Within minutes of meeting Dr. Sara Bhattacharji she was sharing this story from her days in a health clinic in rural Tamil Nadu, India:
“When two physicians started the clinic, a couple of decades ago, it was the only medical facility for about 80 km. That’s pretty far if you’re traveling by foot or by mule. Most of our work was general care, but sometimes people came in with more serious injuries. One of those days a man from the neighboring village came in with his hand wrapped in old cloth. During a local fight his hand had been badly cut, so I set to work cleaning and stitching up the wound. As I was working we talked and I asked what he planned to do once his hand healed. Expecting the man to talk about returning to his work as a carpenter, he instead looks up and says ‘I’ll find that bastard who did this and cut off his nose.'”
“So the hand I was repairing would be used to inflict more harm. I could cure this man’s hand, but could I heal him?”
Over the following days I learned from Dr. Sara how the currents and questions of health run beneath every part of life. We have an amazing capacity for cure. This past summer I worked in an orthopedic hospital where spines were rebuilt and people were given new knees. Technology progresses and we are gradually able to fix more and more of our parts. This is incredible and by distinguishing cure from healing, I do not wish to demean our amazing ability to cure. Without the ability to cure, our capacity to heal would be greatly diminished. But when we become fixated on cure, we often become fixated on parts and risk losing sight of the integrated and multidimensional people we are.
Entering the hospital we often become isolated from our families and friends as they are limited to visiting hours. We also lose autonomy over the most intimate parts of who we are: our bodies. Eating, shitting, and sometime even breathing are taken over by the experts. This allows the experts to affect amazing cures, but what is lost in this style of care?
I don’t claim to have any answers. I am a pure amateur when it comes to our health system. But as I toured around with Dr. Sara deeper questions about what we mean by health kept arising. I find it impossible to isolate who we are into parts and pieces. Instead I see each of us suspended in a web of relationships. You can no more separate the hand from the body than you can separate our selves from our relationships. Sometimes that separation allows us to fix the hand but what would it even mean to “fix” an isolated self? What happens to our health when we lose sight of those relationships with our environment, our communities, our families, our selves?
If you’ll permit me one more story:
The day after meeting with Dr. Sara, I joined her colleague Dr. Sushil John on home visits in Old Town, one of the slums of Vellore. The area is a labyrinth of narrow alleyways and gutters full of garbage and sewage. The bright colors of the simple concrete homes are fading and nearly any unused space has been roofed over with leaves, corrugated iron, or whatever else is on hand, and become someone’s home. Goats, dogs, and chickens roam the footpaths and leave a minefield of feces. Reflecting the economic situation of the majority of Indians, most men here earn about $2 a day, while women average $1.
Walking with Sushil through this ramshackle maze is like walking with a celebrity. As a tall, white man I’m used to attracting a large amount of attention. But here I’m a sideshow to Sushil the main event. Persistently the physician, he humbly deflects praise and seeks to connect and assess. Here we meet Edward.
Sushil found Edward the same way he finds most of his patients: through the community network built up by a group of women working with the hospital. While Sushil was working with a neighbor Karti, who suffers from schizophrenia, he was pulled aside to see Edward. Edward used to work as a painter, but he fell from a ladder and the resulting spinal injury left him a quadriplegic. In this setting he was left to lay on his bed and slowly fade away. There is not much that Sushil can do for a quadriplegic, but he taught Edward’s family how to change his clothes, treat his bed sores, and deal with his catheter. This is far from a cure, but it at least provided a degree of comfort amidst the suffering.
Dr. Sara and Sushil run a unit called the Low Cost Effective Care Unit, connected to Christian Medical College, one of the premier hospitals in Asia. In addition to working with the poor of Vellore, this unit also runs a life skills program to help teenagers develop skills and knowledge around health, time and money management, communication, interpersonal relationships, and goal setting. These skills are a ladder out of Old Town. One of the boys going through this program knew about Edward and approached some of the women with his idea. Together they helped Edward set up a business adding credit to people’s cell-phones. Once word got out, the support for this project has been incredible and now Edward is earning a steady income. Before this would be unheard of, but now he is supporting his family and regaining a sense of dignity and purpose.
The effects ripple outward. When Sushil first met Karti, the man with schizophrenia who led him to Edward, Karti was extremely violent and non-verbal. He spent most of his time locked in a small room because his family had no other way to handle him. Sushil prescribed some anti-psychotics which the family mixed into Karti’s food each day. Within three months he was not only speaking and non-violent, he was able to come out and interact in the community. From there they were able to hone and refine his treatment plan so that when I met Karti days ago he was downright amiable.
I share this tangent because I met Karti at Edward’s home. Once a day Karti comes over and helps Edward keep records for his business. At the same time Edward gives Karti a steady friendship which is vital to his mental stability and well-being. Neither of these men will be cured, but I can’t look at their story without seeing an extraordinary amount of healing.