In the Bonesetter's Waiting Room

by Aarathi Prasad

  Through her oracle Sabawa, this powerful and avenging goddess continues to draw Dharavi’s women to her: women who are in abusive marriages, women who, for whatever reason, are considered by their families to be mad. ‘The devi normally enters people when they are having many problems,’ Rayvan said. Possession and a distressed state of mind are inevitably linked. Sadly, as I would later learn, many Mumbai psychiatrists are unwilling to link the same distress to a more prosaic cause: the domestic abuse suffered by Dharavi’s women.

  Compounding this, there is no psychiatric department at Chota Sion. This situation is by no means unusual.

  World Health Organisation data reports that there are only 43 mental hospitals with in-patient care in the country; for every 100,000 people, there are only two hospital beds reserved for mental health. Though many parents in the country and among its diaspora populations hope their children will grow up to be doctors, in India psychiatrists are not held in particularly high esteem. It is estimated that there are only between 3,500 and 5,000 psychiatrists in the entire country, a number which equates to one doctor to 200,000–300,000 people. At the main Sion Hospital (less well known by its official name, Lokmanya Tilak Municipal General Hospital) victims of domestic violence – generally women – are typically treated for injuries, but not for the wider issues involving emotional or psychiatric fallout because the resources for this are in short supply. To fill the gap between the way Western medicine separates body and mind, patients often consult a baba (holy man) to get rid of the bhoot, but Sabawa believes they are charlatans who take money in exchange for false promises or useless treatments. She is very clear that when patients come to her for help, she first asks them if they have already been to see the psychiatrists at Sion. She asks whether they had been given medicine and whether they have taken it. She will agree to intercede ‘Only if nothing else has helped. Then, it is the work of the devi.’

  In the traditional and folk forms of medicine practised in India, diseases of the body are intricately linked to the condition of the mind, and perhaps also to the idea of a soul. The lack of dissonance in many of those who came to Chota Sion was fascinating – patients were perfectly at ease making an offering to the devi as they passed the shrine en route to their medical appointments inside the building. They had come to be healed, by whatever means.

  This sometimes resulted in clashes between the devi’s courtyard representatives and the hospital medics over the best way to treat their devotees-patients. During one of Sabawa’s rare departures from the shrine, Shankar, the thirty-four-year-old priest-in-training, thought it best to leave a young woman, who had collapsed while waiting in the covered walkway, rolling about the paving slabs in convulsions. Though Shankar had not expected the goddess to jump into action in his mistress’s absence, it seemed entirely reasonable to him that she had chosen to take over this young woman’s body. After all, she had come for divine intervention and Kali Maata was not one to disappoint. However, the truth was that the young woman had been waiting not to consult the oracle, but for her father, who was inside collecting his daughter’s epilepsy medication having left her sitting comfortably on the low wall that bordered the shrine.

  Three floors higher, on a wing of Chota Sion that was bisected by the red-stained stairwell, Western medicine ruled unopposed. The back half of the wing was an L-shaped women’s ward and, much like the staircase, its brutalist space had a long-forgotten quality. Rows of vintage, uncurtained metal-framed beds stood close together policed by severe nurses in old-fashioned, starch-stiffened dresses with navy epaulettes and matching wimples. Infants lay with their mothers on some of the beds; husbands, brothers, fathers sat in the waiting area outside.

  Walking across the hall was like moving forward four decades. I stepped into a corridor of neatly partitioned offices, where smart young women in kurti tops and jeans were busy at their phones or computers: some developing apps, I later discovered, using open source data and GPS to help women in the slums map violence with their phones. Preventing violence, gender inequality and its consequences – depression, anxiety, addiction, disease and disability – was the business of Nayreen Daruwala, a doctor of social psychology who had specialised in mental health. Her office was one of four cubicles which made up the offices of SNEHA: the Society for Nutrition, Education & Health Action, set up nineteen years after Dharavi’s hospital with the aim of reducing maternal and newborn mortality, malnutrition and domestic violence.

