I was myself reminded of a photo I took from Crossword, where his oft-quoted book on famines “Everybody loves a good drought” was (perhaps?) inadvertantly placed under “Indian Fiction”, when he spoke about the time when he was invited to talk on “Indian fiction” on one of his foreign trips which he accepted for he was an authority on the Government documents.

Sainath started in earnest with the rise in petrol prices and deftly manoevered that to a paragraph he read out from a few sheets of scribbled stuff he had brought to the podium. He reassured us that this is not what he often does – read a prepared text. It was from the budget speech of 24th July 1991, when the present prime minister, Manmohan Singh was the finance minister. We got to know this only later though because the context around which “liberalisation” was brought in still exists today….at least for most of rural India. Sainath reminded us that line “…Budgetary subsidies, with questionable social and economic impact, have been allowed to grow to an alarming extent”. Since then, how many such “subsides” have had great impacts?

It appears that such “subsidies” are available for all to see as an inconspicuous annexure to all budgets – “Statement of Revenue foregone” – here it is for 2009-10. This document lists the special tax exemptions and concessions given to individuals and corporates and calculates the revenue ‘lost’ or foregone by the central government as a result of these. The figure is somewhere near 35,000 crore rupees – Sainath reminded us that this is around the money it takes to run the entire NREGA programme for a year – yes, that is what was “foregone” – the new word for corporate subsidy which has now replaced those budgetary subsidies of pre-90s days which had questionable social impact! This foregone revenue is climbing year after year and one of its greatest components has been the custom subsidies. And for those of us who were wondering if our good government was keeping the interests of many of us in mind while it was perhaps waiving off taxes on essential drugs, here is  the list – precious stones and jewellery, mineral fuels and oils, animal or vegetable fats, machinery and electrical machinery. The first one in this list – a Rs 48,798 crore exemption on customs duty for imported jewellery in one year alone – nearly the size of our entire annual food subsidy all for the great drain robbery.

Indian has more billionaires than all Scandinavian countries put together! And this is not merely from the richest cities, we were told. Sainath described those nice weddings in rural India particularly those of Gadkari’s son held in Vidarbha – that place where farmers are killing themselves for debt. Seems a bit exaggerated right – why would farmers kill themselves in a place where 2,00,000 people attended the wedding and aircrafts replaced the usual tractors and trucks for ferrying wedding guests. And who says a village cannot get 24-hour power. No load shedding during gadkari wedding! And no party-specificity with such rich rural weddings – so is the case, Sainath reminded us of the weddings of several others from all parties. India was so shining in these areas, that it was mostly blinding for many who didnt catch the irony. So much so that mass weddings with food were understandably the best social programme in Vidarbha for a long time.

The next 45 minutes was a series of anecdoetes from the 80s and 90s. The wisdom and experience of covering real India for decades was showing – he discussed the problem of “footloose migration” – those people for example from Orissa and Jharkhand who work for a few months in Hyderabad and later in Mumbai who do not get picked up by any census. We heard about that wonderful scheme that was pooh-poohed when launched – the midday meal scheme. The farmers rally or the strike at Maruthi’s Manesar plant for better working conditions that mainstream media took so late to cover. And of course, how many “luminaries” have rubbished all this tripe about farmers’ suicides and have proven it to us by legally deleting famine from their vocabulary through a parliamentary act! More followed on the food security bill.

All in all, it was a brilliant display of wisdom, erudition, spontaneity and a sense of conscience that Sainath demonstrates. He stands today as a conscience for several self-aggrandised and charismatic civil society who forget that it takes more than values and integrity to build a country. Describing himself as a member of the “un”civil society, Sainath repeated his thoughts on the Jan Lokpal Bill from that Berkeley lecture and gave tips on feeding our billionaires. 

