Always ‘reserved’, navigating caste is more difficult than studies for backward class girls in higher education

Lack of quality education, facilities, guidance, economic deprivation and gender discrimination ensure that very few from backward classes reach the threshold of STEM educationMumbai, Maharashtra: Tanuja* (38), a Dalit student from Maharashtra, worked single-handedly as a health researcher to do the primary study of the subject, planning and the actual research in a span of four years. However, when time to publish the research study came, her name was dropped. The institution simply refused to give her credit as an author.However, she quietly kept asking the seniors of the institution to include her name. The head of the department (HoD) scolded her, but Tanuja did not give up. She stood outside the HoD's office for over eight hours. Finally, Tanuja's name was mentioned, but in the abstract only. "Will the institution deny credit to a girl from a dominant class as it did to me?” she reflects.The question has been asked by several women from backward classes and minorities, especially those from rural settings, who struggle against caste hierarchies and monopolies, and gender biases in the field of STEM (science, technology, engineering, and mathematics). For Scheduled Castes (SCs), Scheduled Tribes (STs) and minorities, the struggle begins at home.  Geeta* (32), a PhD student at the Indian Institute of Technology (IIT) from the Dalit community of Uttar Pradesh, has four sisters and a brother. “When I passed class 10, my father refused to send me to a private college in our area. I got a chance only because of my brother," she recalls."Most Gond girls of my age have studied up to class 10 or 12 only. Some are even married. Due to the poor economic status, most families prioritise their son's education. But my father wanted to make me a doctor. As a teacher, his financial status was better than others, though we stayed in a village," says Utkarsha Surpam (23) from the Gond community of Sonegaon in Yavatmal district.Women in STEM face double jeopardy - Caste and Gender (Photo - Representative image/Canva)Access to science entriesGirls from backward classes and minorities pass higher secondary (HSC) examinations with good marks, but they have to prove their merit in the National Eligibility cum Entrance Test (NEET) and Joint Entrance Examination. Students from dominant classes join entrance coaching from earlier classes, but those from backward classes cannot afford it.Despite family support, Surpam learned about NEET just before her HSC examination and had no choice but to join private coaching. "The 45-day course cost Rs 16,000, which was not affordable," says Surpam. As the preparation was insufficient, she studied from home for another year. The following year, she got admission for a Bachelor in Ayurvedic Medicine course in Nagpur.A Balai tribal from Melghat, Yogita Kochalkar (25) went through an arduous struggle for STEM entry. "The colleges and teachers at Melghat were not well qualified to teach science. Therefore, NEET preparation was quite hard." She went to the Nanded district of Maharashtra, 350 km from her home, to prepare for NEET. After two years, Kochalkar secured a seat in Bachelor of Medicine and Bachelor of Surgery. The fourth woman doctor from her community, she currently serves as medical officer at Melghat Public Health Centre.Lack of quality education, facilities, guidance, economic deprivation and gender discrimination (Photo - Representative image/Canva) What the statistics showAccording to the All India Survey on Higher Education 2020-21, the proportion of females from backward classes who have enrolled for STEM courses is significantly less than that of open-class females. The proportion of females from SCs was about 30% and STs only 9%.In March, Union Minister of State for Education Subhas Sarkar informed the Rajya Sabha that over 19,000 SC, ST and Other Backward Classes students have been thrown out of the education stream in the last five years from IITs, IIMs and Central universities across the country. While 14,446 students from the three categories dropped out of Central universities, 4,444 dropped out of all IITs, of which 1,362 were from SC category and 538 from ST category.  