A Public Health Emergency For All

This was meant to be posted yesterday but, the euphoria of Mangalyaan was so infectious that I decided to leave alone morose contemplations of health and disease for a little while. There is much too much that public health service delivery should learn from ISRO even if, the canvasses of space science and health are vastly different and make for tenuous comparison. Mangalyaan and ISRO’s success provoke the question of when (if ever) will health have its Mangalyaan moment? Perhaps, our comparative moment was with Pulse Polio. Perhaps too, euphoria moments are rare in health whatever the achievement. Unlike a World Cup or a Mangalyaan; with health, it is very hard to mobilise a sense of ‘us’, ‘community’ or ‘nation’. The subject seems to engage interest only when it makes a personal house call. Until then it is ever straitjacketed as the outsider other. This indifference is responsible for much health related crises irrespective of whether the sphere is public or personal. Almost universally, governments wake up to the huge price that must be paid for ignoring Health up and until the time when disaster hits. It is just such a situation – a tragic, devastating, and heart breaking crisis – that the West African nations of Liberia, Sierra Leone and Guinea face today with the latest Ebola outbreak. It is a crisis so grave that its spill-over consequences threaten the economic and social stability of these nations and their very future.

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Yesterday, both CDC and the WHO released their modeled predictions for Ebola. The picture is expectedly bleak and both agencies stressed the imperative necessity of an immediate and all-out international response to control the epidemic.

Total number of cases in 2014 (CDC figures)

On 23rd September

5864 (3341 confirmed) Cases are spread over four countries; three of which are completely ravaged and overwhelmed

On 25th September

6263 (3487 confirmed)

Deaths

2811

2917

The total number of people reported to have the disease, in 2014 alone, is greater than the sum of all cases since 1976 when Ebola was first discovered in the DRC

More worryingly, the disease is seeming to grow exponentially with a doubling every three weeks – 47% of all deaths have occurred in the last month. Liberia, especially, is reeling with a 68% increase in the cases in just the past month

 

Prediction figures

Total number of cases by end September

21,000 (CDC)

Total number of cases by early November

20,000 (WHO) More conservative but agrees with CDC on overall long term projection

Total number of cases by mid-January

1.4 million (CDC)/ 500,000 to 1.4 million (WHO)

Public Health response to epidemics. Preparedness as response

A public health crisis of this kind – unexpected with devastating consequences – brings to fore the role of governments in the health of people. The poverty, poor social indicators of health, and inefficient health systems that exist in these African nations are prevalent in many other parts of the globe. Naturally, anxieties are high, world over, about preparedness and response in what really is a time of war for public health. In such a situation, the role of government narrows down to the swift execution of classic Disaster Response and Containment. An effective response strategy is executed with: a) the ready availability of a health force equipped with necessary tools for infection treatment and containment, b) a robust technological database that maps numbers and geography with necessary intervention and, c) a coordination force that links field staff with central command structures for effective exchange of information and response. 

Preparedness is the best response in a health crisis. A lesson India will do well to learn and implement.

But, can a government respond effectively in war when it has not equipped itself during peacetime? What is the level of preparedness that the Indian Government has in place? Peacetime public health interventions require an investment in preventive mechanisms, primary health and, health and sanitation literacy to pre-empt and curtail the spread of an infectious epidemic. A vital public health system should demonstrate:

1.    Adequacy of Healthcare Personnel – Our current Doctor to Patient ratio stands at: 1:1800 The WHO recommended ratios are: 1:1000. Even less airtime is given our acute shortage of nurses. In India, it is estimated that, to reach a Nurse to Patient of 1:500 we would need to shore up the number of nurses to around 2.4 million. There is a growing understanding that a significant amount of medicine and foundational healthcare can be delivered by para-medical training through ancillary academic programs. Such training will concentrate on a more practical hands-on-the-ground training with less of an emphasis on theoretical rigor.  At every level of health care delivery, whether primary generalist or tertiary specialist, nursing care is the most critical pivot around which containment and cure revolve. Degree certification in Rural Medicine and Nurse Practitioners aim to do just that and the government must institute them at the earliest. Not only will such a training empower local population; it will also provide a vital cultural connect to facilitate behavioral change.

2.    Regional/ District hospitals dedicated to Infectious Disease, Primary care, Maternal and child health and Prevention – Instead of setting up large tertiary centers and medical colleges in urban areas that compete with private enterprise; public health is better served by the ramping up mid-size district hospitals that are equipped to treat and respond to acute care. In the scenario of an outbreak, acute care entails early diagnosis, aggressive supportive therapy and isolation. The delay in the diagnosis of Ebola 2014 underscores the need for diagnostics on the ground. While remote tertiary centers can confirm the same with more sophisticated technology; immediate preventive measures can be kick-started on the ground. These nodal centers have great expertise with common and indolent chronic infections but need to be equipped and drill-prepared for more acute and unexpected scenarios.

3.    Training for all ancillary support staff in standardized supportive care and isolation protocols – Apart from training in supportive care, all healthcare personnel must have periodic training in methods of isolation, contact tracing and data recording. When this is enforced in the daily practice of medicine by doctors, training preparedness is easily scaled up on demand. The primary aim of all these measures is for containment to restrain an outbreak to as close as possible to its source. Our population density and 21st century mobility underline the importance of this vital step.

4.    Technology – Coordinated action is a vital part of health. Telecommunications, data and record keeping and telemedicine must link regional health centers with a centralized chain of command to oversee and coordinate. There are enough reasons for such an interlinking to be in place during peacetime. Reasons such as maternal and child health, malnourishment, tuberculosis and immunisation; all of which can benefit from a standardized and coordinated action. It is not just the technology that will be in place if crisis strikes; the work ethic of coordinated and cooperative team action with an adherence to protocols will also be ready to hit the ground running.

