, where and howfar is her
natalfamily?
Such studies of the whole settlement make us conscious of the
continuous process of change that goes on whether we are aware of
it or not. This is especially important if we wish to bring about some
further changes to improve living conditions. Collecting such facts
about a basti helps us also in looking at it in connection with the rest
of the world around us. This again is important, for changes in the
basti are very much linked to changes outside of it. It is always
helpful and necessary to have a wider perspective without losing
sight of the small basti that one is working in.
~
Similarly, you can build a picture ofthe historical development of
the locality. If there are some persons who have been living in the
same area for many years, you could ask them questions such as
these to build up a history of the basti:
• When did the first settlers come into that area?
• What do they remember of the landscape then?
• Who were the first people to come?
.44
What kind of work did they do?
• Does the area have a mixedpopulation in terms ofreligion and
language?
• Has it always been so? What could be the reasonsfor change
if any?
These kinds of surveys also help us to develop an understanding
about the individuals in the community with whom we have to work.
It also helps build rapport and make space for more meaningful
responses to the community's needs. For example, some of the
people from the basti would have retained their original professions,
but many would have changed their occupations over the years. By
talking to them we could know more about the acceptance of these
changes, of the adaptation to city life or the willingness to respond
to changed external situations.
You could do another survey based on specific questions exploring
changed external conditions with the people in your community.
Knowing their perceptions of these specific conditions, peculiar to
urban existence, could be a guide to us as health workers. You could
ask:
• What kind of drainage system does the basti have?
• What is the garbage disposal mechanism?
• Is there a nalah flowing through the community or near it?
• Is the basti located near the railway tracks or a running main
road or highway?
• Is the area situated m an industrial belt of the city?
• Ifyes what are the kinds of industries there?
• Do they emit substances which could affect the health of the
community?
• If so, can the residents do something about it?
The processes which led to the present-day inequity between rural
and urban areas have been taking place over a long period of time.
The evolution of the city itself has been at the expense of the rural
communities surrounding it. With changing industrial patterns
causing changes in agriculture, the exploitation of natural resources
in the rural areas is becoming increasingly evident. The city does
offer jobs and opportunities and even a cash income to a large
population, but it is totally dependent on the countryside for its
survival.
Both industrialisation and urbanisation lead to unprecedented
interventions in natural processes. Unplanned growth of industries
and the proliferation of polluting production processes have ravaged
the city's environment. One indicator of such destruction is the
quality and quantity of air that is available. The accessible air in the
city is not conducive to a healthy life. This is experienced by every
individual in the city whether rich or poor.
How good is the air that we breathe?
Not only do polluting industrial processes affect the balance of
nature and the environment drastically, but they are also responsible
for the growing disparity in the distribution of the natural resources.
Most of us think of air as something freely available in limitless
quantities. However good air is as scarce and as precious as water.
* And an amazing 52% is consumed by vehicles!
About 2971 metric tonnes ofpollutants are released into the air of
Bombay every single day.
(Figures courtesy Dr. S. R. Kamath).
36% industries
€ (• (;( <
46
What these chemicals can do to the living organism is reflected in the
statistics related to the health status of citizens. Below are national
figures for some of the diseases that are very much related to the
■
'
• 36% is used by industries
52% vehicles
€ C ( C C C G € € G C € OC C C C €
• 2—6% goesfor domestic use
C• C
How is the total amount of oxygen available in the atmosphere
shared by different users in Bombay?
€ €
2 to 6% domestic use "
(x €
- Most people are forced to live and work in cramped conditions. Due
to this, they may develop health problems stemming from an
insufficient supply of the life sustaining gas, oxygen. This, however,
" is just one aspect. Much of the air that reaches the lungs is a kind of
"exhausted" air, not only lacking in oxygen but also full ofdangerous
pollutants.
quality of the environment in which we exist. It is evident that there
is no consistent decline in the morbidity or mortality ofthe population
as a whole.
1987
1988
1990
8,90,000
9,375
10,75,000
10,698
11,32,000
9,308
2. Acute diarrhoeal diseases
No. of cases 1,00,80,000
Deaths
6,730
82,61,000
7,290
95,80,000
8,633
3. Asthma and bronchitis
Deaths
1,558
2,097
1,885
4. Heart attack
Deaths
1,261
1,236
Diseases
1. Tuberculosis
No. of cases
Deaths
886
(Source: Health Information India, Central Bureau of Health Intelligence,
Ministry of Health and Family Welfare, Govt, ofIndia, 1988, '89, '91)
What about the water we use?
The other important natural resource is water. Most of our water
supply is collected from rivers and water sources outside the city,
and piped in. A major portion of Bombay's water supply comes from
the Vaitama dam. While this dam gives us plenty of water, its
existence has created summertime droughts in the villages near it. At
the same time that we wish for greater amounts of water for the city,
it is also important to see what the city's demands do to the localities
from which the water is being drawn.
A large part of Bombay's water is supplied to industries. Many
industries are also responsible for polluting the local water resources.
There is very little flowing water here, so pollutants do not get
washed away but accumulate in the soil, and come into contact with
the underground stores of water. You may have seen Municipal
notices on old wells warning about possible pollution ofthe water.
These accumulated pollutants affect plants and marine life as well.
The scale of the unthinking demand put on natural resources in a city
like Bombay disrupts natural balances in unprecedented ways.
The water supplied for domestic use is distributed in a most
inequitable manner. For most of us, this unfair distribution is
represented by the tap timings of the Municipal water supply.
Women, who are inevitably the ones responsible for the running of
the household and hence also for the water supply, find their lives
and schedules being entirely determined by the water supply hours.
47
C C C C C C C C C C C C C C C C C
c
i
he Water Cycle
(based on Samajik Adhyayan, M. P. Pathyapustak
Nigam)
At the same time there are areas where the residents not only receive
running water for twenty four hours, but they have so much ofit that
certain buildings can afford to use water to fill swimming pools. At
the same time, a large part of the city's population do not even have
shelter and they live on the pavements. They get no water or toilet
facilities whatsoever.
The search for work is an important activity in people's lives. To be
able to earn a living in the city, it is assumed that people have to be
ready to give up even the basic necessities such as clean air and
water. For a majority in the same city, the pavement dwellers are
considered almost subhuman. They are held responsible for the
changing face ofthe city and its problems, be it crowded trains, rising
crime or poverty. Everything is traced to these latest immigrants,
who are also the poorest.
The Municipal Water Supply of Bombay
Each ward ofthe Bombay Municipal Corporation receives a direct
water supply for three hours every day. Since water is a resource
for which ire pay, the amount of water reaching each household is
more or less determined by its paying capacity. The same main
feeder pipe carries the waterfor the whole city. Branches lead off
from this mainfeeder to reach right into residential complexes. The
amount of water that would reach a particular outlet point would
therefore depend on the dimensions of the connecting pipes.
There is apparently a well worked out system for determining the
dimensions ofthese pipes. For a building with middle or upper class
residentialflats, the amount ofrequiredwater is calculated keeping
in mind the total number offlats, their area and the number of
people perflat.
48
A
0
O
n
I he size of the supply pipe is then determined by considering the
diaani e of the buildingfrom the main feeder and the pressure of
water at the branching offthe point in the mainfeeder. Most middle
<>r upper class housing complexes are able to invest in their own
overhead storage and pumpingfacilities, providing a twentyfour
hour supply to each flat.
The rule for obtaining a water connection in a low income area or
settledslum is more straightforward. The procedure assumes a low
paying capacity and thus less water is offered by putting in pipes
ofreduced dimensions. In this case a group offifteen neighbouring
households have to apply together. They are entitled to one tap
between all ofthem, whatever the number ofresidents. They get this
water for a continuous period of three hours daily.
Since they are obviously a low income group, they have no option
ofbuilding automatic storage systems. Each household has to store
its own requirementsfor the day within that stipulated time. The tap
timing could be any three hours during the day without regardfor
the user's convenience.
It would seem that even with a basic requirement of life like water,
the paying customers get all the advantages and gratification.
Disparity is very much a part of the city. In fact if we look back,
unequal distribution of water was supported by the caste system in
traditional Indian society. The oppressed castes were allotted
separate wells, usually the ones that were not abundant in water and
necessarily far away from the village itself. The disparity continues
in the city, only now the "caste" is defined differently.
And there is the matter of two square meals
This is how water, an essential input for the body and equally
important for maintaining hygiene and cleanliness, becomes a rare
commodity. There are similar problems with the other major input
to the human body, that is food. These relate to the amounts as well
as the quality of the foods that are available for different sections and
people. Good, wholesome food at affordable prices is again a rarity.
In this particular sphere, things seem to begetting more difficult with
every passing year. With the public distribution system becoming
increasingly irregular and open market food prices soaring, it
becomes more and more difficult to provide the required nutrition
to the family. Often, what appears to be reasonably priced turns out
to be adulterated, not giving the apparent food value and at the same
time having harmful effects.
49
As we have seen in the earlier chapters, it is important for the body
to have a balance of all nutrients. If it does not, it continues to
function but at less than peak condition. Such is the situation for
many urban dwellers today.
n
n
n
The question acquires new dimensions in the matter offood, because
there are many cultural and social values attached here. Though we
live in a cosmopolitan city, people from different regions retain their
own tastes. For example while hot, spicy food is preferred by many,
the type of chillies used are specific to the region of origin. At the
same time, with the stresses ofcity living telling on their health, many
people have given up taking as spicy a diet as they may have indulged
in at home.
Another problem that has come up in recent times, is the proliferation
ofjunk foods which have no food value. These are widely advertised,
and children and adolescents are especially vulnerable to their allure.
As people who are more aware of health than others, health workers
should work against the growing popularity of such products at the
level of community culture. These snacks also take away a large
chunk of the family's already limited food budget. And after the
struggle to provide a proper meal, mothers find that children do not
have an appetite because they have filled up onjunk foods beforehand.
What can we give growing children whose hunger between meals is
no doubt genuine? Greens of any kind eaten raw or with just a bit
C( <(
In many communities there have been successful struggles initiated
by women's groups for proper grain supply at the ration shops. In
recent years it would appear the government policies supporting fair
priced food distribution are gradually being withdrawn. It becomes
the responsibility ofthe residents ofan area to see to it that the public
distribution system works. It is they who have to watch against
adulteration and exploitative price fixing by the shopkeepers.
C
Bombay has a long tradition of eating places run by women from
their homes, called khanawals. They cater to single men living in
conditions where cooking is a problem. They provide home-like
food at minimum expense to the customers, and give the housewife
caterer an additional income. Perhaps many other solutions to
common problems, which benefit both the provider and user can be
invented by those who work in the community.
( ( ( ( ( - ( '( ( ? ( € .
There is also a growing variety of typical city foods, often a blend
of different tastes. A Bombay favourite is vada pav. Filling and
cheap, people prefer such foods even if they are aware of the
amounts of baking soda in it, and the digestion problems due to the
oil. It is a food that can substitute for a proper meal with minimum
expense, and so it is popular.
of cooking are a good source of nutrition, also providing the
roughage that the body needs. During seasons when they are cheap
one should try and eat more of them. Another such group of foods
are sprouts, easily grown at home, and a good source of proteins
even if eaten raw. Then there are other inexpensive snacks such as
ber, groundnuts and sugar cane. You can probably think of several
such cheap food items with good nutritional value.
Solutions have also to be worked out at the community level. In
many middle class housing societies, people make their monthly
food purchases together, to get the maximum concession possible
on the bulk of their collective order. Many work places have
cooperative societies for this purpose. Is it possible to find some
such solutions in the communities that you work in?
Getting rid of the body's wastes
The other major problem in the city is that of sanitation, more
specifically of the availability oftoilets. Lack ofsufficient and proper
facilities leads to many problems, not only for individuals but also for
the health of the whole community. Constipation as well as frequent
loose motions are both chronic problems for many people in the city.
They emerge out of a lack of suitable toilet facilities.
• 72% of the total urban population in India do not have access
to sanitation.
• 80% do not have private latrines.
• 66% ofpublic toilets remain water logged.
(Figures courtesy UNICEF, 1989.)
