Friday, July 14, 2006

The Middle Path

During my medicine posting in my internship training program, I was posted in an exclusive HIV unit. Almost all the patients admitted in the unit were in various stages of the disease resulting from HIV infection.A very scary experience indeed . Being a doctor , I know that touching these patients wont give me the disease , but I also know what a tiny error in judgment while collecting blood or inserting an intravenous line or handling these patients' samples , can do .I mean , there were times when I'd see these patients and then try to think , how would I react to being told that I have this disease that is definitely going to kill me and that I will live for only a few years from now , and the number of years , too can be anything from three yrs to 8-10 yrs.
The number of HIV positive patients in Mumbai is mind numbingly high. Tuesdays (new cases) and Thursdays (follow up) are the HIV OPD days in KEM Hospital. Each Tuesday meant at least 100 new cases in KEM alone.
Consider this scenario : A person hailing from UP (or usually Bihar/TN/Kar) , leaving behind his wife in his native place , comes to Mumbai ,in search of a job.. . . lands up with a menial job as a taxi driver or something even less satisfying - financially . During his long lonesome stay in Mumbai , he succumbs eventually to temptation and visits a CSW (commercial sex worker/prostitute) , gets infected with the virus ; months later gets his wife and kid back here , obviously , his wife , in due course gets infected and then they have a child . The child unfortunately is then HIV positive, with of course, an HIV –ve sibling, who will be left all alone in a few years' time.
The surprising thing about this scenario is the consistency with which it presents itself again and again and again . . .I , personally , in my short stint , have seen at least 25 such patients.
And I thought I had seen it all, until I saw this: Champa, Kanaiamma, Rosy – three HIV +ve hijdas in the OPD.
Hijdas are such a mystery. Now I have had these Q&A sessions with all my non medical friends, when we all are having a night out or something like that, where everybody clarifies their myths they have heard and believed in. Sex related queries, weird medical questions ….the works. And believe me; this issue on Hijdas has come up very often. What is a hijda?

I have friends, who are mortally scared of Hijdas. Many of my friends duck inside the car when they see Hijdas on the road (this group includes fully grown men too!). Puzzlingly, effeminate men or ' baylyas*' are ridiculed by being called 'chakka' or 'hijda', but, surprisingly, every hijda that I or my friends have seen or met has always, unfailingly, been more masculine than all my friends and me put together with their thick baritone voice that's high on bass, along with their, incredibly and amazingly loud clap (which comes out loud in the first attempt!) – "Aye Raju". Add to this , a healthy dose of being felt all over by them - and who wouldn't give money to not be subjected to that. I have also been at the receiving end of some rather nauseous, vulgar and stunningly quick, obscene visuals; which of course make the hijda community, collectively, even more repulsive.
The fact, however is that these Hijdas have successfully managed to only isolate them further. These Hijdas are basically either castrated men or hermaphrodites (born with genitilia of both sexes) or just plain men masquerading as Hijdas. They are shunned from society, regarded as the third sex and are given no social rights what so ever. The result being, they have to resort to obnoxious behaviour so that a fear psychosis is built in the minds of the people who then are vulnerable to demands for money at traffic signals, weddings, child births, etc.
But the most disturbing aspect is their disturbing and promiscuous sexual behaviour.
Hijdas work as CSWs .Yes, prostitutes. And obviously the question to ask is who 'does' them?
Well, a lot of people. Hijdas prefer to be passive partners in any form of sexual contact with men, i.e., they are always at the receiving end, literally and figuratively.
So here are these Hijdas who presented with HIV related symptoms, and were clinically investigated and revealed to have HIV infection. They come to the HIV OPD at KEM Hospital.
Now the governments of Maharashtra and India have done this fantastic job of setting up ART (anti retroviral therapy) cells in main hospitals , which provide anti HIV drugs at a massively subsidized rate of about Rs 1200-1300 per month versus Rs 4000-6000 if taken over the counter. This as a one time expense is affordable , but as a life long recurring expense , it is quite a tough ask.
Well , what about loans ? Most Hijdas are unregistered individuals – with no proof of residence , nationality , ration card , driver's license, election card and passport ; they simply don't exist for the government . And the question of actually paying this large sum , every month, for as long as they might live , only for medicines is a tough one to answer given the means this money is earned. Hospitalisation can further complicate issues...
So, sadly, the Hijdas return to their homes, now diagnosed as HIV +ve, resigned to their fate.
These Hijdas however exhibit great understanding of the situation and refrain from any sexual activity, once diagnosed as sero positive.
Where does this leave them?
What is the government doing for them, who are as much a citizen of this country as you or me? Rehabilitation ? Loans ? Insurance ? Apart from the rare headline grabbing event of a eunuch being elected to the local government body somewhere in the interiors of India, absolutely nothing….
At least the next 'aye raju' you hear, evokes not just fear, but also some sympathy


chandan said...

I know Akshay for last couple of years, he has simply been one of the best persona that I came across in my College life.He has lots of skills not to be mentioned.This touching article has focused his Social concern that many may overlook at first sight(Obviously he always busy playing some pranks!).

All the write-up about the Darker side of Medical proffesion, hard situations that a doc comes across his life, HIV & humanity and everything else.
Superb Job Akshay! I Respect Your Feelings.

Commenting about such a nice article is really like climbing Everest twice in a day!

random_musings said...

dude..nice post...i kinda still identify wit this empathy/ understanding/concern that medcine brings with it...this is what drew me to it...a deserter i mayb but the emotions remain the same...nice work.

narsi said...

Reading your blog one I cant help drawing parallels between HIV+ people and eunuchs (I consider the term 'hijda' as derogatory and would like to restrain it's use.)
Both are shunned by society. Both are feared. why? probably because they are misuderstood.
even if they are understood they are still shunned ...why?

why does society discard those it perceives as malignantly different from itself? Why does it not cross check this perception?
I have no answers to these questions and more which arise in my mind....
yet do i find htem isolated?
NO! they are unknowingly reflected in so many other spheres..
I am tempted to and will pinpoint the cause of rise in such bias to the general decline in empathy , patience and tolerance..
As some extremists like to chant often "..... Mandir yahin banayenge.... "
Of what use is a healthy body driven by a diseased mind...
The HIV virus infects the body of the person it inhabits.. But its greater and more potent threat lies in the infection it causes in our the minds of the society in which these people live.

Varsha said...

Nice post.really thought provoking about hijdas..were you in ARP unit?? You write well....nice blog.

Veena said...

well, in some countries eunuchs are not treated as outcasts... in singpore (i think) they actually perform concerts and shows which are extremely popular and from some pictures i've seen, these people look quite pretty. so if its sad to be born as a eunuch, its sadder to be born here as one. somehow, i feel terrible to be saying something like that, sad to be in a society which forces me to pity them so much

Anonymous said...

i still get scared of them..

Akshay G N I said...

I know u , anonymous , your name is mentioned in the blog.
and , rima , there isnt anything to be afraid of . they arent going to eat u up , are they ?