June 18, 2019April 22, 2020 3min readBy Rohan Shah
More than 700 cases of Human Immunodeficiency Virus (HIV) have been diagnosed since April in Pakistan, 576 of which are children. Experts believe that the practice of reusing infected needles at physicians’ offices, hospitals, and transfusion sites are the primary cause for the outbreak.
HIV weakens the immune system by destroying cells that, under normal circumstances, combat infection and diseases. Such immunosuppressed individuals become more susceptible to other potentially fatal opportunistic infections such as herpes, pneumonia, tuberculosis, amongst many others.
Authorities have traced the epidemic’s origins to Dr. Muzaffar Ghangharo, who is alleged to use the same needle on multiple patients. Ghangharo was arrested on April 30 following a national outcry and charged with unintentional murder, Reuters reported.
Some of the parents visiting Ghangharo’s clinic in Larkana, a city in Sindh, Pakistan, wanted a second opinion when their children were not responding to care. After taking their children to see Dr. Imran Arbani at a different medical center, Arbani suggested testing for HIV as a precaution.
On April 24, the first test results came in: One child was HIV-positive. There were 14 more positive test results, according to an op-ed by the province’s deputy commissioner Muhammad Nauman Siddique published on May 20.
The children ranged in age from two months to eight-years-old. In most cases the parents of these children are not HIV-positive, authorities said. And, according to UNAIDS, the province accounts for nearly half of the 150,000 HIV-positive cases in Pakistan.
After news of the infected children broke on television, “there was panic, hue, and cry,” Masood Bangash, a district police officer, told NPR.
The deputy commissioner of Larkana’s municipal government called for free screenings for anyone who was concerned. As of May 20, more than 10,000 children and adults have been screened as part of the ongoing government effort.
Parents demanded Ghangharo be screened as well, and he was also found to be HIV-positive.
I have been accused of playing the main role in spreading HIV. I am a qualified pediatrician. I had no idea I was infected. I would have taken treatment had I known I had HIV. I never felt any signs and symptoms. I am fully active,” Ghangharo said in a video filmed in jail and released on social media the day of his arrest.
“Also, why would I do this to innocent kids? What enmity do I have against these innocent children that I will infect them with HIV?
Pakistan’s Ministry of Health has requested an emergency visit from the World Health Organization (WHO) to help curb the outbreak and provide expertise to manage the existing cases.
According to NPR, the CEO of the Sindh Health Care Commission Dr. Minhaj Kidwai, an independent government-funded group, believes the outbreak is a result of “contaminated syringes, syringes that are reused for injections in children, unscreened blood transfusions and reuse of dextrose and saline drips.”
In all of Sindh province, Kidwai told NPR, investigators have identified some 500 clinics, labs and blood banks with unsafe practices or evidence of quackery in the past three weeks. In Larkana alone, 147 facilities have been “sealed” or shut down pending further investigation.
The Pakistani government is committed to fighting this outbreak and has ordered 50,000 HIV screening kits and allocated resources to provide the appropriate antivirals and medications for treating the HIV-positive individuals. Blood from several blood banks that are suspected of conducting unsanitary transfusion practices have also been recalled to deter the further spread of the disease.
The investigation is ongoing as authorities try to determine whether the outbreak was the result of unsafe practices in the doctor’s clinic and other clinics in the region.
January 16, 2023January 16, 2023 6min readBy Sejal Sehmi
I was a mere 14-year old on the fateful night of 22 April 1993. The night that witnessed black teenager Stephen Lawrence brutally murdered in a racially motivated attack as he waited for a bus. The night that cemented my fear, that the colour of my skin does matter. The same night that confirmed my indifference as a British Asian in the United Kingdom — were we really united? Fast forward to May 25 2020, the murder of African-American George Floyd by a white policeman was the turning point for British Asian author and my lovely friend, Shweta Aggarwal to finally break her silence and narrate her story of colourism, in her new book, “The Black Rose.”