This is the situation in officially recognised slums. There are a large
number of people who do not come under this category and so do
not even figure in such statistics. As a result of this state of affairs,
any open and shielded ground is used for defecation. The long tracks
of the suburban railways are a common accessible place. Women
however, have a special problem. They have to use these public
places under the cover of darkness, and so have to adjust their
timings accordingly. Late night or early morning is also a time when
the trains are not so frequent or crowded, allowing for some shelter
from public gaze.
Sakubai works in five houses, doing the floors and washing vessels
and clothes. Of these however, there is only one house where she is
allowed to use the toilet. Sakubai plans her day in a such a way that
she reaches that house in the middle of the day, though this means
walking longer distances.
Meena works in the packaging department of a pharmaceutical
company. Although there are twenty women working there, no
toilet facilities are provided. Of her thirty minute lunch break, she
spends about fifteen minutes to go to a nauseating overused toilet
in another factory, awaiting her turn in the queue.
Manju sells pins and bindis in the local train. She keeps jumping in
and out of trains all day. Her prime concern is dodging the police and
getting into trains without changing platforms. In this process she
never gets to reach a toilet. Some time late in the night when the
trains are empty she relieves herself in the coach. She does not like
dirtying the compartment, but does she have an alternative?
Shamshad, an LIT. graduate appeared for ajob interview. Off the
record she was told that her name had been taken to be that ofa man,
and had they known otherwise, she would not have been called. The
company did not have any women on their rolls and their excuse for
not hiring a qualified woman was that they would have to construct
separate toilets for women.
Suppression of the urge to urinate is the cause of a large number of
ailments in women. Women'sgroups have made demands for special
additional toilets for women at all railway stations for these reasons.
; In the situations that we have narrated, the circumstances that a
< person is placed in dictates the natural urges of that person. Any
■' solution to all these problems can only come from efforts taken by
; the community as a whole. Sulabh Shouchalaya is an example of the
i use of an alternative management strategy for public toilets that
seems to be working well.
■
j
Take a surveyfor yourself making notes ofyour observations in a
notebook.
• What are the common health problems ofpeople in your basti?
How many of these can you see as emerging from unhealthy
living conditions?
Have you observed any special problems of women apartfrom
those related to reproduction?
, 52
• Is it possible to introduce some changes through cooperative
efforts by the community?
• Can you see discriminatory practices affecting individuals
within households? Can anything be done about it?
This study cannot be done quickly. It is something thatyou will have
to keep working on as you go about your daily tasks.
When we are talking about bringing about good health, it is
important to not get disheartened by the distressing magnitude of the
situation. It is important to act in whatever way possible individually
and as a community. Such actions can help people to gain the
strength to survive in the grim circumstances of the city. At such
times it is also strengthening to know that the body itself has its own
adapting mechanisms with which it tries to survive in as healthy a
way as is possible. This adaptation of course has its limits, and it is
part of our work as health workers and as individuals to aid the body
by giving it more space and less strain.
Can something be done about the workplace?
One important objective which attracts people to this city is work.
Bombay does provide earning possibilities to most ofits immigrants.
The industries and the allied services, as well as the fact that there
are some persons with a large purchasing power, have made the city
into a centre for consumer goods and trade. People survive here
doing all kinds of tasks.
Working in the industries and other occupations creates strenuous
situations for the persons involved It could be the timing of shift
duties which disrupt the biological c'ock and rhythm of the person,
or it could be the travelling in the crowded trains and buses and the
stress due to it. Besides ofcourse there is the noise and pollution that
surrounds us wherever we go in this city. There is also a great deal
of stress caused by the effort to maintain all the various schedules
in situations that are many times not in our control.
In the industries where workers are supposedly working for heavy
salaries, many suffer losses in their vision, hearing, and sense ofsmell
in the strenuous working conditions. By the time they retire they
suffer from chronic ailments and weakened bodies, old before their
time. Insufficient regard for safety precautions and uncaring attitude
ofmanagement towards workers leads to many accidents, and often
such incidents do not even come out into the open.
.
Health workers should make it a point to learn about the
compensations available in case ofaccidents related to the workplace.
53
It is not as if the law or the legal proceedings would always be in the
favour of the worker but it is important to be aware of one's legal
rights, however limited they are. There are a number of individuals
and organisations who work in the area of occupational health and
we have given a list of these at the end of the book.
More vital for a healthy work environment is the creation of
situations where the risks are minimised and occupational hazards
with long term effects on health are prevented. This consciousness
amongst all people including workers is on the rise today.
Building such awareness has not been an easy task. In the past
workers would often reject the demands of trade unions for
environmental safeguards, special safety equipment and protective
clothing. Their argument was that if management was willing to
spend on these, then the same money could be converted into extra
allowances which could be added to their salaries.
The management would also be happy to avoid the extra work
involved in instituting the changes, and things would continue as
before. It was also felt that it was somehow unmanly to wear
earplugs, gloves or face masks when people had been working for
years without such protection. Even if such devices were provided,
they were not used on grounds ofdiscomfort in an already overheated
and uncomfortable situation.
Increasing awareness about occupational health hazards has had far
reaching consequences. In the same factories where workers
demanded risk allowances about ten years ago, today they insist on
protection and demand changing ofproduction processes to minimise
risks..
I n these situations it is also important to remember that often medical
experts are as unaware of the hazardous effects of certain industrial
processes as the public. This was starkly brought to light in the
Bhopal gas disaster at the Union Carbide plant in 1984. Not only did
the disaster claim thousands of lives when it took place, there are
thousands of survivors still alive today whose lives are completely
mined. The experts were at loss to provide relief and explain what
had taken place because they had no knowledge of the chemicals
involved. It is thus vital that the individual persons themselves
acquire as much knowledge as is possible both for monitoring of
their work environment and for taking preventive measures.
While some provisions are provided for the workers in the organised
sector who work in industries covered by regulations there are a
large number who work in sectors that are not under the umbrella
of such regulations. Most conspicuous among these are the rising
54
numbers of women who sit at home and work on a piece rate basis
for contractors.
The jobs offered to women have always been underpaid and highly
discriminatory. Women have been working in the service sectors as
telephone operators and nurses or in the pharmaceutical and
electronics industries at backbreaking, routine, monotonous jobs.
The shift duties in these places disrupt the possibilities of a normal
life forthese women who are already carrying a double burden ofthe
wage work and the housework.
In the rural ureas, women form 27% of the workforce involved in
agriculture, forestry, horticulture and related activities.
Compared to this, just 13% ofworkers in the organisedsector in the
urban areas are women
(Figures courtesy Census ofIndia, 1991.)
It has been observed that professionals like nurses sometimes
develop a kind of paralysis of the mind because of frequently having
to work extra shifts, constantly on their feet, without adequate sleep.
The most common job for women in the pharmaceutical industry is
packing. Both sitting for hours at a time and carrying loads lead to
severe backaches and other problems like menstrual disturbances
and while discharge. The exposure to drugs while doing tasks like
filling of capsules can have other dreadful effects not only on the
woman herself but also on the offspring that she may have in future.
And yet these are the tasks that women are offered.
In 1991, the International'Labour Organisation put together a
number of studies carried out in different parts of the world and
concluded that the majority of workers in all parts ofthe world were
women, and they received much lower wages than men doing
comparable tasks. Most of these workers had no access to social
security benefits. Though some countries did have social security
schemes, most home based workers did not avail of them. The 1LO
also noted that the home based workers as a group worked for
longer hours and were more exposed to health and safety problems.
They performed both domestic and paid work throughout the day
and were always alert to the pace and quality of work for fear of
rejection.
A study based on interviews of home based workers in the slums of
Bombay has startling revelations. This study has found that backaches
55
and body aches, loss of vision, migraines, respiratory problems,
excessive white discharge, urinary tract infections figured prominently
among the health problems of home based workers.
The problems of health are reflected at various other levels. The
difficulties of the financial situation and the physical and mental
stress of coping up, give rise to many insecurities. The city has
become a ground for all kinds of competition operating at every
level. Life has become a process wherein people become alienated
from themselves. This sense ofalienation and insecurity marginalises
a large section ofpeople, and does not allow them to claim even basic
human dignity for themselves.
What about those on the margins?
Khushboo has come from a town on the borders ofMaharashtra and
Karnataka. She comes from a community who marry off their
daughters to the local god in childhood, making them into devadasis.
Khushboo was forced to work on the highway as a roadside
prostitute catering mainly to the truck drivers, based at a place near
her village. She then chose on her own to come to Bombay and work
in the red light area as a professional prostitute.
Prostitution is a major trade which works at the expense of women.
It has social sanction because it is believed that men have unlimited
sexual urges and also that women's role is to satisfy these. In a city
where lakhs of men live alone for years, there is a market for paid
sex, which reduces women like Khushboo into a commodity.
The rise in the number of STD cases registered by Government
hospitals and the fear of the spread of AIDS has brought this issue
i ato the limelight. Once again prostitutes are being victimised. Men
who go to prostitutes are considered a high risk group. No one talks
of the susceptibility of the prostitute to such health disorders.
Socially, it is the prostitutes who are looked down upon, not their
clients.
Prostitution is also a kind of threat held over the heads of all women.
It marks a divide between the bad prostitute and the good housewife,
a permanent reminder to all women to stay within the limits
prescribed by society. If they toe the line and obey the father or
husband, they will be looked after. Otherwise they will have no
choice other than to become prostitutes. The sale ofwomen's bodies
is an expression ofthe control over women's sexuality and independent
existence.
56
According to a 1991 study quoted in WORLD AIDS, it is believed
that 90 million persons suffer from sexually transmitted diseases
(STDs) annually in India. However not all will approach the
established health structure for treatment. STDs have come to be
viewed as the wages ofsin, and approaching the health authorities
is tantamount to making a public confession of one's sexual life.
Incidence of sexually transmitted diseases
Year
No. of cases reported and treated
(in lakhs)
1975
4.11
1979
5.36
1984
9.19
1986
12.76
1989
13.64
(Source: Health Information India, Central Bureau of Health Intelligence,
Ministry ofHealth and Family Welfare, Govt, ofIndia.)
Myths of maleness and femaleness colour much of our behaviour.
The image of the hero as an aggressive, inherently violent and
uncontrollable male youth has been cultivated in popular film
culture. The only expression that such young male characters have
in response to any trying situation seems to be violence.
The fact also remains that such fictitious characters reflect the
authentic unrest and insecurity in society, especially amongst the
young. With the growth ofconsumerism and easy access to anything
that may be on sale, we see agradual change in culture, even amongst
those whose parents' values would clash with such activities. Drugs,
alcohol, rape, pornography, murder, fighting, extortion are gaining
credibility in this section of the population. Gangsterism is taken up
as a profession, and being a member of a gang is a sign of prestige.
The lesson of the modern era seems to be that practicing violence is
the only way to survive.
As a city we have undergone the trauma of the 1993 riots, of the
mindless carnage during it and in the subsequent bomb blasts. And
today we are experiencing an increased level of gangland violence*
which seems to touch everyone from child brown sugar addicts to
57
top industrialists. It is a much more violent situation than any in
recent times. In all this open violence it is going to be all the
powerless sections, especially women who will be the biggest
victims. Is there something that can be done by the community to
turn back the wave of violence?
n
r>
n
o
n
n
n
n
n
Some questions to think over with others:
• What was the experience ofyour community through the riots
and during the process of returning to normalcy ?
• How many bluefilm parlours are there inyour basti ? Who goes
to them?
* Why do you think that they do?
• What is the situation ofprostitution?
These contradictions are a part ofurban life. The city promises work
for all, but unemployment has increased and so has poverty. One
wonders if a development process based on unplanned industrial
growth, automation and monopoly production, could be seriously
aiming to reduce poverty.
In such a bleak atmosphere it is easy to ignite a dispute, arouse
animosity and create violence without much engineering. This is
what was seen in the city of Bombay in early 1993. A sense of unrest,
and the possibility of riots had been in the air all through the
preceding year.
And yet, this dream city has a specialty of its own, a humanity that
co-exists with all the tensions, which emerges out spontaneously in
the most unexpected of places and times. That is when one is happy
to 'say "I am from Bombay."
58
<
• What is the drug abuse and drug peddling situation in your
basti?
c l C © C C €> C (• €• € € ’ C O C C C C €' C & G’ © C O O O O € €> €
• Are there any liquor dens in your basti?
