Gandhi’s Vision of Swaraj

 

Mr. Ramchandra Guha, a renowned historian & a prolific author was invited as a resource person for a NIRMAN Workshop. Following is the transcription of his talk given in front of young NIRMAN participants on November 27, 2017.

I am going to give you a perspective as a historian on India’s journey since independence. It’s been 70 years since independence - what we have done, our achievements, failures, unfinished tasks, and I am going to use a frame of reference: Gandhi’s vision of Swaraj. It is a particular vision that Gandhi had which is, unfortunately, not well known. He wrote a book on Swaraj which was an important book but, in my view, it is a book of limited reference to India because it was written when Gandhi hardly knew India. Gandhi was an NRI in South Africa when he wrote about Swaraj. He wrote that book in 1909. At that stage the only India he knew was Kathiawad, where he grew up.

He was born in Porbandar, then he went to Rajkot, then he went to London, got a law degree and came back. He practiced briefly in Mumbai, Rajkot and went off to South Africa and in 1909 when Gandhi wrote about Swaraj, he had never been to an Indian village. So, that is why, his mentor Gokhale told him, ‘when you come back to India, spend your first year in India getting to know it’. So, he came back in 1915 and spent one year travelling across India, which deepened his acquaintance with the country. In 1917, he went to Chamaparanya, which was his direct engagement with peasants and workers and with laboring classes. Till then he had been in middle classes. He had given some speeches, but he had not interacted with working people. So in 1917, in Chamaparanya, he worked with peasants, with farmers. Then he comes to Ahmedabad, where he had already established his ashram. In 1918, he was involved in the famous Satyagraha for textile workers. The same year in Kheda, there was Satyagraha of peasants. Then in 1919 there was the Roulette’s act. In 1920, there was a non-cooperation movement and then he travelled all across India.

             4 Pillars of Gandhi’s Vision of Swaraj

So, the vision of Swaraj that I am going to give you is Gandhi’s vision of Swaraj, not a Hind Swaraj. It is a little old article that he wrote in 1921 at the height of non-cooperation movement. Now, the non-cooperation movement brought together for the first time a cross section of Indian society asking for freedom from British rule. So, it was North Indians, South Indians, Hindus, Muslims, Parsis, men, women, workers, peasants, lawyers, editors and so on, and it drew upon 6 years of intensive work that Gandhi had done. In the article he said, ‘my vision of Swaraj is like a bed upheld by four sturdy posts and these 4 posts are non-violence, Hindu-Muslim harmony, abolishment of untouchability and economic self-reliance (Swadeshi)’. Now this is the vision of Swaraj I want to begin with.

This is a beautiful image – that Swaraj will be solid, secured if it is based on these 4 pillars, the distinct pillars coming together. This was in 1921. Swaraj came much later. And now 70 years since Swaraj was formally achieved, since political freedom came, how robust are each of these pillars? Now that is the assessment I want to give you as a historian. It can be explained what each of those 4 pillars are.

When Gandhi said that the first pillar is non-violence, what he meant was that we are fighting against British using non-violence unlike other Colonial countries. When Gandhi said even Swaraj will based on nonviolence what he meant was that after we get independence, our disputes between different sections of India will be settled by debate and dialogue, not through violence. That is why he adopted a multi-party democracy, unlike in China whose freedom from Europeans was through violence and was exerted in one party state, which of course then consolidated and perpetrated violence of other kind. So, the first pillar of Gandhi‘s Swaraj was supposed to be multi-party democracy where Indians will exchange ideas and resolve disputes peacefully through debate. That is the first pillar.

                    The second pillar he called as Hindu-Muslim harmony. Now this was fundamental view of Gandhi. It was opposed by Jinnah – he wanted a separate Muslim country. It was opposed by Hindus, by Savarkar, who said that Hindus are superior to Muslims. But, Gandhi believed, when India will become free, it must be a non-denominational state, that its polity must not be defined by single community. But, he also believed that the content of Swaraj – its politics, social lives, its culture – must not be defined by a single language. This is a very great innovation of Gandhi! This Political Innovation is a departure from the way the rest of the world understood what nationalism is.

          In 19^th century Europe, nationhood meant, to be French, you speak French. The state religion of France was Catholicism, which means Protestants were second class citizens and Jews were third class citizens, and we must have one common enemy called England. We must consolidate ourselves by fighting against England. If you cross the channel and go to England, you will see that the English definition of nationalism – who is great patriot of England? He who speaks in English! So, minority languages like Welsh, Gaelic were removed. One standard language has to be spoken by one region. English nationhood was defined by saying that we are superior to the French. Now that is the model of nationalism which was spread across Europe. This is not only a joke – Pakistan is a perfect European nation! Gandhi’s innovation was to say that Indian nationalism will be different. In fact Gandhi’s closest friend, C. F. Andrews, was an English Christian priest.

Religious and cultural pluralism, which includes linguistic pluralism, is the second pillar of Swaraj. Every Indian must have freedom to speak language of her choice and to worship the god of one’s choice or no god at all. There is lovely little old book on Gandhi called ’An atheist with Gandhi’. This is by man called Gora – Ramchandra Rao, he was well known Gandhian social worker in Andhra and played a big role in promoting the abolishment of untouchability in 40s and 50s. He was an atheist. He was a militant atheist like Richard Dawkins! So, the second pillar of Swaraj was the freedom to have your view, all faith or not faith at all. To speak whatever language you want and not to have language imposed on you. True religious, cultural, and intellectual pluralism was the second pillar.

          The third pillar is what Gandhi defined as abolition of untouchability. Remember this. In 1921, when non-cooperation movement started, Gandhi said that we will be fit for Swaraj only if we abolish untouchability! This is a very revolutionary act because no leader of congress party had said that or understood that. Tilak wanted the freedom from British rule. Gokhale, Bhagat Singh wanted that too but Gandhi said, ‘No, we are not fit for freedom if we oppress a section of our own society’. However, I would say that the Gandhian vision was incomplete. It has not included abolition of gender distinction because the two fundamental axes of inequality in India were and still are caste and gender.

        There are two ways in which Indians divide. First is horizontally, by language and religion. So, Maharashtrians are different than Gujaratis. That is horizontal division. Vertically, Indians were historically divided by caste and gender. Sawarnas are superior to Dalits and men are superior to women. Gandhi said a great deal about abolition of untouchability but he mentioned little less about gender distinction. However, the constitution took this idea forward. Ambedkar and Nehru were instrumental in drafting the constitution and were more progressive on this question than Gandhi was. So, the third pillar is abolition of social inequality, where everyone is an equal citizen, and that is what the constitution did.

The forth pillar is economic self-reliance. That was obvious and remains very important of course. The fourth pillar does not need much explanation. In 1920s and 1950s, India was a poor country, there was mass poverty. There was destitution, malnutrition, infant mortality. So that is the fourth pillar.

So, I am going to use that as my point of departure. These four pillars that Gandhi outlined for Swaraj were incorporated; we could say that the constitution is a detailed elaboration of these pillars. Constitution mandated democracy, the constitution abolished untouchability and constitution made men equal to women. The constitution designed a federal system where every state could devote to and promote economic development. 

The Post-Independence Scenario

So, now it is 70 years since independence. The in the second part of today’s session I am going to provide my assessment as to how robust each of these four pillars are. I am going to take these pillars one by one - democracy, religious and cultural pluralism, caste and gender inequality and economic self-reliance.   

