Gringos in Global Health

Pranay, like it or not, you will be a gringo in India. Dr. Guerrant warned me as I got ready to fly to India for a global health rotation. Gringo is the picturesque Latin American term for foreigners. I felt outraged. After all, I am a passport carrying citizen of India! Born in humid Kolkata and raised in the dry heat of New Delhi, I am quintessentially Indian. So what if I had spent my entire adult life studying in America? I was still bristling at Dr. Guerrants warning when I boarded the bus that morning.

After tossing three well-worn one rupee coins to the conductor, I curled myself into a window seat. I say curled because it is impossible for anyone taller than 411 to sit in those seats without an impressive display of contortionism. Reading on the bus is almost impossible; the jerks feel strong enough to rearrange ones visceral organs. If this were not enough, the imaginative interpretation of traffic laws by most bus drivers is sufficient to reacquaint any traveling atheists with the deities they staunchly deny.

The imaginative interpretation of traffic laws by most bus drivers is sufficient to reacquaint any traveling atheists with the deities they staunchly deny.

Five minutes into my jangly bus ride, I saw a lady, in a gorgeous saffron sari squatting behind a small bush. She was defecating. Seeing the bus approach, she made a few perfunctory moves to conceal herself, but she knew as well as I that it was futile. I averted my gaze to give her some privacy. Though I had seen similar sights hundreds of times before, it shook me up in a way that the bus could not. I was struck by how different my India was than hers.

You know youve been left out of the prosperity party when you cower behind bushes as you carry out you basic bodily functions.

A vocal minority of Indians boasts of overtaking Chinas economy soon. We have come a long way from being an impoverished British colony. Middle-class Indians like me suddenly have the capacity to patronize brands such as Bvlgari and BMW. But you know youve been left out of the prosperity party when you cower behind bushes to carry out basic bodily functions. This is the case for more than six hundred million people in India who do not have access to bathrooms. Thats twice the population of the United States! Structural violence and institutionalized inequalities underpin these disparities.If we prosperous Indians allow the creation of a permanent economic underclass, wont our democratic claims ring unforgivably hollow? Wont history judge us harshly for this denigration of our fellow humans?

Doctor sahib, can you help me?

My reverie was suddenly broken by my young co-passenger who had had spotted my stethoscope. I clarified that I was a lowly med student, but agreed to look at a leg wound that he wanted to show me. The wound was crusted with matted mud and some dried exudate. A fly promptly buzzed onto and began feasting on the grime. I waved the fly away with my hand and suggested some simple wound care and tetanus prophylaxis to the boy.

My English is inspired by Oscar Wilde. His was inspired by necessity.

Sometimes, Indians communicate more by jiggling their heads than they do through their words. There is the ready sideways head-jiggle of the Indian who is on the same page as you and then there is the slow, tenuous cranial swaying of the Indian who is mystified, but too proud to admit it. From the amplitude and frequency of the boys head, I could tell that my vocabulary and accent were impenetrable for him. My English is inspired by Oscar Wilde. His was inspired by necessity. I broke into Tamlish (a hybrid of Tamil and English) and descriptive gestures to communicate with him.

As I clumsily counseled the boy with broken words and jerky gestures, I felt a sickening twinge: I truly was a gringo. For all intents and purposes, I spoke, a different language than the majority of Indians. The rupee had a completely different meaning for me. The three rupees I had paid thoughtlessly to the conductor were almost ten percent of the daily earnings of millions of Indians who subsist on 99 cents a day. I dont fit into the bus seats because they were designed for the millions of Indians who are stunted by malnutrition and chronic disease.

In that moment, I resented and despised everything from my expensive education to my polished accent. They were exposed as the products of inequalities deeply ingrained in Indian society, the same inequalities I vehemently decry. I felt like I had somehow swindled the man next to me. I stepped off that bus shaken.

As I reflect on that bus ride five years later, I cant help but think of Jawaharlal Nehru, Indias first prime minister. He once said: Im a queer mix of the East and the West; out of place everywhere, at home nowhere. And he was not kidding: Nehru, Mahatma Gandhi, and many other prominent Indian leaders during Indias freedom struggle against the British were from privileged families and had enjoyed luxurious educations abroad. Upon their return from the prosperous West, they found a yawning chasm between themselves and their beloved countrymen. They felt guilty about the disparities and also puzzled over how they were going to gain the trust of the Indian populace to lead them in revolt against their British colonizers.

Nehru, who had cultivated his diction at Harrow and then Cambridge, was reportedly unintelligible to the millions of Indians for whom such luxuries were inconceivable. Rejecting the posh life he could have enjoyed as the scion of a prosperous family, he worked hard over years to tailor his rhetoric for Indian ears and improve his Hindi. Mahatma Gandhi toured the country for one year after he returned from South Africa. During this time, he talked sympathetically to Indians from every walk of life and sought an understanding of their tribulations. He also reinvented his externalities-- carefully selecting his, now trademark, hat and loincloth-- to better represent the Indians he wished to serve. Both conducted themselves with transparent dignity and compassion. In time, these extraordinary leaders bridged the gap with passion, cultural sensitivity, and a determination to serve. Thus, they led the country against the British into a better, freer future.

Aspiring global health leaders training in wealthy countries who dream of returning to serve their countries can learn from Gandhi and Nehru. Im not necessarily advocating radical sartorial changes a la Gandhi. But we will have to learn to bridge the socioeconomic chasm to serve them. We will all do so in our own ways. The disparities between us and our countrymen and countrywomen are tragic, and they place a responsibility on our shoulders. After all, our brains are unimpaired by childhood malnutrition. Our education has not been truncated by a dearth of funds. Our bodies have not been crippled by preventable diseases.

Gringos or not, we have the capacity to advocate for our voiceless brothers and sisters.