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. 

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.