Laurie's New Groove

This week has been the coldest yet in Jaipur. My flat is cold. The office is cold. The outside air is cold and sadly it is usually warmer than my flat or office. Every day I wear long pants and leg warmers (not the kind from the US in the eighties), at least three shirts, a thick wool sweater, a coat, a hat, a scarf, and sometimes my ski gloves. I sleep in about the same number of layers. I have also taken to boiling water, putting it in my Nalgene bottle and sleeping with it for extra warmth, which makes me feel very nineteenth century. I was talking about the weather with my landlord, and he said that what we are experiencing is not normal for Jaipur; usually by this time in the year it has begun to get warmer again. Oh well, I should appreciate the cold while I can, before I start writing and complaining of the 45-50oC heat, which is about 113-122oF for those of you not intimately familiar with the Celsius temperature scale.

This week has been a big turning point for me. I feel like I have finally adapted to living in India. Things that concerned me before no longer bother me as much, and, yes, the change was pretty abrupt. Maybe it is because I got up every morning this week and exercised. Or maybe my ability to finally exercise on a daily basis is a result from my mental shift. I don't know. What came first the chicken or the egg? At any rate, I hope it is a permanent change. It has also allowed me to engage on a deeper level with my students. I think I have been emotionally holding back from them, because I was wrapped up in not being able to work to the best of my abilities due to lack of resources and organizational support at my NGO. Anyway, I have much more energy and feel more like true self than I have since arriving here. Yippee!!

This week India celebrated Republic Day on the 26th. Bodh had several celebrations. On the 25th, students from several of the different bastis came to the Kukas campus (Bodh's main office, which is located outside of Jaipur) and performed and displayed their artwork. At the end of the program everyone sang "We Shall Overcome" in Hindi, which was very moving. The whole event was actually pretty emotional. I also had mehendi (heena) done on my hand for the first time. On the 26th Bodh staff got to choose one of the bastis in which there is a Bodh school to celebrate Republic Day with the community. I went to the Guru Teg slum (a predominantly Sikh community) and watched more student performances and got some great photos of the kids there. I continued the celebrations by coming home and doing laundry for four hours, which means I scrubbed clothes in a bucket for a long time. Can you say prune hands? Yes, my life is the picture of excitement. Try not to be jealous.

On a more sober note, I found out that one of my class ten students got married this week. I had not seen her in class and so asked about her. Her classmates told me her family was having some troubles, and one of their solutions was to marry off their daughter. She did not want to get married. I know that Rajasthan has more serious issues with child marriage than other states, but one of my sweet students being forced into marriage made it a reality. She's fifteen. She should still be in school with her friends, being silly, being a kid. I also know that handful of my students were married when they were five or six, as is pretty common in villages here, but none of them have actually gone to live with their husbands. (FYI, the average age of marriage in India is just above 17 years of age, but the average age in the state of Rajasthan is three years younger than that. Rajasthan also has some of the worst nutritional problems in India.)

To completely shift gears and talk about something shallow, I got to ride in a car last night. It is only the fifth time I have ridden in a car since being in India. The other four times were all very brief, maybe five minutes each. But last night I was in a car for a solid hour. It actually made me giddy. I think it was so exciting because the car was actually warm and very comfortable. The seats were probably the most comfortable things I have sat on since being here, and I cannot describe how refreshing it was to be in a vehicle with shocks.

This upcoming week also marks a big symbolic step in my time in India. When January ends I will have officially been here five months; half of my fellowship will be over. This will be commemorated by a very special event, the changing of the toothbrushes. (Before coming to India, I used a mechanical toothbrush on which I would change the head whenever it looked like it needed a new one. Thus, I did not have a good idea of when one should normally change toothbrucshes.) When packing to come here, I brought two new toothbrushes with me and decided I would start using the second one when half my time in India was over. I would have changed my toothbrush earlier if I had not had it fixed in my mind as an event that could only take place once I had been here five months. Thus, Thursday night my old, orange toothbrush will be retired after a final brushing and be replaced by a new, Oral-B, light blue toothbrush. All are invited to make the journey to Jaipur to attend the ceremony. It should definitely be worth the time, effort and/or money it takes you to get here.

