FOCUSSED
GROUP DISCUSSION: DISEASE IDENTIFICATION AND TREATMENT IN ZENANA COMMUNITIES IN
PAKISTAN
Focussed Group Discussion
ZENANAS
1. Demographic Information:
1.
Shafat 22 years 8th class Tailor
2.
Ghulam Mustafa 23 years 6th
class Dancer
3.
Abdul Ghafoor 20 years 6th class Tailor
4.
Ashraf 22 years 8th class Tailor
5.
Mahak 20 years None Dancer
6.
Fauzia 23 years None Dancer
7.
Shama 22 years None Dancer
8.
Chandi 20 years None Dancer
9.
Anju 25 years None Dancer
2. Criteria:
The criteria was decided after discussion with the zenana peer educators and also after looking at the In-depth interviews of the zenanas. The final criteria for the participants was as follows:
·
Must
be a Zenana
·
Age
should be between 20 and 25 years
·
Should
not be related to each other and also should not be friends of each other
·
Should
not be from the intervention site
·
Should
not have knowledge of the intervention
·
Should
have never seen or met the facilitator or the transcriber as both are frequent
visitors to the project/intervention site
3. Methodology:
Participants
for the discussion were recruited by peer educators. None of the participants were from the project intervention
site. The peer educators brought all
those acquaintances who either had no knowledge about the intervention or if
they knew about it their knowledge was minimal.
The
objective of the focussed group discussion was explained to the participants
and they were given the choice of leaving the group if they wanted to. They were further told that if they felt
uncomfortable at any point during the discussion they could quietly leave and
sit on the side.
No
incentive except fare money, iftari cum dinner (due to month of Ramadan) were
offered to the participants.
Participants
sat in a circle with facilitator and transcriber at the head of the
circle.
4. Findings:
1.
Health and who is healthy?
Health
was associated with delay in ejaculation during sex and then with physical
appearance. Mostly (7/9) participants
defined health and a healthy person through his performance in the sex act such
as ability to hold ejaculation while having sexual intercourse.
This
was further qualified by some (5/9) that healthy person is one who did not use
any artificial means i.e. drugs or injections to delay the ejaculation and
totally depends on his own strength.
There
was consensus in the group on who is strong and how one can restore strength in
ones body. Almost all the participants
agreed that strength was directly linked with blood in the human body and if
one wastes blood then it would automatically result in loosing strength. All the participants said that masturbation
and frequent sex is the most common form of loosing blood and consequently
loosing strength.
Health
was linked with physical appearance.
Few (4/9) thought that people who are tall, fair and have hair on their
head are healthy.
“A healthy person is that who is tall and has fair skin with red cheeks, face is heavy, head should be full of hair, should also be good looking and must have a moustache”
Very
few (2/9) felt that mental tension is also linked to health and a single person
connected health to maintaining a schedule of sleeping and waking hours.
2.
Disease
Disease
was mostly seen in context of sex. While reflecting on what is disease, the
entire group linked disease to sex .
Sexual activity and its excess was seen as a disease as well a cause of
disease by the entire group. Most (7/9)
built a connection between the mental state blaming it to be dirty and making
individual want excessive sex during the night that takes away the strength
from a person’s body leaving the face pale and sickly in the morning.
“People see dirty movies (blue prints) and then their minds get fixed on sex. They constantly think of doing the same thing that they see on screen and once they start doing sex then they do not stop. This is disease because when one keeps on doing sex then the blood is gone from the body by constant discharge of semen”.
Some (5/9) described love as a sickness that leads to lot of mental stress and finally takes over the mind and body leaving the individual incapacitated.
“Love is a the most
terrible disease to inflict an individual.
It takes over the mind and body.
All waking and sleeping hours are dedicated to one who is the object of
love and God forbid if that person is be-wafa (unfaithful) then for all times
to come it leaves scar on person’s mind”
“Love is a disease. It takes away the thinking power from an
individual and creates mental tension.
One who is in love dies many deaths because of this tension. Pray to Allah that nobody falls in love”.
Very few (2/9) linked disease different medical abnormalities such as high blood pressure, diabetes, heart condition, stroke etc.
Mental
stress was seen as a disease by a single person. He suggested that constant worries was a reason for sickness and
it led to medical complications in the body forcing the body to become weak.