BOMBAY’S PUBLIC HEALTH SYSTEM
<
GENERAL DATA
Greater Bombay population
11 million
Actual burden
15 million
Population density
Health expenditure of BMC and State government
18,000 per sq km
:
: Rs. 300 crores annually
Estimated daily morbidity (at 1%)
.1,10,000
New cases
2,20,000
Old cases
3,30,000
Total cases
HOSPITALS
PRIVATE SECTOR
State Central
Govt Govt
BMC
TEACHING HOSPITALS
4
4
—
GENERAL HOSPITALS
13
7
10
OTHER HOSPITALS
4
6
—
149
3
• 22
10,000
6,000
3,000
25
2
—
DISPENSARIES
■
BEDS
MATERNITY HOMES
Hospitals and Nursing Homes
1,000
Beds
10,000
Medical Practitioners (including unqualified)
40,000 to 50,000
ESTIMATED DAILY tlSERS OF BMC &
STATE GOVT. FACILITIES
75,000 persons daily
OR
••
274 lakhs per year
(Figures courtesy Ravi Duggal of CEHA T)
6
o
—
- - -- . . *^- * * ■ •
-.
.
. . -4
This map is imaginary and not according to scale. It represents the idea that health facilities in Bombay are concentrated in south
and Central Bombay whereas the population pattern has changed over the years, and the majority of the people now live in the
northern suburbs.
o
o
o
o
o
o
Chapter V
WHAT HAPPENS WHEN THE BODY
BREAKS DOWN?
The body tries to constantly adapt itselfto external situations in ways
that would help maintain stability and efficiency. Considering the
conditions of living for most people in an urban environment like
Bombay, it is almost a miracle that they manage to function as
efficiently as they do. And yet there are problems and situations in
which breakdowns do occur, in which a body is said to be in a
diseased state.
Nagamma has not been able to go to work for several days. She has
severe backache and feels uneasy and restless. She is also suffering
from heavy vaginal bleeding. Nagamma is a construction worker
and every day off work results in a loss of the day's wages. She
cannot afford to sit at home. If the illness persists, in two or three
days her children will have to go hungry and they may also fall ill.
There is no time or money to go to a doctor, and she also knows that
the doctor can't do much to help. She feels that she will get relief if
she stops working, but that is not a choice open to her. In any case,
she gets work for only eight months in a year.
When Nagamma had been ill earlier, Sarala had insisted on taking her
to a private doctor. The doctor had said there was nothing seriously
wrong, and he had given some pills. The medicine had helped
Nagamma somewhat, but the doctor's fees-could not be paid every
time. The medicines were also expensive. So long as Nagamma
pushed herself to go to work, her husband was not bothered. On the
contrary, he kept cursing Nagamma because he could not have
intercourse with her when she was bleeding.
The diseased state is not something which has a standard definition.
While Nagamma knows she is ill and must rest, her social position
is such that she has to insist she is fine and continue working. Being
ill or being healthy is very much determined by an individual's social
status.
Our bodies are very specific to each one of us. We live in different
material, social, and emotional worlds. And everyone has different
physical capacities and endurance levels. Thus if a breakdown
situation arises, our responses may be as distinct as our experiences
are.
The stereotyped image of a heroic woman is that of a resolute
person, capable of taking immense amounts of suffering without
complaint. The more hardships such heroines endure, the stronger
they seem to become. Such images of ideal women are constantly
repeated to us from childhood, in the form oftraditional stories, local
gossip, films and TV serials.
This role model strikes deep roots inside every young girl. Thus in
the usual family situation, the woman in the house does not take to
her bed until it is absolutely impossible for her to carry on with'her
normal routine. In the process of doing what is expected ofa "good"
woman, she may be causing great harm to herself, but no one really
looks at that. We have all come across such instances, in our homes
and elsewhere, and have perhaps been pressurised by circumstances
to act this way ourselves.
As we said earlier, the otherwise fitter female fetus has lower
chances of survival after birth than her male counterpart. This is
because the girl child is discriminated against in every aspect of her
upbringing, even when she falls ill. Her nutrition, health and
educational requirements do not engage the attention and the
resources of the family in the same manner as her brother's needs
would.
Daily wage earners like Nagamma have to work continuously in
conditions of acute physical discomfort. They have to keep up their
activity until age makes it virtually impossible for them to sustain it
any longer. On the other hand, there are people who can take the
liberty of a day's rest, with full wages paid, for a mild illness. How
ill a person is, is therefore a very relative term. It is a subjective
interpretation of one's own state.
60.
(illustration from Taking Sides, C. Sathyamala et al, AN1TRA, 1986)
This table gives the age specific death ratesfor the urban male and
female population in India for the year 1987. The death rate as
given here is the percentage ofthe corresponding totalpopulation
ofthat age group. The rates are higherfor infants and women in the
reproductive age group. Beyond thisfprobably the total number of
women has gone down so much that the death rates have also
reduced.
'•'stimated age-specific death rates in urban India
Age group
Male
Female
Average
0-4
18.1
18.2
18.2
5-9
1.3
1.9
1.6
10-14
l.l
0.9
1.0
15-19
1.2
1.8
1.5
20-24
1.6
2.1
1.9
25-29
1.8
2.0
1.9
30-34
2.6
2.1
2.3
35-39
3.1
2.7
2.9
40-44
5.3
3.1
4.3
45-49
7.0
5.7
6.4
50-54
12.5
8.6
10.7
55-59
19.8
13.1
16.7
60-64
31.9
23.2
27.5
65-69
47.9
34.4
41.0
70 and above
97.0
81.2
88.5
Source: Sample Registration System, Registrar General, India.
. 61
Yet the fact remains that physiological disorders of the body do
occur. Despite the body's capacity to adi.pt to all kinds of adverse
situations, in spite of the fact that the body tries its best to maintain
the internal equilibrium, there occur states of breakdown when the
body fails to continue normal functioning.
So what would be our answer to the question "What is falling ill?"
We would identify illness as that state of the body in which there is
a failure of the internal mechanisms in adapting to changes in the
external environment. This results in breakdown of the equilibrium
between the internal and external environment.
In whatever way we understand illness, we need to realise that the
breakdown which is visible to us, and which we see as an illness, is
the culmination of something ongoing. It is the final manifestation
of a process in which the body has been struggling to continue
efficient functioning under adverse conditions.
What we call the illness is a description of the visible symptoms of
the disease. The symptom is just an indicator of the disease. It is not
the disease itself, and definitely not the cause of the disease. Because
of the diseased state, the particular abnormality, and disturbed
internal equilibrium are apparent. Hence what is visible and accepted
as disease is something like the shadow of the problem, not the
problem itself.
Think of any major illness that you have had or someone close to
you has had.
•
What do you think were the causes?
•
Did you go for any treatment?
•
Didyou consult a traditional healer, or a modern doctor, ordid
you combine both styles of treatment?
Similar questions can be asked ofother people in the community in
the course ofyour usual rounds. This could help you to form a
picture of the attitude towards illness that generally exists in the
community.
The illness, as distinct from its symptoms and its causes
What is the reason for the occurrence of breakdown? Even though
visiting a doctor or a hospital for treatment is a common thing in a
62
city like Bombay, in most cases the patient's understanding of why
the illness has come about is quite different from the doctor's .
People often attribute the cause to some supernatural power. An
illness could be described as bad luck or as the result of someone
having cast an evil eye (nazar lagana) on the victim. Or it could
described as possession ofthe body by an evil spirit seeking to inhabit
an innocent person's body.
Such "causes" have been traditionally linked to major illnesses,
especially those which are rare and seem inexplicable in origin. The
cure of such illnesses is also then concerned with supernatural
factors. The treatment is centered around getting rid of the
supernatural influence.
Searching out and punishing the person responsible for invoking
such spirits is considered a long term solution to the problem. This
can become a vicious matter, and a powerless person, often a
woman, is singled out and accused of being a dakin or witch. Popular
opinion is aroused against her, and the entire neighbourhood is led
to commit violence against her.
Studies in some communities have indicated that a woman identified
as a dakin is often a woman on her own, someone apart from the
norm. She is different, self-confident lives a somewhat rebellious
life, and by just being what she is, she is considered a threat to
society. In reality however she would be poor, and amongst the most
marginalised people ofthe community. Many social and physiological
problems are considered to be the "doing" (karni) of such women.
Most communities have also had traditional healers ofvarious kinds.
These are persons who have inhefted a knowledge base built over
centuries of observation and experimentation. They do not think in
the manner of a medical doctor, but they understand the body and
the medicinal properties of plants and other materials from the
surrounding environment. Many such healers are women, and every
grandmother has a stock of such knowledge commonly called as
"Budhiya kajhola" or "aajibaicha hatwa". However, such practices
have not always been seen in a positive way by the powerful in
society.
In the West and in India, such women have been persecuted because
their knowledge, and the influence and power arising from it. While
their method of healing has been criticised, there has also been a
systematic attack on them as persons. Until recent times, in the West
such women were called witches, and harassment and killing of
women accused of witchcraft was very common at one time. So
much so, that "witch hunting" became a commonly used phrase in
the English language for wrongful persecution of innocent people.
63
In our understanding, we aucepi noth the traditional and modern
systems of dealing with disease. We think that the traditional
systems of healing have evolved on a basis of understanding and
reasoning of their own, and are effective and viable for several
important reasons. Most importantly, these remedies work effectively
for many common ailments, they are administered sympathetically,
and they cost much less than modern medicines.
At the same time however, people calling themselves traditional
healers may indulge in practices based on superstition. They may
exploit the simple faith of people to charge them exorbitant fees.
They may even be using steroids and other modern drugs in the guise
of herbal medicines. Many such "healers" flourish in Bombay.
We believe that all such efforts have to be carefully examined much
in the same way that modern medicine's "scientific" and "rational"
understanding of disease and treatment also needs to be tested and
examined. Modern medicine too cannot be accepted without
questioning.
Is there a war going on?
Ho w do weunderstand the causes ofbreakdown within the framework
that we have so far evolved? We would now like to look at the
dominant understanding of disease in modern medicine, and at the
limitations of this approach. At the same time, we would try to
explore possibilities of interaction with the modern health delivery
system in ways that become effective and meaningful for. users.
The dominant u nderstanding ofdisease in modern medicine has been
based on cause-effect explanations. This has helped to bring the
understanding of disease out of the realm of the supernatural, and
made it possible to look at disease in a more rational way. The basic
idea is that every phenomenon has some material cause which set it
off. For most diseases, various kinds of micro organisms in the
environment have been identified as the major cause.
The body is a part of nature, and it continuously interacts with all
kinds of other organisms. We live peacefully with most of them and
this is how millions of species of life forms survive together.
However there are certain micro organisms which are not usually.
part of the ongoing process of maintaining the internal equilibrium.
They disrupt the usual body processes, upsetting the internal
equilibrium of the body as a whole. The body has a mechanism with
which it tries to deal with such situations. This is called the immune
respond of the body.
64
The immune response is usually understood as a defense mechanism.
The body is said to attack the "foreign" organisms that invade it by
setting up a resistance army to exterminate the intruder. Such
terminology and imagery is the language ofwarfare and is very much
a product of the dominant social thinking around us. The first
response to issues concerning aliens or any unwanted external
elements is to wage attacks and wars.
An insect living on a particular plant may be going about meeting its
requirements much the way we meet our own needs. However its
existence is seen as an "attack" on the farmer's crop and the typical
response is to eliminate it with the strongest pesticides possible.
People have now come to realise that such methods do not really
work in the long run, that you destroy many good things alongside
the harmful, and that you could end up having more resistant formss
of the same pest over time.
However such an ideology, of attacking and exterminating is
constantly being justified and practiced all over the world. Not only
do we come across this attitude in the treatment of illness, but also
in the social field.
Anyone who does not "belong" is attacked by others who claim to
belong, and wish to retain the purity of the group that they are part
of. The groups could be nations, religious communities, sects,
castes—eveiywhere the assault is on the "otherness" of the group
taken to be the enemy. It is on the same militaristic basis of
understanding that the immune system is often seen as the body's
mechanism to attack and exterminate the invading organism.
Protection is not the same as warfare
We would like to follow a different path towards developing an
understanding of the immune response. We believe firstly that it is
not a defence mechanism as much as it is a protective one. Its
purpose is not to exterminate anything that does not fit. Its actions
are more directed towards nullifying any disruptive effect that these
organisms would have on the normal environment. The presence of
effects which could be harmful and destabilising to the body set off
the immune response. It is a process acting to preserve the internal
environment rather than to eliminate external alien organisms.