And for those who would rather listen to Sainath himself and trust me the talk was one of his best  (the recording is not!) – see http://dl.dropbox.com/u/2047439/sainath/data-2011-9-16-19-05-15.3gp and http://dl.dropbox.com/u/2047439/sainath/data-2011-9-16-19-59-12.3gp (Thanks to Anush)

See also

• Indian media – politically free, prisoners of profit
• Three weddings and a funeral
• Reception after reception for Gadkari’s son
• Revenue foregone, but not forgiven
• Corporate socialism’s 2G orgy and all his other articles archived on India Together

A neglected statue and a neglected message

Some things are better assumed and neglected, than acknowledged and attended to. In public health research, these often find a passing mention in “Discussion” section where findings are explained, and worse still, may be as a “contextual” element. Prime among this is corruption. Corruption in health services is nothing new. Perhaps merely a sub-set of the general corruption prevalent in administration of public services, the corruption in health is much more than merely a “contextual” element to be taken into consideration in planning and implementing health programmes. Nor is it merely a feature that may explain some of the poor health outcomes that we often find. Corruption is directly, causally linked to poor health service delivery. We KNOW this and we SEE it. Yet, when I read several reports and documents at national and global levels, there is an obvious glossing over of this feature – as if this is some minor itch that governments will eventually get to.

In writing this comment to the Lancet, I had the privilege of partnering with somebody who has led a tirade against corruption in health services in my state, Karnataka in South India. As a chairman of a government appointed committee on health care for our state, he took a bold and courageous step in putting “corruption” as the main problem that the health services ail from. As I describe in the comment, this led to a long chain of events including the strengthening of the Lokayukta, an ombudsman institution that helps uncover corruption.

Yet, this is not enough! Over a decade of very active ombudsmen in Karnataka have not achieved much beyond making corruption a public issue. It continues to parasitise the reforms and innovations that we so fondly and techincally design for health systems strengthening. Of what use is a good HR policy if people accept money for transfers? Of what benefit is drug price control orders if there is collusion among officials and companies for mutual benefit at the cost of the system?

I really do not know what it is – lack of evidence? lack of resolve? In fact, I wonder sometimes, if corruption is a feature of the system or a bug?

NB: This appeared as a guest post on the International Health Policies Blog of the Institute of Tropical Medicine, Antwerp as a part of the Emerging Voices Initiative. Thanks to Kristof Decoster and David Hercot for the help and support.

We cannot stay silent. Do your bit – raise your voice, write letters, support campaigns and make the ones in high places aware that they cannot sit quiet. Sign the online pettition or write to the president, as these people did. Write in your local languages and local press and spread the message.

A recent photo of Binayak Sen: Courtesy NDTV

Reproduced below is the statement of Jana Arogya Andolana from Karnataka.

We, the Jana Arogya Andolana Karnataka (JAAK), the Karnataka chapter of the People’s Health Movement, which is a coalition of Karnataka State level networks, organizations and persons actively working for health rights in the State, express our outrage at the verdict of the Raipur district and sessions court judgement declaring Dr Binayak Sen guilty of criminal conspiracy of sedition. Dr Sen has an illustrious record of over 25 years of selfless public service in areas of health and human rights. He has been the General Secretary of the Chhattisgarh People’s Union for Civil Liberties and Vice-President of the National PUCL and has contributed to the democratic movement in the country. He has been closely associated with the Jan Swasthya Abhiyan, the Indian chapter of the People’s Health Movement.In recognition of his work, the Christian Medical College, Vellore conferred on him the Paul Harrison Award in 2004, which is the highest award given to an alumnus for distinguished service in rural areas. He continues to be an inspiration to successive generations of students and faculty. Many of his articles based on his work have been internationally appreciated. His indictment under the draconian and undemocratic Chhattisgarh Special Public Security Act, 2006, and the Unlawful Activities (Prevention) Act, 1967 and the sentence of life imprisonment is utterly condemnable. Not only has the farcical nature of the trial been reported in the media, the charges against Dr Sen, of engaging in anti-national activities, have been widely held as baseless.This judgment is an unacceptable attempt to intimidate and vilify those who advocate for the rights of the poor and the marginalized, and reveals the indiscriminate use of state machinery to stifle democratic dissent.

JAAK believes that a great derailment of justice has been done, not only to Dr Sen but also to the democratic fabric of this country. We consider this as a typical case where the judiciary has betrayed the cause of the poor and the marginalized of this country. JAAK salutes Dr. Sen’s work, and also demands that the unjust and erroneous judgement be reviewed immediately.

The Government playing Blindman's Bluff with its citizens instead of being inclusive!

Responding to a call posted on the Rajya Sabha Website where now and then, standing committees mulling over our collective future as a nation act responsibly by inviting comments, I sent off the following comments on the proposed amendment to the Indian Copyright Act, 1957. All in all an opportunity which has only been half, if improperly used by the Government. In any case, in hope that all comments are given their due, I have shared mine within the deadline of May 31st, 2010 (So, run and send yours too; there are two more days).