              

To begin with – how robust is our democracy? Now, at a formal level we are been successful. That is, we have established a multiparty system based on free, fair and regular elections. And this is major achievement of Independent India. If we look around us at Pakistan, at Bangladesh, at Nepal, at African countries, India and Sri Lanka are the only two ex-colonial countries of Asia and Africa that, for entire period of independence, regularly held free and fair elections. Though money plays a part, the richest party can lose, as happened in Delhi last time or, as it happened in 1977 after the emergency. It happened in many states e.g. when Dravidian party first beat congress in 1967, they did not have the money, so on and so forth.

So, free, fair and regular election is an important achievement of independent India. But, other aspects of our democracy are less robust. E.g. parliament hardly functions and this was not always the case. If you see the debates in the 50s, 60s, 70s, they were very vocal. Now, no one wants to discuss what happened and the state assemblies function even less. So, the election is a major aspect of democracy but that is not the sole aspect of democracy. We are in danger of being reduced to what I call the ‘election only democracy’.

You have to understand what democracy means is that election gives you the right to be in power for five years but that does not give the right to be immune from criticism for five years. In fact with criticism you will govern better, you will have a healthy democracy. Vidhan Sabha is not meeting. The bureaucrats can’t give honest advice because they will be transferred. You want to control the press. If they are picking on you, you will withdraw advertising, you will set a tax case against the proprietors. Writers are being killed! This is not how a democracy functions.

If you go to the British parliament, there is a regular system in which maybe once in a week, maybe once in fortnight, the Leader of Opposition asks questions to the Prime Minister and it is telecasted live. ‘You have done this, this is not right. This is the problem, here are the facts, and this is the research showing’ and then Prime Minister has to answer back. So, this is how you can see how the government doing, how legitimate are their criticisms, how convincing is the defense of Prime Minister. That’s a very good custom. That’s how democracy should function. I am not saying that our democracy is crumbling from inside, because we do have freedom of movement. A very important part of democracy is the freedom of movement. That I can come from Bangalore to Maharashtra or you can go from Maharashtra to Arunachal Pradesh. So, our democracy is moderately well established. Some of the key institutions, such as parliament and press, are functioning below par.

Second pillar I defined as religious and cultural pluralism. Now, one of our great achievements is our sustenance of linguistic pluralism. I told you that one of Gandhi’s great innovations was to depart from European model of one language, one religion, and one country. Jinnah, the first governor of Pakistan, in his first speech of Pakistan told Bengalis that you have to learn Urdu. In 1948, that was his first speech and that sowed seeds for a civil war that led to separation of Bangladesh.

We have 17 languages on our rupee note. Why we have to have that? Because each of them has its own script and the script is sacred. First decision you make is what language you speak. Before you become Muslim or Hindu, you are Marathi speaker or Hindi speaker or Kannada speaker or Tamil speaker. And the script is different! French, German are different languages but use same script yet they are different. That is what I have to explain to my American friends. Tamil is older than Sanskrit. Oria, Kannada, Telagu, Malayalam – they are 1300-1500 years old. How can we deny those languages? Language is culture, history, everything! So, Gandhi in 1927 said every major language of India may have its own state in which it can conduct its business in its language. Maharashtrians can have Marathi, they can give school instruction, judiciary, court decisions, Government Offices and so on so forth in Marathi. That promise was made. The Kannadigas joined, Maharashtrians joined, Gujaratis joined and all joined the congress movement.

In 1947, after India’s independence battle, India was divided and Nehru and Patel went back on that promise. They were too scared of further division. This is the paranoid pattern of model of European nationalism and Jinnah’s position – if you speak another language, you become another country. So it was not considered. And then Patel died. There was revolt in all sections of congress party. At that time, congress party was ruling all over India. Congress was a very dominating party in 1950. But it was a democratic party. So, although Nehru was the dominating figure, he had to take account of sentiments of his party. He was forced to conjugate the states to the organizing commission. But the principle was accepted in 1956. Then in 1956, finally, the promise was honored that Gandhi had given.

Now, in the same year that PM Nehru considered that we will reorganize the map of India on linguistic lines, the PM of Sri Lanka S.W.R.D. Bandaranaike instituted the policy that made Sinhala the sole language. And Tamil speakers of the north were relegated to the 2^nd class status. They had to learn Sinhala to get into the civil service, to become a judge, to become teacher, anything. There was a debate in parliament and at the debate, a far-sighted Sinhala MP said to Bandaranaike, ‘Don’t do this. Two languages, one nation, one language, one long civil war’ and that’s what happened. Bandaranaike did not listen to him. He imposed Sinhala in Tamil areas and the result was a civil war. In India one language could have multiple civil wars.

This is the great achievement that we have shown to the world that linguistic uniformity is not a precondition for patriotism. You can speak different language still you can be as good or as bad as an Indian. So, when it comes to Gandhi’s second pillar, which is cultural pluralism, the linguistic part is robust and solid because if India was to be anything at all it was something other than a Hindu Pakistan. And Gandhi would have been deeply distressed of insecurity and vulnerability of our minority communities especially in the last few years. So that’s the second pillar.

The third pillar is caste and gender inequality. Here again it has been both progress and regress. As I said, in our society, culture and religion, inequality was deeply entrenched. The caste system is legitimized by Hindus and by Muslims. And you will meet people who will try to confuse on this by quoting that one verse in a scripture. Against that 1 verse, I can tell you 5000 verses that show inequality. This is very important thing that in our ancestry and our heritage, there are some truly nasty things too. Inequality among us by caste and gender is deeply entrenched in Indian tradition, be it Hindu or Muslim or Christian. In churches in Kerala Dalit Christians had to pray outside. And, of course, women in most religious traditions can’t become priests. They are not allowed to interpret the holy texts or reinterpret it. So, we were in a deeply unequal society and our constitution makers recognized this. The greatness of the constitution is that it completely negates, in these respects, the Gita, the Quran, the Manusmriti, the Bible, everything, and it says we don’t care what these people say, as far as concerned, there can be no discrimination based on caste and gender and this should supersede all religious traditions when it comes to caste and gender because inequality of cast and in gender has disfigured our society.

Now, in 70 years we have made quite a lot of progress e.g. I see that 50% of you are women. Now, if in Sevagram, in 1967 there would have been a meeting of social workers, there would not have been 50% women. So, we have made slow and incremental progress towards becoming a more equal society. Two signs of this outside the realm of social work are that there is a steady delinking of caste from occupation. Once upon a time, a Brahmin could not become an entrepreneur, a Dalit couldn’t become a school teacher, and a Yadav couldn’t become a lawyer. This is one sign of the loosening hold of caste. The question of gender – there is steady delinking of family from marriage. More and more women can now choose their romantic partner. These are the two very important things that I like to put before you, because the choice of your profession and the choice of your life partner should be your choice, not what society says or tradition says. More and more individuals can decide what profession they want to choose regardless of what the caste they are from. More and more women are free. It’s slow but it’s happening.

