Blessed by drops from the Ganges, then paying 100 rupees for it

Varanasi – the city of Shiva, one of the holiest places in India and one of the oldest cities in the world. Mark Twain wrote that ‘Varanasi is older than history, older than tradition, older even than legend, and looks twice as old as all of them put together’. It is a city centered around 80 ghats lining the Ganges and inviting Indians from all parts to bathe in the brown and trash-filled water said to wash away sins. At the Manikarnika Ghat, I watched the cremation ceremony of five people at the same time, burnt at varying distance from the Ganges relative to caste. All, however, have being freed from the cycle of reincarnation as long as their ashes make it into the Ganges and past the goats and dogs sifting through and looking for something to nibble on.

Life here revolves around the Ganges, as residents come to say prayers, bathe, wash clothes, light candles, take boat rides, wash their buffalo, meditate, and hold festivals along the river. The sight of such religious ferocity attracts visitors from all countries and makes Varanasi one of the destination spots for most travelers to India, especially for those who come searching for a spiritual awakening. The arrival of many laid-back, soul-searching foreigners has also attracted business-oriented Indians and has given Varanasi the reputation of being a city of scams, a reputation that my experience upheld. I spent one day in Varanasi yet felt harassed for money consistently and scammed at least four times.

“I cannot take you physically to Shanti Guest House because rickshaws are not allowed there but I can take you to Yogi Guest House, which is also in your book,” the rickshaw driver told me as I got off the train. I checked, agreed and after putting my bags into the room I headed out to walk to the Ganges, a supposedly five-minute walk from the hotel. After twenty minutes of walking, I came to realize that this was not the hotel I had been told about. There were at least eight guest houses named Yogi and I was staying in the ‘Old Yogi GH.’ I walked back furious and found the hotel packed with tourists, four more who had arrived since I left. I stopped one girl outside the hotel and asked her if she knew that she had also been scammed.
“Yeah, I realized that four hours after I arrived but I don’t really care.”
“Really,” I said, “it makes me rather upset.”
“Well, me too, but they are nice guys and very relaxed, and they set me up with some really nice bud [marijuana] so I don’t mind. I don’t know how long exactly I am staying for but it’s cool.”
That seemed to be the attitude of most guests and the way that Old Yogi got away with this scheme. Foreign visitors did not want to argue but rather get along with the people and attributed the confusion to culture. It made me even more upset that not only was he tricking tourists into his guesthouse but that this scam was only encouraged by their actions in going along with it.

I quickly picked up my bags from my room and walked out of the hotel 1.5 hours after I had dropped my stuff off. Before I could leave, I was pulled back in by the manager, who asked why I was going and demanding 150 rupees for the room I had booked. I refused to pay since I had been blatantly lied to about the room and had only been there 1.5 hours, which began an hour-long argument. His attempts to physically intimidate me or threatening to cancel my visa only made me more upset and eventually we called the US Embassy to resolve the issue. “You can do two things,” she said on the phone, “either call the police who will come and spend the next three hours with the two of you, or pay him the 150 rupees and move on, regardless of who is correct.” Getting involved with the police, however, was not something I wanted to do, considering I had been previously told not even to stop and help a car that had gotten in an accident because the police would eventually come and harass you not only for time and endless questions but money as well.

This was the first but not the last scam. Later it was at the Ganges, when a man put flowers and a candle into my hand, a red dot on my forehead and said a prayer for my family, enforcing at the time that it was free and he was a religious man. After finishing and while wetting his hands with the Ganges and spraying it onto my head, he told me that unless I gave him money there would be a curse on my family. Also there was the boy who worked on the boat given by the hotel to its guests for free morning rides to view the Ganges at sunrise, who pulled at our clothes incessantly asking for money. Or the man who came and stood at my side while was watching the cremations, explaining the different castes being burnt and then asking for money since “the information was not free.” Or the second hotel attendant who had told me the night before that I could keep my bags in my room until I had to leave at 7pm, although checkout time was at noon, yet the next day claiming he told me to put it in the storage room and for that he needed 100 rupees.