5.    Last but, perhaps, most important of all – Health literacy. This phrase has been in use in policy manuals and training modules for so long now that it might well have lost its meaning. The most critical aspect of health is the end-consumer. When that person at the bottom of every policy initiative is empowered with basic health and sanitation literacy, it is then, and only then, that vitally important behavior change can happen which in turn will ensure the effectiveness of public health measures. Without the cooperative involvement of the community, public health investment will continue to be good money down a long leaky drain.

Can Universal Health Coverage – a peacetime strategy – mitigate the consequences of an epidemic? Can it mitigate the spread of an epidemic? There is ample reason to believe it can. UHC is not an end-game. It is the strategy that opens up the door to more strategic allocation of government resources in health.

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In the NEJM’s special issue on Ebola; the President of the WHO writes on the critical role of poverty in the spread of disease through the poor and underdeveloped regions of the world. It is the nature of epidemics to strike first at groups that lack access, to health and to support factors grouped together under ‘social determinants of health’. Some of which are poverty, overcrowding, malnourishment, poor immunity due to other chronic debilitating diseases, poor access to water and sanitation and, illiteracy. Access to health, sanitation and literacy are the game changers in this cocktail. Armed with these, people have the necessary enterprise themselves, to equip for push back against the others.

Public Health Coverage does not only empower the poor. Critically, it also opens a window of opportunity for the government to streamline its engagement with health delivery – how much, in what and to what spread? In India, there is an extensive public health network that is  already in place. Much of it is poorly staffed and inefficient forcing people to choose private medicine with the burden of heavy out of pocket expenses. Rural Medicine and Nurse Practitioner certification will provide the necessary manpower.

With a focus trained on delivery of specific services, public health can concentrate its energies on foundational primary care, prevention mechanisms and health literacy. Further, mapping tertiary treatment to coverage in private centres (as is already underway with RSBY) will ensure access to all tiers of healthcare. Health insurance coverage must be made mandatory for the middle class and above. Both arms of Universal coverage will need strong government regulation and price controls.

For India’s health policy makers the Ebola epidemic is a critical wake-up call to review strategy for the way forward. In 1991, an economic crisis forced India to deregulate and push through reforms that were totally alien to the existent climate. Decisive, out of the box thinking at that crucial juncture put the Indian economy on a trajectory of growth and economic development. This is Health’s 1991 moment. A carpe diem moment to strategize for 21st century realities with the aim of creating a health system that is prepared and delivers.

Universal Health Coverage is the lead wagon on the new track.  The constant chatter of economics, investment, free markets and trade is jarring when there is no parallel movement on the critical sector of health. What will it take to get the Ministry of Finance to share space with the Ministry of Health? For our policy makers to comprehend that it only takes one wretched, measly little virus to bring the whole pack of glittering cards tumbling down. To comprehend that our health system needs an urgent revamp and needs it now.

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Supplementary information:

Atypical presentation of Ebola 2014

The current outbreak has two specific and distinct geographical clusters – one centred around three adjoining nations of Western Africa and the other, in the DRC (Democratic Republic of Congo). These two loci are sharply distinct with no traceable contact and have been declared to be separate and independent of each other.

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Ebola is a viral zoonotic disease. In other words, it is caused by a virus that is usually found in animals and which infects humans only upon transmission by direct or indirect contact with the animal. Fruit bats have been identified as the most likely reservoir source of the Ebola virus. The initial point of contact between bats and humans (whether it was single point of contact or multiple and if so, how) is not confirmed but suspicion strongly points to improper sanitization of bush-meat. Once Ebola takes root in a human, it can then spread from humans to humans through contact with the body fluids of the infected person. Therefore to contract the infection, one must necessarily be in contact with infected fluids like saliva, vomitus, blood etc. This makes the disease far less contagious than airborne viruses like influenza. Yet, its virulence and its rapid spread due to patient mobility is reflected in the high case fatality rate and the rising numbers of those infected.

The nations of Western Africa have not reported a single case of Ebola before this outbreak. The only known case from Cote d’Ivoire was in a vet who was infected while performing an autopsy on a chimp. He recovered and the disease ended its run in him. No other case has ever been recorded from the region. Further, the symptoms are very similar to two other diseases – Cholera and Lassa fever – both of which are endemic to the region. Naturally, it was these more common diseases that were initially suspected to be causative. With no prior experience with Ebola and with no sophisticated diagnostics on the ground, the crucial diagnosis was delayed for four months between the initial breakout in Dec 2013 and confirmation.

How are epidemics like this controlled? Ebola spreads by contact. So, the first measure is strict and comprehensive isolation. Isolation is the most effective method of containment of rare and rapidly spreading epidemics. With isolation, the virus is denied access to another host (an uninfected human body), terminates its life cycle in the infected patient and the infection’s spread is halted.

The other measure by which the infectious outbreak is controlled in the group is by raising immunity through vaccination. Responding to the urgency of the deadline many experimental drugs and vaccines are currently being rushed down the pipeline but it is an enormously difficult task to research, put through trial, and manufacture sufficient quantities of drug. Antiviral therapy is often seen as a magic bullet. It is not. The human body mounts an immune response against the virus. Shoring up the body’s natural defenses and treating the clinical consequences of Ebola (dehydration and electrolyte imbalance) with simple supportive therapy can make a big difference to the case fatality rate.

International Response

The national responses are creditable considering the prevailing circumstances of desperate poverty and inefficient heath systems in countries just recovering from debilitating economic consequences of protracted civil war. But the sum of many delays in diagnosis and the lack of a timely and coordinated international response have been costly. Also, the dissemination of information, in a calm and assured manner, on the importance of isolation and sanitation would have helped win public cooperation and support. Instead, there is now the additional burden of dealing with a fearful and restive public. A climate of mistrust, stigma and superstition has made many patients go underground and a large number of cases are unreported.