Aggarwal’s gripping memoir emits so many emotions; that of an awakening, a voice that has been suppressed for years, filled with anger, mistrust and guilt. But most importantly, “The Black Rose” successfully disrupts the narrative that consistently allows society to box someone as indifferent based on a visibility factor. For Shweta, this factor was the colour of her skin. The injustices she consistently endured via some family members and fellow South Asian peers throughout her life, was as a result of her skin tone failing to qualify as ‘acceptable’, or as she often quotes in her book, not ranking high enough on the ‘fairometer.’ Whether she was in India, Japan or London, the scale was never too far behind.
Within the first chapter, she recalls as a child in India, the distinct lack of subtlety displayed by certain family members through direct taunts of her duskier appearance in comparison to her parents. She realised that she wasn’t in complete isolation from this prejudice, as her maternal aunt and uncle were also harshly nicknamed on the basis of their skin colour — Kaali (black) and Savla (wheatish). Aggarwal was left mortified by what many South Asians sadly still continue to casually exercise. Echoing similar incidents within my social proximity, it’s infuriating witnessing the recipients of such remarks surrender to laughing at themselves too.
Except it isn’t funny. Born into a culture where conversations on religion, caste and hierarchy in India are still so prominent, the comparison of Aggarwal’s skin colour being as dark as that of the domestic help (often from poorer families), prematurely planted seeds in her mind that she simply didn’t belong with her family, especially when she was sent to boarding school. Her lack of self-worth coupled with these taunts, gave her a whole new vocabulary for the letter B, that grew in parallel with the ongoing prejudice and anxiety. B for blackie, beggar’s child, bedwetter! Not funny, but derogatory. Post her book launch that Brown Girl Magazine attended, she tells me,
I personally feel we are way behind when it comes to understanding the importance of mental health. Name-calling was normalised and if you objected, you were ridiculed further with remarks such as ‘So sensitive! Can’t you take a joke?’ Body and colour shaming can lead to a feeling of inadequacy in the victim, which can further lead to depression and much worse mental illnesses.
During the 1984 Hindu Sikh riots in India, where over 3000 Sikhs lost their lives, Aggarwal recollects the frightening moment when she and her classmates fled into hiding to escape the violence during a school trip. As a means to save all the students from harm, the Sikh boys were forced to remove their turbans and long hair — their visible identities stripped to keep them alive. Yet, ironically, even in this horrifying situation, Aggarwal felt least at risk, attributing this self-assurance to her darker appearance.
The crux of her self-loathe was the love-hate relationship she formed with skin whitening creams. The birth of Fair and Lovely, India’s most renown brand (now known as Glow and Lovely following a backlash) was notorious for selling the damaging message that fairer skin equated to a happier and fulfilling life. For it was fairer skin women that would qualify for marriage — clearly their only sole purpose!
Tactfully using famous fair-skinned Bollywood actresses in television ads and posters, their so-called perfection would scream out to vulnerable young girls. (Men were targeted much later on, but the importance seemed less). Akin to the wretched beach body posters plastered on every corner in January — because apparently bikinis only look good on a certain body type — the damaging message remains the same. Social acceptance comes at a cost, and that cost is to look a certain way.
It’s an extension of the dated methods imposed on women from the womb, where mothers are lectured on drinking milk with saffron to ensure the baby is fair, traditional matrimonial sites asking women to specify skin colour, and women being told to stay out of the sun. These socially ingrained views are eventually developed into modern day methods in the form of cleverly marketed consumables. Aggarwal admits,
Most people only use the cream on their face just as I did. At that time, I didn’t even think about the rest of the body. I felt that if the face becomes fairer, that will be enough for acceptance. My mum noticed the difference for sure and I was lighter by the time I met my husband, Amit. I must admit the addiction is a combination of three factors: the justification in your own head, the strong marketing message that ONLY fair is beautiful, and the ‘compliments’ from those around you.
I admired Shweta’s honesty on admitting what essentially was a dangerous obsession that she remained faithful to throughout her teenage and adult life. A ritual that, whilst prompted gradual results in her appearance, was never going to eliminate the insecurities she felt within herself. Moments of joy with her husband and children on holidays abroad, would be broken up by the need to ‘fix’ any damage the sun may have inflicted i.e. reverse her tan. The booming tanning industry in U.K., her now home, and admiration of her ‘sun-kissed’ look by Brits initially surprised Aggarwal — as if her colour had now gained acceptance.
