May 12, 2015 (7:45pm IST)
Today I visited the tribal communities in VHM’s Mobile Health Unit – an Indian ambulance that carries large quantities of prescription drugs. In the MHU was a pharmacist, a physician, a driver, and yours truly. The typical routine is the following:
The driver pulls into a community with a few houses isolated from other villages by several tens of kilometers. Once in an area accessible by the people of the village, the driver sounds an alarm and honks his horn several times. If patients come to the ambulance, the back door is opened, and the physician comes into the back and begins to see patients. At the time of complaint, the physician diagnosis the patient and medication is prescribed. The pharmacist fills the order before it is even written, the medicine is handed to the patient, and the next patient begins to enter the ambulance.
This is repeated on average of eight times a day (meaning eight tribes) for six days a week. Today we saw a little over 50 patients. 0 of the patients would have access to care otherwise.
The word tribal, at least from my American perspective, brings about this illustrious image of chanting around a fire, hunting game, rival tribes, and maybe even mile long lacrosse games. This erroneous image was brought to my attention during my first day in Saragur, where the dentist in charge of “Community Health” drew distinctions between Indian tribals, Native American tribals, and African tribals (although other distinctions are necessary), suggesting Indian tribals have more amenities and are more modernly situated than common depictions of African tribals or earlier Native American depictions.
Near Saragur, these tribals generally live in facilities that are worse off from those in the urban populace. But, at first glance, this is not readily apparent. The colors and sizes of the village homes frequently match that of Mysore and the rural towns in the H.D. Kote taluk. And as a foreigner, if I was blind folded and walked into a rural residence area and into a tribal residence area at the beginning of the day, I would not have been able to tell the difference. It’s only on closer inspection that you begin to make distinctions.
In general, it appears that the tribals are at great distances from other peoples, meaning that they likely see the exact same hundred people (or less, I would say a tribe is generally much less than 100 with a mean around 40 people) everyday of their lives. They have little or no transportation out of their tribe, and, if they did, it would be 20-30km to commercial activity they don’t have access to in their own tribes.
Yet, many tribals have electricity and access to general pop-culture media, betraying the image I had of “tribal”. Upon examination, tribals are often physically indistinguishable from those who the physicians call “non-tribal” (Occasionally a tribe will have darker skin. Dr. Kumar, the pediatrician, let me know, with a grin on his face, that one tribe produces particularly hairy babies). I need to inquire more into how one tells if someone is tribal or not, but as far as I know, you trust the patient when they say they are tribal or non-tribal – this is significant for the following reason.
The Indian government, I have been informed (by anecdote), has numerous programs to assist these tribals. They live in 100% subsidized homes – meaning they do not pay rent, but own their home outright. If tribal children get into a college, the college tuition is 100% subsidized. They are given a generous ration of rice, the popular local product (often wheat), and cooking oil per person in the household. VMH also has allowances for tribals making healthcare nearly free for them – not so for non-tribals. (So, it seems it might be in your benefit to not be “tribal” but for the government to consider you tribal).
But the issue becomes how these government recourses are used. With the income the tribals do not have to use for food or mortgage, it is often used on alcohol and cigarettes (as told by the physician running the MHU, who often have cases of alcohol or tobacco abuse). It seems recourses need to be diverted into these communities that includes programming against these tendencies seen in the tribal villages. Targeting programing at the youth level might be beneficial.
Personally, while visiting the tribes, I had a lot of attention on me – I assume because of my whiteness, but maybe due to the fluorescent yellow “Michigan” on my shirt and “M” on my hat. Maybe because I cannot hide that I am foreigner. And, at first, I was extremely timid to even leave the MHU, but following the maxim “When in Rome…” I decided “When in tribal India…” and at the rest of the tribes I came out of the MHU and tried to have interactions with anyone who was willing to hear me make noises that I take as English and they take as blabber.
Regardless of why I attracted so much attention, the children were most impacted by my presence. In one tribe they played a game of chicken, seeing who would get closest to me before I turned around. When I turned around and smiled, they would all run away. Half giggling. Half terrified. In another tribe, two friends tortured their third by picking him up and throwing him in my general direction. After getting back to his feet, he promptly ran away in the opposite. Its fine – I wouldn’t want to be by me either.
My favorite tribe involved a similar scenario, but here were maybe a dozen kids – a large sum compared to the others. A fearless child came within a few feat of me, and I indicated for him to hit my hand in common “High-Five” fashion, but he did not comply. (Stupid American. I assumed “High-Five” is a universal behavior, just like the head nod I keep forgetting not to do.) I illustrated the action I was soliciting for by slapping my own hand. Enamored with the rapid movements of my hands, the child, with a lowered gaze, proceeded to gently place his hand in mine. Confused, I decided shaking his hand was the only option in response to this behavior. Once the most awkward handshake between a two-year old and twenty year old ended, he ambulated away. This action, however, indicated to the kids that I was semi-safe to play with – or at least tease. One girl began to make a rolling r sounds at me ( “r-r-r-r uuuhhh, r-r-r-r uuuhhhh, r-r-r-r uuhhhhh” – that onomatopoeia does not do the sound justice) and whenever I turned around to look at her, she erupted with laughter.
Despite these rather non-intentional games where I seemed to play the monster, the children never failed to frantically wave as we left their community. A memory not easily forgotten.
Overall, the MHU is truly an innovative way to give people healthcare who would otherwise not have access to care. I keep repeating this phrase in my projects and journal “access to care”. But why so important?
It is my firm belief this repetition is well warranted. Access to healthcare is access to a sustained high quality of life. Access to healthcare means a treatable disease like TB becomes six months of medication, not death. Access to healthcare means in the face of disease, I live a few more days – to see my child graduate, to see my child marry, to see my sister go to school.
Access to healthcare is so fundamental – I am not sure I will be able to ever find the words to explain why. But it is necessary to find them.
We share this earth with so many other organisms and we are horribly outnumbered. If we are to continue living, we will continue to encounter organisms, plagues, and diseases our body is not yet equipped to fight. If we have the technology and ingenuity to combat these diseases, infections, and syndromes, who are we to dictate who is given that chance? Do we let the the wealth you are born into dictate that? Your race? Or maybe the geography of where you are born? All, I think, are a poor way to decide who deserves that chance.
My belief is that it is our collective duty to our species, our brothers and sisters, tribal and non-tribal, that everyone should be given the opportunity to fight disease and infection so that they may pursue “Life, liberty, and the pursuit of happiness” not based on to whom, when, and where they were born. For what is life without health? What is freedom without life? What is happiness without freedom? I will contend, and in good company I think, health is integral to all three of those principles. So please, moving forward, lets work to provide it to as many as possible.