February 9, 2010

Street medicine in the Abode of Peace

"Rickshaw madam?"
These were three of the shoutouts that were inevitably heard in intervals of about 5 feet as we arrived in Shantiniketan, and ironically unfitting for the town that means "Abode of Peace". It became quickly annoying to be constantly confronted with bicycle rickshaw drivers who had a competitively aggressive technique for getting passengers; that is, by shouting at them repeatedly in an attempt to convince them that they needed to be transported. Telling them we could use our own two feet was futile, as they generally would remark how far away the town was and that we could not possibly walk the 2 km to get there. On the other hand, despite the hassle of these public transporters, I was attracted by the reality that all transportation was either by foot or by bicycle. It seemed that everyone owned a bicycle--the street was overcrowded with them. This environmentally friendly quality and the much appreciated reduction in noise and air pollution forgave the irritating rickshaw drivers who were only trying to make a living and provide a service. The people here were surprisingly open and friendly compared with the city, as a shopkeeper brought us to his friend's home when we inquired about using a toilet. And the "Abode of Peace," eventually lived up to its name once we left the train station. After a breakfast of puri and sabzi, we continued walking past goats, cows, and handicrafts. Even more than the relative silence of the countryside, I enjoyed that the town is a cultural and artistic epicenter, as it is the home of the Visva Bharati University, founded by the Renaissance man, the Leonardo Da Vinci of India, Rabindranath Tagore. He was a heroic painter, poet, singer, and playwright, his talent and passion leading him to open schools all over West Bengal, create masterpieces of writing and painting which I have been appreciating, win the Nobel Prize for literature, and basically become West Bengal's cultural hero as well as my own. His paintings are atmospheric and expressive, and he valued the traditional Bengali painting styles when the British empire threatened to eclipse it with its own European styles and techniques. His poetry speaks to the truths of daily life, spirituality, and human nature. It enthralls me to read more and inspires me also to write. His art school, the Khala Bhavana, was a museum in itself, which made up for the fact that the actual museum was closed. I was impressed by the very artistic nature of the architecture--buildings covered with drawings, mosaics, murals, and relief sculptures. Meanwhile, art students worked in teh quiet afternoon on their wood sculptures and oil paintings. The other schools included the Institute of Humanities, Science, Dance, Drama and Music, Rural Reconstruction, the Indira Gandhi Centre for National Integration, Centre for Rural Craft, and the Centre for Social Studies and Rural Development. I would enroll there if I had the chance. In the evening we enjoyed the local handicraft and music fair that occurs every Saturday night to exhibit local crafts, food, and Baul (gypsy style rhythmic traditional Indian) music and dance. The place brimmed with creativity and an appreciation for art. In the morning I enjoyed a fantastic run through the countryside where I passed peasants, those whose agricultural lifestyle had the beauty of simplicity, but which certainly require extremely hard labor to make their livings. The rice paddies and potato fields, the children playing, the cows being brought into town, the bicycles commuting from the countryside, all made me want to both find out more about these poor villagers' lives, and even live there myself.

And if the culture, the art, and the peacefulness of rural life in Shantiniketan weren't enough to win me over, I also got a delightful taste of the medical programs for the rural villages and tribespeople. We were greeted there by a Canadian man named Brian who runs an NGO called the Peace Clinic, one of the towns social development organizations working on education, health care, and health education for the poor people there. We did not even know this man prior to our arrival, but he took us into his home for the night, and showed us all around the town. More fascinating even than the art school of Tagore was our conversation about public health and medicine and its role in social justice movements. His organization runs a clinic for a nominal fee for small basic needs, since the nearest health center is over 6 km away. They have conducted a survey of teh state of health in teh tribal areas nearby to evaluate the population's health risks and problems (diabetes is big there) and access to health care. These people lack access to basic health care due to their geographical distance and destitution. They are working to teach villages about simple first aid and early child health and hygiene so that they can pass down knowledge to fellow villagers through the sustainable method of health education. But what excites me the most is their beginnings of a street medicine program with an outreach component, a mobile clinic proposal that they were working on when we called. It would improve access to care for those most marginalized rural folks who speak only indigenous languages. Though there don't seem to be "homeless" people here in the countryside, it is a different kind of "street-dwelling" where everyone lives at a level of poverty that compromises health in similar ways. Their mud and hay thatched huts provide adequate shelter, but often collapse to suffocate the inhabitants during the rainy season, and their dirt floors prevent the maintenance of good hygiene. I suppose it would be comparable to the city's slums, as they barely have enough to maintain such a roof over their heads and to provide food for themselves. Most people were farmers, it appeared, and the land was thankfully plentiful. Their problems were less about nutrition and more related to social and infrastructural needs like access to education and health care. Now that I write this I am filled with questions about the people I could only view briefly from the roadside, but people who smiled as I passed on my run. I desperately want to return to work with this group as they begin a street medicine project in this rural setting, a place I feel more suitable for me than the city. Even after such a brief visit, I feel sincerely that I have finally found my niche of future work--rural street medicine.

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