The Sidhbari area has a population of round 5,000 farmers, shepherds and labourers. There is a high level of illiteracy and most families have incomes below the national poverty level. Until recently, when the slate mines were closed, the men would supplement the meagre returns from small scale farming by working in the mines. Now they travel further seeking labouring work as no alternative form of employment is available in the locality. This exacerbates the endemic problems of drinking and gambling among the men and places considerable economic and social strain on the families.

Family access to health facilities is limited, particularly for the women and children who rarely venture out to seek medical help due to financial and social restraints. The local government hospital is far, overcrowded and so unwelcoming that village people put off venturing there until they are very sick. Many private clinics have recently opened in the area but they are commercial ventures and are unreliable in the service they offer. Therefore Nishtha provides for the poor and for those who would otherwise be unlikely to access medical care. While treating them medically, we are able to understand their interests, issues and constraints and work with them through our Community Centre Programmes.

Focus on Women and Children

Women and children particularly suffer due to social constraints, hard work, childbearing/rearing and other family responsibilities. Whilst the men and boys are able to go out to work, unless they are attending school or college, girls are discouraged from going out and taking jobs and are therefore confined to the home. Society strongly favours the boy child, whilst a girl is regarded as a misfortune and a drain on the family. Traditional marriage customs dictate that girls are married away from their families, loosening links with childhood girlfriends and family members, and placing them in an insecure and vulnerable position in the husband’s family. When widowed they are considered bad luck and are therefore looked down on.

Women are not encouraged by their husbands to seek medical help and therefore are greatly helped by a welcoming medical facility offering affordable medical care. Because of the previously high mortality rate amongst males due to mining accidents, there is an above average number of widows in this area. This socially vulnerable group receive special consideration from our clinic.

Where women suffer, the children in the family are inevitably adversely affected in terms of their development, health, education and emotional well being. At Nishtha, we therefore focus on child nutrition and health. As an important part of this, we also involve the local children and youth in developing their skills, extending their learning, becoming aware of environmental issues, and in sports and cultural programs.

Nishtha’s Experience of Working with the Local Women
In response to the needs of the community as perceived through the perspective of the clinic, since 1999 we have been holding educational and awareness-raising workshops for groups of up to 30 women and girls. These groups are mostly made up of people who live in our immediate village. Trained and experienced experts from other organisations are drawn in to work alongside our staff and Trustees to organise and run these programmes, making them effective and dynamic events. They have been attended enthusiastically by the local people and have generated positive, active, self-confident women in the local community.

With Nishtha’s encouragement over the last 9 years, the village women, young and old, have been putting on plays on local issues and tribal dances on International Women’s Day, 8th March. We are gradually extending this programme to include more women from the surrounding villages.

Working with Local Youth
Since 2001 we have extended our workshops to the local youth, in order to generate awareness and information sharing on sexuality and their role in society. As Dr Barbara has concluded through her homeopathic case histories, many chronic health problems are rooted in the marriage. It is therefore essential that we also include men in our work to raise awareness and reduce their role in women’s problems. “Eve teasing”, domestic violence, dominant and aggressive behaviour due to social frustrations and alcohol are all male issues which directly affect women. Such problems need to be addressed skilfully: for example, we have provided the local youth club with equipment for sports and physical training. These activities are a distraction from the alternative male pastimes of drinking, gambling and “eve-teasing” which are common in the wayside cafes.

Research and development
Research is the essential first tool to identify the diversity of local felt needs and for developing appropriate methods to meet those needs. Moreover, getting to know our constituents better is seen as an essential requirement to being able to serve them better. With these aims in mind, a demographic research project was launched in 2003, in which information about each patient who visits our clinic is recorded on a computer data base. Detailed socio-economic information shows the male/female ratio of our patients, poverty levels, the villages they come from and their literacy levels.

This valuable data is now available to us and is being utilised to establish the areas of greatest need. In this locality, several categories of women have emerged as being in particular need. These are:

Female Family Members of Alcoholics
Alcoholism is endemic in this society where the lives of men are physically hard and unrewarding. Domestic violence is often interlinked with alcohol abuse, and women who are abused are often faced with an economic crisis as well. The majority of the man’s income is frequently spent on drink (and often smoking and gambling), and women are left to piece together sustenance for themselves and their children. There are few places that a woman may go to seek refuge from a drunk and abusive spouse. Women are reluctant to turn to neighbours, and their natal family is often at least a bus-ride away. While some women do seek shelter with their own parents, many others are unable to do so due to the costs of travel or the realization that they will not be supported by or will bring shame on their relatives.

The provision of a shelter cum refuge for women within the Nishtha Community Centre provides victims of violence with a place to go for immediate safety. Group sessions with survivors of domestic violence provide this very vulnerable group of women with a safe space to talk about their difficulties and support to find solutions to their challenges of living with an abusive husband. Couple counselling is also available for those husbands and wives who are willing to embark jointly upon the path of changing patterns and avoiding violence. The regular Wenlido self-defence workshops held in the Community Centre also provide women with basic skills to survive and escape from violent episodes.

Women who are Damaged Emotionally
Between 5 and 6 million people in India are unable to function comfortably in their daily lives due to emotional problems which cause considerable distress to the individual and the family. This affects their inter-personal relationships, their position within the family, their occupational productivity and economic status, and limits their ability to access services such as health and government support.