 Martin Luther King famously said ‘the arc of history bends towards justice but it bends rather slowly’. So we would like it to have faster but when it comes to the challenge to caste and gender discrimination, India is progressing in right direction. May be you would like it to be faster, maybe it is faster in cities than in the countryside. Maybe it is more visible in southern and western than in north India. So, there are these regional variations but overall you can see the arc is bending towards justice. When it comes to social justice and discrimination in India, there is one exception, it is important, I have said this everywhere, it is particularly important in Shodhgram, Gadchiroli. When it comes to Dalits and women which are two traditionally discriminated groups in Indian society, arc of history is bending towards the justice slowly but, when it comes to the third group, the Adivasis, in many parts of India they may be even worse off. In Gadchiroli, because SEARCH and other organizations have been doing good work in the community, the Adivasis seem to be on the right track. But in Orissa, Chhattisgarh, Jharkhand they are grievously discriminated. They are the ones who lost their lands to public sector, to power plants and dams. They are the ones who are losing their rights to mining companies today. They are unrepresented in the political class. Dalits and women are there in political class - Sushma Swaraj or Mayawati or Ramdas Athavale or Ramvilas Paswan. You have prominent Dalit leaders or women leaders; Mamta Banerjee, Sonia Gandhi etc. You don’t have a single prominent Adivasi leader. You have Dalit intellectuals, women intellectuals, women editors, Dalit High Court Judges. Adivasis are firstly discriminated economically. 40% of all those who have been displaced by developmental projects have been Adivasis. Historically, they are the 8% of population but 40% of those are displaced. If we look at the studies, when it comes to the access to education and health programs, they are worse off than the Dalits. So, economically and socially they are suffering and politically they are invisible.

             Now we come to the last pillar – Economic Self-reliance. This is a subject on which I am not an expert, I know much more about culture, society than economy. So I will not speak at length. Again, I will say we have made substantial progress in last twenty five years. There has been steady increase in wealth in nation, poverty rates are going down across India. All this is important and necessary. I will say briefly that for all the economic progress we have made, there remain two dark spots. One dark spot is the phenomenon of jobless growth. Although we have very impressive rate of economic growth, this wealth is not creating enough jobs, unlike say countries like China, Vietnam, South Korea and even Bangladesh, where economic growth has been powered by manufacturing and job creation. The service sector, which is capital intensive, creates very few jobs and all across India we have angry young men. They are promoting violence for different causes - from right wing Hindu fundamentalism to left wing Maoist extremism. They are men who can’t get dignified employment because our economic growth is not creating jobs. These are all men who can’t get jobs in Infosys. Sometimes they kill themselves. Even the farmer suicides are mostly men. So, this is something to ponder upon that we have made major progress in economic self-reliance but we have done it without creating enough jobs for men and women. Secondly, we have done it with little regard to environment. Our pattern of economic growth, though it is wealth creating, it is environmentally disastrous. India is an environmental basket case. Our rivers are biologically dead. Our cities are polluted – worst in the world. Our forests have been degraded or destroyed. Our ground water level is depleting massively. We have not really integrated environment parameters into our economic policies.   

Citizenship & Democracy

So, I have given you broad brushed picture from how we have done since independence and given you the picture which tells you what starting with Gandhi’s vision of Swaraj would be, trying to take each of these 4 pillars – politics, culture, society and economy. I have tried to show you whatever the things we have done to make these things robust, what ways we have failed to give you a sense that there is much work yet to be done. Young people like you who will take a major role in taking this forward. I would like to end with an image of my own. I gave you Gandhi’s vision of Swaraj, I will give you an image of citizenship and democracy. Democracy rests on a three legged stool and what are the three legs? First leg is state or government. Second leg is the private sector and third leg is civil society. Each of these three legs must contribute.

The state must be run by people who are hardworking and committed of whole values of constitution – that is the first leg. Unless you have an efficient, fair and transparent government, you can’t have a stable democracy. The second leg is private sector. They are very important because we were and still are very poor country. We need to create well-paying jobs and entrepreneurs, enterprises to get us out of this grinding. And the third leg is Civil Society. 

What is the role of civil society? The role of civil society is to make up for the failures of other two. How do you make up? In two ways. One is civil society has an activist dimension and the other is constructive dimension. So if the private sector pollutes the river, civil society will start dharanas, they will put the press, they will file PIL and force the government to act. In economic terms it is known as externality. Somebody else is paying for it. So, to increase your profit, you will pollute the river. Pollution has sound economic logic from the point of view of the pollutant. So, civil society’s job is to sharp spotlight on the failures of governments. The RTI movement is another example. Or if police do too much violence, human rights activist will show the conditions of prison. So, civil society has two pros - one is to spotlight on the failures of the first two legs – government and private sector and the second is constructor. In Gadchiroli, since the government hospital is malfunctioning, and maximum private hospitals are not going, Abhay and Rani Bang setup this hospital and so on. So, these are the two aspects of role of civil society. Now you all are young and I should say something about these two aspects. Both are valid. Some individuals are trying to go towards path A, some are inclined to path B. And it is not that A is superior to B. It’s often a matter of what the situation calls for and what your temperament demands. Medha Patkar has a certain kind of temperament, those who found Shodhgram have certain type of temperament. Both are important. Unfortunately, in the civil society movement, activists are looked down upon. Those who do constructive work think that activists are doing this only for publicity. Activism must always be nonviolent and constructive work must always make use of high quality science. As a citizen and someone who is scholar and who has studied both activist groups and constructive work, I felt that both are good. Few people can combine both in their lives. One of my great heroes, who lead Chipko Andolan and nonviolent Satyagraha in which women were major participants to stop commercial felling in Himalaya. But once felling was stopped, he turned his attention to constructive work i.e.to re-vegetate the barren lands.

Now, I have given you this image of 3 legs of democracy – State, private sector and civil society. In the 1950 and 60s, when republic was established the first leg, that of the state, was absolutely outstanding. I can tell you and this is the judgment of a historian, Nehru was the greatest PM of independent India. I am not saying that he did not make mistakes, he did. He stayed too long and should have retired in 1958. Sardar Patel was greatest home minister that we ever had, B.R. Ambedkar was the greatest law minister we had. But, not only at the level of politicians, but we also had outstanding civil servants. In my book ‘India after Gandhi’, I described a man - Sukumar Sen who set up electoral system. There has been no chief election commissioner like him. So, our state performed outstandingly and politicians, bureaucrats, judges were outstanding and they made up for non-performance of the other two legs. Civil society was really weak in 50-60s. And only in 1970s, it started becoming strong. Likewise private sector in 1950-60 was very timid, risk aversive, not at all dynamic. So, for the first two decades, Indian democracy was kept together by visionary political class and extremely competent and incorruptible civil service. Now it has become reverse. Political class has become self-serving, provoking discord and violence. The bureaucracy has become timid, subservient to political class and often corrupt. But, the private sector and civil society are doing much better than they did before. You have a very active and creative civil society but our state is under performing. So your responsibility is greater and you will have much more exciting journey.

Thank You!

 

 

Q & A 

Q1. My question is about democracy. As we see representative democracy is not working as we want to work it. Can we see a direct democracy as a solution and what are the dangers of that?

I repeat what Winston Churchill said, whom I normally don’t quote positively. He said, ‘parliamentary democracy is the worst form government except for all the others’. So, I believe, and I have thought about this very seriously, representative democracy is not functioning optimally so we change it to something else. Firstly, how do we change it? Can we make it function better? I believe we can make it better in two ways. When we became independent in 1947, because we had just been divided into India and Pakistan, there was a lot of nervousness. Princely states were not yet been integrated. Hyderabad was an independent state, J&K was independent state so we needed a strong center. Now, as we become a more mature, confident and older republic, we are not nervous that we will break apart. So, we need to give more power to states that is already happening today. We have to take one step forward and give more power to the Gram Panchayat, district officers. This is the next step. This is not happening.

