Villa Serbelloni, Bellagio, Lake Como, Italy

Wendy on the patio, Villa Serbelloni, Bellagio, Lake Como, November 1992 - On a day of "mists and mellow fruitfulness"

Lake Como in the Italian lake district is the most beautiful of the lakes in that region, a Y-shaped lake with the small city of Como at the western end, St Moritz in Switzerland above the mountains at the eastern end, Lecco to the south, and the town of Bellagio in the apex of the “Y,” where there are views of all three arms of the Lake. It is a setting of great beauty but little if any strategic importance. There has been a settlement there since very ancient times, always sought out and usually occupied by the rich and powerful. At the height of the Roman Empire, Pliny the younger, a scholar who had strong aesthetic sensibilities, built a villa here and his statue remains in the grounds of the Villa Serbelloni to this day. After the end of the Roman supremacy, the site was occupied by a succession of powerful families including the Sforza dynasty until it passed into the possession of the minor but wealthy Serbelloni family, who sold it to a Swiss hotelier who in turn sold it to Ella Walker of the American liquor family of Hiram Walker. She married into the Italian aristocracy and became a principessa (princess) so during the lifetime of her husband the property was again in the possession of the Italian nobility. She was childless. At her death which was many years after her husband’s, she bequeathed the Villa Serbelloni and its lands to the Rockefeller Foundation, and it was made it into a prestigious international study and conference centre.   

I have had three visits to the Villa Serbelloni, two to conferences and the third time, as a scholar in residence. The first conference I attended was in September 1982, to join one of the working groups preparing the 10^th revision of the International Classification of Diseases.  I was back at the Villa Serbelloni for another conference in May 1985, where the theme was the future of health and health care services. My third visit to the Villa was as a scholar in residence, where I planned and wrote the first draft of a monograph on ethical problems that can arise in epidemiological practice and research. (Parts of this have subsequently been published as chapters in books and as free-standing papers in peer-reviewed journals but the book was never published in its entirety).

The main building of the Villa Serbelloni occupies a level clearing close to the heights in the extensive grounds, which descend to the lake shore on the south (Lecco arm) of Lake Como and east. It is a 17^th Century palace that was completely renovated when the Rockefeller Foundation assumed ownership. It has several commodious rooms and suites – library, dining and sitting rooms, a music room, others upstairs set up for conferences, and a few spacious bed sitting rooms for guests. The out-buildings include a 17^th century tower with a large bedroom on each of its three floors, and next to it, the Sfondrata, a longer, lower building with more rooms for guests. About half way up the hill to the Villa, another building, the 17^th century Maranese, contains studio suites for scholars in residence and conference guests. On my first visit I had the room at the top of the tower, and was lulled to sleep each night by the gentle lapping of water against the base of the tower and awoke each morning to the same lovely water music. It was a splendid place to be for a week, although low water pressure made the shower function poorly, or not at all if anyone on one of the lower floors turned on a tap.  I was rapporteur for the conference, which meant that at the end of each session I had to write up the proceedings.  Then at the end of the afternoon session, I had to dash down the hill to the tower, have another shower and dress formally for dinner, missing most of the aperativi and preprandial conversation.  On my second visit, my room was in the Maranese, and although Wendy was not allowed to stay at the Villa Serbelloni with me, she stayed in a small hotel in Bellagio so we could enjoy this extraordinarily beautiful part of the world together during my time off, and she was allowed to dine once or twice as my guest.

When I returned as a scholar in residence accompanied by Wendy in November 1992, we had just come from a final visit to my dying father in Malta and throughout our stay each international phone call for me (for some reason there were many) induced a premonition that he had died. As it turned out, he survived until New Year’s Day, two weeks after we got home to Ottawa. We began our brief period in residence in the Maranese but were uncomfortable there, especially walking to and from meals on frosty mornings and cold dark evenings, so we moved to a studio suite in the main Villa after a few days when a room became available. Our windows gave us a superb view of the western arm of Lake Como with the steep mountains on the Swiss side to the right and the hills of northern Italy to the left, the blue waters of Lake Como in the middle.  There are several smaller out-buildings on the high ground above the Villa, including two set up for artists and composers, equipped with a grand piano.  Wendy spent some time in one of these suites composing a piece of music during our stay, and occasionally used the other to touch up the pictures she was painting of the spectacular scenery.  She was experimenting with oil pastels and produced a dozen or so vivid sketch paintings of the Villa, its grounds, and views across the lake to each shore in the distance.. When we got home I had several of her pictures framed and I have three of them on the wall of my home office as a permanent reminder of that lovely place and an all-too-brief interlude in our lives.

It is the policy of the Rockefeller Foundation to mix scholars in residence from diverse disciplines, the humanities, creative arts, natural and biological sciences, philosophy and so forth. Those with whom Wendy and I shared our time at the Villa were probably a rather typical mixture. They were all interesting people – some unforgettable. One was the writer Jonathan Franzen, a youthful novelist of great promise. His prize-winning novel The Corrections, may have been born there although he was ostensibly working on a different book. Another was the historian of colonial America, Bill Chafe.  The book on which he was working (political chicanery in early 19^th century USA) came out a year or so later to receive high praise and several awards. The (adopted) Australian visual artist Merilyn Fairskye, at the time resident in New York, was a rather beautiful young woman, perhaps of Armenian heritage I think. She and a youngish Brazilian philosopher had a brief but quite torrid romantic liaison.  There were several others – a composer and his wife, another musician, from the University of Indiana at Bloomington, Indiana, two poets, a husband-wife combination from Oregon; two urban sociologists, one from Stanford, the other from NYU, who were jointly writing a monograph on alienated youth in the counter-culture; and  a woman with middle-eastern roots who had a rich knowledge of Farsi (Iranian) literature and culture (but rather repulsive table manners – she had a partial set of dentures that she removed and put on the table beside her to eat parts of her meals).  In the evenings we all came together for general conversations about life, the universe and everything.  It was among the most mind-expanding and memorable experiences I’ve ever had, and it inspired Wendy to compose a piece of music and to paint some excellent little pictures.

