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Vellore, Tamil Nadu, India
I'm a frood who knows where his towel is.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Tuesday, July 19, 2011

A brown sahib in a bus


Date: 07/19/2011

The bus starts out empty.

“Pranay, like it or not, you will be a gringo in India.” Dr. Guerrant warned me as I got ready to fly to India, my own country. Gringo is the picturesque Latin American term for foreigners. Personally, I had felt slightly outraged. I am, after all, a passport carrying citizen of India! Born in humid Kolkata and raised in the dry heat of New Delhi, I did not consider myself a brown sahib, a term reserved for the educated Indians who served the British raj in India. Brown sahibs were often more English than the English.

I was still bristling at Dr. Guerrant’s warning when I boarded the bus this morning. After tossing three well-worn one rupee coins to the conductor, I curled myself into a window seat. I say curled because it is impossible for anyone taller than 5 feet to sit in those seats without an impromptou display of contortionism. Reading on the bus is physically impossible-- the customary jerks are colossal enough to rearrange your visceral organs. If this were not enough, the imaginative interpretation of traffic laws by most bus drivers is sufficient to reacquaint any traveling atheists with the deities they staunchly deny.  I have learned my lesson and now just sit and commune with my fellow Indians quietly.


And ends up looking like this.

Five minutes into my jangly bus ride, I saw a lady, in a gorgeous saffron sari who was squatting behind a small bush. She was defecating. Seeing the bus approach, she made a few perfunctory moves to conceal herself, but she knew as well as I that it was futile. I averted my gaze to give her some privacy. Though I had seen similar sights hundreds of times before, it shook me up in a way that the bus could not. I was struck by the thought that my India was so different than hers.

“India’s economy will soon overtake China’s,” is the proud boast of a vocal minority in India, a minority I regrettably belong to. Indians like me suddenly have the capacity to patronize brands such as Bvlgari and BMW. You know you’ve been left out of the prosperity party when you cower behind bushes as you carry out you basic bodily functions, clutching at the last vestiges of your dignity. This is the case for 638 million people in India. That’s twice the population of the United States.

Two schoolgirls were sitting in the sear in front of me. They were attired in white shirts and navy blue skirts. I got occasional whiffs of coconut oil from their well-oiled braids secured with ribbons that matched their skirts. The braids oscillated in phase with the stochastic shudders of the bus. A wave of nostalgia gripped me as I heard them chanting the preamble to the Indian constitution, a feat every good middle-schooler in India is expected to master:

What do I have in common with these men?


We, the people of India, having solemnly resolved… to secure to all its citizens:
Justice, social, economic and political;

Liberty, of thought, expression, belief, faith and worship;

Equality of status and of opportunity;
and to promote among them all



Fraternity assuring the dignity of the individual and the unity and integrity of the Nation

I couldn’t help but wonder: if Justice, Liberty, Equality, and Fraternity are the lifeblood of modern democracies, is India, with its extreme inequalities, truly a democracy? If we, wealthy and educated Indians spout clichés, act fashionably desensitized to the poverty in our faces, and allow the creation of a permanent economic underclass, won’t our democratic claims ring unforgivably hollow? Won’t history judge us harshly for this denigration of our fellow humans?

 “Doctor sahib, can you help me?”
My reverie was suddenly broken by my young co-passenger who had had spotted my stethoscope. I clarified that I was a lowly med student, but agreed to look at a leg wound that he wanted to show me. The wound looked dirty and was crusted with some dried exudate. A fly promptly buzzed in and began probing the injured area. I swatted the fly away with my hand and suggested some simple wound care and tetanus prophylaxis to the lad.

Often Indians communicate more by jiggling their heads than they do through their words. There is the ready sideways head-jiggle of the Indian who is on the same page as you and then there is the slow, tenuous cranial swaying of the Indian who is mystified, but too proud to admit it. From the amplitude and frequency of the boy’s head, I could tell that my vocabulary and accent were impenetrable for him. My English is inspired by Oscar Wilde. His was inspired by necessity. I broke into Tamlish (a hybrid of Tamil and English) and descriptive gestures to communicate with him.
We need the optimism and perseverance of this man. He knows the street will be dirty within hours and yet he sweeps undaunted.


As I clumsily counseled the boy with broken words and jerky gestures, I felt a sickening twinge: I truly was a wretched brown sahib, a gringo. Dr. Guerrant was right. I spoke, essentially, a different language. As is the case with visiting Americans, the rupee had a completely different meaning for me-- the 3 rupees I had paid thoughtlessly to the conductor are almost 10% of the daily earnings of millions of Indians who subsist on 99 cents a day. My parents, both Doctors, kept saved me from debilitating malnutrition and paid for expensive athletic abilities. No wonder I look physically distinct from the emaciated poor who comprise the bulk of India’s population. In that moment, I resented and despised everything from my expensive education to my posh-sounding accent. They were exposed as the products of inequalities deeply ingrained in Indian society, the same inequalities I vehemently decry. I felt like I had somehow swindled the man next to me.


