My heartbreaking session with the village health workers and its influence on my life

I had an especially powerful and moving session with the village health workers the other day that I feel is important to write about. We were discussing anxiety and after some repetition of the meaning and symptom of anxiety about a third of the women recognized it in themselves. It was a powerful hour and a half of life story sharing, crying, and mutual support as we all came to realize the extent and toll of mental ill health in this area. It was especially emotionally jarring for me because many women looked to me for help and I felt powerless to do enough.

Before I go on, however, I think it’s important to give some background. I have been teaching these women about mental health for the past two months, covering such important topics as mental illness, mental health (in a positive sense!), depression, and now anxiety. They are soaking in the material because they are absolutely incredible women keenly interested in improving the situations of their fellow villagers. My initial goal is to just raise their mental health literacy so that they are even aware that mental illnesses exist and then to discuss prevention and treatment! There is, of course, plenty of experience with “madness” and people talking to themselves, etc., but no knowledge of where this comes from, no idea that excessive sadness or worrying can also be seen as illness, and no concept of the possibility of treatments. It’s been quite eye-opening to realize that I am introducing many of these women to a world in which these afflictions need not be accepted as a normal part of life but instead treatable and preventable life phenomena.

It took some time for them to understand depression. It’s understandably difficult to conceptualize for the first time without any prior life exposure to the idea, and I broke it down to an imbalance of the “juices” in the brain caused by a particularly stressful life experience that causes excessive sadness. It’s tricky work because for people who haven’t grown up with a culture that includes psychology the idea that “excessive sadness” can be an illness is not intuitive or easily accepted. After running through the symptoms, however, and talking about how depression is different than sadness because of its duration, interference with daily life, and physical symptoms, the women began to open their eyes to this new world.

With this solid foundation teaching anxiety was much easier. On the second day, however, during the review, the meaning and symptoms of anxiety finally sunk in for many of the women. During the tea break three of them came up to me and shared their stories. The first woman, Soonya, talked about her daughter. The daughter’s husband beats her, causing her to sometimes feel that she is suffocating, to occasionally tremble all over her body, and to feel her heart beating rapidly whenever he comes near her. The second, Jyoti, discussed her own experience earlier in life with suffocation, trembling, dizziness, worrying too much, intense fright, and avoiding certain situations born out of her experience in her husband’s family when she hadn’t yet given birth to a son. The last one, however, was the most powerful.

Surya (pictured) is a new village health worker with a gorgeous smile and eager countenance. She quietly told me about her life, looking into my eyes with her soul as she recounted her pain and yet expressed her strength. When her husband is around things are fine, but when he is gone her father-in-law beats her up. She has many of the symptoms – palpitations, suffocation, dizziness, and difficulty sleeping – and others indicating a coexistent depression. It was tough to hear. Then she asked me what to do. Knowing that medication, counseling, and support groups wouldn’t make a difference without the triggering situation of her abusive father-in-law being removed I began to hatch a plan in my mind where she teamed up with the women’s group and accost the man demanding that he stop. At this point, the translator looked at me and laughed a sad laugh. “This is India,” he said, “if she does that, she’ll be thrown out of the house.”

As the translator and I talked it out and realized that nothing could be done, Surya waited patiently for the reply in Marathi. How could I tell her? How could we say that there is a route to a better life, and that the main part of it is something seemingly impossible? How could I tell her she was trapped, and unless she found a way to escape life was only going to get marginally better with medication and counseling? I ended up thanking her for her strength and saying this was a very difficult situation that would require more discussion, and that we should wait for Dr. Shobha. It was a dodge, but I didn’t know what else to say.

We returned to class, they shared their stories, and what was supposed to be time to make up skits turned into time to discuss reality. Emboldened by the previous village health workers, woman after woman came up and shared their life histories of abuse, of getting burned for not having enough dowry money, of getting beaten for producing daughters and not sons, and even of getting stabbed by a drunk and angry husband. They shared the symptoms of anxiety they expressed, and we had an all-too-real and unexpected session of “case studies”. When asked, 1/3rd of the women stated they had contemplated committing suicide.

It was heart-breaking and unsettling, but for me the most difficult part was their request for help. They all looked to me, and I explained that I am actually not a doctor, that I am just a student and that I teach myself what I teach them. I have promised to look into counseling and support groups so that we can work together to start those programs but the lack of an immediate response or answer saddened me. These things take time, and it will definitely be awhile before they will find the happiness of health again, but I just wish there were systems in place already.

The class ended with my repeatedly thanking them profusely for their courage and strength to share their life stories. I talked about the trust and community that had been built today. We then stood in a circle, held hands, and sang their song telling women to leave the kitchen and come together to make a better world. It was powerful.

In the days that followed I spent awhile reflecting on Surya’s position. She is not alone. There are many thousands of women here and around the world who are trapped in such situations. Women have incredibly low value placed upon them here. I believe, from a materialist viewpoint, that this is largely so because of the Indian social practices of patrilinearity and dowry. In India, a poor family loses its hefty investment in raising their daughter when she leaves the house for her husband’s upon marriage. On top of that, each daughter means a burdensome dowry that often puts the family in debt but must be paid if she is to marry. These social practices are incredibly difficult to alter, but it makes me wonder dreamily if only, if only. It would make such a difference.

The stories of the women made me appreciate with new insight the good brought by feminism in the West. India has only a budding women’s movement, and it only really reaches the rural areas via development organizations. There is a lot to be done, but people are working on it. Social change takes a long time. We were there earlier, and we ourselves still have a lot further to go.


And that change for the better is what I am committing to. People here often ask me what I plan to specialize in or do after medical school, and I tell them that I don’t know. I am keeping my options open. I am, however, certain that I will make it my life’s work to bring more good into this world. And I will no doubt draw some lessons from this place. Jamkhed has a chapter in the WHO’s book on mental health policy in which they discuss how their work for women’s empowerment, the end of casteism, and poverty reduction has affected the social determinants of mental health and produced a healthier society. In this preventative view, by making the villages a better place to live materially and socially they have created physically and mentally healthier populations. In other words, they have created “development”, and they did it by wielding their knowledge of curative care in ways that went way beyond the hospital. I imagine I will do something similar.

The next question is whether that will be in mental or physical health. I don’t know. I have read about and sort of understood how mental health is a blind spot in global health. It’s not talked about enough and still stigmatized in our society, let alone not having any knowledge about even the existence of mental illness in many parts of the world! But that weakness was brought home to me in this experience. The mobile health team has been working with some of these women for 30 years and even they didn’t know all of the stories nor understand the anxiety many of these women were experiencing. Jamkhed has made a huge difference in physical health for 40 years, but only recently has mental health become an objective. I understand the need, but we’ll see where I go. Either way, that class was quite a powerful learning experience, and I don’t think I will forget it anytime soon.


*The names of the village health workers have been changed*