Like the Sharp Edge of a Razor

Scenes of the Howrah slums (Top: shacks by the railroad. Bottom right: a bangle factory)

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.

Ms Emelda Allen, part of the support staff at Calcutta Kids

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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[1]. 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.[2] 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.

A man unplugs the sewers after the flooding

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 [3], or even just taking a walk back from the office to the clinic[4], 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.  

Not his finest moment on the silver screen…
(Bubble Boy. Dir by Blair Hayes. Touchstone Pictures. 2001).

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.”[5]

We’re biased in our fears of potential threats: with flair for the dramatic[6] and emotional[7], 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[8] 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.[9]

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.


Sanity Check

On the Howrah Bridge

“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.

Terracotta cups with chai during a downpour
Ragda Patties (Photo courtesy of Sriya Sriyakrishnan)

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

Sir,

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[10].

Yours faithfully,

Pranav Reddy

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?

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[1] 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.

[2]At this moment, I had fairly vivid flashbacks to studying for Parasitology at OSU. I thought about what a petri dish would look like from a single droplet from the gray pool, and then about what kind of strains could potentially be growing. Wasn’t it Giardia? I vaguely remembered it being water-borne and causing some nasty stomach issues (but don’t they all?).
[3]Buses, for either getting on or off, only stop for women, not for men (as a rule of thumb). I’ve thought about buying a wig for my daily commute.
[5]“How Americans are Living Dangerously” TIME Magazine. Nov 26, 2006. (http://www.time.com/time/printout/0,8816,1562978,00.html)
[7]In Nobel Prize-winning behavioral economist Daniel Kahneman’s book Thinking, Fast and Slow, he quotes researcher Paul Slovic:“’Risk’ does not exist ‘out there,’ independent of our minds and culture, waiting to be measured. Human beings have invented the concept of ‘risk’ to help them understand and cope with the dangers and uncertainties of life. Although these dangers are real, there is no such thing as ‘real risk’ or objective risk.’In his book, he details how research Slovic did showed that research subjects thought that tornadoes caused more deaths than asthma, even though asthma kills 20 times as many people.
[8]Calcutta is the only city in the world that still has the archaic man-drawn rickshaw. There’s been numerous attempts within the city by human rights groups to ban them, to no success. Despite their callous nature, I saw their usefulness when the main roads flooded, and the only traffic movement was from the carts that weren’t electrical. I still refuse to use them, and to quote Simon Winchester’s Calcutta: “The city is deeply embarrassed by their very existence. How can a it project itself to the world as a successful and cosmopolitan city when it still exploits people quite so blatantly and inhumanely as to use them as human mules?”

Born in Halifax, Nova Scotia, and raised in Cleveland, OH, Pranav has been involved with health policy, bioethics, and global health throughout his time at Ohio State. There, he helped found the third national chapter of Project Nicaragua and participated in multiple service trips to the rural mountain town of Rancho Grande for initiatives in nutrition, education, and agriculture. Pranav also helped found the Bioethics Society and participated in Yale's bioethics summer program, researching the ethics of GM crop usage in the developing world. He interned in Canadian Parliament for Dr. Carolyn Bennett, the Liberal Health Critic, working with the Health, Development, and Food and Agriculture profiles, co-organizing conferences, and writing nationally televised addresses. In addition, Pranav has traveled to India to investigating eye-care health networks in Andhra Pradesh and writing his Honors Thesis on the political context for health system reform in the state.

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3 thoughts on “Like the Sharp Edge of a Razor

  1. Pranav
    Great post. Loved reading it.
    Re risk my uncle gave me some sage advice about a year ago which I converted into an article. He said” In life you can make things happen but can never prevent something from happening”. Think about that. It gives me a different perspective on risk taking and mitigation thereof.
    Best
    Sridar

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