3.
Identification of a sick
person
Almost
all (8/9) participants felt that it was very difficult to identify a sick
person. There was consensus amongst the
group on the issue that outwardly condition was generally deceptive and could
never manifest the disease of the person.
“People can hide their sickness. Money
helps in making a sick person well”
“Whatever is inside one can
never find out. A face may look very
beautiful but the inside may be totally eaten”
While discussing how to identify a sick person, the group distinguished sickness from weakness. Some (5/9) felt that sickness should not be confused with weakness. According to these participants weakness was a consequence of sickness and not a disease itself.
Few (2/9) linked identification of a sick person to individual’s inability to perform sexually and satisfy the sex partner.
“In bed one finds
out whether the person is sick or not.
If he breathes heavily or his legs start aching or a vein is constantly
twitching then one knows that the poor wife would never be sexually satisfied”
“When one ejaculates immediately then it is obvious that the person is sick and it is not difficult to identify him”
A
single person thought that death is the consequence of sickness.
4.
Knowledge about sexually
transmitted infections (STIs)
The
entire group knew that there were diseases that transmitted through sex. One of the reason cited by some (5/9) for
sex to be called “bura kaam” or “bad work” was due to it being a source of
transmission of diseases.
“If one is not doing bura kaam one would never contract disease. It is always due to bura kaam that one gets disease”
“Bura kaam transfers disease
from one body to another that is why it is called bura kaam”
“When one is indulging in
bura kaam then the punishment for it is disease like TB, Cancer, impotency”
While
discussing their knowledge participants talked about different symptoms linked
with STIS such as puss discharge in urine, anal warts, and sores on genitals.
5.
Source of knowledge
The entire group (9/9) described their own experience with one STI or another as the source of their knowledge.
“Our knowledge on these
diseases come from our experience”
“The kind of work we do, we
all experience some disease at one point or another. Every one does not have similar habits of cleanliness but then
even with cleanliness what do you know about the client. He may be carrying
some disease. Like we talked about this
thing earlier that some people have disease inside but they are beautiful from
outside”
6.
Treatment of infection and
where to go for treatment
Most participants (7/9) said that they would get themselves treated for the infection. Some (5/9) added that they would not consider money as a determining factor in their treatment as their health was vital to them. Few (3/9) said that they will also motivate their sex partner to get themselves treated if those partners were infected with some disease.
In terms of where the participants would go for treatment, almost all (8/9) said that they would go to a doctor. They qualified the doctor to be someone who is working in a hospital or in a private clinic. Any other person who merely checks blood pressure or injects patient was clearly not a doctor.
“A doctor is
someone who is qualified and sits at a hospital or a private clinic. There is a difference between a compounder
and a doctor. Doctor is educated and
compounder learns from experience. We
know who the doctor is and we only consult doctor. People who own medical stores are not doctors”
A single person out of the entire groups said that he would go to the Hakim for his treatment. He felt that disease gradually takes over the body and Hakim’s medication has the tendency of gradually fighting the disease thus according to him it was logically right that something that gradually takes over should be countered the same way otherwise the treatment would not be effective.
The group did not agree with this argument since they felt that Hakim’s treatment is slow and they do not have the kind of time. According to them treatment should be quick and effective so that they could return to their work i.e. dancing and selling sex.
7.
How to treat a sick
person
The entire group shared the view that a sick person should be treated nicely. They qualified their statement by adding the following:
“One should love
the patient. Good food should be given
to the patient”
“One should massage
the body of a sick person”
“Patient should be
kept in a tension free environment”
“Patient should be
kept happy”
“One should look
after the patient and treat him nicely”
When the group was asked to reflect upon how to deal with a person with dangerous communicable disease the responses were different from the above.
8.
How to deal with
person with dangerous communicable disease
Mostly (7/9) participants felt that the person should be quarantine and all his utensils should be separated. The reason given for doing this by all the above was that a carrier disease or virus can be transmitted by remaining in close proximity as well as sharing eating and cooking utensils with the sick person.
“If a sick person
dies we burn the bedding that she/he sleeps in, so if a person is very sick
then he should not only be separated from the health people but also his
utensils should be separated. No one
should eat in the same plate or eat the left over from his food, similarly
nobody should drink water from the same glass”
However the entire group said that the dynamics would change if the dangerously sick person was a family member in which case it would not be possible to isolate the person.
