Of Princes and Paupers: A Tale of Two Indias"It was the best of times, it was the worst of times, The Paupers One of the reasons I came to India was to gain experience, interact, listen, learn, build relationships and hopefully assist the rural poor. So far I have only experienced the widening gap and barriers between the rich, the not rich, and the impoverished. I experienced the now cliché saying of "India is a land of contrasts" on my first trip to India in 2004. In Mumbai, especially, new BMWs whizzed by some of the most expensive real estate in the world while begging, malnourished mothers and children watched from their squatter settlements along side the road. My final paper was even entitled "Finding the Breath of God in the Land of Opposites." But actually living in relative affluence in Udaipur while desiring to "experience poverty/live with the poor/assist the poor" has been weighing heavily on my mind. For awhile I was floating in the ARTH's nice office with upper class Indians carrying out data analyses for various projects and living in a nice modern home. I needed to get out and see the village outreach. So I decided tospend three days in village called Delwara which represents this reality. I am an outsider and nothing will ever change that fact. I could also be classified in what Robert Chambers in his excellent book Rural Development – Putting the Last First a "development tourist." Although the author examines this topic in much more detail, in sum a development tourist is often an urban-based professional (I'm not a professional obviously) who carries various sorts of biases and visits rural conditions for a brief amount of time with a specific objective. I am not living a total immersion experience like a social anthropologist or a Peace Corps Volunteer which also possess various biases and advantages in understanding rural village life. I am a field student who can make the world/classroom as big or small as I want it to be. Delwara is a village about 40 minutes outside Udaipur by bus through the winding Aravelli Range. Vinod Verma, the man who supervises ARTH's Home Based Management of Newborns project for Delwara, met and took me to his house where I would be staying just off of the national Highway No 8. His family of three boys and wife live in one room with one cot and marble floor – a modest but livable home in a concrete structure that houses several other families. Community squat toilets are outside the room and the bucket shower room is atop the roof. As to not expel Vinod's family to sleep on the roof, I assured him I would be fine sleeping on the floor in the adjacent vacant room with no ceiling fan. I understood the following two hot nights why they thought a ceiling fan was so important. I ate very well in his house though. His two-year old son's never-ending curiosity always had him searching my things. His eldest son suffers from cerebral palsy and cannot walk or communicate normally; he doesn't attend school but is obviously loved and cared for by his family. My role in Delwara was/is simply to be an observer of ARTH's study/intervention called Home Based Management of Newborns (HBMN). Here is an excerpt of my journal when I visited a town called Rasjasmand on July 13 to observe the project in that outreach area. It gives a good representation of the overall project. "My driver coordinates the HBM project for the villages I visited. We drove through another myriad of marble owners and slab cutters to reach the house of a Shishu-Rakshi, a village health worker trained by ARTH to carryout care of new mothers and newborns. After waking her, my guide started collecting data from the SR's previous month's work. I soon found out what this entailed when we visited a nearby village to check-in on a newborn and her mother. I removed my shoes and entered a dimly lit room with the mother resting on her side on a bed with a ruffled pink blanket beside her. The SR, supervisor and I sat nearby on the floor. I kept thinking to myself, 'Is there a baby underneath that blanket?' It could just as easily been a ruffled, lone blanket. The SR moved towards the mother, and yes uncovered the newborn resting warmly underneath the blanket. She placed the small newborn on a tarp between the SR, supervisor and me. The fragility of life lay right before my eyes. The SR then took the pulse and weight of the baby, temperature of the mother and baby, and inquired whether the mother was breastfeeding. To weigh the baby, she simply put a small sling around the body and attached it to a portable, small scale and then lifted the apparatus with baby an inch or less off the ground. All these data contributed to a perspective on the baby's and mother's health. Weight gain indicates an overall measure of health. Pulse and temperature may indicate whether the baby/mother is fighting infection or recovering form sepsis. Exclusive breastfeeding promotes healthy weight gain and nutritional status. The supervisor inputted all these data and more into standardized booklets collected individually for each mother/child and compiled into the overall data of the study. My understanding of the study is that the training of the local village health workers, the shishu rakshis, in providing newborn care can effectively reduce neonatal mortality and promote safe motherhood. Back at the office I saw pictures of the training sessions in which twenty or so SRs were being trained. I was experiencing public health on a grass-roots level. The SRs would seek out pregnant mothers, track their progress, and offer antenatal and postnatal care." I ventured out with Vinod on similar excursions in Delwara and nearby villages. We often would stop at Anganwadis, government built concrete structures that act as community centers. Old women often cook for kids or toddlers at these places – a sort of day care I gather. But