Why I disagree with John Mayer

Date: 08/07/2011




This is a personal reflection about my work this summer and my last post on this blog. Please excuse the fluctuating volume; this is my first project of this sort. Thanks for following my blog this summer. I'm immensely grateful. Here's a text of the video:
                          
Me and all my friends
We're all misunderstood
They say we stand for nothing and
There's no way we ever could


Nowe we see everything that's going wrong
With the world and those who lead it
We just feel like we don't have the means
To rise above and beat it


So we keep waiting 
Waiting for the world to change
We keep on waiting
Waiting on the world to change


                              --John Mayer


After my experiences this summer, I find that I rather disagree with John Mayer. I just spent six weeks in India studying malnutrition and working with people who were sick because they were poor and poor because they were sick. The one thing that’s clear to me is this: the situation is urgent. Sitting around waiting for it to change will not work.


The bulk of my work this summer involved a case control study that looked at the link between cognition and malnutrition. I was rather surprised at my results and my mentor believes we have prima facie evidence that upholds our hypothesis. I cannot talk more about it here out of privacy, sensitivity, and scientific concerns. Apart from this work, I participated in community health screenings under the supervision of some young doctors from Christian Medical College. The camps were held in villages near Vellore. In three weeks, I met, examined, and spoke to around four hundred individuals. I heard hundreds of complaints about bodyaches and counselled hundreds on their nutritional intake. I also had the privilege of helping out dozens of kids with nutritional issues such as vitamin, calcium, and iron deficiencies by providing them with supplements, deworming tablets, and counseling their parents. There was tremendous satisfaction in the knowledge that such early interventions would have a large ripple effect.


However, my levity and optimism took a titanic blow when I used my newly acquired skill of cardiac auscultation to detect mitral regurgitation in a child and then found that he would probably not be able to afford the necessary treatment. The incident brought me face to face with the limited scope of my interventions. It wasn’t that it was bad. It simply wasn’t enough. We need to go beyond the biomedical level to the socio-economic and political level of medicine.


 Of course, any time I mentioned political fixes in India, I was met with a barrage of cynicism and disgruntlement with the political machinery of our country. “There’s no political will”, moans one. “These bloody politicians are all corrupt”, groans another. This isn’t a surprise considering the recent political storm about high level corruption in the Indian government.  I like to refute these tigerish outbursts by reminding these indignant folk that we don’t live under the tyrannical rule of a monarch. Votes are the lifeblood of politicians. As public intellectuals, we can agitate and spread awareness so that public health and health inequalities become serious voting issues. This needs to be done not only among the rich and educated but also among the poor and illiterate who are more susceptible to demagogues. Gemlyn George, one of the doctors I worked with this summer opines that Indian politicians don’t find working on public healthcare a lucrative source of votes because the pay-off is slow and is unlikely to benefit them politically in the near future. It’s time to make it worth their while to fix our healthcare nightmare.


One of the issues that is aching for a political remedy is that of the stigma and lack of awareness that plagues Leprosy patients in India. I visited the Schieffelin Leprosy Research & Training Centre near Vellore where I met many patients of Leprosy who quietly endured the deformities and disfigurements that their circumstances had brought onto them. I plan to write a lot about Leprosy and the specific ways in which it can be attacked politically and socio-economically, but I want to dwell here on the moment I shook the clawed hand of a Leprosy patient. It was a feeling of incredibly inadequacy. He had lost his position in society and the use of his hands. What had I lost in my life? The hair on my head? Romantic relationships? This man’s suffering was on a scale beyond my comprehension. I felt petty. 

Dr. Rama, my absolutely amazing mentor.

My Indian mentor Dr. Ramakrishna pointed out to me that I was witness to the fortitude of the human spirit even in the face of the adversities of poverty and disease. Despite their bereavements, and suffering, the people around me, including some Leprosy patients, smiled. The children frolicked and goaded me brattishly to take their pictures with my camera. I saw a rickety old grandmother dance with a little too much gusto in a shockingly orange sari in her grandchildren’s wedding. Our car got rather delayed one day due to the festive Aadi celebration in which seemingly the entire population of Vellore took to the roads. Life goes on, believe it or not, and not always in a dismal way. I will probably never understand the source of this resilience, but I shall always bow my head in reverence.


