The cost of forgetting Ballia

In the day or so before June 1, 14 people died in Bihar of heat stroke. Ten of these people were election personnel deployed to oversee voting and associated activities in Bihar and Uttar Pradesh, and of them, five died in Bhojpur alone. On Friday, at least 17 people in Uttar Pradesh, 14 in Bihar, and four in Jharkhand had died of heat-related morbidity. And of the 17 in Uttar Pradesh, 13 deaths were reported from Mirzapur alone. This is a toll rendered all the more terrible by two other issues.

First, after the first phase of the polls, the Election Commission of India (ECI) recorded lower voter turnout than expected (from previous Lok Sabha polls) and blamed the heat. Srinivasan Ramani, my colleague at The Hindu, subsequently found “little correlation” between the maximum temperature recorded and turnouts in various constituencies, and in fact an anti-correlation in some places. By this time the ECI had said it would institute a raft of measures to incentivise voters to turn up. These were certainly welcome irrespective of there being a relationship between turnout and heat. However, did it put in place similar ‘special’ measures for electoral officials?

On March 16, the ECI forwarded an advisory that included guidelines by the National Disaster Management Authority to manage heat to the chief electoral officers of all states and Union territories. These guidelines had the following recommendations, among others: “avoid going out in the sun, especially between 12.00 noon and 3.00 pm”; “wear lightweight, light-coloured, loose, and porous cotton clothes. Use protective goggles, umbrella/hat, shoes or chappals while going out in sun”; and “avoid strenuous activities when Balliathe outside temperature is high”.

A question automatically arises: if poll officers are expected to avoid such activities, the polling process should have been set up such that those incidents requiring such activities wouldn’t arise in the first place. So were they? Because it’s just poka-yoke: if the process itself didn’t change, expecting poll officers to “avoid going out in the sun … between 12 pm and 3 pm” would have been almost laughable.

The second issue is worse. Heat wave deaths in India are often the product of little to no advance planning, even if the India Meteorological Department (IMD) has forecast excessive heat on certain dates. But to make matters worse, there was a deadly heat wave last year in the same region where many of these deaths have been reported now.

Recall that in the first half of June 2023, more than 30 people died of heat-related illnesses in Ballia village in Uttar Pradesh. After the chief medical superintendent of the local district hospital told mediapersons the people had indeed died of excessive heat, the state health department — led by deputy chief minister Brajesh Pathak — transferred him away, and his successors later denied heat had had anything to do with the deaths.

So even if the IMD hadn’t predicted a heat wave in this region for around May 30-31, the local and national governments and the ECI should have made preparations for heat exposure leading at least to morbidity. Did they? To the extent that people wouldn’t have had to be hospitalised or have died if they’d made effective preparations, they didn’t. Actively papering over the effects of extreme weather (and of adverse exposure) has to be the most self-destructive thing we’re capable of in the climate change era.

Featured image: Representative image of a tree whose leaves appear to have wilted in the heat. Credit: Zoltan Tasi/Unsplash.

Hot in Ballia

More than half of the deaths reported during the heatwave in Uttar Pradesh and Bihar this week were reported from just one district in the former, called Ballia. On (or around) June 17, the medical superintendent of the Ballia district hospital was transferred away after he attributed the deaths (until then) to the heat. He was replaced with someone else.

The state government also dispatched a team of two experts to the district to assess the local situation (as they say). One of them was director of the Uttar Pradesh health department for communicable diseases, A.K. Singh. In one of his first interactions with the press, Singh indicated that they weren’t inclined to believe the Ballia deaths were due to the heat and that the team was also considering alternative explanations, like the local water source being contaminated. I think something fishy could be going on here.

First, Hindustan Times reported Singh saying “the deaths at the hospital were primarily due to comorbidity and old age and not heatstroke”, erratic power in the area, and the time taken to reach the hospital — in effect, everything except the heat. Yet all these factors only worsen a condition; they don’t cause it. What was the condition?

Second, a reporter from The Hindu who visited Ballia learnt that it will take “more than seven days” to issue the medical certificates of the cause of death (MCCDs), so the official cause of death — i.e. what the state records the cause of each death in this period and circumstance to be — won’t be clear until then.


Aside: During the COVID-19 pandemic, the Indian Council of Medical Research issued guidelines that asked healthcare workers to not list comorbidities as the underlying cause of death for people who die with COVID-19. This didn’t stop workers from doing just this in many parts of the country. I’m not sure but I don’t think similar guidelines exist for when the underlying cause could be heat. The guidelines also specified the ICD-10 codes to be used for COVID-19; such codes already exist for heat-related deaths.


