XXXIV. Monsoon, Famine, Gandhi and the Spinning Wheel

Most of the time that I was in Navi Mumbai clothes would take only a few hours to dry after I would wash them. The drying time became progressively shorter as the days became hotter. Then, about three to four weeks ago (in the beginning of May), the air became noticeably more humid. The clouds began forming in different patterns (see XXIII. Expectations and Experience), and it even rained last Wednesday, the 20th.


India has two monsoons. The Southwest, or Advancing, Monsoon is the larger of the two. It is the one that arrives in Mumbai in the first week of June. The pressure differentials created by the blazing heat of central and northern India and the cooler moisture-laden air over the Arabian Sea is the engine that drives the monsoon. It typically transfers copious amounts of water from the Arabian Sea to areas on India’s West Coast, through Central India, over the Gangetic Plain, and up to the Himalayas in India’s far north. The Retreating Monsoon is associated with lighter rainfall and tends to drop more precipitation in southern part of coast of the Bay of Bengal; mainly in Tamil Nadu, where I used to live (near where the rice paddies shown are located), and parts of Andhra Pradesh.


The Advancing Monsoon visits India every year. Just how much it will rain is unpredictable. Two years ago nearly one meter of rain, i.e., 37 inches, fell in Mumbai in one day. One night in 1978 in Mussoorie, a Hill Station in Northern India, it rained so hard that I thought the force of the water would tear the roof off the house. Sometimes the rain is too light to allow for a decent crop; and the effects are sometimes quite localized. Because of the extreme heat, the difference in how the land looks and what it can produce can be striking, as these pictures taken in South India illustrate. However, it always rains; and in sufficient quantities over large enough areas to obviate drought as a sufficient cause of widespread famine.


Farmers depend on this rain. Though often having legitimate complaints about its amount and timing, it is dependable. We know this from records kept for hundreds, indeed thousands, of years. I learned about this because I had become interested in why Indian famines escalated to the scale of events that killed millions of people in the 19th century, slowly receded in the last seven decades of the British Raj, and disappeared entirely in the second half of the 20th century.


As mentioned in XXIII, and described in a full-length research article that I will be happy to provide to anyone who requests it (1), neither the occasional light monsoon nor population expansion were responsible for catastrophes such as the Madras Famine of 1866. Rather, these tragedies were played out against the background of human greed and disrespect for indigenous systems of social, economic and food security that had been developed over very long periods of time. These included the use of temple tanks for irrigation and water rationing; famine protection depositories into which grain stores were placed in times of plenty; the capacity to blend production of various food and non-food crops to meet the needs of the people; and the exigencies of the weather.


Many sincere bonds of friendship and love between individual British and Indians were formed over three hundred years. Indeed, there are numerous accounts in the historical record of British civil servants speaking out on matters of abuse, cruelty and neglect in the matter of resource allocation and unfair taxation. Still, the British came to India for one primary purpose; to extract its enormous wealth. Extractive economic systems do not much care for the needs of the people who produce the wealth. Simple visual inspection of a railway map of India reveals a system designed for moving goods from the interior to India’s main ports. That was the primary vehicle for extracting wealth, and because of how it was configured it would be difficult, or at least very inefficient, to move food and other commodities within the country on short notice.


The famines of the mid-1860s were a direct consequence of two essential factors: 1) the disrespect for human needs and cultural achievement and 2) events transpiring on the Eastern shores of North America. Beginning early in the 19th century, the British had forced Indians to purchase manufactured textiles made from cotton produced by slave labor in the Southern US. With the blockade of shipping during the Civil War they immediately ordered Indians to make up the large shortfall. Their intransigence to adjust to this reality by allowing Indians to revert to time-tested methods of allocating land resources to a combination of textile crops (cotton, jute, and indigo) and food crops and to move food around to meet local needs (the Retreating Monsoon did fail in parts of Madras State in that fateful year), they sentenced millions of people to death. So, as I tell my students in South Carolina, which was a major producer of cotton and Charleston was one of the ports most affected by the blockade, this is a superb example of a real, direct relationship between oppression in one part of the world and its affect on similarly oppressed people in another, seemingly unrelated place.


