Friday, 16 March, 2007

A room full of friends

In December 2006, just a few days before we began this blog, Thelma and I attended the annual meeting of the medico friends circle at the National Tuberculosis Institute, at Bangalore on the theme ‘Public Health Education’. We spent two days among a whole lot of old and new friends discussing the theme in the typical mfc way – which was a meandering discussion leading often to a lot of ‘heat’ and then some ‘light’ occasionally. But that’s not the purpose of this reflection. It is more to report about an uncanny experience of connectedness that one felt as one surveyed the room from various vantage points during the meeting. Seldom does one attend a technical or professional meeting and find oneself in a roomful of friends – not acquaintances or colleagues but friends!

Friends of the 1970’s and 1980’s

As I looked around the room there was Anant Phadke, that veteran activist, who had first inducted me, 30 years ago into the medico friends circle in 1976 when I met him as a PG at the All India Institute of Medical Sciences during a Society of Young Scientists meeting. We had discussed societal analysis of the current challenges of science in India and he inspired me with his unbounded enthusiasm for rational prescribing and drug policy issues. Not only did I join the mfc enthusiastically a few weeks later but I even took over convenorship of mfc from him in 1984. I was not surprised when at one point of the meeting in Bangalore, he gave us all one of his short lectures on the ‘moribund state’. Anant had not changed in 30 years

There was Mira Shiva, who had walked into the Department of Community Medicine at St. Johns Medical College in 1978 after completing her MD in Medicine from CMC Ludhiana. After her MD she wanted to do rural service and be in Bangalore where her sister Vandana taught at the Institute of Management. We had an interesting discussion that led to her returning to Delhi, joining VHAI, as one of the early VHAI Health fellows with that unusual Jesuit Fr. Tong. Later she was part of the famous trio of VHAI- Sathyam, Shivam, Sundaram! Mira decided to focus on rational drug policy issues which I had suggested was a better use of her MD, and the rest is history!

There was Satyamala also a part of the trio of VHAI who worked for some years in VHAI after graduating from CMC-Ludhiana. She then wrote the famous manual ‘Taking Sides: the choices before the health workers’, which many of us have used as a great example of teaching health workers about the social-economic-political-cultural determinants of health. Later she and Thelma were fellow researchers studying the aftermath of Bhopal Gas Disaster. They both wrote reviews of thiosulphate poisoning and got involved with various studies. They followed each other through MSc Epidemiology at the London School.

There was Dhruv Mankad . We had worked together on Medical Education and later on ‘Medical Pluralism’. Later he took over mfc convenership from me in 1986, receiving the famous black trunks of mfc and a gunny sack full of mfc bulletins, which were the only assets of this organization that moved every two years from convener to convener.!

There was Babu Mathew, a friend from early St. Johns days. As a trade union leader much before his stint with the National Law School we made an interesting attempt to interest trade unions in occupational health issues and issues of culture and move them beyond traditional preoccupation of unions with wages and bonuses. We tried with the Widia Union to convince them that ‘hazard allowances’ or ‘bottles of horlicks’ were not as sensible demands as ‘cleaning up the occupational environments from specific hazards’. We hoped to empower trade union members to get management to improve occupational health and safely measures on the shop floor. But this idea in the late 1970’s, was probably too much ahead of its time. The experience dampened some of my occupational health zeal. I had returned from the London School where apart from the public health degree I also acquired an industrial health degree from a unit set up by the Trade Union Congress Centenary in UK, with strong pro-trade union orientation!

There were Chinu and Renu, one among the legendary couples in Community Health in India. Both had been enthusiastic young staff members of VHAI, who in the early 80’s tried to get Voluntary Health Association of India members and mission hospitals to understand the challenges of health management. The book they wrote with Sr. Carol Huss was a favourite with CHC in the early years. But it was the ‘LOCOST’ effort of Chinu and the Sahaj effort of Renu that kept us in touch in one way or the other all these years.

There was Shyam Ashtekar - the ‘David Werner’ of India who had been a friend for years always keeping us informed of all that he worked upon to revolutionise community health worker training in India. From algorithms to lessons from S.E. Asia, from his book on Health and Healing to his current passion for distance learning and open university approaches, he and his wife Ratna have been trainers of health workers par excellence for a long time.