It was a frustrating day in Varanasi yet supportive of a trait characteristic of northern Indians as more aggressive and direct than southerners. This trait was expressed to me as early as six months back by my neighbor on the plane ride from the U.S. and then further while living in Jamkhed. A tension seems exist between the north and south that began as early as 1500 BC with the Aryan invasion from Afghanistan. Not only did the Aryans push the Dravidians (an advanced tribe inhabiting northern India at the time) into the mountainous regions of the south but they also brought the caste system, a feature initially based on color (Dravidians were darker skinned). The clearest difference that exists presently is language as southern languages (ie. Tamil) are of Dravidian origin and northern ones (ie. Hindi) of Sanskrit base. The north and south have progressed at different rates as the prosperity of the south has come on trade and the north more on politics. I have not yet been able to travel through most southern states but the change in feeling as I traveled limitedly throughout the north was apparent.

Welcome to the Himalayas

Wedged in between two men in a three-row minivan, the twenty Nepali’s and I rode over and around mountains. The road was windy and the driver was not hesitant to take the turns far too quickly, probably accounting for the one bus every three weeks that tips over the mountain and certainly accounting for the girls in the row in front of and behind me burying their faces in plastic bags with uncontrollable vomit. The breath of cold but fresh air was very much welcomed when their mothers would open the window to throw the bags onto the street. The mountains were thick green and covered in agriculture ridges, so that the mountains looked like steps rather than slopes, a tribute to the fantastic job in creating viable farmland in difficult farming conditions. The green farmlands were often dotted with different colors and shades, due to the varied crops or a group of red and yellow houses that constituted a mini-village. They also gave an incredible view on the three-hour journey from Kathmandu to Dhadingbesi, the capital of Dhading district where my Paideia friend Jessie Kaplan was stationed for her ten month stint working at a local school.

To get to her house from Dhadingbesi was an hour and a half trek up a mountain to visit her host-family. We climbed on trails through farmland and forest and along ridges that wound around steep rocky hills, past houses made of red, yellow and grey stones and “namaste”ing the small Nepali women carrying straw baskets strapped to their heads, going up until we arrived at her home. The home was large for a typical Nepali family but what seemed to be typical for Brahmin’s as they were - the first floor made up of the kitchen and the second floor storage, with a small side room for beds. The view was included on all “mountain homes” but it was only the more awesome with goats and chickens hopping around your feet and buffalos and cows eating on grass in the shed next door, waiting to be milked. The family owned farmland but the father was a teacher, so workers were hired to take care of the crops as the mother cared for the house and the livestock.

The experience was refreshing compared with the oncoming heat in Jamkhed, yet the effect of the mountains was highlighted the next day when I visited Anandaban Hospital, a hospital run and started by Leprosy Mission International dedicated to the physical and social rehabilitation of leprosy patients, but also serving all non-leprosy patients. Sakala, a Nepali friend from the two-month diploma course, gave me the tour of the facility, showed me the difference between multi- and pauci-bacillary leprosy, and discussed the difficulties in the holistic treatment of leprosy, accounting for Nepal being one of the few countries that has yet to eradicate leprosy (meaning a prevalence rate < 1 per 10,000).

While leprosy can be detected early, most patients live in villages where, like in Dhading, they walk great distances daily, often uphill, carrying food and water and causing great toll on their bodies. If they contract leprosy, they often hide it for fear of stigma and the need for hospitalization, which affects income. So they wait to report skin lesions, continuing to strain their body and causing eventual deformities since they can't feel their formation. Eventual, the deformities are too hard to ignore and too evident for the community to keep quiet and they are forced to go to the hospital where they remain for an average of twelve weeks for multibacillary treatment.

Five days were spent in Nepal in order to renew my Indian visa, three of which were spent in Kathmandu itself. Throughout my stay and through conversation, it became clear how difficult the situation seems to be in Nepal. The civil war and new Maoist government has spurred the creation of numerous rebel gangs and groups, responsible for murders of journalists, robberies and often for the strikes that seem to inundate Nepal – during my stay it was by road workers who had shut down the main road from Nepal to China. “There are no government programs that effectively assist the needy population in Nepal,” one man told me. While he may be exaggerating, the lack of government intervention is evident as there is no food program for farmers in Dhading, as Anandaban hospital lacks sufficient government funding, and as I had to cover my nose while walking through Kathmandu since trash was collected on the side of roads in huge dirty piles with pigs and dogs scrounging through them searching for food. Nepal, though, was a beautiful country (with equally beautiful women) and my limited stay was very enjoyable.

