By Md. Uzair Belgami:

The following words are addressed especially to you, those who hope to realize the ‘Great Dream’ of entering a medical college. The following words are also addressed to you, those who are studying or have finished your Medical degrees, and are now living the ‘Great Dream’ of studying/having graduated from a medical college (though, of course, I presume most of you, by now, have come to realize that the “Great” in the above expression, mainly signifies the “great” volume of the syllabus, rather than the “dream” itself!)

I would like to convey to you something very important, something which you, of all people, should be well aware of and anxious over, and yet it appears, are pathetically & woefully ignorant and apathetic of. I would like to tell you very briefly, about the health situation in India:

Today, India is considered around the world as a rapidly developing country posting economic growth rates of around 8-9 percent consistently over the last several years. Along with China, which is much further ahead, India is seen as a powerhouse of the global economy in the decades to come and already it is home to a very large number of dollar billionaires, perhaps the largest such number in Asia.

If you take a look around this vast and populated country though, the picture that one sees is not as rosy as it is made out to be. India is also home to the world’s largest number of people living in absolute poverty. In 2007, a study on the unorganized sector in India, based on government data for the period between 1993-94 and 2004-05, found that an overwhelming 83.6 crore people in India live on a per capita consumption of less than Rs.20 or O.50 US cents a day.

In 2010 a UNDP/Oxford University study, using a new Multi-dimensional Poverty Index (MPI), said that eight Indian provinces alone have more poor than 26 African nations put together. The report said that acute poverty prevails in Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh and West Bengal which together account for 42.1 crore people, 11 million more “MPI poor” than in the 26 poorest African countries!

India, today, is harboring a major health disaster, which can be described quite accurately as a “genocide”. There is a specific technical reason for using the word genocide and it is not wielded in a rhetorical manner.

The Indian National Nutrition Monitoring Bureau (NNMB) tells us that over 33% of the adult population of India has a Body Mass Index of less than 18.5, and can be considered as suffering from chronic under nutrition. If we dis-aggregate the data, we find that over 50% of the scheduled tribes (Adivasis), and over 60% of the scheduled castes (Dalits) have a BMI below 18.5.

The WHO says that any community with more than 40% of its members with a BMI below 18.5 may be regarded as being in a state of famine. I hope you realize, that by this criterion, there are various subsets of the population of India – the scheduled tribes, scheduled castes etc. which may be regarded as being permanently in a state of famine!

So, it is not any general population that is suffering the consequences of poverty-induced malnutrition but specific ethnic groups and hence the use of the term ‘genocide’ as per the United Nations definition. All this is, of course, in addition to the mundane reality, to which we have become habituated, of 43% of children under 5 in India being malnourished by weight for age criteria. India has the world’s largest number of malnourished children and according to the UNICEF, over 20 lakh Indian children die every year due to malnutrition related diseases.

The salt in the wounds, is the scarcely known fact that it is precisely these sections of the population, the tribals, scheduled castes & tribes living in malnourishment and famine, are being subject to ruthless land displacement policies and exhortation of their natural resources, for the development of industrial power-houses and factories, the benefits of which the victimized people scarcely receive. It is ruthless and pitiless genocide — and shockingly, with the primary responsible being the Indian State.

In our country, the “future superpower” of the world, under-nourishment kills around 25,00,000 people annually, malaria kills 9,00,000, air pollution kills 5,27,700, tuberculosis kills 4,00,000, and road accidents kill over 1,00,00 people annually! These are all preventable causes of death! It approximates to around 12,000 Indians dying every single day. There is no conflict in the world, no terrorist, or no President, because of whom the daily toll of lives reaches such catastrophic peaks!

The country you live in is one in which even the silent genocide of millions every year due to neglect and poverty, does not touch the conscience of the rulers, or the conscience of the public at large, or most pitiably the conscience of most of the medical practitioners & students. Nobody is deemed punishable or accountable for these deaths due to disease as they happen without a single shot being fired or any explicit form of violence used.

Nowhere else in the entire world will so many people be allowed to die like this every year without sparking off a revolution!

So, amidst this deluge of misery and injustice, the question now lies heavily on your shoulders, why are YOU studying medicine? The question was posed to some of my classmates at the Bangalore Medical College, and their answers (I am sure they would be similar among any other students in any college, across India) ranged from:

“Well, because it was the most prestigious career choice, and there’s lots of money involved while we’re also helping people”

to, “My father is a doctor, so I too became one”

and, “I want to study medicine here, then go to the United States. Doctors earn so much money there!”

also “I don’t know, I guess I kinda like wearing white coats”…

Amidst the entire situation I have described above, this, for me, is the most frustrating and depressing! The medical students in India, who are most apt to arm themselves with the knowledge and know-how to make a meaningful contribution in the health situation in this country, are some of the most apathetic and insensitive. The medical students whose voice would be respected and listened to keenly if only they chose to lend their voices to those that need them, instead are too busy studying for entrance exams and the like. The knowledge of ‘medicine’, which could be used to effect a great change in this horrendous environment in which we are living in with our eyes closed, is instead treated as just another career and livelihood by doctors and medicos. Our system of medical education is such that, it creates people who gain a lot of knowledge on medicine – but, it seems, lose their conscience along the way.

So, my advice to all medical students is this: widen your horizons, do not be just another one of the cattle in the herd. Start reading whatever you can find, in books, in websites, in magazines, even on facebook — about the repulsive health conditions in the country we live in. I promise you, the more you read and learn, the more shocked and appalled you will be. Go on a trip with your friends to Chattisgarh, to Bihar, even to the nearby village just outside your town/city, or at the least, the slum which I am sure you will find not more than 5 kilometres from your house. Pull your head out of the ground that you have unconsciously stuck your head, ostrich-like, into. Explore Indian society in its comprehensiveness and reality — not just the upper 5-10 percent of society that we comfortably, happily live & dream in. Do this, and you can take my word, you will not be the same. Do this, and you will not look at ‘medicine’ in the same selfish, apathetic and oblivious manner. Do this, and I very much believe & hope, you will be inspired and extolled by your conscience onto a journey towards a meaningful and serious contribution to health, to humanity in this country.

How exactly you will set about on this revolutionary path, how you & I can change these repressive & depressing state of affairs? this is the subject for another discussion, which will be very soon I hope. For now, let us start thinking and understanding the why, rather than the how. Let us start reading, travelling and understanding the situation here in India, outside of our comfortable little lives. Let us learn what we so criminally and unfortunately are not taught in our seminar halls, but which is so absolutely necessary for us, as medical students and doctors to know. The challenge and urgent necessity for us today, is to connect our medical knowledge and courses — with humanity, with the society (not just the small percentage of society we live in, through which our eyes are never able to see, but the whole Indian society). This situation will not be tackled by a host of speeches and ‘thakreer’, but through youth who will strive with their lives and their ‘career’. I hope we can discuss & explore this further and share ideas in the future. Until then, keep pondering, and keep wandering.

Perhaps your reading this, will inspire you to think about the large majority of this society who are isolated and ignored, and not just the upper fortunate few among whom we so proudly serve, with the prestige & status of the ‘white coat’. Perhaps you may begin to hear the silent voices of the millions, who are calling for your help, whose future you can change. Perhaps, this may inspire you to a new beginning.

By
Md. Uzair Belgami
House Surgeon,
Bangalore Medical College & Research Institute

Large Excerpts & Data taken from
(1) the speech of Dr. Binayak Sen at Gwangju, 2011
(2) The Editorial, “Health & Society/Sehat aur Samaj” journal, issue 1, by Satya Sivaram