Although the days were short by that time of the year, the weather was fine and sunny almost all the time we were there, cool but not cold nights, warm but not hot sunny days.  I worked moderately hard but allowed enough time off for a couple of cruises on Lake Como, once into Como itself, the other to the nearby lakeside towns of Mennagio and Varenna.  The alpine region of Northern Italy is very beautiful, this part perhaps the most beautiful of all. Ideally, I think we would both have preferred to be there entirely on holiday but my conscience would not allow me to do this, so I had to leave much of the sight-seeing and exploring to Wendy while I sat at my desk gazing at the beautiful view out the window, thinking beautiful thoughts and attempting to capture them in bad prose on floppy disks. There was abundant time, however, for leisurely walks on the paths through the grounds of the Villa Serbelloni, where the late autumn fruits, notably bright red persimmons and a few plums, were ripe for the plucking.  We strolled down to the lake shore beside the tower where I had stayed on my first visit, around the paths higher up on the east side towards the Swiss mountains, and down on the other side towards and into the village of Bellagio. Some days after lunch we sunned ourselves on a patio outside the dinning room.  I have a fine photograph of a group of us relaxing there one sunny day, with the Swiss mountains glistening in fresh-fallen snow as a back-drop.

South facade of Villa Serbelloni  and approach drive to front entrance on opposite side of Villa

Alas, too soon it was all over. We came back into the town of Como in the Villa’s limousine, caught the train to Lugano through the spectacular network of tunnels through the St Bernard Pass, and on to Zurich, whence we flew home to Ottawa barely ten days before Christmas of 1992.     

Phone calls

Wendy and I were among the first to get our phone number on a "Do Not Call" list that ought to have protected us from what are best described as junk phone calls. These irritating calls habitually come at meal times. It didn't do any good. Junk phone calls are as obtrusive as ever, but now most speak with recognizably American accents, revealing their origin beyond the reach of Canadian regulators. "This is Lisa calling to warn you are paying too much interest on your credit card account..." Lisa still calls, but never gets beyond "This is Lisa...", or just "This..." before I hang up. There's no way to block these calls because Call Display tells me they come from an unlisted number. It's the same with a few other irritating calls, the caller is immune to call-blocking.

Not all unexpected phone calls are unwelcome. I reflected on this recently when I had a half dozen irritating calls one day, including one from Lisa or one of her family.  When the phone rang again  and Call Display told me it was a government number, fortunately I didn't snarl "What is it this time!" but politely saluted the caller in my usual fashion. That call came from the Governor General's office and was to inform me that I had been admitted to the Order of Canada.  It was the latest of a dozen or more life-affirming phone calls I can recall with the good news that I've been selected as recipient of an award, and a confirmatory letter will follow.

On a sunny summer Saturday in 1964 when we were living in Burlington Vermont,  Stuart Morrison phoned me from Scotland. Wendy and the kids were already in the car, we were about to set off somewhere exciting. I almost didn't bother going back indoors when I heard the phone ringing. Stuart was calling  to invite me to join the staff of the Usher Institute of Public Health at the University of Edinburgh. By then we had been living in the USA long enough to know beyond dispute that though we were happy in Vermont, we didn't want to settle for life in the USA, didn't want our kids to become American, to acquire American values and customs. That call gave us the opportunity to choose between moving to the Johns Hopkins School of Hygiene and Public Health in Baltimore, and Edinburgh, where both of us had lived for a while before we met and married. It was a no-brainer, despite the much lower salary in Edinburgh.

Two other phone calls out of  the blue were invitations to edit important books. Both calls are engraved in my cerebral cortex. One day in late winter of 1977 Steve Jonas phoned me from New York to tell me that the selection committee of which he was chairman had ranked me first among the candidates to become editor in chief of the Maxcy-Rosenau reference textbook of public health. I wasn't even aware that I was a candidate. I felt unqualified to edit a massive reference book I regarded as quintessentially American. Reluctantly, after much arm-twisting, I agreed.  Everyone seemed well pleased with the result and despite being more aware than anybody else of gaps and defects in the book (no chapter on health economics for instance) I'm happy with it.  It gave me a platform from which I made statements on important issues in public health practice, science, and policy. Some of my statements have become part of the language and lore of public health. This book consolidated my position as an internationally recognized authority on public health and led to other invitations, most of which also started with phone calls. The best of these was from Kerr White, at the time the president of the International Epidemiological Association. He called one day in 1982 to invite me to become the compiler and editor of a Dictionary of Epidemiology, to be sponsored by the IEA and published by Oxford University Press. Working on this was probably my most pleasurable professional activity. It put me at the centre of a worldwide network of aficionados, people who care deeply about precision and accuracy in use of technical terms.  Interestingly, more than half don't have English as their mother tongue.

On balance, despite junk calls and long-winded bores, I'm grateful to Alexander Graham Bell for his useful invention.

