Showing posts with label india. Show all posts
Showing posts with label india. Show all posts
Wednesday, September 18, 2013
An unedited impromptu interview with a community health worker in India
Thursday, August 13, 2009
Is there an inverse relationship between tradition and regulation? A Comparison between Canada and India
Indian culture is one of the oldest if not the oldest living culture still going strong. Without a doubt, one of the factors that generated that kind of longevity is tradition. Regardless of how we might judge tradition with a 21st century lens, a strict family structure with rigid social and cultural norms has got to be one of the reasons for India’s perseverance.
One of the hardest to understand cultural differences between India and Canada is the tradition of marriage. “Dr. Sanjay” (not his real name) is in his 30’s and a typical upper-caste Indian man. He is very handsome and tall but yet single. He is a senior resident doctor of community medicine at PGI. He led a tour of the community health center in Kheri for a group of doctors from North Koreans and myself. The North Koreans doctors, Dr. Sanjay, and I discussed each of our country’s courtship rituals on our way back to PGI medical center. The North Koreans asked if he was married. He said, “no.” As we were discussing this, a beautiful young rural woman passed by our van. I said, “in Canada, if we found her attractive we could approach her and ask her for a date, and if things worked out it is possible to get married. “ Dr. Sanjay said, “That would be next to impossible here.”
Another part of our tour was to observe a public health class. During the class discussion about private and public health, I was invited by the teacher to speak about the Canadian healthcare system. Being an American who lived without health insurance for many years and who now resides in Canada I had a pretty good personal perspective on each system. After sharing my experiences about the Canadian system, the students discussed the Indian health care system. I was impressed by their description of India’s far-reaching delivery of health to its people, but this interaction prompted me to ask an important question: why does Canada have generally very good health outcomes but India has some really poor outcomes?
I began to try to think of reasons and issues besides the obvious ones like population and colonization. This led me to a peculiar realization. India has one of the most rigid social structures on earth, yet the ability for the people to follow government regulations seems like a monumental task. And paradoxically Canada has very little real tradition, and there is no rigid social system. You can walk out of your house and marry anyone you please, and yet if you drive without a seatbelt or on the wrong side of the road you would be severely punished maybe even lose your license. To me the striking difference is a culture of safety—seemingly simple safety regulations that most people in Canada have no difficulty following are almost non-existent in India.
This difference makes me wonder if the health system is the most important way of preventing mortality. This question led me to develop four ideas that, in theory, could take the burden of prevention out of the hands of the health system. These include 1) a general culture of health awareness, 2) stronger regulations, 3) definite and immediate accountability for infractions, and 4) improved infrastructure like clean water, safer roads, sidewalks, etc.
While these are challenging and sometimes expensive endeavors, I have noticed an improvement in some of these areas since my last trip to India, in 2001, in things like public smoking restrictions and at least minimal seat-beat laws. Changing culture is rarely easy, but it won’t happen without starting somewhere. Public safety has to be assimilated into construction, food production, the work place, transportation and any business where people can be harmed by products.
Canada has great infrastructure. Water for human use is filtered and treated to a high degree of purity, roads are safe, and building construction is highly regulated for safety. Contractors and developers can get arrested if they cut corners on building codes, there are elected officials in charge of checking on zoning and building codes of safety, and they have the authority to stop construction or penalize a contractor if unsafe construction practices are used. These regulations are designed for both the construction phase, to protect workers and the public, and for the completed phase, to ensure that buildings don’t collapse or require nearly immediate repairs.
In addition, driving in India is a high-risk activity. On the 5-hour drive from Chandigarh to the Delhi airport, I saw two immediate wrecks probably involving fatalities, three trucks overturned, and numerous automobiles driving on the wrong side of the road. To a North American observer, this disregard of road safety seems to be a point of pride with many Indians, as if they see any demonstration of fear about daily driving habits to be a sign of weakness. This type of cultural myopia is hard to change. When I discussed road safety with many people, they often laughed at our concern and shrugged off the seriousness of accidents. But road accidents in India are extremely high.
According to a Boston Globe article using World Health Organization statistics, “road accidents now are the number two killer of young people age 5 to 29 worldwide…. [In India], an estimated 270 people die each day from road accidents, and specialists predict that will increase by roughly 5 percent a year.”