There was Manisha Gupte – whom we got to know as part of the FRCH group in mfc in the late 1980’s. A radical feminist, she worked on collective efforts like the Radical Journal of Health; the research in FRCH, the CEHAT experiment and finally the Masum project! We have all been in touch sharing notes, and perspectives occasionally and the listening to her songs of the movements at meetings.

There was Amar Jesani another of the FRCH, gang, who then became part of the CEHAT team and the Radical Journal of Health. A friend on a mission to bring ethics into politics, health activism and health professionalism. We have watched, supported and been inspired by his efforts to study medical exploitation and privatization in health care in Mumbai, and moving from enquiry into action and from action into training.

The development of the Radical Journal of Health by a Socialist Health Collective, a new initiative by a small group of friends within the larger plural medico friends circle during my convenership years, brings to mind the famous Hoshangabad session where heated discussion took place trying to decipher each friends ideological classification. I turned out to be a ‘liberal Gandhian Marxist’ and all these years I have wondered what that meant!

There was Shashikant who through the HALO foundation has continued to inspire generations of young medicos in and around Aurangabad and Mira Sadgopal who was with Kishore Bharathi and the Hoshangabad science experiment and then moved on to interests in women’s health issues, dai training and folk remedies.

There was Veena Shatrughna who apart from researching nutritional challenges all these years at the National Institute of Nutrition has been part of the mfc trio from NIN who consistently have flag waved for social determinants of nutrition and the feminist paradigm. It was nice to see Veena with the ANVESHI gang but we missed Kamala Jaya Rao and Mahtab Bamji, - the other two member of the trio

There was Narendra Gupta – the veteran from Rajasthan whose Prayas group in Chittorgarh which he started with his wife Preeti in early 80’s has championed cause after cause for health of the marginalized and the adivasis in the state. A great experimenter with the politics of engagement – Narender has been an old friend who confidently engaged with the state when possible and disengaged with it when inevitable – teaching us many lessons in the process.

Friends of 1990’s

There was Shiv Chandra whom we contacted when he was professor of Preventive and Social Medicine, Ajmer during the Medical Education study of CHC in early 1990 and has kept in touch on and off all these years.

There was Ritu whom we got to known after she moved from medical college to the JNU department. We had many common interests, debates and initiatives especially around Medical Education. Ritu always had a knack of creating an ‘inclusive balance’ when the debates got intense or conflictual

There was Sunil Kaul, that committed Gandhian, ex Army pacifist and community health veteran of Urmul, Majuli and now co-intiator with his wife Jennifer of ANT – Bongaigaon (he was inspired by the study of ants to build a NGO network of resource persons learning from ants and the way they organize things!) I remember the meeting in a hostel room in London where I convinced Sunil to be a CHC team member for a short while between Majuli and Bongaigoan – which he did and has remained a close friend all these years.

There was Prabir, who became a friend when he dropped out of medicine at CMC-Vellore in his pre final year disturbed by the fact that his medical education had cut him off from society. Most medicos seldom are even aware of this inevitable reality! He was allowed official sanctuary by CMC-Vellore at CHC - Bangalore to spend 6 months in an elective experience – which was later written up as a project of a medical student exploring society. This included his discussions and explorations with CHC, CMSS- Dallirajhara, Sidda medicine etc. Prabir’s serial post cards have kept us in touch with him – all the way through his field involvement, in Bihar and Jharkhand, his MD-PSM at CMC- Vellore and involvement with immunization/Pulse Polio in Bihar .

There was Madhukar, who came from Chennai as a young medico in his third year on a Science fellowship to the Indian Institute of Science. Madhav Gadgil felt CHC would be a better link for him. He worked on a project on hospital waste management and kept in touch with us all through the rest of his MBBS and then during his MD( PSM) in CMC- Vellore. He joined us as a research assistant for a while during his PG study leave, kept in touch with us all through his Sundaram Medical Foundation days including during his studies on caesarean sections in Anna Nagar. He has remained a friend all these years as a budding epidemiologist and an enthusiastic teacher of epidemiology.

There was Anand Zachariah one of the CMC-Vellore gang, a more recent friend of ours – a second generation connection in the Zachariah family, since his father had worked with us on reorienting medical education for some years before the son continued the quest exploring anthropology in medicine, HIV-AIDS and involvement of small hospital experience in medical education.

