AMR across lifecycle: The life of Rani

The following scenario has been developed by GEAR up to illustrate the ways in which gender and other inequities shape susceptibility to, exposure to, and treatment of AMR through the life course. Rani is a fictional character, but her experience is based on reality.

Infancy: Rani’s life began in a small village in rural Maharashtra, India. As an infant, due to poor living conditions, food insecurity and lack of clean drinking water she was malnourished with a weakened immune system. Her brothers always seemed to get the larger portions, leaving Rani hungry. Her childhood was spent fetching water from the village well, a daily chore that exposed her to contaminated water sources. The inadequate sanitation system meant that resistant infections spread frequently and widely, particularly among the girls in her community. 

Adolescence: As Rani entered her teenage years, the burden of domestic labour fell heavily upon her shoulders. She spent hours cooking over smoky chulhas [cookstove], the acrid smoke stinging her eyes and lungs, making her prone to pneumonia. Handling uncooked food, she was constantly exposed to bacteria. 

Her menstrual cycles brought another layer of vulnerability, with recurring urinary tract infections (UTIs) and reproductive tract infections (RTIs). Information about proper hygiene and antibiotic use was scarce. Household elders had decision making authority to decide when and where to seek healthcare, and Rani was not involved. 

Adulthood: After getting married, Rani fell pregnant and was suffering from a UTI, her husband purchased a medication from local informal pharmacy without diagnosis. Rani, needing permission from her mother-in-law to seek medical help, often delayed treatment.

Wanting to provide for her new family Rani started working as a waste picker on the fringes of an informal settlement. She collected plastic bottles, caps, boxes and metals to sell on to scrap dealers. She carried heavy loads in the heat of the day and was physically exhausted and dehydrated. She woke before light to do this work was worried for her safety. Women were sometimes victims of sexual gender-based violence. 

Rani also kept chickens. The agricultural extension programs, dominated by men, rarely targeted women like Rani, leaving her uninformed about safe farming practices and the dangers of AMR in livestock.

Older life: As she aged, menopause brought hormonal shifts that made her even more susceptible to infections. Rani didn’t have many friends or family to talk to and lacked access to medical help. Limited access to social networks and health facilities meant she was isolated, lacking vital information about AMR and appropriate antibiotic use. She became the primary caregiver for her grandchildren and ailing relatives.

One day, Rani developed a persistent cough and fever. The local clinic, now even more strained, could offer little help. The antibiotics they prescribed were ineffective. The infection, resistant to most treatments. Rani succumbed to an untreatable infection. 

Consider the following prompts for reflection:

• How did social-cultural factors contributed to Rani’s vulnerability to infections and AMR?
• Think about the specific ways in which gender inequality impacted Rani’s health and access to healthcare throughout her life.
• How did various environmental factors increased Rani’s risk of infection – how did her roles within her family and community contribute to these exposures?