Many cars do not have operable seat belts, and children ride on motorcycles and scooters without any protection. In Canada this practice is illegal. In fact, it is also so culturally abhorrent that people would call the police and look down on such a person. Because I am a cultural relativist, I don’t judge Indian people who chose to ride a motorcycle with a child, as I understand there are many factors that influence behaviors. But I am concerned about safety. My biggest fear in India is seeing an accident involving a child being slammed onto the asphalt—if I witnessed such an incident I would never forget it.
Much of India’s charm is its stalwart retention of its culture, even in the face of westernization. In Canada, without the long tradition and strong culture, sometimes there is a loss of identity, as people seem to be grasping for something to believe in. Also, such stringent regulations can sometimes be claustrophobic and create a backlash. It is precisely in this dilemma where the public health worker inside me, who believes in safety and longevity as a human right, and the dedicated traveler, who believes that culture is what makes us unique, collide. But I do think a happy medium can be achieved slowly.
One of the hardest to understand cultural differences between India and Canada is the tradition of marriage. “Dr. Sanjay” (not his real name) is in his 30’s and a typical upper-caste Indian man. He is very handsome and tall but yet single. He is a senior resident doctor of community medicine at PGI. He led a tour of the community health center in Kheri for a group of doctors from North Koreans and myself. The North Koreans doctors, Dr. Sanjay, and I discussed each of our country’s courtship rituals on our way back to PGI medical center. The North Koreans asked if he was married. He said, “no.” As we were discussing this, a beautiful young rural woman passed by our van. I said, “in Canada, if we found her attractive we could approach her and ask her for a date, and if things worked out it is possible to get married. “ Dr. Sanjay said, “That would be next to impossible here.”
Another part of our tour was to observe a public health class. During the class discussion about private and public health, I was invited by the teacher to speak about the Canadian healthcare system. Being an American who lived without health insurance for many years and who now resides in Canada I had a pretty good personal perspective on each system. After sharing my experiences about the Canadian system, the students discussed the Indian health care system. I was impressed by their description of India’s far-reaching delivery of health to its people, but this interaction prompted me to ask an important question: why does Canada have generally very good health outcomes but India has some really poor outcomes?
I began to try to think of reasons and issues besides the obvious ones like population and colonization. This led me to a peculiar realization. India has one of the most rigid social structures on earth, yet the ability for the people to follow government regulations seems like a monumental task. And paradoxically Canada has very little real tradition, and there is no rigid social system. You can walk out of your house and marry anyone you please, and yet if you drive without a seatbelt or on the wrong side of the road you would be severely punished maybe even lose your license. To me the striking difference is a culture of safety—seemingly simple safety regulations that most people in Canada have no difficulty following are almost non-existent in India.
This difference makes me wonder if the health system is the most important way of preventing mortality. This question led me to develop four ideas that, in theory, could take the burden of prevention out of the hands of the health system. These include 1) a general culture of health awareness, 2) stronger regulations, 3) definite and immediate accountability for infractions, and 4) improved infrastructure like clean water, safer roads, sidewalks, etc.
While these are challenging and sometimes expensive endeavors, I have noticed an improvement in some of these areas since my last trip to India, in 2001, in things like public smoking restrictions and at least minimal seat-beat laws. Changing culture is rarely easy, but it won’t happen without starting somewhere. Public safety has to be assimilated into construction, food production, the work place, transportation and any business where people can be harmed by products.
Canada has great infrastructure. Water for human use is filtered and treated to a high degree of purity, roads are safe, and building construction is highly regulated for safety. Contractors and developers can get arrested if they cut corners on building codes, there are elected officials in charge of checking on zoning and building codes of safety, and they have the authority to stop construction or penalize a contractor if unsafe construction practices are used. These regulations are designed for both the construction phase, to protect workers and the public, and for the completed phase, to ensure that buildings don’t collapse or require nearly immediate repairs.
In addition, driving in India is a high-risk activity. On the 5-hour drive from Chandigarh to the Delhi airport, I saw two immediate wrecks probably involving fatalities, three trucks overturned, and numerous automobiles driving on the wrong side of the road. To a North American observer, this disregard of road safety seems to be a point of pride with many Indians, as if they see any demonstration of fear about daily driving habits to be a sign of weakness. This type of cultural myopia is hard to change. When I discussed road safety with many people, they often laughed at our concern and shrugged off the seriousness of accidents. But road accidents in India are extremely high.