Marathi shikane mala garajeche ahe, karana mala Jamkhed madhye maza anu bhavayeche ahe

Learning the language has been invaluable to my enjoyment in Jamkhed. From the start I was dedicated to learning Marathi. Being able to speak Spanish in the U.S. has opened up doors and allowed me to enter a part of America (both North and South) that would otherwise be invisible, especially in the Bronx where over 50% of residents are Latino. Learning a language is more than just acquiring an ability to speak but rather language explains community and tradition that translation cannot convey. How villagers communicate and what words they use to describe situations say a great deal about the values held by that person and in that community.

The first two months in Jamkhed were often spent in the library with Sunil, the fluent-in-English librarian and friend who agreed to teach me Marathi. We went lesson by lesson through a Learning Marathi book, learning vocab and verb tenses to create necessary sentences. At times we sidetracked to the necessary yet inappropriate sentences that for some reason I never had trouble remembering, while “the house is made of wood” never could stick in my mind. My vocabulary grew quickly yet my ability to speak with people and use that vocab in conversation moved unnervingly slow despite my efforts.

Initially I was embarrassed to speak. I thought I had previously overcome embarrassment from speaking Spanish and attempting Chinese. However, struggling through a simple sentence as “I slept well last night” for two minutes with a village health worker staring at you wide-eyed (or at times with a smile she is trying hard to keep down) is difficult. Men, however, were not afraid to laugh and I often felt more relieved with them laughing than with the patience of the VHWs trying to understand me. The embarrassment gradually subsided but my conversation grew equally slow as my vocab continued to improve.

Learning a language seems to be a lesson in overcoming humps. Upon beginning the hypertension and alcohol study in Indiranagar (the slum area across the street from CRHP), I initially went with a social worker named Ratna who translated when I did not understand. Two weeks after beginning the study, however, she could no longer go and I was forced to survey the village with Lalanbai and Asha, two VHWs who spoke zero English. The changeover was the best thing that happened to me. It forced me to speak and get over the fear of speaking not only fluidly but confidently, as the study depended on it. After two weeks of being alone, my Marathi had improved five-fold and I had hurdled the hump. The biggest change has been not in my ability to speak but rather understand. Previously, the accent and quick-speaking scared the hell out of me despite the fact that I knew the vocab. But through continuous conversation their sentences seemed to move slower, not out of their mouths but rather in my mind.

Among the many things Marathi has allowed me to learn, there are a few that stand out in particular. One is the aggressiveness with which Indians speak to each other. There is little politeness in conversations, as questions are screamed at the men and answers are yelled back. Without understanding what is being said, every conversation seems to be an argument when really they may be talking about the effects of high blood pressure. There is also little use of thank you, please, excuse me or I’m sorry in the language. In fact, I have never heard anyone say please in a sentence since I have arrived and an American friend has been told that she should not say thank you so often because “it makes you look weird when no one else says it.”

Another benefit has been the ability to ask follow-up questions. While measuring BPs we have often found ourselves on the floor of straw huts with no electricity and no gas stove. Through conversation initiated from study questions, the lives of the local villagers are elaborated and better understood. One family in particular showed photos of them standing in front of their plastic-covered straw house (plastic from road advertisements to deter rain in the monsoon season), yet they, and their house, were knee-deep in water. They had no where else to sleep, though… “but that is when good work comes,” the father said frankly. Their three daily meals presently consist of Indian flat bread made from sorghum (glutton-free wheat) and chutney, and two meals per week of goat meat.

I am far (very very far) from fluent and often can not hold difficult conversation, but simply being able to continuously speak has not only opened up my world but has shown respect to a community where I am living for one year. Hindi, while perhaps more useful to learn, is not the local language and it does make a large difference to the community whether I choose to speak Hindi or Marathi.

One of my favorite occurrences during the study is when the family I am visiting lays out a floor mat to sit on and I take three minutes to introduce the study, explain its purpose, let them know that I will take their BP first and then ask questions, that their answers are confidential, and that a follow-up will be conducted. After the three minutes, as I unfold the BP cuff to measure, the patient will continue to stare at me and ask “Tumhee Marathi bolata ka?” – “You speak Marathi?” – not because they didn’t understand but rather they couldn’t figure out if I was really speaking Marathi. I have recently begun all conversations with “Me tora Marathi bolato” – “I speak a little Marathi” – yet afterwards and after explaining the study for three minutes, their puzzled face still asks “Tumhee Marathi bolata ka?”… at which point Asha steps in to explain the study.

