Volume 002

Public Health

May 2021

The Femur Bone

There is a Margaret Mead story that comes back to public consciousness each time crisis hits. Mead, an American cultural anthropologist who radicalized science and sexuality in the 60s and 70s, especially by making them talk to each other, was once teaching a class. A student raised his hand and asked what was the first sign of civilization in a culture. Expecting fishhooks, clay pots or even evidence of fire as an answer, Mead contradicts expectations by saying that the first sign of civilization in an ancient culture was a femur (thighbone) that had been broken and then healed.

Mead goes on to explain that a broken leg, in ancient times, means you die. You cannot run from danger, get to the river for a drink or hunt for food. No animal survives a broken leg long enough for the bone to heal.

But a broken femur that has healed is evidence that someone has taken time to stay with the one who fell, has bound up the wound, has carried the person to safety and has tended the person through recovery.

Helping someone else through difficulty is where civilization starts, Mead said.

We all felt this instinctively during the second wave, didn’t we? Whether we were in an ICU giving our loved one, and the patient next to them, a sponge bath because the nurses were so exhausted, they could barely speak. Or when we were on the phone with strangers, guiding them through symptoms and D Dimer reports, or on Zoom meditation sessions with another set of strangers, chanting names of people we have never met.

As the forces gathered, cohorts of care grew. Even as we saw the largest civic action of public safeguarding each other’s physical, mental and spiritual health, we felt we needed to investigate how we got here. In a time when Ketto has rebranded itself as a medical bill fundraising site (48 crore raised by citizens for other citizens), what is the promise of public health that India makes to its taxpayers?

A feminist public health approach is rooted in social justice, calculates efficacy only if the underserved are served, and questions assumptions about what is enough. It politicises care, even as it celebrates it as a fundamental human value. It regards the well-being of the planet, and everyone on it, as a pre-requisite to individual well-being. It makes it plain that there is no right to life if there is no right to health and connects dignity and equity for all its cornerstones. As a feminist education enterprise we are moving beyond the critique of public health in India to investigate solutions; structural, clinical, and some that have existed in community knowledge but are currently under the spell of neo liberal amnesia.

In our instinct to learn, in the following eight weeks we will speak to economists, doctors, activists, policy makers, community medicine experts, ASHA workers, health reporters and climate change specialists to put together a map of possibilities. If we are building a new feminist future, what would public health look like?

We have Ashish Kothari tell us about communities that survived the pandemic in ways that may sound innovative, but could just be plain old sensible. We have Menaka Rao, a health reporter who ground her teeth in TB wards, on what we didn’t learn from the TB epidemic. We have Dr. Sanjida Arora from CEHAT who argues for violence against women to be seen as a public health issue, and reminds us that we still have medicine textbooks in which heart attacks are only had by men. We have Clifton D’Rozario, who reminds us that Right to Food could be the starting point of any public health debate.

There is the intrepid development economist Reetika Khera who tells us how investing in public health actually makes economic sense for the country. We also have Dr Aqsa Sheikh who gives us five incredible tips on making public health more accessible for people across sexualities, and religions. And Sunita Rani, an ASHA worker from Haryana tells us the reasons behind a rising trust deficit between the communities and the state, and some chilling stories from the ground.

We have a disturbing reality check on how the digitisation of health with the UHID impinges on our consent as well as right to privacy with Rohin Garg of Internet Freedom Foundation. To understand how ableism influences public health, we have Dr. Shriyuta, who breaks down the hierarchy of healthcare (able bodied, upper caste males make our curricula and policy). And prisons were on our mind this last few months, especially the question that what happens to our right to health when we are incarcerated? Anubhab Atreya of Studio Nilima, an Assam-based research collective explains why prison health is public health.

On Nirantar Radio, we have the podcast that was an excuse for us to exorcise our ghosts; in Living on Your Own in the Pandemic, we speak to five people across urban and rural, across age, gender, ability, on what living alone in the second wave was like.

Apeksha Vora did sessions with our field digital educators, which used theatre pedagogies to help process pain and grief in our bodies, to help us process the pain and grief we were witnessing in our neighbourhoods. From empty hand pumps to too many prayers in the local mosque, you can watch what rural India felt, and read the pedagogy here.

If you haven’t read our backstage deep dive into the volunteer networks that turned the second wave of Covid-19 into a storm of collective care, do read it here.

Prompted by Ashish Kothari, and in our commitment to alternatives, we bring to you two community models of health. We have Dr. Priyadarsh Ture from Shaheed Hospital in Chhattisgarh, a hospital which still gives out a bed for Rs. 10, and was built by miners, for the miners’ community, and now serving tribal populations across the district. From Sittilingi in Tamil Nadu we have  Dr. Lalita Regi, who helped found the Tribal Health Institute, a full fledged hospital run and owned entirely by tribal communities, which also comprise its medical staff. 

In our research, the familiar holy grail named Public Private Partnerships kept rearing its ever-growing head, so we spoke to Bijoya Roy of CWDS, who has been in research around PPPs for years. She offers a bracing reality check on how PPPs have shaped the healthcare sector, and hence redefined the role of the state, often at the cost of the citizen.

The cost that the citizen bears is documented in Indebted, our co-produced video report with Chambal Media, that reminds you why medical debt continues to be one of the largest drivers of poverty in India.

As part of public health, we are looking at mental health beyond clinical definitions, and through voices that challenge normativity. Jayasree Kalathil’s is a writer, activist and researcher, and has worked for decades to challenge a medical model in understanding psychosocial disabilities. In her interview, she takes us through methods of peer support that may help us see that non consensus reality could be the only reality. Dr. Kiran Valake, a medical practitioner, writes a much needed essay on how caste realities intersect with overall health debates, as well as the very experience of being a student in a medical college. And do listen to our podcast series Mann Ke Makhaute, in which we interweave literary fiction with real life experiences, to explore grief and emotional violence

The learnings are coming to us thick and fast, and we hope that these conversations and insights iterate what all of us have been feeling. My health, and hence my life, is connected to yours.

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