Even with excessive, ill-considered manipulation by the British, during the height of the worst famines, India produced more than enough food to feed itself – if only the British would have allowed its distribution to places of extreme need. Gandhi recognized that the disruption of cultivator-land and other labour relationships was a necessary cause of famine. He also knew that this disruption and the feeling of supremacy, and economic domination of one people over another that it required, would ensure continuation of the master-slave relationship that was the bedrock of colonial domination. Understanding that control over traditional means of production and the fruit of their labour would release Indians from the shackles of foreign domination, the spinning wheel became the symbol and, to some extent, the vehicle of the Freedom Movement that led to Indian Independence in 1947.

Reference:
1. Hebert JR. The social ecology of famine in British India: lessons for Africa in the 1980's? Ecol Food Nutr 1987;20:97-107.

XXXIII. Good Bye India

It is a little before midnight on Sunday the 24th of May 2009. I am about to board an airplane bound for Newark, New Jersey.

For the 18th time in 32 years, I am saying goodbye to India tonight. Like an old friend that accompanies me on many such farewells, I was expecting to feel sadness. But that emotion has not surfaced. It may come to visit me on this long flight to Newark; in these many hours, as we begin our flight in the tropical latitudes and fly over the Asian Steppes through darkness ensured by moving quickly in the same direction as that of the earth spinning on its axis (and only a bit more slowly at the lower latitudes we will traverse). This time, when I am neither where I was nor where I will be, is unpredictable for what it can, and often does, bring up.

I thought that maybe the sun of a long arctic summer day would elicit the response. As we approach the East coast of Greenland I feel no sadness, but great nostalgia for the other times that I have done this and the way things have transpired over these decades. I recall being glued to the window the first few times that I took this trip. The vastness of the earth and the difference in the topography from what most of either India or the US looks like is a marvel to behold. The sight from this vantage point (39,997 ft) has been available to humans for only a small fraction of the time we have existed as a species in the vastness of time and space.

This departure was well planned and timed to mesh with the goals of a life lived in two places. I was deliberate in wanting to savor goodbyes over food and thoughtful conversation, two themes that characterized my time here more than anything else. After returning from the Kutch, it lasted a week; including a long, relatively relaxed weekend.

I leave India with a sense of profound gratitude for the relationships that have been strengthened and deepened over these months and for the new and wonderful people I have met over these months. I also feel blessed to have supportive family, friends, and colleagues back home who helped to make this productive absence from the day-to-day routines of life possible, even if electronic communication kept me very much engaged for nearly the entire time. Pictured here are Drs. Rajiv Sarin, Pradnya Kowtal and their lab personnel.

Despite working hard and accomplishing much, my life in India has been characterized by simplicity and lots of time to think in quiet solitude. I recall my friend Bill Hrushesky (here with Harris Pastides) expressing envy at my having the opportunity to spend long periods of time alone to be with myself, think, and recreate. I have loved this part of the reality much more than I thought that I would and have savored times that I have spent with people all the more because of it.

As I said back in the beginning, I began writing this blog in part to pay back the debt that is incurred on such journeys through life. Given that I wrote this mainly to explain myself to people back home, it is interesting that about half of the comments I receive are from are Indians. Apparently, thoughtful perceptions on great cultures have appeal both to those who live in some familiar corner of that reality as well as to those who are altogether unfamiliar. Pictured here are Dr. Ashok Varma, his family, and members of his lab.

At my best, I see the world through a scientific lens, as a seeker and a skeptic. I have tried not to be too analytical, but I want to learn enough to relate back to what I already know, synthesize the thoughts and perceptions; and inform others about the relationship between science and culture. As a Senior Research Fellow focusing on the epidemiology of cancer, that is how I interpreted my obligation to the Fulbright Program. I have accepted the charge with joy, passion, sincerity, and inquisitiveness. I am sure that Healis colleagues, especially Mayuri Sawant (far left), and Drs. Mangesh Pednekar and Prakash Gupta can relate to this.

