To Undo Your Belt and Look for Trouble
Ms. Emelda Allen eyed me judgmentally from head to toe. “The rains have come late this year, but they have come strongly, no?” She stated this nonchalantly, in a strain of English that one only heard from those Indians who had decades of interactions with British nuns. Then, flipping her sari over her shoulder, she waded in. “Walk in the middle. It’s shallower.”
I hesitated and at the same time tried not to show my hesitation with the unexpected circumstances. Ms Allen and Seema-di, one of the community health workers essential to Calcutta Kids’ mission, were leading me through Fakir Bagan (“Garden of the Ascetic”), one of many technically illegal settlements that have sprouted up along the railroad tracks running toward the main train station of Howrah, Calcutta’s sister city across the Hooghly river. These slums are full of migrants from other parts of the country, mostly from neighboring states like Jharkhand or Uttar Pradesh but some as far as Tamil Nadu and Andhra Pradesh, who come looking for jobs and economic prosperity.
We were walking door-to-door visiting the homes of pregnant women where the health workers, including Seema, explained what they should be doing to ensure their health, and their child’s health. She cajoled the mothers on a variety of essential topics: what they should eat, how they should rest, where to register for the delivery, and what medications they could take. Here, poverty was as much expressed in the form of knowledge deprivation as much as in economic deprivation.
Leaning down, I rolled up my already-drenched pant legs to my knees. I wasn’t sure it’d be enough. Should’ve brought an umbrella, I thought, but then again, the blazing heat just a half-hour ago had given no indication of the ferocious monsoon storms that were in store for us. They never did. I looked ahead: a gray pool was gradually rising and overflowing from the sewers. This pool had some kind of nebulous black clouds floating in it, along with the occasional empty bottle or stray dog. I would later be informed that this was normal for a hard rain in Fakir Bagan; the feeble infrastructure was simply not capable of handling it, and the massive flooding was a regular feature of life there. I looked to where Ms. Allen was, and followed her down the middle to the next home, the sullied water rising up my legs. It was my first day working with Calcutta Kids.
Risky Business: Welcome to Calcutta
“Life is best organized as a series of daring ventures from a secure base.”- John Bowlby, British psychoanalyst
Over the last month or so in Calcutta, I’ve been thinking consistently about the idea of risk. Whether it was stepping into murky water in a flooding slum or jumping to catch the (most likely) last bus back to South Calcutta while it’s still moving , or even just taking a walk back from the office to the clinic, I’ve come to a general conclusion about this:
I take on more risk here in an hour than I would in a month at home in Cleveland. More risk in a month here than a lifetime in the States.
Most of our lives we rightly attempt to mitigate risk, especially the risk of our eventual death. Insurance, seat belts, occupational work standards are all protocols that have made our environment safer, lengthened lifespans, allowed our bodies to be more secure from physical harm. But the truth is, we human beings are horrible at understanding and perceiving real risks for what kills us. We have, as TIME magazine noted, an “old brain in a new world”:
“These two impulses–to engage danger or run from it–are constantly at war and have left us with a well-tuned ability to evaluate the costs and payoffs of short-term risk, say Slovic and others. That, however, is not the kind we tend to face in contemporary society.”
We’re biased in our fears of potential threats: with flair for the dramatic and emotional, but against the abstract and long-term (global warming comes to mind). But even with our deeply embedded irrationality, the U.S. and most nations included in the category of the developed world have done an overall decent job of mitigating and spreading risk.
Here in Calcutta though, it’s more of a mixed bag. I think of every passing man-drawn rickshaw as I walk in the city, with their spikes poking out menacingly, inches from my calves. First, selfishly, I think of the terrible plight that would befall me if a spike were to scratch my leg. I briefly imagine the rust breaking off into my bloodstream, the terrible tetanus affliction, and a dingy hospital room where I’d wait for hours for treatment. Then, less selfishly, I remember that people live their entire lives with this risk or even greater risk.
We can look at life expectancy, an admittedly crude indicator of how well a society’s doing in terms of avoiding mortality and morbidity. Over 100 years ago, in the United States, the life expectancy for a baby at birth that was male was 47.9, and female was 50.7 (CRS Report for Congress, 2006). That means I’d be expected to be six feet under in a little under three decades from today, and in two years I’d have my mid-life crisis. Today, of course, those numbers are at 74.8 and 80.1 respectively. In India, the life expectancy ranges from 58.0 to 74.0, averaging out to 65.1.
But that’s an average. In the slums, the life expectancy recalls some other numbers: 47 for men and 51 for women. It’s almost exactly what America had a hundred years ago (pre- water filtration, when people still died in the U.S. of dysentery Oregon Trail-style from heading west). Worldwide, one-seventh of us (meaning the global population) will soon be in slums with conditions not unlike the kind I encounter daily in Fakir Bagan (UN Habitat Report: State of the World’s Cities 2008). Risks abound here, and it plays a clear and central role in the lives people are able to live.
That, in the end, is essentially what Calcutta Kids is doing as well. They enter this game of risk in the middle of a mother’s life and the beginning of a child’s, through nutrition, immunization, check-ups with an on-staff physician, and regular meetings with our health workers to make sure that all the necessary health behaviors are being followed. Indeed, any healthcare in its essence is trying to reduce the risk of death or illness.