Thanks to a tweet from Sunil Abraham of Centre for Internet and Society.
It is a laudable effort of the Government to bring the existing legislation up to date with international consensus and frameworks. Kindly note the following comments.

1) We endorse the reading of “fair use” to apply to private and personal use legalising any use of copyrighted material for private or personal use such as making backups of material for personal use, which in some country contexts (like the DMCA of USA) has not been read as fair use.

2) While it is commendable that the Act removes the need to pay royalty/seek permission for conversion of copyrighted text to Braille, the spirit of inclusivity is lost as most people with visual impairment have moved on to e-readers and audiobooks. We strongly recommend that the amendment be widened to be applied for all types of devices/technologies that are geared towards making a particular text available for visually impaired. Such a wide application of the amendment would make India indeed a pioneer in inclusive legislation.

3) We appreciate the move to give content creators more rights over their creation and this move to shift some power from industry to individuals who create content is commendable.

4) While the efforts to provide copyrights as a right to assert authority over intellectual or other kinds of original work is an important role for legislation, we believe legislation should also make space for frameworks which explicitly try to improve and open up opportunities for collaboration. Various such frameworks are in use worldwide today, one well known among them being the Creative Commons system. Original work ‘copyrighted’ under this system encourages the spirit of sharing while still allowing the creator to retain ‘intellectual rights’ over his/her work.

For more, please see http://creativecommons.org/education?utm_source=ccorg&utm_medium=ccedu

Leading institutions and governments are now in the process of adopting and endorsing the Creative Commons system. We request that the Committee consider the option of providing a legal space to such licensing within a legislative framework.

Dr. Srinivas had started his career as a doctor trained from Karnataka’s oldest medical colleges, Mysore Medical College. He had joined the state health services early and had worked in remote primary health centres as a doctor and later in hospitals. He had risen up the long ladder stretching form a PHC medical officer to the level of a Project Director of Reproductive and Child Services for the State of Karnataka more recently. After retirement, his rich experience would not be wasted; the state continuing his services as a consultant to help implement the most important initiative these days, the NRHM. Among the lively discussions between the participants and him, was one important aspect of leadership – by example.

Dr. Srinivasa spoke of the fundamental nature of organisations; of adopting the values and principles of the leader. While most people are sincere in their work inherently, many others are fence-sitters, as he called them. They adopt the values of their leader. He also quoted from experience. It is critical for government services to produce such leaders, for in adopting these values of service and dedication, not only would they be transforming the way in which they work, but they would be transforming their entire institution.

Such is the case of the district hospital in Tumkur. The district hospital in Tumkur is an ancient one. It is one of the older large hospitals in the state of Karnataka, having been established a year after independence in 1948. By a strange quirk of fate, the then Maharaja of Mysore, Sri Jayachamarajendra Wodeyar, who was to inaugurate the hospital abruptly left the venue, for the day the hospital was inaugurated was the day that Mahatma Gandhi was assassinated. The inauguration stone that marked the occasion today lies within the walls outside the office of the District Surgeon. The hospital caters to over 2 million people in Tumkur district, and what a responsibility to manage a hospital of such a size given such a task….

Dr. Pratap Surya is the District Surgeon, the man who is at the helm of affairs at the hospital. He has indeed a mammoth task on his hands. Being the head of a large 250-bedded hospital that sees over 1000 people a day is no joke. A random sample of the patients reveals the enormous service that the hospital renders – one of the patients from Midagesi, a distant town in the taluka of Pavagada had come in search of the ENT surgeon for the chronic infection afflicting his adolescent son. He was a landless labourer from there, nowhere else to go for him; the bus charge from his place to Tumkur and back, and the wage loss resulting from a loss of one day’s work together added to quite a burden. There was another person from the town of Madhugiri, an old man who had come hoping to improve his vision by getting rid of the haze that had recently developed in his eye, a cataract. The hospital in Tumkur has an ophthalmologist and an ENT surgeon to cater to both of them. I ran into the gynaecologist, Dr. Diwakar in the corridor. He had just finished a caesarean surgery to save the life of a mother and the newborn. In this case, the newborn was positioned transversely in the mother’s uterus, thus not being able to be delivered normally; a classic indication for a caesarean section. If the mother had not reached the hospital in time from the distant village beyond Madhugiri town, the physiological process of childbirth could have been fatal for both the mother and the child. In her case, thankfully, the newly launched service of 108 had promptly brought her in time for the procedure. The woman being from a family that is below poverty line, like almost all of the patients that obtain service at the hospital had undergone the procedure completely free of cost.