          In 50s, 60s and 70s, the PM was nervous about giving power to the CM that has changed. Today CMs are nervous to give power. MLAs do not want to give power to the bureaucrats. We have to have the third layer of democracy stronger and stronger which means that we also have to give financial power. In some states this is not happening. So that is the one way in which we can reform our system.

Q2. European concept that you talked about – one country, one language, one enemy, one religion, so notwithstanding the currently popular vulgar definition of nationalism, what can be the factors which can create that nationalistic feeling which will probably prevent the country from falling apart?

I gave a long lecture on this which is up on YouTube. It’s called patriotism vs. jingoism. I defined patriotism, what I called constitutional patriotism and I said jingoism is the one where to be good Indian, you have to be Hindu, speak Hindi and hate Pakistan. And why in jingoism on the rise? Because Congress party is in the hands of the Rahul Gandhi! How can congress party claim to speak on inheritance of freedom struggle? They are just a family firm! Firstly they don’t understand what Gandhi, Tagore and Nehru were. Those three showed us how to love your country with its richness and its diversities and be immersed in it, serve it without succumbing to this European mode of nationalism. Why is that tradition gone? So the reason is the congress party. Main vehicle of what I called constitutional nationalism has degenerated into the corrupt and useless family firm. Second reason is that in India, the Left is very influential. They shape the discourse – scholars, media people, lawyers, many professors, thinkers, great playwrights of Maharashtra have been leftist. The Left in India, what I call them ‘Antipatriotic Left’. They have very amiable features. They struggled, they worked for equality. In Kerala and in Bengal, there are no Hindu-Muslim riots. They have some very good features. They have no Swiss bank accounts but they are antipatriotic. All their heroes are foreigners. In the CPM annual convention, there are four pictures- Marx and Angles- two 19^th century German thinkers, Lenin and Stalin- two 20^th century Russian dictators, not a single Indian. I told my Marxist friend that ‘Bhagat Singh ko waha daal dijiye’. He is leftist like you. So it continues till present and JNU has been the battleground for this. I have said this in my talk. In 1960 they said Chairman Mao is our Chairman. Today they say Hugo Chavez is greater than Mahatma Gandhi. And their contempt for Gandhi is greater than the RSS’s contempt for Gandhi which was great enough. So I think these are failures of the liberals.

Q3: About Gandhi-Ambedkar debate

          This is a very important question and I have written about this is various places – the second volume of my Gandhi biography has hundreds of pages on this. But, let me make a few points. Firstly, the way social change happens in India or in any society, the way you move towards a more just society, is when there is expression from below and above. The closest comparison to caste discrimination in India is racial discrimination in North America. In the 19^th century, you had abolitionists like Fredrick Douglas who were black and you had Lincoln who was a white who said you have to end slavery & that led to the civil war. A 100 years later you had Martin Luther King’s movement and you had Lyndon Johnson and his white advisors who saw the moral force of King’s words and were willing to change the laws accordingly. So, change comes only when there is expression from below and above. In South Africa, Nelson Mandela needed FW de Klerk, who was a white president who told the national party, ‘abandon your racism’. That is very important. So, India needed Gandhi and Ambedkar both, at that stage, though they were adversaries, and we still need them both, because their tasks are unfinished. Now, unfortunately it has become polarized. The Amedkarites are obsessed with Gandhi and hating Gandhi but the Gandhians have also failed. The Gandhi’s movement in the 50’s should have carried on attacking untouchability; Vinoba Bhave & others didn’t recognize this. If Gandhi had lived for more 15 years, and he would have seen the caste discrimination, he would have organized a satyagraha. So the Gandhians failed, in the 50s and 60s. Not just the Gandhians, upper class Hindus failed. Upper caste Hindus who were swayed by Gandhi to open their temples went back to their old ways and then in the 60s the Ambedkarites organized – the Dalit Tiger movement happened. No major politician of the congress party or no major social worker of the Gandhian stand took the abolition of untouchability as a major part of his movement.

Gandhi and Ambedkar you can draw upon them in different ways, you don’t have to choose. A Dalit can say I am more inspired by Ambedkar, because Ambedkar showed me the way. Someone like me can say I am more inspired by Gandhi but I also admire Ambedkar. But, if you understand this fundamental principle of social change – effective social change happens when there is expression from below and above. Ultimately, the social movement from below has to be complemented with change from above or the system won’t change. Totally different example, in gender is great British political thinker John Stuart Mill, who in the 1870s wrote an article why women must have the vote. Few years later, women got the vote. Gandhiji himself was impressed by the suffragettes in London. So, it is a very important thing that – how to communicate that to radical Ambedkarite thinkers – but I think Gandhian’s also have to bear a share of the blame because they focused on many things in the 60s and 70s. Of course Marxists didn’t understand caste at all, but the Gandhians also – post Gandhi Gandhian movement, I mean if you read Vinoba, if you read JP, they didn’t think about caste issue. Gandhi understood it very clearly but not Nehru, not Patel. In fact, the only person among Gandhi’s contemporaries who understood this was, Mahadev Desai who died in 42, and to a limited extent Rajagopalachari. So I think these are some issues but, my view as someone who was born after both Gandhi and Ambedkar had died is that, it was very fortunate for us that we had both of them because both of them should not pass society in different ways, we need both of them to move towards a more just, more inclusive, more democratic society; we needed them then and we need them today. 

Dr. Varad Puntambekar of NIRMAN receives prestigious Rhodes Scholarship of Oxford University

Dr. Varad Puntambekar, presently working as a Public Health Fellow at SEARCH has been selected for the prestigious Rhodes Scholarship and will be pursuing a Masters/PhD at Oxford University from September 2022.

A native of Bhopal, Varad completed his MBBS from AIIMS Delhi. Rather than following the usual route that most young doctors do, Varad was seeking opportunities to work in the area of public health and managing health systems.

He became part of NIRMAN and that brought him to Gadchiroli for the first time. Post his internship at AIIMS, he decided to work full-time at the grassroots to broaden his understanding and contribute to solving issues at the community level. In sync with the spirit of experimentation, he received NIRMAN’s Kar Ke Dekho Fellowship and started working in Gadchiroli from February 2021. 

At SEARCH, Varad has been a part of a variety of activities – preparing community guidelines for Covid-19, improving vaccination coverage in villages, providing clinical services in OPD and IPD, benchmarking mental health service provision by deciding indicators to improve quality of mental healthcare, training of community health workers & awareness for de-addiction in villages – to name a few.

His internship in Delhi changed his perspective of looking at healthcare systems. “My stint as an intern during MBBS provided me with the important learning that a clinician is just a small though important part of the healthcare system. There are a lot of other things which need to be mended,” says Varad, citing it as his motivation to become a ‘Problem Solver’ & solve community health problems rather than just playing the limited role of a clinician.

Varad believes that grassroots level experience is the only true experience. “Working in a confined & comfortable environment will only give you a diluted view. It is essential to explore & experience the real challenges in order to prevail over genuine community health problems. For that we need to first work at the grassroots level,” adds Varad encouraging young doctors to take up challenges at the grassroots level.

In addition to actual real-life work experience, Rhodes Scholarship will offer Varad an excellent opportunity for academic training at Oxford. He wishes to continue working on problems prevalent in the community in the long term.

They say difficult roads often lead to beautiful destinations. When your choices are unique, the outcome is often extraordinary. Varad’s story is one such case!

We congratulate him for his achievement & wish him the best for future endeavours!