Third: Do the district authorities, and by extension the Uttar Pradesh state government, have complete knowledge of the situation in Ballia? There was the unfortunate superintendent who said there was a link between the heat and the deaths. Anonymous paramedic staff at the Ballia hospital also told The Hindu that “some of the deaths were heat-related”. Yet the new superintendent says the matter is “under investigation” even as one member of the expert team says it’s yet to find “any convincing evidence to link the deaths with heatstroke”.

I really don’t know what to make of this except that there’s a non-zero chance that a cover-up is taking shape. This is supported by the fourth issue: According to The Hindu, “the [Uttar Pradesh] State Health Department has asked the Chief Medical Officers of districts and the Chief Medical Superintendents of district hospitals to issue statements in coordination with the concerned District Magistrate only during ‘crucial situations'” — a move reminiscent of the National Disaster Management Authority’s response to the Joshimath disaster.

For now, this is as far as the facts (as I know them) will take us. I think we’ll be able to take a big stride when the hospital issues the MCCDs.

Being apolitical doesn’t mean politics doesn’t exist

A few years ago, we had a writer who would constantly pitch articles to us about how the Indian government should be doing X, Y or Z in the fight against this or that disease. Their submissions grew quickly tiresome, and then wholly ridiculous when, in one article (well before the pandemic), they wrote that “the government should distribute good-quality masks for TB patients to use”. That the government should do this is a banal truism. But to make this recommendation over and over risks hiding from sight the fact that the government probably isn’t doing it not because it doesn’t know it should be done but because it has decided that what it is doing is more important, more necessary.

I find myself contending with many similar articles today. It is people’s right to express themselves, especially on counts on which the Indian government has dropped the ball via-à-vis the country’s COVID-19 epidemic. But to repeat recommendations that are often staring most of us in our faces I fear could be harmful – by only reminding us of what needs to be done but hasn’t been, over and over, is an act that deepens the elision and then the forgetting of the real reason why it hasn’t been done.

This doesn’t mean reminders are redundant; to the contrary, there is important value in repetition, so that we may not lose sight of which outcomes are ultimately desirable. But in tandem, we also need to start acknowledging what could be standing in the way and contemplating honestly whether what we’re advocating for could surmount that barrier. (This issue is also of a piece with the one about processes and outcomes – whereby some commentators stress on what the outcomes can or should be but have nothing to say about the processes that will get us there.)

For example, what happened to the rapid self-administered COVID-19 tests that many scientists in India developed last year? A reporter with an appetite for a small investigation could speak to the researchers, university administrators, the DST or the DBT as the case may be, and finally to officials in the Union health ministry, and weave together a story about where exactly in this pipeline of translation from the lab to the market the product vanished. There is value in knowing this but it is not paramount value. It is on equal footing with the view, from the perch of the political economy of public healthcare, that the Modi government is unlikely to okay the widespread use of such tests because many Indian states, especially BJP strongholds like Uttar Pradesh and Gujarat, are widely underreporting cases and deaths, and a state-managed project to suppress this data is easier to do with centralised testing facilities instead of freely distributed rapid tests whose results can also be quickly crowdsourced.

Quite a few authors of articles (many of them scientists) also like to say that we shouldn’t politicise the pandemic. They ignore, deliberately or otherwise, the fact that all pandemics are political by default. By definition, a pandemic is an epidemic of the same disease occurring in multiple geographically distinct regions at the same time. Governments have to get involved to manage them. Pandemics are not, and should never be, carte blanche for scientists to assume power, their prescriptions to assume primacy and their priorities to assume importance – by default. This can only lead to tunnel vision that is blind to problems, and in fact solutions, that arise from social and political compulsions.

Instead, it would be much more valuable if scientists, and in fact any expert in any field, could admit the politically motivated parts of a government’s response to its local epidemic instead of forcing everyone else to work around their fantasies of separation – and even better if they could join the collaborative efforts to develop solutions instead of trying to solve it like a science problem.

Anthony Fauci demonstrates this same… attitude (for lack of a better word), in an interview to Indian Express. When asked how he might respond to India’s crisis, he said:

The one thing I don’t want to do and I hope it doesn’t turn out this way, is to get involved in any sort of criticism of how India has handled the situation because then it becomes a political issue and I don’t want to do that since I’m a public health person and I’m not a political person.