The old man from Madhugiri will have his vision soon. The ophthalmologist scheduled his surgery for the upcoming batch. The ENT surgeon, who single-handedly manages the entire department will soon see the adolescent boy from Midigesi, in time for him and his father to catch the evening bus back home; he cant miss another day of daily wage. The taluka of Madhugiri could rest easy, avoiding its tryst with yet another maternal mortality, thanks to 108 and the gynaecologist at Tumkur. This was yet another routine day in the government hospital in Tumkur.

Yet, it is not automatically so. A lot of effort has gone into managing the hospital. It is but easy to target government hospitals for their poor quality of care and negligence. Easier still to say “privatise”. But, when one sees the segment of people who these hospitals cater to, we understand the importance of strengthening them; and it is not for lack of effort by the local staff that these ills plague the government system. People like the present District Surgeon, Dr. Pratap Surya are the foot soldiers of health care to the masses. Neglect and carelessness in the leader could easily have a cascading effect on the staff. But, Dr. Pratap Surya, by sending the right signals of integrity, service-mindedness and discipline – he leads by example.

Of course, there are problems. Why do poor people have to travel for such a long distance for an ENT consultation? Why wasnt the mother with a transverse lie diagnosed well in advance, so that she need not have come at the nick of time to the district hospital? Moreover, why aren’t such services available at the sub-district level itself? Why is the district hospital so overcrowded?

Thankfully, the launching of the NRHM holds promise. The priority accorded to maternal and child health and the resulting strengthening of referral units to prevent infant and maternal mortality, upgradation of neo-natal ICU’s in Tumkur district hospital, and of course the leadership by example provided by people like Dr. Pratap Surya, one can see encouraging signs of improvement. Let us hope that the efforts of several people within the system like the district surgeon or Dr. Srinivas and many others among the Tumkur district health team will result in better quality service to the poor.

It is no measure of health to be well adjusted to a profoundly sick society.

- Jiddu Krishnamurti

Gubbi, a Taluka headquaters in Tumkur district

Gubbi is a small town in Tumkur district in Southern Karnataka. Gubbi Veeranna, one of the well-known theatre personalities from Karnataka who started the first Kannada theatre hailed from here. Historically, the town was well-known for its local markets for cotton and areca nut. As early as in 1871, Gubbi was a municipality of its own. The Imperial Gazetteer of India in 1871 talks of the monthly ‘jaatres’ or fairs which were well known for the sale of cotton cloth, blankets, rice and other articles from as far as Malnad (the mountainous monsoon-fed wetlands to the west) to the dry areas of Rayalaseema and the low hills of Arcot to the east and South. Today, Gubbi is a taluka headquarters in Tumkur district and is one of the ten talukas in the district.

Gubbi is about 20 km from Tumkur and is situated along the highway to Honnavar from Bangalore, that passes through Tumkur. The taluka hospital of Gubbi is along the highway passing through the town. The Administrative Medical Officer, the doctor in the hospital tasked with managing this hospital is Dr. NL Dani. The hospital was a Community Health Centre earlier with 30 beds being upgraded now to a 100 bedded hospital.

Dani is one of the participants of the capacity-building programme organised by IPH and its partners in Tumkur. Dani is a paediatrician by training with three decades of experience. He is today managing a 100 bedded Taluka hospital. His hospital sees over 200 patients in a day, is severely understaffed and morbidly overloaded. In these days of panchayati raj, he is answerable not only to his superiors in the hallowed chambers of the directorate in Bangalore, but also to the representatives of the people in the narrow chambers of the Gubbi Taluk Panchayat.

Gubbi Taluka Map

The hospital provides out-patient services to nearly 300 people in a day. At a time when there is a beeline towards corporate hospitals and having busy evening practices, it is heartening to see Dani and his colleagues in Gubbi hospital providing services within the constraints they face; and these are many. Dani conducted a study in his hospital to understand patient satisfaction, as it bothered him that most of the people obtaining the services at Gubbi hospital were reporting that they were not happy with the services. Was there truth to this?

