In the early 1970s, most of India's people lived, as they had for millennia and still live now, in rural villages. In those days perhaps only Calcutta, Bombay, Delhi and Madras had populations in multiples of millions; and few other cities had as many as a million. However, almost all the services were concentrated in the cities, and rural villages had little or nothing: no sewers, no electricity, no public transport - and no doctors. National planners wanted to turn this around. I was among the many experts from abroad who came to offer advice and assistance. I went to India in 1974 as one of a team of three experts on medical education and health care planning. My partners on this mission were Ted French from the University of Edinburgh and Robert Stillmann from the University of Basel and the Canton of Basel Health Services planning commission. We began our work in Delhi, where for 2 weeks we discussed strategies with our Indian and WHO/SEARO counterparts. These were the top brass in the Indian Ministries of Health, Education, Rural Development, the Indian Council for Medical Research and the Indian national medical licensing board. The WHO/SEARO staff included Haresh Chandra (a pediatrician) my friend Ray Mills, a former colleague from my Edinburgh years; and among others, a nice young man, Om Auraura, who was the executive secretary for this mission, perhaps for the whole enterprise of injecting doctors into rural health care in India. After 2 weeks in Delhi we flew to Madras, now Chennai. We had a few days in Madras, and more discussions with local staff who were testing a few plans to deal with rural shortages of health care providers, then went on by car to Pondicherry, to the Jawahal Institute of Postgraduate Medical Education and Research (JIPMER) where there was to be a national conference on rural health care with health planners, administrators and medical school teachers. There was a proposal that medical graduates must spend three months in a rural community clinic during the compulsory pre-registration year (the year they had to do after completing the medical course, before they were given a licence to practise on their own). There were some obstacles in the way of the proposal. It violated the human rights of the young graduates. There were no suitable clinics in most of the places where the doctors would be required to work; nowhere in the villages for them to live. Many women graduates (about half of the medical graduates in India) could not be expected to endure the harsh living conditions in the villages, where there were few or none of the amenities they were accustomed to. All that is another story. This is the story of my experiences on this particular visit to India, perhaps mixed a little here and there with bits and pieces of other visits to the Subcontinent.
In Delhi we stayed at the Janpath Hotel, a cheap but comfortable place a couple of blocks from Connaught Circus, the commercial centre of New Delhi. The Janpath was frequented more by Indians than expatriate Europeans. It had a musty odour due to the pervasive mildew that afflicts everything in warm parts of the world that get monsoon rains; and on top of that, an indefinable and basically attractive smell of Indian cooking. They kept a tolerable table in the restaurant, and excellent room service with early morning tea, served with a great flourish by the room-boy who held the teapot high in the air to let the tea cascade out in a long thin stream into the cup that he held about the level of his knees - a widespread Indian custom.
New Delhi is a modern city, laid out in a pattern of concentric circles connected by broad boulevards. Parliament and government offices occupy a couple of the circles or circuses and adjoining boulevards close to the centre of the city. The World Health Organization South-East Asian Regional Office (WHO/SEARO) is a fine modern building architecturally similar to regional offices in Copenhagen, Alexandria, Manila, Brazzaville – the same architect designed them all. But it is on one of the outer ring roads a long way from the seat of government and the commercial and shopping hub at Connaught Circus. From the Janpath Hotel we had to take a taxi to WHO/SEARO. However, we could walk comfortably from the Janpath Hotel to interesting local restaurants near Connaught Circus, and to the shops of the government-run Cottage Industries which stocked arts and crafts from all over India, and on beyond to the fascinating alleys and sprawling bazaars and street markets of Old Delhi; and on beyond these to the heart of the Delhi of the Moghul era, the Red Fort. It was splendid having all this within easy reach, and our time in Delhi was so arranged that there were two free weekends.