Anyway, enough of this meandering message. I am signing off until next week when I will hopefully have all sorts of wonderful and exciting things to share about my trip with Gia (another AIF fellow) to Jaisalmer and Jodhpur.

Lots of love,
Laurie Mason

Dedicated to Rahul “Kamble”

A name that existed for less than 24 hours but a boy that will forever be remembered by the women at Saheli and me.

In my medical career thus far, I have had one patient die under my care, my direct service as a student: one very sweet Mr. R.W. during my general surgery rotation in my third year of medical school. He was old in age, a poorly controlled diabetic for many years resulting in the amputation of one leg below the knee and had been hospitalized for many weeks. His bed sores were the first I had ever seen in my life and after which I have not seen any that can nearly compare in severity. I remember going home one evening after rounding on the four patients I was carrying thinking that he was doing better but still has a long journey ahead. The next morning, I arrived early to prepare my notes—gathering the vitals and events from the previous night—and walked toward the file cabinet. His chart was not there. I checked on the computer for his vitals but his name was missing from the list. He had died during the night and I only found out in the morning. It was a difficult experience; my first time dealing with someone that I was caring for as a student doctor, yet there was an element of distance still because he was not my sole responsibility. There was always someone above me, a resident or attending, ensuring this gentleman’s care.

Friday morning just before 5am, my second patient died: A young, vibrant, energetic, sharp, rascal of a child named Rahul.

For the first week of January, I was on vacation with my parents and sister around Maharastra and then traveled to Dubai for a week. It was the longest time that I had been away from the Saheli crèche since I started working there in September. Sometime during those two weeks of my absence, Rahul had contracted measles from one of the other children. There were approximately nine children total with measles, exemplifying the inadequate access to immunizations in marginalized communities of India. These children—the next generation of commercial sex workers, beggars, or thieves, or potentially computer engineers, doctors, or teachers if they stay on track with their education—comprise a mixed group. Some lived with parents who were knowledgeable enough to take them to the doctor at birth and in infancy; some have never known the touch of a medical professional. Still, they all live in the constant threat of malnutrition, physical abuse, and neglect. Basically poverty.

The crèche was started to battle against these obstacles by providing a safe space for the children. The goal was to take them out of the brothel environment and give them a chance at a better life. The difficulty comes when providing proper care in terms of nutrition, education, health check-ups, and exercise is directly linked to money and time. This is where I fit in: As a medical student from the United States, I am supposed to fill this gap in delivery of health care. As an American India Foundation fellow, I am supposed to fill this gap in money and time. I cannot help but feel responsible for taking vacation, time for myself, to return only to the uncontrollable situation at the crèche of Rahul’s medical condition.

Back to the story, I arrived at the crèche on Tuesday. Rahul had been having low grade fevers on and off over the last few days by report from the women. He was breathing comfortably though very irritable and refusing to drink any milk. They had gone to the doctor the day before who prescribed Albenmite for the tape worm that he vomited a few nights before. We revisited the same physician at 5pm on Tuesday who said that Rahul seemed to be improving but that we should add Cefpodixime. I learned later that he was probably giving coverage for any potential superinfections associated with measles. We returned to the crèche that evening and gave him some vitamin B and iron supplementation for the angular cheilosis at the corners of his mouth. Granted one dose was not going to cure his deficiencies that may have caused the lesions, but it seemed like the best course to take at present.

