STD Survey, DAV

In the mornings at DAB, we did a survey on Sexually Transmitted Diseases. We were stationed in the main Asha building in the slum, and women were recruited to participate if they had any questions relating to personal areas. It was difficult to manage the survey, since neither Madeleine nor I speak Hindi. We had Rani, the regional leader, and the team leader of DAB working with us. The latter however, did not speak very coherent English. She also was not very patient so we would ask her to explain something and she would answer curtly yes or no which did not adequately respond to our inquiry. We learned the questions in phonetic Hindi and I was able to pull most of them off rather well. The downside is that coupled with my Indian looks, naturally the patient would assume I spoke fluent Hindi and would launch into a babbling explanation. I would just have to listen for key words, and then ask them to repeat to the translator. Another issue is that many of the women, understandable, assumed were doctors. One afternoon on a Friday a woman came in with fever and pain, but we had to reluctantly explain that we could not help and that the doctor would be in on Monday.
We asked them about excessive discharge, pain during intercourse, any unusual lumps or bumps, abdominal pain, any abnormal periods, and finally referred them to Ranjina for a breast examination. The majority of women experienced pain in the lower belly area. We would then write out a referral slip for Doctor Sharmila in the Asha Center Polyclinic. Many of them also had symptoms of STDs, Pelvic Inflammatory Disease, and Urinary Tract Infections. Yeast infections also are common in the conditions here in India. It is always hot and humid out, and people do not use toilet paper, instead they rinse off with water, leaving a warm, moist environment which is ideal for bacteria to grow.
It upset me to see how many women had suffered and had nowhere to ask for help. A few women had suffered from symptoms for a year or more! During one breast exam, a lump was found the size of an apple on the side of her chest. She said she had endured it for ten years. Fortunately it was benign, but the idea of just living with such a growth without having it looked at for a decade, blew Madeleine and I away. The Asha women explained; if there's a problem with the husband, its a huge deal and everyone gets upset, same reaction if a child, particularly a male child, has some affliction, but a woman's problem, they gestured, is pushed under the rug.
We surveyed about 120 women during my time there, and a rough estimate would be that at least 75% of women were recommended to the doctors clinic. It was frustrating not to be able to follow up on the diagnosis of the problems. A couple women we overlapped with during our shadowing hours but not many. Another huge problem is that obviously for the treatment of an STD, both partners need to participate. Logistically, many of the men work during the morning hours when the clinic occurs, and culturally, the men often assume it is the woman's problem and she should fix it alone. The disease then is perpetually passed back and forth.
It was a nice environment to work in, all women, working for women's health. It was interesting to be immersed in the Hindi language. In some ways I learned a lot from trying to decipher the exact problem in my limited Hindi. At the same time it was so frustrating not being able to fully communicate. Madeleine and I were saved from any awkwardness regarding the questions since we did not understand word for word what we were saying. Most of the women were quite willing to be honest about their situations. The Asha women clearly helped create a comfort zone where talking about such ailments was safe.