Although this shift in emphasis may appear at first glance to be just
a different way of saying the same thing, it is much more than that.
It forms the basis of the understanding of disease, and indicates the
way in which treatment would be carried out.
If the understanding is that exterminating the disease-causing
organisms is the suitable course of action, then all kinds of anti
This is a symbolic sequence illustrating virus
takeover ofa healthy cell and subsequent
events
65
bacterial drugs would be recommended. If on the contrary, the
understanding is that activating a response to preserve the internal
balance is required, then the treatment would be vei v different, it
would be more oriented towards strengthening the natural processes
that exist in the body, and which become active in the presence of
any disruptive element.
The immune response
The protective activity on the part of the body operates at various
levels. There are two main groups of immune responses. One group
works against specific objects which are known to the body. This is
called the specific immune response. The other group is the non
specific immune response, in which there is no particular recognition
of the causative organism, but there is a general reaction to things
that are considered to be unnatural to the body and not required to
be present.
With regard to the non-specific immune response, there are a
number of barriers, starting with the skin, which do not allow the
disturbing organism to enter the body. Not only is the skin a physical
barrier between the body's internal environment and the external
environment, the secretions from the skin also act as chemical
barriers of a sort.
Besides this, there are other surface barriers like the mucous
membranes at the openings of the body. These secrete a sticky fluid
called mucus, capable of carrying away particles adhering to it. The
hair at the entrance to the nose which traps fine particles entering our
bodies through the air we breath, works in a like manner. The
sneezing and coughing reflexes that act when we inhale dust and
other irritants are similar barriers. Finally of course, there are
innumerable micro organisms all over the surfaces of the body,
inside and outside, which prevent others from taking over their
space, and thus act as a proiective cover.
Explore all the openings in your body.
What are the natural barriers andprotective mechanisms working
to safeguard the internal environment at each of these places?
But some still manage to get entry
In spite of all this, there could be minor cuts, scratches or bruises
through which certain of the unwanted micro organisms could enter
66
the body Usually, there is an intense reaction to these by the body.
It activates itself locally, in that particular area to prevent the spread
of these unwelcome organisms to the whole body. The idea is to
throw out the incoming organism and also to repair the cut in the
tissue as soon as possible. The inflammation or pus formation that
takes place at the site of an open exposed wound is such a reaction.
These localised reactions also induce systemic changes in the body,
one of which is fever. Fever can be explained as an attempt to raise
th* body temperature-to a level where the micro organism cannot
survive. An increased local activity at one point thus leads to a
certain kind of change all over the body.
Some ent ry of micro organisms also takes place through the regular
channels of entry in the body such as the gastro-intestinal tract,
through the food we eat, or the respiratory tract via the air that we
breathe in. Disruptive organisms entering the body in such ways are
absorbed into the blood stream, and from that route, into the whole
body.
Most such entrants are either bacteria or viruses. It is important to
be aware of the differences between them and also to know how the
body naturally responds to them.
While specific bacteria and viruses may act in their own particular
ways, certain broad generalisations hold.
Bacteria are unicellular organisms which can sustain their own
lives, provided theyfind a suitable environment, nutrition and so
on. Some bacteria actually destroy the cells surrounding them by
releasing chemical substances that are certain to cause damage.
Other bacteria just release toxins that disrupt the function of the
organ or the tissue.
Some common bacterial infections are typhoid, tuberculosis,
pneumonia, leprosy.
Viruses, on the other hand, are small bundles of the basic life
determining chemicals. They have to live in other cells to survive,
and once they move in, they take over the energy production
mechanisms of their hosts.
A virus could multiply rapidly within a host cell, turning it into a
kind offactory to reproduce itself In the process it may use up the
cell's essential constituents and end up in killing the host. The viral
particles released from such a host cell would then enter the
neighbouring cells and repeat the process.
67
Some other viruses replicate fairly slowly. They could become
associated with the basic genetic material ofthe cell and replicate
along with the host cellduringcelldivision. Thus their characteristics
are passed on and could remain in the cell and the bodyfor many
years before any actual disturbance is perceived.
Commonly found viral infections are measles, common cold,
influenza, malaria, scabies, herpes zoster.
Due to this basic difference in them, bacteria and viruses act very
differently in the body.
When looking at the action of organisms we must also pay attention
to the pathway through which they enter the body. If a virus or
bacterium enters a part of the body which does not provide it with
a suitable environment, it is not going to cause damage, and it may
not even survive there for long. It could even happen that in one part
ofthebody a certain bacterium plays an important rolein maintaining
internal equilibrium while the same organism could cause serious
problems elsewhere.
Urinary tract infection for example, is a very common infection
among women. The organisms that cause this trouble are part of the
digestive tract and are an important presence there. It is only when
they enter by chance into the urinary tract that they become a cause
for infection. The usual explanation given for the entry of such
bacteria into the urinary tract is improper washing after defecation.
There could, however be other reasons too. One common cause is
carelessness on the part of male sexual partners regarding personal
hygiene, which ends up giving wonfen chronic infections in this area.
Infrequent urination, water scarcity situations or general low
nutritional status could make some women more prone to these
infections than others. The broad health situation of most women is
not constant, and those who suffer urinary tract infections are prone
to get recurrent attacks
How does the body respond to organisms?
All of us are constantly exposed to a variety of sources of infection.
Yet we actually fall ill comparatively rarely. One of the responses of
the body to the entry of an unwanted substance or organism into, a
cell, or into a certain vicinity, is through specific actions at the
cellular level. This is called the specific immune response.
A specific immune response is either generated through creation of
antibodies or by the action ofspecific cells present in the body, which
themselves act like antibodies. Essentially, the incoming organism's
68
structure is ascertained and its chemistry is taken into account. This
interloper is called the antigen, or toxin. The antigen's activity is
neutralised or nullified in two basic ways by the body. It could create
antibodies which lock the antigen inside a structure, not allowing it
to act or spread further. Or, it could neutralise the bacteria or virus
by building locking structures on the cells themselves.
You must have heard people say that once you have had measles you
will not get it again, or at least not in as severe a form. The same is
said for many other illnesses. How does the body acquire the ability
to protect itself from a disease that it is already familiar with?
In the case ofexposure to a virus or bacterium for the first time, there
is an initial non-specific immune response. Here, physical and
chemical barriers to neutralise and inactivate the newcomer come
into play. When these fail, there is an effort at intense and localised
non-specific activity. Meanwhile, the body uses the time to generate
a specific antibody response. This antibody then reaches the site of
action to deactivate the antigen. If the non-specific response is
sufficient to discourage the antigen, the specific antibodies created
would not be used at all.
If there was a case of exposure to the same antigen in the future, the
same sequence of events would probably take place. However the
difference would be that the specific immune response would get
activated much sooner, and with greater intensity. Essentially the
person would have some immunity.against that particular strain of
bacteria.
(adaptedfrom Human Physiology, the Mechanisms of Body Function,
Pander et al, McGraw Hill International Editions, 1986.)
The same princi pie comes into play when we get ourselves immunised.
A small quantity of antigen is introduced to the immune response
system of the body, and it creates the necessary antibodies which act
when the body is exposed to an infection of the same type.
The second kind of immune response is that in which there is no
creation of antibodies but wherein the cell itself has receptor sites
similar to antibodies. In this case, action can be taken only when the
69
. antigen of the disruptive organism is present on a cell surface The
antigen gets attached to the receptor sites of the immune cell, and
becomes neutralised. Obviously the number of organisms that can
be neutralised in this way are much smaller in number than in
antibody action. The targets in this case are usually are virally
infected host cells of the body, and possibly cancer cells, which are
body cells that have gone berserk.
Deactivation of affected cell by sensitised white blood cell (Adapted from
Cerottini)
Both these kinds of cells, the ones which help in producing the
antibodies and those which themselves help to mediate immunity,
are present in various parts of the body. They are found most
particularly in the lymph nodes and the spleen. This information is
helpful in detecting infections and diagnosing illness, as we shall see
later on in the chapter.
Although it sounds as if the two types ofcells are very distinct, there
is a great deal of linkage between them. Activation of cells of one
kind could lead to some other follow-up actions. Or it could lead to
inhibition of some other reactions.
There are feedback mechanisms at work here too, which could act
positively or negatively on each other. Antibody formation could be
triggered because of an activated cell-mediated response, and the
latter could also set off the former. The two types of cell actions
could even inhibit each other's activities.
As in the case of inflammation, here too there are systemic changes.
A change in body temperature because of the breakdown of
temperature control mechanisms is one of the commonly observed
responses of the body. It is an indication that in a inter-related selfsustaining multicellular organism like the human body, the breaking
down of an antigen cannot be an activity left to one or two types of
cells. It is the whole organism that has to work here.
On the whole, action against any infection means a great deal of
work for the body. During and after such periods of illness, the body
would need specialised care and rest. The reverse would also hold
70
true—if the body is not strong enough or not quite equipped at the
time that an infection enters, it would find it difficult to resist it.
The tragedy of the failed immune response
Lately we have been hearing a lot about AIDS, or acquired immune
deficiency syndrome. In AIDS, there is a breakdown of the immune
response of the body, making it susceptible to all kinds of disease
producing organisms. Under normal circumstances, precautions
can be taken to prevent the entry of unwanted organisms into the
body, but there is a limit to the amount of care a person can take. If
we were to worry about catching infections all the time, we would
get very little done in life!
Most of the time, we are not affected by potentially harmful
exposures because the immune response protects our bodies, as we
said before. In the case of a person suffering from AIDS, this
response is non-existent. So, if an organism finds an entry into a part
of the body where it can create havoc, the AIDS sufferer's body
cannot counter it in any way.
In normal situations human beings carry of a lot of organisms, from
which their bodies are protected. A person suffering from AIDS is
however, unprotected and hence more at danger when coming in
contact with other people. The tragedy is that people with AIDS are
shunned, and considered a risk to others. In fact, they are more at
risk from the so-called healthy people.
Here in this small manual, we do not have the space to go into the
social and other dimensions of AIDS. However and there is a lot of
material available on the subject elsewhere, and the list at the end of
the book mentions some such sources. We are very much aware that
it will be a disease devastating the lives of many families in the near
future, and society as a whole will have to find means to cope with
the crisis.
The germ is not the whole story, how does it find a home?
In the usual teaching about disease, there is a lot of emphasis on tiny
villainous creatures called germs. Such talk about kitanus, orjeevanus
orjantus creates an overwhelming impression of a war situation. It
seems to follow that all we have to do is to stamp these enemies out
of existence with the right injections and pills, and all will be well.
We disagree with this inordinate emphasis on germs, and other
causative explanations for the onset of disease. Since immune
response is essentially an indication of how effectively a person can
avoid an illness or a breakdown, it is obvious that the general health
71
n
n
status of a person is an important factor in determining whether she
will get an illness or not.
The health status in turn is linked with the economic status of
individuals and of families as an economic unit. Energy generation
is based on food intake, and health is determined to a large extent
by nourishment. Additionally, it is not only the amount of food but
also the quality that matters, which is why we are taught about
having balanced diets. Besides the adequate types of material, the
body also has a requirement for specific chemicals which are being
constantly used up, and which need regular replenishment.
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The comparison between the two families speaksfor itself.
(based on Shareer ki Jankari, a book prepared through the collective efforts
of 72 women from Rajasthan, active in a health programme. Kali for
Women, 1989)
Poverty does not permit people to eat what they need for health. It
is difficult for most people to be able to achieve a balanced diet in
a city like Bombay. While there is disparity and inequality between
different sections in the city, within the family too, there is further
inequality. The men and boys receive favoured status.
Women in every family not only eat last, but also eat less of what
would be considered "good" food. For the double burden of the
work they bear in the house and working outside, and the third
burden of child-bearing and rearing of children, they in fact need
extra supplements of almost all nutrients.
Women need more iron in their diet than men, for example, to make
up for the amounts of iron lost in the menstrual blood every month.
The social and other biases do not recognise this need. As a result,
an estimated 90% of Indian women suffer from anemia. Less iron in
the blood results in lowered oxygen supply to the whole body, which
in turn means reduced activity on the whole, and as a further
consequence, increased proneness to disease.