‘जाऊ स्वतःपलीकडे – परिपूर्ण आयुष्याच्या शोधत’

‘आरोग्यम् धनसंपदा’ हे शब्द आपण अनेकवेळा ऐकत असतो. परंतु आरोग्य म्हणजे केवळ शारीरिक असा मर्यादित अर्थ घेत मानसिक आरोग्याकडे दुर्लक्ष केले जाते. वस्तुतः मानसिक स्वस्थता नसणे हे एका व्यक्तीच्या जीवनात अनेक नकारात्मक परिणाम घडवू शकते. विशेषतः मनसोपचारतज्ञांची तुटपुंजी उपलब्धता असलेल्या ग्रामीण भागांतील रुग्णांना व पर्यायाने त्यांच्या परिवाराला अनेक भीषण परिणामांना सामोरे जावे लागते. मानसिक आजारांबद्दल समाजात असलेला न्यूनगंड आणि ग्रामीण भागांतील ढिसाळ आरोग्यव्यवस्था यामुळे मानसिक आरोग्यसेवा पुरवणे हे आव्हानच ठरते. हेच आव्हान समर्थपणे पेलण्याचे काम करत आहे आपली नाशिकची निर्माणी मैत्रीण डॉ. हर्षाली मोरे.  

हर्षाली तिच्या प्रवासाबद्दल सांगते - “दहावीला चांगले गुण मिळाले होते पण तोपर्यंत करिअरचा गांभीर्याने विचार केला नव्हता. म्हणून माझ्या पालकांच्या सल्ल्यानुसार विज्ञान – बायोलॉजी – वैद्यकीय प्रवेश परीक्षा असा प्रवास करत मी MBBS (सेठ जी.एस वैद्यकीय महाविद्यालय – मुंबई) पर्यंत पोहोचले. त्यात माझे आई-वडील स्वतः डॉक्टर असल्यामुळे या क्षेत्रात काम करणं म्हणजे स्वतःमध्येच लोकांना मदत करण्याचं एक माध्यम असतं हे मी मला ठाऊक होतं.”

 

विचार उद्युक्त करणारे अनुभव

हर्षाली तिचा MBBSचा अनुभव सांगते - “जिथे प्राथमिक पातळीवर आरोग्यव्यवस्था रुग्णांपर्यंत पोहोचायला हवी तिथे तसं न होता रुग्णांना अगदी शेवटच्या स्तरापर्यंत आणि मोठ्या रुग्णालयांपर्यंत धाव घ्यावी लागत होती. यात रुग्ण आणि रुग्णाच्या नातेवाईकांना होणारा त्रास दिसत होता. या गोष्टीचा रागदेखील येऊ लागला आणि रुग्णांवर केवळ उपचार न करता त्यापलीकडे त्यांच्याशी संवाद साधण्याचा प्रयत्न मी करू लागले.” हर्षालीसोबत मुंबईला शिकणारा आणि निर्माण सातचा मित्र डॉ. मयूर पवार सांगतो – “स्वतःच्या भावनांवर नियंत्रण ठेवत समोरच्या व्यक्तीच्या भावनांना समजून घेण्याची क्षमता हर्षालीमध्ये आहे. या क्षमतेचा रुग्णांसोबत संवाद साधताना निश्चितच उपयोग होतो.”

 

महत्त्वपूर्ण वळण – निर्माण

आयुष्याच्या या महत्त्वपूर्ण वळणावर हर्षाली निर्माण या शिक्षण प्रक्रियेत सहभागी झाली. “निर्माणमुळे मला स्वतःपलीकडे पाहण्याचे धैर्य प्राप्त झाले. अवतीभवती चाललेल्या करिअरच्या जीवघेण्या शर्यतीतून मी बाहेर पडू शकले. रुग्णांकडे केवळ ‘Case’ म्हणून न पाहता त्यांच्याकडे माणूस म्हणून पाहण्याचा दृष्टीकोनदेखील मला निर्माणमुळे मिळाला.” निर्माणच्या शिबिरांनंतर वैद्यकीय क्षेत्राला एक वर्ष सेवा देण्याच्या बॉण्डची (अटीची) पूर्तता करण्यासाठी हर्षालीने डॉ. अभय आणि डॉ. राणी बांग यांची SEARCH (गडचिरोली) ही संस्था निवडली. इथे हर्षाली Mental Health Department मध्ये मेडिकल ऑफिसर म्हणून सेवा देत आहे. “पुढे जाऊन Medicine, Public Health किंवा Mental Health या व्यापक विषयांपैकी एक विषय निवडण्याचा माझा मानस होता. बॉण्डसाठी SEARCH निवडण्याचे कारण म्हणजे इथे विषयांच्या खोलात जाण्याची संधी आणि उपलब्ध असलेले अनुभवी लोकांचे मार्गदर्शन. त्याशिवाय ग्रामीण व आदिवासी भागांतील रुग्ण तपासण्याची संधीदेखील इथे मिळणार होती.” घरून या निर्णयाला तीव्र विरोध झाला नसला तरी हर्षालीच्या आई-वडिलांना चिंता मात्र वाटत होती. परंतु जशी तिला पुढील दिशा स्पष्ट होत गेली तशी त्यांची चिंतादेखील कमी होत गेली. “आपल्या कुटुंबाचा पाठिंबा मिळवण्यासाठी आपल्या विचारांमध्ये स्पष्टता असणे महत्त्वाचे असते”, असे हर्षाली म्हणते.  

 

गडचिरोलीतील अनुभव आणि मानसिक आरोग्य

गडचिरोलीमध्ये सेवा देत असताना आलेले अनुभव हर्षालीला अजून प्रगल्भ करत आहेत. मानसिक आरोग्याशी संबंधित समस्यांचा ग्रामीण / आदिवासी कुटुंबांवर होणारा परिणाम, व्यसनांमुळे उध्वस्त होणारे परिवार व त्यांचा समाजावर होणारा दुष्परिणाम आणि उपचार केलेल्या रूग्णांच्या चेहर्‍यावरील समाधान पाहून अजून चांगलं काम करण्यासाठी मिळणारी ऊर्जा असा व्यापक अनुभव सध्या हर्षाली घेत आहे.

SEARCH रुग्णालयातील अनुभवी नर्सिंग असिस्टंट आणि हर्षालीच्या सहकारी रंजीता डे सांगतात – “एखाद्या रूग्णाला शांतपणे कसे हाताळावे व डोकं थंड ठेवून कसं काम करावं या गोष्टी डॉ. हर्षालीकडून मला शिकता आल्या. अनेकदा वेळ-काळ व स्वतःचं खाणं-पिणं मागे ठेवून रूग्णाला सेवा देण्याला प्राधान्य देताना मी डॉ. हर्षालीला पाहिलं आहे. तिला आपल्या जबाबदारीची पूर्ण जाण आहे हे यातून दिसतं.” 

मानसिक आरोग्याच्या प्रश्नावर काम करतनाचा अनुभव हर्षाली सांगते - “कित्येकवेळा मानसिक आजार हा केवळ एका व्यक्तीचा त्रास म्हणून पाहिला जातो. परंतु ग्रामीण व आदिवासी भागांतील कुटुंबांत जर एकमेव कमावती व्यक्ती मानसिक आजाराला बळी पडली तर पूर्ण कुटुंबाचे हाल होतात. गावातील एखाद्या मानसिक रूग्णाला वेडा म्हणून वार्‍यावर सोडून दिलं जातं. अशा रुग्णांची वेळेत व योग्य उपचार मिळाल्यास ठीक होण्याची शक्यता असते. याशिवाय दारू व तंबाखू सारखे व्यसन हे सबंध समाजासाठी घातक कसे आहेत हे देखील मी गडचिरोलीमध्ये जवळून अनुभवलं.”  