Valuable community roles

Long ago, probably in 1956, I was jeered at a medical meeting. A pompous family doctor with more hubris than competence or charisma had boasted that his job was the most important in the community, and he ought to be paid accordingly. I, also a family doctor at the time, followed him to the podium, and before beginning my prepared talk, sought to restore a sense of proportion. I said we wouldn't win friends by boasting about our own importance; in a complex industrial society, many play essential roles. Garbage collectors, bus drivers, telephone linesmen, many others, are just as important. If one occupational group was the most important, it was school teachers, especially teachers of very young children. Without them, our culture, would collapse, I don't think I mentioned kindergarten teachers: in Australia in1956 most children's education began in Grade 1. In an ideal world, I said, primary school teaching would be the highest paid occupation. The audience, almost all family doctors, booed, hissed, even shouted their outrage. At the coffee break, a woman doctor much older than I said she agreed with me, but I wouldn't win friends with remarks like mine. I've said the same again rather often since 1956, and sometimes have even been applauded. Now I'm delighted that my grandson's lady love is a kindergarten teacher and I am eager to meet her.

Hamilton and NOTL

It is heart-warming to have friends with whom I feel as comfortable and relaxed as I would if they were members of my own family.  It's like this with Karen Trollope Kumar and her husband Pradeep Kumar who have been living in Hamilton since they returned from the Himalayan foothills in the late 1990s. I flew to Toronto island airport last Friday and home to Ottawa yesterday, Monday. Karen drove to the airport to collect me and again to drop me off.  On Saturday and Sunday we drove to Niagara on the Lake, known and pronounced as NOTL by many of its aficionados. We saw two light frothy comedies, very suitable summer fare, especially in the stifling heat wave conditions we have endured lately: a Noel Coward play, Present Laughter, on Saturday, and on Sunday His Girl Friday, a play based on a marvellous screwball movie comedy that in turn was based on a successful Broadway play called The Front Page. Karen's 90-year-old mother, Bernice Trollope, joined us on Saturday and we met David and Desre as well.  Conversation revealed that Bernice Trollope's late husband and Desre's father were engineering students in the same year at Witwatersrand University in Johannesburg. It's a small world.

Every time I travel along the Queen Elizabeth Way from Hamilton to NOTL I'm distressed to see how that once bountiful orchard and vineyard district, the Niagara Peninsula, is being relentlessly eaten up by exurban sprawl and industrial development. I've been travelling that road since the early 1970s, close to 40 years and the change in this period is depressing. Since I last passed that way about 4 years ago, some spectacular architectural structures have appeared, but they are no substitute for the fruit trees and vineyards that they have replaced.  Bricks and mortar and paved parking lots can never replace fruit trees. Instead we import fruit, and grapes, and increasing quantities of wine, from South America, with no thought for the carbon fuels combusted to fly produce all the way to Canada. It's all adding to the climate forcing that is  pushing the world closer to a tipping point from which there will be no return. This whole north east sector of North America is also afflicted this year by unprecedented heat and drought conditions. The country everywhere is dry and parched, like South Australia in high summer, not a blade of green grass  to be seen in many lawns. The grape vines near NOTL look good, but they are heavily irrigated.

It is worrying, and a sign of the corrupt times we live in, that the government of Canada, in thrall to the oil industry in Alberta, has systematically dismantled the data gathering and monitoring systems that in some cases have been operating for over 50 years; they do not want evidence of environmental damage and deterioration to impede the political decision to accelerate development of  the environmentally destructive tar sands. This ultra-conservative government is so scientifically illiterate that they don't understand that greenhouse gas emissions and stratospheric ozone depletion are two entirely different processes. They have shut down not only carbon dioxide monitoring but UV radiation detection services in the high Arctic, the early warning system that can advise all north Americans when UV radiation levels are becoming dangerously high. As for the tar sands, an area about the size of Florida has already been devastated and emissions from the refineries and extraction plants is the largest single contributor to fossil fuel emissions on earth. We know this only because the Canadian government can't stifle data sources outside Canadian jurisdiction. Their policy is enriching oil companies and the ultra-conservative party now running affairs in Canada. For the sake of future generations here and elsewhere on earth, I hope this government is soon swept from office, but I fear that their appeal to simple-minded people to reduce taxes could keep them in office until it is too late to save the world from passing through the climatic tipping point that will lead to irreversible changes, perhaps to mass extinctions, including extinction of many humans. As Aeschylus put it in Medea, "Those whom the gods would destroy, they first make mad."

How did I ramble off on that tirade? I've said nothing about how splendid it was to see and stay with Karen and Pradeep, and to have conversations with them and with their two splendid young adult offspring, Sonia and Raman, both of whom are students at McMaster University, Sonia about to start her MBA, Raman half way through his medical course.  I feel optimistic about the future after talking to these two bright youngsters.

Voices from the past

Here are excerpts from some of the messages I've had from former students. All but one of these came from people with whom I've virtually lost touch, so they reopened a welcome line of communication:



Congratulations on receiving the Order of Canada. It is well deserved! I often think of how much you supported me and helped me to organize my year of electives trip around the world during medical school. Thank you so much...I think it was one of the best things that I ever did. Now my daughter is hoping to study medicine and I hope that she does it with a global perspective. As I  am slowing down my work at the hospital I am doing more teaching in the developing world. I was teaching in Uganda and Haiti last year and am planning to go to Tanzania in October.  Wishing you all the best!  



John so very very pleased to hear that you have been appointed as an
Officer of the Order of Canada. So well deserved - your contributions to
epidemiology here and abroad have been stellar. I am proud to have been
your student - lo those many years ago. Congratulations! 