MSF deserves much credit for its stellar commitment to the ground task from the very beginning. In August, the WHO declared Ebola an International public health emergency and joined MSF in underscoring the need for urgent and immediate international aid. Significant action on this front has been the establishment of two global initiatives – the Global Health Security Agenda and UNMEER (UN Mission for Ebola Emergency Response). UNMEER has been called the greatest peacetime challenge that the UN will mobilize and for now is centered in Accra and will oversee an international coordination and mobilization effort from there. Established through a unanimous UN resolution on September 23rd; it speaks volumes of the urgency of the situation that an UNMEER team is already on the ground. The UN estimates $600 million as the cost for regaining control over the situation. Individual nations have lent assistance to the international and non-governmental organisations with ground health care workers and aid. India has around 45,000 of its citizens spread over the region and has lent an initial assistance of $500,000. Within the country; airport surveillance, quarantine and contact tracing have been engaged in high gear.

The governments of Sierra Leone and Liberia have repeatedly stressed the urgent need for health care personnel and beds. The NEJM reports that a facility treating 70 patients needs at least 250 health care workers. MSF has a current capacity of 180 beds in Liberia. They need at least 800-1000 more in that country alone.

The difficulty of mobilizing large scale hospital and isolation workers and equipment in a short time has prompted suggestions from the medical community to enlist those that have recovered as a volunteer task force. Another suggestion that has found less unanimous approval is mobilizing local society with training in home care as was done with the last century’s small pox epidemic. This dilemma for strategists is increasingly fait accompli for patients and their families. Treatment centers are overflowing with patients who can’t be treated because of an insufficient number of beds and healthcare workers. It is in this circumstance, of an overwhelmed health system operating in a climate of social unrest and fear, that homecare and home isolation is still being considered (despite its great risk of unmonitored isolation and supportive care) as a viable interim measure.

 

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Paraphrasing Mr Mehta

For writers, the fashionable dictum of our times is: Keep it short and keep it simple. Fewer words, inclusive styles and conversational vocabulary are readability mantras that writers use as editing guidelines for the first draft. As with every evolution this journey too has many reasons; all satisfyingly, argument worthy. High on my list are the democratization of both writing and reading and, the end-of-century dominance of the ‘American way’ in all things life and living. After all, writability is hardly worth pursuing when the game is one of numbers and anti-anti elitism is the new exclusive club.

What came first is yet another chicken and egg conundrum. Did reading styles, that skim and speed read for take home points, devalue the exercise of crafting a good sentence? Or did the proliferation of writing, as wrap for a couple of readable comments, bring out our closet speed reader? However that argument resolves itself is not relevant to the generally accepted notion that much writing today is driven by the urge to opinionate, not interrogate. Ultimately, canonical faith needs to persuade in simple and familiar language if it wants to propagate belief.

“Never use abstract nouns when concrete ones will do. If you mean “More people died’ don’t say ‘Mortality rose’”. Famous pithy takes on writing like this quote from the redoubtable CS Lewis, are unfortunately used to make the case that words of more than seven to nine letters make for ponderous prose. It is true that deconstructing highfalutin concepts to comprehensible prose is a fundamental need for the popularization of academic subjects. It is equally true that simplistic prose in commentary cannot hope to stimulate anything more than simple thought. This is proven, without much effort, by the visible degeneration of Opinion columns to little more than, ‘have opinion will write’ drivel.

A writer who breaks this mould is Pratap Bhanu Mehta. His column in the Indian Express is a joy to read not only for the content of his thought, but also, for the style with which he articulates it. Almost every sentence manages the feat of being both scaffold for its kin and a stand alone quotable. His latest in the paper does not fail expectations. Writing on the flaws of the UPA as a cautionary tale for the new government; it is counsel that we would, each of us, do well to read and emulate in our own spheres of influence.

As tongue in cheek response to my own griping and as annoyed counter to a friend’s use of the word ‘pedant’, and also, with apologies to fans of new age wisdom; I have paraphrased his words to fit the standards of ready reckoner readability.

  1. Institutions sustain and enrich our lives. Whether in our personal and professional relationships or in our daily interaction with impersonal systems like the Law; it is worth remembering that each one of us is a cog in the wheel. We need to work on the wheel in order to make it turn and spin our way. Expectations always stand second in line behind responsibilities.
  2. It is more important to be credible than clever. Without the credibility of belief and/or action; argumentation, however cleverly spun, will fall flat.
  3. Plan for the long-term. The short-term is but a rung in the ladder that can be adjusted for height. You don’t have to win every battle. Let go of a few; but (and this is an important but) let go with the clear foresight of a purpose bigger than the moment.
  4. Confidence in self can degenerate, without warning, to intellectual sloth. Channel confidence to build credibility. Validation is a virtuous cycle.
  5. Nurture criticism without rancour. Without honest feedback, you are trapped in an echo chamber where all you will do is wither and fade.
  6. Communicate to get to power. Communicate to stay in power. Communicate to rise in power. In short; communicate. No one is born a mind-reader. Very few study to be mind readers and then, they often get it wrong.
  7. Never underestimate the power of error. Or, the power of others who will drum up your errors for their gain. A rise into grace is never as spectacular as a fall from it.

With this effort, I am assured that all clamour for dour, bulleted, get-to-the-chase prose is doused and that you, my dear reader, have fled this page to the delights of his own meticulously crafted one.

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Responding to #VAW. Once more and again

On a good day; it is hard to find much that’s wrong with Twitter. The bonhomie, the banter, the cerebral and the goofy, all meld together as epitome of all that is wonderful with it. But, the communal nature of the place ensures a downside too. And that, is the sadness which queues up in Timelines with a regularity that’s almost predictable based on who or what you follow. Sorrows happening elsewhere find their way into our lives here, as news feed of obits and, brutalities scroll past disbelieving eyes in varying shades of vile and venal. They come to inform, to instigate grief and outrage and from there, hopefully, to initiate change. That they come with expectations of response is obvious. What the nature of the response should be, is less certain.

