Though a straight line appears to be the shortest distance between 2 points, life has a way of confounding geography. Often it is the dalliances and the detours that define us. There are no maps to guide our most important searches; we must rely on hope, chance, intuition and a willingness to be surprised.

Saturday, November 07, 2009

Hope Among The Poorest - Orissa, India.

After what seemed like an eternity, but was actually 6 months, I was back in India last week. I spent all but one day in Delhi progressing the two projects that comprise the largest part of my role with Opportunity International. I want to talk about that other day, when I journeyed more in curiosity than purpose, but ended up with a real need to ‘do something’.

I’ve seen a lot of the Indian subcontinent now, the North (Punjab, Nepal and the Himalayas), the South (the big cities of Hyderabad and Bangalore, Kerala and Tamil Nadu, and Sri Lanka) and even a little of the West in Gujarat. But I’d never been to the east. The east is a whole other realm of India again. Different languages (Bengali), very different cities (Calcutta) and states that have more in common with neighbouring Bangladesh than with the rest of India.

Orissa stretches along hundreds of miles of India’s eastern coastline. Its population of 37m makes it middling in terms of Indian states, and therefore pretty devoid of outside interest. Of course, you wouldn’t expect this place to gain much international attention, even if its population is greater than either Australia or Canada, two perennially newsworthy parts of the world. But how excluded and remote is a place when a 1999 cyclone (Cyclone 5B) could kill 10,000 people without even being considered important enough to warrant a name?

Despite vast mineral reserves, that are only now being tapped by international mining companies, Orissa is marked by having possibly the worst development stats of any Indian state. Life expectancy is shorter, education levels lower, infant mortality rates higher than anywhere else in a country which generally performs very poorly on the Millenium Development Goals. And that’s why Opportunity International have more partners based in Orissa, than in any other state.

If you want to tackle poverty, this is the place to come.

I was the first person from Opportunity to go to Orissa. Though I didn’t perceive any risk in the areas I went to, the state does have a reputation for lawlessness. A headline in this week’s Indian newspapers read “Maoists blow up guesthouse” (though no-one was injured) and there’s a lot of socialist activity and civic unrest.

Of the three microfinance institutions that we work with in Orissa, Manas and I visited Peoples Forum – one of our newest partners – to review their work generally, and to make a visit to a very interesting new development project there.

We met two groups of women who are part of a microfinance program that has been running since 1989 and now has 25 branches and 35,000 clients.

The first group of 10 women make saris. They have borrowed Rp10,000 (about $250) each from Peoples Forum to pay for materials. They will repay the money over 18 months and then be eligible to borrow more money and expand their business. It was important to see where the women work – each of the rooms is barely bigger than the loom it accommodates. The rooms are dark with small windows, which are lit by light bulbs even in the middle of the day. And the work is hard, physical work. There’s a lot of effort needed to operate the machines.

And what do they get for this hard work?

Before Peoples Forum came along and provided the group with a loan, each of the women saved around Rs50 per month, and over a period of 18 months they had saved Rs1050 each in total, or about $25 in total.

Imagine where you were 18 months ago and then imagine you had spent every day since then working 8 hours a day in a small, dark room in a tropical environment, just to earn as much money as the typical Australian would spend on a round of drinks or a couple of cinema tickets. It’s staggering.

But the MFI is trying to change this. By giving the women training and business support, they can earn more for the saris and increase their income and the amount they can save.

The second group was even more interesting. The women here make ropes from raw material, again working 7-8 hours a day in the tropical heat, where peak temperatures can be 47C.

They purchase about $30 of raw material and it takes the group of 10 women 3 days to turn that into ropes which they sell for about twice as much. All told, this gives them an income of about $1 each per day. But again the MFI is giving the women hope of improving their lives. Through a loan, they will purchase an additional machine that will allow them to work more effectively, and they are even building a ‘factory’ of sorts that will let them work indoors in the monsoon season.

What is really remarkable about this group is that the majority of them used to be lepers (they are ex-lepers as Monty Python would say). The houses that they are building with the profits from their rope making business are being built virtually next to a government-built leprosy mission. And they used to live in the mission, until they were cured.

It is remarkable to think of the obstacles these women have had to overcome. Not just issues of caste, poverty and their status as women in India’s poorest state, but also the stigma attached to leprosy. They are now running their own business and earning money that they are using to improve their lives.

This is something that microfinance has always been about –demonstrating that people who are poor and excluded still have value in society. The work that Peoples Forum are doing is just taking that one step further.

And the last program we visited on the day is arguably yet more ambitious.