I read the Ottawa Citizen this morning with great pleasure and pride of your achievements, and your admission into the Order of Canada.  I cannot think of a more deserving recipient.  I feel truly privileged to know you, have had you as a teacher and mentor,  and to have learned so much from you over the years.

Congratulations on your Order of Canada award – it is well deserved!  You are truly a role model for young physicians, and have made a lasting contribution to the field of epidemiology.  The Citizen article was lovely but didn’t tell the half of what a wonderful person you really are.

I must say you have always been a "GIANT" to myself and Christopher, and we are both delighted that Canada has chosen to recognize you!   Congratulations, on an absolutely fantastic achievement - and fit and deserving emblem of your life's work. 

It is very sad that you aren't able to share this with Wendy, and I am not deeply religious, but I am spiritual - and I believe she will be there with you in spirit when you receive it.  How could she not be?  After spending your whole lives together she is a part of you.


And here's one more that came to the Dean, and was forwarded to me on July 17:


Please forward my congratulations to Dr. John Last.  Dr. Last was very influential personally to me during my studies at the Faculty of Medicine from 1975-1979.  

He enabled me to do an elective rotation in Sri Lanka in pediatrics as well as in Public Health.  It was the highlight of my medical studies and even though I eventually became a plastic surgeon, it enabled me to be much more appreciative of different cultures and customs in patients as well as people I have met throughout my life.

I have always been indebted to Dr. Last for this wonderful experience, and am thrilled that he has received this honor.

unexpected and welcome benefit of OC

After the news that I had been appointed an Officer of the Order of Canada became public, there was a blizzard of emails, a hurricane of phone calls and even a few letters by old fashioned snail mail. Among all these there were a few from very old friends and former students with whom I had lost contact long ago. This was an unexpected and most welcome bonus. I think I've responded to all of these messages now, and the email addresses are safely stored in my address book.

Among those I heard from with congratulations is a frequent correspondent, my friend Ron Laporte from Pittsburgh.  Ron asked me to write a few sentences for his Supercourse newsletter. I don't think there is a copyright on the sentences I dashed off and sent straight back to him, so I'll repeat them here:

When I was a pimply 13 years old, I wanted to be a writer.  I’d read Somerset Maugham and a few others who’d moved on from medical school to become successful writers, so I decided to aim for medical school.  By the time I was 15 or 16, poised to start in medical school at 17 because there was a world war going on, I realized I couldn’t invent plots or develop characters, and had a tin ear for dialogue, so a career as a creative writer wasn’t for me. In time I became a tolerably competent clinician, then an epidemiologist.  But love of words and writing bubbled away below the surface. I found a way to combine my medical background and my love of words, composing definitions for the Dictionary of Epidemiology, the Dictionary of Public Health, writing Public Health and Human Ecology, editing Public Health and Preventive Medicine (“Maxcy-Rosenau-Last”), the Canadian Journal of Public Health, and sundry other journals and books.  During all this time, I was corrupting the innocent young minds of medical students with the subversive notion that discovering and accentuating the determinants of good health was a career aim at least as worthy as exploring arcane details of serum electrolyte levels or genomic structure of an individual patient. In part of my spare time I counseled medical students about career options, emphasizing that it is important to keep open as many options as possible for as long as possible, thereby avoiding the hazard of overspecializing. Paleontologists demonstrated that species which overspecialize risk extinction when conditions change rapidly. That can happen in medicine too. In epidemiology, it’s valuable to have more than a nodding acquaintance with the Big Picture, rather than focusing on the fine detail in one little corner of the picture.  This perspective makes it easier to connect the dots – which can come from any number of disparate scholarly and applied fields – and thereby make a new picture altogether, a picture that explains important truths which had previously been obscure and mysterious. The great discovery I have made is that it is enormous fun doing this, and even more fun when there’s an opportunity to infect students with enthusiasm to do it too.   

Perhaps the greatest privilege I enjoy is that the work I do is fun.  Only a tiny minority of humanity can honestly say this: my work is fun to do.  I wouldn't keep on doing it as I race towards my 86th birthday if it wasn't fun.

Shameless self-promotion

The temptation to post this was irresistible! And why not a bit of self-promotion?  Normally I'm rather shy and self-effacing, but there are times when it's appropriate to come out into the limelight briefly.  This, I feel, is one of the times.

The Ottawa Citizen reporter did a reasonably good job I think.  He got a few details slightly wrong, but overall his story was reasonably accurate.  I was a pimply-faced brand new teen ager of 13 or thereabouts, not a young man, when I had aspirations to write novels.  I'd discovered by the time I was 15 or 16 that although I could write quite well, I lacked the imagination to create plots, I had a tin ear for dialogue, and I couldn't create characters.  Novel-writing would have been an uphill struggle without these fundamental skills. I demonstrated my ineptitude in a few short stories I wrote when I was a medical student. Two or three were published in Phoenix, the Adelaide University magazine and two others, now lost without trace, got into a men's magazine, either Man, or Men Only, I forget which. All I remember is that the less said about them the better.

But I can write.  I can express complex concepts in clear and plain language that others tell me they find  easy and even entertaining to read.  I've put that skill to good use writing textbooks of my own and chapters in other people's books, and in composing definitions for the Dictionary of Epidemiology and the Dictionary of Public Health.  The Ottawa Citizen's photographer skillfully posed me in front of the row of big fat textbooks of public health that I edited, and asked me to hold a copy of Public Health and Human Ecology, my very own book, the one I'm proudest of.  I couldn't have asked for better.