Obits have the acronym that sounds more like a barking order than honest grief. Even if, its rampant use seems more like misuse; at least, it is harmless and well intentioned. On the other hand, our insta-response to the more common stories of murder and mayhem, combines rage, abuse, argument and misinformation, is designed to be little more than a vent and must therefore give us some pause. Yet, against every common sense, we rise easy to provocation. Rise in collective reaction as giant waves of outrage that we direct against systems and mind-sets; but, that instead, somehow manage to crash on our own borders as shipwrecked fury. In a rare case, this outpouring leaves behind a ripple of online activism that vows to hold the flame. More commonly, it’s over almost as soon as it started. And we are alone again with the familiar hollow feeling; a nag of: something done but nothing achieved. A feeling of having clanged doors that turned out to be windows and that, still, didn’t open.

Despite these misgivings, I’ve been on Twitter long enough to know that its outrage is rarely ignored. The swell from here spills over onto the MSM and from there to the powers that be. That ought to feel like a good thing. Yet, it reeks of short-term gain with no definitive long term outcome. More unhappily, that short-term gain is usually nothing more than mere tokenism but it seems to satisfy and the storm of our rage is allowed to dissipate.

Violence against women (#VAW) is one such example. It is episodic, complexly intertwined with many other social determinants, and is often happening elsewhere and to someone else. Every now and then, a particularly unspeakable horror is inflicted on another hapless sister, our carefully constructed assurances crumble once more and again, we rise in a clamor of outrage. The same cycle repeats and it goes like this: We convince ourselves the sound of our sinking sorrow is actually the cadence of our rising voices. The noise hits tipping point, some token response is crumbled our way (the standard for rape now seems to be – fast-track courts), we pipe down, carry the grief around awhile, and limp back to the routines of our lives. Most of us have neither the time nor the energy to be single-minded about staying on course with something that is periodic and happening elsewhere. That last about it ‘happening elsewhere’ is often used as accusatory judgment. In reality, no ‘elsewhere’ is that far that we don’t feel the desecration each time as if it was our own. The next time too (and there will be a shameful next time) we will return to re-enact the stages of our public grief. Excoriate ourselves for not doing enough. Set ourselves up to be judged by cynical eyes that view our reactions as, flavor-of-the-moment activism. Every woman knows in her bones the falseness of that charge. But, Twitter after all is the giant sinkhole that sublimates our closet dilettante.

WSJ Graphics         A Rape Map Of India: Pic Source

This time, it was Badaun. We are still going through the stages as I write. Nothing new; nothing different. Even the standard diversionary shift is down pat. In this case, it is an argument over photographs – should they have been posted online. Meanwhile, the children are dead. Tokenism is out in full force and our grief seems to be waning.

It’s embarrassing. And distressing. That a matter of such importance is colored by so much drama and so little gravitas. What difference are we really making? What difference has been wrought? What are we hoping to spur with photographs? What are we doing here that is changing anything on the ground.

The Delhi protests against the Dec ‘12 rape of a student (called by many monikers, none of which I like; but, uncertain of what the law says on the subject of naming her, I’ll toe the line and call her Nirbhaya too) were indeed a defining moment. Out of that came: the Verma commission report, a 1000 Crore fund in Nirbhaya’s name, the Vishaka guidelines for workplace harassment (originally espoused in 1997) passed into Law and six dedicated fast track courts that were set up for Delhi alone.

Unsurprisingly, all of them have problems. The 1000 Crore fund proved to be one in name -barely a Rupee has been allocated; the Verma Commission’s suggested changes to the Vishaka guidelines have not been incorporated and the jury is still out on the benefits of fast track courts. Most of the Verma Commission’s recommendations, though considered thorough and comprehensive, are yet to be implemented. The only heartening news is that the number of reported and registered complaints of harassment and rape have gone up. But, here too, the convictions continue to be few and far between.

In light of this, of what use is outrage? The scrolling stream of erupting emotion seems to have little, if any, teeth to mobilize actionable change on the ground. In despair, this time, I tried tagging the Prime Minister – an exercise in foolishness for someone with my modest profile and as expected, it yielded nothing.

Our response to rape and #VAW might yield a better result if it is channeled at a specific target and is incisive and persistent in its attack. The problem of rape has thrown up two such targets. One: Police reform. A factor that has time and again been cited as a potential game changer for gender abuse. And, two: Inadequate sanitation. Badaun has once again brought to the fore the horrific chance-consequence of a lack of sanitation. What for us is a matter-of-fact guarantee as to not even merit a second’s thought; for these children, is a matter of life and death. The simple ordinariness of a humble toilet should become something that girls and women get used to having in the relative safety of their homes, schools and communities.

As with most other things; for outrage to be effective it must be directed at a precise target. The word ‘Rape’ doesn’t fit the bill anymore. ‘Police reform’ and ‘toilets for girls’ do and are actionable targets. Activism directed at them will be a harbinger of a more lasting change.

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Jallikattu – a case for cultural evolution and responsible activism

This is a very hard subject to write about. But, it must be done since I am now answerable (to myself primarily) for commenting on Twitter, twice, both times without having considered the issues particularly incident to the case. It must also be done because I am an ardent believer in animal rights and support activism for the cause.

It is hard to write; for, the exercise necessarily entails I appraise myself of the details and circumstances of abuse are very hard to read and digest. Sometimes, you simply don’t want to know the grit on the ground. Floating in the abstractness of the measure of blue in the sky (very interesting by the way) is so much more comforting by contrast but, you then shouldn’t be mouthing off on activism. So, suitably chastened, I set out to understand the facts about Jallikattu with as bipartisan a view as I could summon.