When Prabir, Madhukar and Anand began the unusual collective experiment of being co-conveners of mfc (perhaps the only time in mfc when there was a trio of co-conveners) we in CHC provided what little support we could to this trio of friends.

Then there was Sabu George, an unusual and somewhat unsung public health hero. After his PhD in nutrition he worked with us at CHC, helping Thelma with the Integrated Health Nutrition and Population project for Karnataka. He then became the most passionate public health advocate against female foeticide when the public interest litigation he and others filed during an earlier phase received a positive result. Many young public health advocates coul learn from his intensity and perseverance.

There was Raman – part of the trio of medicos from All India Institute of Medical Science which included Yogesh Jain and Prashant, whom we befriended when they visited us in their under graduate years from AIIMS. Since the mid 80’s. we have been in touch through their undergraduate years, their MDs, their stints at AIIMS and Karmsad and finally as they evolved into the Jan Swasthya Sahyog team at Raipur along with Anurag and Biswaroop.

It was a strange feeling to be in this roomful of friends, many of them going back nearly three decades. It was even a more strange sense of connectedness when we realized that they represented a roomful of CHC connections as well.

Ravi D’Souza and Sunil were CHC governing body members; Shyam, Dhruv and Shashikant, had been members of the CHC extended team who evaluated the JSR and Mithanin/SHRC projects. Amar had been in CHC’s external evaluator in 2004 and Madhukar, Anand and Prabir were part of the extended team who reviewed CHC in 1998. Narendra Gupta was the external evaluator of the CH Fellowship Scheme and many others had participated as mentors in the CH fellowship scheme as well including Narender, Sunil, and Rakhal. There was also a roomful of CHC fellows - Madhukar, Prabir, Anant Bhan, and Rakhal, (pre-fellows): Abraham, Jyothi, Naveen, Ameer, Satyashree, Vinay (past fellows) and Rakesh, Harish, and Junaid (present fellows) as well as some potential fellows among the other youngsters in the group. Finally there was the whole new team of CHC was there led by Premdas, the new coordinator.

The Community Health Circles of friends within the larger medico friends circle – a strange feeling of awe, fellowship, thankfulness and connectedness! An experience of history both at personal and CHC level!

Sunday, 11 March, 2007

Poems from Bangladesh

Selected from the book Poems from Bangladesh: The Voice of a New Nation.

The Blood Bank

Each day blood flows on Bengal’s soil:
every traveler leaves behind some of his blood
in this blood bank
where it is stored for the future needs
of the land.
Each worker walks this route
where he sows the seed
of a bleeding sun,
the farmer and the rickety old canvasser
store their blood
in the same blood bank.
Bengal’s blood is drawn inexorably towards the soil.
And though the river may dry and the sea disappear,
the garland of nature she wears may dry,
Yet one day from this same blood
shall emerge a new river
a fresh garland of nature,
the village that was once destroyed
And so who wants to keep his blood
In the blood bank at the hospital
Where it becomes polluted
With the poison touch of glass bottles?

There can be no blood bank better than Bengal’s soil
where each drop of blood donated become ten drops.
And that is why people no longer go
to the blood bank at the hospital:
Bengal’s blood is drawn inexorably towards the soil.

- Humayun Azaad

The Lonely Man.

He was sitting alone:
with a tear-stained face.
I asked him: Why?

He looked at me silently
and kept quiet.

I asked him again: Why?
again he looked silently
into my eyes
and said nothing.

Then he got up and went away
leaving behind his silence.

- Omar Ali

Only One Colour

There is only one colour today: red.
There is only one song : the slogan.
There is only one first raised: that of the procession.
Our newspaper : the poster.
Only one colour : red.

When the laughter of my people turns to tears,
when the singing voice of my people turns into a cry of pain,
then from a colourful landscape comes a poster like lava from a live volanco:
we want food, clothes, the right to live!
This land is mine,
this soil is mine- and all its dust
mingles with my blood,
The people of this beautiful land
have staked their claim to what they own.
Victory and defeat coexit in war:
we have no reason to give up hope.