  The room was large, white and sparse, furnished only with a desk, her laptop, a mobile phone, four plastic chairs and a ceiling fan that was never silent. The folders shelved in a small built-in cupboard made her office a hub of interaction, with a regular influx of colleagues fishing out files, raising questions and engaging in project discussions with Nayreen, whose warmth and energy were almost palpable. Either side of the filing cupboard, windows framed sections of the vast spread of tightly packed, monsoon-sodden tarpaulin-covered houses down below, giving a powerful sense of being entirely enclosed by the slum. Through the windows, damp breezes brought the smell of rain and periodic refrains of Allahhu akbar from Dharavi’s muezzins below.

  I asked Nayreen what she made of the goings-on in the hospital shrine below.

  ‘After the hospital rebuilt the shrine, people started considering Sabawa to be pious and asked her to help them out in difficult situations by praying to the goddess – they approach her in difficult situations, they make offerings of goats as a sacrifice to alleviate problems in their lives and appease the devi. People resort to all sorts of things in Dharavi – there are healers for jaundice, skin, mental health, venereal disease, blindness; there are bone-setters. Dharavi is a mini India, it’s amazing how they blend over here.’

  The slum had certainly been a magnet for economic migrants from the countryside. Nayreen explained the difficulties facing farmers in making even a small profit or repaying loans. Among farmers in India, suicide rates are shocking. But an income was not the only reason people came. ‘Healthcare in Mumbai is actually quite good – in fact there are people who come to Dharavi especially to get treatment,’ Nayreen continued. ‘Some of them may already have had family here, but while they waited six months to be seen, or while they or their parents or wives or children continued their treatment, they became settled. They work here, their kids start going to school, they stay. On the other hand, some people have a distrust of medicines and hospitals,’ she continued. ‘They say, “I’m not mad.” They think they get ill because someone “put something on them”. If women are in anxiety or depression, they’ll say, “She’s got the devil in her – when it leaves, she’ll be fine,” or when they have an attack, they’ll go to a baba. They’ll be fine for a while, but then come again to Chota Sion.’

  The gender-based violence project that she heads came about when a neonatal doctor called Armida Fernandes noted that many of her patients were talking about the violence they faced at home. She was trying to save mothers in labour and the lives of their new babies, but realised that nothing was being done to protect their health once they left the hospital. Together Armida and Nayreen began approaching every doctor at Chota Sion, asking that they refer anyone showing signs of domestic violence for psychological intervention. The assessment of the mental health of women suffering abuse was something that had never before been offered to Mumbai’s poorest migrant families.

  It was slow to get off the ground, with women reluctant to consider counselling. ‘They’d say, “I don’t need treatment, give me money for my daughter’s education instead,”’ Nayreen recalled. It came as no surprise. Physical violence, particularly towards wives, is accepted as normal. ‘Many women say things like, “He was right to beat me, I didn’t put enough salt in the food,” or the husband’s parents ask their son, “Why are you treating her so nicely? You should beat her.” It’s accepted by men and women, it’s the husband’s right.’

  Throughout 2001, Nayreen recorded intervention in only seventy-eight cases; they now have
a database of 4,000, ninety per cent of whom are residents of Dharavi. ‘I’ve seen women come in with all kinds of conditions – terrible head injuries, broken noses. But because the centre has become more popular, we see women coming earlier.’

  In Dharavi, one-brick partition walls divide the crush of tiny houses. These rows of homes have front doors that face each other across narrow alleys – gully streets in which people must almost press against each other to pass. Here, privacy is rare and community is key. It was the power of word of mouth – gupshup, chit-chat, the intervention of mothers, elder sisters, aunts – that saw SNEHA’s initiative snowball. Through aligning with these intimate lines of communication, Nayreen’s fifteen years building the counselling centre at Chota Sion have given her an encyclopaedia of stories ranging from the inspiring to the weird and the simply terrifying. There was the tale of the woman who dipped a piece of paper into her husband’s tea every morning to cast a spell on him to curb his infidelity. It was her way of taking control in a world where women have little. More alarmingly, the soothsayers who ‘prescribe’ these chits of magic paper sometimes also infuse them with herbal poisons, for extra potency.