History

Jallikattu lays claim to a hoary history and antecedence from the Tamil Sangam period (300 BC- 300 AD). A celebrated literary work of the time – the Silapadikkaram, describes a bull-fighting sport which also seems to have doubled as a Swayamvaram (a festival wherein prospective grooms had to demonstrate their suitability by passing a series of obstacle tests). Clearly, the sport has evolved from then. The modern day version is traced back 400 years to the reign of the then King of Madurai, Thirumala Nayikar. Today, it is neither a bull-fighting sport; nor a test for matrimonial suitability. It is now diluted to a bull-taming festival but retains a vestige of masculine preening and is meant to be practiced thus: ‘aggressive’ bulls are released from their pens into enclosures and young trained men demonstrate their valour by charging the bull and holding onto its greased body for as long as they can; before, either the bull flings them down or, the men quiet it down. Generations of selective breeding have resulted in recognizable groups of especially mighty and temperamental bulls; the more famous among them is called, Pulikulam.

Controversy

Jallikattu is considered cultural tradition in the deep South districts of Tamil Nadu where it is practised. Apart from heralding the harvest festival Pongal, it is also seen as mandatory to auspicious fortune. But, a sport that involves a battle of strength and wits between powerful bulls and headstrong men cannot be docile. Whether due to heightening animal activism, religious globalization or simple tourism; the sport has come under increasing scrutiny in the past decade. Further, in an unfortunate collision with the flat-world hypothesis, an equivalence is alleged between the tortured cruelty of the Spanish bull-fights and this bull-taming sport despite ample knowledge that the bull (by every account) is neither ever killed nor is it intended to be. Yet, in recent years (and again, this finds consensus), the practice has become more violent and has changed character. Bulls are put through abusive and cruel treatment on the day of the event by subjecting them to both substance abuse (alcohol or by application to the skin of irritants) and physical abuse (I do not wish to detail such torments but Clause 17 of the SC judgment quotes the AWBI report in depth and it is a wrenching read). Verified and documented incidents of cruelty, torture and abuse of the bulls, on the day of the sport, have led to frequent run-ins with animal rights activists. Things finally got to a head and the matter was taken to court.

Litigation history

The AWBI (Animal Welfare Board of India – a statutory body) and PETA (People for the Ethical Treatment of Animals – the largest not-for-profit corporation for animal rights in the world) sought a ban on the grounds of animal abuse and public safety. In 2006, the Tamil Nadu HC delivered a ban under the provisions of the PCA Act (Prevention of Cruelty to Animals Act). From then, for the past eight years, the ban has gone through many stages of cyclical negotiation when it has been alternately lifted, revoked and diluted. In 2009, the State, in an effort to reconcile the parties, passed the TNJRA (TN Jallikattu Regulation Act) which imposed stringent terms for the sport to continue  under non-abusive conditions. One of which, was that Jallikattu could only be allowed under the watchful supervision of the district collector, superintendent of police and AWBI representatives. The JRA has laid down the rules hard and consequently, the number of Jallikattus has steadily dwindled from 2000 participating villages to a mere 25 this year. Yet, 2010 alone witnessed 12 deaths (human deaths) and 1614 injuries (both animal and human, I presume). While the regulation ensured the practice was restricted to large groups and to a few months of the year; it failed to deliver on conditional requirements of the PCA. The affiliations between the State and organizers ensured that the act was reduced to hogwash. The matter reached the Supreme Court with both the TN government and the organizers are defendants and after deliberations, the SC delivered its final verdict last month banning the sport.

The Prosecution argued on the basis of ‘flight response’ and that the PCA should override the JRA. The Defence argued for cultural preservation, cultural tourism, and insisted  that the ‘degree of suffering’ of the bulls was not enough to come under the ambit of the PCA. The Court ruled that the JRA was anthropocentric in contrast to the eco-centric welfare legislation of the PCA and as such, the latter had pre-eminence. The ban was upheld and its reasoning detailed in a long judgment of staggering scope and scholarship (recommended reading).

The consequences have been swift and harsh. Yesterday’s papers reported; many bull-owners have had to sell the bulls to the slaughterhouse. An outcome, I am sure, no animal activist would have wanted.

Opinion

Despite their deeply entrenched faith in the veracity of their individual positions, both sides have uncomfortable questions to face.

  • The argument that the bulls are ‘naturally’ aggressive can’t hold much water with most ethologists. These bulls are trained to be temperamental but, despite that, a clear flight response is documented every time.
  • That the bull-owners pamper and invest (according to some reports, upwards of 15K a month) in the upkeep of the bulls is not contested. That, however, is an irrelevant defense against cruelty considering that the abusive treatment is meted out on the day of the event. Section 3 of the PCA clearly defines the duties of animal caretakers (bull-owners in this case) to include both, caring for the welfare and the well-being of the animal and, at the same time, protecting it from harm, suffering or abuse.
  • If the bull-owners were seriously interested in the welfare of their animals or in cultural tradition; they would not have allowed the degeneration of the tradition to an exercise in hostile and unruly behavior. Cultural tradition is something that is actively supported and protected; you cannot fall back on it as convenient excuse for degenerate versions of what might have once been aesthetic. The learned judges opine on this very point with an excellent quote from Professor Salmond: “Custom is the embodiment of those principles which  have commended themselves to the national conscience as the  principles of justice and public utility”.
  • Much talk circulates about the investment of money in the sport. There is, however, scant information on how much money is made living off and through these bulls for sport and stud services.
  • While lamenting the bulls that have already been sold to the slaughterhouse because of the ban; there is silence on what happens to these bulls once they become old and infirm? What is their fate then? Is what happened yesterday only an acceleration of an inevitable destiny?

Animal rights activism is a very tough grapple when it comes to the rights of domesticated animals. These animals have their agency usurped twice – once by the process of domestication; and then again, by activism that, having argued and won the case against the first, is stranded on a course of action from thereon. It is wise to tread slowly in such areas and with humility. The effort to cast this battle in the false dichotomy of good and evil/ right and wrong will yield disastrous consequences, most of which are then borne by the very animals you set out to save. It is often the case, that the people who work closely with these animals are more knowledgeable and equally empathetic and these qualities allow for easy negotiation of a middle ground. In this particular case; what strategy did PETA and/or AWBI, have for these mighty creatures once the ban took effect.  The sight of these gorgeous bulls being used for commerce in their own death as they were in life, is especially painful to bear. PETA is also answerable for selective targeting of practices. The use of animals for sport is equally odious in ‘glamorous’ horse racing and I expect and hope that PETA will  stay true by targeting the Turf Clubs next.