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Factors such as poverty, inequality, reduced access to resources,
and so on, have their impacts in other spheres also. Most people do
not have healthy places to live or work in. The sanitary conditions
and the water facilities are not adequate, and because of these
situations the communicable and other diseases like malaria and
tuberculosis are rampant. When we talk about health, we must
always keep this overall social situation in mind.
Discussions about the dismal health picture often end up blaming
people, particularly poor people, for their state. For many years
now, one of the most popular arguments to explain poverty, and any
other social problem for that matter, is the overpopulation argument.
The people of India are themselves to blame for their own problems,
it is said, because they have too many children.
In the city of Bombay where the desired population control targets
have been achieved to a large extent, what do we see? In spite of
achieving the targets the general living status of the people has not
improved. On the contrary, it has deteriorated further. The disparity
in access to resources which meet the natural needs of people is
lopsided. It is this unequal distribution that leads to the appalling
conditions in which the human body has to survive. The extra stress
that adverse conditions put on normal functioning leads to
breakdowns, and makes the onset of disease a common occurrence.
What are the common events in breakdown?
There are some common illnesses in Bombay, very much a product
of the environment here, and the lifestyles people lead.
Colds
The common cold is a viral infection and except for letting the
antibodies do their work, there is not much that can be done about
it. The antibodies can be helped by building up good resistance, as
expressed in the proverb "Feed the cold".
There are some measures that can be taken to give some re lieffrom
the discomfort of the cold. For soothing the affected membranes
one can take steam inhalation. Keeping the mouth moist also helps.
This is why chewing toffees or lemon drops gives relief.
Cold capsules and other instant reliefs publicised in the media are
not ofmuch help asfar as the cold is concerned. While we know that
the miraculous recovery shown in the advertisementsis exaggerated,
73
we still succumb to the message. Perhaps it is because one suffers
so much that one thinks that anything is worth trying out.
Ifat all the remedy seems to act, it is probably because by then the
body has produced its antibodies and brought the cold under
control, and the natural period of the cold is over.
Colds and asthmas due to allergy
In medical terms, allergic colds and in more extreme cases asthma,
are an outcome ofhypersensitivity ofthe immune response. In other
words, an overly sensitive response of the body to some outside
substance.
In the normal course ofevents, an upper respiratory tract infection
wouldfollow a bout of the common cold. However, a recent study
by the Rotary Club ofBombay, shows that 60% ofpeople in the city
sufferfrom this illness. This is unusually high and mainly due to the
pollutants in the air.
This type ofcold comes in theform ofattacks. Many people suffer
severe attacks and they take recourse to every possible type of
medicine. There is again not much that can be done except to get
testedfor the substances causing the allergy. Several allergens may
be involved, but even ifone is traced, and a drug which can prevent
an overly sensitive reaction to that allergen isfound, it could give
the person some relief and reduce the strain on the body.
Medication may reduce the severity ofthe attacks by restraining the
body's reactions to irritating substances in the atmosphere. The
general precautionary measures for such illnesses is to eat at
regular hours and sleep at regular intervals. This may be a dream
as far as most of the citizens of Bombay are concerned.
Problems of the digestive tract
Another set ofcommonlyfoundillnesses are related to the digestive
tract. Among them is chronic constipation or chronic diarrhoea,
excess acidity, stomach ulcers, stomach aches and other pains due
to gas build-up. Most of these problems are related to the strained
conditions and irregular life patterns in Bombay.
Symptomatic and momentary relief for such illnesses can be
achieved, but not permanent cures. Precautionary measures such
as eating at regular intervals, ensuring thatfibrousfoods like green
leafy vegetables are included in the meals, and avoiding spicy
foods, may help to a great extent.
Fried and spicy foods generally contain amounts of baking soda
w hich irritate the stomach linings, but there is not much choice on
the Bombay’ streets. Most ofthe items arefried, made with potatoes
and have lots of spices, salt and soda in them. The taste for such
foods are built up as aprocess ofadaptation to the city environment.
The most one could do by way ofprevention is to avoid eating such
foods as a regular practice, before stomach problems become
chronic.
What about good blood and bad blood?
Although these social and environmental conditions are an important
cause of disease, there are other factors at work here too. We are
quite used to hearing statements such as, "These lower caste (or
poorer class than the speaker) people breed too much", or "They are
ofbad blood", or "They are that way from birth, even if they try, they
can't change".
Or we may hear the arrogant voice again making statements about
"our family" "our people", and how such superior persons cannot
allow themselves to get tainted by mixing with people of lower
quality. Hindi films are full of blazing dialogues like "Meri ragon
mein mere gharane ka khoon hai, isliye..." with the speaker
attributing all kinds of superhuman qualities to himself in the name
of his clan.
The question is, what is it that flows in the veins of the family? As
we know, right from the moment of conception, when the single egg
cell from the mother joins with the father's sperm cell, every
individual carries genetic materials from both parents with her. This
differentiates one human being from another biologically. It accounts
for certain differences in our external appearances, and also the
visible similarities to our parents and siblings.
The problem today is that these facts are being used to give a
scientific basis and credibility to discriminatory and unjust social
practices. It is being used to justify the ugliest human behaviour,
communal and casteist in nature. Although there isgenetic inheritance
from one's parents, it is difficult to say with any kind ofcertainty how
important they are in shaping our adult selves. In other words, no one
can tell which of the external and internal characteristics that typify
a person are the way they are because of genetic effects, and which
due to the complexities of human existence, especially in a big city
situation where life has changed so drastically in such a short time.
Modem medicine has madesome advancesin detectingand identifying
genetic patterns which make some persons more susceptible to
certain kinds of diseases than others. Because of this knowledge it
75
is possible for example, to study the genetic make-up of a couple,
and if the risk of a certain disability to their future offspring is
evident, they can be advised accordingly. In our opinion however,
the reductionist approach to medicine sometimes stretches this
understanding a bit too far at times. As a result, genetic causes are
dragged in to explain every type of disease and pattern of behaviour,
particularly so-called aberrant behaviour.
The outcome of this could be a perverted social philosophy, which
dictates that some people are supposedly genetically superior to
others, and only they should be allowed to have children. The other
inferior people should be sterilised for the good of society. When
taken to an extreme, such thinking finally dictates that the ones
classified as inferior do not even deserve to live. And that they should
be locked up and killed, as has happened in many countries at
different times in history. In modern times, the perpetrators of such
crimes often twist and distort the findings of genetic science to
justify their actions.
But what do gene pictures tell us?
There are certain kinds of malformations that have been linked to
particular genetic patterns. For example, on the basis of a particular
gene picture, it can be said that a person has a greater probability of
getting sickle cell anemia, than another person who shows another
kind of picture. In this illness, the capacity of red blood corpuscles
is impaired, their hemoglobin content and hence their oxygen
carrying capacity is reduced, and the result is a form of anemia which
makes the person prone to infections.
Similarly, certain diseases like diabetes, which is impairment of
sugar metabolism, are hereditary and their continuation through the
generations is carried in the genes. In like manner, there are other
genetically indicated problems, such as those related to blood
clotting, muscular dystrophy, Down's syndrome, and others, whose
presence can be detected in the fetal stage much before there is
physical manifestation of the disorder. If the parents of such a child
can be warned ofthis, and the necessary precautions taken right from
infancy, that person has more chances ofleading a smoother life than
otherwise.
Kunda was promised as a bride to her father's sister's son almost as
soon as she was born. In the Konkan region, this is a preferred form
of marriage, and it is said to reinforce the good relations between
two families who are already bound by marriage relations in the
previous generation. She and her cousin were married as soon as he
got ajob and a place to stay in Bombay. Her first child, Vidya, turned
out to be hearing-impaired. She struggled to get her into a special
76
balwadi with other such children, to buy her a hearingaid, and to give
her speech lessons at home, according to the way it was done at
school. When she became pregnant again she was overjoyed, but this
time too she was shattered when the infant boy turned out to be even
more hard-of-hearing than his sister. Sarala was very disturbed when
this was discovered, and she wished that she had known ofsome way
to predict and prevent it.
Children of couples who are cousins or close relatives are more
prone to have impairments and inherited illnesses than others in the
community. Being from the same family, they receive a comparatively
smaller variety of genetic materials from their parents than others.
In contrast, people with greater diversity in their backgrounds are
less likely to have coinciding hereditary health problems on both
sides of the family. Gene pictures help closely related parents to be
warned about the existence or possibility of an impairment long
before the birth of a child. The couple can then think over the
decision to have the child. If the problem is serious, they could
perhaps decide not to have children, and to seek an alternative such
as adoption.
Who's to decide what is normal and abnormal?
People suffering from some of these disorders cannot manage their
lives in the same way as the majority of people. We have all seen the
difficulties faced by visually impaired people in the transport system
of this city. It is much the same for those without limbs and other
physical problems creating difficulties in movement. Our world is
structured and constructed in way that is suitable for people with
certain abilities. Those who do not fit into the accepted criteria are
dismissed as abnormal. Society seems to make little effort to include
the different abilities and disabilities of people in its range.
As in Kunda's story, the responsibility for disabled persons falls on
the family concerned. Usually it is the mother who does her utmost
to support the affected child, and make her life bearable. Another
one of Sarala's neighbours, Mahmooda, has a mentally retarded
daughter called Yasmin."She is determined that Yasmin should be
independent, and be able to at least manage her daily chores on her
own, and not have to rely on others when she grows up.
Mahmooda looks after the house, does piece-rated embroidery
work at home to earn some extra money, and still she makes time for
her daughter. She has got her admitted in a special school but it is
far from her house, and the travel up and down, twice a day, takes
upto three hours, and a great deal of energy.
77
For the last ten years Mahmooda has struggled with Yasmin's special
needs, getting little help from her husband and other "normal"
children. She has surely achieved a better future for her daughter, but
she has aged by twenty years in this time. Such problems are usually
not considered problems of society as a whole, and not much is done
at the at the level of community. It is left to each individual to find
a solution within their restricted resources and knowledge.
In recent years, individual solutions are being offered to the family
in terms of pre-natal diagnostic tests. With the help of these, the
mother can choose not to give birth to a child who would suffer from
predictable problems. Otherwise, there is very little by way of
rehabilitation efforts made to facilitate normal life for such people.
There is hardly any data collected on the extent of these problems.
Even the availability of diagnostic tests is not widely known. The
general public are not aware of the conditions under which a
pregnant woman should go in for such tests. In the meanwhile, the
diagnostic tests are most widely abused for detection of the sex of
the fetus. If it is female, the fetus is likely to be aborted by parents
desperate for a son. In Maharashtra, it is illegal to use any diagnostic
method for sex-determination. Only a few registered genetic clinics
are allowed to carry out pre-natal diagnosis, that too only for
detecting genetic abnormalities. Even so, there is widespread misuse
of these facilities for sex-determination and pre selection to favour
males.
According to the Maharashtra Pre-Natal Diagnostic Regulation
Act, the conditions under which a woman is considered eligiblefor
pre-natal diagnosis are asfollows.
•
If there is history ofgenetic abnormalities in the family.
•
If she is 35 years of age or above.
•
If she has a history of spontaneous abortions.
•
If she has been exposed to hazardous teratogenic (capable of
bringing about genetic changes) materials during the
pregnancy.
Though individuals who resort to these tests do so undoubtedly due
to their own problems, what are the ultimate outcomes of such
testing? Is it not further weakening the status ofwomen? It is almost
as if being of the female sex is itself a mistake in this male-dominated
society. Despite laws discouraging screenings for sex pre selection,
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doctors and their clientele seem to be determined to help each other
in secretly carrying on a crusade against women at large.
Their actions question the right of women to existence in our
society. The irony is, that all this is being done in the garb of helping
women. Both the mothers ofdaughters, and the unwanted daughters
themselves, are supposedly being aided by such activities. Ultimately,
society gives sanction to women's negation in these ways.
Additionally, by treating these acts as private, no thought is being
given to the breakdown of the society as a whole in the long run. It
is impossible to imagine the consequences when the sex ratio of
women to men, bad enough as it is, would become even more
adverse to women.
Thinking in the short run, disasters in the long run.