Poster Poster Poster
Procession Procession Procession
People People People

- Kazi Hasan Habid

This struggle will go on

This people will fight on.
This war is our war, this war will go on,
No more shall we live
with death and shame:
this struggle is for our right
to live with honour, to free ourselves:
countless people
shall fight to the end.
Our struggle will go on .
This war is our war, this war will go on.

Deceit, fraud, intrigue
darken the nights
but we are the charioteers of time
keeping a silent vigil all the while;
we have sacrificed our peace
We shall offer our security
we have forgotten our fears
We shall disown our bones
and when the need arises
we shall offer a river of our blood.
Our ceaseless march will demolish
all terrible odds on the way:
even the mountain on our track
shall move one day.
Our struggle will go on.
This is our war, this war will go on.
We always hear death’s rebuke
and yet in dark cemeteries
we sow the seeds of dawn
In our lacerated minds
and in the routine agony of our lives
mingles the deadly venom of many snakes
and yet with tireless care
in every moment of our lives
we sustain the thirst for life in our dreams.
What to we have
that we shall regret its loss?
What is defeat
for those who have staked their all?
We have traveled for days
down this dangerous track
we do not share its phantom fears.
And though this endless journey may exhaust us
our minds will remain clear:
our route is distinct, we know the direction
and the passion of the march itself thrills us.

The road is difficult and there are many barricades
but millions share our suffering,
the countless sorrows we have known
flame in our eyes
Incenditarizing our differences.
We shall break through this dark night’s fearful barriers
we shall dare to proclaim the freedom in our hearts
and under the rays of a new sun
we shall sign with fire
this oath of struggle
Our war shall go on.
This struggle is our struggle, this struggle shall go on.

- Sikandar Abu Jafar

Nasrul Islam

Even today we are confused:
we depend on false and worthless words
Like a child who does not understand
but plays and while playing hesitates,
tired, searching endlessly for the right path.

In the unknown abstract world of philosophy
our long march
has not yet found its destination:
our skies are not yet free
from fear.

Yet we dream
of a new world that will come with victory:
when the sleeping days wake,
when the distant horizons rage
as the clouds war with fury:
when your lute of fire will play,
the lonely search in our weary hearts
catch fire----

and on that great day
we will not forget you:
you are the poet who showed us a new route,
who journeyed the same way.

- Begum Sufia Kamal

Rabindranath Tagore

If I am slaughtered
all that will remain of me,
my blood, my flesh, my bones will be Bengal,
my grief, my pain, my love, my final peace
shall belong to Bengal.

Bengal has suffered greatly
and yet in spite of her suffering in her literature
and in her songs
is the passion for her language:
this is the anguish we share.
We respect the memories of
shakespeare, Dante and Tolstoi
but in the blood of my heart
remains Tagore

All the time
when I eat, sleep or am awake,
In solitude, or among people,
a song echoes in my heart
in the language of Tagore.
This language rescues my heart
from the narrow confines
of its home
and opens fellowship
with people
All over the world.

In each recess
in each cranny of the brain
in the winding lanes of the heart,
it silently wanders
with or without words.
ours is the language of Tagore
this is the language
that is language
this is Tagore

and us.

- Niyamat Hussain

Tuesday, 6 February, 2007

Beyond Neelganj - understanding the crisis

After nearly three months of internship at the Neelganj camp, I spent a week in Ranchi, Bihar, at the Ramakrishna Mission Ashram and their farmers’ rural training centre, Divyayan. The ashram was part of the Tagore family property and was run by Swami Yuktananda, a radical monk for whom ‘adviasi empowerment was higher priority then teaching Vedanta'.

During this week I met a young East Pakistan refugee - Abul Kalam, who had decided to become a Mukti Fauji and was spending some time preparing himself for the training in guerilla warfare. Abul knew very little English and my Bengali was just basic but he managed to give me a completely different picture from the one I had picked up in 3 months of volunteer work. The deeper crisis of genocide and ethnic cleansing needed an understanding of the socio-economic, political and cultural determinants of conflict and of ill health. I had not been trained for this in medical school. The chat with Abul on the top of Tagore hill was my first lesson. The week with Swami Yuktananda was my second.

Today, as I look through the notes of these discussions, I recall some of my early insights into the refugee crisis.