The next morning I returned to the crèche to check on Rahul and immediately saw that he was tachypneic with a respiratory rate in the 40-50s and tachycardic in the 115-120s. There was obvious nasal flaring and subcostal retractions (though I know you mostly see those in babies, with his weight of only 10kg for an estimated 5years of age, it was apparent). I recommended to the women that we admit him to the hospital because I did not feel comfortable caring for him at the crèche. We quickly packed his and one of the Thae (sister)’s overnight bags and went to a seemingly respectable and proper pediatric hospital. We waited for half an hour even though I stressed the critical nature of our child’s case versus the well-baby checks that were ahead in line. Our name was finally called but only to sit in another set of chairs, outside the waiting room but closer to the office door. Our names were called again, this time to sit in the office but in the back row watching the previous patient’s examination.

As a side—the idea of HIPAA, privacy, and confidentiality does not exist in India. It may be changing in the adult patient population, especially in the private hospitals modeling after the States and Europe, but definitely not in the pediatric population.

Finally, we approach the physician’s desk, not examination table because the doctors never touch the patients anyway, and he asked,

“Name?” “Rahul.”

“Surname?”... well, we did not actually know his surname because we did not know who his father was, whether he was alive, living in Pune, anything. “Kamble” we answered.

“Age?” “5 years” estimating based on his activity level, motor and speaking skills, and the fact that he has 6 other siblings.

“Address”… well, again that was tricky. He lives in the Saheli HIV/AIDS Sanstha Sangh crèche. As I have mentioned before, we are an NGO advocating for the rights—health, HIV and AIDS education, financial security—of commercial sex workers in the brothels of Budwar Peth. There is was, on the table lay our loving boy Rahul breathing heavy and right next to him the words HIV, commercial sex workers, and Sanstha (charity). I worried that we would have trouble with a hospital admission for those very reasons, but somehow I had faith in this physician. I was wrong.
He diagnosed post-measles pneumonia, by his account bilateral after investigating with fluoroscopy. “Change the antibiotics to amoxicillin with clavulanic acid, get these tests done (CBC, ESR, CXR), then come back in three days.” Out the door.

I still felt that Rahul should have been admitted to a hospital for IV rehydration, IV antibiotics, oxygen, and close observation. The doctor, a well established pediatrician far more knowledgeable than I as a student, sent us home. I emphasized to the women at Saheli to take special care of him that night, making sure he drinks the oral rehydration solution and milk and takes his medications appropriately.
The next morning, I took Rahul for the clinical tests and not to my surprise, the doctors at the testing center refused because he needed to be admitted immediately. I took him back to the crèche and again, we packed his bags and went to a different hospital.

This morning at 5:14am my phone rang. It was Didi from the crèche. In Hindi, she asked if I could come to the hospital. “Rahul’s condition is very serious” she said. It was dark and ominous as India seems to be in the early mornings, with few street lights lit and many random men walking aimlessly. I knew I would have to wait 45 minutes until it became light out before I ventured alone in a rickshaw through the red light district to reach the hospital on Laxmi Road. I quickly dressed in a sweater, long pants, and juttis to keep warm and waited on the main road. A few rickshaws passed with passengers; there must be a rickshaw stand down the road. The only problem was I was standing under the one bright lamppost and it was still just breaking into the day. Then a rickshaw-walla pulled up to me and I asked for V.J.Talkies on Laxmi Road. He knew the road but not the hospital and I did not know how to direct him. I pleaded that he find another auto for me that knew how to get there, assuming that most likely he would continue with his day disregarding my call for help. The “every man for himself” mentality is so strong in India that I assume it at all times. Ten minutes later, I see three headlights careening my way. A new character in the story yells for me to get in, that he does not know the way but one of his men does. We race in the opposite direction from the hospital to an auto waiting for me. I jump out of one and hop into the other, not paying in the chaos for that timely and selfless act. This here is a small shout-out, please excuse the informality, to that essential and unforgettable character. I finally reached the hospital; Didi was standing outside to receive me.

“Madam is coming also. I’ll wait. You go upstairs.”