We are sitting on a dynamo of human capital that is slowly going to waste to due to stupid reasons. I particularly like analogizing our healthcare situation to a leaking tap. Like the drops of water lost, the loss of human capital does not seem huge at first. However, the drops and lives add up over time. Fixing these small leaks of human capital all over the world would be transformational. The world would change. As educated and relatively prosperous people of the world, we have the tools to do this! We have done so in the past, don’t be cynical about trying again. Most importantly, please don’t sit around waiting with your friends for the world to change. It won’t until you change it. 

Confused in Chennai, Vacuous in Vellore

Date: 07/01/2011

A street view of Vellore

The cool interiors of the aircraft gave way to a tarmac that was bindingly bright and blistering at a 100 degrees Fahrenheit. With a groan, I shrugged off my black sports coat and boarded the bus that ferried me to the terminal. As I was exiting the bus, I heard an unintelligible (to me, at least) yell.

Lady: (insert white hot fury expressed in Tamil that made the tarmac look cool)

Me: (dumb look)

Lady: (angry gestures that I should let her spawn exit the bus first)

Me: Sorry!

As I let the kid and the lady exit the bus, I experience deja vu. I was in the South.

Vellore is marked with the red oval.

India is a massive country with 1.2 billion people. The country is divided into 28 states and 7 union territories. The states were created along linguistic lines. Each state is roughly the size of a European country so traveling between states is almost like traveling between different countries in that the language and the culture changes distinctly. The steepest divide lies between the northern states and the southern states due to reasons beyond the scope of this blog post.  I'm now in the southernmost Indian state of Tamil Nadu. The main language here is Tamil. It is one of the most educated and progressive states of India. There’s a widespread delusion among second generation Indians in the US and even some non-resident Indians that you can communicate with basically everyone in India if you speak Hindi and English. In my case, three days in Tamil Nadu have rendered any vestige of that belief dead in the water. More on this soon. 

My bus ticket to Vellore from Chnnai. Journey time: 2.5hrs

I took a bus from Chennai to Vellore and then was mobbed by auto drivers. Autos (as in Auto Rickshaws) are surely a conspiracy of some religious secret society to ensure piety among Indians. When you’re within an Rickshaw as it careens through Indian streets at imprudent speeds and brushes aside pedestrians who’re forced to run for their lives, you quickly abandon atheism/agnosticism and beg God to forgive your waywardness and get you home safely. A young lad in the mob of auto drivers finally out-shouted everyone and gave me an organ-rattling ride to my accommodations. He must have heard my liver rattling against my ribs so he decided to regale me with his life story and simultaneously practice his accented Urdu on me. He was the sole offspring of his parents and was married very early so he had no option but to forego education and take care of them by driving his auto. When we got to Bergen house (my guest house) I poured myself out of the rickshaw, gave him a generous tip (for not killing me and to take care of his pregnant wife), and began dragging my suitcases up the stairs. He rushed up and asked to make a request of me.

Me: What do you want?

Lad: Sir, when you’re a doctor, please charge the impoverished half the rate you charge the wealthy.

Me: Will do

The significance of the request was not lost on me. The impoverished fall ill more often and suffer great economic setbacks due to medical expenses, which-- in turn-- leads to more sickness. A real poverty trap. Esther Duflo and Abhijit Banerjee do a beautiful job of describing it in their book, Poor Economics. An interesting discussion of it can also be found in a report by Harold Alderman for the disease control priorities project.

Bergen House: my wonderful, though slightly pricey, abode in Vellore. It's on the CMC college campus pictured below.

The next day, I got a call on my room’s phone. A deep voice identified itself as Dr. Ramakrishna, my mentor at CMC. He’s the head of the Dept. of Gastroenterology and is involved in all sorts of brilliant project. He drove down a few minutes later to pick me up from Bergen House. Dr. Rama is a tall man who talks deliberately and takes a second to think before answering your questions in a lucid and well-considered way. Even his laugh is deliberate, deep, and rich. We began talking about the logistics of my project and talk turned to the state of healthcare in India. By the end of the ride ee were discussing the disorganization and the inadequacy of funds that plagued the public health system. India spends about 3% of its GDP on health. America spends about 17%. neither extreme is good. One of the interesting things Dr. Rama said during the ride was with respect to cancer. He said that India has a poor tumour directory because documenting tumours is very very far from his priority. When faced with the illness of a family member, Indians, particularly poor ones, are known to sell their lands and take outrageous debts. Therefore, his main priority is actually to prevent cut-throat money lenders, witch-doctors, and quacks from bleeding patients dry.