Short term remedies are usuallyjust namesake solutions. In the long
run they create unmanageable problems. A familiar example of this
is the DDT spraying that was carried on throughout the 1950s and
60s to get rid of mosquitoes and malaria. During the years of
exposure to DDT, the surviving mosquito strains developed resistance
to DDT at the genetic level. Now they do not get affected by the
DDT-type sprays any more. In a similar manner, many disease
producing bacteria have been driven to develop more virulent
varieties by the uncontrolled use ofantibiolies. These new strains are
producing outbreaks of new. forms of old diseases, resistant to
known drugs, and effectively incurable.
At the same time there is a growing phenomenon of induced genetic
problems and few of the planners and decision makers seem to be
conscious of the need for stringent safeguards against them. Even
where they exist, they are not enforced. Vast quantities of toxic
chemicals are constantly being released into the atmosphere without
regulation. In modern times, living in a city like Bombay, we expose
ourselves to a host of chemicals whose effects are invisible at the
moment.
To add to the problem, there is insufficient knowledge of the long
term effects of toxic substances. The Bhopal gas victims were
exposed to immense quantities ofone such chemical in 1984. To this
day, the survivors carry the scars and lead an impaired existence,
unable to return to their normal ways of life. The outcome and effect
on the generations to come is yet to be seen.
In the absence of sufficient information of the effect of the gas on
unborn fetuses, many victims' groups had demanded pre-natal
diagnostic facilities after the disaster. The government denied
79
provision of such facilities because it would imply that they accepted
the possibility of the long term and teratogenic effects of the gas.
The quick needle is not the best cure for all ills
The exposure to toxic chemicals and other environmental changes
leading to permanent mutations and genetic changes is one of the
horrifying ways in which modernisation affects our bodies. The
other is intervention of medical technology in the process of curing
diseases. Here the attitude towards ill health itself is very crucial in
shaping both the patient's and doctor's responses to illness.
When people are ill, they need to get immediate relief. Illness could
' mean a khada in employment and loss of wages, and if prolonged
’ even a loss ofjob, not something that most people can risk. So they
i: call on doctors, demanding an instant cure. This anxiety is used by
< the doctors to earn money.
Sarala remembered that some years back, not far from her basti,
there was a private dispensary run by a very unusual lady doctor,
widely known as Doctorin-bai. She tried to be thorough in her
questioning ofpatients, and she did not like to prescribe drugs unless
she felt that they were really necessary. Sometimes she would not
even give drugs but send away patients by saying that they should
take plenty of fluids and rest for a few days. In any case, she never
dispensed drugs herself, she only wrote prescriptions.
This approach did not make her popular. People felt that they were
not getting their money's worth. They said that she didn't know the
- latest medical developments and wasn't quick and effective like
other doctors. They would give a strong injection without being
asked, and here one had to beg this stubborn woman, who would
flatly refuse. "What difference is there between her and my
grandmother?", someone said, "Granny would have said the same
common-sense things I" She gained a reputation ofbeing an eccentric.
People started avoiding her.
; Stories about Doctorin-bai’s outlandish behaviour spread. She was
seen chasing out salesmen from drug companies, saying that her time
was exclusively for patients, and not dalals. She refused to take their
free samples, which most doctors took and sold to patients. Once
when the parents of a sick child showed her the drugs that another
doctor had recommended, she went and fought with him outside his
dispensary and called him a murderer in full view of his patients.
This made her most unpopular with all the locality doctors, who
openly ridiculed her methods. The nearby chemist would laugh at
her patients when they came with prescriptions, saying she didn't
80
know how to prescribe the really powerful medicines. He would
offer his own advice instead. Many of the patients would fall for it,
wasting their money, and hurting their own systems by confusing the
course of treatment taken by Doctorin-bai.
Doctorin-bai struggled for some years with her dispensary and her
simple style of practice. She didn't seem to care that her practice was
small, she said it permitted her to give proper time to those who
came. Unfortunately a day came when she felt she could not continue
fighting the expectations that most people have ofdoctors any more.
She went away, disillusioned, and was soon forgotten by the very
people about whom she felt so strongly.
As patients we look for instantaneous cures and doctors often
exploit this desire by prescribing strong drugs that may give a false
notion of immediate well being, but do not attend to the cause of the
disease at all. The patient who wants to get well soon also supports
this course of action, not realising the extent of damagebeing caused
to the body's own capacity to resist illness. The greed of doctors and
the need of poor patients for a quick cure combine to create a
situation where even the obvious sincerity ofsomeone like Doctorinbai does not impress anyone as being effective.
Often the patient does not also get cured by the drugs because they
are irrationally prescribed or formulated, have dosages less than
those required or are combinations of constituents that nullify each
other's effects Most doctors rely for all their information about
drugs on the drug companies whole sole motive is profit making. -
WHO has been putting out a list of essential drugs which form the
basic minimum number of drugs which are necessary in 90% of
diseases. The list contains only 300 drugs of which only 20 are
combination drugs. In contrast, the number of drug formulations
available in the market in India is a staggering 60,000!
A study undertaken by the health group LOCOST based in Baroda
revealed some interesting facts. For example, in the 1,524 cough
syrups that they studied, almost all formulations had a combination
ofan expectorant (a phlegm releasing constituent) and a suppressant
(a phlegm suppressing constituent)!
The possibility of making money on the ills of others manifests itself
in other ways in the medical field. Making the headlines from time
to time is the problem of spurious drugs and adulterated drugs.
Besides the manufacturers, officials making bulk purchases ofdrugs
at both public and private hospitals have been implicated in such
scandals. What can one say about such deliberate acts, aimed at
making money at the expense of the lives of ill persons?
81
The wrong pill is worse than no pill
What about the problems arising out of the treatment itself? Any
business venture has to make sure that paying customers keep
coming back. Sometimes, doctors prescribe unnecessary drugs just
to ensure the return of the patient.
Away from doctors, we also tend to dose ourselves on our own with
unnecessary medicines. Popularly advertised brands ofremedies for
headaches, common colds and coughs are found in every home, and
taken without discrimination. The actual medicinal content of these
drugs is not always adequate or effective. We often do it just to feel
good, and besides the damage that can take place, there is always a
danger of becoming dependent or even addicted to these easily
available drugs.
Sometimes patients tend to act like consumers who want the best
and latest within their resources. Without realising that part
treatment with a variety of drugs and approaches can make their
illness more problematic, they go flitting from doctor to doctor
looking for a magical cure. Each doctor does his own diagnosis, and
recommends what he wants, without bothering to find out what has
been prescribed earlier.
In modern life, one ofthe major causes of illness is use of wrong and
even harmful drugs. It is essential that we have information about
any drug that we consume, whether it it self-prescribed or prescribed
by a doctor. This is necessary for our active participation in the
therapy we undergo.
In a situation where even doctors are ill-informed and rely on the
misinformation put out by the drug companies, there are groups that
are working towards generating and providing correct information
about drugs. One such group active in Bombay has taken up a
project to set up a People's Drug Information Centre (PDIC). They
are in the process of putting together information about drugs, their
chemical constituents, their action, their correct dose, conditions
under which they are necessary, conditions in which they are
counter-productive, harmful or unnecessary and their possible side
effects.
Women as contraceptive users form a special group of drug
consumers. Drugs like contraceptive pills are taken by healthy
individuals, and they not only have the potential to harm the
patients, but also the generations to follow. Lately, we see new
82
contraceptives being distributed to the public by way of trial,
usually without informing the recipient ofits experimental nature.
The new long-acting contraceptives have known potential to cause
genetic abnormalities. The recently introducedanti-fertility vaccine
has the possibility of interferingwith the immunological system as
well as affecting the genetic make up ofthe person. So long as these
drugs stop births, not much attention goes to their other possible
effects, and these are thrust upon unsuspecting healthy women.
Learning to recognise the signs
When the system of health care works in a such a short sighted and
careless manner, and when the whole environment seem to be so
adverse, thequestion ofour physical health acquires new dimensions.
We have to begin to take steps for ourselves as individuals and as a
community. It is important that we understand a disease beyond the
symptoms that it manifests. It is necessary that we give preventive
measures greater importance. And finally, even if affected by
disease, we need to deal with the cause itself, and not be satisfied
with just suppressing the symptoms.
The stresses of modern living often ingrain a careless attitude
towards the body, discouraging people from tuning in to themselves.
A feeling develops that if something goes seriously wrong, there is
always some solution with the experts.
Understanding what may be wrong, and being able to describe it to
the doctor, is important for cure. This requires a conscious and alert
observation of one's own body all the time, not only when one is ill.
During the course of our work in this field, we have come to feel that
it is the personal responsibility of each one of us to be in tune with
our own bodies. Learning to understand its rhythms and variations,
to perceive the changes from the normal to the abnormal, is not
difficult. Each person can work out the vital indicators for themselves.
Fever, swellings, headaches are all manifestations of the breakdown
that affects a normally functioning system. The different character
of symptoms exhibited during various phases of an illness can help
in diagnosing the problem. Here are some examples relating the
symptoms to the causes of breakdown.
Fever
There is constant heat generation and heat utilisation in the body, as
we have seen m the previous chapter. Simultaneously, there is
continual regulation of temperature within the body to enable it to
83
function efficiently. However occasionally, due to certain changes
within the body, there is a rise in temperature called fever.
Patterns have been observed in fevers. For example in malaria, there
is a rise in temperature followed by intense bouts of shivering, and
a fall in temperature. This cycle takes place every twenty four hours.
If the sufferer and the people around her keep a note of the pattern
ofchanging temperatures during a fever, it can become an important
tool in recognising the problem.
Keeping a temperature chart is not as complicated as it may sound.
All that is needed is a thermometer, a pencil and a page from an
arithmetic exercise book marked with squares. The bottom line of
the page could be marked to show the timings of the temperature
readings, and the line at the extreme left couldshow the temperature
readings as shown. The observations made at regular intervals can
be marked with a point on the chart, and a line can be drawnjoining
these points. The line reveals the pattern of the fever.
This chart shows a record ofa viralfever where the person is taking
an anti-pyretic drug every six hours. The fever responds to each
drug dose but keeps rising again anddoes not come down to normal.
We attempt to keep body temperature at normal because most ofthe
organs in the body, especially the brain, are sensitive to high
temperatures. A prolonged bout of high temperature can cause
damage to the brain, so there is a need to act immediately.
Fevers are usually treated with a group of drugs called anti-pyretics.
The fevers of typhoid and pneumonia-like bacterial infections do fall
with doses of anti-pyretic drugs. However, the temperature does not
totally come down to normal. This is also the case with the viral
fevers. It follows, that if a fever does not come down after taking an
84
adequate dose of anti-pyretic drugs, it must be created by one of the
infections above.
In the case of tuberculosis-type of infections, there is no alarming
rise in temperature but there is a definite rise at particular intervals.
Since the increase in temperature is not very uncomfortable, it is
neglected and not given proper attention. This leads to a advanced
stage ofthe disease, and greater long term damage to the body, even
if it is treated later. Social understanding of diseases also plays a role
in the management ofthe disease, and so the person who is suffering
from fever has to play an active role.
Swellings
There is a need to differentiate between different types of swellings.
There are some due to physical injuries like fractures and sprains,
and there are other swellings, such as those of the lymph nodes,
which come up as a reaction to illnesses, especially those caused by
infections.
The body responds by producing cells to fight the infections and this
is why we see swellings of the lymph nodes. For example a throat
infection gives rise to swelling of the glands in and around the neck.
Similarly cuts, wounds and injuries of the hands and legs can cause
swelling ofglands in the arm pits and in the groin. Certain infections
of the lymph node can give rise to swelling of the nodes themselves,
as happens in one kind of tuberculosis.
Swelling as a result of injury is due to damage to the muscles most
of the time. The blood vessels are ruptured and the swelling is an
outcome. With experience one can differentiate between types of
swellings and diagnose the nature of the injury. For example, a
swelling caused by a fracture does not come down with time as
happens with a sprain.
A third type of swelling is due to joint pains and joint swellings and
is very common in the cities. This is due to various reasons but is
often caused by an auto-immune disease where the body reacts
against its own cells, and there is reaction in the joints which is
observed in the form of swellings.
Observing changes in the body such as increases in temperature and
swelling are just two examples of what we mean by becoming
sensitive to the body. All the effects observed have to be seen
together to be able to make a clear diagnosis. Thus an alert
observation of the whole body becomes an important aspect of
looking after ill health.
85
Using the whole-body chart at the end ofChapter II, when visiting
a person who is ill you could ask questions such as:
•
•
What kind ofpain is there and where?
