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In the Sunderbans, women in the dark zone of depression
By Sharmistha Chowdhury
Everyday, when Badal, a sturdy, young man in his early 30s returns home at dusk, he finds his mother, Kamala, sitting placidly in the verandah, staring into the distance with strangely unseeing eyes. The house, otherwise, is abuzz with activity. His daughter is bringing in the cows, his sons are clamouring for some muri (puffed rice) and his sister-in-law is trying to manage a dozen chores at once. The still and silent Kamala is an odd sight in this busy household, but no one seems to mind. The family never forces her to do any work against her will.

Growing up in a remote village in the R-Plot island of the Sunderbans, Badal has always seen that his mother is different from the other women in his village and he has accepted it as a fact of life. When he was a child, his neighbours had told him that his mother had ‘mathar byamo’, a colloquial Bengali term for mental health problem. And that was it. He does not remember ever seeing Kamala being treated for her condition. “She is physically very fit,” he asserts confidently, “and can work like a horse when she feels like it.”

Kamala, unfortunately, is no sad exception. A recent survey conducted by the Future Health Systems (FHS), an international research programme consortium established in 2005 with support from the UK’s Department for International Development, and the Institute of Health Management Research (IHMR), has revealed an alarming trend of rising mental health problem among women in the Sunderbans.

The Sundarbans, a unique biosphere reserve of mangrove forests and now a UNESCO global heritage site, is a cluster of more than 100 islands located in the extreme south of West Bengal. But juxtaposed with its claim to fame as a global heritage site, is the extreme vulnerability of its nearly 4.5 million people who are struggling against geographical challenges, health, livelihood and all the basic amenities.

Mental health problems, especially among women, threaten to be one of the most critical public health issues here. The FHS-IHMR study reports that the most visible indicator of psychiatric disorders is the prevalence of deliberate self harm (DSH), or ‘attempted suicide’ cases, which, despite its severe limitation in capturing the total mental disease burden, projects the severity of the problem to a large extent.

Shibaji Bose, Policy Influence and Research Uptake Officer with IHMR, says, “The challenging geo-climatic conditions of this region make the male child an object of necessity in every family. After all, it is the male who can eke out a living from the dangerous forests and rivers, it is the male who can migrate out for work to ensure the family’s two meals a day. This is the common perception. Women whose first child or two is a female have to face unimaginable pressure and it becomes a very common cause of depression.”

According to a study based on the admission data in 13 Block Primary Health Care Centres (BPHCs) in the Sundarbans, a little more than 5,000 non-fatal DSH cases were registered in the three years between 1999 and 2001. In other words, an average of approximately 11 such cases was registered per month in each BPHC. Two crucial findings of this study are worth noting: First, about two-thirds of the admitted persons (for non-fatal DSH) were female, and second, 85 per cent of the admitted persons had committed DSH by consuming chemical poison, specifically, organophosphorous pesticides.

The more recent evidences on registered DSH cases, collected through the FHS-IHMR survey, reflect an increasing trend in its prevalence. In the period of six months between April and September 2008, a total of 1,181 cases of non-fatal DSH were registered in the same 13 BPHCs, implying that the average of such cases per month in each BPHC has gone up from 11 to 15 between 2001 and 2008. The share of pesticide or chemical poisoning in total DSH cases has also increased to 89 per cent.

A study (published in ‘Tropical Medicine & International Health’ in February 2009) conducted on the clinical records of patients admitted for attempted suicide to six government hospitals in the Sundarbans found that women accounted for 65 per cent of DSH admissions and 67 per cent of the deaths. The vulnerability of women to mental disorders in particular and to general health problems in general has its root in the highly fragile status of women in the Sundarbans, chronically perpetuated by poverty, domestic violence, and utter indifference of society to their problems. Suicide is, however, an extreme manifestation of mental ill-health and affects only a few. Underneath DSH remains a complex set of psycho-social stressors, which are closely linked to the livelihood challenges in the region.

According to Dr Barun Kanjilal, Professor (Health Economics & Health System Research) at IHMR, “The livelihood insecurity, which is a product of a complex link between repeated climatic shock and chronic poverty, is the main reason why Sunderban women are disproportionately affected by mental health problems. The deep insecurity reflects in the high prevalence of domestic violence, growing number of destitute women, and increasing gtrafficking, which is a particular cause of insecurity among younger women. Ironically, the easy availability of modern agricultural inputs, like insecticide, has made it easier for them to find a ‘solution’ in suicide.”

There is a high presence of stressors in the Sundarbans. Besides poverty and economic stress, there are the ‘modern’ malaises like marital conflicts, alcoholism and resultant torture and extra-marital affairs. The most common mental diseases, as found in one study, are major depressive disorders, followed by Somatoform pain disorder, post traumatic (animal attack related) stress disorder, and adjustment disorder.

In villages adjacent to the forests, where communities depend on fishing and collecting forest produce, people are especially vulnerable to animal attacks. Women, who often spend hours standing knee-deep in the water, collecting spawn, are dangerously exposed to sudden attacks by tigers or crocodiles. In addition, there is always the lurking fear of widowhood – every time the man ventures out on a fishing trip or in the forests to collect honey, the woman is filled with trepidation. It’s a feeling she never gets used to. ‘Will he return home safe? Will the forests return him whole? Will the river not swallow him up?’

Such mortal terror, which is an intrinsic part of the life of women in the Sunderbans, leads them to adopt a fatalistic coping strategy such as superstitious responses and dependence on local gods and goddesses, such as ‘Banbibi’, and traditional faith healers, known as ‘Gunin’. While these are perceived to be acting as protective shields against anxiety-related and other mental disorders, actually they only serve to intensify the stress.

Compounding the problem is the fact that few women are medically treated for their conditions. The FHS-IHMR study states, “The psychiatric disorders swell with increasing suicide attempts because neither the people nor the providers consider their prevention as a serious health action.” However, now that a series of surveys have revealed the extent and enormity of the problem of mental ill-health among the women, governmental and non-governmental organisations and institutions working in the region will hopefully address the issue.

“The challenge,” concludes Bose, “is not merely to expand health care services in the area, but to weaken the barriers that keep people away from effectively absorbing the benefits of such expansion. In other words, the challenge is to bring about positive behavioural changes that will encourage and prompt the community to ensure prompt medical attention to women when they are seen to be displaying disturbed or unstable behaviour.”

—(Women's Feature Service)
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News Updated at : Sunday, December 2, 2012
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