In all possible places, there is money being poured into the infrastructure here. Sure, the power still goes out a few times a week, the roads are insane, and the sheer number of humans, cows and dogs, presents unique challenges to city planners. But public works projects abound. The road from Mysore to Bangalore is being expanded from 2 lanes to 4. The expansion proceeds, while farmers drive their cows along the shoulders, and dry their rice crops on the hot asphalt that hasn't yet been opened to traffic. Overpasses are going up all over town, and there is even talk of a Bangalore Metro. This strikes me as a particularly bad idea. Seeing what's above ground here is enough for me to seriously question what is, or would be underneath.
This is a country with all the drive and interest in running the world. One thing that seems to hold it back is this overwhelming sense of paternalism that pervades everything. I was at a bar/restaurant in Mysore two nights ago, and discovered that I couldn't go to the rooftop garden area because I was a man alone. It was reserved for "ladies and families". In other words, if I had a woman with me it'd be fine. In the States, this discrimination is limited to "free drinks for ladies", with the intention of skewing an unfair sex ratio for men more in their favor. Here, it has the opposite effect. Men drink with one another, families, couples, anyone else, drinks together. I, being a man on my own, drink alone. I guess this all relates to the general demographics of the country. The newspapers always run stories on the sex ratios of various districts and municipalities. It is not uncommon here for there to be 900 (or fewer) women for every 1000 men. Pregnant women have sonograms here to determine whether they want to keep the baby. This is officially illegal, but there are "diagnostic clinics" all over the place, and an investment of a few thousand rupees now saves many thosands in dowry, and lost wages later. A cold calculation, but this is a tough place to live. I hope these things change as the brutality of underdevelopment abates. India is moving forward. I think it could use a dose of healthy libertarianism. People in the United States sometimes call government tyrannical. They see Washington as the new King George. Funny that those same people voted for a guy named George. But they know nothing of the baroque bureaucracy, endless processions of civil servants, rules, rules, rules. I understand that this holds back a potential tidal wave of chaos, but it seems to retard true progress. Immaculate starched shirts, and blazers vs. Anarchy. Who wins?
This paternalistic effect resonates clearly in the work that I am doing here. Going to hospitals and public health clinics, you see patients overwhelmingly at the mercy of undermotivated staff. There are a lot of people trying to do a lot of noble things in the country sides. A lot of lives saved, and people who are really there to help. But at the end of the day, the patient is the object, and not the subject of the health system. In particularly poor and underserved communities, this manifests itself in the small bribes that desperate people pay for a stretcher, an IV, anything. Some discussion my the work I am doing will make more sense of this.
I am traveling to five separate districts in Karnataka State; taking surveys and focus groups at one District Hospital, one Taluka (sub-District) Hospital, and one PHC. This is a large-medium-small approach. In all I will have visited 15 health facilities, surveyed about 100 people, and conducted 5 focus group discussions. So far I have visited 3 of the 5 districts. I'll give a description of each here:
Gumballi Disrict:
This was the first place I went to. A largely flat area, inhabited by poor farmers, harvesting rice and sugar cane. The roads were fairly rough, and the population scattered in the country, and in some hamlets peppered over the landscape. I arrived at Kollegal on a bus from Bangalore, and got off the bus into a swirling dusty-diesel sort of mayhem. Everyone was staring at me and my stupid backpack with all its straps, buckles, cantilever mechanisms and the like. I had to get out of there. I called my contact for Gumballi, and he was on the other side of the terminal, waiting for me in the health center ambulance. All the people I am working with are employees of Karuna Trust, an NGO that has health centers throughout the state, and supplies medicine to perhaps 20% of its overall population. The guy who picked me up as a short, mousy-looking guy. He never smiled, and spoke broken English. Soon he explained that another doctor would be joining us who spoke better English. This guy spoke it a little better, but this was counteracted by a general stupidity, his needing me to explain things at every site, for every survey. It was slow going that day, moving from facility to facility. We completed the surveys and focus groups, and found that 1) everyone was satisfied with the health services, and 2) that no one had had to pay bribes for service. This was good for the people and bad for my data. We went back to the Gumballi PHC, and settled into a mosquito-filled evening on the drenched plains. People were nice there, but overall, it was very isolation.