According to a Boston Globe article using World Health Organization statistics, “road accidents now are the number two killer of young people age 5 to 29 worldwide…. [In India], an estimated 270 people die each day from road accidents, and specialists predict that will increase by roughly 5 percent a year.”
Many cars do not have operable seat belts, and children ride on motorcycles and scooters without any protection. In Canada this practice is illegal. In fact, it is also so culturally abhorrent that people would call the police and look down on such a person. Because I am a cultural relativist, I don’t judge Indian people who chose to ride a motorcycle with a child, as I understand there are many factors that influence behaviors. But I am concerned about safety. My biggest fear in India is seeing an accident involving a child being slammed onto the asphalt—if I witnessed such an incident I would never forget it.
Much of India’s charm is its stalwart retention of its culture, even in the face of westernization. In Canada, without the long tradition and strong culture, sometimes there is a loss of identity, as people seem to be grasping for something to believe in. Also, such stringent regulations can sometimes be claustrophobic and create a backlash. It is precisely in this dilemma where the public health worker inside me, who believes in safety and longevity as a human right, and the dedicated traveler, who believes that culture is what makes us unique, collide. But I do think a happy medium can be achieved slowly.
Thursday, July 09, 2009
Personal Paradigm Shift
Spending 11 weeks this summer in India, where the heat is 109 degrees and walking 4 days per week, administering surveys door-to-door, negatively affects my daily routine of Tai Chi. It is simply too hot to move. I have been doing some Chi Gung at night before bed. But I still feel like I am missing my daily one-hour routine of Tai Chi. I have felt jealous of my friends back in the US who aren’t missing a beat in their own practice. Then I had an epiphany that led to my own personal paradigm shift.
My choice of going into health research as opposed to acupuncture or some other health care delivery was just the beginning of incorporating my research into my life. Scientific research is a systematic method of adding knowledge about the world around us by collecting data, lots of data. My research here in India is trying to ascertain how people’s dietary habits impact their physiology. What I am finding thus far is that small, simple choices in an individual’s and a culture’s diet can negatively impact their life span. In short, people’s cultures are killing them slowly.
My research in India takes me door-to-door asking people in their homes about their lifestyle choices. Everyday I meet people who are overweight, with high blood pressure, not exercising, making poor dietary choices and of the age where their first MI (myocardial infarction, or heart attack) is not far off. So many of them think that they are healthy and that they are eating just fine. They truly are in a state of denial. The stats tell another story: About 17.5 million people die from cardiovascular related deaths every year. That is 30% of all deaths in the world, which means that CVD kills more people than any other disease.
Although I haven’t been doing as much Tai Chi as I like, I am seeing first hand through a scientific lens that, overwhelmingly, lifespan is determined by the choices people make day in, day out, many of them based on cultural norms. The average life span in India is 64 years of age. The people I meet here are creating a pattern of behavior that will affect their child’s life span as well. Science has given me the tools to see this. By collecting data from hundreds of people I can infer whether a certain behavior is rampant or not. If you just follow a tradition or culture that is orally interpreted or passed down in books you might not notice what is actually happening on the ground. A state of denial is created because tradition is kind of like a rule book or a map following it confirms you are doing well. Unfortunately, many of the directions are flat out wrong or not appropriate to the present time frame. I am finding that the people of India follow their traditions and are very devout, much like people of other places, but unfortunately without that scientific lens they can’t see where the health outcome of their tradition leads. The Hindu religion states the eating of meat is forbidden, with beef strictly taboo. Although the attitude toward chicken is more casual, many people proudly don’t consume it for religious reasons. However, chicken is a more efficient protein, with less fat, than the daily consumption of whole milk (in tea and drunk plain), paneer (a type of cheese), and whole milk yogurt that makes up a big part of the Indian diet.
