This past week, I was fortunate to accompany the program director at FPAI-Hyderabad to his bi-weekly trips to local slums and villages where outreach clinics have been set up. During both of my trips to Jinnaram and Rasoolpura, I began to gain a better understanding of the difference and similarities of an urban versus rural setting.
My first trip was to Jinnaram, a village area located on the outskirts of Hyderabad. The car ride to Jinnaram, passing through acres of rice fields and countless poultry farms, took nearly 1.5 hours to reach our destination from the FPAI office. Upon arrival to the FPAI family planning clinic center, I was surprised to see the overflow of patients lined up in the waiting room to see the doctor. I initially expected the demand for services to be low since it took only 5 minutes to drive through the main road in Jinnaram. Patients ranged from grandmothers and grandfathers in line for routine check-ups to young mothers cradling their newborn babies. The resources of the center were well stocked, with patients receiving free medication at the end of the visit as well. The biggest challenge of all was being able to be creative when simple tools like table stirrups were not available. The doctors at FPAI courteously allowed me to sit-in on screenings and observe a couple of procedures. Patients underwent a visual inspection screening for cancer using acetic acid. Being in a rural region, the accessibility to certain tools could be unreliable. When the examination lamp broke and a flashlight was nowhere to be found, the doctor improvised by using her phone’s flashlight to finish conducting the cervical cancer screenings. To observe a different poverty environment, FPAI led me to their outreach clinic in an urban slum called Rasoolpura.
On the drive over to the Rasoolpura slum, I discovered that I was working in the second largest slum in Hyderabad. With a length of just over 1.37 kilometres, the narrow alleyways and stacked houses push the boundaries for occupancy capacity. Rows of blue barrels lined the sides of homes as families stock up on filtered water, sourcing the water from an NGO donated water tank that is often refilled unpredictably. The conditions of the population living in the urban slum seemed to face more challenges to achieve a high quality of life as I learned about their lack of a filtered water source, cramped living spaces, and low wage amounts that had to cover all food and living expenses. However, people in the rural regions are able to produce their own food, so their living expense are cut down. Many of the patient that visited the Rasoolpura clinic found out about the services through word of mouth and community-based advocacy. Each day, the doctors and nurses walk around the slum to share information with people about sexual and reproductive health after completing their shift at the center. The main operating challenge for the rural slum was having patients become aware of the services, so FPAI tackles this challenge by going door-to-door and distributing contraceptives in this manner as well.
Not only was I able to learn about the clinical side of healthcare in these regions, I learned about non-medical factors that directly impacted community members’ quality of life as well. As the living conditions and resources differ in each urban area compared to a rural region, I found that in both communities young women were motivated by similar reasons to sign up for skill training classes. From computer training to embroidery to beautician training, the centers provided a wide variety to satisfy each person’s own interest. Some people did not plan to continue higher education due to restrictions from their father. They wanted to build embroidery work skills to have a source of income to support their siblings and save money by making their clothes themselves. Others have plans to get their Bachelors or Masters degrees and simply took embroidery classes to fill their free time as they transitioned between school years.
The wide variety of future aspirations showed evidence of the rapid progression towards further education of young women in India and the resilience of girls to pursue an opportunity of higher education. However, the most distinct progress I observed amongst the young women was the willingness to pass along the information they gained through the sexual and reproductive health seminars. In a partnership with FPAI – Hyderabad, these girls had gotten information about a wide span of sexual and reproductive health topics. When I asked if they passed along the information to anyone else, many said they utilize the knowledge gained through the workshops to help their younger siblings learn about sexual and reproductive health topics (SRH topics). A young mother, with a 5-year-old daughter, said she was willing to discuss SRH topics with her daughter in the future. This confirmation shows a bright future for the next generation of elders to become more comfortable addressing SRH topics with their children. The evolution in SRH topics is rapidly changing within the younger generation and allowing for greater freedom of discussion. Regardless of their positioning as a youth from the rural villages or urban slum, I noticed a positive reception in wanting to pass along SRH information to future generations and reducing the taboo stigma around SRH. The generational shift towards open mindsets about historically unspoken topics is prevalent in both rural and urban settings.