Health-seeking by Peri-urban/Urban Migrant Labouring Dalit - PowerPoint Presentation

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Health-seeking by Peri-urban/Urban Migrant Labouring Dalit Residents: tracing perceptions over twenty-five years

MAGic 2015

Anthropology & Global Health

9-11 September 2015

RITU PRIYA

Centre of Social Medicine & Community Health

Jawaharlal Nehru University

New Delhi, IndiaSlide2

The Structure of this Presentation

Narratives from four studies conducted in Delhi between 1988 and 2015 among Dalit, Poor, Migrants

Relating their perceptions of their own health and its determinants with their sense of empowerment or dis-empowerment

Examining other explanations for their perceptionsSlide3

DEFINING EMPOWERMENT

Empowerment is a process of transition from a state of powerlessness to a state of relative control over one’s life, destiny, and environment.

This transition can manifest itself in an improvement in the perceived ability to control, as well as in an improvement in the actual ability to control.

The sources of powerlessness are rooted in social processes that disempower entire populations or groups.

Therefore, the empowerment process aims to influence the oppressed human agency and the social structure within the limitations and possibilities in which this human agency exists and reacts. Slide4

THE CONTEXT

Dalits as the lowest caste in a birth-based, hierarchised, social system.

The Dalit identity is stigmatised, related to ‘polluting occupations’.

Dalits are among the poorest; Migration to urban areas into manual occupations is for reasons of survival or a striving for mobility or both.

Dalit migrants from rural to urban areas gain some caste anonymity, but continue to be stigmatised as the ‘dirty, poor, ignorant, backward, ….’

Improved political and economic conditions have lead to a sense of empowerment in some sections of the Dalits, a perception of improved wellbeing.

However, they remain at the bottom of the socio-economic ladder in the city and its peri-urban areas. Thereby, tend to live and work under insanitary conditions.Slide5

THE

FOUR NARRATIVES from DELHI

Resettlement colony residents, largely Dalit (and poor muslim) in the wake of a Cholera epidemic—1988-89

Dalit migrant construction workers from Rajasthan (Tonk) to Delhi —1989-90

Urban health seeking behaviour among the homeless, slum residents and middle class— 2013-14

Migrants in Peri-urban Village off Delhi, largely Dalit

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Resettlement colony residents, largely Dalit in the wake of a Cholera epidemic—1988-89

Cholera outbreak in 1988 in the resettlement colonies:

Contested perception of the extent of problem:

Initial perception/statements—“This happens every year at this time.”

As media picked it up and reported it as a crisis, cases of diarrhoea were dealt with in a panic

Contested Causality:

Insanitary conditions all around the colony were pointed out as the cause. Angry and blaming the administration for the insanitary conditions.

Did not agree with the administration that it was the hand-pumps bringing up contaminated water, placed it on the filth around.

Victim -blaming / Stigmatisation , De-stigmatisation and Empowerment:

Mass education messages gave derogatory images against those who use the open spaces for defecation.

Then the Prime Minister and his wife visited the slum colony and the responses changed to narrations of how they had come, how they had chastised the local functionaries instructed the officials to take effective action,

Further, myth making started— how they had taken the PM’s wife by the hand to see the state of the public toilets, and how the PM’s wife’s clothes got soiled in the toilet ’s slush and so she had borrowed one of theirs to change into!

The visit was an empowering events, and the myth-making was an expression of their need to make the most of and enhance that sense of empowerment.Slide7

Dalit migrant construction workers from

Rajasthan (Tonk) to Delhi —1989-90

The migrant construction workers stayed at the construction site in make-shift shanties, and experienced visible health loss:

lost children to diarrhoea, fevers and accidents, and

themselves lost significant body weight when they came in from the village.

They perceived it as such, “Our health is worse here and better in the village”. They blamed it on:

“gandavda (the filthy conditions)”,

the changing water as they moved around with the work, and

the heavy manual work.

Shared community perception was of empowerment from the past, “Our wellbeing has improved, health has deteriorated.”

Well-being was viewed as greater

izzat

and

azaadi (

dignity and freedom).

This was a consequence of their collective struggle for social mobility and having been palpably achieved, ‘untouchability ‘ and its symbols having been overcome to a significant extent.

Yet they came, and that was the over-riding of ‘well-being’ over ‘health’. Slide8

Construction workers contd…..

But there were differences within the group, and three approaches to life and health problems were discernable:

those with a socialisation in a value frame of ‘achieving equality through collectivisation, self-restraint, self-improvement thro education and moral action’, took preventive/promotive actions for health even when it meant loss of wages. They were also able to use traditional and modern medicine more rationally.

those who were socialised more into ‘mobility by any means’ did not take preventive/promotive action other than the irrational modern ones based on medical technology, and they resorted to irrational use of modern medicine much more.

those who strove for mobility but did not find success and so adopted a ‘fatalist’ attitude to life. They neither took much preventive /promotive action nor were they able to use modern or traditional medicine effectively.

So the empowered ones acted on the risk perception because they gave greater priority to health as compared to the others who felt less empowered and with lower self-esteem.Slide9

Urban health seeking behaviour among the homeless, slum residents and middle class— 2013-14

Rapid survey undertaken among three sections across 4 cities

In Delhi, all three socio-economic groups resorted to the informal practitioners of modern medicine and the chemist to varying degrees. They all also used traditional remedies and folk practitioners.

Among the low caste migrant slum residents, traditional home remedies based on their knowledge of natural therapies carried from their original homes had been in practice even in Delhi where they had found places where they could source many of the medicinal plants they knew back home.

But now this has declined markedly, and as poignantly stated:

“because we have lost confidence in ourselves”Slide10

Migrants in Peri-urban Village off Delhi,

in Ghaziabad, largely Dalit

Relatively prosperous area with half the families being in-migrants from far off rural areas.

Mainly engaged in vegetable cultivation with domestic waste water.

In an area with fertile agricultural lands being taken over since the 1960s for ‘development’, defence establishment, roads, industries, urban residences and leisure park.

Chemical contamination of water and air from industrial effluents and air pollution. This is different from the traditional insanitary conditions.

Largely, they do not articulate any problem with the use of domestic waste for irrigation or the environmental contamination by chemicals. They also use the vegetables grown in these fields. Thus the traditionally known ‘pollution’ is also rationalised by the economic option it provides, in a context of greater acceptance of pollution.

Viewed in the context of the other studies, we expect them to articulate perceptions of the pollution and its impact on health IF the following conditions obtain:

(i) the experience of negative impact on health, or a public discourse that changes the perception of what they observe,

(ii) a sense of empowerment in controlling their life conditions, (disempowerment limiting critical thinking and its articulation)

(iii) a confidence that they can do something about the risk, that the risk is acknowledged and acted upon.

The migrants in peri-urban Karhera have not observed/experienced the negative consequences in major health terms even though they observe the risky conditions and are aware of the possible negatives.

On the other hand, they have experienced an improved socio-economic context due to the very phenomena that are producing the risk- industrialisation and urbanisation- and so those with a greater collective and rational-moral perspective state the risk while the others do not.

A deeper engagement with the village residents may reveal their perceptions regarding the pollution and its impact on health. Slide11

contd…

Since, in the peri-urban Ghaziabad village,

all caste groups have experienced the empowerment of ‘modernising’ and ‘urbanising’,

but also the dis-empowerment of lands being taken away, and not being fully given urban amenities or obtaining the urbanised cultural capital etc,

consciously acknowledging and stating the risk without being able to do anything about it would make life’s contradictions extremely difficult, and so would require deeper engagement to be expressed and captured.