If you want to meet an optimist in India, shake hands with a traffic policeman. They deal with chaos beyond imagination.
There is, however, a glimmer of hope. My brain is unimpaired by malnutrition. My education hasn’t been discontinued at an early age due to lack of funds. My body is not crippled by preventable diseases. I have the capacity to advocate for my voiceless Indian brothers and sisters. I owe my country and my fellow citizens at least this much. This will be my atonement.




The progress made so far has been at the pace of a bullock-cart. This is simply unsustainable. We, the privileged children of India, can hasten the process of change.


Wednesday, June 29, 2011

Amputations and Asymmetry

Date: 06/29/2011

I noticed the streams of sweat run down his bare neck and chest as I was squashed between my brother and sister-in-law in the back of a small air-conditioned Hyundai. It was an oddly humid night in New Delhi and he was only wearing a loin cloth. He was younger than me and, for a second, I found myself envying his toned chest and abdominal muscles. But my envy was short-lived because I suddenly realized the most striking thing about this handsome lad: he was missing his left arm and leg.

Asymmetry is one of the first things we’re taught to note as medical students. Perhaps that’s why I was captivated by him when I saw him hobble up to the car next to mine at a red light. I anticipated that he’d come to us next and started scrambling for my wallet and couldn’t find any reasonable change-- the smallest denomination I had was a 500 rupee note (~30 USD PPP). I frantically urged my mother, brother, and father to give him something smaller, but the light turned green and we had to drive off just as he got to our car. His eyes met mine for an instant. I wanted to tell him to wait. I wanted to tell the traffic light to wait. I wanted to tell my father, who was driving, to wait. My voice failed me in my desperation, the car moved on and he was gone. I slumped back in my seat and felt ill.

I’ve seen beggars all my life. I’ve seen mothers with desperate looks in their eyes and emaciated babies cradled in their arms braving the heat and the horrific fumes of vehicles at red lights. I’ve had mud-smeared children, with bellies distended because of protein-energy malnutrition, approach me with their pleas for alms. I’ve been threatened with curses and promised divine blessings by beggars of several different faiths. I’ve seen hundreds of mangled bodies-- amputated limbs, distorted trunks, legs bowed by vitamin and mineral deficiencies, blind eyes, and undernourished bodies that just barely look human, clinging to a wisp of life with progressive tremulousness. Why then did I feel ill? I should have been inured to these sights by now. Was it guilt due to my relative prosperity? Was it my long sojourn in the west? Was it the incongruity of the coexistence of his muscular physique and his chopped-off limbs?

I don’t know.

As I slumped silently in the back of the car, my stomach churning at the lachrymosity of the situation, my thoughts drifted from the asymmetry in the lad’s amputated body to the asymmetry in the landscape of Indian society. New Delhi is filled with posh malls, BMWs, palatial bungalows, luxurious hotels, and world class hospitals. It’s also home to emaciated children, amputated beggars, and poverty that is capable of exhausting the world’s supply of tears. I understand how it is easier to ignore the agony of people who live away from you and whose suffering doesn’t immediately affect you. However, I cannot fathom how the lawmakers of India, who inhabit Delhi, reconcile themselves to the simultaneous existence of BMWs and beggars in the city and the dichotomy of malls and mutilations. I beseech them to do something.

This slum, under a bridge in New Delhi, is only a few kilometres of the government of India (pictured below). Note the infant in its mother's arms.



When I got home, I looked at the Rs. 500 note in my wallet. I hadn’t been able to give it to the anonymous amputee. Any middle class person would have justified my inability: “It’s too much”. In a practical sense, they’re right. You’d have to be very very rich to be able to give Rs. 500 to every beggar you meet in India. However, I feel Rs. 500 is simply not enough! Even Rs. 5000 is decidedly not a long term solution that’ll free them of the poverty trap. Instead of only giving money once in a while to a beggar whose sorrow moves us, it is important for us to agitate, to educate, to advocate, to vote, and to ultimately bring about significant changes.

Perhaps giving alms to beggars is something we do mostly to salve our consciences, to atone for the asymmetry.


P.S: In the upper-middle class Indian society I inhabit, encounters with amputated beggars are usually followed by discussions of horrific gangs that abduct and amputate children to force them into mendicancy. This practice was also depicted in Slumdog Millionaire, where a homeless child who was a decent singer was taught a religious song, blinded in his sleep, and forced into beggary. These discussions frequently (not always) conclude that we should not give money to the mutilated mendicants on the streets. The logic: by not giving alms we express a refusal to be emotionally manipulated that will make this heinous practice unprofitable and force the gangs to find other wicked ways of making money. I follow the logic, but-- at the end of the day-- it doesn’t help me ignore the individual pain of crippled beggars. What if he isn’t the pawn of a diabolical gang? What if he really has been disabled by some tragic accident and can’t find work? And even if he is the victim of a gang that is using him to tug at my heart strings, can’t I at least spare him a beating from his boss today by making sure he doesn’t go back empty handed?