I explored this fascinating city pretty thoroughly in my abundant spare time, adding to the little knowledge I had gained from a previous visit. Two years later Wendy was with me when we stopped in Delhi for a week or so on our way back from my next WHO mission in Sri Lanka, and we explored more of it together. Delhi has been inhabited for many thousands of years, since neolithic, perhaps since paleolithic times. Like Rome, it carries many traces of past civilizations. The earliest literate civilization of India had settlements here. It has been a focal point for sciences such as astronomy (really astrology) since before the Christian era. Among the impressive remains of former cultures are several strange-looking structures that were used by ancient astronomers, akin perhaps to the druids who constructed Stonehenge, but the structures in Delhi are far more sophisticated methods of measuring and predicting the solstices, the phases of the moon, positions of the planets, and to observe meteors and comets. Hinduism predates the birth of Christ. So there are many ancient Hindu temples and shrines, as well as others that have been built over the centuries. Buddhism too has had a strong hold since its beginnings, so there are Buddhist shrines and temples, and temples that follow Zoroastrianism, Ba'Hai, Sikhism, and synagogues. The Moghul invasion in the 11th and 12th centuries brought with it the rise of Islam; so there are some mosques, including the Great Mosque that is one of the holiest sites of Islam. The Moghuls were eccentric Moslems: their legacy to civilization includes the exquisite pictorial art known as Indian Miniatures, meticulously detailed paintings done with a single hair rather than with a brush. What makes them eccentric is that they often feature human forms, which devout Moslems never do. We have two framed on our wall that I brought back from the bazaar in Old Delhi on my first visit in 1972, at the end of a two-month WHO mission in Indonesia.
On the second of my free weekends Om Auraura arranged an itinerary for me to see much that otherwise I would never have seen - including his own modest little home, and his wife and brand-new baby, far away in the teeming suburbs in an area where individual houses had no flush toilets, independent water supply, or electricity. They drew their piped and therefore drinkable water from a communal stand-pipe in the middle of the street. It was cold then, early January, but the local kids were playing and splashing in the water from this tap, making the most of it while it was plentiful - in the intense heat that begins in late April and continues until the monsoon breaks in August, water is too scarce for this to be possible.
Some of the preparations for our conference at JIPMER provided other opportunities for seeing things off the beaten track that are not part of the normal tourist itinerary. The staff of the All India Institute for Medical Research, an outstanding group of internationally renowned scientists and scholars, arranged for us to visit a few rural villages relatively close to Delhi, where, among other things, there were already some medical services and family planning programs in place. In some of these villages we went into a few of the houses (just huts) and saw how the people actually lived. I can never forget the hut where we saw a little girl quietly dying in a corner of the one room in which the family lived. There was not quite enough food to go around that winter, somebody had to go without, and girls are expendable... It is a common enough scene: sons are more important and get at least some food when there isn't enough for everybody. In the quarter century since I saw that little girl dying in a village hut, the plight of females has become worse. Ultrasound and amniocentesis have made it possible to determine the sex of the fetus early enough to facilitate selective abortion of female fetuses, and this is widely practised in both India and China. There is a deficit of as much as ten million girls and young women in India in the early 21st century as a result. Karen Trollope Kumar and I prepared a paper on this and other inequities and injustices against women, for another WHO conference in Bangkok in 1997, and I did not endear myself to some of the male Indian delegates at that conference when I spoke out against the practice in rather undiplomatic language.
While we were in Madras, a steamier, more humid place than Delhi even in what passes for winter in those parts, I visited the old graveyard where many British soldiers and their wives and children lie buried, having died mostly of malaria, or sometimes in large numbers from cholera. This interesting graveyard was an eloquent reminder of the dangerous times when no one knew what caused malaria. In the early 1970s, the malaria parasites responded to drugs such as chloroquin, which we were all taking, so we were safe. In Madras we also visited the first of what eventually became a very large number of holy places. This one wasn't of much account, merely an ornately carved Hindu temple, but it was a foretaste of what was to come.