  • While the exodus had been mostly of Hindu families initially, a significant number of Muslims Bengalis had to flee as well. The local population of Hindus and Muslims shared a common Bengali culture which was a strong bond. Both were oppressed by Punjabi Muslims who were in the army as well as in control of the few industries that were established in a predominant agricultural country.
  • The number of younger women in the refugee camp communities were much less than expected. I learned that this was because many of them had been taken prisoners by the Pakistan army for exploitation.
  • Although the Indian Government and the Indian Army would never openly admit it they were actively supporting and transporting the young volunteers (Mukti Faujis) to special camps where they were being trained to return to their country and fight back .
  • Abul had fled from Narayanganj, a few miles out of Dhaka where he had lived. He had walked a long distance to Agartala in Tripura, to the safety of the Ramakrishna Mission. While villagers had provided him food on the way, he had seen first hand the atrocities of the army genocide, the burning of whole villages, the shooting of innocent people, the looting of houses and property.
  • When their leader Mujibur Rehman of the Awami league won the election, the people had expected that he would become Prime Minister of East Pakistan. When this was not allowed he rallied the people in a Gandhian spirit of non-violent Satyagraha. The Army to put down the non violence protests ruthlessly.
  • The Bangladeshi intelligentsia was specially targeted especially the young protestors at Dhaka and other universities.
  • The refugee exodus of over nine million people over the worlds longest border became one of the worst the humanitarian crisis of recent history.

All of this was an unusual formative experience for a young medic. I discovered that health was also about people and their culture, their politics, about class and conflict, about gender bias, community histories, about migration and loss of roots – dimensions I knew little about at the end of 5 years in one of the country’s best medical colleges!

It was a experience that challenged me to face up to the complexity and diversity of refugee health, the inadequacies of medical education and the challenge of going beyond a bio medical framework. A new professional journey had begun!

Wednesday, 24 January, 2007

Becoming a netizen in 2006!

Over the last few days we have been reviewing our work in 2006 at CHC. I discovered that it was a special year of writing and interviews for me because unlike the past years most of these papers and interviews are already available on the net. Have I truly become a Netizen?

  • I wrote about the ‘Savar to Cuenca experience – 5 years of the growth of the Global Peoples Health Movement', a reflection on the growth of the People's Health Movement (PHM).
  • I was interviewed by the ejournal of Social Medicine on the PHM plans, priorities and challenges one year after the Second Peoples Health Assembly. This is now available in English and Spanish
  • At the Global Forum for Health Research I was interviewed by Real Health News about my experience of being both an academic researcher and an activist.
  • At Forum 10 in Cairo in October 2006, a plenary session was facilitated on the new concept and metaphor of ‘ The Social Vaccine’ as a strategy for action on the social determinants of health and to moderate the over emphasis on bio-medical determinism. The background paper I put together with others is a work in progress. This year an extended version will appear in the BMJ and the Forum report. Look out for it.
  • At the Forum 10, a special session was facilitated on Research Priorities for Schools of Public Health in the South and I prepared a compilation of recommendations on the theme from a series of recent sources.
  • Finally for the recently concluded Medico Friend Circle meeting on Public Health Education in India in December 2006, at the National Tuberculosis Institute in Bangalore, Thelma and I wrote a series of reflections on Public Health Education- Policies, Initiatives, Challenges, Opportunities, and Threats. These are now available on as part of the MFC bulletin 320-321.

Very soon a special learning centre archives will be set up on the CHC website which will a lot of material that the CHC team has written or facilitated over the years. Watch out for it!

It seems a symbol of the changing times that while we have just started recounting a public health journey that started in 1971 on this blog and have hardly reached 1972, the journey of 2006 has gone on the net so effortlessly in all sorts of spaces on the world wide web! The rest of the journey will soon be online too once we finishing sorting and collecting notes and photos from all our dustly files and albums.

Wednesday, 17 January, 2007

More images from Neelganj

Inspiration at Neelganj

Generations of medical students and many of our community health fellows and interns have heard me begin my narration of public health experiences from the early lessons at the Neelganj refugee camp (July – Sept 1971). Some experiences in life are very formative and these three months were among them, making a deep impression on me and on my choice of vocation and profession.