Dani approached it very scientifically. He did not take this for granted. Nor did he cursorily conclude on the reasons for patient dissatisfaction. He conducted a study consisting of exit interviews of through a structured questionnaire. Patients were recruited into the study randomly. He considered the following aspects in his questionnaire:

1. Staff availability of patients
2. Basic amenities like toilets, drinking water, ambulance services and drug availability
3. Patient safety in hospital – infection control, physical safety of women and children
4. Perceptions of cost
5. Administrative and procedural problems

The questionnaire confirmed his hunch about dissatisfaction. Presenting the results in Tumkur, Dani also shared the possible reasons for this. On an average, each doctor in his hospital sees over 70 patients in a day. Many of these, of course are specialists who are supposed to be giving a lot more time than they can to these patients that are referred from primary health centres. However, these patients needing specialist care are clouded by many others who come here for routine health problems. There is no referral system in place.

Dani in his study prepared hospital performance indicators for all departments – in-patients, specialities, CSSD etc. He identified issues in human resources, infrastructure and a few other issues as key reasons for the patient dissatisfaction. He found that staff motivation was poor. Also, he was working in a severely understaffed hospital. Recruitment to the hospital happen in Bangalore. While it is easy to upgrade the beds from 30 to 100, finding the requisite support staff and motivated doctors to work here is another story. The district is helpless to fulfill existing vacancies. In addition, he found that supervision was poor. The doctors and other senior staff could hardly devote time to supervise and hand-hold their non-clinical team. Where is the time for management of the hospital?

In addition to doctors not being available in good numbers, the amenities provided were also poor. Residential quarters were not available for all the staff. The hospital lacked good water and sanitation facilities. A reception counter itself was not there.

This was of course a small study done in a small taluka hospital, one among over a hundred taluka hospitals in the country. However, the issue Dani identified for his study, ‘patient dissatisfaction’ is a universal phenomenon in public health services in the country today. In India today, irrational health practices and expensive health care is becoming a feature rather than a problem. Government-provided health services is the lifeline for millions of poor, who depend on these, and for whom health expenditure is often catastrophic. The reasons Dani identifies through his study are also quite representative of hundreds of other taluka hospitals.

Doctors in government services work with many constraints. Staff are demotivated. There is always pressure from elected representatives, sometimes justified, and other times not. Teamwork is lacking and the work environment is not always cheerful or fulfilling. Yet, there are people such as Dani in many of the small hospitals in the country, whose toils go unheard, and whose stories go unsaid. Yet, we often see the glamour and glory that many a corporate hospital catering to a much smaller proportion of people get.

Here is a doctor who in the middle of taluka meetings, trainings, reviews and visits by superiors, also manages a busy clinic as a paediatrician and is expected to manage a 100-bedded hospital for a taluka. In the midst of this, he keeps his spirit alive and did a study to understand and document patient dissatisfaction. We hope that Gubbi finds more specialists and most importantly, committed people like Dani.

Crossposted on IPH India Blog

I have a dream….

If Martin Luther King were born in the forests of BR Hills in Southern Karnataka during the nineties, apart from perhaps running into Veerappan, he could’nt have expected more adventure. Nonetheless, I am sure he would still have had a dream.

His dream would have to do much more with owning a television and watching an action film. It may have been about having a bulb at home and a tap with water. It may have been about seeing the insides of a car or wearing colourful clothes. These are some dreams that a ML King look-alike, Ketha has in BR Hills.

Ketha from Gombegallu

Ketha is a Soliga tribal boy far removed from the realities that some of us take for granted. He does not have a facebook profile and the only tweets he hears are that of a a bird which shares his name, the Kethanakki, named after a tribal god’s coming that this bird announces promptly. He lives in a small hamlet within a wildlife sanctuary.

His life is a part of several debates in which he has no voice. There is for example the school of thought on development that wonders why indigenous tribal people are being ‘developed’. What about erosion of their culture? Another argues passionately that the fruits of development (Facebook and twitter included!) cannot be denied to them. The State refers to him as marginalised and has scheduled him.He is one of the 400-odd tribes in India constituting 8 per cent of our population.