Auspicious time of the year = A lot of weddings

I entered the massive outdoor auditorium and found myself among three thousand other people, with the women on the right side and the men on the left. This wedding was held in Beed, a town one hour from Jamkhed, and I soon came to understand that most of these guests did not know either family getting married but were either from the same village or they had a friend who was. Celebrating your marriage with as many people as possible is not only good luck for the marriage but is good for status and social clout. Most weddings do not lack for a rise in social standing. The couple was also fortunate to have held their wedding on what was declared an ‘auspicious day’ by the ancient Hindu scripture.

There are many auspicious days in December and when combined with cooler weather it breeds a perfect time for weddings. Since the end of November, I have attended five weddings, four of which were arranged-marriages and of equal caste. In only two of them did I know the bride or groom yet in each, upon entry, I have been escorted to the front of the crowd to sit in chairs designated for the family I did not know or for special guests. My presence as a white person at weddings is an excellent sign of status for the families and often guests watch me rather than the wedding taking place. As the honored guest, I am often swarmed by people wanting to take photos, children wanting to shake my hand, and men with a tad too much to drink who want to test their English. The benefit is that I have an awesome view of the ceremony and am assured that I will be taken care of, in terms of both food and entertainment.

Weddings are typically paid for by the bride and her family, along with the dowry that the bride gives. In order to please the groom and his family, the wedding needs to showcase as much opulence and wealth as possible. Wedding saris (Indian dresses) are pieces of artwork and are inlayed with gold and have incredible stitch work in vibrant reds and blues. The dowry gifts given to the groom are often on display and have included refrigerators, cars, motorcycles, plates and dishes, and pure gold. The dowry also often includes acres of land, animals and houses that are not found at the ceremony. At the nicer weddings, gifts are also provided for each and every guest. Women usually receive a sari (surprisingly one-size-fits-all) where as for men, food and sweets or cloth suffice.

The most exciting thing about the wedding is the food, as each guest is expected to eat until they burst, a luxury also administered by the wife’s family. I have heard that guests attend weddings simply for the food and in the car on the way there people often discuss their excitement and anticipation for the delicious food. The nicer the food and set-up, the wealthier the family. The most high-caste wedding I attended offered a buffet of platters from not only around India but around the world. Tandoori chicken, Malaysian stir fry, Rajasthani snacks, Kashmiri curry, and Italian ice cream & dessert were all at peak freshness. And each guest had a server who carried your plate and walked with you, suggesting the best food and standing next to your table until you were ready for seconds. At a Jain wedding, there was a fruit bar that not only offered fresh fruit but fresh juices. Even at the least-opulent wedding in a local village, each of the thousand guests ate rice, daal, veggies, chapatti and jilebi (sugar-filled jellies) on a banana leaf plate to their heart’s content.

An ultimate show of wealth and tradition is the entry of the groom. At the Jain wedding, the groom arrived on a horse covered in jewelry and fabric. Before entering the hall, first his and then her family blessed him by feeding him, covering him with water and colored paste/powder, and whispering words of blessing in his ear. Simultaneously, a hired band played in front of the horse with men and boys dancing, of which I joined and was taught how to dance in the Maharashtrian way.

What I have yet to observe are the traditions that take place for days before the wedding ceremony. These events are reserved for family and customs vary by caste, religion, state and village. In most Hindu marriages a wedding pole is made and the bride and groom walk around it seven times in a counter-clockwise direction to sanctify the marriage. These poles are fascinating and intricately carved with symbols and stories that mean more than I understand. In some traditions, I have heard that both the bride and groom are forced to sit on stage as family and friends give them a hard time through jokes and make fun of them through stories, similar to the best man grilling the groom in America.

Following the wedding ceremony is a departure party for the bride and her family. Since the bride goes to live with her husband and his family following marriage, it can often be months or years before the daughter sees her family again. This day is often filled with joy and sadness. Yet all these events bring together friends, family, fellow villagers and me in heaps to celebrate the marriage.

What makes you "talkative as a parrot and as cunning as a jackal, then roar and fight like a tiger only to end up rolling in the gutter like a pig?"

The metal trash bin was half-filled with jogri (sugar cane juice) when it was covered with a lid and put over a fire. A tube was stuck into the bin around two-thirds of the way up, connected within the bin to a metal plate that condensed the evaporated gas into liquid when water was poured on top. The liquid flowed from the plate, down the tube, into plastic bins and eventually into a glass exchanged for ten rupees (20 cents), and finally into the mouths of what seems to be the majority of the men in Indiranagar.