Over 9 million refugees from East Pakistan (before it finally became Bangladesh) walked across a 1500 mile common border with India, to escape the ravages of a political genocide in early 1971. The government of India was forced to organise nearly 1000 small and large camps, as close to the border as possible and made a national appeal for volunteers, social workers and health professionals to help serve the refugees.

Three of us, young interns from St. Johns Medical College, Bangalore – Dr. Vikram Venugopal, Dr. Gouri Thattil and myself volunteered and reached the Neelganj refugee camp of over 5000 inhabitants in early July 1971. The camp between Barasat and Barrackpore in the 24 Parganas district of West Bengal was one of many supported by Caritas India. Along with a pathology technician and two religious sisters who were also trained nurses, the three of us managed the basic health services from a bamboo hospital that we constructed as a symbol of appropriate technology in cooperation with the refugees. As the only member of the team who had working knowledge of Bengali, I became the informal team leader as well as the roving doctor who along with a basket of essential medicines made home visits (if you could call the 3’ x 6’ brick lined, thatch and bamboo camp sites which were the temporary shelters for these refugees as ‘homes’).

As I read through the letters I have written to my medical college – fourteen of them over three months, that had been displayed on the student and hospital notice boards to inspire and provoke more students and interns to volunteer, I recalled some inspiring experiences, some touching moments and many learning experiences. These included:

  • The challenges of organising the health care of 5000 people on a piece of land, a little smaller than an average football field.
  • The creative challenge of designing a small dispensary with beds and stands for intravenous drips and small partitions for delivery and dressing rooms – all of them using bamboo and jute and thatch.
  • While two of my colleagues treated the dysenteries, pneumonias and malnutrition of the majority, the technician and one of the trained nurses managed the skin, ear, and eye infections. I and one of the sisters did the camp visits, the onsite TB injection service, and managed the deliveries.
  • TB was rampant and you did not need an x-ray to make a diagnosis. A good history skillful auscultation and tapping, gave adequate clues to extensive cavitations and the therapeutic response to early treatment was dramatic!
  • Amidst all the distress and overt suffering it was people’s capacities that were inspiring. These included the patience shown by the women and children as they waited in queues for food, milk, clothes, blankets, medicines; how the refugees were always finding time for some laughter, merriment and singing of haunting Bengali rural melodies; our team being involved in making makeshift fishing nets and traps. These were all thought provoking experiences illustrating the survival capacity of the human spirit- a lesson never taught in medical school.
  • Illness was just one of many challenging episodes in a life full of challenges. It didn’t stop life, work, shopping, entertainment, gossip or conflict. Child bearing and rearing went on as they had always gone on- normally as part of life without waiting for medical intervention. Another of those little details not taught in medical school!
  • While we knew that health was ‘physical, mental and social well being’, our medical education had taught us little about mental health- much less about the trauma of disaster, rape, displacement, abandonment and genocide. There was an epidemic of psychosomatic complaints and it took us many weeks to understand the determinants of these problems and at the same time discover the ‘miracles of healing’ that a little listening, a little affirmation, a little pat on the back and loving attention could achieve.
  • Delivering these hardy Bengali women of their small malnourished little babies without the aseptic environment and stainless steel paraphernalia of hospital labour rooms was a challenge. The next day we found them back in the queues and involved in the demands of daily living. Postnatal advice taught to us in medical colleges suddenly became slightly irrelevant!
  • Finally, training our own ‘barefoot brothers’ who were not doctors but functioned as auxiliaries to distribute bread, milk, mats, soap and handle epidemics of scabies, conjunctivitis and cholera was a great learning experience. We were inspired by common sense rather than any medical college dictums.

Years later, when the Alma Ata Declaration was evolved in 1978, the lessons of equity, appropriate technology, intersectoral development and community participation which we learned in these formative community experiences in a refugee camp were formally endorsed. None of us were public health experts – just a bunch of young medicos with piles of enthusiasm, some common sense and a lot of youthful overconfidence that saw us through those early experiences. Three little anecdotes are also part of my repertoire of community stories from the Neelganj experience.

An old woman reappeared in the patient queue the day after she had been given two weeks ration of vitamins, claiming to have finished swallowing all those vitamins and not feeling better. It took us a while to realize that what she was seeking was psychological support and some company, in an otherwise desolate and hopeless personal situation.