I climbed five flights to reach the PICU, where I frantically searched for the pediatrician covering Rahul. I explained to him that I am a medical student from America working at Saheli and I asked what the situation is. He began to explain…”Rahul’s condition was very serious when he arrived yesterday, he has been sick for a long time with measles and at some point he developed severe pneumonia on the right side, he was already very malnourished with stunted growth, he looks much too small to be 5 years old, we tried to give him oxygen but he kept tearing the mask off his face, shaking his bony head side to side, he kept asking for thumb’s up to drink, in the night he had difficulty breathing so we intubated him, he went into cardiac arrest, we started chest compressions”…At some point I realized what I was listening to. I was in the middle of the speech that doctors give to family member when a death has occurred. With my foot in the first true door to the medical profession as a 4th year student, I should have understood. Still I listened with hope…“we were able to bring him back for a bit but he is so small, his condition was very bad when you brought him in yesterday…” My mind spinning, “What is his condition right now?” “He is no more.” “I’m, sorry, is he dead?” “Yes.” At that moment, Madam ran into the room. We stood in silence for a few moments, denial battling reality, and then the tears came. I keep agonizing over how I could have let this happen, why did I not insist that we hospitalize him sooner, on Tuesday when I first saw him, then he might be alive right now. But we went to the doctor, and I am just a student, and the doctor changed the antibiotics and said come back tomorrow. Then on Wednesday at the crèche when I held Rahul in my arms, his heart pounding above 100 and his breaths double the normal, I pushed for him to be admitted. We went to another doctor and he did the same, changed the antibiotics, ordered some tests, and sent us home. He even knew that he had pneumonia because I told him to listen to the lungs, that I heard crackles and maybe felt a consolidation. They are doctors, not students! How could they have let us just go home? I was furious, frustrated, and ashamed at the same time—furious that things like this occur in America also, frustrated that the situation in India involves such complicating factors like the child of a commercial sex worker living in an HIV/AIDS NGO in the red light district, and ashamed that I did not do enough to help. To prevent his death.

I walked into the physician’s room where he lay wrapped in a pink and purple fleece blanket, the tube still in his mouth outlined by some blue dye to soothe the angular cheilosis. The two Indian doctors, both in their second year of training for an M.D. in pediatrics, and Madam stood watching me. I lay my forehead on Rahul’s chest and I whispered ‘I am so sorry.’ I felt Madam’s hand on my back, motioning for me to control myself and pull away, but I had to tell Rahul. ‘I am just so sorry.’ I closed his eyes tight and walked out of the room only to meet his mother sitting on the bench outside. My eyes lifted to meet Didi and Madam’s stare and I knew their thoughts; they looked to me as Saheli’s doctor to tell Rahul’s mother that he is no more.

We brought her to a smaller room downstairs, the best location to control her grief and avoid making a scene in the children’s ward. Madam’s eyes set my heart pumping fast but I could not gather the words, a mix of fear and practicality that I do not speak Marathi. My eyes replied. She started explaining that Rahul had been sick for a while…sangithla, zala, aushwad…the only words I could discern. Vardla. Vardla? Vardla. Just then, I learned a new vocabulary word. She wailed and turned to Thae, yanking at her fluorescent lime green sari with yellow sequins to cover her mouth, the smell of alcohol filling our small circle. The next moments are blurry in my memory and all I can remember now is that she and Thae left to find the father. Questions flooded my head on how they would find him, who he is, is he really the father or just her current lover, is he going to be violent, will be hit me when he learns that they consider me the doctor who is supposed to be caring for these children, will he also be drunk?

Now standing at the entrance of the hospital were the remaining in the group: Madam, her husband, Didi, Frola Thae, and me. We waited in the cold of the early morning, though I did not know the reason and did not feel like I could ask what was to happen next, when the small Maruti ambulance-van pulled up. Madam’s husband ran upstairs to bring Rahul, still wrapped in the pink and purple blanket with small brown bears smiling and playing about the fleece, to the van. He lay Rahul in the stretcher and I followed, sitting at the back of the van with my hand on the bundle, Didi then Frola Thae, then the door slammed shut. We drove; I guessed the destination but did not dare to ask. This was going to be my first.