Order of Canada

Several weeks ago I had a phone call from the office of the Governor General of Canada, informing me that I would be appointed as an officer in the Order of Canada. At first I thought someone was yanking my chain, that this was an elaborate practical joke. I emailed and phoned back to the GG's office; yes, it was true.  Nothing much happened for a while, then I began to get emails and letters, and finally a small package containing two lapel pins, the elegant little white stylized snowflake with a little gold maple leaf in the centre; and finally today, on the eve of Canada Day, the list of new appointments to the Order  of Canada is published in the newspaper.  So it's true, and I can finally believe it. I am appointed in recognition of my contributions to public health and epidemiology.  I can wear the elegant little lapel pin, and at an investiture later I will get a larger medal to wear on a ribbon around my neck on formal occasions, assuming I ever get invited to any. Naturally I am really chuffed by all this.  I just wish Wendy was here beside me to share in the glory. It isn't, and it won't ever be the same without her.

John Last, MD honoris causa Edinburgh, 2003

                           

 With my two dictionaries,
   APHA, Boston, 2006

With some of the books I've written or edited

 

Sri Lanka 1976 (via Bombay and other places)

Here is another post that condenses a chapter of memoirs that I wrote 20 or more years ago about an episode in my life and Wendy's.  This one has the benefit of some photo illustrations. 

In the Christmas-New Year week of 1975, I was briefed at the South East Asian Regional Office of the World Health Organization (WHO/SEARO) in New Delhi for a mission in Sri Lanka.   I was asked to examine, advise and report on the status of education in maternal, child and family health at the two medical schools in Sri Lanka, the 100 year old University of Columbo medical school and the recently established new medical school on the Peradenya campus, near Kandy. 

Structures used by ancient astronomers (astrologists?) Delhi

After my briefing, by rights I ought to have flown direct from Delhi to Columbo I had made provisional bookings to do this, before I left Ottawa. Both Air India and Air Lanka had direct, non-stop flights. But somebody in the Regional Office in Delhi made a costly blunder. My reservation had been erased from the new computerized booking system. My ticket had to be rewritten, and I had to fly Delhi - Bombay - Columbo.  Because of the way the flight schedules were arranged, I had to stop overnight, and furthermore, on New Year's Eve. To cap it all, the only hotel that had any rooms free on that night of all nights in the year, was the Taj Mahal, the most expensive luxury hotel in Bombay, if not in all of India, prices far above the normal room rate allowed to WHO consultants. When I arrived at the Taj Mahal Hotel, the clerk at the registration desk said that because they were so heavily booked, the only space they could give me was the Viceroy Suite on the top floor, which was normally rented at an astronomically high rate; but as the booking had been made for me by WHO, they would let me have it at the regular room rate. I had to promise to be out of there by 9 am on New Year's Day, as one of the local millionaires had reserved the suite for a private party starting later in the morning. I assured the reservations clerk that this would not be a problem: my flight for Columbo departed at noon, so I had to be at the airport by about 9.30-10.00 am. That New Year's Eve at the Taj Mahal Hotel was one of my rare luxurious experiences. Too bad I was on my own, and too tired and too poorly dressed (no smart dinner jacket) to enjoy it! The Taj Mahal Hotel that New Year's Eve was playing host to many of Bombay's Beautiful People – Bollywood movie stars and directors, their mistresses and lovers, captains of industry and commerce and their spouses, the rich and famous people of that great city, all sumptuously dressed, or for many women, undressed with much succulent and shapely brown skin on display. I was very hungry and had to wait over an hour for my modest table for one, discretely hidden behind potted palm trees in a corner by the servery door where no one could see my scruffy bush jacket. I ordered the hottest curry that they had, a serious mistake: my mouth was sore and numb for several days. I was still eating, and washing it down with ice-cold beer, far into the night.

Later I strolled out into a velvety warm and balmy Bombay night, to be accosted by the most revolting collection of deformed beggars I have ever encountered. They scuttled around me, silently for the most part, like nothing so much as a horde of large spiders, holding out hands, or stumps, in some cases feet. Probably most had been deliberately deformed as infants, their arms and legs broken and left to set in bizarre positions, so that they could eventually become professional beggars, arousing pity by their appearance, part of the property of some pimp who used them as other pimps use prostitutes. I had heard about these pathetic creatures before I came there, indeed I had gone outside on purpose to see them for myself. The reality was much worse than my expectations. Rohintin Mistry writes vividly about the underside of Bombay in his wonderful Dickensian novels, but wisely draws the line this side of describing the appearance of these deformed beggars. It may have been the most stomach-churning sight I have ever seen.  I retreated, walked a little longer in the private interior courtyard of the hotel, then retired to my suite, which occupied about half the top floor of the hotel, with a superb view out over the bay, a crescent of silvery waves below the Esplanade, the row of lights and handsome high-rise towers along the shore all the way to the India Gate and beyond. How sad to be all alone in this splendid setting!

Next day I got to the airport in time to ensure a window seat near the front on the left-hand side, and on a clear sunny day I flew down the coast of India, much of the time just out to sea far enough for the coast and the land immediately behind it to be clearly visible. We had already started our descent by the time we came to the southern city of Trivandrum in Kerala the home town of my friend and Ottawa colleague Rama Nair, and I had a clear view of its beaches and the rolling breakers coming off the Sea of Arabia, fishing nets hanging to dry from palm trees.