Another group of people strongly believe that he and his kind living in protected areas are in fact the obstacle to the conservation of our forests. Wherever, man and wildlife have tried co-existance, some say has ended in a diasaster. Inviolate areas for wildlife are touted as a prerequisite for any conservation strategy. Others weave a more utopian reality for Ketha, suggesting that conservation of wildlife and human livelihoods can go together. Others nuance it further saying that this has definitely happened in some areas. Ketha, of course is blissfully unaware of such realities.

Where would he read these debates? In the textbooks….

Hardly….In the textbooks, Ketha finds references to events, he cannot understand even….such as September 9/11 terror attacks on the US. While, this chapter in the 9th Standard English textbook of Karnataka State Board makes a good effort at trying to convey to Ketha what a watershed these attacks were for global politics, it perhaps misses the boat on connecting with him on issues closer home such as tigers, tribal people or traditional knowledge.

What about the internet? Hardly. Ketha has no access to the internet. Having a local NGO run a school itself is such a privilege for him, when compared to his other tribal brothers in other areas.Perhaps, on the internet, Ketha could have participated in these debates that adorn journals and blogs.

Ketha and Pareto come to my mind as I read the recent guarantee of broadband internet access to every Finn as a fundemental right. I still remember joking about how I am waiting for the day when the Indian State will guarantee 2 Mbps per citizen with unlimited download as a fundemental right. Less than a year from my joke, a country that Ketha has never perhaps heard of, has guaranteed it. Recently, when Michael Moore made that wonderful ‘reality show’ called Sicko, he apparently removed scenes shot about the Norwegian health care system, because, nobody would believe it!

Anyways, my point is that there is today within Ketha’s lifetime, a country where broadband internet access has been granted as a fundemental right, while in Ketha’s country, we are still wondering how to give him and his kind a good primary education.

A particularly hot Sunday morning, the stench of the Yamuna and the recent disquiet from yesterday’s tragic blasts did not deter the Sunday outing of Delhibird to Okhla Bird Sanctuary, geographically in Uttar Pradesh, but only about half hour drive from the national capital.

A chance meeting with Gopi Sundar who studies Sarus Cranes and a co-incidental phone call from Anshu of Delhibirds regarding the outing made it possible for me to join the group to Okhla. We left Delhi at 5.40 AM and reached Okhla at 6 AM. The twitching of the Lesser Whitethroat and the ammoniacal odours of the Yamuna welcomed us (For those who think I am overstenching the Yamuna, see quote of the day below). We parked within Okhla and walked down the trail with agricultural fields on one side and dry marsh land with tall grass on the other with the ‘pie’ of male bushchats every few metres apart. A lone Common Babbler on the trail ahead excited me quite a bit, we southerners not having this ‘common’ cousin of our babblers.
We reached the end of the trail overlooks the Yamuna waters with tall grass, a few settlements and stray cattle separating us from the water. Somebody pointed out a large bird perched at a distance and the day started. Even as the scope was being set up, several binocs went up and a tentative diagnosis of a hepatic female cuckoo was announced. The barring on the upper tail, its
large size and the very fine nature of the barring on the underparts was bringing Eurasian Cuckoo in my mind. The scope brought some clarity – the yellowish bill and the plumage indicated that it was a juvenile. The throat had relatively lesser streaking and the underparts were also quite dark with the fine barring. With a lingering doubt in everyone’s mind, we settled for juv. Greybellied Cuckoo. A few record shots from the photgrapher friends will settle the id soon perhaps.

A courageous group of delhibirders turned waders and waded through some water, vegetation and whatnot to reach the water. They were rewarded with Blacktailed Godwits, Ruffs and several other waterbirds. Just then, we all had seen a female Marsh Harrier and even as I was about to mention Migrantwatch, KB Singh informed me that he would be logging it into MW
today! The other group which stayed put were witness to an Rufousbacked Shrikes, an oriole in flight, red munias and black drongos. On the other bank, meanwhile were over a hundred terns, mostly whiskered with some river terns fishing. As we returned, Gopi scoped a few Spotted Owlets roosting in a Banyan tree nearby. A Greater Spotted Eagle and a Pariah kite circling
together as we walked back was another highlight of the morning.