We reached a remote part of Pune and drove through the main arch, passing Rahul’s mother and father traveling by foot to meet us. There were several small buildings, tan walls stained with betel nut and dirt, and a few families squatting on the grassy areas. My eyes caught glimpse of a mother and son sitting near a blazing open fire and I wondered. We parked at the beginning of a long ramp leading up to an open room and a few offices inside. Rahul’s father and Madam’s husband removed the little rascal from the van and placed him on a pale green metal stretcher provided by the center. The pink and purple bundle, tightly wrapped and secure, looked so small on that stretcher. I just could not believe what I was seeing. The two men carried the pale green metal up the ramp to the open room where the ceremony was to be held. Rahul’s father disappeared for a while and the women sat on a wooden bench close by. He reappeared dressed in a simple white dhoti, resembling a thin toga split in two pieces. He sat with a pot-bellied man wearing a smooth white undershirt interrupted only by a white string traversing his chest from one shoulder to the other hip. This string under his shirt was the only sign to me that he was a priestly man, for otherwise, he exuded little warmth or divine spirit. Another man joined the two already seated around a small fire bringing his betel leaf plate and mixing the atta (flour) and water within. There was a smaller leaf bowl with five long cylindrical collections of rice. The ceremony started in Sanskrit, no one able to understand, then switching to Marathi when Rahul’s father was directed to wash his hands and change the direction of the cloth slung over his one shoulder to the other shoulder. Watching for twenty minutes, I kept wondering where and how Rahul was going to be cremated. The father then stood up, taking the balls of prepared atta and rice over to Rahul who quietly lay on the stretcher. He tore off some rice and placed it in the boy’s mouth, in his two nostrils, over his two small eyes, and inside his tiny ears. He then positioned one atta-rice combination on Rahul’s forehead, one beside each ear, one on his chest, and one over his neck. I watched; I had never even seen this in the movies. This was real and I was a part of it. I had only been in India for five months, just starting to form solid relationships with these women; it was clear they wanted me to be there, for them and for Rahul. The father then was instructed to pick up a mutka (clay pot) filled with water and place it on his shoulder. Madam’s husband was called to hit the mutka with a sharp stone, piercing a hole in the pot so that a stream of water perfectly and smoothly sailed out of the back side. The father walked around the pale green stretcher, the water splashing on the ground behind him as he moved. Again, the rock hit for a second hole. He slowly circled again with two streams softly pouring out from his shoulder. Again, the third hit and circle. He halted back in starting position, some words spoken in Marathi, and suddenly I watched him drop the mutka. The shattering sound shook my whole body and my eyes shoot to the small pieces of clay and droplets of water coving the ground. My guess was that Rahul was now purified for the afterlife and the divine bodies were awakened to receive him. I hoped for a life better than the one he has lived these past 5 years.

The father and Madam’s husband picked up the pale green stretcher with the small bundle of pink and purple fleece and carried it away, the women wailing Rahul’s name and more gibberish in Marathi. I was almost thankful that they were not speaking in Hindi, their words a jumble of sounds rather than translating true meanings. Still, the look of anguish on their faces and the shrill nature of their wails, I could feel the true meanings. We watched the stretched leave our room and enter another, the final destination.

The women gathered together and walked down the ramp, Rahul’s mother and father in arms, Madam and her husband in arms, me holding my sweater tight around my own shivering arms. They were going back to Saheli or their homes to shower, as tradition calls for a bath after touching or seeing the dead. I was told to go home, take a bath, and rest for the day.

Rahul, I love you and will always remember your wily eyes.