Even in my beloved Tai Chi there is very little information on dietary behaviors. There is some wisdom on the balancing of the 5 elements and their dietary correlates: sweet, sour, salty, pungent, and bitter. Unfortunately, it doesn’t give any measurements or of course the wise sages could not fore see the transition from a rural old world diet rich in whole grains to a modern diet full of processed refined grains heavy in salt and sugar. Consequently, Tai Chi instructors without training in western science do not pass on that kind of wisdom. The Tai Chi literature also says to avoid any type of cardio activity. Although there is some wisdom within those words when applied to elderly people but it is poor advice for middle-aged adults who are in need a cardiovascular exercise for their heart.
Absorb what is useful, discard the rest
It is difficult not to be influenced by cultural traditions. Tradition gives many of us meaning in life and even makes us aware of many positive activities as well. The Tai Chi literature is full of all kinds of awesome behaviors to follow, that is why I love it and read so much of it but there is a fundamental lack of precision. Following the scientific method gives me the insight of what is actually happening on the ground from the data collected. The choices I make of which many come from the Tai Chi literature are tempered and corrected by the large body of literature amassed by the western science paradigm. So I can as Bruce Lee has advised, “absorb what is useful, and discard the rest.”
My choice of going into health research as opposed to acupuncture or some other health care delivery was just the beginning of incorporating my research into my life. Scientific research is a systematic method of adding knowledge about the world around us by collecting data, lots of data. My research here in India is trying to ascertain how people’s dietary habits impact their physiology. What I am finding thus far is that small, simple choices in an individual’s and a culture’s diet can negatively impact their life span. In short, people’s cultures are killing them slowly.
My research in India takes me door-to-door asking people in their homes about their lifestyle choices. Everyday I meet people who are overweight, with high blood pressure, not exercising, making poor dietary choices and of the age where their first MI (myocardial infarction, or heart attack) is not far off. So many of them think that they are healthy and that they are eating just fine. They truly are in a state of denial. The stats tell another story: About 17.5 million people die from cardiovascular related deaths every year. That is 30% of all deaths in the world, which means that CVD kills more people than any other disease.
Although I haven’t been doing as much Tai Chi as I like, I am seeing first hand through a scientific lens that, overwhelmingly, lifespan is determined by the choices people make day in, day out, many of them based on cultural norms. The average life span in India is 64 years of age. The people I meet here are creating a pattern of behavior that will affect their child’s life span as well. Science has given me the tools to see this. By collecting data from hundreds of people I can infer whether a certain behavior is rampant or not. If you just follow a tradition or culture that is orally interpreted or passed down in books you might not notice what is actually happening on the ground. A state of denial is created because tradition is kind of like a rule book or a map following it confirms you are doing well. Unfortunately, many of the directions are flat out wrong or not appropriate to the present time frame. I am finding that the people of India follow their traditions and are very devout, much like people of other places, but unfortunately without that scientific lens they can’t see where the health outcome of their tradition leads. The Hindu religion states the eating of meat is forbidden, with beef strictly taboo. Although the attitude toward chicken is more casual, many people proudly don’t consume it for religious reasons. However, chicken is a more efficient protein, with less fat, than the daily consumption of whole milk (in tea and drunk plain), paneer (a type of cheese), and whole milk yogurt that makes up a big part of the Indian diet.
Even in my beloved Tai Chi there is very little information on dietary behaviors. There is some wisdom on the balancing of the 5 elements and their dietary correlates: sweet, sour, salty, pungent, and bitter. Unfortunately, it doesn’t give any measurements or of course the wise sages could not fore see the transition from a rural old world diet rich in whole grains to a modern diet full of processed refined grains heavy in salt and sugar. Consequently, Tai Chi instructors without training in western science do not pass on that kind of wisdom. The Tai Chi literature also says to avoid any type of cardio activity. Although there is some wisdom within those words when applied to elderly people but it is poor advice for middle-aged adults who are in need a cardiovascular exercise for their heart.
Absorb what is useful, discard the rest
It is difficult not to be influenced by cultural traditions. Tradition gives many of us meaning in life and even makes us aware of many positive activities as well. The Tai Chi literature is full of all kinds of awesome behaviors to follow, that is why I love it and read so much of it but there is a fundamental lack of precision. Following the scientific method gives me the insight of what is actually happening on the ground from the data collected. The choices I make of which many come from the Tai Chi literature are tempered and corrected by the large body of literature amassed by the western science paradigm. So I can as Bruce Lee has advised, “absorb what is useful, and discard the rest.”
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