Tag: untouchability

The life and death of ‘Chemical Nova’

You know how people pretend to win an Oscar or a Nobel Prize, right? Many years ago, I used to pretend to be the author of a fictitious but, blissfully unmindful of its fictitiousness, award-winning series of articles entitled Chemical Nova. In this series, I would pretend that each article discussed a particular point of intersection between science and culture.

The earliest idea I had along these lines concerned soap. I would daydream about how I was celebrated for kickstarting a social movement that prized access to soap and ability to wash one’s hands under running water, and with this simple activity beat back the strange practice among many of refusing to wash one’s toilet oneself, instead delegating the apparently execrable task to a housemaid.

The fantastic value of Chemical Nova should be obvious: it represented, at least to me, the triumph of logic and reasoning above class-commitments and superstition. The fantasy took shape out of my longstanding ambition to beat down a stubborn Creature, for many years shapeless, that often caused a good review, essay or news report to inspire only cynicism, derision and eventually dismissal on the part of many readers. It was quickly apparent that the Creature couldn’t be subdued with deductive reasoning alone, but for which one had to take recourse through politics and individual aspirations as well, no matter how disconnected from the pretentious ‘quest for truth’ these matters were.

Chemical Nova dissipated for a few years as I set about becoming a professional journalist – until I had occasion to remember it after Narendra Modi’s election as prime minister in 2014. And quickly enough, it seemed laughable to me that I had assumed upper-caste people wouldn’t know how soap worked, or at least of its cleansing properties. An upper-caste individual invested in the continuation of manual scavenging would simply feel less guilty with a bar of soap placed in his dirty bathroom: for scavengers to wash their hands and not be at risk of contracting any diseases.

The belief that ‘the job is theirs to perform’ could then persist unfettered, rooted as it was in some sort of imagined befoulment of the soul – something one couldn’t cleanse, out of reach of every chemical reagent, or even affect in any way except through a lifetime of suffering.

It was a disappointing thought, but in my mind, there was still some hope for Chemical Nova. Its path was no longer straightforward at all insofar as it had to first make the case that the mind, the body and the community are all that matter, that that’s how one’s soul really takes shape, but its message – “ultimately, wash your hands” – still was an easy one to get across. I was tempted and I continued to wait.

However, earlier today, the Creature bared itself fully, exposing not itself as much as the futility of ideas like Chemical Nova. An advertisement appeared in a newspaper displaying a pair of hands kneading some dough, with the following caption: “Are you allowing your maid to knead atta dough by hand? Her hands may be infected.” The asset encouraged readers of the newspaper to buy Kent’s “atta maker & bread maker” instead, accompanied by a photograph of Hema Malini smiling in approval.

Malini has been the brand ambassador for Kent since 2007 and the incumbent Lok Sabha MP from Mathura since 2014. I’m not sure of the extent to which she knew of the advertisement’s contents before her face (and her daughter’s) appeared on it. Her affiliation since 2004 with the Bharatiya Janata Party (BJP), known for its favouritism towards upper-caste Hindus (to put it mildly), doesn’t inspire confidence but at the same time, it’s quite possible that Malini’s contract with Kent allows the company to include her face in promotional materials for a predefined set of products without requiring prior approval in each instance.

But even if Malini had never been associated with the product or the brand, Chemical Nova would have taken a hit because I had never imagined that the Creature could one day be everywhere at once. The chairman of Kent has since apologised for the advertisement, calling it “unintentional” and “wrongly communicated”. But it seems to me that Kent and the ad agency it hired continue to err because they don’t see the real problem: that they wrote those words down and didn’t immediately cringe, that those words were okayed by many pairs of eyes before they were printed.

The triumph of reason and the immutability of chemical reagents are pointless. The normalisation of exclusion, of creating an ‘other’ who embodies everything the in-group finds undesirable, is not new – but it has for the most part been driven by a top-down impulse that often originates in the offices of Narendra Modi, Amit Shah or some senior BJP minister, and often to distract from some governmental failure. But in the coronavirus pandemic, the act of ‘othering’ seems to have reached community transmission just as fast as the virus may have, finding widespread expression without any ostensible prompt.

And while Kent has been caught out evidently because it was the ‘loudest’, I wonder how many others don’t immediately see that what they are writing, saying, hearing or reading is wrong, and let it pass. As Arundhati Roy wrote earlier this week, the attainment of ‘touchlessness’ seems to be the new normal: in the form of a social condition in which physical distance becomes an excuse to revive and re-normalise untouchabilities that have become taboo – in much the same way soap became subsumed by the enterprise it should have toppled.

Examples already abound, with ministers and corporate uncles alike touting the prescient wisdom of our Hindu ancestors to greet others with a namaste instead of shaking hands; to maintain aachaaram, a collection of gendered practices many of which require the (Brahmin) practitioner to cleanse themselves of ‘spiritual dirt’ through habits and rituals easily incorporated into daily life; and now, to use machines that promise to render, in Roy’s words, “the very bodies of one class … as a biohazard to another”.

It started with a bang, but Chemical Nova slips quietly into the drain, and out of sight, for it is no match for its foe – the Creature called wilful ignorance.

Featured image: A snapshot of William Blake’s ‘The Great Red Dragon and the Woman Clothed with the Sun’, c. 1805-1810.

Three overlooked reasons why India’s healthcare indicators remain abysmal

Scroll.in
January 2, 2015

The Bharatiya Janata Party-led Central government announced in July that it would roll out a National Health Assurance Mission, whose aim would be to provide some free medical services to reduce “out of pocket spending on healthcare by the common man”.