-Vaani Garg

Stepping Into Budwar Peth

My first few weeks in Pune, I was overwhelmed with the opportunities in front of me. As a medical student, I already had a strong foundation in HIV and AIDS, both the clinical aspects from my work in the hospitals and the social implications from previous work in Spain and South Africa. Still, there was so much to learn about the situation specific to India and to Pune. I was eager to see how this new place, my Sahara Allhad with its key players of clients, care workers, and physicians fit within the larger campaign against HIV and AIDS.

In the first week at Sahara in mid-September, I shadowed the physicians on rounds to learn their approach to HIV management and care in a low resource setting, to meet the clients at the center and make them familiar with my face, and to absorb as much Marathi as I could. As a highly proficient conversational Hindi-speaker, in that I can tell a rickshaw-walla where I want to go or buy most things that I would want from the market, I was eager to improve my Hindi and pick up a little of Marathi if possible. As such, my most immediate connection was with Laksha, a commercial sex worker originally from Nepal who had been working and living in Budwar Peth, Pune for several years. Though HIV negative, she came to Sahara through an affiliation with our partner NGO Saheli and received compassionate and comprehensive care for injuries sustained after an altercation with one of her customers. Simply stated, she was thrown out of a window from the third floor when a customer was unhappy with her services. The result: a fractured hip and a significant loss of income from this imposed "medical leave."

She spoke with a lisp, the left corner of her mouth opening very slightly while the right moved ferociously with expression. Her words required the movement of every muscle in her face minus those of that left corner. She was very clever, making shrewd observations of her surroundings and retaining no filter for the ideas expressed. I wondered if her sharp tone and manner was the result of cultural differences or that she had mild mental retardation. After discussing my observations with the physicians at the center, I found out it was likely the latter, which sparked another series of inquires about Laksha and her profession—How did she get to India? Under what circumstances did she start in Budwar Peth? Was she able to understand the intricacies and complexities of the brothels and commercial sex work? Was she different from other commercial sex workers because of the mild MR and how? My questions were endless.

I missed her farewell party as I was already on route to Mumbai for another project for Sahara, but I heard from my roommate that it was an emotional affair. The men at the center, usually very stoic and proper, except of course when they are dancing as is a common observation of India, expressed their concern and warmth for Laksha. They bid her farewell back to Nepal; she was discharged under the presumption that her brother was taking her back to their village to take care of her.

These three months so far in India have passed very quickly; I feel like I have done so much and absolutely nothing at the same time. I have seen and learned countless facets of India, tangible knowledge at my disposal right now mixing with some subconscious understanding of this place. I know that right now I cannot realize a large portion of what I am actually learning here; it resides just below the surface.

In this first week of December, after starting the month off with a flurry of activities for World AIDS Day—presentation of our research paper at the General Practitioners Association and Indian Medical Associations of Pune Conference plus Wake Up Pune events of street plays, condom distribution, games to raise awareness, and a drawing competition at one of the local cinema complexes—I went on my first field visit with Saheli into Budwar Peth. To give a little background, Saheli is a collective of commercial sex workers that advocate for their rights to proper healthcare, financial security, and basic human rights. Their relationship with Sahara Allhad and several other NGOs culminated in the formation of Wake Up Pune in 2006, a campaign started to raise awareness about HIV and AIDS within all communities of Pune.

As for my role at Saheli, I am in the process of creating a medical chart for each child. In order to compile the most complete and thorough past medical histories, I started interviewing the mothers every Tuesday. Currently, mothers are invited to drop off their children to the crèche at any time, for any reason. There is no system in place to gather information about the children when they are dropped off, often due to the time constraints on the mother to quickly return back to work or the shortage of staff dedicated to the crèche to maintain such detailed records (we are slowly developing materials to fill this gap). Anyway, critical to my work with the children is an understanding, or at the very least some exposure, to their living conditions prior to the crèche. My first visit into any brothels of India, my second visit to a brothel ever with the first being the red light district of Amsterdam, was surreal.