But who are we seeking acceptance from? A society that is still deep rooted in patriarchy forcing women even now to adhere to dated rites of passage that holds no relevance? Or a society that seeks to point out one’s indifference because of how they look — their skin, their religious attire, their weight? Or a society that passes judgement on a woman’s self-worth, and continues to abuse that same woman behind closed doors under the eyes of Goddess Kali? Aggarwarl goes on to explain,
The more damaging perceptions of colourism, are that ‘fair is rich’, ‘fair is successful’ and ‘fair is better educated’. Essentially, ‘fair is supreme’ in every sense. And if that’s the case, where does that leave dark-skinned people? In Ukraine, for example black and brown people were discriminated against and not given a fair chance to save their lives. Is it fair to be denied a basic human right — survival — based on your colour?
I personally was curious to know from my family what the definition of prejudice in the Hindi vocabulary is and how it is/was applied to in India. “Pakshappat” (taking sides) or “poorva dhaarna”, were the closest pure Hindi definitions known to my cousin, yet rarely used. However, my dad stated that “hum bedh bhau nahin hai” was the common term used to state amongst family and friends when someone was not biased and believed in equality. Somehow, colourism never really came under that category. A sentiment echoed by some of my Chinese and black friends . Even in parts of China and Africa, the belief that darker skin is perceived as inferior, is accredited to stereotyping certain groups of people as manual labourers working under the sun, and therefore of a lower class or caste. Does Shweta believe we can change this attitude?
A couple of my aunts are still reluctant to help me with my mission. One even said ‘it’s pointless fighting it’, while one said, ‘everyone has the right to define beauty for themselves and being fairer is what beauty is for some.’ The problem with this is that people then start to look down on people who aren’t. Colourism, casteism and classism divide people, creating more unrest in society. If we continue to aspire to be fairer, we’re still encouraging white skin privilege, and encouraging colonial values. The more we allow ourselves to succumb to these social constructs, the more enslaved we feel internally. Melanin is crucial for protecting our skin against the harmful radiation of the sun. Feel blessed that you have it and wear it with pride!
I wonder how we can dare to walk shoulder to shoulder with our black friends in the Black Lives Matter movement, if we refuse to face up to our own biases against colour? We seek equality in the U.K., but deny our deep-rooted prejudice, whilst a white privileged man lectures the world on the difference between racism and unconscious bias (yes Prince Harry, I’m looking at you!). “The Black Rose” has paved a way for many more voices to speak out against the damaging impact of colourism, and in my view, rightly belongs under the definition of prejudice in the collective South Asian vocabulary.
“The Black Rose” is available to purchase on Amazon.
Mental health is quite the subject these days, its troubles affect everyone; it knows no gender, orientation, race — it strikes upon one’s inner journey. But specifically, what have not been put in the same sentence are men, mental health and vulnerability. Too often it is seen that men are not allowed to show their emotions. But the aftermath shows that this repression of emotions bleeds into relationships, substance abuse, domestic violence, and more. It is seen time and time again in films, books, art — it’s all too familiar.
And it is beyond the point of “let’s talk about it.”
Time for action.
Mental health hits close to home for me. As a filmmaker, I will always share my journey with others. – Jacquile Singh Kambo
Men, mental health and vulnerability often aren’t talked about enough. “Embrace” is a short film that seeks to change that. It is a short animated film about Arty, a well-dressed man who has no face, gets ready for his date until he meets a younger version of himself. Arty and this younger version of himself delve into a surreal world where he learns to embrace himself. It’s him versus himself.
The façade self; the feeling of wanting to be somebody — are all things people are dealing with especially in adult life. From the dating world to the social media world — it feels like different masks are worn only to make us feel faceless, feel numb or a nobody. Too many masks could make people feel like a lost identity amidst everything that is going on in this crazy world. Out of touch, and out of life — with others and with themselves. The masks are metaphorical, the story is internally about men and mental health. Arty learns to ’embrace’ himself and to overcome his internal struggles.