  Then there was the story of one of Nayreen’s colleagues, Sitaram, and the exorcism performed on his wife after a seven-day prayer session in the local Presbyterian church. ‘But Sitaram is a Hindu name,’ I said, confused. Nayreen smiled. ‘No one can explain how his wife got better. There must be an explanation, but it seems like a miracle – she was very severely ill. You should ask him about it.’

  When I found Sitaram, he was in an arts centre that Nayreen and colleagues had set up. Finding space for an art gallery in Dharavi had been a costly challenge, but inside Colour Box the work of local women was being arranged for the Dharavi Biennale – the world’s only Biennale hosted in a slum. The art they had made – textiles, furniture, paintings with themes of family, martial discord, rape, dreams of homes that were safe and salubrious for their children – functioned as therapy, as well as developing vocational skills and for earning an income for the artists. The facade of the narrow rented building – which had once been crumbling plaster and exposed brick – had already been painted with the project’s colourful logo, a quadrant containing a heart, an eye, a cross and the symbol for infinity, symbolising health, art and recycling. Like the tarpaulins from luxury apartment builds, in Dharavi, everything became something else.

  Outside Colour Box, Sitaram greeted me jovially, chatting as we walked back to Chota Sion and periodically shielding me from the chaotic rush of vehicles which paid pedestrians no heed. He was the kind of person anyone would take an instant liking to: friendly, funny – with a delightful grin that lifted up his neat moustache when it appeared. As he negotiated the feinting umbrellas and found us footholds along the main road, which was rapidly filling with water, he told me how his wife, who had been diagnosed with multidrug-resistant tuberculosis and given months to live, had woken up one morning speaking in tongues. Specifically, in Tamil, a south Indian language that she had no previous knowledge of or exposure to. Sitaram had been born into a Hindu family from a rural Maharashtra village, raised in Dharavi and later became a convert to Christianity. Much as the patients who saw no conflict in making offerings at Sabawa’s shrine en route to accessing modern medicine for the problems that ailed them, Sitaram seemed to be relating a similar underlying narrative in which, in seeking a cure, the lines between the spiritual and the physical were blurred. When doctors were unable to effectively treat his wife’s tuberculosis, she both continued drug treatment and turned to the Christian church – and later the Hindu temple – in the hope of being healed. Though bearing parallels to devi possession, speaking in tongues seemed like a particularly ‘Christian’ phenomenon, for which Sitaram naturally turned to a Dharavi church.

  ‘We are from a village in Maharashtra; Varsha, my wife, spoke only Marathi,’ Sitaram told me.

  ‘So how did you end up at the church? Is your family Christian?’ I asked.

  ‘My family all converted. I did too. I was happy to.’ He smiled his jolly smile. ‘I like Jesus. We took my wife to the church and the priests sat in a circle around her and prayed. She kept talking in Tamil, but after seven days, she stopped. She was healed.’

  ‘And what about the tuberculosis?’ I asked.

  ‘For that, there was nothing we could do. Her lungs seemed entirely damaged. The medicines were not working. I sent her back to the village for a while with the children – I had to work but I thought she would be much more relaxed there, it is less stressful, you see.’

  I nodded.

  ‘In the village she was taken to the temple. The devi is worshipped there, she was the goddess we prayed to before. In the temple, the villagers said prayers for her. Then the goddess spoke to one of the village women and she told us, “Your family has left your own gods, your own beliefs. Come back to the goddess and whatever is inside your wife will leave her.” Varsha stayed in the temple. There they prayed over her and one day, her hair suddenly became wild like the goddess’s. They told me the goddess had entered her and when she went back to normal, after the prayers had finished, she was better. The tuberculosis had gone.’

  As we arrived at the gates to Chota Sion, I found myself partly attempting to calculate the probability of recovery from an apparent advanced state of lung damage and partly getting used to the divine modus operandi that Dharavi’s residents seemed perfectly at ease with.