I arrived at Saheli under the impression that I would be interviewing two more mothers, but because they had just finished a PLHA meeting (People Living with HIV and AIDS), all of the mothers were too busy to meet with me. I finished up some paperwork and then inquired about possibly visiting the brothels. As I mentioned before, it was always on my agenda while working at Saheli, to visit at least once if not multiple times to truly get a sense of the living conditions and atmosphere for the children, but as life and work tend to be slow in India, I found ideas of mine slowing in urgency as well. Today though, since I was already at Saheli with nothing substantial to do, it was the perfect opportunity.

I went with Mandekini, a peer educator on staff at Saheli, and Tara, a former commercial sex worker who has now exchanged her responsibilities in the brothels for those in Saheli. Mandekini's task for the afternoon was to collect financial deposits from the men and women in the brothels that would go toward the Saheli Collective Bank for future savings. We left the office, headed down the street crossing five stores, and turned right. I had not realized that the brothels were right there, that I pass the main entrance area every day after getting off my rickshaw to work. At the entrance to the core, the heart of Budwar Peth stood several barber shops, music and candle stores, condom stalls, and paan stalls. I pictured the men getting ready to visit the brothels, choose who they want to be with for that ten minutes, one hour, overnight. I felt disgusted.

There I stood, in my traditional and conservatively tailored peach and violent salwar-kamez, the spring colors striking yet inappropriate for the December weather, with my hair in a pony-tail and my shoes shining of gold beads and sequins. My skin color looked very fair compared to the Maharastran and South Indian women who comprise the majority of those trafficked into this particular district. I also do not look Nepali or East Asian, again separating me from a large majority that resides in Budwar Peth. By my looks, it was clear that I was an outsider. I was not wearing a provocatively tailored salwar-kamez, a stylish western top with a mini skirt, or a neatly arranged sari. I did not have on the signature red lipstick. I did not have my hair down, beautifully styled and combed. Looking at my feet and some of theirs, however, I did notice the similarities in our shoes with the stylish shapes and shiny colors. To repeat the classic cliché: I could be in their shoes, with just a turn of events if my grandparents were limited in their provisions for my mother and father, if my parents did not immigrate to America, if they were struck with some devastating financial misfortune, if, if and if.

It was a strange feeling, standing there. Within seconds, I felt Tara’s hand on my shoulder. For the next two hours, her hand did not leave contact with my body—my shoulder, my hand, my hip, my side. Her body language conveyed a sense of protection, either for me to keep me from walking away, being taken by someone, or getting approached for conversation OR for the women, to make her fellow sex workers comfortable with my presence in their neighborhood. If it was moderately apparent from my dress, it was blatant from the unfamiliarity of my face; they were a tight community and I was not a member.

I looked left and right recalling Amsterdam, its red light district, and the countless differences. I can still picture the women standing in the windows literally since they and their services were for sale. I remember each woman having her own window, barely any standing in the doorways or streets, and the overall atmosphere feeling like a normal commercial street lined with several small quaint boutiques. In Budwar Peth, the overcrowding of India was apparent and visible as five to six women stood outside one doorway with three to four more just inside and several others in the building. I wondered what the insides looked like; I wondered whether I would get a chance to find out. I was just about to ask if they could take me inside a brothel house, being proactive to learn as much as I could, when Mandekini asked if I minded accompanying her in to collect money. It hit me; they were accustomed to seeing the unsanitary, cramped, and disheartening conditions of the brothels. She was concerned for me. I did not hesitate for a moment and nodded my chin side to side signaling that I was comfortable.