Mission Ashra is Peoples Forum’s project to provide care and shelter and rehabilitation to women who have ended up abandoned on the streets because they are mentally ill.

Why do they end up on the streets? Firstly, there is a real stigma attached to mental illness in India. When someone develops a mental illness, their family often aren’t able or willing to take care of them. And they are just dumped by their families. It may seem unimaginable, but often these women and girls – one-third of the ashram’s patients are teenagers – are taken to the city on the pretext of a holiday. And at the end of the holiday their families will just leave them in the hotel room.

The natural reaction to this is horror and disgust. But understanding why this can happen is important to understanding why the small ashram that Peoples Forum is running could have a transformational impact far beyond its doors.

Attitudes to mental illness are shaped by education and experience. A lack of education and community awareness in the poorest parts of rural India, mean that mental illness is often thought to be incurable, a curse, and something that dehumanises people. This leads to a situation where the family feels that abandoning the individual is the only option they have.

The second reason that so many mentally ill women languish on the streets is that, once they are in that situation where they’ve been abandoned, they have very limited capacity to help themselves. If you’re suffering from depression or schizophrenia, you find it difficult to seek help or to even look after yourself. And these women are very vulnerable. When the ashram rescues women, many of them have been the victims of physical or sexual abuse.

Almost all of the 150 women at the Ashram are from a very poor background. Many have been rescued as a result of a call to a public helpline that the Ashram provides. When they arrive at the ashram the woman will find herself in a site about as big as football field, maybe a little longer, and a little narrower. The facilities are limited. There isn’t even enough space in the rooms for beds. The beds have now been taken out and mattresses placed on the floor to accommodate the women.

There are a formidable list of mental conditions here (depression on its own would rarely be enough to see someone end up at the Ashram) and I feel sure even the best resourced facilities would find this patient-load challenging.

But, despite limited space and resources, the Ashram does appear to have great success in looking after patients. Drugs are part of the answer – they have a full time pharmacist – and psychiatric care is available from nurses and a part-time psychiatrist. At the same time its obvious that drugs and medical attention are only part of the rehabilitation process. Perhaps just as important is the love and care being provided. On top of that, the Ashram makes stimulating activities a key part of the women’s daily experience. Yoga, music, gardening… these all provide some routine and stability to the patients’ lives, something to fill their time, and to give them some meaning.

But of course the ultimate goal is to treat the illness and make the women well again and able to go back to their families. That’s absolutely the aim of the ashram. And reuniting women with their families is a key part of what they do.

And they have mixed success, which is perhaps not surprising. You can split the women into a couple of different groups. There are a group of women who have ‘gone missing’ – perhaps run away from home, or been abducted. In many cases their family will have thought they were dead. Often they are overjoyed to find their daughter or wife. But in many cases, because there is such a stigma attached to mental illness, that they don’t want the person back even when they have recovered. And that can cause huge rejection issues for the patient, and a relapse into depression and further mental illness.

But mixed results does not mean the Ashram is not successful. Over 250 women have been reunited with their families in the last 6 or 7 years. With limited resources Mission Ahra is providing an absolutely essential service.

And really, although it was very upsetting to see people in a distressed condition, in what I perceived to be a bleak and comfortless environment, actually these women are the better off. What is really heartbreaking is to think of the women out there who aren’t getting even this basic care and shelter.

There are only 2 sites like this in the whole of India. The other is in Chennai in the south of India. With government resources for mental health extremely limited, there are thousands of women with mental illness in India who are left vulnerable with no support. It is no exaggeration to say that the life-expectancy of these women is very short, and quality of life is desperate. It really does break my heart to think about this.

But there is hope here too. As with their microfinance programs, Peoples Forum are demonstrating something really powerful. They are demonstrating that mental illness does not make someone less than human. These are human beings too. And they deserve care and love. They are also showing that, with care and shelter, many of these women can recover and go back to their families.

Before I’d even left the ashram I’d started to think about what I could do, and what Opportunity could do. We have expertise in two things that gives us a real possibility of helping here – we can sell a story to people when we find something truly inspiring and we can leverage something that works to expand that solution and maximise impact.

Mission Ashra has the capability to not just help a few mentally ill women, but to change perceptions of mental illness. Peoples Forum would like to move to a new, larger site with better medical facilities – effectively something more like a hospital. This may start locally, and modestly, but I believe it can grow fast. I’ve already made this presentation to colleagues and we are taking the first steps to make things happen.

This last picture may appear to sum up how bleak the Ashram is, but actually these women are relatively lucky. The ashram is giving hope. The alternative is hopelessness.