“One cannot throw
out one’s own blood relative. If a dear
one is sick you look after him and not isolate him”
Very few (2/9) said that love and attention should be shown towards a dangerously sick person.
9.
AIDS and how it is
contracted
Most (7/9) participants linked contracting AIDS with sexual activity. Some of these (4/7) described multiple sex partners as a reason for contracting AIDS. Few (2/7) thought that AIDS is contracted by discharging inside and a single participants from these said that AIDS is contracted by first penetrating penis in the anus and then not cleaning it and putting it in the mouth of the partner.
One participant thought that AIDS is contracted by touching each other meaning if an infected person touches a healthy person the healthy person would contract AIDS by this touch.
Another participant thought that AIDS is contracted like any other disease such as cold, cough etc.
10. Source of
knowledge
Almost all (8/9) said that they have heard about AIDS from the television. A single participant narrated his own experience as the source of knowledge.
“A Zenana friend
who had gone to Dubai contracted AIDS.
He came back and died of it.
Nobody bathed him because people were scared that they may also contract
the disease. He was buried in a wooden
box”
11. How to prevent oneself from AIDS
Prevention from spread of HIV/AIDS was linked with condom use. Several participants (5/9) said that all sexual activity i.e. penetrative sex should be done with condom.
Few (2/9) said that one should avoid kissing people because that could transmit the virus from one person to another. They used Tuberculosis to suggest that AIDS could also be transmitted through this mode.
Others (2/9) said that AIDS is something that once contracted cannot be treated and there is no treatment for it. They said that they had learnt this from banners and other such advertisements.
12. What should a
person with AIDS do
The entire group agreed that the person should consult a qualified doctor for treatment of the disease. However, they did say that there was not treatment or cure for it.
They further added that such person should however be isolated.
“he should go to a
qualified doctor but people should not keep any contact with him. We would not meet a person who have AIDS”
“Should go to a
good qualified doctor. If he can be
treated then it is okay otherwise we will stay away from him”
“We will hate such
a person. Nobody would be with
him. He will be all by himself or Allah
would be with him”
The second half of
the FGD was focussed upon perception of self.
The issues for discussion in this part of the FGDs were generally picked
up from the In-depth interviews of Zenanas conducted as part of this
assessment.
What is a zenana?
The entire group (9/9) said that Zenana are by birth different from male child. They explained that the “rooh” or the spirit inside of a zenana is that of a female and this is from the time of birth however, the outside body is that of a male.
Bodily he is a male
but has all the feelings and sentiments of a female, like me, I am a boy but my
heart wants to dress up like a woman”
“When a mother
gives birth, she says that she has given birth to a boy. Little she knows that what the child will
become when he grows up. Like me, I
have rooh (spirit) of a female. Set
males on fire, what have we have got to do with them when the spirit is that of
a woman. This beard and moustache is
not our doing, this is from Allah”
“We are like this
from our childhood”
“No matter how rich
a zenana is and may also be married but he will never be able to satisfy his wife and would always want to come
back to this field (singing, dancing and sex with other men)”
“The rooh (spirit)
would not let a zenana live in peace.
If he keeps on living with his parents he would suffocate, if he runs
away he would be better off”
“Those who have the
habit of penetrative sex meaning who wants to be penetrated are not always
zenanas. They are the ones who have
been penetrated in early childhood and then a little worm is born inside the
body and that worm wants sperm to feed itself and it keeps on forcing the
person to get penetrated but then these are not zenanas. Zenanas are born from their mother’s womb”
Linked to this question when the group was asked how they felt upon being called as zenanas?
Everyone responded that initially when they were young they felt bad but as they grew up they started liking it. They mostly (8/9) linked their approval of what they were being called to their skills of dancing and singing.
“Started liking it
when I started dancing and people started praising my dance then I liked being
called a zenana”
“When somebody said
something nice about me”
When the dimension of marriage was included in the same question then the participant reacted differently. Almost all (7/9) felt that if married then it is derogatory to be called a zenana and reflected upon the complications linked to it.