A young 18 year old boy was diagnosed as being mad and violent. His feet were tied to a bamboo pole but he was fed and cared for by his camp neighbours. My ethical conscience at a very early stage of formation was appalled at this community-mediated restraint. Persistent talking and listening in a gentle but confident way to all his shouting and growls for a little while each day for nearly a week, including sitting closer and closer to the boy who was a ‘violent psychotic’, was an experience in patience. I broke through the psychological barrier on the 7th day. What could have been a physically violent experience if he had attacked me as predicted by all concerned resulted in a bear-hug full of emotion and uncontrollable sobbing, once I undid the rope restraining him. The personal story that followed was one of greater anguish. Of a young 18 year old who had seen his mother and sister being raped by the soldiers and had been unable to do anything but run away in fear! This had made him very angry, guilty and uncontrollable, leading to a violent psychosis. It needed patience and listening skills to get through but are we as young doctors taught to listen?

On the day before some of my fellow team members were returning to Bangalore, after a spell of volunteering, the informal community leaders of the refugee camp invited us for a late evening get together with a request to receive some ‘precious gifts’ from the community for the services we had rendered them in the camp. We counseled the community with some degree of youthful arrogance not to spend their meager resources of distributed rations and supplies in buying us gifts from the local market. The ‘precious gift’ they offered us was an evening of folk music accompanied by a small harmonium, and drums loaned from the local market. We were humbled when they told us that ‘Tikka Khan’ the Pakistani general who led the genocide could not take away their Bengali culture which included the songs of Tagore and Nazrul Islam, since it was an inseparable part of them. It was the deepest lesson in community health that I have received in 35 years – that the culture of a community is a unique, significant and basic unit of their lives. Whether poor or rich, destitute or refugee, one’s culture is one’s asset!! Yet most of us complete professional medical education in this country with seldom even one lecture on culture!

The little album of photographs (taken by me with a little, borrowed, old box camera) and the file of published letters and reports has been a constant reminder of these first learning experiences based on an intense community based and community oriented field posting. The first of several, over the last three decades but probably the most inspiring.

Monday, 1 January, 2007

Why blog?

For over three decades - starting as a young medical intern working in an East Pakistan refugee camp in India in 1971, I have been exploring an alternate paradigm in medicine and health in which people and the community are at the centre of community/ public health and not the professional doctor or the market of medicine. This search for an alternative paradigm has taken me through several roles and challenges till 31st December 2006. These roles have included student, teacher, researcher, husband and father, health action initiator, health movement member and leader, policy advocate, health activist and community health resource person at local, regional, national and international level and above all a learning facilitator and peer supporter for 35 years.

From 1st January 2007 I begin a new phase of slowing down, to revisit and review all the papers, correspondence, diaries, photos, CDs and reflections that were part of these three decades of health activism and public health professionalism. I am initiating this blog today to revisit this personal journey highlighting the personal and the intimate, the funny and the frustrating, the high points and the low ebbs, the enlightenment and the confusions, the political and the farcical, the tumultuous, the disappointing, the sublime and the ridiculous events in this inspiring journey. I hope to share flashbacks and stories from the past; reflections and reviews from the present; predictions and prophecies for the future as a stimulus and support especially for all the young people who in their early twenties and thirties are beginning this journey of self discovery and self fulfillment. All these years in spite of the growing grey hairs, the creaking joints, the circulatory blocks and the stresses and strains of too much activism and too much professionalism I have remained at heart a young medico searching with passion, openness, eagerness and rigour for new perspectives and new paradigms - enjoying every bit of this long journey.

Since 1980, Thelma has been a cotraveller, wife, life partner, inspiration, mentor and coworker in this exciting journey. As an epidemiologist and public health policy consultant her path has been similar and sometimes different. We share perspectives and paradigms but also view things differently because of our different professional training at postgraduate level, life experiences and different types of involvement in public health and community health. We have our shared spaces and our separate spaces, our shared experiences and our separate experiences as well. This blog is one such shared space. It is a small personal offering to a new generation of activists, as age creeps up in belief that it will inform, inspire, support and facilitate more searching and more action. There are times in all our lives that we want to be MAD not in the psychiatric sense but in the sense of Making A Difference. This blog will recount some aspects ot this MAD personal journey even as we reflect on the present and the future.