Not often is it discussed that men should have a safe environment to be vulnerable, amongst others or even other men. Perhaps this is because men are wired to put on a façade when things go wrong, when things get difficult, or when true emotions are not expressed. If these are not dealt with, it can lead to other relationships, including romantic relationships. Further it becomes a cycle: suppression could lead to aggression, substance abuse or self-sabotaging behaviors and could create a toxic environment. Many of these arise from childhood trauma. Quite often childhood is repressed or ignored, and one may take their troubles along with them into adulthood. Perhaps revisiting the roots of the past can help one become successful in a better tomorrow. “Embrace” is an example of how important it is for men to embrace their past.
“Embrace” was meant to be a live-action film — until animation was considered. Seven years of re-writing, re-working, and digging down deep with the characters for the story to better fit the message at its core. Animation is an underrated avenue for a universal story that became the key pillar for “Embrace”. What many do not know about animation is that you can create a serious subject matter in a light-hearted way that is universally acceptable. Men and mental health are heavy subjects for some, but animation allows the exploration to become innovative, creative and fun. Animation allows the experimentation of entering surreal worlds.
For example, in “Embrace” Arty enters a surreal world where he has to go up against a younger version of himself — to unmask the root cause of his internal struggles and give himself the “big hug” he needs. This heart-throbbing metaphor is captured in animation that a live-action film couldn’t have captured. The freedom of animation helps tackle tough subject matters about self-love, and how we must embrace the soul, the child, the person within.
The Story Behind The Story
There are many inspirations behind “Embrace”. Film noir, the silent film era, surrealism and the works of Christopher Nolan and David Lynch — the film is able to articulate something far more special. This is more than just a mental health piece for educational purposes. This is a classical narrative from beginning to end; a story of important themes and beloved characters that needed to be shared with the world.
It is not often the words mental health and men and vulnerability are discussed under the same umbrella — especially with growing hypermasculinity, and the likes of social media where facades are put up and the vulnerable parts of ourselves aren’t as expressed. It is here where the film encourages men to look within themselves, and allows them to be vulnerable to themselves. Perhaps this is an important step to better themselves on the journey to have successes (whatever success means to them), and to enlighten and lift those around them. The first step should always begin with “you.”
It’s tough to find places where men have access in ways of improving their mental health without feeling like a patient or a victim in the institutionalized realm. It’s tough to find places where men can talk to other men about their struggles among peer groups, educational groups, and more.
The “Let’s Talk” phase and awareness is long overdue; it is indeed time for action. Perhaps creating seminars or group-related events and activities to help create vulnerable environments. Art or art therapy can be a great way of producing something stemming from the inner journey. Or maybe it is time to look at “sick days” as “mental health days” as well. Perhaps more can be done to simply just talk about it. It’s time to give ‘doing’ a chance to start in our close-knit communities.
Maybe if one learns to ’embrace’ themselves, only then, perhaps one can fully understand others and their pain — and have the vision of empathy for others. “Embrace” took seven years to write and a year of animation for a four-and-a-half-minute short film. The film is about self-love, embracing one’s self before one can see empathy for others. It is produced by Raman K Fenty and Jayesh Kodwani and his team, directed and written by Jacquile Singh Kambo, co- written by Sidartha Murjani and stars Jenna Berman. “Embrace” has received numerous international accolades including Best Audience choice at the Emerging Lens Cultural Film Festival of Halifax, Nova Scotia, as well as acceptances in hometown Vancouver, Canada; Goa, India and Chicago, United States.
If you are struggling with your mental health, please call your regional crisis hotline. These are a few non-crisis mental health resources for men’s mental health.
Traditionally, psychotherapy has let women down. This is not to say that women and other minority group members have never received help, but rather that the therapy they received made little attempt to address the root causes of their problems. In focusing narrowly on the personal and individual, which a lot of mainstream approaches focus on, they ignore the big picture and miss the point. An alternative approach — feminist therapy — can help challenge the norms and support South Asian women in a more comprehensive way.
A therapy which fails to address power issues in people’s lives automatically reinforces oppression. Feminist therapy is a way to look at people as part of society and not merely as individuals. As more people of marginalized identities realize that the cause of their mental and emotional difficulties are not individual factors but structural, they are seeking more thoughtful therapists and counselors. Feminist therapists are aware of the cultural dynamics that uniquely affect women and keep these at the center of their practice.