  By the time SNEHA opened its doors in 1999, its clientele had long since become inured to cases of extreme violence to which both they and the police routinely turned a blind eye. Back in her third-floor office, rain still battering the tarpaulins below, Nayreen recalled to me her frustration at two early cases concerning the murder of young women. The first victim was the fourth wife of a man who set her on fire because she had brought no dowry. The second case was very similar, but in neither were there any witnesses willing to give evidence. Nayreen had told me of the strength of the community in Dharavi’s mini-India. The bond between neighbours that provided fraternal support, but which could also become a wall of silence in the face of trouble, would become one of the greatest allies and obstacles to SNEHA’s work.

  And then another murder was reported. ‘This time it was a twenty-one-year-old woman who had just got married. While she was walking home one day, two men followed her making lewd suggestions. When she ignored their catcalls, they said she had disrespected them. The next evening they and one of the men’s wives came to her door and forced their way in, severely beat her, locked her in her house and then set it alight.’

  As the recent reports of gang rape testify, violence against women in India remains a depressingly intractable problem today, not just in Dharavi but across socio-economic groups throughout the country. But for Nayreen, this historic burning drove home the fact that the circle of violence and mental illness among both women and men would require much more than counselling if it were ever to be broken. ‘The whole community saw what was happening, but no one intervened – and afterwards, no one would talk. We had no clue what we were going to do. There were several other NGOs that could have helped gather evidence, but none did.’

  While the badly burned victim fought for her life in hospital, Nayreen continued to work with police and the public prosecutor, trying to to build a case against those responsible.

  ‘I was curious about why no one in such a tight-knit community was prepared to speak out about such a brutal and unprovoked murder of one of their own.’ Nayreen ascribed it to a mixture of fear and the cultural acceptance, ingrained over centuries, that men had the right to assault women with impunity. Mothers often stay in abusive relationships only for the sake of their children, and sometimes blame them too: Nayreen has heard five-year-olds say that they feel it is their fault that their mothers suffer. The deep and lasting psychological damage of such cycles of violence is not difficult to imagine.

  ‘It’s the whole family unit – that case made me und
erstand that traditional psychotherapy would not be possible,’ she went on. The ‘family unit’ in Nayreen’s terminology was far broader than immediate relations. It included those who held honorary titles of uncle or aunt (who could be anyone at all) and even close neighbours. All were invested in their community relationships, so any could be quite seriously affected. ‘Slums are strong communities. When I began offering counselling sessions, the whole family would come – mother, sisters, neighbours. It became community counselling.’

  The girl who had been attacked died from her burns, but she first rallied sufficiently to give a statement identifying her killers, who were subsequently gaoled for fourteen years.

  Because of her involvement, Nayreen had become a target. ‘One of the men swore that he would take revenge on me. I don’t know what will happen. There are only a few years to go now until he’s released. But he’s had counselling in prison, he is not as violent as he was.’

  Stoic as she is about the murderer’s reformation, it would be a satisfying end to a sad, violent story if he were to emerge from his sentence a milder man. To change the trajectory of culturally accepted violence has always been the aim of Nayreen and her team. There are now ninety-two local women’s groups with more than a thousand members, and counselling programmes at Chota Sion that both women and their husbands attend regularly.

  In India today, the healthcare given to many women is ensnared in gender inequality. Under her perpetually whirring ceiling fan, Nayreen and her colleagues explained to me at length how differently men and women are treated when they become physically or mentally ill – barriers that can be erected both by the Indian healthcare system and by the people it is supposed to serve. Gauri, the coordinator for SNEHA’s counselling centre, described to me how, in many Dharavi families, if a man is ill it’s common practice to take him to hospital, while a woman in the same situation is just given a bottle of simple painkillers by her in-laws and stays at home. ‘And worse,’ she told me, ‘depression – any kind of mental illness in women – is seen as grounds for divorce; a reason to abandon their wives with nothing, no support.’