Sri Lanka in 1976 was at peace, if rumbling ominously a little. Occasionally I met people, such as an elderly Hindu holy man in Columbo, who could tell of arbitrary arrests and torture. But at both campuses of the University of Sri Lanka, Sinhalese and Tamil staff worked amicably together, most of the time in English. What is more, though we often complain about the wasteful repetition of memoranda at the University of Ottawa in both official languages, at least both have the same alphabet. In Sri Lanka, every notice, every set of handouts at the medical school, had to be in three languages each with its own alphabet: our customary alphabet for the English version, the curlicues and circles for Sinhalese, the hanging squarish script for Tamil. Some exodus of talent had already begun by 1976, but this was mainly the lure of higher incomes in the rich oil states of the Middle East, or the superior research opportunities for gifted people that led so many of these very bright Sinhalese and Tamil medical scientists and scholars to leave for Europe or America. Of course the flight of talent, and of many others, got a lot worse after the war broke out to establish a separate Tamil state a few years later. 

Rural market, Sri Lanka

Base of the ancient rock fortress, Sigurya - we climbed the ladders and paths to the top, definitely the scariest climb of our lives!

Both in the weeks that I was on my own, and in the weeks that remained after Wendy joined me, there was a great deal to see and do in Sri Lanka, as well as my official duties. In addition to many photographs in the family album, I have a plethora of vivid and colourful recollections, too many to relate fully without exhausting me and boring anybody who reads this. This account can't aspire to be anything other than some random recollections.

I started my work in Columbo, where I stayed at a small hotel frequented mainly by cut-rate German tour parties. It was odd to hear the waiters and the room maids talking in broken German no better than my own, as they took orders from the guests. There was air conditioning (very welcome, but noisy) and a small swimming pool, but I avoided it as I had ones much like it in Jogjakarta and Surabaya in Java a few years earlier - here too, as there, I noticed that many of the plump herren and their often shapely fraus or frauleins who did use it had red eyes and irritating skin rashes later. I was struck by how cheap everything was. I bought a whole pineapple one day for the local equivalent of less than a
cent, could almost have had a bath in its plentiful sweet juice; and paid about a cent to have my sandal strap sewn back on when it broke.

View of Sri Lankan countryside from summit of rock fortress of Sigurya (about 250 m above surrounding countryside)

Columbo is a large, dirty, noisy city and seaport. It had gone downhill since I had first been there, going ashore from the RMS Strathnaver that took me to England in 1951. In those days, the Galle Face Hotel on the sea front, where we young Australians en route to England had stopped briefly for a cold beer, was a proud, grand, exclusive place that had been reluctant to admit a rather rowdy and casually dressed bunch of youngsters. By early 1976, it had a musty, mouldy atmosphere, its carpets had become threadbare, its elegant furniture scuffed and decrepit, its staff demoralized. The deteriorating esplanade in front, and the lawn that had once been immaculately manicured, were strewn with litter and the tawdry stalls of street vendors. Even in late morning a few street-walkers plied their trade there, something that would never have been tolerated in the old days, I was told. Some new luxury hotels were being built, though I fancy none were then complete, at any rate in Columbo. In some ways Columbo resembled a shabbier and small-scale version of any large city in India at that time. Several of the expatriates I met, people living and working there for longer periods than I, who were familiar with both countries, remarked on the similarities, and the way India was advancing but Sri Lanka was not. The differences undoubtedly got a lot greater after the war began. Almost the only make of car was the Indian-made Morris Minor (in India the locally made version of the Morris Oxford was most popular at that time); and many of these Morris Minors were on their last legs, or wheels. When Wendy and I were on our way to catch a train to Hikkadua on the south coast to celebrate our wedding anniversary a few weeks later, the taxi that was taking us to the station lost a wheel. As we sat in the back, we looked out and saw the wheel rolling along beside us, and a moment later there was a grinding crunch as the hub scraped along the road surface. We missed the train because of this, and had to go south uncomfortably by bus.

View from our bedroom, Mrs Wickramasuria's guest house, Peradenya

Names in Sri Lanka reveal people's ethnic background, as they do in Ulster and in the former Yugoslavia. The Sinhalese, a proud, even arrogant race, handsome in a heavy-featured way, mostly have polysyllabic names ending in -aratne, -asnaika, -asuria, etc, though some have ancestors who adopted Portuguese names during the period of colonization that began very soon after Vasco da Gama serendipitously "discovered" this island that he called Serendip. So there are Soysas, Fonsecas, Fernandos. The Tamils also have polysyllabic names but they are completely different, with quite recognizably different endings: -anayeram, -sanderam, -underam and the like. The Tamils began moving into Ceylon many hundreds of years ago - it is almost possible to walk across the shallow sea from the southern tip of India in Tamil Nadu.  In British colonial times, many Indians from Tamil Nadu were imported to work as cheap labour on the tea plantations; so the numbers, especially in the northern quarter of the island, rapidly grew. The old Sinhalese culture resisted colonial dominance and successfully defended itself for several generations from its highland fastnesses. When we went by train to Kandy, sitting in the parlour car at the back with its picture windows and specially inclined seats to look back as we climbed the precipitous cliffs of the escarpment on the way to Kandy, it was easy to see how this highland region could be defended against everything except modern weapons. The Sinhalese culture has ancient origins, going back to the earliest days of Buddhism, perhaps earlier. They are very musical people whose festivals at the Poya (full) moon and at the innumerable ceremonies in the holy city of Kandy, are dominated by music (bells, pipes, flutes, drums). We met several talented musicians: "Bas" Basnaike the professor of physiology at the Peredenya campus, and Ralph de Fonseca, the professor of public health at the Columbo campus, were both brilliant pianists. I met a rather beautiful young woman at a party, who was about to leave to begin training as a concert violinist in Germany. The 5th Century frescos that have survived almost intact beneath an overhanging rock face high on the side of the fortress of Sigiriya, include several musicians (although there is more emphasis on beautiful bare-breasted damsels serving fruit to their masters).