It was a great opportunity to meet some birders from Delhi. It’s amazing how many of them have heard so much about BR Hills. The recent photographs from BR Hills had made it even more of a top destination for many of them. Between the harriers and the munias, the conversation moved from Migrantwatch to the top-ten photographers announced by Kolkatabirds and slowly strayed away to idlis and dosas, and at some point, we all dispersed
to Sagar restaurant in Noida, where I gulped down the most expensive idlis of my life. As all breakfast convos go, this one too was unmatched in its width of topics – conservation policy, judiciary, ethics, choice of ‘spirits’ and what not!

A morning well spent with delhibird members and I look forward to birding again with them whenever I visit Delhi.

Quote of the day (Heard over breakfast

“I saw a Small Blue Kingfisher once. It dived into the Yamuna…..it then turned Pied”

List of birds seen

1) Grey Francolin – Francolinus pondicerianus
2) Lesser Whistling Duck – Dendrocygna javanica
3) Spotbilled Duck – Anas poecilorhyncha – Hundreds!
4) Northern Shoveler – A. clypeata – 2 females among the spotbilled ducks
5) Green Bee-eater – Merops orientalis
6) Juv. Cuckoo – Possibly Greybellied?
7) Greater Coucal – Centropus sinensis Roseringed Parakeet – Psittacula kramerii
9) Spotted Owlet – Athene brama
10) Laughing Dove – Streptopelia senegalensis
11) Eurasian Collored Dove – Streptopelia decaocto
12) Yellowfooted Green Pigeon – Treron phoenicoptera 3 different flocks of
approx 12-15 pigeons
13) Whitebreasted Waterhen – Amaurornis phoenicurus – heard only
14) Purple Moorhen – Porphyrio porphyrio
15) Ruff – Philomachus pugnax – 4 in flight
16) River Tern – Sterna aurantia
17) Whiskered Tern – Chlidonias hybridus
18) Pariah Kite – Milvus migrans
19) Marsh Harrier – Circus a. aeruginosus
20) Greater Spotted Eagle – Aquila clanga
21) Little Cormorant – Phalacrocorax niger
22) Little Egret – Egretta garzetta
23) Cattle Egret – Bubulcus ibis
24) Grey Heron – Ardea cinerea
25) Purple Heron – Ardea purpurea
26) Night Heron – Nycticorax nycticorax
27) Painted Stork – Mycteria leucocephala
28) Rufousbacked Shrike – Lanius schach
29) Rufous Treepie – Dendrocitta vagabunda
30) House Crow – Corvus splendens
31) Eurasian Golden Oriole – Oriolus oriolus – seen in flight
32) Black Drongo – Dicrurus macrocercus
33) Whirring call of Common Iora?? Aegithina tiphia – Not confirmed
34) Redvented Bulbul – Pycnonotus cafer – outnumbered its whiskered cousin
35) Redwhiskered Bulbul – P. jocosus
36) Ashy Prinia – Prinia socialis
37) Lesser Whitethroat – Sylvia curruca
38) Tailorbird – Orthotomus sutorius
39) Common Babbler – Turdoides caudatus
40) Purple Sunbird – Nectarinia asiatica
41) Red Munia – Amandava amandava
42) Silverbill – Lonchura malabarica
43) Scalybreasted Munia – L. punctulata

Late last year, Aphu died. A healthy young man, he was among the people hired to carry luggage and supplies for a group of people. We were visiting the village to see how we could address their health care needs. Cystic fibrosis did not dry up his lungs. Neither was it any of those eponymous autosomal diseases that strike the young, of which we learn so much in medical school. These diseases were very interesting, with articles about them in journals describing correlations to genes with numbers like the latest version of MS Windows. They all had their “Disability adjusted Life Years”(DALYs) that were screaming out their importance to be taken up in any of the new programs that the State might decide to launch. But, these rare and publishable afflictions were not among those that Aphu was ever afflicted with. He died, quite simply, of malaria. Quite ironic, that a country with nuclear power still has anaemic mothers and malaria deaths!

I have been to Aphu’s village a few times with the wildlife scientists who work here. His village happens to be surrounded by one of the northernmost primary rainforests in the world. The place teems with biodiversity and the forests of Arunachal Pradesh have witnessed descriptions of a new species of bird and even a new primate, all in the past few years. Although, it is the tiger that has given this area its protected status, it is not for the tiger that this national park and many of the forests in Arunachal Pradesh are known. They are famous for their rich biodiversity including several endemic insects, butterflies, birds and plants. Such rainforests play a central role in wildlife conservation and climate change. However, climate change and global warming are distant issues for the Lisu and other tribal people living in and around these forests. Strangely, tigers aren’t.