They have to prove themselves at each step as they got admission to reserved seats. A peculiar narrative has been generated to term reservation as anti-merit. Mayuri More (26), an engineering student from Nanded district, says, "Comments on reservations are often passed by friends and professors casually. It hurts a lot, but I do not know how to respond. I choose to be quiet or avoid them.""It is shocking to know how educated people, including doctors, academicians, researchers and policymakers, negatively perceive reservation. They must acknowledge and understand its importance," remarks Dr Sylvia Karpagam, a public health doctor and researcher, who had analysed the (ab)use of social media platform Twitter (now X) by Indian doctors in the context of reservation.The Times of India analysed details of nearly 57,000 students admitted to 409 colleges last year. The average NEET score of students in government-controlled seats was 448 out of 720, while the quotas under private control averaged just 306. Incidentally, the average score of students admitted under the SC quota in government colleges was 398 and the overall average of SC students in all colleges was 367, both much higher than the overall average for privately controlled seats.Mostly, girls and women face subtly critical comments about academic performance, isolation by peers and discrimination in training practices (Photo - Representative image/Canva)Practice of discrimination changesMost of the backward class girls come from rural areas and are first generation graduates in their families. Their caste identities are barriers to their participation in cultural events and academic conferences."We feel the difference at each level… The opportunity to lead any initiative or programme is always missed," says dentistry graduate Anuja Bhavare (27) from Nanded. "IITs have student councils. But backward class girls are never allowed to participate or play a leading role in the elections," says Geeta.Even professors raise questions about their meritorious performance. In a well-known science institution, the campus interviews for SCs and STs were about to begin when one of the professors on the panel said, "Chalo jaldi ye SC, ST walon ko nipta dete hai [Let us get rid of the interviews of SC and ST candidates soon]. After these, some good candidates will come."Over the period, the practice of discrimination has changed. Dr Jyotsna Waghmare, a Dalit professor at the Institute of Chemical Technology, says, "Nobody now directly tells you not to touch the teapot or glass of water. But the policy of caste discrimination is rampant to stop you in the way of progress like education, job and promotion. Everyone knows this, but no one dares to speak forward."Mostly, girls and women face subtly critical comments about academic performance, isolation by peers and discrimination in training practices. In May 2019, Dr Payal Tadavi, the first woman doctor from Adivasi Muslim Bhil community, a Scheduled Tribe, killed herself due to the alleged casteist abuse from seniors. This when the practice of untouchability has been criminalised by law.“Direct koi nahi bolta, magar koi chodta bhi nahi [No one discriminates directly, but no one spares you],” Geeta remarks. Shortage of professors from backward classesAlthough backward class girls are surviving in the disparity, it has not been possible for them to move on to PhD and higher jobs. As a result, there is a significant shortage of female professors.According to an article, How India’s caste system limits diversity in science, on Nature website, 98% of professors and over 90% of assistant and associate professors are from privileged class at higher-tier IITs and Indian Institute of Science, Bengaluru, while all the faculty at the Tata Institute of Fundamental Research in Mumbai are from the privileged castes.  Girls studying in IIT say backward class students feel confident when they see their representative in the faculty. "We run support groups to help backward class students. We cannot reach all of them because there are not enough backward class professors to support us. When their numbers increase, the anti-caste movement will flourish and there will not be a single suicide in IIT," they hope.Dr Gita Chadha, a Professor in Sociology at the University of Mumbai, has been working on Feminism and Science Studies for about two decades. "We should remember that science institutions are part of our society, so its perceptions exist in these institutions also.” Women in science and technology are rarely found at the levels of professors, heads of departments, directors, senior scientists and consultants. In BTech, Geeta was the only one among the four girls in her class to pass. She got campus selection and joined a big company in Pune. However, she was ostracised right from her seat. Some colleagues insulted and belittled her. Frustrated with the harassment, Geeta finally resigned."The caste discrimination that I endured in the company for two years still hurts me. As I left the job when I had a bond agreement on, that month's salary and provident fund deposit were not given to me. I have not even received my experience certificate."Tanuja says she unwillingly quit her job because her name was not mentioned as an author in the research. “After working so hard, it was tough to leave the job. The matter still bothers me," she said. The research is now in its final stages, and the subsequent research paper is about to be published. Tanuja hopes against hope that her name will be present.  *Names changed to protect privacyEdited by Rekha PulinnoliCover Photo - Facing barriers while reaching the threshold of  STEM education (Photo - Representative image/ Canva)