During my visits to the Peradenya campus, I found a wonderful place to stay, first on my own and then with Wendy. This was a guest room in Mrs Wickramasuria's home, the Menaka Guest House (named for her younger daughter, Menaka, a young woman with Cushing’s syndrome). Mrs Wickramasuria's marriage had broken up. Her husband was a disgraced member of the medical profession who had gone to Australia, leaving her to survive with the remnants of her dowry, her family estate, and to eke out a living by renting rooms in her home. She was still young enough (late 30s, I would guess) to attract a lover, a member of parliament who visited her at weekends. One weekend during my stay, before Wendy arrived, I was working in my room while she and her lover were noisily enjoying themselves in the room next door. She emerged to get me my evening meal late in the afternoon, with towsled hair, her sari hastily rearranged. I was not too surprised when we got a Christmas letter at the end of that year, announcing the arrival of "Baby" - not named until some years later, because a good Buddhist  custom is to await a favourable astrological conjunction of the planets before a child is named (also, until recent times, it made sense to wait until there was a reasonable likelihood that the child would survive infancy).

Eighth Century ruins, Anarhadnapura

Carved lintel, Kandy

We shared our bedroom at Mrs Wickramasuria's guest house with a family of very quarrelsome sparrows whose nest was in the cover of the fixtures for the ceiling fan. They got quite upset if I turned the fan on. There seemed to be two cock sparrows who had fierce territorial fights, drawing blood and shedding feathers, waking us every morning an hour or so before we needed to get up. We had a superb view across the valley to the high hills and the tea plantations on the other side, where the peaks were often cloud-covered. At dusk every evening we saw a great cloud of large fruit bats gliding by from their roosts in the trees of the National Botanical Gardens to the orchards on the outskirts of Kandy on its hill at the head of the valley. 

I walked everywhere. There was a bus service to the campus but it was erratic and infrequent. It was about 3 kilometers down the hill, along the road and across a few lawns and playing fields of the Peradenya campus to the medical school where I was working. My task was to interview the staff, to discuss with them their curriculum development plans and to advise them about innovative teaching methods, better ways to use their contact time with students, integration of basic and clinical sciences, etc. (After we returned to Canada, I described this and the prima donna conduct of professors who ran their departments like potentates of medieval fiefdoms, in a little paper called "What determines quality in medical schools?"). My routine was to walk down the hill in the morning, back most days at lunch and siesta time and then back and forth again in the late afternoon, a total of about 14-15 Km a day, most of it in warm but not too hot sunshine - Kandy and Peradenya are high enough to be spared the steamy heat of the coast. Peradenya is a new campus with residences for students who come from all over the island. Sri Lanka had universal education for both boys and girls, free to the end of secondary school, and only a nominal charge for university tuition. Entry requirements were relaxed, so a very high proportion of young people went to the universities – they, of course, did not want to spend the rest of their lives working in the paddy fields. At the Peradenya campus many students lived in residences, the ‘boys’ on one side of the campus, the ‘girls’ on the other.  It was just as well.  Even with the distance that separated them the sexual tension among these youngsters was palpable  -- I could almost smell the pheramones. Their light clothing in that tropical island didn’t help. Most girls wore miniskirts rather than saris, and that didn’t help either…   Entry to medical school and to a few other faculties such as law, was more rigorously rationed, but the output of the two medical schools when I was there far exceeded the national need for doctors. This little nation was exporting at that time well over half its output of fully trained health professionals, nurses as well as doctors. And the training was good, by and large. Such a hemorrhage of trained professionals could not be long sustained, and would soon have had to be controlled by some means. It’s too bad that it had to be a brutal war which brought this about.

The little lake in Kandy

On sitting and standing: I learnt the hard way that on public transport it is mandatory to give up one's seat to Buddhist monks, no matter how young they may be. Many children enter their period of service at or even before puberty. One evening during my time at Peredenya I came back from a meeting with the Minister of Health in Columbo, tired, hot, late on a crowded bus (I had to use the bus because the trains had been stopped by a lightning strike). I had to stand, propped up really, between scores of other hot, tired, irritable people, until we reached the head of the pass to the highlands. Then gratefully I seized a seat. But a young lad in Buddhist robes came and leant over me, and everyone around me made me aware in no uncertain manner that I must stand so he (about a third or less my age and strong as an ox) could sit. We had similar experiences many times. Wendy also soon found out that her bottom was broader than those of the locals, which seem to be wedge-shaped. They had an extraordinary facility for spotting a tiny postage-stamp sized piece of seat between two sitting passengers, and insinuating themselves into this space. Thus a train seat meant for six people soon came to hold ten, perhaps more.

Standing Buddha, Sri Lanka

Sri Lanka is a truly beautiful place, a jewel of an island every bit as lovely as Java, and with no active volcanoes. It has more than Java in several ways, notably that there are large numbers of elephants. They are used as beasts of burden and in the innumerable ceremonial processions and religious festivals in Kandy. There are also a few remaining herds of wild elephants, one of which we saw one day as we were being driven to the ancient ruins of Anuradhapura. We also saw, or I did, the daily bath, complete with soap and scrubbing brush, that the elephants get if their work includes carrying Buddhist priests to the sacred Temple of the Tooth, which holds a very holy relic, a tooth from the Buddha himself. There are many water buffalo, gentle, lovable beasts, and monkeys which are often very tame. I have a nice picture of Wendy feeding a monkey which took food straight from her hand.  We were so fortunate to see it all while Sri Lanka was still at peace, and to see so much of it. Yet even then we were warned against going to the northern tip of the island, where the population is almost 100% Tamil. I think the repression of the Tamils, and their inevitable revolt against this, had already begun, but news of this was being carefully suppressed.

