Richard Smith: A day in village India

Richard Smith“The village is the real India,” said an Indian friend, echoing Gandhi and the continuing belief of many Indian intellectuals. “What is the village but a sink of localism, a den of ignorance, narrow mindedness, and communalism [putting your own ethnic group ahead of society],” said Bhimrao Ambedkar, who drafted the Indian constitution and was the first “untouchable” to receive an overseas education.

 Both statements were in my mind as I sat in the house of the panchayet (headman) of Jagadeenahalhi, a village of about 600 people in Karnataka and close to Bangalore. I was there with two community health workers, three community health doctors from St John’s Medical College in Bangalore, a catholic college committed to serving the poor, and two colleagues from the National Institutes of Health in the US. [I may be using panchayet wrongly. It is the council of the village, and after a good bit of time on Google I’m not certain that it does mean leader. Somebody will correct me if I’m wrong, I hope.]

The panchayet was hugely jolly, laughed all the time, and seemed delighted to have us there. He is elected to his position, but serves alternating terms of five years as the role switches between “upper” and “lower” castes. As in Britain, an election is coming, and the women of the village, whom we met later, joke that this is a good time to get whatever you want.

We are there because we are starting a project to identify people in the village at high risk of cardiovascular disease and then use community health workers to help them improve their lifestyle and take any treatment that might be necessary. The panchayet is pleased that this is happening and tells us that many people in the village have “sugar diabetes” and that people are dying of heart attacks.

As we leave, he insists that we come and see his field of cabbages, which is small but well irrigated, and gives me a bag of potatoes. The village has no tarmac road but does have a primary school, and all our conversations take us back to the teacher, who is clearly a driving force in the village. We walk past the small houses, some very brightly painted, past the water tank where villagers come to collect water, and past dirty ditches filled with rubbish and murky water to the house of the leader of a local woman’s cooperative.

Almost a dozen women are sat on the floor in their brightly coloured saris, and with the community doctors translating we question them. They are a group of about 20 women from the village who all contribute 30 Rupees (around 50 p) each week to create a pool of money that is lent to members of the group to perhaps buy a goat or some seed or start a small business. The money must be paid back with interest. It’s a microfinance scheme started some nine years ago with the encouragement of the government. The women meet once a week to thrash out both business and social issues. There are eight such groups in the village.

They are happy to answer any question.

“Why are there no men?” “Men are too unreliable?”
“Do the men object to you forming a group?” “They did at first. Not now. They see the benefits.”
“Do you lend money for sickness?” “Yes.”
“What happens if a woman can’t pay money back?” “We give her time. We help. We’re friends.”
“Do you campaign for better facilities for the village?” “We do. We get together and go to the panchayet.”
“Can you stop the men drinking, smoking, and playing cards?” “We try, but we’re not successful.”

There’s lots of laughing as we talk.

Before we leave we sit down among them and have our photographs taken. I feel privileged to have the opportunity to meet them.

We then drive to Mugalur, a bigger village where St John’s has built a community health centre. On the way we stop at a temple with the brightly coloured, semi-naked Hindu gods swarming over the tower of the temple, monkeys joining them, and a collection of blind and elderly people begging outside. We wash our feet and hands and together—Hindus, a Muslim, some Catholics, and an atheist—receive a blessing via the priest from Krishna, who can be glimpsed deep in the temple covered in flowers.

At the clinic we meet “Dr Daisy,” known in the village as “the god of sight” who has removed over 5000 cataracts, often from people who haven’t been able to see for years. She can remove a cataract and insert an intraocular lens in about five minutes, and once did 120 in a day. “If I need a cataract removed I’ll go to her,” says one of the community health doctors.

We also meet a professor of paediatric orthopaedics who comes to the clinic once a month to see children with deformities caused by birth injury, cerebral palsy, infections, accidents, and unhealed fractures. He does such a good job that his clinic constantly grows and adults come as well, but nobody is turned way. “Consanguinous marriages are a big part of the problem” he observes.

Then we get to sit cross legged (ever tougher for my old joints) and talk to the 11 community health workers, again all women. Some of them have been working with the clinic for 13 years, doing an ever wider range of tasks. They are paid, have high status in their villages and know everything about everybody.

“Doesn’t knowing so much about people mean that they respect you but keep you at a distance?” I ask, thinking of John Berger’s account of the life of a country GP.

“No, definitely not,” they answer, clearly thinking my question strange. Their value comes in large part from their intimate knowledge of their villages. “It just doesn’t work to have community health workers from other villages,” observes the community health doctor.

After answering dozens of questions from us they ask us questions. What are we expert at? My colleagues from NIH explain about their interest in chronic disease. When it’s my turn, I answer truthfully but maybe a touch pretentiously: “I’m expert at nothing but interested in everything.” This causes the translator and then the women to explode with laughter.

On our drive back the community health doctor explains that the villagers have sold all the land around their village for sums that are huge to them. A politician has bought the land and will have no difficulty getting it rezoned from agricultural land to land for development. Then he’ll build luxury houses to provide homes for the software engineers from Bangalore, which is rapidly swallowing up the surrounding countryside. The villagers, although temporarily rich, will lose income, and the traditional village will die. Worst affected will be the landless labourers who will share none of the payment for the land and the very poor, the “untouchables,” who cluster away from the village.

Eating jackfruit and reflecting as we drove back on the quotes that began this blog, I thought that I’d seen more nobility than ignorance in the villages, but will India avoid the urbanization that seems inevitably to accompany development? I doubt it.