Our culture has always seen man as one of many creatures, of and by nature (the judgment quotes the Ishopanishad to illustrate this point; I have added the verse below). Hinduism does not accord our species a foolish exceptionalism above and beyond all others. Our folklore is rife with stories of animal law and justice. We practice a benign sharing of resources with other animals exemplified best in the cows that inhabit traffic islands and our street dogs who negotiate traffic crossings with aplomb. But apart from this genial side; there is also a dark underbelly of torture and cruelty towards animals. It is impossible for me to say how recent a phenomenon it is; but it would not be illogical to deduce that it is relatively recent and has paralleled the crumbling of social structures elsewhere. Culture is ever evolving. Each time, it evolves in aspiration of a higher ground. With Jallikattu too; the practice has evolved from the time of the Sangam and should continue to evolve if it wants to stay afloat. If only to save the fate of the bulls and their owners for this current generation; the practice must be allowed to stay albeit with strict conditions to evolve and with immediate effect to, at best, a bull-race. There are better avenues for entertainment in the 21st century than the sadism of using animals for sport.

——————————————————————————————-

From the IshOpanishad; as quoted in the judgment:

“The universe along with its creatures belongs to the land.   No
creature is superior to any other.  Human beings should not  be  above
nature.  Let no one species encroach over the rights and privileges of
other species.”

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The Culture Of Conservatism

The dust-up over Mr. Muthalik’s acceptance into the BJP is fresh grist for the mills of the culture-and-politics debate. With the BJP poised to make a comeback, the talk raging in club and canteen alike, is expectedly getting heated and will likely stay that way until May’s answer to this Umm al-electoral Maarik. After which, interest might wane but is unlikely to disappear for the argumentation has at long last found firm ground and is here to stay. That’s because there is a larger something at the nub of it. Something that transcends politics. And that is the right to own and express cultural identity by Hindu Indians without being dubbed fascist or fundamentalist.

In everyday parlance, culture wars pit conservatives and liberals against each other on either side of a fence. Often, that is a doubly reinforced electric fence with poison tipped spikes for backup. Seriousness aside; try transposing common understanding of these terms to the Indian context and the cognitive dissonance becomes obvious when, suddenly, Left, Right, their Wings, Conservatives, Progressives, etc., all morph into un-unravelable skeins of woolly definition. The terms translate this way here: Indian Left is the motley bunch of usual culprits; Indian Right is Right Wing loony; Indian Liberals only get their rosettes if they belong to the upper echelons of one (just one) political party and/or circumnavigate the concentric whorls of the literary sphere and, Indian Conservatives are the indescribable NOTA group. Leaving aside ‘Left’ and ‘Liberal’ which play somewhat true to righteous type; it is ‘Right’, ‘Right-Wing’ and ‘Conservative’ that consistently enmesh to belie definition.

Conservatives and Liberals split fundamentally on economics and culture. In recent years the field of Political Physiology has ensured that the divide gets more evolved company. Biology too now finds its place alongside culture and economics as a credible separator of political preference. There are defined psychological and biological explanations for behavioral differences (twin studies ascribe as much as 40% to DNA) between the two and it is possible that evolution might have selected for that variance to exist. While the arguments over economics have had their fair share of the Sun; considered debate on culture is near absent. What stands in its stead is the noise of outrage. Over freedom of speech, Khaps, marriage and family values, moral policing and patriarchy.

The more traditional socio-religious conservatism has two broad divisions – cultural conservatism and social conservatism; Right and Right-Wing respectively. While there are overlapping areas of interest;  in the Indian context the distinctions are more defined than the overlap which typically, is generalized and overplayed. The two preeminent issues that social conservatism in India is pre-occupied with are: freedom of expression (often demonstrated as aggressive protest over published word or art) and moral policing or vigilantism. Ugly demonstrations of muscle power are indeed more media worthy than critical thinking but, that is not the only reason social conservatism finds pre-eminence in the debate. It is also, artfully deployed as a whipping boy to muzzle conservative thought and voice. More egregious than this however, is the canard that secularism reposes safe only in the cocooned custody of Left and/or Liberal. This unfounded argument of calculated convenience is used to daub the entire mass on the other side of the fence as fascist and communal. It is more than a worrying possibility that the rise in social conservatism is a reactionary response to the relentless ridicule of Hindu customs, belief and thought.

Matters get more interesting when contemplating conservatism from a cultural context. As the term implies, culture and traditional orders of life and living inform the ideology to a great extent and, it is therefore a natural next step to ask: what is the culture in question that is in play here. In the modern context; cultural and religious identity might not be directly interchangeable. Yet, religion is a major feeder of cultural identity and group culture is often rooted in religious affiliation even if individuals are at personal liberty to transcend these definitions. Being thus identified as a prime driver of identity; the principles of Hinduism merit scrutiny. Attempts to do so have immediately raised the clamour that the sum of creeds that rest under the classified banner of Hinduism can’t be corralled similarly under the ideological. Such pronouncements are not just self-indulgent celebrations of ignorance (the subject of texts is addressed, here); they raise suspicion of ulterior motive because of the stubborn refusal to educate and engage. Here verily is a case fit for the dictum: Suppressio veri; suggestio falsi.

There is a commonly held belief that monotheistic religions that have a single codex to follow are more ‘religions’ than those that are not. This is only one perspective (a human one at that) and not a supernatural decree or diktat for how or what a religion is. Yet, that this narrow view spread and took root is hardly surprising given that it is both studied and propagated as such. The most celebratory characteristic of Hinduism is its immense and extraordinary diversity that is yet tethered firmly to a nodal commonality. Features of Hinduism that I describe here-under are not interpretations but direct transmissions of learning from texts of Hinduism and which any practitioner or seer will attest to.