Christian Medical College (CMC): One of the finest medical colleges in India.

Having ascertained that I hadn’t had sufficient breakfast, Dr. Rama took me for a vada ( a delicious lentil based southern recipe) and delicious filter coffee. Drs. Pugazhendhi and Shrikanth accompanied us. Once we got our coffees and vadas, we sat at the table looking at each other with awkward smiles. Dr. Rama introduced an icebreaker

Dr. Rama: Do you pronounce your name the Bengali way (PranOY) or the other way (PranAY)

Pranay: PranAY.

This gave me the opportunity to rant about my appalling name. The ice was broken. Phew! We were all chuckling now. Next we talked about my complete incomprehension of Tamil.

Last year, I had brought my then girlfriend to India. It is only now that I understand her plight. She had been mostly dependent on me for translating the goings on even though she spoke a little Hindi that she’d learned from Bollywood movies and Rosetta stone. 


I, on the other hand, was utterly dependent on Dr. Rama and the other doctors for communicating with people. I felt like a complete moron standing around, not understanding a SINGLE word. I felt even worse when people broke off their high-speed conversations to explain the gist of the dialogue to me. They did this very slowly in case I didn’t understand even their English. Vettri, the driver who has been taking me around, probably thinks that I am mentally challenged because our conversations go as follows:

Vettri: (in Tamil) You need to go to that shop to get a passport picture.

Pranay: (thinking he’s asking me how I like Vellore) errr...very nice

Vettri: (now confused, still in Tamil) Umm...go to that shop over there, I’ll wait here.

Pranay: (thinking he’s talking about films) I’d love to watch a Tamil movie. English subtitles?

Vettri: (in heavily accented and broken english) Go to the damn shop now.

Pranay: (with my patented look of dumb incomprehension) Eh?

Vettri: (gesticulating furiously now) GO!

Pranay: (understanding finally dawns) Ok, ok, keep your shirt on.

I’m obviously kidding. Vettri has shown me the greatest politeness and tolerance. However, I do need to learn some Tamil to make things easier for the people I’m working with and the individuals I’ll be interviewing.

I’ll write more about the projects I am involved in in future posts. Watch this space. I’m also putting up pictures from the trip on my flickr photostream.

In India, the versatility of your vehicle is only limited by your imagination. Kudos to this gentleman in Chennai who had precariously balanced this old television on his motorcycle.

Vanishing and Reappearing

Date: 06/17/2011

The writing's on the wall: I am going to do horribly on the final exam for the gastrointestinal system because my brain is already yearning for the heat of the Indian summer and Indian chillies. The latter has a remedy (Indian mangoes!!!) and the former is meant to be suffered bravely (which allows you to boast freely when you meet people from more temperate parts of the world).

I was just having an evening coffee with a friend from med school. As we parted, I got into my car, revved up the engine and almost ran the stop sign just as she was crossing the street while also being on the left side of the road. She gave me a very very befuddled look and I had to embarrassedly tell her to move on and not judge me (Sorry, Sandi!). What can I do? My brain thinks it's in India already.

My flight to India is on Tuesday. I get to fly my favourite carrier: Jet Airways. They serve mango lassi and Indian food and, most importantly, give me a chance to catch up on all the escapist Hindi cinema that I've been missing in America. As I get closer to my flight, I cannot get a quote from one of my favourite books, "If on a winter's night, a traveler" by Italo Calvino, out of my head:

"To fly is the opposite of traveling: you cross a gap in space, you vanish into the void, you accept not being in a place for a duration that is itself a kind of void in time; then you reappear, in a place and in a moment with no relation to the where and when in which you vanished."

You can imagine how exciting the prospect of "reappearing" in India is for me.

This picture was taken three years ago in the Montreal airport as I waited to vanish and reappear in New York City.