On the drive south from Madras to Pondicherry, we passed by the remains of a very holy place, Mahabalipurum. This ancient temple had been built on what was then a sandy cliff overlooking the sea, perhaps a kilometer inland. But that coast is slowly being eaten away by the waves beating in from the Bay of Bengal, and by the time we saw it in 1974, all that remained were some blackened and partially submerged rocks several hundred meters out to sea. If we looked closely we could just make out the remains of the carvings that had once decorated them. So the sea has advanced over the land to a distance of well over a kilometer in that part of the world, in about 1600 years. Devout Hindus still come from all over India and beyond to worship at Mahabalipurum, to see what remains of the original temple, and to leave their offerings of flowers and fruit at a relatively new and much more modest temple that stands on the sandy shore a hundred meters or so from the breakers. Global warming and rising sea levels will very likely soon inundate that one too.
Pondicherry, in addition to being the site for JIPMER, is a very interesting place for other reasons. It was the capital of the French enclave in colonial India, and the locals include some who still speak French as a second language after Tamil, because of continuing commercial ties to modern France. More interesting than this is the ashram for which the modern city is famous. Early in the 20th century, a young local woman decided to devote her life to uniting all the world's religions. She used her family fortune to establish the ecumenical ashram that now attracts Christians, Jews, Hindus, Moslems, Buddhists - basically, when I was there, young women and men who were opting out of western industrial society and seeking a simpler way of life. In the city and bazaar, we saw many blond, bare legged Scandinavians, crew-cut or bearded Americans, Brits, Canadians, Japanese, Australians, Kiwis, Israelis, young people from all over, often easily identifiable by the national flags sewn to their back-packs. The Holy Mother, as she became, was still alive in 1974, old, frail, but still apparently vibrant and dynamic. I would like to have visited her and the ashram but we weren't able to fit this into our schedule. Strike out one holy place, but we more than made up with others, for missing that one.
Many Tamils are short, roly-poly, brown, happy-looking people. The director of JIPMER, Shiva Balasubramanyan, was no exception. He was also very bright, very able. He and his colleagues were doing interesting research on leprosy, which was common in the south of India then. They had managed to grow the lepra bacillus, a notoriously shy organism that is extremely difficult to cultivate in non-human hosts. They were using a local variety of mongoose, an armour-plated animal a bit like a South American armadillo. Another success was demonstrating that the lepra bacillus could pass from one host to another in blood ingested by bedbugs. After learning this, we examined our bedding very closely to ensure that there were no bedbugs.
We needn't have worried. Our accommodation in Pondicherry was spotless, a private guest house run by one of the many acolytes of the ashram - so the place was full of pamphlets and books about the Holy Mother and all her good works. Our bedding, and more important, the mosquito netting, were immaculate, intact and effective. One reflex I soon acquired there was to sweep my hand around under the rim of the toilet bowl before seating myself: the local culecine mosquitoes which carry dengue and occasionally more exotic arbovirus diseases, even more occasionally filariasis, like to roost in the cool, sheltered crevices just below the rim of the toilet bowl. This is not very far from the area where Ronald Ross discovered the anopheline mosquitoes that carry malaria - much smaller mosquitoes, like the no-see-ums of the North American prairies. We saw some of these after being shown how to look for them, and realized how meticulous Ross must have been to find them, because they are nearly invisible.
From Pondicherry we fanned out into the surrounding countryside to visit more villages where preliminary plans were being tested and where, perhaps recent medical graduates could be placed. I saw for myself that it would not be as easy as the medical bureaucrats from Delhi had hoped it would be, to find places for these young doctors, especially the women, to live. All that was to be vigorously debated when we had our conference, the climax of all these activities, the following week.
