XXIII. Expectations and Experience

When I come to India I expect certain things. Some of these are well known to people here. They would include: A plethora of wonderfully spicy Indian food from a country larger and more culturally and linguistically diverse than all of Europe, North Africa, and the Middle East combined. A riot of colors and cultural experiences. From late March until the monsoon begins in early June (and beyond), luscious mangoes in plentiful supply. Periodic, and in some instances daily, blackouts euphemistically known as “power shedding” (but not at ACTREC, which is a Central Government of India facility).

I also expect to speak Hindi on the street and in the market (which does surprise many people); but primarily English to colleagues with whom I work daily (which doesn’t); traveling by very punctual and highly efficient public transport whenever possible; and bucket baths using primarily cold water (which is getting harder to find right now).

Both in India and other places, I choose my colleagues because I see in them a combination of some traits that I do have and some that I lack. I suppose that they choose me for similar reasons. Generally, my colleagues become lifelong friends and acquaintances. I still publish papers with people who were in my doctoral program. It is not uncommon for one of my papers to have as co-authors people whom I have known for decades and others who are current graduate students. The are all very, very smart, insightful, punctual, kind, facilitative, and progressive in their thinking.

I have really good nighttime talks and walks with Dr. Rajiv Sarin, Director of ACTREC. These conversations, often involving a third person, almost always concern philosophy, global health and environmental problems, and how our work might change the world. Indeed, I sort of expect that any time we meet the conversation will go in this general direction. It does; but the exact path it takes is always somewhat surprising as well (just as these pre-monsoon clouds were to me). Of course, we also connect on the scientific basis of our relationship: to discover the genetic and environmental causes of cancer.

Similarly, when I am at Healis, the kernel of the talk is about science but it reaches into many other parts of life. Earlier today Drs. Mangesh Pednekar, Prakash Gupta, and I met to discuss a paper we are writing on tobacco use, including bidi smoking, and cancer incidence in the Mumbai Cohort Study. It seems that these little cancer sticks that are now being sold in the US and Europe as a “safe and more natural” alternative to cigarettes are more strongly related to incidence of several cancers. Discussing these issues with colleagues who are very statistically inclined and doctorally trained in epidemiology keeps the mind well focused on the science. Clearly, the implications for social justice are ominous; most of these bidis are made under brutal conditions by whole families, including children, who are locked in a cycle of poverty. The environmental effects of growing tobacco are equally unpleasant; I picked tobacco as a child and saw the effects on the land first hand, and going into rural areas in India (the 3rd largest tobacco producer after China and Brazil) brings one up close to the environmental devastation that it causes here (deforestation, habitat loss, topsoil degradation).

Sometimes, but not too very often, I make errors in judgment. So, what I might have expected does not occur, or is just plain wrong. Sometimes these errors in judgment create problems, but usually they are amusing or revealing, or both. Today, when I left home, I was thinking “I need a haircut.” I love getting a haircut here because for an extra Rs30 (US$0.60!) I can get a full head and upper body massage. Wonderful! Well, today was also the day that Healis is preparing to update its website. Given that our pictures will grace the new pages, it seemed clear to me that Mangesh (with whom I have lunch every day when I am at Healis) and I should both go to the barber, get cleaned up, and have massages. So we did. In my estimation It was one of the best such massages ever. So, when I asked Mangesh if he thought it was the best ever, he said he agreed – having never had one before! I was as surprised about that, as he was about my getting one every four weeks or so. When we got back to the office we had a good laugh about this, including with Dr. Gupta and Quayyim who also seems to like these little lapses into sensuality. As you can see, he knows a thing or two about haircuts!

Here we also are seen practicing our discussion of the acceptance, without revision, by the:
• New England Journal of Medicine of our recent paper on FEV and all-cause and cancer mortality in the Mumbai Cohort Study!
• Journal of the American Medical Association of our recent paper on body mass index and cancer mortality!
• Lancet of our recent paper on bidi smoking and cancer incidence!

XXII. Feeding Frenzy, Fear, and States of Grace

It seems as though we Americans live in a world where most people feel desperate and overwhelmed too much of the time. Everyone in the whole world is grappling with “security,” but the US seems to be the most fear-gripped society on earth (at least compared to what I have seen and experienced in the 75 or so of the countries I have visited and the 4 in which I have lived for an extended period of time). It is amazing that Indians, though much poorer on average than Americans, are generally much less buffeted psychologically by these external realities. I do see glimpses of this deep insecurity other places as well, and as a species uniquely oriented toward the future we may just be hard-wired to be afraid. Also, it seems to be getting worse in India over time. So, this is not a uniquely American phenomenon – though it tends to be more extreme in the States than any other place that I have experienced.

The spring is always a difficult time for us in academic medicine and public health because many grant deadlines occur from mid-April until mid-June. This is an especially acute phenomenon right now with the “feeding frenzy” the American Recovery and Reinvestment Act (ARRA) has spawned in terms of enticing-looking grant opportunities. Of course, that is overlaid on, and in large part driven by, the greed-induced economic downturn. That seems to induce anxiety – all on its own.

As Parker Palmer, one of my favorite authors on the topic of education generally (The Courage to Teach: Exploring the Inner Landscape of a Teacher's Life) and life’s purpose (Let Your Life Speak: Listening for the Voice of Vocation), astutely points out, people don't think clearly in a state of fear or desperation. It may seem easy to talk philosophically about this from halfway around the world. My reality, though, is that I can feel the pressure from here. It is unmistakable. I am grateful to be here, partly because of the perspective and the relative simplicity of my life. Still I am driven to generate University of South Carolina-related products at twice the rate here as I do when I am there! It is like a blooming miracle; and not an entirely joyful one at that (though there is some joy in it, too)! Of course, the combination of all the work, including having to resubmit our Center of Biomedical Medical Research Excellence (COBRE), and the unbelievably bad timing of the CPCP move (nearly two years late) and a number of other things could have ruined my sabbatical; but I made two choices and prayed /meditated. The choices are:
1. To do this work, indeed all my work, in a state of appreciation and grace. In order to do this, I need to clear my mind and focus on things for which I am needed back home; yes, I hate the place in some ways (for the waste, consumerism, greed and arrogance), and love it, too (for the honesty and hard work of so many people, the willingness to self-correct, and the natural beauty of the place). It takes a lot of effort to stay in a state of appreciation and grace, but it is much better than any alternative I could (or can) imagine. It is wonderful to be loved and wanted; even needed!
2. To promise myself two wonderful holidays. One, along the way (i.e., after the ARRA and COBRE dates, but before the (CDC) Special Interest Project (SIP) final push (a wedding in Delhi and then 3 days in Nanital). The other at end of the SIP nuttiness (at an Ayurvedic Spa in the Kutch, Gujarat).

What I prayed for? Wisdom. Ganesh is always on my mind and usually staring me down. I think that his counterparts in my culture of origin are St. Jude and St. Christopher. Of course, some of this wisdom comes in the form of living in the present. I've talked about that before, too. Glorian and I had a wonderful day in Lonavala [See pictures at the top; the wooden beams in the hilltop temple (those are the steps up) are 23oo years old] before she left for the states (Glorian has a real eye and ear for the unusual – including these two hibiscus flowers kissing, at ACTREC). I had a great weekend with Hemali and her family last week, and then visited with Prakash and his family last night. Families are a big deal in India. Jane, Christine and I would almost always eat a homemade dinner together. Back in the US that is a rarity. Here in India it is the norm. I think that the social cohesion and the real support of the omnipresent family helps reduce the fear and anxiety.