TB counsellors turn saviours in rural Maharashtra, but their services won’t last longer

Saksham Pravaah project of Tata Institute of Social Sciences is to be phased out by next year, with no clarity on any backup government mechanism to provide crucial follow-up treatment for drug-resistant tuberculosis      Pune, Maharashtra: Every week, Praveen Ambekar (30) would meet Anita* (35) at the district TB centre in Pune for her counselling session. All went well until Ambekar noticed some behavioural changes in the patient during the follow-up treatment. “The untied long hair and a big dot of kumkum (vermillion) on her forehead seemed unusual. Though she has been taking medicines on time, I also noticed that she spoke only with her family. After interacting with the family members, I realised that she was suffering from a psychotic disorder, one of the commonly observed side-effects of the medicines administered to treat Drug-Resistant Tuberculosis (DR TB),” Ambekar told 101Reporters.Ambekar is one of the 214 TB counsellors under Saksham Pravaah project of the Tata Institute of Social Sciences (TISS). Introduced in October 2015 to address the psychosocial issues of DR TB patients and to ensure the completion of their medical treatment, this on-ground support will be phased out by next year due to budget constraints. The Global Fund, an independent and non-profit foundation, offers limited support to the project.“It is important to understand the role of counsellors in dealing with DR TB patients. For instance, Anita lives in Vehle, about 50 km from Pune. She showed signs of mental illness, but her family thought Dev Angat Yene (a goddess) possessed her. She was not getting the help she needed,” Ambekar explained.“I counselled the patient. The family accepted her condition, but the patient did not. So, I consulted with the doctor, who prescribed psychiatric medicines… To get her to take them, she was told they were for joint pain, another side effect of DR TB drugs. After a few months, she recovered completely, her symptoms were gone, and she started communicating with others. A couple of months later, she was cured of TB,” he said.It took two years of follow-ups, counselling and consistent medication for Anita to recover fully, which showed how a counsellor could act as a bridge between the patient and the healthcare system and ensure a sustainable and safe recovery. The situation on the ground and the fact that the number of DR TB patients in India has doubled from 34,000 in 2016 to 68,000 in 2019 pose big questions for the healthcare system.Who will play the role of counsellor once the TISS project ends? Who will address the psycho-social issues of patients? Can adherence to treatment be increased without addressing these issues? Will we achieve the goal of eliminating TB by 2025 without these counsellors?Path to recoveryDR TB occurs when the Mycobacterium tuberculosis becomes resistant to the drugs used to treat TB. It often develops when patients do not stick to treatment or take it only partially. The treatment demands frequent changes in therapy as drugs may not respond, which prompts new drug trials. It may even take up to two years to cure patients. Severe side effects of medication are another issue.Of the 2,30,000 TB patients in Maharashtra last year, over 9,000 had DR TB, according to the state public health department. The total number of identified TB patients in 2021 and 2020 were 1,99,000 and 1,60,000, respectively.  To assist and guide patients during the difficult road to recovery, counsellors under the Saksham Pravaah were integrated within the National Tuberculosis Elimination Programme (NTEP). The counsellors now work in all district TB centres in Maharashtra, Gujarat, Karnataka and Rajasthan.“Tuberculosis is a known disease, but the patients and their families have many doubts after the diagnosis. Due to the daily patient load, neither the doctor nor the staff at TB centres have enough time to clear them. Here, a counsellor’s role becomes essential,” Shweta Bajaj, senior project officer, Saksham Pravaah, told 101Reporters.“The Ministry of Health and Family Welfare has also initiated counselling training for all NTEP health workers with help from the TISS and other educational institutions. Now all employees will be taught counselling skills,” said Bajaj. Lokpriya Meshram (far right), Saksham TB counsellor for Amravati, with a patient at their home (Photo - Shailaja Tiwale, 101Reporters)A lifeline for rural patientsLocated almost 160 km from the district headquarters Amravati is Titamba village in Melghat tehsil. When DR TB patient Mukesh* (27) had a fever and cold recently, his father had to wait for two days to earn enough money from daily labour to take him to Amravati. Mukesh already suffered from adverse drug reactions and meanwhile, his father was worried that he is unable to eat anything due to nausea and vomiting.  