After an accident at his workplace, Bhoomi, a 26-year-old from rural Tamil Nadu, India, lost interest in work and isolated himself from everyone. His neighbors were at a loss to understand the change in his behavior. He was labeled a “lunatic,” which worried his parents and propelled them to seek help.
Thirty-year old Vijaya (name changed) spent 10 years of her life not talking to anybody. Her parents were daily wage laborers, scraping together a sparse living in India’s southern state of Tamil Nadu. Unaware of any treatment, and afraid of being stigmatized or shunned by their community, they did not disclose their daughter’s illness to anyone. Instead, Vijaya suffered in silence, confined to the house, and hidden from public view.
It was only when the Tamil Nadu government’s Mental Health Program (TNMHP) reached out to their community that Vijaya’s life underwent a dramatic change. After six months of working with the program’s community facilitators, Vijaya’s parents took her for treatment, and within a year, the young woman began interacting with others more frequently.
Poor mental health places a huge burden on individuals, families, and society. From developed countries to emerging market economies, mental disability – ranging from common mental disorders such as depression to severe mental illnesses and retardation – has profound impacts on people’s economic and social well-being.
Not long ago, fifty three year old Parvati Amma was told that she was too old to train as a mason. But that didn’t deter this feisty lady. She took the rejection as a challenge and went on to ace the class.
Parvati Amma comes from Pulkattai village in the southern Indian state of Tamil Nadu where the Tamil Nadu Empowerment and Poverty Reduction Project (TNEPRP) has conducted a unique experiment. In an effort to raise the very low levels of women’s participation in India’s labor force, it is helping rural women break into jobs that are traditionally held by men, where they could increase their earnings significantly.
In this part of Madurai district, most of the men folk are successful masons. The women worked as helpers, merely passing tools to the men as they laid brick over brick to build houses and office blocks. Being unskilled, the women earned half the men’s wages.
Even though Tamil Nadu is one of the most urbanized states in India with high literacy rates, new buildings are proceeding apace amidst the state’s booming construction industry, attracting over a million migrant workers – more than a tenth of whom work as unskilled labor. There is, however, a paucity of trained masons.
The challenge for the women was to take on age-old social and cultural barriers and enter into this exclusive male preserve. Masonry has never been seen as a woman’s job in India, much less in this conservative rural area. For a start, the women wear sarees that constrain them from climbing onto scaffolding to build the higher storeys. Masons are also required to travel long distances for work, and staying away from their families is not something the women could easily do. Apart from mobility constraints and worksites that are not women-friendly; domestic responsibilities, burden of child and elderly care, and a conservative societal outlook, are all challenges.
Nonetheless, the women of Madurai’s Pulkattai village were not to be daunted. They saw this as an opportunity to prove their worth and double their wages in the bargain.
Supported by a visionary panchayat president and an expert mason from the village who had confidence in the women’s capability – Parvati Amma and 25 other women joined the masonry training offered by the project.
Erwadi is known for its 550-year-old Badusha Nayagam Dargah—“Erwadi Dargah,” one of the biggest shrines in India. Every day, numerous devotees of different faiths visit the shrine from surrounding villages, states, and countries. Among these visitors are a large number of people who suffer from mental illness and have come to pray for a cure. Some of them see the Dargah as their first and only hope—guided by the magico-religious belief that illness is caused by the possession of evil spirits or the performance of wicked magic—while others have turned to the shrine as a last resort after receiving ineffective treatment.
When I visited Erwadi Dargah in 2013 and met with a team working on a local program called District Mental Health Project (DMHP), an important partner of the World Bank-supported Tamil Nadu Mental Health Project, they expressed an urgent need to help the devotees affected by mental illness. Their subsequent discussions with representatives of the shrine revealed a lack of information on potential treatment options and strong resistance against medical interventions among the devotees. At that time, the team knew of a similar circumstance in another part of India—the state of Gujarat—so they invited the representatives of Erwadi’s religious community to learn from peers in Gujarat about complementing religious rituals with medical treatment.
And thus started a unique experiment called “Dawa-Dua,” or prayer-treatment.
That’s why, in 2012, we launched a comprehensive social and clinical care program with the government of Tamil Nadu to inform and educate local communities on mental health issues, as well as to encourage families and people affected by mental illness to seek treatment. Working with leading local health practitioners, we based the campaign on a core message that was simple, powerful, and resonated with the community: