XXI. Breaks

When I am home, if I do not work in my garden, or at least explore around the place, a couple of times a day, my academic productivity suffers. That’s why I created an outdoor office (under the umbrella) by the pool. Forcing myself to sit and work does not produce good results. I am good for 45 minutes, at the most, before the most distressing things start to happen. I know this is true because I have done a few small experiments to test the hypothesis.

Self-discipline is another matter; it is something that all great masters recognize as essential to success. It is always some kind of yoga. Today, it was hatha yoga, walks, eating lots of fruits and nuts, and then a planned treat to go to Kharghar in the early evening and eat at a nice restaurant. The delay in gratification worked. It was a very satisfying day – including two postings here. At certain times, I need to build things in wood, or metal, brick or stone; though that option is mainly unavailable here. At others, I need to chase a ball moving at high speeds in a small space at close quarters with another human being (who is a friend). That option should be available soon!

I like being new places; and sometimes even visiting old ones. Typically, though, “being” someplace usually is a lot better than “getting” there. Like most things in life, though, it depends. After the 14th World Conference, I planned two outings – one with other conference attendees/friends (mainly Americans) to a beach house south of Mumbai and the other, with Glorian Sorensen, to Lonavala (a Hill Station West of here) on Monday before she went back to the states.

We left for the beach trip from the Gateway to India (that’s the boat we took for the great escape, a bit obscured by the early morning fog). This Gateway and the Taj in front of it got a lot of notoriety back in November. But I relate to these places mostly from having visited often with Christine when we lived here in 1997-8. On Sundays, we would often sit on the first floor (equivalent to the second floor in the US) restaurant of the Taj eating pesto and enjoying the scene below. Of course, it also was nice to be part of the scene, spending a little time hanging out on the esplanade in front of the arch.

Going into rural India is always such a treat. We passed by boats dressed up for Holi, a market with people selling flowers and food, another one of what must be millions of archeological ruins, and then on to this most amazing beach.

That’s Ratesh (who also applied to be a Fulbrighter next year) and his wife Petra (Glorian took the picture). I swam off this beach for a long time and it felt like a great big, whole body massage! Then, I actually got a whole body massage! Well, it doesn’t get a lot better than that. I don't get to see Americans, or any other foreigners, here very much. So it was a real treat to talk to people who shared elements of my culture. Our Indian hosts also made people feel very much at home, including providing a spectacular venue (that we agreed we would not photograph), exquisite food, and even massages!

XX. Meeting at The 14th World Conference

The 14th World Conference on Tobacco OR Health connected people from many parts of the world. It also represented a real opportunity to see how these communities of scientists and activists are connected generationally. We can now assume that tobacco causes many chronic diseases. Accumulation of this knowledge is the bedrock on which the foundation of anti-tobacco advocacy is built. Science provides the means for testing hypotheses (Does it work or not?), estimating effect sizes (How much of the substance produces what effect?), maintaining the knowledge, and drawing inferences based on what we have learned. The assumptions that we can now make about the harmful effects of tobacco are built on the experience and findings gleaned over the previous half century of scientific work – much of it brilliantly thought out and meticulously executed, right here in India.

Dr. Prakash C. Gupta, President of the Conference, Director of Healis Sekhsaria Institute for Public Health, my main colleague here, and the official host for my Fulbright Fellowship, began working with a remarkable team of people led by the legendary Dr. Fali Mehta back in the mid 1960s. Many of these people, mainly dentists and oral pathologists (including Dr. Bhonsle, shown on the TIFR campus looking at the sunset 45 years after he was first hired), were Dr. Mehta’s students. In a very real sense they grew up with one another: attending each others’ weddings; rejoicing in the births of their children; thinking, planning, and analyzing data; and finally doing what needed to be done with the new-found knowledge. Over the years I have visited them in their homes and they have come to stay with Jane, Christine, and me in the US.

Though some have died and others have left India, their legacy is something that lives on in many ways. I love to tell the story of the Basic Dental Research Unit/ Epidemiology Research Unit, Tata Institute of Fundamental Research because it is a classic in combining excellent epidemiology, clinical practice, and laboratory-based basic science. It is through the work of this group, conducted over three decades in various parts rural of India, that we now understand the process of malignant transformation by which oral precancerous lesions become oral cancer. This formed the basis of our understanding of the basic process of tobacco carcinogenesis and led to intervention trials in many of these same parts of India over the next decade, and now are being conducted all over the world. This work also formed the basis for our investigations, in some of these same parts of India (Bhavnagar District in Gujarat, Ernakulum District in Kerala, and Srikakulum District in Andhra Pradesh) into the role of diet on which we collaborated and published in the 1990s and into the first couple of years of this century.

Seeing the Healis Sekhsaria Institute for Public Health booth at the Conference was a treat for experiencing the generations coming together to educate and make the world a better place, as an opportunity to actually feel the energy of this expansive group, and to see Dr. Bhonsle’s incredible traveling tobacco paraphernalia show.

This meeting, which spanned a half century of work and brought people together from around the world, provided a rare occasion to pause and reflect. Some newer members of the team (including Glorian Sorensen from Harvard, whom I introduced to Prakash nearly a decade ago) never met the original members, other than Prakash. Neha, pictured by Dr. Bhonsle’s traveling tobacco paraphernalia show, met some of them at the 14th World Conference. The team picture that you see here may very well be the only one that shows members of the original team with people who have joined as recently as this year. Some of these new members are younger than the children of the original cohort (some of whom also attended) and, has been the case from the beginning, remarkable people from all over the world are attracted by the magnetic pull of all that is good about these remarkable people and their calling.

XIX. Glimpses from the Mundane and the Material

When I first traveled within India back in the 1970s, it almost always was by overnight train. On these trips, there were the inevitable 21, or so, questions. These included ones such as: Where is your family? Are you married? Friend or Wife? How much did that backpack cost? How old are you? What does your father do? What is your education? How much money do you earn? Do you like Indian food? I met this Canadian man, Peter, who printed out an answer sheet for the questions he was regularly asked. He mentioned that people received this very favorably, often asked a few other questions, usually by way of clarification, and then they would move on to other matters for discussion.

As much as I was amused by these questions, the latitude I was given to respond, and the true interest in my response; I was more struck by how very soon after we dispatched with the 21 questions and answers that the conversation would turn toward things spiritual. Religion was mixed up in this, but not in the kind of pedantic, often proselytizing way that I experienced religion to be used in the US. People really did want to probe the depths of human understanding to discover and ponder universal truths that would emerge from this kind of discourse. Over that time and in the subsequent years that I lived here I got very used to, and comfortable with, this kind of exploration. I was willing, indeed eager, to drink from this deep well of potential understanding because I learned a lot about myself and what I have found to be universal truths along the way. I think that everyone who seeks to understand life’s deeper meaning wants this. It is sad that so few receive it.

In retrospect, the absence of this probing introspection and deep connection with others was a major source of culture shock when I did return home. Big cars were the outward manifestation of the shock; and they have gotten ever bigger over the years! Of course, they are “needed” to cover vast distances at high speeds because we have been deceived into believing more mundane, crass, and
superficial things are the necessities of life. Having embarked on this cumbersome journey, the privacy entailed, indeed effectively required, shuts out any such possibility of spiritual striving – though I rarely even perceive dim glimmers of the urge.The Indian middle class is growing and with that growth has emerged a trend toward private automobiles (along with the hostile urban environments it creates) and airplane trips (with forward-facing seats and short travel times) that have dampened this experience in important ways.

Still, on the way back home to Kharghar by train from the 14th World Conference on Tobacco OR Health on Thursday night I was able to converse with a retired Army colonel on topics ranging from price supports for agricultural commodities to the inevitability of terrorist attacks in a world without understanding, respect and love for one another. It also comforts me to know that conversations with colleagues here almost always turn to the philosophical, if not explicitly spiritual, underpinnings of what we do. I cannot work this hard without belief in the inherent goodness and worth of it all. I am happy to report that I also have drawn colleagues back home into this kind of discourse; for example, we have written this wonderful paper, which I hope folks will have time to read when it comes out in April or May: Hebert JR, †‡Brandt HM, ‡Armstead CA, *‡Adams SA, ‡Steck SE. Interdisciplinary, translational, and community-based participatory research: finding a common language to improve cancer research. Cancer Epidemiol Biomark Prev 2009;(in press):00-000.

XVIII. Hello, Kolkata and Mumbai

I was torn between completing my thread from the more distant past to connect the ideas of social, environmental, healthcare, and economic justice back to famine or to focus on the intertwining of very recent events with memories of events and people who emerge from the more recent past. Knowing that many people who read this want to know something of the day-to-day life here, I have opted for the latter (that's Mangesh Pednekar, Associate Director of Healis and one of my main collaborators here with Hell's Preferred Citizen). I see a way to connect this newer thread to the other, older, one. So, I promise to do that in the near future.

After saying my goodbyes in Chennai, I said a whole bunch of hellos in Kolkata. The South Asian Regional Fulbright Conference brought together 78 Fulbrighters from countries throughout the region, but mainly India. About 2/3 were students of various types and the rest were lecturers and senior scholars (that's Janet Lilly, fellow Fulbrighter and Chair of the Dance Department at University of Wisconsin posing next to a poster of her then-upcoming performance at Tagore's ancestral home in Kolkata). I was among the older people present and recall with colorful and exuberant vividness those days when I was as young as the youngest people in the room. It was a wistful feeling of nostalgia that I savored – I loved both the energy and enthusiasm of the youth, which is expressed nowhere better than in relation to a foreign culture and the experience of us old India hands who have spent many decades sampling from the feast on which the young are now gorging themselves. The topics, ranging from classical Indian dance, to temple architecture, archeology of the oldest sites of human urban habitation (in the Indus Valley), law, textile art, public health street theatre, stem cell research, music, forestry, translation of ancient Parsee texts, and camel genetics was intoxicating. The energy of the students was equally amazing and there was absolutely no way anyone over 30 could have kept up (and, to the best of my knowledge no one tried). Kolkata prides itself on being the “cultural capital” of India; so, there is excellent scope for partying.

As I said earlier, above all else the Fulbright program is about international understanding. I would guess that this group of remarkable people, each in her or his own way, will doing more to advance world peace and the prestige of our country than the entire military budget of the US in a year. The bonds of friendship and understanding that are formed under such conditions of joy and deep respect for the lives, beliefs, and aesthetic values of others are deep. How beautiful; and what a bargain.

On Thursday morning I returned to Navi Mumbai and then shifted to Mumbai for the 14th World Conference on Tobacco or Health last Saturday. These days have combined meeting with old friends such as Prakash Gupta and Glorian Sorensen (flanking me in this shot) and taking in both the most amazing inaugural ceremony I have ever witnessed at a conference [the whole place erupted (in a nice way!) with everyone dancing – lead by troops of very talented Indian classical dancers and musicians and 110 slum kids trained and sponsored by Salaam Bombay Foundation] and a cultural night that was in many ways like celebrating Holi in the villages of Northern India (and it was Holi – marked by the last full moon before the vernal equinox).

XVII. Saying Goodbye

There is a lot of asymmetry and apparent unfairness in life. But there are certain symmetries about which we can be certain. For each birth there will someday be a death. For each hello, however happy or sad, there will be a goodbye, however sad or happy. For every first step, first experience of the swim in the pool, first day in the office, first day of school (that's Christine with her parents on the day she left for college), there will be a last. If we are lucky and careful (but not too cautious!), these entrances and departures will be done with grace and aplomb. Whether it is a matter of simple luck, or perhaps something as complicated as karma, sometimes we are afforded the opportunity to say our goodbyes with the time needed to honor those relationships we cherish. So far, I have almost always had the opportunity that I felt I needed. The saddest final goodbyes are those reserved for those who have not lived long enough to have realized their full potential or those who depart with regret and remorse for not having lived a kinder or more meaningful life.

The last time I took this trip from Chennai to Kolkata it was by train (not airplane); my next birthday, which I would then celebrate in that great city with some very raucous acquaintances of mixed Indian and Russian descent, would be my 30th (not my 60th); and even the names, Madras and Calcutta, would roll off my tongue differently (and in a way about which I feel nostalgic) than these new names do.

As someone who likes to travel, I have always preferred being the one to leave to being the one left behind. Still, there is sadness in knowing that the things I have come to appreciate in my new “home” (and in some way, anything deserving of a real goodbye becomes home) will be greeted by the rising sun of a new day that I will not experience. When I left Karamoja after my last visit and before the coup that would remove Milton Obote from power, I assumed that I would never return. When I left Madras in 1980, I knew that I would return – and have done so in 1984, 1993, 1998, 2008 and 2009. Each time, however, it is a different place. Though they have the same names and some shared aspect of personal history, even the people are changed in some important way.

My stark assessment, and I say this with no bitterness at all – but more a sense of sad resignation, is that the world is worse off now for the many decades of our having lived here than it was before we started. The adults of today’s world have a lot of remedial work to do to make this planet a fit and sustainable place for the generations behind us. This must be done before we can say our last goodbyes with the kind of peace and satisfaction that comes from a life well lived. Most of the people I have come to know in my work and other aspects of my life know this, even we do not articulate that belief very often.

XVI. Uganda, Take Two

When I returned to Uganda in 1984, it was to a different set of experiences. I had graduated from my doctoral program; so, there was a kind of earnestness that I had not had previously. Still, it very much had the feel of the “Year of Living Dangerously” and I can only marvel at my recklessness and naïve sense of adventure. Although I returned to Karamoja, and had the more frightening experiences on this second trip than the first; I spent significant (including in terms of my own development) time in the West Nile, the native region from which Idi Amin hailed and that had been totally off limits the year before.

Though situated at the same latitude as Karamoja, but in the northwest corner of the country, the West Nile was in many ways, but not all ways, its opposite – very lush, green, and humid – sort of the picture that I had of the tropics before 8 years of living off and on at these latitudes disabused me of that misconception. In many, but far from all, ways it was paradise on earth.

It was Cole’s idea that I would weigh and measure every child I could find in the region; ostensibly as a way to document the need for aid and to assess what could be done to reconstruct the region. Once again, James was my partner.

Roughly the size of Connecticut, the West Nile had a population of about a half million in the mid- to late 1970s. The nearly 10,000 children we measured on our excursion through the region were too young to remember having seen a European, as the last one had departed before the “War of Liberation” (wars are always given such nice names). So, I was quite a novelty. The only “crop” that we saw growing was cassava (yucca), as that requires little tending; so, it is ideal for people who need to leave on short notice with no guarantee of return. At that time, we estimated that the entire population of the region was no more that 1/10th that of the mid-1970s.

We were there in May, which is high mango season. I love the taste and smell of ripe mango; and it was eerie to drive for long stretches through mango forests (these were big trees, not the short cultivars of modern mango farms) without seeing people and the Land Rover’s wheel wells and undercarriage literally dripping and drooling with gloriously fragrant, deep yellow-orange mango juice. Many of the children had schistosomiasis, but were generally a bit better off nutritionally than their Karamajong counterparts.

On our last day on the West side of the Nile we engaged a ferry to cross the river. It was not terribly wide at that point – maybe a few hundred meters at the most. I recall our “guards” – there were 14 “soldiers” armed with AK47s and rocket-propelled grenades, had an average age of about 14 years, and eyes redder than any of my fellow travelers in Afghanistan 8 years earlier. When we started being shelled from several hundred meters upstream (perhaps even a kilometer, as we were in the very north of Moyo District in Ugandan territory and the fire probably was coming from Sudan) I really regretted that we had a petrol, rather than diesel, vehicle (as we were carrying an extra 200-liter barrel of the more explosive liquid in the back of the Land Rover). Swimming with the other creatures in the river while be shot was about as unappealing as finding ourselves in the center of a raging inferno. We made it out of there physically unscathed and decided to continue on to Kampala; even though we had lost radio contact (the UN radio was constantly on) along the way. Driving through the infamous “Luwero Triangle,” we entered the city in the evening a couple of days later. It was pitch black and, with the exception of small arms fire, very quiet.

The fog of 25 years is not heavy enough to remove the stark images of those days, but with the exception of trips through geographic space, the temporal ordering gets a bit confused. Perhaps just before that trip (but I think it was afterward) I got a call from Bjorn saying that Satya had suffered a stroke and might not live. Until then, the fear and excitement associated with trying to survive while helping others kept me numb. I now know that this is not an uncommon occurrence for soldiers and others living in war zones. The news of Satya stung deeply and very personally. I went home and cried myself to sleep.