It just seems to me that, right now, India is in a very difficult and desperate situation. I just got off, in preparation for this interview, I watched a clip from CNN… it seems to me it’s a desperate situation. So when you have a situation like that you’ve got to look at the absolute immediate.

I mean, first of all, I don’t know if India has put together a crisis group that would meet and start getting things organised. I heard from some of the people in the street bringing their mothers and their fathers and their sisters and their brothers searching for oxygen. They seem to think there really was not any organisation, any central organisation.

When asked about what India should do towards getting more people vaccinated:

You’ve got to get supplies. You’ve got to make contractual arrangements with the various companies that are out there in the world.

😑 And what about the fact that the US didn’t just advance-book the doses it needed but hoarded enough to vaccine its population thrice over, and blocked a petition by India and South Africa, and some other countries, to release the patents on US-made vaccines to increase global supply?

Fauci’s answers are, again, a reminder of which outcomes are or ought to be ultimately desirable – what goals we should be working towards – but simply repeating this needs to stop being a virtue. Fauci, like many others before him, doesn’t wish to consider why we’re not on the path to achieving these outcomes despite fairly common knowledge of their existence. He may not be a political person but being apolitical doesn’t mean politics isn’t involved. The bulk of India’s response to its COVID-19 epidemic has been driven by political strategy. Is the idea that even the ideal part science can play in this enterprise is decidedly finite so off-putting?

And even if there is a legitimate aspiration to expand the part science should be allowed to play in pandemic governance, scientists need to begin by convincing political institutions – and not attempt to seize power. They may be tempted to, as we all are, because our current national government seems to think accountability is blasphemy, and without being accountable it has stopped speaking for the people of the country, even those who put it in power. Nonetheless, the fruits of scientific work need to be democratic, too.

I would also contend that Fauci complicates the picture by implying that there can be a clean separation of political and scientific issues on this matter; many scientists in India and perhaps too many people in India have an elevated opinion of Fauci, to the point of considering his words to be gospel. As one friend put it recently, “Unbelievable – the idea that a single white man is the foremost disease epidemiologist in the world” (emphasis in the original). “How do people say it with a straight face?”

This post isn’t intended to disparage Fauci, even if our exalted opinion of him deserves to be taken down a few notches. Instead, I hope it highlights how Fauci nicely demonstrates a deceptively trivial prejudice against politics that, I could argue, helped land India in its latest disaster. Even when he pitches, for example, that India should lock itself down for a few weeks – instead of a few months like it did last year – he is at liberty to ignore the aftermath. We are not. Does that mean a lockdown shouldn’t come to be? No. But if he accommodated the political in his considerations, will it mean a man of his smarts will be able to meaningfully contemplate what the problem could really be? Maybe.

Featured image: Former US President Donald Trump, VP Mike Pence and NIAID director Anthony Fauci at a press briefing at the White House on April 16, 2020. Credit: Public domain.

Review: ‘Paatal Lok’ (2020)

I binge-watched Paatal Lok today, a show on Amazon Prime India about a cynical cop who is all too familiar with how the The System works and who gets a high profile case by chance – to investigate a conspiracy to assassinate a hotshot journalist. I highly recommend it. It is a gritty, neo-noir slow-burner that starts with the flame on high.

This said, you should avoid it if you are averse to violence. In fact, Paatal Lok‘s principal failing is that it is peppered with scenes filled with gratuitous violence – physical, verbal and systemic – especially against women, trans-women and young adults. There is considerable violence by and against adult men as well but I’m not sure that is nearly as disturbing. Most of it could have been avoided, or simply alluded to instead of being enacted in painstaking detail. (If you watch Tamil films: recall the sexual violence scenes in Super Deluxe, 2019.)

A second failing, if only to my eyes, is that Paatal Lok for most of it seems to offer a slice-of-life take on events except in its conclusion, where it wraps up many narrative arcs more optimistically than they might actually have panned out. (Again, if you watch Tamil films: recall the conclusion of Jigarthanda, 2014.) But if you can ignore this criticism or find a way to disagree with it, please do.

Paatal Lok showcases the politics-caste-crime nexus in India’s Hindi heartland, especially in and around Bundelkhand, and its intersection with mainstream journalism. It’s raw, no other way to put it, as it puts on display the primal nature of local politics, life and love where mafia money, caste violence and familial honour intermix freely. Ceaseless heat and dust, loud expletives, the bloated egos of politicians’ and businessmen’s sons, brandished guns set the tone. Mongrel dogs play an important part in shaping the fates of many characters but it’s really a dog-eat-dog world only for the humans, whether in the desolate gullies of rural Punjab or in the glitzy studios of TV news channels.