Alcohol-making is a job usually done by tribal groups and it is no different in the slum area across the street from CRHP. Tribals had settled in some years back and found that selling alcohol to locals was very profitable. As the villagers began to drink nightly, they wanted something that would hit them harder, that would continually take them to a place further from where they were. In response, alcohol-makers began to put all sorts of things into the alcohol to make it more potent – battery acid, trash, detergent. This local brew of alcohol, or moonshine, is very popular among drinkers, who prefer the low cost and high return to the manufactured alcohol available in town at shops, which goes for 80 rupees per bottle. One glass of this moonshine would seem to suffice for one hell of a night for a typical man, but through conversations with villagers I have found that most drink up to six glasses per day, including in the morning.

In the district of Gadchiroli, however, with the highest ratio of tribals to non-tribals in the state of Maharashtra, it has been illegal to sell any form of alcohol since 1996. A pre-ban survey from the early 90s showed that about 100,000 males in the district were frequent drinkers, 10,000 were addicts and a surprisingly high number died of alcohol-related consequences. In addition, annual sale of liquor in the district was about 200 million rupees while the government’s total annual support for all district development programs was 140 million rupees.

This survey and the subsequent community-based movement to ban alcohol were mobilized by SEARCH (Society for Education, Action and Research in Community Health), a voluntary organization started by Drs. Abhay and Rani Bang in 1986 to provide community care and conduct research on the health of women and children. SEARCH served as my last stop after visiting Sevagram.

The anti-alcohol campaign started through village-level meetings with women and youth to discuss health problems, which elucidated the destruction of lives due to alcohol addiction. Men got drunk, did not go to work, failed to support their families, beat their wives, quarreled, fought and even killed each other. Practically all women seemed to have suffered due to alcoholism among men. Many of the men did not disagree, they just didn’t have the power to stop. Using this high community interest among women and youth, SEARCH mobilized villagers to collect data on the problem and then bring it back to each village to see the response.

As awareness grew, boys in two village youth groups organized a ban on liquor – alcohol stores were closed, bottles were broken, drunks were fined. To bring the movement to scale, SEARCH helped to organize 349 villages to pass resolutions to ban all liquor. Anti-alcohol groups sprang up, including a district-level Darumukti Sangathana (Liberation from Liquor). Making of moonshine stopped but manufactured liquor shops stayed open, invariably owned by local politicians making good money. The people decided they could no longer depend on the government to control alcohol so they partnered with local experts and honest officials to start the People’s Liberation from Alcohol coalition. In 1992, they presented an anti-alcohol resolution supported by 10,000 delegates from more than six hundred villages. In 1996, the state government finally banned the sale of alcohol in Gadchiroli, banning locally-made alcohol and closing all commercial liquor shops. Follow up surveys showed that within two years alcohol consumption was 60% less than it had been before the ban.

There are multiple things that really impress me about SEARCH’s anti-alcohol work. Alcohol was a problem identified by the villagers as something that needed to be addressed and Abhay and Rani Bang took it on full-steam, regardless of if it was a problem they identified. Despite the fact that taboo associated with alcoholism and despite the numerous death threats and jailings they had to endure, they pushed on for the benefit of the community. The purpose of the movement was much larger than their reputation and they were willing to put it all at stake for the benefit of the village. In addition, although alcohol has been banned, they recognize that the problem is not solved and that alcohol can still be snuck in or made under cover. To continue to help addicts who want to quit, they run five-day deaddiction camps with detox in the villages themselves, helping people combat alcohol and/or tobacco addictions. The fact that men attend camps in their own village shows the alcohol-associated stigma has been overcome.

Visiting SEARCH and their deaddiction camp also reinforced a desire to understand the scope of addiction and alcohol abuse in the slum area across from CRHP. Along with a staff member familiar with Indiranagar and the local village health worker, we have begun a survey measuring hypertension, tobacco use, alcohol use and diet among all men in the village. Although going into the survey there was a lot of doubt as to the comfort of men to discuss alcohol, we have so far found that (similar to Gadchiroli) men recognize it is a problem and want to quit, but they just do not know how.

Unrelated, I have posted many new photos onto Webshots if you would like to take a look. Click Here to see them.