Of those with severe emotional problems in India, by far the majority are women, for whom unequal social status, limitations upon their role, abusive relationships and other issues can lead to particularly high and sustained stress levels. Women invest hugely in family, children and other care giving roles, they are conditioned to prioritize others’ emotional needs over their own and are commonly riddled with shame and low self worth. Women’s work is often undervalued and does not empower them in social and family negotiations.

Women are often the victims of emotional and sexual violence, both within their own families and if they go outside to work. In a culture in which women are blamed for causing a man to abuse them, they get little support whatever age they are. This can then lead to a sense of helplessness and lack of pleasure in their lives – which in turn can give rise to depression, anxiety, psychosomatic illnesses and other emotionally-based conditions. While some of these problems can be addressed through group activities, such as our Wenlido self defence programme and discussion groups, other problems may be helped through individual consultations with Nishtha’s doctors, homeopathic treatment, or sessions with our psychologist.

Single Women
This category refers to all women who live outside the norm of marriage. It includes widowed women, divorced and abandoned women, and never-married women who are above the customary age for marriage. In India the main task of women is to get married, produce children (preferably male) and nurture the family. If a wife loses her husband through death or abandonment, it is considered her fault and she is socially de-valued. If she leaves him, by casting off her role as a wife she is considered dangerous to society. Equally, society considers that a woman who fails or elects not to get married is very strange and the object of scornful curiosity. These are traditional views commonly held in India, not only in village society but also in many urban, even educated communities. They are the gut reaction of the general population and as such they impact enormously to reduce women’s capability and strength.

Several women’s organizations in India have conducted activist research projects and created spaces for single women to identify their common concerns and to address their collective needs: most significantly, Jagori (primary office in Delhi) and Astha (based in Rajasthan). In so doing, they have forwarded the category "single woman". However, until Nishtha took up the cause of single women, no such project had been undertaken in this area.

In June 2005 Nishtha held the first of a series of workshops specifically to identify and empower single women in the area. This was joined by experienced facilitators and representatives from the single women’s movement in Rajasthan. Along with our own activities of holding meetings and offering training and assistance to start self help projects, it was agreed that Nishtha would function as a key operative in the Single Women’s Movement in Himachal Pradesh, working along with SUTRA, the nodal NGO in this State. Nishtha has engaged field workers to extend our reach into the villages in the district, concentrating on particularly remote areas, and are now in contact with more than 800 single women. Nishtha engages in documentation and needs assessment; encourages women to become involved in our programmes, and offers specific help where needed, thereby providing single women with an effective support network.

The vast majority of the women contacted through this project are widows and the rest are unmarried, separated or very occasionally divorced. They suffer numerous economic and social difficulties as well as emotional and physical abuse, particularly from family members, and consequently require tremendous strength and courage to negotiate the challenges of their daily lives. Many of the issues that we are finding through contact with the women can be addressed most effectively through the creation of a space for single women to discuss their collective concerns. Nishtha provides this space by organising regular meetings in the villages and encouraging women to become involved in our programmes and activities.

Women in economic distress
Many women who experience economic distress also fall under the previous categories: for example single women, women who have suffered emotional damage, and wives of alcoholics all tend to experience significant economic difficulties

Income generation through self help is the main focus of this Nishtha project. Training such as in massage (which is an acceptable way for a woman to make a little money in the village), sewing and embroidery provide the skills needed to set up small scale projects. These then provide new economic opportunities for some of the most vulnerable women in the community. Another important aspect of our work is legal advice and assistance, helping to ensure that women are accessing all available government schemes which might assist them.

About to be married and newly married women
This is an important group of women who have special concerns and needs. In this society there are restrictions on them leaving the house, doing meaningful activities, and they are isolated from those with whom they might share their fears, concerns, and difficulties. Young women who are about to be married are usually socially isolated as they no longer attend school and their families guard their movements to prevent any scandal or even rumour.

These young women are often both excited and terrified about the massive change that will occur upon marriage. As almost all married women leave their natal home and reside with their husband and his family, a newly married woman is cut off from her support system, friends and family, and is thrust into the most vulnerable position that she will likely experience in her life. She is confined to the home and the family fields, and it often takes years for her to develop her own support system in her husband’s community.

Young women from Nishtha’s area - both newly married and about to be married - have suggested that, whilst they are not allowed to attend the youth club, a sewing centre would provide them with a legitimate space to gather and to learn a useful skill. Sewing is an activity which in-laws or parents would see as valuable and so would permit them to leave the home. Our sewing centre thus provides a space for these young women to talk about their fears and difficulties, while also learning skills that will save them money and perhaps earn them a small amount of income through marketing of bags and other saleable products.

Young People
Not only girls but boys too experience tremendous stress in teenage, when they struggle to reconcile the ever increasing differences between them and their parents in what they expect out of life. The incidence of suicides in young people is increasing as they see little hope of fulfilling their own or their parents’ ambitions in this highly competitive society. Arranged "in caste" marriages, lack of earning opportunities even with high educational achievements, and their feelings of frustration at not being able to live the good life as shown on the TV and in films, all contribute to creating problems for young people in our area. Emotional and social difficulties such as depression, alcoholism, drug taking and petty crime can then be the results.

Nishtha Community Centre offers a wide range of activities and interesting events for young people including sports, outings, trainings, computer education and the libraries of movies and books. In 2008 we are enhancing this with the introduction of the Jagori Knowledge Centre which will provide extraordinary access to information and will become the basis for launching local radio programmes on current events and topics of local interest. Involving young people in this way then becomes a positive investment in the well-being of the whole community.