This story begins over breakfast at Chateau Montebello, half way between Ottawa and Montreal, on a February day in 1982. There was a conference on medical education, attended by eminent overseas authorities, including Sir Douglas Black, president of the Royal College of Physicians, He was the principal author of the Black Report, on Inequalities in Health. I'd known him for many years; we have mutual friends whom I wanted to ask about, notably Jerry Morris, my mentor at the MRC Social Medicine Research Unit in 1961-62. On the last morning of the conference, I joined him for breakfast. He and Jerry were life-long friends, he a son of the manse, Jerry the son of a rabbi, both reared in Gorbals, the Glasgow slums, both with the permanent reminder of this in their thick Glasgow accents. As I sipped my tea, I popped a Chloroquin tablet into my mouth and swallowed it, but not quickly enough to avoid the bitter taste. It made me grimace, and, noticing, he raised his eyebrows. I murmured, "Chloroquin." He remarked drily, looking at the hard frozen snow outside, that this was hardly the time or place to be taking antimalarials. I told him that the next time I sat down to breakfast, I would be in Calcutta.
That statement proved to be close, but not quite accurate. That afternoon, I hitched a ride to Mirabel Airport for my long flights to Calcutta via Heathrow and Dubai. I arrived at Dum Dum, the airport outside Calcutta in late afternoon of a pleasant sunny day; Professor N.S. Deodhar met the flight. He was another old friend. We drove into Calcutta in a VW van escorted by soldiers on motor cycles, carrying rifles. Bandits were active in the area around the airport, so this was a sensible precaution. Deodhar said on the way to my hotel that he would leave me to get a good night's rest, and would collect me at 5 am sharp next morning, to take me to see a new rural health centre. At first I thought he said 9 am, but after he had repeated it a few times, it sank in - he really was planning to collect me at 5 am. I had been travelling for about seventeen hours in the air and several more on the ground, across ten time zones; I knew I wanted nothing so badly as a good night's sleep, and wanted nothing less than to get up at 5 am. But it sounded like an interesting day in store, if I could survive it.
The Oberoi Calcutta is a rambling old colonial bungalow style hotel, set behind high stone walls. My suite of rooms was at the back, far from the noise of the busy shopping street in front. My windows, ten feet above a narrow lane, were barred and covered by mosquito-proof wire mesh screens. Before I went to bed, I looked out on this microcosm of Calcutta street life. Two girls about 10-12 years old paraded shamelessly and cheerfully back and forth trying to attract hotel guests, holding the hems of their short skirts up under their armpits whenever they thought someone was looking at them, rolling their naked hips lasciviously, flashing white teeth through scarlet, heavily made up lips. They were the youngest prostitutes I had ever seen. Further along the lane were cooking fires and mats where people lived, a few of the half million or so citizens of Calcutta who have no other home but the street. A few days later when I was coming back from a shopping expedition, I came up the two steps at the gate in front of the Oberoi Calcutta, and had to step over a dead baby, that probably had been alive when somebody left it there half an hour or so before. Calcutta is a good place to see life and death in the raw.
True to his word, Professor Deodhar collected me, more dead than alive, at 5 am. It was still dark, and I had been woken by the room-boy half an hour before, at 4.30 am, seemingly just moments after I had fallen asleep. I had had time only for a long shower and a cup of scalding hot tea, hadn't felt able to face the fried eggs that came with it. A pleasant surprise awaited me in the VW van: as well as Professor Deodhar and one of his colleagues, there was another old friend, Zbigniew Brzeziński, escaping from a Warsaw winter. I often seem to run into him in tropical parts of the world when it is winter in Poland. We had some fine and civilized conversation that morning as we drove across the plains of Bengal. I was working then on the first edition of the Dictionary of Epidemiology. Zbigniew challenged me about the definition of "epidemiology" that I had circulated not long before this to about 30 eminent epidemiologists around the world including his colleague in Warsaw, the former IEA president Jan Kostrzewski. The final clause in the definition of epidemiology, "... and the application of this study to the control of health problems," is there because Zbigniew persuaded me that morning as we sat in the back of the VW bus: as an abstract study, an end it itself, epidemiology is sterile - its purpose is to control health problems, and this must be spelt out in the definition. Later I successfully defended this argument in debates with some academicians who said epidemiology is a pure science. So the wording of that definition is a permanent reminder of what turned out to be a memorable day.
We stopped for breakfast about 8 am, at a rather shabby but graceful government rest house, one of the many relics of colonial India to be seen in those parts. So my remark to Douglas Black about sitting down to my next breakfast in Calcutta was only out by about 120 Km, though a world away in tranquillity and, of course, empty of bustling throngs of people. And a very good, nourishing breakfast it was too, fresh hot buttered toast, eggs and bacon (for us two meat-eaters) and tasty, spicy Bengali rice patties.