There are many ideas that have emerged over these months. The list of topics is much longer now than ever. The creative juices have flown with the stimuli, which have been plentiful and varied. I hope that the discipline that I have established over these months will serve me well as I merge back into my home culture.

My plan is to continue writing after I return home. I realize that there are many things about life in my little corner of the US that people will find interesting and I know that I will look at things differently – at least for a while. The Grand Opening of the Cancer Prevention and Control Program in the new building, arriving back home in late spring having missed the seasonal transitions that I enjoy so much, and having Christine home from college for the summer should all contribute to my mind remaining open and receptive.

XXXII. Interdisciplinarity and Community-Based Participatory Research

As Bose came to understand and social activists like Martin Luther King discover in their work, the human tendency to create systems to preserve privilege and power are not expressed exclusively in archaic systems of social and religious hierarchy. Many other structures, though not as elaborately worked out as the Indian system of caste, devolve almost naturally and inevitably from this human propensity for control to create “clubs of the initiated.” These eventually stunt growth; and have done so across a wide span of human endeavor, including the sciences. Just as the leaders of “religious right” confound ignorance with faith, the leaders of these “clubs” confuse membership (often entailing affiliation with “elite” institutions and placement in special structures that they have created) with merit. The absence in major general medical journals of results from the Mumbai Cohort Study; well designed, uniquely positioned to pose and answer important public health questions, and one of the largest cohorts in the world, may reflect this subtle prejudice. Results from the study are widely published in highly ranked specialty journals such as the American Journal of Epidemiology and the International Journal of Epidemiology. So, it is not for lack of technical excellence that manuscripts are summarily rejected, without review, by mainline general medical journals in the West.

Blind spots inevitably exist within specific domains of scientific expertise and breakthroughs often come from the fresh perspectives of non-experts, as pointed out in Dr. Harold Varmus’ Book, The Art and Politics of Science, and was evident in the early discovery that tobacco causes cancer by one of my mentors, Dr. Ernst Wynder, when he was a medical student at Washington University! Recognizing this, the Cancer Prevention and Control Program is strongly committed to interdisciplinary science. Our nine core faculty represent four different departments in two schools at USC. Our pending Center of Biomedical Research Excellence application to the National Center for Research Resources will add seven new faculty from six schools within USC. Affiliate members represent nearly 20 departments in five different universities across South Carolina. In order to work together effectively we need to create intellectual oases where we can meet to discuss and exchange ideas in nonjudgmental ways. It also means that we need to get to know enough about what each other are doing so that our understanding is not superficial, even if we may not be able to function as bona fide experts in the “new” area. While talking about this is simple enough, doing it is another matter. Egotistical attachments to very deeply ingrained senses of order and worth are hard to break. It is rare to find people who can give these up at all, let alone easily. So, we work hard to maintain a respectful, inquisitive attitude towards each other as well as colleagues we invite in as collaborators.

We also are committed to community-based participatory research (CBPR), a collaborative approach to research that equitably involves partners in the research process and recognizes the unique strengths that each brings. CBPR emerges from a tradition in environmental health and social justice that encourages social activism and recognizes unique strengths and perspectives through active participation in the research process. The National Cancer Institute (NCI)-funded South Carolina Cancer Disparities Community Network is the main, but not exclusive, vehicle through which we do CBPR. Dr. Leslie Cooper, our Program Office at the NCI and an important team member, is pictured with Dr. Cheryl Armstead, CPCP core faculty member from Psychology, in the Congaree Swamp National Park, located in a very rural area of Lower Richland County just 25 kms (15 miles) from the University of South Carolina in downtown Columbia. By defining team building around projects more broadly to encompass CBPR we honor the community by acknowledging that it has special expertise and specific ways of collecting information and transmitting knowledge. In that sense the community, too, represents disciplines of thought and conduct that embody intellectual domains worthy of equal partnership. In the photo to the right Ann Pringle Washington, President of the Eastover-Lower Richland Business Association, with whom we work on issues ranging from organic farming to healthcare, is second from the right, flanked by Leslie and Cheryl. In a recently published article we describe the important philosophical and practical similarities between CBPR and interdisciplinary research (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;18(4):1213-1217.).