Life of course is fraught with risks everywhere. What I’m coming to realize is that we have to take the decision as to which risks are acceptable and which are not. Any industry or organization without any risk of failure, like some bureaucracies I’ve encountered here, enters a sort of living death, a zombie mode of complacency and slow-moving fans. This happens equally in individuals as well. I think it boils down to not accepting risks that cripple our ability to live freely and with capability, while also understanding and even embracing the risks that enable life and living itself.
“The attitude is not to withdraw from the world when you realize how horrible it is, but to realize that this horror is simply the foreground of a wonder and to come back and participate in it.”- Joseph Campbell, mythologist
The sensory overload, though wasn’t limited to just my first day. Assault has come from every angle over the last month. Along with physical risks to bodily health, there’s a not insignificant risk of going mad from two main culprits: overstimulation and bureaucracy.
We tend to compartmentalize things pretty clearly in America and the developed world. Factories are in this district, restaurants are over there. Cute, suburban McMansioned neighborhoods are cordoned off from nefarious elements like waste dumps. Here, on the other hand, the smell of feces and body odor, human sweat and exhaust fumes, freely mixes with the sweet aroma of freshly boiled chai or the delicate fragrance of tamarind and mint water for delicious street-side pani-puri. In the slums, within an even more compressed space, bangle factories are adjacent to homes and restaurants, pseudometallic toxins leeching into the air, the workers’ faces maskless and their hands gloveless. The pink clothing dyes run into the streetside sewers, out of which a goat sips.
Despite the horror in such a scene, there is a beauty to life in Calcutta, in the slums and the city. It’s absolutely the most photographable city I’ve ever been to, the people are friendly and prone to debate (Addas, in which men sit for hours and discuss politics late into the night on the curb smoking beedis and drinking, are common. If nothing else, I’m going to weasel my way into an adda, whether I know Bengali or not.), Some of the street food I’ve had, when measured in pure, unadulterated pleasure, is better than five-star fine-dining. On the other hand, a mental health risk that I refuse to admit has any beauty is the extensive red-tape for simple tasks, from getting internet to getting registered to get into the country.
An example of the phenomenon: I forgot my phone at a (famous) local sweets shop, where it was deposited to the local police station. After a long and convoluted conversation on a friend’s phone, finally figuring out that it was at the police station, I made a trip there (where it was, of course, not at the address the officer gave me on the phone). In the office, there were seven officers “assigned” to my case of the lost phone. For six of them, this work involved staring at me, not believing that I didn’t know Bengali despite my brown skin, and for the other, gradually sipping on chai waiting for another officer who knew what to do. When the officer finally came, he unloaded on me with everything he knew about America (“my brother is in California!”), he insisted I wouldn’t have to do any of the usual paperwork since I was a countryman (I wasn’t about to speak up then about my U.S. passport sitting on his desk). Then he proceeded to dictate to me a letter for official purposes, that I began scribing word for word. Here it is, reproduced below, in his words and in my handwriting:
To the Officer-in Charge
Kolkata, West Bengal
I, S. Pranav M.A. Reddy, son of Satti Sethu Reddy of Tadepalligudem, Andhra Pradesh inform you that this day (October 5, 2012) I came to K.C. Das shop to have a dessert with friends and carelessly forgot my mobile phone (it was an iPhone Apple edition) to take with me when I left the place. Later, I come to know through a friend and colleague, Mr. Hunter Gros, that the phone has been deposited to this police station as informed by the on duty officer Sub Inspector [name redacted]. I came to this place and after verifying me through proper procedures conducted by aforementioned sub inspector, the phone was handed over to me for which I am really very much grateful.
Needless to say, I made sure I snapped a picture of the letter when 6 of the 7 officers weren’t looking (you can’t win em all). The experience is surreal in a Kafkaesque way, and can even be fun if undertaken with a sense of irony. Survival here requires being both detached and deeply attached, being both a spectator and having skin in the game.
Check out my blog and others on the AIF blog website, where you can catch the experiences of AIF Clinton Fellows. One of my favorites this month: Brian Tronic working for People’s Watch, a human rights org in Madurai: What good are human rights?
 By ‘us’, I am including my friend Sriya. Sriya is my partner AIF Clinton Fellow placed at Calcutta Kids, a graduate of Brandeis originally from Bombay, and working on a project related to behavioral change communication. She also has near infinite patience, judging by her sympathetic efforts to translate Hindi for me.
On any given walk, it’s possible that a brick might fall from the sky at any moment, as it already has once a few feet from me, or that a bus (not meant for these narrow and impromptu streets) might run me over flat, as it almost has more than once.
Imagine the fear against car accidents if it happened in one fell swoop like planes crashes: each year there’s 40,000 fatalities from cars and 200 from planes. Yet fear of flying afflicts more of us than fear of driving ever does.
This is, admittedly, a negative view of healthcare, focused on the disease and pathogen prevention(“pathogenesis”) part of the equation. The sociologist Aaron Antonovsky came up with a profound insight into health from his studies on resilient Holocaust survivors: a new focus on what made healthy groups healthy and how they managed ever-present stress, instead of the traditional focus on disease. He called it “salutogenesis.”
Yes, he actually made me write that at the end.