Even so, 95% of graduates return to an urban practice or hospital

Sevagram, Service Village in Hindi, is a village 12 hours away from Jamkhed. The village served as Gandhi’s ashram beginning in 1936 and also plays host to the Mahatma Gandhi Institute of Medical Science, where I visited after Kanha to learn about the Department of Community Medicine. The department is doing great work on two fronts: first in motivating and encouraging medical students to practice in more rural areas, not only by force but also inspiration, and second by working to build the capacity of the village through CRHP-similar methods. Both these endeavors breathe of Gandhi’s hope for India, and even more his message for Sevagram. In 1945 Gandhi asked Dr. Sushila Nayar to begin a clinic for small infants and women in the village, in hopes of training village health workers and empowering the common Indian village to deal with the core health problems disproportionately affecting the rural population.

The reality is that India graduates roughly 30,000 doctors per year¹ yet hardly any can be found practicing in rural areas, all choosing urban centers instead. To try to curb this trend, the government has set up primary health centers for every 100 villages, creating an auxiliary nurse midwife to provide immunizations and monitor pregnant women, and instituting village-level traditional birth attendants for deliveries not done in the hospital. While this has created more jobs and more locally-available health staff, the effects have hardly been felt. A 2003 study in rural Maharashtra showed that only 12% of pregnant women receive the minimum antenatal care package, even though this is a service provided by the ANM.

To address the inequity in infant mortality and disease transmission, doctors are needed in the rural areas. Doctors are needed where health status is at its most fragile – in the rural village, not in a private practice in Pune. Doctors are needed where the majority of patients are, not where they could travel to, forcing them to miss work and pay unaffordable fees.

The success of CRHP empowering illiterate village women to reduce the prevalence of disease and sickness in their community has been made possible by the low-cost and supportive secondary-care hospital at CRHP Jamkhed that the village health workers can refer to. Without the hospital, patients would have to be referred to the district level hospital one and a half hours away and at times 2-3 times the cost for the same operation (for example–delivering via cesarean at the district hospital: 15,000 rupees or $300. At CRHP’s hospital: 5,000 rupees).

Even with VHWs, ANMs and TBAs, doctors are needed in rural areas to provide the necessary secondary and tertiary care that untrained professionals are not able to care for. Presently, when villagers have serious health problems, there seem to be three options: either they miss work and visit a hospital, they ignore the problem in the hope that it goes away, or they visit a traditional healer or village-level medical provider with no medical training who tends to give antibiotic injections for every complaint. There is little room for easy decisions and every choice has bad implications.

The department of community medicine has responded to this need by instituting programs to orient the students and provide them with a personal experience of rural life. Immediately after admission to MGIMS, first-years have an orientation in Gandhi Ashram for 15 days. Further, all first-years have to live with a family in a village for 15 days to carry out health, sanitation and nutrition surveys, returning each subsequent year for follow up. Finally, since 1992, it has been made mandatory that after medical school, new graduates serve for two years in rural villages, working with Institute-approved NGOs or in a government rural health center.

As I spoke with med students at MGIMS, I asked them what their plans were after graduating and completing their two-year rural fellowship. The first year students expressed their interest in staying rural and practicing medicine in the village. Answers from fourth and fifth year students: two wanted to be orthopedic surgeons, one an optometrist, and practically all said they planned to live in an urban setting. The attraction for doctors to urban life is just too great. If they are originally from an urban area, than they are practically foreigners to village life. If they are originally from a rural area, becoming a doctor is viewed as their way out. Being a doctor in an urban area pays more, as the patients tend to be wealthier and the problems more specialized. Plus, for their family, money is important, as they can now put their children into a private school and “give them a better future,” as one student put it.

Dr. Garg, head of the department, admitted that there is little in the village that attracts doctors to practice there. The education system tends to be worse and the government has set up no incentives to bring doctors away from urban life and into the village. Plus, as an outsider to the village, the doctor has to either find a house (difficult in a small village) or build one (which he/she tends to have little interest in doing). Perhaps the government should set up housing for doctors and compensate them to live in more rural settings? At what cost, though, must you motivate the physician to practice morality and equity? Whatever the solution, it must be accompanied by a change in the mindset of the physician to view medicine not as a lucrative profession but as the opportunity to meet the needs of the sick and enable the village to become healthy and productive.

Dr. Bang from SEARCH-Gadchiroli put it well when he told the story of Akbar and Birbal:

Akbar asks Birbal to find the ten most foolish men from his kingdom.

Birbal went yet was able to find only nine foolish persons; finding the tenth one was becoming a difficult task.