 

पुढील दिशा

पुढे जाऊन हर्षालीला Psychiatry मध्ये पोस्ट ग्रॅजुएशन करायचे आहे. मानसिक आरोग्य ठीक नसलेली व्यक्ती परिपूर्ण आयुष्य जगू शकत नाही असे तिला वाटते. “आपल्या अवतीभवती समस्या ठळकपणे दिसत नसली तरी अनेकजण मानसिक आरोग्याच्या समस्येने त्रस्त असतात. मुळात मानसिक समस्या असणं, ती ओळखणं आणि त्यावर उपचार करायला तयारी दर्शवणं याचं प्रमाण आपल्या समाजात कमी आहे. शिवाय Depression, Anxiety यासारख्या सामान्यतः आढळणार्‍य मानसिक समस्यांमुळे देखील एखाद्या व्यक्तीची उत्पादकता आणि त्याच्या आयुष्याचा दर्जा खालावत जातात. अनेक अभ्यासांतून असेदेखील पाहण्यात आले आहे की या सामान्यतः आढळणार्‍या मानसिक आरोग्याच्या समस्यांचा जास्त धोका हा तरुण व नोकरदार वर्गाला असतो. यासगळ्या गोष्टींवरून मानसिक आरोग्य किती महत्त्वाचं आहे हे स्पष्टपणे कळतं.”

समाजाच्या मनातील न्यूनगंडापासून ते मानसिक आरोग्याच्या समस्यांशी लढण्यासाठी असणार्‍या तोकड्या आरोग्यासुविधांपर्यंत अनेक आव्हानांचा सामना करत हर्षाली पुढे वाटचाल करत आहे. मानसिक आरोग्याच्या क्षेत्रातच पुढे जाऊन लोकांसाठी काम करण्याचं तिचं ध्येय आहे. “एका व्यक्तीच्या जीवनातील नात्यांचा त्याच्या मानसिक आरोग्याशी असलेला परस्परसंबंध कसा असतो हे मी मानसिक आरोग्याच्या प्रश्नावर काम करताना शिकले. त्या अर्थाने आपण सर्वच आपल्या अवतीभवतीच्या लोकांना त्रस्त करून सोडलेल्या या समस्येवर मात करण्यासाठी महत्त्वाची भूमिका बजावू शकतो. स्वतःपूर्ती मर्यादित न राहता स्वतःपलीकडचा विचार करून लोकांसाठी काम करण्याचा अनुभव मला समृद्ध करणारा वाटतो. असंच पुढे मानसिक आरोग्याच्या क्षेत्रात काम करण्याचं माझं ध्येय आहे.”

डॉ. हर्षालीला तिच्या आयुष्याची दिशा स्पष्ट दिसत आहे. तिच्यासारखेच अनेक तरुणतरुणी, विशेषतः आरोग्याक्षेत्रात काम करू इछिणारे तरुणतरुणी आज त्यांच्या आयुष्याची दिशा शोधत आहेत. अशा प्रत्येक तरुणतरुणीने स्वतःला प्रश्न विचारायला हवा –

‘स्वतःपलीकडचा विचार करून समृद्ध व परिपूर्ण आयुष्य जागण्याची खुणावणारी संधी मिळवण्यासाठी मी ‘स्व’ च्या कोशातून बाहेर केव्हा पडणार? 

Dr. Mrudula Bhoir: A Medical Officer in Delanwadi

It is quite a transformative journey from being one of many medical students in Mumbai, to running a primary health centre (PHC) in Delanwadi, a remote village in Gadchiroli district in Maharashtra. As daunting as this transition sounds to any urban dweller, fear was never a passing thought for Dr Mrudula Bhoir, a medical graduate from Seth GS Medical College and KEM Hospital. Originally from Thane, Mrudula is completing her MBBS bond as the PHC’s primary medical officer. My interview with Mrudula was an attempt to understand her journey and her lessons as a government officer and a propeller of social change. My visit, however, transpired to be more than just an interview. It was a glimpse into the reality of healthcare challenges in rural India, through the lens of a young doctor in search of her social purpose.

As Delanwadi awoke from its slumber on a crisp December morning, I entered the gates of the village’s PHC to interview my friend and medical officer Dr Mrudula Bhoir. In the early hours of the morning, even before crowds gathered for the comfort of chai and poha at the local tapriwala, eager patients awaited their doctor who was deeply engrossed in a heap of paperwork as I entered her quarters. She had been tallying the doses of vaccinations administered that month over a warm cup of green tea, in preparation of a monthly administrative meeting with the taluka (block) health officer. A typical Wednesday for Bhoir.

As part of her usual supervision duties, I accompanied Mrudula to a sub-centre (an affiliated health unit under the PHC) in the village of Kulkuli. The facility was thoroughly managed by a jovial and sincere ANM (auxiliary nurse midwife), Sister Karangame. As both of them spoke over the monthly activities of the sub-centre, a grave expression overtook Sister Karangme as she discussed the concerning case of Tulsi, an expectant mother, two-weeks past her delivery date, who had refused to visit the PHC to seek care. Post-term deliveries pose great risks to the fetus and have higher chances of resulting in maternal death, a steadily decreasing yet serious cause of mortality in India. To examine the baby’s health and determine the reason behind Tulsi’s reluctance to seek medical attention, the three of us set out to visit her home in the village of Ramtola.

Surrounded by farmland, Ramtola was on the periphery of a slim kuccha pathway, the only connection to the main road, which made it nearly impossible for Mrudula’s car to progress. With Vidarbha’s punishing heat and relentless rains, making the main road inaccessible in the monsoon, I could only imagine the struggle it would take an ASHA worker or a pregnant mother to travel to the PHC by foot. It would have taken at least half a day.

Besides a frail grandmother resting on a cot in the backyard, the house was empty. There was no sign of a pregnant woman. As we waited outside the home, Mrudula pointed to an inscribing on the wall. Marked on the side of the house where a list of dates on which a healthcare worker had visited Tulsi’s home. Every pregnancy, birth and death are meticulously recorded by ANM workers, who regularly visit and examine women to ensure a healthy progression for the mother and baby. To encourage her to go to the PHC, Tulsi’s house was visited 13 times in the last month of her pregnancy. This was no mean feat as I recalled our journey to reach Ramtola.

We were startled by the rattling noise of shifting vessels from behind the house. Our patient had been cleaning the house. With the hem of her sari tucked at her waist and beads of sweat trickling down her brows, it seemed Tulsi had been at work all day. She turned to face us, and our eyes immediately locked onto the protruding bump. Her petite frame managed to balance her immensely swollen belly remarkably well as she swooped to pick up the washed vessels. Mrudula broke the silence- her voice sharpened at the sight of Tulsi’s exertion. Dawakhanat kashala nahi yet? Khup dhoka hou shakte tula ani tujha balala. Kiti vaat bagsheel? (Why do you not come to the PHC? You and your baby could be at risk. Why are you waiting for so long?) To which Tulsi’s only reply was mala kahi traas nahi hote madam (I have no pain madam).