Feminist therapy has a lot to offer to women of color, particularly South Asian women. It is formed on the assumption that social forces impact, and these forces include the many identities that a South Asian woman holds — including race, ethnicity, caste, etc. Feminist therapy can help support our clients and us as therapists to conceptualize the client’s difficulties, as not just stemming from internal sources, but as an outcome of the deep-rooted patriarchal system.
Feminist therapy is the key to a progressive approach towards mental health care. There is a lot of awareness about feminism nowadays and women encourage feminist approaches to therapy. Feminist approaches look at how social and political forces interact with our own identities. Feminist therapy especially puts in a lot of emphasis on how our intersectional identities such as religion, family dynamics and social class plays a role in our own gender identity. Feminist therapy can help support our clients and ourselves as therapists to conceptualize the client’s difficulties as not just stemming from internal sources, but rather face the impact of the deep rooted patriarchal system.
Here are some important aspects of a feminist approach to therapy, whether you are a therapist or someone who wants to start therapy themselves:
Therapists’ own biases
Therapists, while working with South Asian women, as with any other client, need to put in their own personal work in understanding the assumptions and biases that they may hold towards these identities. If a counselor holds bias that a South Asian woman is timid, or doesn’t know what she wants, it may cause the counselor to take in a more direct approach rather than a collaborative one.
South Asian women are often being told what to do. Hence, therapists who may choose to be more directive rather than collaborative, may often reinforce the position of power and authority onto a South Asian woman reflecting what she faces in the world. South Asian women, especially who may have not been exposed to therapy, may look at counselors from a view of receiving advice or guidance. It is through our own ability to explore and process our biases that we can help challenge this narrative for the client, and help take a more collaborative approach.
Exploring identity work
It is important for a therapist to be aware about gender, sexuality and the intersectional aspects of feminism; about how sexual minorities, caste, religion impact gender in influencing the kind of experiences that women face. The counseling relationship is a space for clients to process the identities that are the most salient to them. We can start off with providing some context and psycho-education around the purpose of understanding these identities. Helping the client process different identities that are important to her can help take a more holistic approach to understand her difficulties. We can help provide information around how every identity that we hold impacts us in some way or the other, because of its interaction within the social context. This can also be a time when a client may self-disclose about their own identities, if comfortable and appropriate, to model this understanding.
Ask instead of assume
It is considered best practice with every client to ask their preferred pronouns; as well as identities they would like to highlight at the beginning of the counseling relationship.
Asking, instead of presuming, can help clients hold their voice from the beginning of the counseling relationship and create a safe environment. Processing identities that are salient to them and opening up space to share other identities can help clients share openly about how they choose to identify with their gender/sexual identity. It creates space for clients in the process of exploring their identities, to get curious about their identified gender/sexual identities for the first time.
One of the initial and ongoing processes of feminist therapy is educating women from a collaborative aspect. Providing psycho-education about their rights, consent, impact of patriarchy and other systemic factors promotes empowerment. While providing psycho-education, it is important to process the power dynamics in the relationship and model consent within the relationship by exploring the question: “What is it like for you to hear this information from me?”
We as therapists can be considered as guiding forces, but we should also be mindful that we are providing this guidance and information from a collaborative aspect rather than enforcing authority or being direct. South Asian women are often asked to respect people in authority and not defy them. We, too, as therapists may end up reinforcing these patterns, and instead need to do our own exploration by engaging in psycho-education with collaboration and continuing to check in with the client’s internal process.
Hold context around starting therapy
A South Asian woman puts a lot of thought into seeking therapy. The cultural stigma towards mental health can have an imperative impact on her recognising that therapy could be a potential need to take care of herself. Along with the courage that it takes to reach out to a therapist, either openly or whilst keeping it hidden from her family, there may also be a potential element of what kind of therapist do I want to see. Especially for South Asian women living in the US/UK or other Western countries, there may be a significant deliberation that goes into seeing a white therapist v/s a person of color therapist v/s a south asian therapist.