Much of the remainder of the outbound journey is blurred: jet-lag caught up with me, and I fell asleep several times, despite Zbigniew Brzezeński's diligent efforts to keep me awake and talking. He believed, correctly, that it's best to stay awake when the sun is up, to get over jet-lag as rapidly as possible. I awoke around 11 am, just before we reached our destination, the health centre that Professor Deodhar was planning to show us.
I think Zbigniew, who had been in Calcutta a few weeks already, was almost as surprised as I was, to discover that we weren't there to see a new rural community health centre, but rather to see where it would be when it had been built. We were part of the official party that would preside over the opening ceremonies before the first spade was turned for the foundations to be laid.
It was quite a large official party: representatives from the national government in Delhi, the state government and the local government of that part of Bengal, the national and local health departments, and Professor N.S. Deodhar, in his capacity as Director of the All-India Institute for Hygiene and Public Health, in Calcutta... and Professor Deodhar's two distinguished overseas visitors, who had come all the way from Canada and Poland, just for this occasion. I didn't know this at the time, though I heard Zbigniew's name and mine as one of the introductory speeches was made in Hindi or Bengali. We were all seated on a specially erected open-air stage, in front of a great sea of brown faces of dignitaries and local citizens, several hundred who had assembled for the occasion (or for the free meal that came after it). I was seated near the end of the front row on the stage, nodding off from time to time despite the fact that I seemed to be the focus of so much attention, as was Zbigniew - our pale faces in sharp contrast to the prevailing browns.
Suddenly Professor Deodhar jogged my elbow, having crept along behind the row of seats from his place near the middle, to whisper in my ear, that it was my turn now to make a speech. Make a speech? Me? On what, why, for how long??? My recollections of the next few minutes are confused. I recall standing (swaying a little from side to side as though drunk) at the microphone. I must have said something. Perhaps I said how intimately entwined primary care and public health must always be, especially in rural community health centres. I wished the new health centre success and its staff happiness... something like that. It felt like a very long time, or like a few seconds, it's hard to say which, before honour was satisfied and I slunk back to my seat, shuddering. Zbigniew was better prepared than I; no doubt he had been awake when Deodhar told him a speech would be expected of him, and he had had time to prepare something. He spoke, however, in Polish! He told me later that as nobody would understand he could say anything; anyway, there had already been speeches in Hindi, Bengali, perhaps Urdu, and of course English (and my Australian) maybe other languages for all we knew. He has a fine sense of humour and he enjoyed the Polish joke he told, even if nobody else did.
Then there was a large lunch, with lots of those tasty and spicy Indian dishes, which I gobbled hungrily. I don't know what my stomach was expecting to get or what time zone it thought it was in, but it certainly got a pleasant surprise, and set to work digesting it all, fortunately successfully and without mishap. Having slept part of the way out, I hadn't realized how far we had travelled; it was actually about a five-hour drive from Calcutta to the village where the new community health centre was to be built. Now we had to turn about and go back to Calcutta. My heart sank when I realized towards the end of the long lunch that we faced a five hour drive. As soon as I knew this, I was eager to get on the way. My bed was calling me, and I knew that ProfessorDeodhar expected me to give a lecture and a seminar at the All India Institute the next day. Finally we set off on the return journey about 4 pm. So I would be in bed by about 10 or soon after, if all went smoothly. But all didn't go smoothly.
Although I was wide awake now, it being according to my internal clock about getting-up time, we were all rather quiet. I was enjoying the scenery, the teeming life in the villages through which we passed, the open, slightly undulating countryside with trees, ponds here and there, many rivers, water buffalo, and the ubiquitous cows, scraggy greyish white nondescript animals sacred to Hindus, that wander everywhere in India, even in the bustling heart of huge cities like Calcutta. Soon, too soon, it got dark. Sunsets are spectacular, but twilights are short in that equatorial part of the world; now all we saw were occasional trees close to the road, flashing by in the rather dim headlights; and villages in many of which there seemed to be no electricity, just oil lamps and open fires. I was finding the ride increasingly bumpy, the seats over the back wheels of the VW bus increasingly uncomfortable.
The driver too became aware of the bumpiness, and stopped the car. We had a very flat tire, on which he had been driving for some time - indeed, we were driving on the rim, no wonder it felt so bumpy. We all got out while the driver set about changing the wheel, which was fairly soon accomplished with the aid of a reasonably efficient flashlight. So far so good. But as soon as he let the weight of the car subside on to the spare wheel, it too proved to be flat. We all could see the great rent in it - perhaps it also had been driven too long after it went flat.
