Dr. Renu Rajbhandari has established a preventive health and treatment program for rural marginalized Nepalese women, including former prostitutes with AIDS. The program attacks the socioeconomic roots of the deadly female migration from Nepalese villages to Indian brothels, while also extending basic health education and services to needy village women.
The New Idea
Like many doctors, Renu feels she must do more than passively treat those illnesses that afflict her patients. Instead, she feels compelled to try actively to prevent diseases that threaten the lives of Nepal's citizens, including attacking the underlying social and economic issues that put people at risk. She recently established the Women's Rehabilitation Center, designed to help women who are culturally discriminated against, such as AIDS patients and former prostitutes. Because AIDS and prostitution are closely linked, Renu is helping to put a stop to the victimization of women that forces them into this means of support and creates a cycle of exposure. Through this center, Renu also extends health services at the grassroots level, and creates greater awareness of AIDS, particularly among this high-risk group. Under the umbrella of the Women's Rehabilitation Center (WOREC), Renu has launched a three-pronged attack against the dangerous cycle by which the majority of poor rural girls go to India to work in brothels, usually returning with HIV and other sexually transmitted diseases. To help those already suffering from AIDS, she provides counseling and rehabilitation. To help those at risk, she provides information about the dangers of AIDS. And to break the cycle, she helps women establish local enterprises that provide a living without recourse to prostitution. She is convinced that her approach is appropriate for the agrarian rural communities of countries such as Nepal, where women have long suffered from widespread social, cultural, and economic injustice.
In the Nepalese hills the active labor force is underemployed or unemployed during the agricultural off-season, with little opportunity to support even a subsistence lifestyle. This situation causes a mass migration of the active labor force. Particularly disturbing is the number of women and girls who go (or are sent) to India to engage in prostitution. Based on a preliminary study of the Sikharbeshi region, Renu believes that about ninety percent of thirteen- to twenty-year-old girls move to Indian brothels, usually for eight to fifteen years, after which they return to their native villages. In Nepal overall, some 200,000 women work in these brothels. These girls and women are the single largest source of STD/AIDS transmission in rural communities. This situation not only destroys the social fabric of Nepal, but exposes these women, and by extension their otherwise largely isolated villages, to the AIDS virus.
Nepal is already beset with many problems, including illiteracy, unemployment, poverty, endemic communicable diseases, and a deteriorating economy and environment. The disadvantaged segments of society are having great difficulty supporting themselves because of extremely high inflation and a narrow resource base. Nepalese women are especially vulnerable because of their lack of status within the family and society.
The HIV-positive women have to face social rejection, discrimination, and humiliation. They are not accepted by their families, their coworkers, or the community. If they are married, they are often rejected even by their own husbands. Many have children whom they will have to care for while trying to cope with their own social, health, and economic problems. They become homeless, jobless, and helpless. At this point, Renu stresses that these women can see only two bleak options: to return to prostitution or to commit suicide. In most cases, they choose the first. This, of course, exposes exponentially more people to HIV, whether back in India or in local Nepalese communities. There is an urgent need to provide these women with various forms of assistance, including shelter, food, health care, confidence, and occupational and emotional support. The establishment of the rehabilitation center, the first of its kind in Nepal, will meet these needs.
Renu has developed with WOREC a tripartite strategy to attack this cycle in all its phases. She seeks to help those already exposed to HIV, to educate those at risk, and to break the cycle before its conception. To help those who have already become AIDS victims, WOREC provides counseling, shelter, and medicine. The center headquarters at Gausala, Pashaputi organizes "health camps" in places where migration has been particularly marked, providing free medicine and workshops to create AIDS awareness. Already this program has had considerable success. For instance, at Sikharbeshi, the program has helped former prostitutes regain acceptance in Tamang society. Programs have also been established at Rajabas, Udayapur, Mahanki, Bouddha, and Kathmandu.
To educate those at risk, WOREC has produced a set of easily accessible materials, including leaflets, a book, and a cassette. These materials are discussed and disseminated at the various centers around Nepal, and, as of December 1992, a program was begun that carried the information directly to Nepalese prostitutes working in Bombay.
To break the cycle before it begins, WOREC has initiated an ambitious program to help poor women create or find work outside prostitution. At Sikharbeshi, for instance, a program called Bamboo Based Enterprise has been founded. Thirty-four women have been trained at the center to work on this entrepreneurial project, which provides them simultaneously with basic literacy, AIDS awareness, and the means to support themselves in the future without recourse to prostitution. The project aims to reach both women who have already been forced to turn to prostitution and those likely to. Another similar enterprise has been organized at Udayapur (called the Sikki Based Enterprise), and others are in the planning stage.
Renu believes that population migration, particularly into prostitution in India, can, to a great extent, be checked by educating the women and encouraging them to participate in enterprises that utilize local, readily available resources. This not only will help women of poor households generate extra income, but will also educate and motivate youths to participate in similar enterprises. Consequently, the migration of girls and women to India will be reduced. This will ultimately reduce the magnitude of the spread of AIDS/HIV in the community. Renu's strategy is to extend WOREC to high-risk districts step by step, helping the rural population, particularly women, understand their own needs, resources, and responsibilities. Consequently, priority is placed on educating them for optimum utilization of their available resources (including manpower of the household), while taking into consideration their social responsibilities. She is convinced that rural communities would begin to move toward prosperity if they became more aware of epidemic and communicable diseases, basic health care, and sanitation and were provided with technical assistance for both farm and non-farm enterprises.
Born in the village Padampur of Siraha district, Nepal, Renu felt at an early age a need to help the poor and diseased that she saw in her village. She was admitted to the Institute of Medicine, Kathmandu, after completing her high school education, and subsequently went to the Moscow Medical Institute in Russia to follow her dream. Immediately after qualifying as a doctor, Renu returned to Nepal and started working at Maternity House, Thapathali, Kathmandu. She transferred to the Kanti Child Hospital, Kathmandu, and then to Siraha Hospital, Chitwan. For the last two years, she has been working at the Central Health Laboratory, Teku, Kathmandu. In the course of her work she has interacted with patients belonging to a broad variety of ethnic communities and socioeconomic strata, and has increasingly felt that the national health services are not only insufficient but also inappropriate for rural communities. She felt there was a need for efficient health education programs at the grassroots level because of the dangers of poor hygienic and sanitation conditions due to ignorance. When she joined the Central Health Laboratory, she had the opportunity to become familiar with the working styles of the AIDS Prevention and Control Program. She also participated in some of the villages' AIDS meetings, but remained unconvinced that the spread of AIDS/HIV could be checked only by simply conducting classes and publishing booklets.
Finally she decided that to overcome the health problems of the Nepalese rural poor, a comprehensive program would have to be designed that addressed at once the causes of disease as well as the symptoms. She placed a high priority on making AIDS awareness an integral part of the program. Guided by this philosophy, Renu established the Women's Rehabilitation Center in June 1991, and has since provided leadership to this service-oriented, citizen organization in her capacity as executive director.