This afternoon (5/2/07) I was meant to meet with both the occupational therapist and the social worker. On my previous visit to CHAD (on Pongal's Holiday) I met with Mrs. Susila John, the social worker and Mr. Murugesa--seems to be operations director in the office of the OPD. I decided to speak with Mrs. Susila again because I had more questions about the cultural practices related especially to marriage. Our previous visit proved to be very enlightening because she entertained all of our questions very openly. Her answers were always very honest, even in this meeting. She shared that the problems with marriages, especially in this village was that 1) many are consanguineous, with a high percentage of those being mother's brother (uncle) marrying neice (mother's daughter), 2) girl goes to live in husband's parent's home--automatic challenge with change of environment, but increased power-struggle problems with mother-in-law, 3) Spousal abuse is very prevalent, 4) girls are married very young and children are expected to follow closely after the marriage. These are only some of the problems for which she counsels couples about marriage. I also asked if she knew if other areas (like the areas served by the CONCH nurses) had access to the same kind of services or if they could attend the activities like the Newly Married Couple Counseling session with the CHAD village members. She seemed to think that those other groups had access to similar services, but that CONCH often refers to CHAD, so it was not impossible that couples/families couldn't seek counseling care here. I shared with her a case of a woman suffering from HTN who was complaining of increased frequency of episodes. She recited correct medication regimen to the written orders, but when asked about situations/environments surrounding those episodes, she shared that her husband's condition (very poor prognosis, suffering from DM, HTN, Chronic Renal Failure, Heart Disease) and the conflicts her children (espc. son with love-marriage daughter-in-law from the north who only speaks Hindi, family only speaks Tamil) are those times. Mrs. Susila felt that this was not a situation would necessitate separate wife, husband counseling, but that some counseling could be addressed with/for the whole family.
I then asked about what happens to those individuals who remain single. Is there a stigma associated? Then Mrs. Susila and I began talking about our own families. She shared that her husband's sister is a physician who never happened to get married, it got too late (age 29) and so instead she lived with her mother (until a few months ago when her mother passed) and only has two dogs who keep her company. To be single does come with a bit of social discomfort, but altogether it is viewed less as a problem—though still a problem--than it was in the past. I think that my understanding is a bit skewed; I cannot fathom the idea of being an “outsider” simply because I might be single at 28 (which might very well happen to me!) or because I am a widow.
Because I was Miss Curious George, I continued my twenty questions tirade asking about homosexuality and its prevalence here. Mrs. Susila said that society is so strongly against it, that no real statistics exist—at least for this region. Similarly, like suicide, it’s not openly shared. I asked if HIV + patients were linked at all to this idea of homosexuality (a common link in the U.S. beginning in the 1980s). No, evidently the prevalence of HIV+ is so great and the unknown figures related to homosexuality are presumably small, the social stigma linking the two is not found.
At CHAD (Community Health and Development), Social workers host a newly weds group counseling and teaching session. Teachings when the couples are together are related to communication, challenges in marriage, prevalence and inappropriateness of abuse, children. Apparently, when the question was asked about how many times is it ok to hit your wife, the answer was typically 1-2 times. Here, spousal abuse is common and often not viewed as wrong. The social workers made it a point to dispell that belief and encourage other ways to resolve conflicts.
Then, separately, male and female, are taken to learn about and ask questions about the different reproductive cycles, family planning methods and what to expect from sex. I took pictures of the models used! These girls were very young, and unfortunately, this group was not very talkative, either. Only a few questions were asked, whereas I was told that usually the group is livelier and more openly curious (because they know they are in a safe place). While in the large mixed group, their husbands had shared their wishes about how many children they wanted, but this was a time that the women could express their wishes--especially if they differed from their husband's. There was a showing of a condom, though no demonstration of how to use it. I am assuming (because my Tamil just isn't that good) that the instructions were given on proper use AND its prevention rate. All of these young married women shyly passed it around the circle. The other common forms of family planning here are tubectomy (most common after 2 live birth children--though some families wait until they have a boy before they stop), oral contraceptives, IntraUterine Device (Copper T). Condoms, according to a research study done on women in an urban health center in Aurangabad, India, were found to be used by only 5.33% of women seeking family planning methods. The study also found that nearly half of the eligible women(women of childbearing age) were not practicing any method of family planning. The listed reasons were--in arrangement of highest to lowest common percentage answer-- 1) little perceived risk--as at perimenopausal stage 2) lactation 3) ignorance 4) side effects of contraception 5) opposition from the husband and family (yes, husbands often still have to give permission for invasive and more permanent measures of contraception here) 6)lack of information. Some 26% also listed religion as another contributing factor opposing the use of contraceptive measures. The urban centers here in Vellore is dominated by the Muslim community whose religious values include bearing large families.
I am able to see the conflicting value systems that exist now. These families have very strong beliefs, especially that large families with many children are a blessing from God. The government also has formed its own beliefs. Seeing the overpopulation of this already densly populated country, the government encourages families to have only 2 children, though it doesn't limit them to that number officially. The Tamil Nadu government is also trying to encourage families who have had 2 girls to avoid trying to have a boy by putting money in a dowry-like fund (Rs. 25000--not sure if it's per girl or total) to be accessed only after the girl has reached 21. Interesting.
Tamil Nadu still has a dowry system in its culture. Dowries are often lump sums of money, but may also be promised items like car, refridgerator, house, etc. The gold that the women wear is also part of the dowry, but it is meant as the woman's lone possession. Kerala, the southern state to the west of T.N. eliminated its dowry system many years ago. Here it is the cause of many family tensions and debt. I was posted in the Medical ICU for one afternoon recently, when I learned about a young female patient who, just days after delivery of a baby boy, poisoned herself by ingesting a pesticide. Suicide attempts (and successes, unfortunately) are commonly committed this way. I learned of her because the nurse was having to express breast milk so she wouldn't develop painful breast engorgement. I asked what the probable cause of her attempted suicide was and the nurse suggested the idea that the family--or rather, Mother-in-law--was still dissatisfied with the dowry. I thought for sure that the family would be extactic about her delivery of a baby boy that a dowry wouldn't matter any more. Evidently I was wrong.
Enough of the ugly. Every culture has it. I don't need to dwell on it. Yesterday, I spent the whole day with friends and their families! How lovely. At Irene's home (she's the nurse I mentioned that I went with on all of the RUSHA events) here in Vellore, she showed me a video slideshow of a friend of their's wedding (Christian). Since I haven't been able to attend a wedding during my time, here, this was a great second best! There is SO MUCH symbolism and ceremony in the weddings here; BEAUTIFUL! Garlands of flowers that they exchange around each others' necks, gatherings of family & friends for engagement ceremony, another ceremony on the day just before the wedding (I forget what it is called! eek!), and the wedding! And for each there is a costume change! Colors are not necessarily prescribed. In the North parts of India, women will wear a red or dark red sari for the actual wedding. In the south, all colors are game! (Kavitha, the medical student from KUMC here with me--and my roomie--purchased her wedding sari here and its dark green.) Christian weddings, though often have cream colored saris for the actual wedding ceremony. Weddings Are a BIG TO-DO! Attendance is often over 1,000; the rent out wedding halls just to fit everyone; and depending on the religion, the wedding ceremony itself may last several days! FUN! Ay, more to come! :)
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