We had stopped between villages, out in the open countryside. There had been no electric lights in any of the last few villages we had passed through. Would there be any, and more important, any auto repair works, in the next village on our way? Professor Deodhar and his colleague conferred with the driver in whatever language they had in common, Bengali I suppose. No cars had gone by since we had stopped. Zbigniew and I were dismayed by this turn of events, Deodhar clearly was embarrassed and discomforted by our predicament. Anyway, he and his colleague (whose name I have forgotten) and the driver reached a decision. The driver set off on foot, trundling the less badly afflicted of the two wheels, hoping to hitch a ride as soon as possible, to get to the first town along our way where the tire could be repaired. Professor Deodhar, his colleague, Zbigniew and I, got back into the VW van, where at least we could sit down, to wait, for what I gloomily thought would be many hours if not all night long. There was very little conversation. Zbigniew asked whether we would be likely to get back to Calcutta that night, and how could he tell his wife, whom I knew to be a worrier, what was happening. Deodhar answered that he didn't know.
I became increasingly conscious of two things. The first and more important was that I was very, very thirsty. I had had several cups of tea at lunch time, as well as some fluid when we stopped for breakfast on the outward journey. I felt very parched and dehydrated, so much so that my voice sounded odd when I asked plaintively if we had anything to drink in the car. "Of course," said Professor Deodhar or his colleague - but we hadn't, someone had forgotten to refill the thermos flasks we had brought from Calcutta; all but one were empty, and that one provided no more than a mouthful each for those who wanted it, of nearly cold, very strong tea. I gulped down my ration gratefully, but it hardly touched the sides. The other thing I became conscious of were many whining mosquitoes, and the fact that quite a lot of them were biting me. Were they anopheline or culex? I asked Deodhar, who reassured me that we were in a malaria-free region. I doubted this, and was thankful that I had started Chloroquin a couple of weeks before. But suppose they were culex? Was dengue, or Japanese B encephalitis prevalent in the area? Zbigniew had worked a good deal in malarial areas for WHO in earlier years. Professor Deodhar is a world authority on tropical diseases. I was diffident about exposing my ignorance in front of these experts, so I didn't ask the questions that were bubbling into my mind. I pulled down my sleeves, made sure no flesh was exposed between my shoes and my trousers, minimizing the target the mosquitoes could strike, and settled into a sulky silence.
It felt like an eternity, but perhaps was no more than an hour, before the driver was back, driven back in a truck, with the wheel repaired. Sometimes things get done surprisingly rapidly in India. He soon had it back on the car, and we were on our way. The next town along our road back to Calcutta was quite large, as we saw when we came to it; there had been no difficulty at all getting the tire mended there; and when we came to it, Professor Deodhar and the driver agreed that the other wheel should be made road-worthy too. We parked at the garage for this to be done.
Across the street, festooned with little fairy lights, was a stall selling bottled soda water. Oh Joy! My terrible thirst could be satisfied. We began to walk towards it. Perhaps the others were better dark-adapted than I, certainly they were not jet-lagged. They saw, I didn't, the deep ditch, an open sewer, about a foot across and a foot deep, that lay between us and the soda-pop stall. Suddenly, there was no solid ground under one of my feet, and I splashed up to mid-calf in this stinking mess of raw sewage. I was lucky not to break any bones, not even the skin surface, which could have been serious enough - who knows what lethal pathogens may have lurked in that putrid stuff? There was a stand-pipe and tap beside the soft drink stall, and there we washed off the worst of the foul-smelling ordure that had filled my shoe, soaked my sock, and the bottom six inches or so of my trouser leg. I was past caring anyway. But the others weren't, when we got back into the car. Even with all the windows down to let the air circulate freely, I did not smell very nice. Zbigniew sat as far away as he could for the rest of the journey back to Calcutta, which took another two hours or more... I was in bed soon after midnight and had perhaps the best sleep of my life.
The rest of the story is more cheerful. Hotels like the Oberoi Calcutta offer a wide range of services, shoe-cleaning of course, and dry-cleaning. Next morning in my shining clean shoes, my other trousers, clean socks, shirt and tie, I felt decidedly better when Professor Deodhar's driver collected me around mid-morning. My lecture had been moved to a more civilized time slot just before lunch, my seminar postponed to the following day. All was forgiven. But sometimes when colleagues in the comfort of Ottawa speak enviously about glamorous international travel, I wonder how they would have reacted to that memorable day trip in Bengal.
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