Mandekini walked first and I followed, Tara waited and chatted with the women and girls outside. The hallway was five feet long, very narrow and dark leading to a staircase on each side perpendicular and vertical to our path. We turned the sharp corner to the right and carefully climbed the stairs. The medical student in me kept thinking about the cleanliness of the area and I tried not to touch the walls or steps as I moved. This task was quite difficult as the staircase was barely wide enough for one person, Mandekini having to turn with one shoulder leading. My petite size enabled me to walk facing forward, though I too turned a bit to avoid contact with the walls. We stepped up thirteen steep times and turned a sharp left to a small room divided in half, one side as the kitchen/laundry/water use section and the other side as a sleeping space with a mat on the floor. We collected ten rupees from one woman and continued to the back area. We walked along another narrow hallway coursing like a square donout that then opens to the center, a loosely railed terrace overlooking the floors above and below. I was shocked to see so many children and men living in the brothels. I knew the estimates of over 300 children living in Budwar Peth but actually seeing these children and knowing that the kids I work with in the crèche at Saheli used to live here was overwhelming. I guessed the men were husbands, dhalals (pimps), or both at once. We turned another corner to climb another set of stairs reaching the third floor, the entire time I was thinking that the building could collapse any second. The structural support seemed so withered and weak. This top floor room looked like what I had imagined; a large room with bedrooms resembling office cubicles large to only fit one twin bed and complete with a door. The wallpaper of the room alternated between posters of deities like Laksmiji, Durga Mata, and Ganpati Papa and bollywood stars like Sharukh Khan, Rani Mukherjee, and Abishek Buchan. One of the women was much older and dressed in a heavy ornate gold necklace. She was the gharwali (the female head who controls the house). She looked at us with disgust and walked into a room slamming the door behind her. The two women sitting on the bed stood up but motioned for me to wait before I sit down so that they could spread a clean sheet. I did not hesitate in sitting; I assumed it was not a bed used for customers and I did not want to offend them. They smiled and giggled, looking me up and down. I smiled back and asked how they are in Hindi. Astonished at my accent, they giggled even more. The taller one with dark skin, long black hair, and features that in another life may have bought her a modeling contract with Ford in Manhattan reached into her blouse and pulled out her bright pink wallet. She handed me one hundred rupees, saying that she did very well this week and wants to save a little extra. They offered us chai but Mandekini refused saying that we had more work to do. For the next two hours, we weaved in and out of the brothels all tucked in small gullies. We collected money from all sorts of women, the most startling being those who appeared well into their 60s in age. Mandekini explained the problems with older commercial sex workers who make very little money but have no refuge. They must continue to work because there is no where else to go or no other means to live. Just to illustrate, some of these older women make only ten rupees for ten minutes. Ten rupees equals a quarter of a dollar.
We collected nearly eight hundred rupees and set off to return to Saheli. The entire time fumbling through the small winding streets I had kept my head down, my eyes fixed on the ground so that I would not trip. For some reason, as we approached the main road, I looked to my left. Laksha? She was sitting at a doorstop, wearing the same yellow and white nightgown that she wore every day at Sahara. It took me a few seconds to recognize her, to locate her face in my memory because she was completely out of context in the wrong environment from which I had met her. What was she doing back in the brothels? She was supposed to be safe back in Nepal, her brother taking care of her. She jumped up with the right side of her face smiling. She grabbed my hands and pulled me close to her, “what are you doing here? You shouldn’t be here. This is a bad place. What are you doing here?” I told her that I work here, meaning at Saheli, but she mistook my words for meaning Budwar Peth. She panicked with her Hindi now pressured and jumbled. She was clearly upset that I had become a commercial sex worker.

I sat her back down on the doorstep, squatting next to her and rubbing her back. I explained my relationship with Saheli, an organization with which she had become very familiar, and that I was just here to collect money for the Saheli bank. I asked how she was doing, how her hip was feeling, why she was not in Nepal. No answer. Laksha just smiled and walked away saying ‘Vaani, Vaani, Vaani.’ I turned back to catch up with Mandekini and Tara, explaining to them my relationship with Laksha. I walked out of my first experience in the brothels of Pune starting with amazement at the sights, shifting to concern for the future of every soul there, and finishing with being absolutely humbled by the care and worries of one woman for my safety and future.


Names have been changed for confidentiality

-Vaani Garg