It is thought that the NHAM could be active as early as this month, and could cost $26 billion, according to a senior health official. This is a noble gesture: according to a report on healthcare costs in the BRICS countries (Brazil, Russia, India, China and South Africa), out-of-pocket expenditure pushed as many as 60 million Indians below the poverty line in 2010.

Going by a Planning Commission report accessed in May, India spends only 1.04% of its GDP on publicly-funded health, while its total health expenditure (public and private) was 4% in 2010-2014. The same report aspired to increase public health spending to 3% of GDP by 2020 and to 4% by 2025. A lot has changed since then, especially when the Narendra Modi government cut down the health spending by $900 million for 2014-2015 citing lack of funds.

Nonetheless, the reason India’s healthcare indicators remain abysmal is not just a question of money (after all, ours is one of the fastest growing economies). The problem is a persistent rash of doublespeak that denies the people a coherent healthcare system. While successive governments have committed to various goals, no government programme has yet focused on the three most important problems facing India’s health at once: a mismanaged regulatory climate, corruption, and the caste system.

1. Contradictory regulations

The problems with regulation are illustrated by India’s medical tourism industry, which according to government sources will be worth Rs 9,500 crore in 2015, and as much as Rs 54,000 crore in 2020. Almost 75% of the medical imaging equipment (worth Rs 18,000 crore in 2011) that services this industry is imported and the value of imports themselves grew at a compounded rate of 16% in 2010-2014.

There is an import duty on fully-finished devices to the tune of 10%, whose cost is transferred to consumers. It gets better here: if device components are imported individually and then assembled in India, there is an additional excise duty and VAT, increasing the device cost. This tax suppresses domestic manufacturing of diagnostic equipment and the import-intensive economy it fosters continues to inflate healthcare costs in a country where only 30% of healthcare is publicly funded.

It has also led to a chicken-and-egg squabble between medical advocacy groups in the country. For example, ahead of the presentation of the Union Budget in 2010, the Department of Pharmaceuticals sought a cut in the customs duty to facilitate imports, while the Association of Indian Medical Devices Industry sought a hike to promote domestic innovation.

The report that claimed out-of-pocket expenses had pushed 60 million people below the poverty line also found that urban centres were the primary users of sophisticated medical equipment even as the per capita expenditure on medical technology in the country was a frugal $2 to $2.5.

2. Corruption and Inefficiency

A part of the problem is corruption and inefficiency. There is no national body to oversee the procurement and provision of generic medicine, which currently originates from local manufacturers known to operate their plants in unsanitary conditions. On April 7, the day Sun Pharma announced that it would fully acquire Ranbaxy Labs, Wockhardt publicly acknowledged that its plant in Aurangabad had been found to contain urine and mould in the vicinity of testing samples during an inspection by the US Food and Drug Administration.

All three companies now are disallowed from exporting certain drugs to the US and Europe. The reason they are allowed to release their drugs in the domestic market is because there is a demand for generic drugs and because there are about 1,500 health inspectors for more than 10,000 factories in the country, resulting in one in every 22 locally-produced samples being of substandard quality. In Tamil Nadu alone, 4,000 health inspector positions remained vacant in 2012.

Moreover, public healthcare professionals are not up to the mark. As the recent Chhattisgarh sterilisation camp tragedy illustrated, medical camps are often understaffed by ill-equipped doctors and technicians. One surgeon at the Chhattisgarh camp reportedly performed 83 tubectomies in six hours. In Odisha, cycle pumps were used to dilate the cervices of some women in a sterilisation camp.

Data from the Ministry for Health and Family Welfare shows that, since 2008, 700 people have died after going through government-sponsored sterilisation programmes.

3. Caste system

What exacerbates all these issues is the social setting their providers and users are situated in, and the caste system in that setting. On November 20, Arundhati Roy gave a lecture at the University College London, titled “The half-life of caste: The ill-health of a nation”. She started by saying, “We are still a society where a public health worker will refuse to touch children who are ill because they are untouchable. There are doctors who refuse to do a post-mortem because it’s polluting to touch” a dead body.

She argued in the lecture that the notions of purity and pollution that casteism enshrines, whose persistence M K Gandhi secured by institutionalising them during the freedom struggle, often deter good health practices, especially among poor women and children and those belonging to the lower castes. As the chart below shows, India’s infant and maternal mortality rates are worse than those of its neighbouring countries and BRICS nations.

1418035383-447_Mortality-rates-2013-IMR-MMR-chartbuilder

As the British medical journal The Lancet wrote in an editorial on November 29, “This ingrained inequality has led to tacit acceptance of the caste system, which has created, among other challenges, a preventable epidemic of mortality among women and children.” In effect, irrespective of what changes are instituted at the top, they will not reach the masses if access to healthcare and medical services remains segregated by caste.

These three hurdles are further compounded by successive governments’ tendencies to confusion. On one hand, Prime Minister Narendra Modi promises more All India Institute Of Medical Science in the country and on the other cuts the health budget by $900 million. The United Progressive Alliance government before him managed to eradicate polio but let that pursuit overshadow that of full-immunisation, the rate of which has fallen in developed states like Tamil Nadu, Maharashtra, Haryana and Punjab.

Such equivocal measures are the product of the thinking that health is purely a biological concern, not influenced by understaffed training institutions, overzealous eradication drives, import-friendly regulations, inexplicable shortage of health inspectors or segregation by caste.