these are the places we would find the village health worker too. After reviewing the latest standardized booklets of newborn data, we would check up on the newborns as described above in Rajsamand. Houses in the villages vary by village and in size. Rocks are widely available because of the Aravelli Range. Villagers often remove them from the fields and stack them in endless walls to denote their property. They are stacked and used with various types of mortar for houses – dung or dirt/clay mix covered with a white plaster. Roofs are sometimes layered with wood sticks and with piled stones on top. Some have dirt floors and some have concrete. In inner villages, some people live in concrete houses from past Rajput or Mughal figures. In outer villages, five or so goats are sometimes alongside people within the hut in a designated section. Some have sporadic electricity, which is used for one light bulb and a fan if available. As I would enter these houses the mother would often be resting on a wobbly cot with the newborn under a blanket at her side. Otherwise the baby hangs in a basket from the ceiling. Flies predictably irritate anyone in the room. Two babies we visited had sepsis, a blood infection that causes half of all neonatal deaths here. The babies with sepsis had swollen, bloated stomachs. The supervisor and SR delivered some antibiotics and described how to use it and to go to the hospital if the child did not get better. A grateful farmer gave Vinod a large squash in appreciation. Another baby was not breast feeding. When the mother said it was a month old I even knew something was awry because it was smaller than even some of the younger babies. The SR had the woman put breast milk into a pan and pour it into the babies mouth. These are simple interventions that could potentially save millions of lives. Four million babies die in the first month of life called the neonatal period; that is about 10,000 deaths per day*. Three million of these neonatal deaths occur in the first week of life with 1 million dying on the day of birth*. Infections like sepsis/pneumonia, tetanus, and diarrhea account for 36% of all deaths, preterm deliveries, 26%, asphyxia, 23%, congenital problems, 7%, and other causes, 6%*. It is obvious from my brief trips to the villages that such deaths go unrecorded and unnoticed to the outside world. I sat in on a verbal autopsy of a seven day old newborn that died even though it was born into an upper-middle class village family and they made it to the city hospital when trouble arose. These verbal autopsies are part of the study to determine the neonatal mortality of the region and to document why such babies are dying so interventions can be more effectively implemented. The Lancet Neonatal Survival Series notes, "The additional cost of maintaining recommended newborn health interventions at 90 percent coverage in the 75 countries with the highest mortality rates is estimated at to be US$4.1 billion per year, on top of the current spending on the US$2.0 billion. About 30 percent of the cost is for interventions specifically for newborns, while the remaining 70 percent is for interventions that would also benefit mothers and older children. The total of new spending per capita is only $0.96." To put this in perspective, the US currently spends $9.0 billion per month on the war in Iraq^. The Princes Literally and figuratively in the middle of Delwara amidst this maternal and child morbidity and mortality lies a world class luxury hotel called DeviGargh. This Mewar fortress built to resist the Mughal invaders of the 18 th century was converted into a posh hotel to cater to the rich. DeviGargh formidably rises above the village atop a ridge. Translated in Sanskrit as "Goddess Fort," the likes of Elizabeth Hurley and Paul McCartney who stay here may indeed live like gods compared to those below. As a foreigner, a local guide in the town square told me I could stroll up to the gate and get a free tour. "Foreigners can go anywhere," he declared. He is right in more ways than one. I can leave India and the village at anytime unlike the villagers. With the color of my skin as my pass, I cruised by a guard through the steep wall that divides the villagers from the fortified rich. After all, the purpose of a fortress is to keep people out. I met a young man from Punjab, a recent graduate of hotel management, wearing a "Trainee" badge. With my guide I viewed various air-conditioned, marble-plated, spotless, modern rooms with spas, Western toilets, DVD players, TVs, and pools. Cleaners and servants obviously seemed trained to always say, "Good afternoon sir" whenever they passed me. Looking out the windows of some rooms, I viewed the green, beautiful hills of the Aravelli Range. The village below easily sank into the periphery. Yet I could look down into the houses from some patios and view the colorful saris dotting the fields and streets below. The people were smaller. I could not see the well in the town square where a man drowned the other day. The 25 year-old snake charmer, one of the lowest of the scheduled castes who are even shunned by other untouchables, was an alcoholic and drunk at his time of death. He must have died midday but no one heard his cries. The elder men of his extended family squatted and smoked nearby and asked to see the picture printed in the newspaper article about the tragedy. Some of the houses with newborns reside directly adjacent to Devigarh's wall. Looking up from the streets below, Devigargh seems so close and yet so far beyond a villager's grasp. A couple of the houses possessed a poster which pictured two doves and read "Love is Enough." I found this significant for those living in relative poverty. Such a sign can be a reminder that the opulence of Devigargh can be too much. As the Beatle and DeviGargh guest suggest, "All you need is