What other symptoms or complaints are there?
•
What is the pattern of the incidence of the symptoms?
• Are there any chronic complaints? Any long-term illnesses?
•
Can any changes be made in the food and water being
consumed by the person?
•
Can changes be made in the pattern of work and rest?
•
Have there been any recent changes in the environment or
lifestyle?
•
Is there a background ofstress operating? Can it be dealt with?
It's only when all the people--the ones who are ill, those looking after
them, the health care workers, the planners and administrators-all
consciously participate, that ill health can be tackled. It will have to
be individual and collective effort—pooling together knowledge and
experience of all sorts. In the next chapter we will explore efforts
made on these lines in various parts of the country.
86
Chapter VI
OUR BODIES IN OUR OWN HANDS
We now come to the end of this exploration. And at this stage we
seem to have arrived at a basic principle: to be healthy we need to
act. Each one of us and all of us together have to be active agents
in a process that would keep everyone healthy and well.
Even in a city like Bombay where there is no personal time, where
all jobs are quick jobs, where everything is bought and sold, where
expertise of all kinds is available-even here, it is our active
intervention that is needed in every aspect of our lives. As life in this
city becomes faster, more commercialised and tiring, it is natural to
wish that someone else takes responsibility for our lives. In the case
of health this someone else would be doctors and the impressive
array of technology and drugs that they use.
In such an atmosphere, it seems impossible to imagine that ordinary
health workers can do something, even something small at the
personal level, and thereby gain some kind of control over the
situation. To be able to work in the wider community and to involve
all the people, seems an even more formidable task. But it is feasible,
others have shown, and their efforts could be a source of strength
the health worker. Much more than just dispensing available
{contraceptives and completing immunisation schedules is possible,
pnd it is in our hands to do it.
K
87
This belief stems from a knowledge of efforts made in other parts of
the country in this direction. In rural areas, where the health care
system fails to provide qualified doctors and well equipped and
properly staffed health care centres, communities have got together
to evolve ways of dealing with emergencies, minor illness or other
requirements on their own.
Self help in this context has meant equipping the community. The
attitude of these efforts towards the structure of the health care
delivery system has been critical. However, the context of these
efforts has primarily remained the situation of ill-health in the
absence of facilities provided by modern medicine.
Alternatives in the community
In a small village in Madhya Pradesh, one such effort had been made
about ten years ago by a voluntary group called Kishore Bharati,
working for development and education. The programme was
named Zaroori Davai Suvidha and it ran with the help of the local
village women. These women could not read or write. Every time
that there was an illness in the family, they tried available herbs and
other preparations. Then they would come rushing to the
organisation's campus some distance away, looking for the go// that
would bring instant relief. A doctor working in the organisation was
in touch with them.
To avoid this situation of running to the doctor every now and then,
the women came up with a solution of making the golis available in
the village itself. But when the women could not read how would
they identify the medicines? They decided that each woman in the
group would keep only one type of medicine. So then there was a
bukhar wall bai, ulti wall bai, khansi wait bai, and so on. Anyone
who needed a specific medicine would go to the relevant woman and
get themselves treated.
This process went further. Every week the village had a dawakhana
with the doctor from the organisation. All the women with the
medicines would also come and join this open air dispensary. They
would discuss the kind of illnesses that had come up in the previous
week, who they had given the medicine to, for whom had it worked
and for whom there were other problems.
This was a time of learning for all the people around. The discussion
would go on to why some illnesses were on the rise, what could be
the possible reasons, how they could be tackled at the village level
and so on. The villagers tried to 1c ok at their problems and find some
solutions on their own while insisting collectively that the government
88
9
9
9
n
0
9
9
9
9
9
C*
9
9
0
9
0
O
©
n
n
0
0
0
0
fulfill their tasks of ensuring clean drinking water, and of making
proper health care facilities available in the official health centre.
The Zaroori Davai Suvidha was an effort initiated by local village
women with the help ofa conscientious and thinking doctor, and the
support of an organisation which wanted to generate people's
participation in their own development.
At another level, there are efforts being directed by some groups,
especially women's groups, towards women's health. Their start is
from a totally different perspective.
Arakkonam is a small town in Tamilnadu. A voluntary group called
the Society for Rural Education and Development has been working
in the villages around this town for a number of years. Their efforts
have been directed towards organising landless agricultural labourers,
especially women. As part of this work, women's need for birth
control was perceived as a major need, and the group took a decision
to address it.
Having begun from people's needs, as against the government
machinery which begins with population control as the premise for
distributing contraceptive methods, their work and its emphasis was
very different. The activists of the Society for Rural Education and
Development did not just hand out technological methods and think
that they had addressed the need.
The health workers who were working on the programme first learnt
and tried to understand menstruation and the menstrual cycle. This
involved both the details of the internal chemical changes during a
cycle, as well as the overall changes within the body. An effort was
made to understand how the existing contraceptive methods worked.
These were evaluated on the basis of the knowledge and experiences
of women who had already used the available methods.
Efforts were made to explain these facts to as many women from the
villages in the Arakonam area as possible. Simple devices like charts
and songs were used to communicate to illiterate women. Barrier
methods like condoms were found to be safe and so the health
workers tried to initiate dialogues with men about use of condoms.
These were actively propagated at all levels in the villages that they
worked in.
The work did not just end at birth control. From the fertility
awareness programme which helped women observe their menstrual
cycle, the issue of white discharge emerged as a major concern.
Reproductive tract infections, and sexually transmitted diseases
began to be looked into, discussed and spoken about aloud. Along
89
o
o
with this, the issues have extended to include others, such as the
man-woman relationship and the question of women's health status
within the family. Matters of silence are being brought out into the
open.
Accessible nutritional supplements are being found, so that women
can take them and counter rampant malnutrition, often the cause of
white discharge and weakness. At the same time, existing methods
oftreatment for these ailments are being tested and given credibility.
Thus, what began as a programme for meeting the need of women
for birth control, has stretched by itself to include the general health
problems of women within their social and cultural status.
It is not as if these efforts are taking place only in the rural areas. In
urban centres also, such work based in the slums and low income
group colonies has been going on. One such programme is the
Samudayik Swasthya Karyakram of New Delhi—a programme run
in the settlement colonies in the expanding suburbs of Delhi by a
voluntary organisation called Action India.
The Samudayik Swasthya Karyakram is also a programme dealing
with women's health. As in Arakkonam, the first identified need was
birth control. Once again, the emphasis was on learning more about
the normal functioning of the body, especially the menstrual cycle,
rather than just dispensing contraceptive methods in the manner of
sweets. A general understanding of what one means by healthy and
normal, and what one means by normal fertility within that, was a
starting point. Fertility awareness—learning, teaching and actually
charting one's fertility cycle was part of the process. Looking at
women’s overall status in society was another.
Another exercise was that ofrecording and surveying the experiences
of women with the commonly used and available contraceptive
methods. A detailed survey was carried out on female sterilisation
operations, a widely accepted method in those areas. The health
workers who designed the survey, collected the data and analysed
it, were semi-literate women from the bastis. The findings of this
survey were used to initiate a dialogue with the local government
health centre which had conducted the operations. Women's
experiences were collated, and the accountability of the health
centre and its staff were sought, on the basis of these discussions.
This is a specific case ofwork by a voluntary group in an urban centre
where hospitals, dispensaries and other facilities are available. In
familiarising women with their bodies, not only are issues related to
their overall reproductive health raised, but also efforts can be made
to try and positively identify the contraceptive methods that women
would like to use. From amongst such women is emerging the
90
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o
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o
n
O
O
O
O
O
0
demand on the government to provide female barrier methods.
These are not available under the official family planning programme
on the ground that Indian women do not like to or cannot use these
methods effectively.
How does it compare with the situation in a regular health care
centre? We give here the story ofone such woman whose encounter
with the health system represents the overall experience.
The individual on her own
Salma was a young woman, mother of two children, living in
Bombay. She had conceived her second child immediately after the
first when she was not prepared for it at all. After the second child
she was very keen to use some contraceptive method. She came to
know of a new method being given in the local hospital through her
neighbour.
This was a long-acting contraceptive implanted under the skin ofthe
forearm, and it promised to be a convenient method of birth control.
She went and got herself implanted with a capsule, and her agony
began soon after. Her menstrual cycle went out of control. She was
bleeding almost continuously throughout the month. The excessive
blood loss led to a lot of weakness and failing health.
Every time that she approached the hospital she was given some
medicine which gave temporary relief. She carried on like this for
almost four years, repeatedly contacting the authorities, but not
being taken very seriously each time. At no time did she have even
an inkling that she and others like her neighbour were part of an
experiment, to test the drug on women over a period of time to see
their effectiveness. They finally removed the implant after four
years, not out of regard for her, but because the hospital trials were
coming to an end. By the end of this period Salma was in no state
to conceive again and her family insisted that she have a tubectomy
so that she does not suffer any more.
Salma started with a need for a temporary contraceptive method ■
because she wanted to space her children. She ended up with a
permanently impaired fertility and weak health for the rest of her life.
Who is being made more healthy in this process? We hear similar
stories all the time about women who seek family planning at official
health centres. They are offered any method that is available without
regard to their individual constitutions, preferences and needs,
based on targets that the government has set. Complaints about such
methods are not recorded or acted upon, the patient is just treated
temporarily with some medicines and pushed aside.
91
The other important lesson that such an apparently contradictory
situations highlights is that of the need for each one of us to equip
ourselves to question, and then only critically accept existing
knowledge. From the policy makers' perspective, implants are
touted as the latest and ideal birth control method with no attendant
problems, and appear totally acceptable. Ordinary health workers
are not supposed to question the wisdom ofthose who are qualified.
However because we are health workers, we need to ask a few
questions before passing on such methods to the women who come
to us for help.
What is the definition of an "ideal" method? What are the limits of
"acceptability"? What are the biases resorted to in defining these?
Should menstrual disorder be treated as a minor side effect that is
inevitable when using a birth control method? Should the knowledge
ofthe menstrual cycle be used to come out with devices that interfere
with the natural cycle, which often has unexpected consequences?
Or can one use this knowledge to understand the fertility cycle and
find means of handling it?
The alternative methods tried out by these voluntary groups are no
doubt slow to spread, and require a lot of involvement and patience
on the part of both health workers and users. But if we want to arrive
at an different understanding of health in the long run, and want this
understanding to have a meaningful impact on our lives, only such
dedicated efforts will help.
We need to become alert and active ourselves. Take the area ofbirth
control. If a proper kind of sex education programme is taken up
among young girls in the community, self confidence is built. If girls
they are given opportunities to be more independent, awareness of
the body increases. Perhaps then, health disasters such as Salma's
would not be allowed to occur, because women like her would have
been better prepared to handle such situations right at the outset.
This is something that we can work towards and achieve.
Health care is not about being ill
Besides women's health, we are also concerned with general health.
We do not have to wait to fall ill before we start thinking of our
bodies. Action has to begin much sooner and it has to be
multidimensional. Our bodies are working continuously, trying to
carry on against all odds. We need to help our bodies to achieve their
potentials. We have to create conducive situations that would allow
all our bodies to function normally. We also need to be more aware
ofbody functioning so that any intervention in it takes place with our
awareness and consensual consent.
92
As health workers we need to create a new relationship with our own
bodies and also help others to do so. It is important to find the space
to listen to the body's needs and requirements. Even within the
restricted space that is available, such relationships need to be
developed. If we can act in some small way to stabilise situations
before a stage ofbreakdown is reached, that could take us a long way
in remaining healthy.
Even if a breakdown does occur, we have to become conscious and
informed patients ourselves. Here the role of the health worker is
very crucial for the community. In a place like Bombay which has
some ofthe best health facilities available in the country, and yet bare
minimum care is not accessible for most, the role of the health
worker as the friend ofthe community is very important. Day by day,
as we are being forced to rely more on doctors and medical
technology, we have to learn to ask the right kind of questions and
interpret the course of action suggested by the doctor.
Doctors after all are part ofthe wider society. They have been trained
in a particular way, and hence can look at problems in a specific way
only. Most of them are not concerned about the social situations in
which the patient lives. How many times have we come across
doctors who would even pause to ask what is the occupation of the
person? Or how many have we seen who would try and look at the
illness in its social context? Most of them have been trained in a
mechanistic way and so can only deal with specific diseases and their
prescribed treatments. In such a situation, looking at health in a way
different from the widely accepted view is more difficult and yet
more urgent.
