Project Ankur Blog, Reflection from Marina Marcus and Srishti Sardana

August 2015

How Do You Feel?

…This is the question that our conversations with people in Baroda, India begin with. Project Ankur has brought us both to a new environment: for Srishti, a new city, and for Marina, a new country. Project Ankur is attempting to explore and better understand the mental health needs and perceptions of female sex workers who work and live in Baroda. In collaboration with local community-based and non-government civic society organizations, our goal has been to directly ask the women about their experiences with mental illnesses, their experiences with sex work, and the barriers, if any, to accessing healthcare services.

Women who participate in sex work have lived through many difficult experiences, such as violence, isolation, social stigma, discrimination, exploitation, and countless other adversities. The available literature highlights similar factors that increase the risk for mental disorders in this population. We were familiar with this research, but felt keenly aware that such distressing contextual information didn’t integrate a sentiment of personal agency, resilience or strength into the images of sex workers that it generated. We wanted to meet the women, listen to their stories, and be informed by them to find out if mental health interventions were relevant to their needs, and if so, how we could build upon their existing systems of support to promote their well-being in a way that empowered their collective identity, while enabling them individually.

We have been invited into the homes of sex workers throughout Baroda to hold focus groups and individual interviews with the women. While we were initially unsure of the access we would have to the community of sex workers in and around Baroda, we are overwhelmed by their acceptance of us, and their willingness to speak to us candidly. The women are coming and they are sharing their experiences of isolation and distress, while providing us with glimpses of the strength and support that they find in each other, through crisis and celebration alike.

Our time with the women has been challenging on many levels. Our role has been to contain their narratives that have long remained quiet. Some of these women have lost love, lost family, lost God; yet they have lived for their children. They have shared stories describing their spectacular sense of motherhood and their commitment to bring up their children with privilege and comfort has often pulled them out of the deepest zones of hopelessness and threats to self – from drugs and suicide. We have found many moments that have resonated with us, and we have found those that have alienated us. They have shared with us their many challenges with mental health problems, including excessive use of intoxicants, depression and ghabraahat (anxiety-like symptoms), and have shown us their scars, injuries and marks on their bodies that are all remnants of their past and the lives they currently lead.

Project Ankur has progressed beyond many hurdles, and we believe that this steady headway has been made possible by the on-ground support of the community health workers, peer educators and the women themselves, who have offered us space within which they have trusted us and confided in us their stories of torture and resilience. The women tell us that no one has asked them about their well-being, or about the impact their work has on their personal lives. No one has approached them with the goal of learning about them and from them. They have also shared some of their resources that make them, or have made them resilient over time, and have expressed their need for services and support for healthcare. While it is clear that their needs are complex and their stories abundant with emotional distress, their motivation to improve their level of access to health resources is present and self-driven. So, how do we feel? Genuinely honored to be given a window into the lives of a marginalized yet highly resilient community of women, and eager to turn our new knowledge into collective action.

Photo provided by authors of the blog. It was taken after a focus group with health workers who treat sex workers and could provide us with information on the general health complaints sex workers may present with, and their points of access into the healthcare system. The photo includes social workers, counselors, a clinical psychologist and a general physician.

Author: Srishti Sardana and Marina Marcus, the 2015 team fellowship recipients. Srishti is in the Masters’ Clinical Psychology program and Marina is a doctorate student in Clinical Psychology, both at Teachers College.