I explain to our community-based colleagues that, as with all human interactions, everyone enters the field of play with preconceptions and prejudices. This is not restricted to university members in relation to non-university members. When I have described some of the preconceptions and prejudices that I have witnessed (or even harbored!) to community members they quickly see the universal nature of the problem. The example on squamous cell cancer of the esophagus that we provide in the article is a mea culpa call to attention regarding the blind spots that we encourage when we work in relative isolation to produce academic products at high speed for personal professional advancement. I want to be clear that I do not think that academic promotion is a bad thing; indeed, I appreciate that is necessary for survival. However, we must be committed to supporting people doing this in a principled way that will lead to reductions in cancer-related health disparities. An important part of the process entails working together to overcome our own feelings of superiority and inadequacy, and acting courageously in support of others who have chosen this noble path.

XXXI. Science and Caste

In contrast to their modern Western counterparts that are just a few centuries old, Indian medicine, astronomy, philosophy and scientific reasoning represent unbroken traditions that had evolved over thousands of years. As an example of its sophistication, Vaisesika, one of the six systems of Indian philosophy, deduced the planetary-like motion of sub-atomic particles thousands of years ago and reduced time mathematically by describing its smallest unit (kala) as the period taken by an atom to traverse its own unit of space; thus anticipating the atomic clock by thousands of years.

The major caste designations refer to occupational categories: Brahmin (teachers, scholars and priests), Kshatriya (rulers and warriors), Vaishya (farmers and traders), and Shudra (service providers and artisans). However, over thousands of years, the system evolved into a method of social separation based on complex system of cultural-religious rules in which hierarchical status was conferred by birth. Indeed, the word for caste, Varna, derives from the Sanskrit word for color. The yoking of science and medicine to the caste system ultimately led to a rigidity of thought that eventually stunted the process of accumulating, storing, and transmitting scientific knowledge. This happened in two ways. First, the caste system prohibited the vast majority of people, with all their intelligence and creativity, from participating in the scientific process, or even from obtaining a general education (which might lead there by “accident,” as it often does). Second, caste prohibitions made it impossible for the Brahmins to undertake things such as dissection of human corpses or even to develop anything but superficial surgical procedures. This severely impeded the advancement of biomedical science.

By the time the Europeans arrived on the scene in the 17th century India was in decline on many fronts, including the sciences. By contrast, Western science was on the verge of entering a golden age of exponential growth both methodologically and substantively. The great Indian scientist, Sir Jagadish Chandra Bose, who was born in Bengal in the late 19th century, is credited with laying the Indian foundations of experimental science, hitherto considered the province of “Western intellectual tradition.” Bose understood that the Western method of submitting theory to scrupulous experimental verification could go hand-in-hand with the gift for careful observation and introspection that was his Eastern heritage; recall orthogonality. Like the dance of inductive and deductive reasoning (more on that later), the combining of Eastern and Western Traditions could lead (and, for Bose, did lead) to amazing breakthroughs across a spectacular array of the natural and physical sciences. Bose recognized that “science is neither of the East or of the West, but rather international in its universality.” And that “India [was] specially fitted to make great contributions. The burning Indian imagination, which can extort new order out from apparently contradictory facts, is held in check by the habit of concentration. This restraint confers the power to hold the mind to the pursuit of truth with an infinite patience.”

What Bose also understood, and evinced in this work, is that major scientific advances often come from individuals outside the disciplines originally called upon to either describe how things work or to find a solution to a specific problem. In some instances, this has involved the creation of entirely new disciplinary frameworks that draw from intellectual and philosophical domains theretofore not linked. Many such examples also exist in the history of science in the West, ranging from astronomy (e.g., the Copernican Revolution) to zoology (e.g., the Darwinian Revolution) to the fields that constitute public health.

Often progress in science is non-linear, resulting from breakthroughs against limits imposed on ideas that define them as "thinkable" at certain times and expansion of the intellectual options and strategies considered "available" at those times. That is, theory change in science depends more on changing intellectual circumstances and possibilities than on accumulation of knowledge within a discipline. Quotes from his meeting with Yogi Paramahansa Yogananda illustrate Bose’ keen understanding of how science progresses: “But high success is not to be obtained with a rigid exactitude. All creative scientists know that the true laboratory is the mind, where behind illusions they uncover the laws of truth.”

What Bose did not anticipate was a kind of caste system in modern science. Although an accomplished physicist, whose work on radio waves predated Marconi’s; he became interested in plant physiology. As that work progressed he “was advised to confine himself to investigations in physics rather than to encroach on their preserves…. [he] had unwittingly strayed into the domain of the unfamiliar and had offended its etiquette.” On the “religious” side he noted: “An unconscious theological bias was also present, which confounds ignorance with faith. It is often forgotten that He who has surrounded us with this ever evolving mystery of creation also implanted in us the desire to question and understand.” Both of these restrictive views are very familiar to those of us who have had to deal with the rigidity of thought within the domains of “techno-science” and “religious fundamentalism,” and the toxic combination of the two, especially over the past eight years.

XXX. Trust, Surrender, Expansion and Health

Owing in part to the salubrious effects of the dry climate in the region and the serendipitous “discovery” that combining Ayurveda, Chinese Traditional Medicine (mainly acupressure, although that also exists in Ayurveda), and Naturopathy produces excellent responses in people with a variety of chronic conditions, the Kutch is now home to five “nature cure centres,” including Ananddhan.


Although the Cancer Prevention and Control Program does not function as a spa, we share the view that people have the capacity to prevent or to alter the course of most chronic health conditions, including potentially fatal diseases such as cancer. Healthful changes in diet and physical activity have central importance in our work and these also figure prominently in Eastern traditional medical systems (and Naturopathy). Of course, spending more time diversifying ones diet and becoming more physically active requires that one also learn to give up toxic, unhealthful things that may be comfortable in their familiarity. This requires that people want to change; which, in turn, entails that they trust that the changes they will make will improve their health. They need to surrender to a “master” whom they acknowledge has special knowledge and whom they believe has their best interests at heart.


Beyond the knowledge we hold, I think that it is important that such teachers impart the belief that by embracing the idea and committing to a path of fundamental change a new world of experience will expand on what had preceded it. I think that many people who will not make changes to improve their health (and I mean this expansively to include psychological and spiritual health) believe that what we might recommend represents deprivation or constriction – a net loss in their lives. As with any form of education, we teach people that in order to make healthful changes they become more mentally active in their pursuit of better health! With the increase in awareness it is inevitable that when they meet with success, their world expands.


Most of my time during this sabbatical has been spent in urban India. My work days have typically been 14 to 16 hours long; waking up very early to catch the tail end of the work day in North America, working through the entire Indian work day, and then working until past noon EDST (about 10:00PM Indian Standard Time) to participate in conference calls, etc., at the beginning of the day back in the U.S. I am good at my work and am a bit of a workaholic; so, this comes almost too easily to me. The facilities at both ACTREC and Healis are superb; so, that also enables me to work full-speed. Fortunately, I have learned that it is not altogether helpful (or healthful!) and I sometimes just need to stop. So, when my friend, Neena, who is a genetics counselor at TMH and lives upstairs from me in the ACTREC campus, suggested that I visit a nature cure centre in the Kutch, I took her suggestion very seriously. Having embarked on similar adventures in the past, I knew that it was important to commit before my natural tendency to resist change and stick with the familiar took hold.


Soon after arriving in India I had weaned myself from coffee but got a bit addicted to morning tea. Since coming here, I have had to give up caffeine in any form. After the first day at Ananddhan the headache disappeared. I have had to surrender to Dr. Joshi, who plans the program (but is very flexible with regard to my wish to experience everything on their “menu”); Tulsi and Giriraj, who do the warm packs; Tiwali, who is in charge of massage and acupressure (and is seen working on Dr. Joshi, who has surrendered!); and Manju, who runs the kitchen. My diet consists mainly of fruits, sprouts, and other vegetables. I am the only non-Indian here, and virtually the entire program is in Gujarati (though virtually everyone speaks Hindi and a little English). I do not always know what is going on, but people are patient and very good natured. I think that this is another important element of health. Whatever we do really should be done with a joyous, open and trusting heart. At my last meal at Dr. Prakash & Alka Gupta’s house before coming here I thanked them for dinner and mentioned that a special ingredient was love. Rather than being taken aback, Prakash simply agreed wholeheartedly.


Since coming here I tried just about every treatment available. It makes for about an 8-hour day, plus some really nice side trips. It is good for me to be on the receiving end of these things – as I think is true of anyone whose practice consists partly of preaching.

XXIX. Travel to the Kutch

In antiquity there were two main trade routes from the Middle East and Africa to India and beyond. Caravans traveled the more northerly of these through Persia, Afghanistan, over the Khyber Pass, into the Indian subcontinent, and often then on to points further north, east and south. Essentially, this was the itinerary I followed on my first trip to India.

The more southerly route went over water, from Indian Ocean ports on Africa’s East Coast such as Dar es Salaam, Zanzibar, Mombasa, and Lamu, tracking a course southeast of the Arabian Peninsula and into the Arabian Sea. The ancient dhow trade from Africa and Arabia relied on persistent “trade winds” that move in a cyclonic pattern from south-southwest to northeast towards more northerly latitudes and from northeast to west-southwest toward more southerly ones; thus ensuring return passage from India and other places in the Orient. In the week that I have been here the wind has blown persistently, and at times strongly, from the west-southwest.

Located above the Arabian Sea and just south and east of the Sind (in what is now Pakistan), the Kutch is a place I have wanted to visit for a long time. Primarily through its port at Mandvi, the Kutch was a center of the dhow trade and therefore had more or less direct contact with Africa for millennia. One can see this in the facial features of some of the people in this region (these are pictures of Rashida and Raju, who work at the place that I am staying).

Because it is separated from areas further north by great salt deserts known as the Great Rann (of the Kutch), on its northwestern frontier, and the Small Rann, on its northeast, it remained in relative isolation from land passage from the north through most of its history. In more ancient geologic time the Ranns (indeed the entire region) was under a larger and more extensive sea than what currently exists.


Although the Kutch looks quiet geologically, it isn’t. The region was the site of a major earthquake in 2002 that leveled much of the built environment, including many villages and most of the medieval city of Bhuj. I am sad that I did not visit the place before that happened. Such is the price of procrastination and dalliance.


I had the privilege to visit the Great Rann on the second to last evening I was in the Kutch. As far as the eye could see there was a vast expanse of salt-crusted earth. When taking these photos with some new friends from the Ananddhan Nature Cure Center I was reminded of times spent around the Arctic Circle – in the summer when the sun has crested the horizon. In the far north, with the sun so low in the sky, there is the constant threat of impending cold (even with global warming it can get very cold). Here, though, that persistent west-southwesterly wind blows warm, almost hot, air across these timeless plains.

XXVIII. The Scientist-Saint in the Indian Tradition

No matter what the pursuit, a limber mind is an important asset. Seekers of deeper truths may be, and indeed often are, technically excellent at one or a few things. Furthermore, as long as we live on this material plane there is a need to do things, make things happen, do what humans do: build! However, for these seekers the capacity to be technically expert is not the goal. Expressing technical excellence is the vehicle, or means, to a worthy end. These special people are able to evince and impart extraordinary grace in combining their sense of life’s deeper purpose with the imperative to serve both material and spiritual needs. My experience of such people is that they are mischievously clever, possess great senses of humor, and have the equanimity to live life with great joy and to convey this to others along the way.


A scientist is, at heart, a skeptic. Spirituality is, by definition, not of this material plane and therefore not “knowable” through the agency of our five senses. The process of scientific enquiry exercises the mind and that may (or may not) lead to pondering life’s deeper purpose or meaning. I tend to think that a scientist’s mind, like that of a yogi, is built to wander in the direction of deeper purpose. When it does, the inevitable question arises: Why? I like to think of this as a many-layered question. In raising a child (and teaching graduate students) I found this to be an especially valuable opportunity to look at such questions as a way to explain (as much to myself as the student) purpose, function, structure, meaning, and worth.

Hemali and members of her extended family, with whom I shared those days at the wedding in Delhi and in Nanital, explain that there is a scientific basis to Jainism. It is borne of careful observation over 2500 years. The Jain religion and philosophical orientation to life is contemporaneous with Buddhism and shares many concepts, including Ahimsa (a commitment not to harm living things). Christianity is newer, but many of its tenets are similar, if not identical (even if many organized Christian religions have drifted far from these fundamental beliefs).

All of these religious paths are consistent with general Eastern philosophical tradition that accords predominance to recognizing Truth as imminent and thereby ascribes central significance to careful observation (including ones own actions and their effects on other people and things). The vast majority of epidemiologic studies on which I have worked (including the Mumbai Cohort Study and other major cohorts and case-control studies) are observational in nature. So, I have chosen a field in which there is an imperative to watch, measure, and understand what “causes” sickness and health in the chaos and messiness of human lives. Patience does not come naturally to me; so, being forced to pay attention to things that can happen only in and through time has been a gift in more ways than just professionally.

India and the United States are different and similar in ways that are not revealed through casual observation. I will talk more about these dissimilarities and similarities later. One tradition that is unique to India is that of Sannyasa. After doing ones duty to career and family a person is free to pursue a spiritual path that may entail service at a level and in a manner not possible under the constraints of having to attend to the demands of professional advancement and acquiring wealth to provide for a family. While not everyone does this and those who do take myriad paths, there is a tradition stemming from a widely held view that doing so is a personal and societal “good.” Even if the Sannyasi suffers material hardship and may become obviously poor, he or she is held in very high regard in society – especially in the places where he or she performs service. This is a picture of Lochan Vishal Sharma, of Jodhpur, taken when I visited him for the first time in 1977 and whom Jane, Christine and I visited on my last sabbatical in 1997-8. He was a civil servant before retiring, can speak five languages fluently, is a mathematical wizard, and was taking care of two mentally ill men and providing water to the people on a daily basis.

Combining the widespread appreciation of spiritual and scientific development with social welfare, has produced some remarkable results. When I am in India I come face to face with people who embody such traits and tendencies. While these people are usually very accomplished professionally, that alone does not set them apart from their peers professionally. I have talked a bit about Dr. Prakash Gupta and his leadership in both epidemiology and in directing anti-tobacco efforts both here in India and globally. Dr. Rajiv Sarin and I are exploring how “big” (well-funded, highly cited) science is tackling the “big” problems of over-population, global warming, and as-yet unanticipated health effects of worldwide environmental change. In his role as the Director of ACTREC, the issue of humane and efficient treatment of cancer patients also figures prominently in planning how to use scarce and precious resources.

Dr. SS Badrinath and Shankara Nethralaya in Chennai are living examples of the scientist-saint and his creation. Shankara Nethralaya is a striking illustration of a first-class eye hospital providing a wide array of services in South India (and into Central India) to the full range of people, from the very wealthy to the utterly destitute. Its outreach includes some of the most amazing telemedicine on earth. It also conducts some exemplary basic science research spanning a broad continuum from the genetic control to environmental epidemiology of eye diseases. Along with Dr. Harris Pastides and other visitors from University of South Carolina a little over a year ago I was introduced to Dr. Badrinath and Shankara Nethralaya by Dr. Meera Nirasimhan, a similarly inclined colleague who grew up in South India, is now a faculty member at USC (in Psychiatry), and performs one month of service/year at a rural hospital in Andhra Pradesh. Since that first introduction I have returned to work with the Shankara Nethralaya team on the trip to Chennai that I talked about in XII. Teachers. Over this time I have learned that Shankara Nethralaya and Dr. Badrinath are nearly household names throughout India – testimony not only to their accomplishment, but to a society that deeply values such work.

I would like these examples to inspire our work in the Cancer Prevention and Control Program. The Scientist-Saint tradition of India is something to which people anywhere ought to aspire.