In his search for the tenth fool, he was walking up and down the road of Delhi. The road was in darkness except for a beam of light falling out from a window of a house. A man was bending and seemed to be searching for something. Birbal approached and asked him what he was searching for.

“I have lost my diamond ring and I am searching for it, and am not able to find it.”

“I can see that you are not able to find it. Where did you lose it?”

“In the forest, on the other bank of the Yamuna River.”

“Then, go and search there.”

“There is darkness there, while here there is light.”

The ring was lost in a forest, but it was being searched on a road of Delhi. Birbal found the tenth fool.

Dr. Bang followed by saying – unluckily, most of our medical research is done in this way. Health is lost in the villages but the research is done in the city, where there is light, facilities, air-conditioned rooms, but there are no problems.

Happy Hannukah! Merry Christmas! And a very happy new years!

Stalking Tigers on Elephants

I had already broken into my packet of Tums, trying to persuade my stomach to hold out the thirteen-hour overnight bus journey, when a man plops down beside me on the bed. On overnight buses, you are give a single bed instead of an upright seat, yet as he lied down beside me, giving me the odd look customary to when most see I am not Indian, I came to realize that this small single bed was two seats. Trying to sleep on a bus that is weaving through traffic, catching every bump, with a Bollywood soundtrack blaring from the speakers and a stranger snuggled up next to me is not easy. I turned, tried to get comfortable yet lay awake, wondering how it was so easy for the guy next to me to simply lie on his back, motionless, and fall into a deep sleep. Twenty seven hours and four bus transfers later, I arrived in Nagpur, then Seoni, then Mandla, and finally Kanha National Park, in the state of Madhya Pradesh.

We hopped into our gypsy safari the next morning at 5:30am, dressed in long sleeves and ready to head into the park and hopefully see some tigers. Kanha is a 2000-square-kilometer national park that regularly tops lists of the best places to glimpse a tiger. The park also lays claim to Rudyard Kipling’s Jungle Book, which is based on a case in 1831 of the capturing of a wolf-boy in the Seoni district. To attempt to see a tiger, we were armed with Santos (our knowledgeable driver), a British couple with two cameras and four lens attachments (one of which was bigger than my arm – “just in case the lighting was right,” he said), me and my Olympus auto-focus hand-held, and a guide who was bundled in five layers of clothing and didn’t speak for the first two hours due to the cold.

The park was fantastic as we drove through a virtually-untouched and overgrown forest, searching for tigers but running into hundreds of spotted deer, langur monkeys, peacocks, gaur (big buffalo), turtles, jackals (small wild dogs) and sambar deer. The rarest were the barahsinger deer, which can only be found in Kanha, and were useful since they howled to each other when they sighted a tiger. Seeing a tiger is no easy task and our driver would often stop in the middle of the road for thirty minutes (we could not leave the jeep), waiting to pinpoint the sound of a howling deer or monkey, and then racing over to the closest area to search for paw prints or listen for another hint.

As we gave chase, we ended up running into elephants who had located a tiger within the forest, so we climbed aboard these massive beasts and trekked out in search. As it was late morning, the tiger was already beginning to relax in the heat and we found her lying under some overgrowth, trying to get some sleep despite the huge elephants gathered around her with humans clicking away on giant cameras. We watched it lie there for some minute and then wobbled back to our safari jeep to let others get goosebumps too. In our jeep, we waited for the tiger to get up and walk around, following it down the road and watching it pay no attention to the fifteen jeeps stalking it as it headed down the road.

The next morning we felt not so lucky, as Santos camped out in the road due to the howling monkeys in the trees overhead but the tiger would not come into the open and show itself. After waiting for an hour, disappointed of not seeing one, we decided to head off in search of other animals, but as we drove we nearly ran over a huge male tiger crossing the road. We stopped and for a second were too stunned to even take photos. It went back into the forest, turned to look at us, decided it wasn’t interested, and continued into the forest. Considering the disappointed state five minutes before, the excitement was similar to watching Chipper Jones hit a three-run home run in the bottom of the ninth down by two runs, when you think the game is all but over and now you have newfound life and enthusiasm.

Kanha lasted only two days and before I could regain sleep I was back on the bus, this time headed to the Mahatma Gandhi Institute of Medical Sciences in Sevagram, where Gandhi set up an ashram and where he began the ‘Quit India’ movement. Traveling through Kanha was great, though, and trekking in open-aired jeeps searching for tigers and other animals was surely an awesome experience to say the least.