Since DR TB treatment is available only in district centres, Mukesh’s father had to let go of a day’s income to take the five-hour journey to Amravati and spend more due to lack of reliable public transport. “It is not always possible for patients from the hinterlands to travel to the district hospitals. Mostly, patients like Mukesh are unable to access medical treatment on time,” Lokpriya Meshram, Saksham TB counsellor for Amravati, told 101Reporters.Even if they manage to reach, they do not get all the treatment under one roof. Sometimes, a chest physician or neurosurgeon is unavailable in the hospital and they have to visit another government hospital or maybe wait for one more day to consult the doctor. Though treatment and medicines are free, the cost of travel, accommodation and food can weigh rural families down.“In such cases, we guide the patients, facilitate their paperwork and help them get treatment the same day with the hospital staff’s assistance. In extreme cases, we also arrange an ambulance for them,” Meshram said.The programme is even more important in rural and tribal areas, where the challenges faced by DR TB patients are acute due to limited healthcare facilities, lack of awareness and resources, unavailability of public transport, social stigma, poverty, malnourishment and fewer income sources.“In Melghat, most families rely on daily wage labour for income. If the head of the family is infected with DR TB, managing two meals a day becomes a difficult task. Moreover, DR TB drugs are high doses of antibiotics. It is not advisable to consume these drugs without a healthy high-protein diet… Some patients take these medicines after eating just mahua ladoos,” Meshram explained.“Counsellors step in here and provide nutritional support, including foodgrain and protein powder, with the help of local NGOs,” she said.Ambekar added that during their personal visits, they come across several patients who do not have a proper shelter, food or income source. “Sometimes, patients are abandoned by their families due to social stigma.”Though TB patients get Rs 500 under Direct Benefit Transfer Scheme, payments are often delayed and are insufficient when no other income source is available. “In such cases, a counsellor arranges mid-day meals by linking the patient with the government's social welfare schemes,” he added.As per the TISS data, Saksham counsellors have linked 5,893 TB patients and their family members to various social protection schemes run by the state and Central governments between September 2016 and March 2020. They have also provided nutritional support services worth over Rs 1 crore to 5,524 TB patients by raising funds with the help of NGOs and from private donors.The TB hospital at the district headquarters of Amravati (Photo - Shailaja Tiwale, 101Reporters)Spreading awareness  In addition to providing socio-economic and mental support, the counsellors spread awareness about the communicable disease. “In Melghat, TB patients do not wear masks or cover their mouth and nose while coughing… they participate in community events, do not seek treatment on time, approach traditional healers, or prefer black magic remedies. As a result, DR TB is spreading rapidly in the interior villages of Melghat… We counsel them about the precautions, assist in treatment and reduce the risk of disease spread,” said Meshram.Patients also have concerns about sex and family planning, which they are uncomfortable sharing with the doctors or clinic staff. The trust built between the counsellor and patients helps in solving these doubts.The Saksham Pravaah counsellors have become an inextricable part of the lives of TB patients in Maharashtra. From October 2015 to December 2022, they have provided counselling and psychosocial support to over 95,000 DR TB patients and their caregivers. Since the closure process is on, their numbers on the ground are going down, which has increased the patient load on the remaining counsellors and has hampered proper patient follow-up.Asked how the public health system will cope with the imminent change, Nitin Ambadekar, Director of Health Services, Maharashtra, told 101Reporters, “We will examine the role of counsellors and take a decision.” The only thing left to be seen is how the DR TB patient care will move forward in the absence of these counsellors. * Names changed to protect privacyCover photo - A Saksham TB Counsellor speaking to patients (Photo - Saksham)Edited by Tanya Shrivastava