Wendy making friends with a distant relative, Sri Lanka, 1976

There were other problems. The worst from my point of view was the stifling bureaucracy which brought almost every activity to a standstill. The paper work involved in the simplest transactions was horrendous. Wendy experienced this too. Soon after I arrived, I lost my sunglasses, and told Wendy about this in a letter. She bought me a new pair and unwisely posted these to me from New Zealand. A day or two before we were due to leave, we got a notice to say that they were at the main Post Office for us to collect, after we had fulfilled the formalities and paid the customs duty. Wendy set off to do this early in the morning. It took her all day to move through the various queues and file the necessary documents, and at the end of the afternoon when she was approaching the head of the line, the place was closed and she was told to come back next day. She could actually see the packet she had mailed a few weeks earlier, and was so angry that she leapt over the counter, grabbed it, and stormed out in triumph. She was probably very lucky not to get arrested and roughed up: most likely the officials were so astonished by this unexpected behaviour from a mild-looking and well-behaved European that they were too slow to intercept her before she made her getaway.  Or they were too lazy. Laziness is a national affliction. Sri Lankans have never had to work very hard to plant or gather their rice crops, fruit falls from the trees, fish almost walk up from the sea into the nets. Since the earliest colonial times there has always been great eagerness to adopt the national and traditional holidays of whichever nation happened at the time to be the colonial master; and as well there are the Buddhist religious festivals to celebrate as holidays, starting with every Poya Day, or full moon. The end result was that slightly more than half of all the days I spent in Sri Lanka were holidays of one sort or another. The combination of excessive paperwork and frequent holidays offered abundant excuses for not getting anything done at all, let alone done on time.

I think we would have tired of this eventually, as we would of Sri Lankan food, despite the good cooking both at Mrs Wickramasuria's and at the hotel in Columbo, and at a few government-run resorts where we stayed, notably the one at Hikkadua where we spent our wedding anniversary that year. Sri Lankan food consists mainly of rather indifferent curries, and string hoppers: glutinous rice, squeezed through tiny holes to make thin spaghetti-like pasta, which is usually deep-fried and not very adequately spiced with condiments. On the other hand, there is fresh fruit in abundance, mangos, paw-paws, pineapples, many kinds of bananas, and a wide variety of exotic fruits I have not seen elsewhere. It is odd that this lovely place, so close to India and to the Spice Islands, should have such bland food. 

After two months there I had had just about enough. But we were not to escape easily. Our flight for Madras should have left in late afternoon. We waited at the airport before even boarding, till long after midnight, and took off for Madras about 4 am. It is less than a two-hour flight. When we came close, the captain came on the air, announcing in a sepulchral voice that he "regretted to inform us" that we could not land because of fog! Both of us, and everyone else on the plane was in despair. We turned about and went back to Columbo, waited there for an hour or so for the sun to burn off the early morning fog, then finally left, and landed safely in Madras about 16 hours late. It was a fitting way for Sri Lanka to cling to us at the end.

     

Our arrival in Madras was by no means the end of the wonderful time that Wendy and I had on that expedition. In some ways the best was yet to be. We met an Indian colleague of mine in Madras, and had a good look at that old city and its colonial British remains, a second look for me. There is a graveyard containing many graves of British officers, their wives, and children, dead at an early age of malaria, cholera or other tropical diseases (malaria was especially lethal). We flew on to Bangalore and came by car from there to Kajhuraho, the site of one of the best preserved of the temples of erotic art; then from there we went on to Agra, where we saw the full moon rise over the Taj Mahal before spending the greater part of the next day exploring this lovely shrine to the beautiful Mumtaz who died so young. And then to Delhi, where I had been several times before, but Wendy had not. We stayed at the old and somewhat seedy but very convenient Janpath Hotel, within easy walking distance of Connought Circus. Wendy found the beggars disturbing, though there were fewer than usual: the government was trying to resettle many of the permanent street people in villages and hostels far removed from the centre of New Delhi, sprucing the city up for an imminent international conference.  

Heraldic carving, Kajhuraho

Erotic statue, Kajhuraho

While I debriefed at WHO/SEARO, Wendy explored the many-layered civilizations of this great city; and we had a few days exploring it on our own, thanks to a convenient weekend. This was to be my final mission as a consultant for WHO/SEARO. To some extent I am myself responsible: my report recommended that it would make more sense, and be cost-effective, to bring visiting consultants from other countries in the region rather than from the other side of the world. But this, of course, was not my final visit to India, nor to south and east Asia. I went back en route to Singapore in 1982, to visit the All-India Institute of Hygiene and Tropical Medicine in Calcutta (described in the chapter on “A Day Trip in Bengal”). I had two visits to China, in 1981 and 1982, and two to Japan in 1991 and 1996.  And in 1997 I had another fascinating visit to Thailand, which was primarily for another WHO mission, but that one was arranged from WHO headquarters in Geneva rather than from the regional office in Delhi.  My explorations of those parts of the world have been brief and superficial, but richly rewarding. I wouldn't have missed them for anything.

Taj Mahal, Agra

Red Fort, Agra

How I became a Hindu

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 21^st 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.