A little monkey business:
.T. Nasipur:
This second district went a bit better. The landscape was hillier, more wooded, carved by gorges filled with lazy rivers, and rocks jutting 100 feet out of the soil. The team I worked with was great. Dr. Archutta Rao was a portly guy in his early 40's with a good sense of humor, and the first person to entirely understand what I was saying in many days. He and his team drove me around from facility to facility, presenting our official letter to the government to cowering Medical Officers, conducting our surveys and an excellent focus group in a side room of an overcrowded rural hospital. The results here were interesting. We found a high level of satisfaction with the services, but people were very angry at the bribes they had to pay for service. This was the poorest place I'd visited, the roads barely passable in places, and the facilities facing the worst crunches of patients that I'd seen here. Dr. Rao pointed to a guy receiveing 10 rupees for something from an elderly woman, right in the middle of a crowded hallway. People were angry, and just waiting to get organized. That night I went to the T. Nasipur PHC and slept on the warm concrete floor of a schoolroom. More mosquitoes, but this time I was smart enough to light up a mosquito coil. Dr. Rao was the most attentive, intelligent person I have worked with so far here. I hope to do some work with him and his team again.
Tithimatti:
The road from T. Nasipur improved as I entered a forest reserve and gained altitude through dense Eucalyptus and Banyan trees. Coffee and spice plantations could be seen from the side of the road, and shacks became concrete houses with red Spanish tile roof. The temerature dropped as we went up, and civilization seemed to be more scattered in the underbrush. I was met by the third doctor I'd work with, a tall guy with a mustache. He was extremely friendly, but after a few hours I found him obsequious and just plain annoying. Is this ok, sir? Is that ok, sir? I just wanted to get the work done. That and he only understood about 50% of what I said. We brought along a couple of young doctors who really did speak English, and conducted our work in three spotless facilities where the doctors and staff were all sincere and attentive to their patient's needs. People were there, but well within the capacity of the system. Everyone was happy to be in that district. It was like Switzerland or something, with a smattering of the general mediocrity of the developing world. The data here was as boring as the Swiss. Everyone was uniformly happy, no bribes, no nothing. Good for the people bad for the thesis. The place I stayed that night was pleasant, but my roommate was a snoorer, and truck bounded up the road rattling my scull until dawn. Oh well. Here's some nice landscape:
So then I headed to Mysore, where this post began. After some mild hassles, I settled at the Parklane hotel, and had dinner downstairs, along with a couple of cold Kingfisher beers. They had live music. One guy on tabla drums, and accompanied by a bamboo flutist. Indian drumming exists somewhere in the vacuum of space between rhythm and melody. It seems to trancend those divisons, and place its listener in a trance state. I visited the Maharaja's palace and got the heck out. It was time to get back to Bangalore. I took the "local" bus-- bench seats, crowds, all that. Traffic was rough we were at a standstill in the heat for an hour. It turned out that the holdup was a wedding on the side of the road. People were just crossing back and forth over the highway with no regard to traffic. My room in Bangalore was peace. I had my first hot shower in days, made some tea and instant noodles, settling into a book and falling asleep by 9:30.
Today, I 'm having a little fun. I went to one of the nicest clothing shops here. The sell all varieties of textiles. I decided to splurge. Here is what I got, all made custom from me, all my measurements taken, and to pick up in about 10 days:
1 suit, cashmere wool blend. Pin stripes.
1 suit, irish linen, tropical.
6 shirts: 4 casual, two dress, all custom fitted.
1 pair of trousers, nice beige pattern.
Total cost (materials and labor): $250.
A shave and a great haircut today: $2.50
This time here: frustrating but priceless.
No comments:
Post a Comment