Upon Mrudula’s persuasion, Tulsi agreed for an examination. I was surprised at Tulsi’s agility and stamina at this stage of pregnancy as she managed to lift an entire wooden cot for Mrudula and Sister Karangame to examine her. The frail grandmother inched herself into the room and crouched near the door, keeping a watchful eye over her granddaughter. Tulsi mentioned she could not feel the baby move as much as the previous week. Mrudula and Karangame exchanged worrying glances but did not voice their apprehension. With Tulsi lying on the cot, Mrudula examined her belly to find the baby’s position was breached, which could cause complications during birth. Mrudula lowered her stethoscope to examine the baby’s heartbeat. She could not find it. Sister Karagngame took a chance by positioning the stethoscope on the other side of Tulsi’s abdomen. She could not find it either.

Mrudula, looking determined, tried a third time. She listened intently, almost as though she were in a trance to locate the rhythm of life. Sister Karangame mentioned how women avoid seeking care during the final weeks of their pregnancy in government facilities, out of the fear of a cesarean section. With mistrust in the medical system mired in many rural and tribal societies, Karangame suspected Tulsi’s family might have had the same reservations. The realization of the medical system’s folly in neglecting to change people’s perceptions of healthcare was quite pronounced at that moment.

I looked around the room. Five women with five different worldviews. One was a woman of old thought, three were women of science. I could only hazard a guess at what Tulsi might have been; sandwiched between tradition and modernity. We were all thinking about it. Had the medical system failed Tulsi and her child? My thoughts were disrupted by a sudden exclamation. Aahe! Heartbeat aahe! (It’s there! The heartbeat is there!) said Mrudula. Sister Karangame rushed to confirm the sound. The baby was alive but in distress. Immediate medical care at the PHC was crucial for the baby’s survival. Both Mrudula and the Sister pleaded Tusli to visit the hospital, but she avoided to meet their eye. Gharvale nahi mante (My family says no) was all she said.

Tulsi’s husband and father-in-law entered the house during the midst of our coaxing. They did not seem surprised to see us there, it felt as though they did not want to acknowledge our presence. Mrudula shared the severity of Tulsi’s health with the family and urged them to bring her to the PHC. She even offered to conduct any procedure at a minimal cost. All the family had to do was bring Tulsi to Delanwadi. Her persuasion was met with an unconvincing reply from her the father-in-law. Alas, we left Tulsi’s home hoping she would make it to the PHC or that the baby would be delivered soon.

It took 14 visits from a dedicated health worker to an isolated home to convince a pregnant woman to seek basic care. Only at the most fundamental level of India’s social structure, deep in the villages of Gadchiroli, did I realize the absolute necessity of health education, the influence of social norms on health outcomes, and the importance of building trust between the medical community and the people it intends to serve.

As Mrudula and I returned to her quarters at the PHC, she assured me this was a typical Wednesday. I was eager to hear more about her experiences in Delanwadi. And so, I started the interview.

Being a medical officer is an immense responsibility. It must be a tall order to match given you are a novice in your profession. What is it like to run the Delanwadi PHC?

Nine thousand eight hundred forty-seven. That’s the number of people under the jurisdiction of this PHC. As a medical officer, I examine around 1500 patients every month. Though, I would say seeing patients is just 20 percent of my job. A large portion of my duties occurs outside of the clinic such as overseeing the five sub-centres affiliated with Delanwadi, supervising field visits to villages, managing administrative tasks, deputing staff, distributing (and withholding) salaries, organizing surgery camps and training the thirteen ASHA workers in my jurisdiction. And, the budget. Managing the annual budget, which borders around 80 lakh rupees is a herculean task, for which I am grateful to Delanwadi’s previous officer Dr Pankaj Aute…and my clerk (laughs). As part of a national health program, I also need to consistently update my knowledge of new medical procedures, vaccination policies, cold chain system management and the demographic statistics of my area. Above all, my most important responsibility as a medical officer is to be calm in the face of adversity.

What have been your most valuable lessons?

Managing staff who are much older to me and who address me as ‘madam’ was odd during my initial days. But it made me realize the hierarchy within the medical system. It was important for me to give my staff respect for their experience no matter their social standing. However, I have not let my staff’s seniority compromise the quality of work I expect. Being in charge of people, I also had to learn the art of delegation rather than taking all the responsibility on myself. As a perfectionist, I couldn’t trust others. I learnt that the world has its own pace, and I need to try to work with it patiently. After all, I can’t expect things to progress with the speed of Mumbai’s local trains.

You went to a prestigious medical college, where the quality of your education was unparalleled. What aspects of your learning and growth did college not nurture?

Empathy. Patients were treated as a case rather than as a person. There is so much more to a patient than their symptoms, like where they come from, what they live through in their daily life and their perceptions of the world. This is not something we are taught to even consider as a part of our diagnosis. In college, patients were regarded as people with white clothes on a bed, which never made me care about their background. In healthcare and medicine, learning about people’s habits matters. Learning where people come from to a hospital, matters. Being an ’outsider’ in Delanwadi, I now realize the importance of social context in my line of work.

During my internship, using finite resources and working within limited means was not a priority. At KEM, our MRI and CT scan machines were running 24 by 7. These facilities definitely made diagnosis easier, but consequently, we spent less time understanding the patient, which made medicine seem like treating the disease rather than a person. Running a multitude of tests on the first day of admission for an anaemia patient, went as far as conducting a bone marrow biopsy. Maybe this is necessary at a tertiary level because doctors don’t have much time to invest in each patient. But many tests could have been avoided and the diagnoses could have been narrowed down if we knew patient history better. Again, context matters. Delanwadi is not equipped with these tests and patients often don’t have the luxury to afford CT scans or breast exams. So, I improvised. I developed an algorithm of diagnosing patients, where their cultural context and habits are key indicators.

In places like Gadchiroli, with a high rural and tribal population, infectious diseases are a scourge for the masses. It’s not that we lack basic treatment methods. People’s health-seeking behaviour and perception of medicine are quite poor. People need to know what they are suffering from and need to receive quality treatment. I’ve learnt that people’s needs are very basic, and half the battle in treatment is being amiable to patients and lending an ear to give them the sense that they are being heard. And honestly, medicine is not rocket science!

Have your ambitions and illusions changed since being a medical student?

As a medical student, I wanted to be a ‘successful’ doctor. Success for me was to be famous and richer than my parents. I saw myself having completed my postgraduation and working in a hospital in Thane. As I entered college, I noticed students had many talents apart from being good in academics. Yet preparing for postgraduation was the most common career choice for students. Many had aspirations to practice in the US and started solving USMLE exam questions since the first year. There were very few people who did things apart from studying for postgraduation, as options were quite narrow and so was people’s ability to accept an alternative career route. I always wanted to do something that others didn’t do. I had an element of righteous anger for injustice and I was also quite the jugaadu (laughs). I recall listening to Dr Rani Bang’s speech at KEM. She spoke about her work at SEARCH (Society for Education, Action, Research in Community Health), in Gadchiroli and how youth should strive to make their careers socially relevant. She was such a fierce personality, it’s a trait I really admire in women. I want to be like her! It was her speech and genuine curiosity that made me apply to SEARCH’s youth development programme, NIRMAN.