love" rings true more often than not. Yet Delwara and the rest of rural India represent a case when it does not. A mother's love for her newborn child cannot alone save a baby born into poverty and without access to quality healthcare. Real India So is DeviGargh or the rest of Delwara the "real India"? For my religions of India class I actually did a presentation on the dichotomy of rural/ urban and rich/poor in India. My conclusion now is the same as it was then – both are the "real India." Several times people have used this phrase since I arrived here. On the way to a wedding through some dark alleys in Udaipur, my host brother had to get out of the car to cajole a resting cow out of the way. My host mother turned around and exclaimed, "This is the real India!" When I returned from Delwara, two of my coworkers asked, "So how did you like seeing the real India?" Even my own neighborhood in Udaipur represents rural and urban India and the wealth gap of modernity. On my walk to the office, I pass day laborers with their lunch tiffins in hand who are entering my upper class neighborhood to work on construction of houses, deeper open sewers, and in the fields. Large concrete houses lie amidst green fields of corn and vegetables. Small houses made of wood also line these fields where people live alongside their cows and water buffalo. When I returned home from Delwara and passed these fields, squatters, and day laborers, my family was moving in a $1200 wood and glass dining table. The fourteen year-old "maid-servant" employed by my host mother, probably one of the day laborers I see everyday, was ready to wash my clothes by hand and scrub my room's marble floor. My host father noted the same day "it's easy to make a dollar, but hard to make a rupee…Money is the most important thing." I wish I would have asked him to clarify what he meant, although I have some idea because he constantly asks me how much everything I own costs. I don't know how much an IT engineer makes in Silicon Valley. But I know a quarter of a million babies who die each year of neonatal tetanus can be saved with two 20 cent immunizations for their pregnant mother*. The real India is indeed maddening. Edward Luce in his book In Spite of the Gods says it best when he writes, "India's economy offers a schizophrenic glimpse of a high-tech twenty-first-century future amidst a distressingly medieval past." I invoked Charles Dickens at the beginning of this mini-essay, because I believe the opening line from A Tale of Two Cities strikingly captures the mood of the charging character of the globalized 21st century epitomized in India. It is the best of times for many with an education, a job, and money. It is still the worst of times for the illiterate, poor, and uneducated. Globalization brings the benefits of modern science and Western standards of living along with the impression of Light and hope of a better life. Yet it also fosters incredulity and promotes realities of unbelievable disparity. The shadow of poverty in the face of wealth makes the Dark seem Darker. Everything does seem before the people of India, yet many still face the harsh reality of chronic sickness, drought, monsoon flooding, and poverty. Judgment is indeed upon humanity at this crossroads of history. This is the real India and the present real world. Citations: Further Reading:
Random thoughts and contemplations: Good development, specifically good rural development, may be one of the most difficult challenges today. Simple interventions implemented in complex social, political, cultural, religious, and diverse settings can go along way. So many of the world's brightest minds go towards developing weapons programs, spaceships, warships, movies, video games, personal stock portfolios and countless other inevitably shallow, meaningless, fruitless, and do I dare say evil endeavors. We need more of the world's brightest students to take on the challenge of good development and the suffering of 2 billion people who live on less than $2 a day. The world needs those who can bridge academia and practice into a concerted action-research, interdisciplinary drive to address the complex reality of poverty. The world needs people who simply know and then care enough to take action. The fate and judgment of humanity hang in the balance. Flies may be one of the most evolutionary advanced creatures, and by that I mean well adapted creatures. They're everywhere and are great at what they do – annoy people, eat crap, and swarm after leftover food. I found this article interesting by Anne Quindlen who raises this issue: if abortion becomes illegal and women have an abortion, what should the women's punishment be? Normally when something is criminalized a penalty goes along with the related crime. In this Youtube video that Ms. Quindlen cites shows how people, in this case antiabortion activists, have not really thought about this question. Quindlin article - http://www.msnbc.msn.com/id/20010696/site/newsweek/ Youtube clip - http://www.youtube.com/watch?v=Uk6t_tdOkwo My host father called to see if I was home. Then he called back to ask if I locked the front gate as to not let their adopted tortoise escape. "This is a peaceful, patient creature," he says. It must be the Jain coming out in him. There is no waste management system here. Trash is just tossed on the ground. My conscience and habits can't take it, so I vainly keep stuffing a small container in my room with trash knowing full well that when it must be emptied, it simply will be tossed across the street. I somehow feel better with this "out of sight out of mind" mentality. Cherish solid bowel movements. Sometimes I yearn to shout, "Yes, I am a white person," to all the stares I receive on the street. How many times do I turn my back on God when I refuse to give beggars notice or money? The world is big and I am little. |