First though, there was another weekend, and a holiday that added an extra day to it. One of the local academics was a devout Hindu who invited Ted French, Robert Stillmann and me to come along with him for a brief pilgrimage to some of the holy places in southern India. We hired a car and driver, and set off south towards the tip of India, but headed inland rather than along the coast. The country there is lush, fertile, much of it low-lying and swampy, with paddy-fields and plantations of sugar cane, bananas, mangos, coconuts and other tropical fruits. It is densely settled, villages teeming with people every kilometer or so, and several large towns or small cities. In many there are holy places: temples, shrines, sacred wells. We stopped at each of these so our Indian colleague could pay his respects. About half way through the pilgrimage, we climbed a long flight of steps up a steep hill near the city of Madurai, where he threw a coconut into a deep pit with a sharp stone sticking up at the bottom, with all the force he could command. If the stone pierces the coconut, this is a particularly holy sacrifice and the one who does it is thrice blessed. Our colleague was successful and we congratulated him. More was to come. The next place was a holy well, where a rather slimy, water weed-encrusted broad stairway led down into the water. We took off our shoes and socks at his request, albeit reluctantly, and dipped a toe each in the murky water. That evidently was the final ritual on our pathway to become Hindus. He rolled his thumb in a paste of ashes and pigment, took each of us around the shoulders in turn, smeared some of the paste on our foreheads. To our surprise, he then announced that we were Hindus. I have a photograph to prove it, but have to say that I have never felt any different since then. However, our other Indian colleagues assured us when we got back to Pondicherry late the following evening that we were indeed from that day onward, bona fide members of the Hindu faith, would be reincarnated, upward if we were good, or lucky, or both, downward if we weren't...
There were other experiences that made this a memorable period. During the conference the following week we had several formal dinners, formal Indian style that is. Most were vegetarian meals, occasionally fish was included. With or without meat, the meals were uniformly delicious, even possible to wash down with tasty non-alcoholic fruit drinks. This part of India is nominally ‘dry’ - not quite total prohibition, but close. Haresh Chandra, among others, found this hard to take. He liked his whisky and soda. Ted French, Robert Stillmann and I liked a beer in this steamy climate, preferably an ice-cold one. We were not always able to satisfy our thirst, certainly not at any of the formal dinners during the conference, nor at the guest house, whose devout manageress kept it strictly teetotal. It was in fact quite easy to live without a cold beer on the days when we weren't able to find a place where we could get one, because the fruit drinks were delicious and thirst-quenching, as they are also in Saudi Arabia and Kuwait, orthodox Moslem nations where alcohol is unobtainable legally. Some time during that week, we went also to the home of the local French consular representative, and there we imbibed some excellent ice-cold Alsatian beer.
Too soon it was all over. We turned about and headed back to Madras, and on to a plane for Delhi. The debriefing was short, but a free day remained, and that was when Robert Stillmann and I took off for Agra and the Taj Mahal. We went by air-conditioned train, a very good way to get from Delhi to Agra, although it is insulated from the local populace more than I would have liked. I have been to Agra several times. I had been during my first visit to Delhi in 1972, Wendy and I went there together a couple of years later, on our way back from Sri Lanka. On this occasion with Robert Stillmann, we went also to the other famous site in that region, Fatipur Sikri; this is like Jaipur, a city of pink marble, but Fatipur Sikri is a deserted city, occupied only by beggars, pi-dogs and a few souvenir stands. I don't know, or don't recall why it was abandoned, perhaps because there is no water there. Unfortunately we got there too late in the day to see it, it was already dusk when we arrived and soon it was quite dark. And two years later, Wendy and I didn't get there at all despite our best efforts to persuade our driver to take us. Many Indians believe it is an accursed place, and are reluctant to go near it. From the glimpse I had of it, I remain tantalized, and would dearly have liked to see more of it, and in daylight. But I was able to see a tiny bit more of India on that visit, because I stopped in Bombay, took a boat ride across the bay, visited the sacred caves south of the city, and had a brief visit to Grant Medical College, one of India’s best, where one of my new friends from the conference at JIPMER was professor of public health.
I would love to have seen a great deal more of all of India, perhaps most of all, more of the lush and beautiful south that we saw so briefly on the pilgrimage to the holy places in the weekend before our conference. But it would take a lifetime to see all that this complex and beautiful land has to offer, and it would take many lifetimes to understand even just a little of its complicated, multilayered cultures.
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