“I have hit many
boys when they call me zenana. There is
nothing to be proud of. It is
humiliating. The family insists that we
get married and then one has to bear the taunts of ones parents, wife and
children”
“To be a born to a
zenana is a stigma itself, people would not accept into marriage a daughter of
a zenana. They will always say that she
is the daughter of a zenana”
“It is tough for the
wife to see the husband getting ready
and putting on the make up and sometimes the son is also there”
“What would the
family think. Wife if she has honor will respectfully spend her days but the
children would run away from the house because they would say that our father
is a gandu (slang for someone who gets penetrated)
The discussion also focussed on the support system of zenanas if they were not married or their families disowned them. Few (2/9) reflected upon this. Generally they said that zenanas do not have any support systems except themselves.
“Who does a zenana
have. It is only his face and
body. Until these two things are with
zenana everything is with him but once these things leave the zenana then
nothing is with him”
“There is no one to
take care of zenanas in the end i.e. old age.
The end of a zenana is very bad”
“Whatever a zenana
should do should be for himself. His
folk would never support him when he is old”
At this point the group was asked to define the phrase “Burai” commonly used by them when referring to their sexual activity.
Several (7/9) felt that their sexual activity with other men is burai (bad work), the reason they all described was that it was denounce both by the world as well as the religion. When probed further they said that people say that it is bad and it is people who also say that religion does not allow it.
“Religiously it is
bad because everybody says so. The
world says it. We are not saying
it. We are only saying what the entire
world says about our sexual activity”
“This is burai (bad
work) that is why we were made to leave the family. World will always call it burai no matter how many Haj we perform
or even if we have Quran in our hands, it will still be called a burai”
There was a single person from the group who felt that he did not feel he was doing anything bad although world may feel differently.
Another participant said that he did not see anything bad in it and terms it as burai because others were using this term for the act.
Following from this when the issue of cruelty was brought to the forum, majority (7/9) said that they considered severing of their connection with their parents and siblings cruelty
“This is cruelty
when your own parents and siblings disown you”
“Zenanas constantly
have to face cruelty and the foremost type is when the parents and siblings
sever their relationship with a zenana”
Similarly almost all (8/9) linked cruelty with lover severing ties with zenana
“Zenana are born to
face cruelty, if a lover leaves the zenana that is a cruelty in itself”
“One boy loved me
for 12 years and now has left me. This
is cruelty”
“This world is a
cruel place. Nobody can imagine the
feeling when one is left by ones lover.
It is ultimate cruelty”
“For us being in
love is the best thing and when the lover leaves us it is cruelty”
A single participant defined cruelty in context of forced sex and beating.
“When a person is
working somewhere and someone beats that person or several person have forced
sex with him that is curelty”
A common term “roti” that is normally used by the zenanas for gang rape and forced sex was probed into at this point.
All agreed that “roti” (literally meaning chappati but also used for an invitation to have lunch or dinner in Punjabi) had nothing to do with the looks of a zenana and that forced sex generally is provoked by a zenana acting difficult to get.
They further shared that when the client feel slighted. He then sets up a trap for the zenana to somehow visit client’s friends house where there are several people and the number could be from 4 to 19 or 20 and then all of the person gathered there would have sex with the zenana forceably. Shaving head or eyebrows of the zenana could also be part of this process and that is ultimate humiliation.
Violence between
the Zenanas and their partners
All the participants agreed that whatever happens in love cannot be termed as violence. They all unanimously agreed that beating is part of the love relationship and that they are the ones who provoke their partners by being unfaithful to the partner.
“When I leave my
garya and go have sex outside with another man that is nor fair to my garya so
I deserve beating”
“In love beating is
a form of caring for each other”
“Whatever happens
in love cannot be termed as violence or something bad”
“I am happy when my
garya hits me. He cares for me that is
why he hits me”
“At that time I am
like his wife therefore he has all the right to beat me”
Whether the garya
calls the sex act burai
The entire group said that the garyas never call the sex act a burai i.e. bad work. They added that the sex partners generally do not comment on the sex act.
Good deeds or
Naiki
Good deeds were mostly (7/9) seen in religious perspective. It was described as something that is done for Allah. Few (2/9) discussed it in the context of their work or relationship.
“Naiki is being
faithful to ones partner and not cheating him”
“Earnings from sex is not halal. The earnings from dancing is the real earning because one sweats while dancing and that is naik kamai (good earning)