In India today, there is a public debate on tiger deaths. Tigers and tribal people are being pitted against each other in conferences and in hallowed policy-making chambers. Co-existence of tigers and tribals is being questioned. In an environment where health care is financed literally out of people’s pockets, a tiger’s fate and people’s health can get intertwined easily. And hunting becomes a means of averting any unplanned and sudden catastrophic expenditure. It is invariably health costs that crop up in the category of unforeseen expenses. With poor access to primary health care or even to community health workers, people in such remote regions often find that hunting can finance their long journeys to towns. And it does not help matters that private providers with expensive secondary level care and irrational practices become the first line health providers for these people. The Lisus travel through about 150 km of thick forests interspersed with rivers often in spate, to reach ‘civilization’. From here, they take a 6 hour bus journey to reach a town where they invariably see a private provider. Roads, understandably are a bigger concern than chloroquine.

I work in an NGO in South India, with another indigenous tribal people, called the Soligas. The forests have shrunken around the Soligas, leaving a 540 sq. km area, still remaining, due to its legal protection by the State. The Soligas were semi-nomadic people, until they were forced to settle due in part to the shrinking forests and the legal protection accorded to their forests. They couldn’t hunt anymore. However, a doctor who settled in these hills 25 years ago, began to provide health care to them. He went further to education and livelihood, as just providing health care was helping their health! This NGO today provides health care, education and livelihood to these tribal people. Today, the elderly Soligas talk about how climate has changed. They do not question it and do not need evidence. They know it and also see how their forests are getting choked from the outside.

These two glaring examples from South India and Arunachal Pradesh in North-east India typify the problems faced by people living in and around forests in India. However, the key is in access to basic health care and livelihoods. Wildlife scientists today see this connection between people’s basic needs and their conservation ethic. In fact, it was a group of wildlife biologists that started a community health care program and an education initiative among the Lisus. I went there to train a group of tribal youth in basic health care. Among other things, I wanted these youth to be able to identify and institute treatment against malaria. It was indeed a satisfying experience for me, to see how wildlife biologists had looked beyond their paradigm of biodiversity conservation, and had looked for solutions outside ‘their box’. We, in health care, sadly are yet to make this connection. A glance at our curricula reveals the level of medicalisation that we undergo. A glance at our policy shows how fragmented and restricted it is.

Shrinking forests are an important reason for climate change, and so are empty forests; forests devoid of their biodiversity. While hunting empties forests in some places, it is firewood needs and fires in other places. It is after all people, who are to blame for this. People living in and around forest areas depend on them for their livelihood and daily needs. And when there are financial pressures for any of their needs, they turn to their resources – forests. Thus, they find themselves being the villains accelerating deforestation and emptying the forests. Isn’t this the same thing that our forefathers did, that we find ourselves in this position today? Can we blame them for being late in destroying their forests, just because, we thought of legal protection for it now, and we have climate change now! As population pressures and urbanization increase in India, rural and tribal India face a different problem; one of access – both physical and financial. It is time for health planners to consider the special needs and contextual factors affecting tribal
people and those living or affected by forests. It would be presumptuous to imagine that national programs for any of the diseases will change the situation with these people. Lisus or Soligas and for that matter any individual is not asking for malaria control programs or early cancer detection programs. They are asking for plain health care – financial and physical access to a person who can cure them of their illness and can help them live a healthier life. A malaria program for them is even lower in priority than a road or a source of livelihood, simply because, they have accepted malaria deaths as their destiny. It is perhaps time to think beyond programs and address health as a need in itself rather than health as a consequence of our programs.

Aphu died of malaria in his early 20s only because he was born in a place where climate change and the biodiversity mattered more than his life. In many areas the world over, where man-wildlife conflicts occur, the situation is similar. How are we going to prioritize between biodiversity conservation and people’s needs? Are our politicians and policy-makers even seeing this problem of ‘First among equals’? The global health research agenda needs to gear up to answer these difficult questions; questions that matter to people dying of malaria in this age, when in many countries, research is addressing carpal tunnel syndrome.