  • Hinduism does not see man as separate and apart from nature and his surroundings. An equal respect for all manner of life-forms whether elemental or complex; human or animal is reiterated in every text.
  • It is not dogmatic and does not seek to be organized into a fixed creed.
  • The two fundamental and distinctive features of Hinduism are Dharma and tolerance. Dharma can be variously construed as duty, law or morality. It is best understood when described as, ‘the law that governs the conduct of man’.
  • Rather than insisting on a credo to experience God and living; Hinduism through its numerous texts directs the seeker to realize the supremacy of the Self over all else. Such thought has an immense capacity for the tolerant acceptance of all belief; even the belief of doubt. It neither preaches violent defence of its principles and/or faith nor, equally, does it believe in asserting its supremacy over other creeds as the sole and only path to Divinity. Rather than occupy itself with converting others to its point of view; it has ever been absorbed with – in the words of the great philosopher, Sarvepalli Radhakrishnan – ‘an eternal quest of the mind’.

With this understanding, Hindu cultural conservatism starts to morph, Maya-like, into a Liberal Humanism and the reasons for the confusion with terms becomes clear. From an evolutionary perspective, political liberalism is the new kid on the block; but it has stayed long enough to find itself a permanent seat at the political table. In a scenario where some of our political beliefs might be chromosomally entrenched; the obvious path forward is to embrace diversity rather than attempt to change it – a common characteristic that Hindu cultural conservatives share with liberals.

Hinduism preaches a conservatism for the Self and/or micro-group and a detached liberalism for the community at large. Cultural conservatives in the Hindu context are concerned with preserving this ethic and philosophy of living. As for the economics, for a country like India that has 840 million living under two dollars a day, it is naïve to envisage a development that does not include the active participation of government. Cultural conservatism would ensure the coexistence of the practiced principle of responsibility alongside the morality of a right.

Culture is a living breathing organism that directly influences and moulds the lives of millions. It is not a curio to be exhibited behind glass panes, in galleries, that seems to say: “Look and admire. But don’t touch; don’t feel; don’t practice or participate. I am not you anymore; I am the other”. Finally and perhaps most pertinent of all, culture and cognition feed into and off each other in a virtuous cycle. The effort to divide and isolate us from our own culture has predictably boomeranged and we are now faced with the problem of an unthinking and exploitable social conservatism that has found its voice on the streets.

Post-script:

This is a hymn from the concluding SUktham of the RigVeda which, according to the Paramacharya of Kanchi, – one of the greatest seers of Hinduism in recent times – is the prime dictum for all Hindus and one that should have greater significance than the national anthem of any country:

“May mankind be of one mind; May it have a common goal; May all hearts be united in love. And with the mind and the goal being one may all of us live in happiness”

It can be read in Sanskrit, here: “Sangacchadhvam Samvadadhvam..

Post – PostScript:

This recitation of the hymn http://youtu.be/B-5pcQ3dEck was shared with me by http://manasataramgini.wordpress.com/ Many thanks to them for the share.

 

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Hinduism’s Canon

It is often said of Hinduism that, unlike the Abrahamic religions, it is not a religion of the book; that it does not have a cornerstone scripture serving as congregator. More than being completely erroneous, this is an uninformed canard that implicitly suggests, Hinduism’s true place is more in line with Paganism than with any religion or creed. Books are not just the foundational bricks of Theology; they are also essential for congealing communities of belief. The unifying force of a book is integral to the survival and propagation of organized religion. Additionally and apart from that self-serving purpose; scripture illustrates the philosophy and thought of the religion which in turn, serves as a bulwark for cultural belief and evolution. That texts are important to religion is thus established. However, the notion that ritual use of a single book by all practitioners, is a necessary determinant of established religion is one that must be countered.

Hinduism does not have only one text; it has a whole canon comprising fourteen texts. But, the way in which these texts are used, in and by the faith, is very different from other religions. Hinduism is as much a creed of learning as it is of the Divine. Learning and the advancement of the intellect is deeply intertwined with the practice; deep enough to not be seen as distinct from it. ‘Pramana’ or, the ‘means to knowledge’ has three core elements – perception, inference and textual knowledge or Shabdha. The Hindu Canon is considered to be just one of the ways of realization (of self and divine). It falls under the category of Shabdha.

In Sanskrit; these texts are called Shastras or the Chaturdasha Vidya (Chaturdasha – fourteen; Vidya – learning). There are an additional four that are more akin to subject specializations; but these too are sometimes included raising the number of primary texts to eighteen. All eighteen are extant. Crowning these texts are the Vedas – the prime scripture of Hinduism. The texts are individually distinct in both content and scope and consequently, do not share the same degree of importance. At the same time, however, they also don’t submit to being categorized into a traditional hierarchy of greatest to least. On the contrary, the onus of intellectual hierarchy is on the learner/ practitioner of the faith. Hinduism’s texts recognize the spiritual and intellectual stage of development of the individual and cater to that hierarchy of personal evolution in the reader, the seeker or, believer. Like learning, Bhakthi or belief, is also understood as subjective experience and is treated accordingly. The philosophy of – to each is given a unique place and purpose and to each too, the responsibility to serve it well – is exemplified by the collected works in the Canon. Irrespective of the stage at which a text has unique appeal; not one of these texts ever becomes irrelevant. Just as cliches acquire new meaning when revisited with personal experience; similarly, each text when revisited enhances the reader with new shades and depth of meaning.

To most English readers of Hinduism the classification of these texts can be baffling. In my own experience (admittedly limited), most books do not classify or detail the texts in a simple format that facilitates both understanding and recall. This perhaps is a contributory factor for the in-vogue misrepresentations. From reading collated across numerous sources an easily comprehensible classification is detailed below that should put paid to the myth of the absent book.