SPOILER STARTS

Funny thing is the journalist starts off accused of being a left-liberal but in the course of the show sells out and ends in the final scene and analysis as a government shill peddling the “Muslim terrorists are out to get India’s leaders” shit.

I don’t know who this portrayal, by Neeraj Kabi, does or doesn’t caricature but it seems both unlikely and unsurprising. I only hope it never becomes about me.

SPOILER ENDS

There are many things to write about Paatal Lok – and will be. It hit me specifically in two ways: first by taking the viewer closer to the Hindustan in Bundelkhand, and then with the trouble it takes to spotlight, lest it seem too subtle, the emptiness at the heart of Hindutva politics.

Every week you read news reports in the mainstream English press mentioning saffron politics directly or indirectly, based on which you develop an impression of how things are run in the Hindi heartland. (I assume here that you live far away, like I do in South India.) But these reports are too refined. They are either about the big picture or they summarise a few important events, and they almost always leave out the sweat- and blood-stained nitty-gritty stuff. This stuff is a constant presence in Paatal Lok.

The other presence is the other standout feature: political Hindutva’s heart of nothingness. In fact, the show is even a journalistic product: the characters and events may be fictitious but the social forces that shape them are quite real. Which political leader is abusing their power – the non-existent ‘Jiji’ Bajpayee or the very real Anurag Thakur – is as much in the public interest as how they abused their power. And as Paatal Lok peels away these impetuses from the actions of right-wing communalists and saffron-clad, flag-waving thugs, it finds an awkward, tasteless silence. This brand of politics is animated by nothing but opportunism, of Brahmin overlords’ ambitions and short-term ‘arrangements’.

Religious sentiments: upsetting them v. getting upset

Featured image: Prashant Bhushan. Credit: Swaraj Abhiyan/Wikimedia Commons, CC BY 2.5.

Get a load of this: Over the weekend, advocate and social activist Prashant Bhushan tweeted saying CM Yogi Adityanath’s anti-Romeo ‘policy’ would imply that the Hindu god Krishna could be classified as a “legendary eve-teaser” in modern Uttar Pradesh. In quick succession, Bhushan had FIRs filed against him from both BJP and Congress spokespersons, in Delhi and Lucknow respectively. On both counts, the charge was of “upsetting religious sentiments”.

This is funny: Bhushan’s tweet does not upset religious sentiments but recalls a story and questions how it will be interpreted in this day. And if the BJP and the Congress have been offended by this, it could only be because they have interpreted his tweet offensively. If reason had prevailed, Bhushan’s statement should’ve been interpreted to say Adityanath’s policy perspective almost directly raises questions about Krishna’s attitude towards women, and the only way the BJP/Congress can imagine it “upsets religious sentiments” is by suggesting either:

  1. Adityanath is right ⇒ Krishna was an “eve-teaser” ⇒ religious beliefs are wrong, or
  2. Krishna was not an “eve-teaser” ⇒ Adityanath is wrong ⇒ Adityanath is upsetting religious sentiments

Either way, the offence seems to stem from someone other than Prashant Bhushan. As for the offended, one thing is certain: women get the short shrift, as usual. They’re once again stuck making lousy choices: between a political ideology that supports honour killings and thinks its women should stay at home, aspire to get married and run a household – and a religious tradition that extols a god about whom the popular narrative is that he “teased” gopis, i.e. women. And this isn’t just the women in UP: it limits the narratives through which women can participate in national politics.

Moreover, it’s ironic that the anti-harassment squads are being called “anti-Romeo” squads. Romeo from William Shakespeare’s tale did not harass. Similarly, the couples being targeted by Adityanath’s anti-harassment squads – the Romeos and Juliets, supposedly – aren’t harassing each other. They’re spending time together in public spaces, spaces in which intimacy is still somewhat taboo because it is even more difficult for them to do so in private spaces. In the more conservative pockets of urban India (I can’t profess to know much about the rural), these spaces don’t exist. Adityanath should instead be empowering the police force and social support groups to intervene properly and sensitively, so those who feel victimised don’t have to seek arbitrary – and often drastic – courses of action.

He should also be cognisant of the fact that his and his supporters’ purported goal to ‘protect women’ robs women of their agency and right to self-determination.