NIRMAN ne kuch alag hi jaadu kar diya. It disillusioned me from my previous notions of being a ‘successful’ doctor. At NIRMAN I learnt the story of a woman named Kaju bai, a veteran community health worker in SEARCH’s pioneering home-based newborn care (HBNC) program. Her story still brings tears to my eyes. She is a widow in the lowest rung of society from the village of Ambeshivani, who may not have studied beyond the fourth standard. Yet the life she has lived and the lives she has saved is no short of a miracle. She has accomplished what pediatricians can perform only after years of training. Her story showed me the power of empowering people through education at the primary level, in inaccessible areas where no one is willing to venture. Kaju bai’s resilience has made me want to inculcate education with my career in medicine. I used to equate random acts of kindness with social contribution. There is so much depth and beauty by directly being in touch with people, which is in the nature of my profession. I want to be the agent of social change to spread that understanding to others. I was convinced that I would go the conventional way by doing a postgraduation. Kitna narrow tha humara perspective…I mean mera. That’s something else I learnt, when you are talking about yourself, don’t talk about the world. I would have done something socially relevant, but not with the conviction and social awareness that I got through NIRMAN and my time at Delanwadi. Indian society is rather rigid and at times unforgiving about achieving life’s milestones at the right age. I would have not been able to accept my decision to come to Delanwadi had it not been for the realization of life’s richness beyond completing graduation for the sake of prestige. This realization gave me the confidence and freedom to live a life with purpose, on my terms.

Didn’t you have any apprehensions before choosing to come here?

Life in Mumbai was certainly different than my reality at present. But I wanted to learn about medicine, the people it impacts and government administration beyond what KEM could teach me. So, I chose to come to Delanwadi. Where else would I have been able to interact with the population I serve so directly? I had no apprehensions of living alone in a village. I lived at home for the 24 years so staying outside of my comfort zone gave me an immense sense of freedom and allowed me to take ownership of my choice to practice here. I also wanted to learn to be more patient and communicate better with my patients, employees, co-workers, and seniors. I would not have learnt this skillset in postgrad; I would have been surrounded by work instead.

Living alone does come with its set of challenges, which I previously didn’t tackle gracefully. I found it difficult to hold it together, especially when I needed an emotional support system. Being in Delanwadi has taught me to seek guidance from my colleagues and seniors at KEM. I’ve learnt to share my difficulties with mentors and keep my cool. I also feel a greater sense of contribution to health education through my work. I have certainly faced many challenges here, which have made me lose my patience at times. But any form of social change requires an investment of time, patience, and perseverance.

advice would you give to MBBS students who are uncertain about their future?

I think to flourish as a doctor, you need to devote your heart to what you feel content in. As unusual as it sounds, happiness and satisfaction are a crucial part of medicine. Medical students really need to ask themselves where their happiness lies. Part of their happiness should also lie in the well-being of others. If you feel unsatisfied with the prospect of being a clinician, then change your line. Work with the administration, government, or NGOs. There is a lot more than you can do, a lot more than our health system needs beyond clinical care.

I would also advise students to derive a personal definition for their purpose in life. The purpose is an internal discovery; it should not be imposed. My purpose is to see society become more equitable through the betterment of our health system. It is a force which drives my life.

Article and images by Jainetri Merchant. Jainetri has completed her Bachelor of Science from the University of Toronto in Canada.

The goal of the NIRMAN program is to contribute to the flourishing of youth in India, facilitate their search for pro-social purpose and nurture them as social changemakers.

A Doctor With A Difference!

I began my journey with NIRMAN in 2014. I was a 2nd-year student of MBBS at the Grant Medical College in Mumbai at that time. As every medical student, my goal was clear, to pursue post-graduation. But what next? What after PG? Maybe super speciality? Maybe private practice? Maybe government practice? I had no idea. As most of the students, I was also unaware of the problems in our society.

When I attended the 1st NIRMAN workshop, I started understanding the challenges which our society faces every day. In the beginning, it was really difficult to digest them and my reaction was that these problems are so big and I can’t do anything about it. It made me helpless. But that’s when I started consciously looking around me and started understanding the gravity of issues faced mostly by the poor and most vulnerable communities in our society. Being working in a government hospital, I did not have to go somewhere else to see how much people suffer. I could feel their helplessness, their limitations to get the healthcare that they really deserve. The 1st workshop of NIRMAN gave me the insight to look into the community and how to identify the problems. As someone said, “Your eyes can’t see what your mind does not know.” So my mind opened and so did my ‘eye’.

But this was just about realization. What next? Was it enough just to have a realization of the problems? The answer was NO. This is where the 2nd NIRMAN workshop helped me. The 2nd workshop was about – “Yes there are problems, but how can I contribute to fix them?” The 2nd workshop gave me the tools required to break down a large problem into smaller ones and then try to fix them. It helped me to convert my helplessness about a problem into a realistic approach to solve it, at least partially if not completely. It also helped me keep realistic and achievable targets and not to be in some dreamy state. The first two workshops were mostly about theoretical knowledge though we also got chances to interact with many people who have done significant work in their fields. But again a question came in my mind that these all people were very senior, age-wise and experience-wise, to me. And as usual, I thought it would be easier for them to solve the social problems with their expertise but I’m nowhere near them to do so. The third workshop of NIRMAN was a perfect solution to this query of mine!

In the 3rd workshop, I actually got to meet a lot of youngsters who were of similar age to me and who were currently working on some specific problem in society. This gave me the confidence that this can be done by young people too. As perfectly matching with the true concept of NIRMAN, this was meeting with and being a part of a ‘Team of Young Social Changemakers’!

Throughout these three workshops, one thing has been common – I have made new friends who think like me and who are willing to do something for society.

The whole NIRMAN process helped me to think rationally and make my decisions wisely and not just based on what others are saying or what is trending. I got a habit to put ‘why’ in front of every choice I now make. There are so many influences in our lives, if we go as per their choices then it’s not our life. I got that courage to go against the flow when I felt I should.

After completing my MBBS, I joined the SEARCH Hospital in the remote district of Gadchiroli and worked as a Medical Officer for 10 months. I saw more than 10,000 patients, predominantly from a low socio-economic background, during this period. I handled OPD and IPD duties, helped organize surgical camps, handled emergencies including snakebites and malaria. 

This entire experience helped me grow academically, socially and personally and solidified my conviction. I gave my 100% efforts during this MOship, saw a variety of patients and learnt so much clinically. Slowly I started treating the patients as humans and not as persons with a disease. Every patient I saw was an opportunity to learn new things. Talking to patients not just about the disease but about their family and occupation was also a learning experience for me.

I was lucky enough to get guides who helped me understand the meaning of ‘medicine’ beyond the disease and I will be forever grateful to them. I have always believed in quality care and not just a quantitative number of games. Every human deserves quality healthcare. During my MOship period, I met with many people from a variety of backgrounds and learnt a lot about things other than medical education, some of them will be staying with me for the lifetime. With this in mind, I decided to pursue post-graduation in medicine and started preparation for the NEET entrance exam. The preparation year was full of stress and competitiveness, but my experience in MOship helped me in solving my questions and the memories with my patients motivated me to do better. After spending one year exclusively with books I, fortunately, got a good rank and I have now joined a residency in medicine in Mumbai.

 I’m looking forward to providing quality care to each and every human being I come across in my work and alleviate his/her suffering as much as possible. I feel that at the end what matters the most is not having any regrets, that I could have done this or that, but I didn’t. I feel content that I enjoyed organizing college festivals and going for bike trips with friends during MBBS, I helped my patients during my MOship and also studied day and night when required for the PG preparation. Hopefully, this journey of personal satisfaction and social contribution will continue for years to come!

 

Dr Amit Giram

NIRMAN 6 Batch

MBBS, Grant Medical College Mumbai

Currently Pursuing MD Medicine at GMC Mumbai

The goal of the NIRMAN program is to contribute to the flourishing of youth in India, facilitate their search for pro-social purpose and nurture them as social contributors.