This is the overall situation. However, in today's context there are
some more matters of concern which also need to be stated. There
is increasing privatisation and commercialisation of health care.
With more irrational drugs coming into the market and with the
pressures of the pharmaceutical companies, many dangerous drugs
and medicines being prescribed. In the urge to make more money,
hospital fees are increasing as also the costs ofdiagnostic tests, often
quite unnecessary.
In such a situation it is essential that we be more patient as patients.
Running from one doctor to the other does not help. In fact it could
lead to incomplete treatments, which could be harmful in the long
run. It also encourages the practice of overdosing or harmful
drugging that the doctors claim they do because patients want quick
cures. In our quest to get well soon we are allowing ourselves to get
cheated and at the same time are also making our bodies less capable
pf following the natural processes of recovery.
93.
It is important that ail factors adversely affecting the normal
functioning ofthe body be tackled, whether they arise out ofour own
actions and ignorance, or out of the disparate and inequitable social
structure. This implies that self help or action on our part would
mean working consciously and actively towards making the best use
of what is available. At the same time, we need to work towards
ensuring that more is available to all of us eventually. It requires
conscious action on the part of each one of us individually and
collectively. Action that can lead to the most judicious use of the
resources to which all of us have a right.
All struggles for equitable distribution of material resources, for
preservation of all life and life-giving atmosphere, for changes in
oppressive norms, for ensuring a humane existence—all contribute
towards better health and are an integral part ofselfhelp. These ideas
should form the backbone of any community health programme.
Obviously violence of any kind, whether it is directed towards
individuals in the family or towards particular communities or
towards nature, creates a situation in which good health cannot
survive. Countering violence also becomes a vital step of the self
help process.
We look upon this book as a miniscule but vital step in the direction
of achieving these dreams in the context of the work of a health
worker or a health programme. For us as writers, this has been an
exploration, the first few steps. These need to be fleshed out, given
a concrete shape and direction with the experiences and actions of
our readers. We know it is possible because we are talking of life,
health, vitality.
In this city each of us has come to gain something material while
making compromises at many other levels. It is our firm belief that
an understanding of the interface of the body processes with work,
life and immediate environment, should help all of us in making the
beginning towards health, both that ofindividuals and the community
to which we belong.
94
APPENDIX
A short list of agencies involved in community health and related activities in Bombay
Name and address
Main Focus
Within Health Area
Contact
Number
Aga Khan Foundation
Prince Aly Hospital
Prince Aly Marg, Mazgaon
Bombay 400 010
resource materials
855 4342
Alert India
Mukhyadhyapak Bhavan
3rd Floor, 6-B Sion West
Bombay 400 022
leprosy
407 2558
All India Institute of Physical
Medicine & Rehabilitation, Haji Ali
Keshavrao Khadey Marg
Mahalaxmi
Bombay 400 034
treatment, training
and research centre,
training of para
medical personnel
394 654
393 878
Ali Yavar Jung National Institute
for the Hearing Handicapped
Kishen Chand Marg
Bandra Reclamation
Bombay 400 050
hearing disabled
640 4170
Apnalaya
New Jaiphal Wadi
Behind Bldg No.7
Armed Police Quarters
Tardeo, Bombay 400 034
organising
community health
education and other
need-based
activities
C/o. Ms. Mehta
362 0878
95
Asha Deep Vikas Kendra
A/18, Achanak Colony
Mahakali Caves Road
Andhcri East
Bombay 400 093
community health
830 1916
ASTHA
Xavier Institute of Communication
St. Xavier's College
Mahapalika Marg, Bombay 400 001
resource materials
262 1366
262 1639
Association for the Welfare of persons with
a Mental Handicap (AWMH)
Basement, Turner Morrison House
16, Bank Street
Bombay 400 023
welfare of the
mentally
handicapped
266 1321
AVEin
Sardar Nagar 4, Raoli Camp
S. M. Road, Sion-Koliwada
Bombay 400 037
resource materials
407 2188
Bandra East Community Centre
Opp. Cardinal Gracias High Schoo]
341/A Siddharth Colony
Bandra East, Bombay 400 051
community health
642 4691
Bombay Leprosy Project
Vidhan Bhavan
Opp. 1ITI, Chunabhatti
Sion East, Bombay 400 022
leprosy
407 4066
Catholic Relief Services
USCC India Programme
Bombay Zone
1 st floor, Eucharistic Bldg No. 3
5, Convent Street
Bombay 400 039
health and training
programmes
23 0834
Childrens' Aid Society
83, T.H. Kataria Marg
Mahim, Bombay 400 016
welfare services
45 2514
Child Relief and You (CRY)
189A Sane Guruji Marg
Anand Estates, Mahalaxmi
Bombay 400 011
resource material
and funding of
projects
309 1151
309 6472
309 6845
Committed Communities
Development Trust
Primrose, 303, Juhu Road
Santacruz West, Bombay 400 049
community health
611 7070
Community Aid and Sponsorship
Programme (CASP)
175, Dr. D. N. Road, Fort
Bombay 400 001
programme providing
supportive aid to
needy children
within their families
261 6034
261 1945
261 3639
96
Community Outreach Programme
(CORP)
Methodist Centre
21, YMCA Road
Bombay 400 011
health education for
women and children
396 3189
Concern India Foundation,
Ador House
K. Dubash Marg
Bombay 400 001
funding of projects
202 9707
Department of Extra Mural Studies
& Dept, of MPSW
T1SS, Deonar Road
Post Box No.8313
Bombay 400 088
\
training health
workers
556 3290
Family Service Centre
5, Convent Street
Eucharist Congress Bldg No. 3
Bombay 400 039
family counselling,
financial aid,
adoption and foster
care
283 1432
Forum for Women's Health
2, Vishwadeep
95, Bhau Daji Road
Matimga, Bombay 400 019
women's health,
contraception,
training of health
workers
437 9482
Foundation For Research in
Community Health (FRCH)
82, A.R.G. Thadani Marg
Worli, Bombay 400 018 .
research projects
and documentation
on health
493 8601
Forum for Medical Ethics
34 B, Noshir Bharucha Road .
Bombay 400 007
publication of
"Medical Ethics"
386 8608
GUARD
5/89, Shanti Niketan
Samata Nagar, Kandivli East
Bombay 400 101
community health
Indian Health Organisation
Municipal School Bldg.
J. J. Hospital Compound
Bombay 400 008
preventive and
educational activities
on AIDS
371 0819
Indian Council of Social Welfare
175, Dr.D.N.Road, Fort
Bombay 400 001
promotion of health
activities
261 1945
Indian Red Cross Society
Maharashtra State Branch,
Town Hall Compound,
141, Shahid Bhagat Singh Road
Bombay 400 023
medical relief,
health training
203 1524
97
K.A.S.A.,
Behind Tilak Bhavan
Kakasaheb Gadgil Marg
1 ladar East
Bombay 400 028
AIDS and allied
studies
KR1PA
Ml.Carmel Church
81 Chapel Road
Bandra West
Bombay 400 050
drug abuse
643 3027
Lok Seva Sangam
D-l, Everand Nagar
Sion-Trotnbay Road,
Sion, Bombay-400022
leprosy
407 0718
Maharashtra Lokhita Seva Mandal
1st Floor. A wing
Adarsh Apts, Golibar
Santacruz West
Bombay 400 055
leprosy and
community health
611 4927
Mobile Creche for Working
Mothers' Children
2nd Floor, Oxford I louse
Apollo Bunder, Bombay 400 001
education, day care
and allied activities
at construction sites
202 0869
Nagpada Neighbourhood House,
Sophia Zuber Road,
Byculla
Bombay 400 008
community health
and other needs
307 2571
National Addiction Research
Centre (N.A.R.C.)
5, Bhardwadi Hospital Complex,
Andheri West
Bombay^lOO 058
drug abuse research
621 2661
National Society for Clean Cities - India
590, Ah Yavar Jung Marg, Kherwadi
Bandra (East)
Bombay-400 051
environmental
awareness
642 9742
Occupational Health and Safety Centre
C/o Blue Star Workers' Union
6, Neelakanth Apartments,
Gokuldas Pasta Road,
Dadar(E), Bombay 400 014
occupational health
PATH
Janata Education & Training
Society, Pailee Pada
Trombay, Bombay 400 088
health education and
awareness
98
555 5164
9
•
9
9
9
9
9
9
9
9
9
9
9 '
9
9
9
9
ft
•
•
•
•
•
iarisar Asha,
103/104, Dunhill Villa, 1st Floor
Besant Road
Santacruz (West)
Bombay 400 054
education for
children on
environmental issues
People's Drug Information Centre (PDIC) Project
c/o Association for Consumer Action for
Safety and Health (ACASH)
2nd floor, Servants of India Building
417, Sardar Vallabhbhai Patel Road
Girgaum, Bombay 400 004
drug information
PRERANA
Kamathipura Municipal School
7th Lane, Sukhlaji Street
Bombay 400 008
AIDS studies and
care of children of
prostitutes
Pride India,
4-C, Swapanalok
47, Lady Jagmohan Marg
Bombay 400 036
disabled children
361 3433
Project SMITA
D-5, Movie Tower
Plot No. 41, Yamuna Nagar
Oshiwara Complex
Andheri West, Bombay 400 058
resource material
626 0109
Samaj Seva Niketan
3 Bhanu Villa
Amrut Nagar
Ghatkopar West
Bombay 400 086
community health
517 1987
Stree Hitakarini
Lokmanya Nagar Compound
Kakasaheb Gadgil Marg
Dadar West, Bombay 400 028
community health
422 0565
Slum Rehabilitation Society
Swapna Safalya
Plot No. F/8/6,25th Road
TPS III, Bandra West
Bombay 400 050
community health
640 8911
643 6782
Snehalaya,
Victoria Church Compound,
Lady Jamshedji Marg
Mahim, Bombay 400 016
programmes to
improve quality of
family life
451 866
453 876
SPARC Byculla Centre
C/o Municipal Dispensary
Meghraj Sethi Marg
Byculla, Bombay 400 008
health research and
drug rehabilitation
centre
54 6258
612 4442
•
•
•
•
•
•
•
•
•
•
•
99
Spastics Society of India
Bandra Reclamation
K.C.Marg, Bandra West
Bombay 400 050
disabled children
644 3666
644 3688
Sulabh Shauchalaya
52/B Sindhi Society
Chembur
Bombay-400 071
installation of public
toilets and bathing
facilities
553 3184
Urban Community Development
Centre (UCDC)
104/B, 14th Road, TPS HI
Bandra West
Bombay 400 050
community health
■ services in slum
-areas
640 6258
Youth for Unity and Voluntary
Action (YUVA)
Room No. 53 & 54, 2nd Floor
Nare Park Municipal School, Pare!
Bombay 400 012
child health and
issue based
activities
414 3498
407 0623
100
A-B
Kidney
C, -D,
Mauth and upper end offood pipe
C, - D. Mouth and upper end of wind pipe
E-F Lungs
G-II Stomach
Heart
K-L
remale reproductive system
M-N
Urethra
0-P Small intestine
Q-R Large intestine
S- T Pancreas
U- V Liver
IK Hladder
A - )’ Hrain
(Hal Uaigyanik Class VIII, Madhya
Pradesh Pathyapustak Nigunt)
vk-'.^-
Y -5
This book has emerged from the concerns of two researchers,
Swatija Manorama and Chayanika Shah. During the past several
years they have worked on science and society related issues,
with particular emphasis oh women's concerns. In the course of
their practice as trainers of health workers, they had. felt a need
for clarity on the social implications of the biological content of
such courses. This is how die idea of working towards a manual
paiM about. They chose to address this work to the specific
problems raised in the urban setting of Bombay. While some
training addressed to rural health workers is available, there is not
much made for the city, it was also felt that voluntary health
workers often require orientation to make use of the health
resources' available in a city, and this work attempts to address
this need.
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. 1
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A - grant from the Bombay Community Public Trust made this
exploration possible.
. SY
CQMET MEDIA FOUNDATION
Tcpjwala'Lane School, Laming ton Road, Bor
>mail:i'cmf@bom5.vsni.het.in ' .
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