It is common to divide the Chaturdasha Vidya into Shruthi and Smrithi. Shruthi (literally, that which is heard) are the older texts learnt by the oral tradition and do not have a known author. Smrithi (that which is memorized and lived by) are auxiliary texts to the Shruthi. They are explanatory decoders of the Shruthi and, unlike them, have identifiable human authors. Many learned authorities differ from this dichotomous division in that, it implies a difference between the two. In reality, the Smrithis are best described as one of many auxiliary texts that contain extensions, additions and commentaries of the Shruthi.

A more felicitous way to classify the texts and their subjects is in the manner of the branching of the tree – main trunk, limbs and branches.

The Prime Scripture: Four Vedas (Rig, Yajur, AtharvanA, SAma)

Each Veda has further divisions based on structure and function. Structurally, there are three sections – SamhitA, BrAhmanA and the AranyakA. Functionally, two – the KarmakAndA and JnanakAndA. The Samhita and the BrAhmanA together comprise the KarmakAndA. These sections concern themselves with recitations, work and worship rituals. The AranyakA along with the Upanishads are intellectual and philosophical expositions of the KarmakAndA.

The text and its divisions have been likened metaphorically to a fruit bearing tree. Wherein the trunk is the Vedas; the forked limbs – the KarmakAndA and the JnanakAndA; the branches – the Samhita; leaves – the BrAhmanAs, flowers – the AranyakAs and finally the fruit of the entire endeavour – the Upanishads.

Auxiliary subjects: The primary division called AngAs; the secondary, called UpAngAs.

The six AngAs:

  • 1. Shiksha – Phonetics
  • 2. VyAkarana – Grammar
  • 3. Chandas – Prosody
  • 4. NirUktA – Etymology
  • 5. JyotishA – Cosmology and science
  • 6. KalpA – Application manuals

The four UpAngAs

  • 1. MImAmsA – Is an exegesis of the Vedas. It’s also one of the six systems of thought or DarshanA. MimAmsA has two divisions along the lines of the Kandas of the Vedas – the Purva-mImAmsA and the Uttara-MimAmsA. The two differ from each other and from Vedanta on the role and nature of Ishvara – God.
  • 2. NyAyA – Logic or reasoning. Is also one of the six systems of thought or DarshanA
  • 3. PurAnAs – Eighteen in number. The collected chronicles and legends of history that are used to elaborate the philosophy and the teachings of the Vedas. The PurAnAs are some of the most important texts of Hinduism; both that they are beloved and are in more common use by the multitude than the other texts.
  • 3a. ItihAsA – The Epics: RAmAyanA and MahAbhArathA. The importance of these two to the Hindu Canon is so great that they have often been called the Fifth Veda
  • 4. DharmashAstrAs – are the SmrithIs. They are auxiliary texts that serve as explanatory reference, manuals and commentaries on the Shruthi. In this respect; they are very similar to KalpA and are an extension of it. Law, the conduct of rituals, personal conduct are elaborated in detail here.

Unlike the Abrahamic books, the Hindu canon does not assert an eternal and insurmountable distinction between God and man. The purpose of these texts is not directed at cementing the influence of the creed but at the intellectual and spiritual growth of the individual. When and if approached in the prescribed method of learning, the seeker is gradually steered away from belief, ritual and materialism to seek and realize the divinity within. The religion, thus, actively promotes a movement from the religious to the philosophical.

Hindu Philosophy is not an esoteric external rumination but an active process (incorporated in daily living) of contemplation, realization and renunciation. In socio-political terms, the religion steers the growth and/or shift of the individual from the practice of duties as conservative householder to those of a progressive intellectual. Once the structure for belief and thought is mastered, the believer is set free to explore his learning in pastures of his own creation, even if, that exercise leads him to denounce the very faith. There are no condemnations here of heretics, apostates and agnostics. Even the denial of faith is approached as its mere converse and is respected and welcomed as a contributory advancement of thought.

Viewed through the lens of time, it is fairly reasonable to assume that a single book of God might struggle to withstand the test of humankind’s insatiable quest for the unknown. That, it continues to thrive as the oldest living religion, perhaps suggests that the multiplicity of Hinduism’s texts is a theological example of successful evolutionary survival.

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See something; Say something

Black boots and bundled bulk in an uniform march of purposeful ugliness

Ceiling droppings of a watch as a phone. Buy ugliness big

Same black brew in same size cups. Even if avatar-ed in ten different names

Food vends pretty into spout and bowl. The ugly; battered and beaten on the floor of steel coffin boxes

A piano, a baby grand, sits in absurd splendor. In front of the yoghurt, abreast and to the right of the News

Mozart gamely drowns himself in every distraction and a train hoots and eases into track

A working animal walks by. If, maybe, he noticed too, my alien state, he doesn’t say

But I am glad he went by anyway.

And, again, the announce in collected calm: ‘See something; say something’.

 

Table 4’s feet pull out of Lego tower shoes.

Table 9’s perfect face in perfect disdain; betrays no strain: ‘will he give me what he must’

Table 10’s lecherous males look my way; I plump myself to meet their gaze

By the road, to Sudbury, a parallel track on another train; same destination different ends

A wind blows the snow off the trees; sweeps the branches and boughs clean

That tangled in the shriveled oak leaves will wait some more. To fall; and then, to melt

A turnstile cracks; I rise along with pounding feet. Pick my box of arranged memories

Empty spaces tactically left for new; Old snagged uglies must wait for a new dawn’s light to vaporize.

 

I am almost there. A couple of miles out under the fruit trees; you will see

The same blue sky and white clouds the same. From this or any distance; pine tree and steeple are but black dots in a landscape

The train hoots around the bend. The very one that is heard, if listened

Strain. To hear. To come and listen. To see and say. Something much or nothing at all

We turn the bend. Sun glare lights the grimy glass.

I noiseless draw the blinds down and in a while again, the calm announce:

‘Westboro. See something; say something’.

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