Can we think of potential factors that may prevent a South Asian woman from reaching out to a therapist who may hold similar cultural identities ?
Can we think of potential factors why a client may want to work with a South Asian therapist?
Explore reasons that led them to choose you
When a client comes in for therapy, she has probably considered the therapist’s background. She may choose to see a non-South Asian woman because of past and internalized fear of being judged by other South Asian women in her life. Or a client may deliberately choose to work with a South Asian woman therapist for perceived similarities in identity. For therapists, it’s important to create space at the beginning of the relationship to ask the client what led them to choose you as their therapist. For clients, it’s important to ask questions about your therapist that are important to you.
Fostering environment for all their identities
Clients are fully seen and valued for all aspects of their identity, background and experiences. It also means that we ground our interventions from a systemic and anti-oppressive approach.
We constantly learn and evolve to provide responsiveness, humility and respect to our clients and really redefine the standard of care based on the identities and background of South Asian women.
Background of the client
Particularly while working with South Asian immigrants, it is important to know the background of the client we work with in order to design culturally-appropriate interventions. As a lot of research has asserted, not all Asians are alike and group differences within Asian groups is often overlooked.
There’s a lot of information and knowledge around Indian groups that tend to be generalized across other communities from South Asia such as those from Pakistan, Sri Lanka, Bangladesh, etc. It is important for counselors to be aware about similarities and differences across these cultures, and create interventions that are more specific to the client’s cultural background.
It is important to check in about how the interventions land with the client. We may use certain strategies from a Western perspective that go into exploring a client’s relationship with her parents or caregivers. This can particularly bring guilt or shame for the client as it may be in conflict with her cultural value of holding respect for her parents.
A lot of the deep respect and regard towards family comes in the form of loyalty and not speaking “ill” about the family with strangers. Reflecting on family, based on Western interventions, can sometimes make it challenging for clients based on their values. Checking in with clients on how these interventions feel, and making space for the guilt and shame to surface can once again help clients to hold value in her own voice.
Examining values and beliefs
Therapy can support South Asian women in differentiating between their own values and society’s expectations. Even though collectivism is a value within South Asian culture, it may not necessarily be an individual value to our clients.
South Asian women very often bear the burden of the value of collectivism where they have to meet family’s expectations, be in touch with other family members and engage in other collective activities. It is an expectation that has been imposed upon them. A therapy space can be a space for clients to explore what their own individual values look like. It can be a space for counselors to collaboratively work with clients in choosing what matters to them, even if what matters to them is to take care of the family.
In this essence, she now has had a voice in choosing how she wants to move forward as v/s feeling stuck in expectations set by others. When the client recognizes that she has a choice in exploring her own values and beliefs, there can be support around how to engage in behaviors that are based in these values. Sue and Sue (2008) has recommended discussion about values, beliefs and behaviors of their family and culture, so that clients can discover those that are for them, those with which they identify and those with which they are ambivalent.
The reason why a South Asian woman may choose to work with a South Asian therapist is to feel understood and not hold the burden of having to explain different cultural norms and expectations. When working with a therapist from a different racial background, clients may feel the need to explain and defend their own culture. It may feel difficult to hear about certain norms being toxic or problematic from someone who doesn’t share the same background as you.
When we as South Asian therapists work with South Asian women clients, we have the unique opportunity to validate the importance/meaning of these cultural norms, as well as challenge its problematic impact on our mental health. We have the context and ability to hold the community and cultural system accountable. It is important to hold the value of one’s desire to have a community and fellowship, as well as hold the impact of this collectivism on the mental health of South Asian women.
It is important to pause and explore: What about the culture feels impactful? How does this impact self-esteem and the way they view the world?
South Asian women are bound by the cultural value of adjustment and acceptance. Accepting our culture the way it is and moving on is what they have been taught to do across generations. The therapy room can be a good space for us to pause and help them choose what aspects of the community are helpful and what feels unacceptable.
This, in turn, can help with increasing their voice and control on their own value system. When they come to you looking for that cultural connection, you can hold space to both empathize with their cultural upbringing and to be able to challenge it. There’s more likelihood that they need it to be challenged and from someone who understands what they are going through.