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!


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