Monday, May 11, 2009


An interview with Dr. Sara Bhattacharjee

Dr. Sara Bhattacharjee in her office

In February, 2009, after a delicious traditional 4-rice South Indian lunch in her office, I interviewed Dr. Sara Bhattacharjee, a primary care and community medicine practitioner at Christian Medical College in Vellore, Tamil Nadu state.

Four-rice traditional South Indian lunch

Until I saw her philosophy in action in the hospital, slums and villages around Vellore, I assumed that our first world country had invaluable advice and example to offer this (emerging? not-first world?) country. How quickly I shed those assumptions!

Grounds of Christian Medical College

Instead, I learned was that by viewing health care as a human rights issue and bringing unpaid volunteers into crucial nodes of a human network, the community itself can be transformed into an enlivened, active, effective organism in which the hospital is far more than a building populated by sick people and white-coated stethoscopes:

Shrine on hospital grounds

As Dr. Sara sees it:“Hospitals need to be seen not as worlds in themselves but as part of the community’s resource for the treatment of illness or the promotion of health,” to be educated so they know what is happening to themselves, to seek out solutions, to show them they have access they didn’t know they had.

Entrance to Low Cost Effective Care Unit

At the heart of Dr. Sara’s Low Cost Effective Care Unit are her volunteers, a small but committed group of nine women, who for the past six years have catapulted their training to enabled the disabled to self-identify their needs into expanding their own skills, initiative and self-worth so that they are now crucial members of

Volunteers and outpatients at village clinic

the community, respected 'go-to' leaders who have raised the community’s sense of self-worth and knowledge, along with their own. Dr. Sara describes it as a dynamic process that keeps giving--at the individual and community levels:

“(After the training)the volunteers were there with knowledge and skill and we thought if there were people there with knowledge and skill and good attitude, perhaps things would happen in the community. What we have found is that these volunteers are wonderful people and the knowledge and skills they have gained they have multiplied and used many times over. They’ve been very innovative in looking around in their own areas and finding resources they could use...even if they’re doing other things...they’re all keen to still get together and come together for monthly meetings and all this is totally voluntary because we don’t really pay them anything. I think it has made a change in all their lives...all of them say: ‘I’ve always wanted to serve, to help people, I always had a mind to serve but I didn’t know what to do. Now I’ve been empowered so when I’m asked I know what to do or at least I’m able to think about what to do’. I think the more they do,
the more they become innovative."

Government-provided wheelchair for paraplegic villager

In one remarkable story, Dr. Sara talks about teenage boys who, when one of their group was diagnosed with cancer, became anxious that they would also get the disease. They approached a volunteer (and, as Dr.Sara put it, “it speaks volumes for the volunteer that they felt they could go to her”) who approached Dr. Sara's team who identified the real anxieties underlying the cancer fears: typical teenage fears about HIV, sex, drinking, drugs or masturbation. The team created a life skills program for the boys who in turn initiated a garbage-cleanup program which led to contact with their elected representative and their subsequent civic empowerment.

The volunteer then asked Dr. Sara: "What about the girls? What can we do for then?" which led to teenage girls creating a program for the isolated elders of the community which in turn led to ongoing bonding of these two groups, the community's underlying network now richer and strengthened, as resilience, generosity and innovation rewarded and multiplied--living proof of what a difference a single volunteer can make in the lives of other and how this becomes amplified when several like-minded women connect to each other for shared purpose, when, as Dr. Sara puts it, "(it creates) a way of working that chimes with the forces of life that exist within the community...Our experience has been that these volunteers have been able to get young people to come together, young people to help them with whatever they do,” to start what has grown into a youth movement in the community.

Painted glass window in hospital hallway

I remind myself that we are in India, talking about slums and very poor rural people where funds are scarce and where poverty does not conflict with human goodness. What a far cry from our society’s flawed concept of
our society's health care!

She explains the difference between community and family medicine: “Community medicine involves a little more focus on health within the community whereas family medicine is focused much more on the individual but sees the individual very much in relation to where they come from; their particular environment is very important to the treatment of disease. She has her young interns spend a week visiting their outpatients at their homes in the slums and villages after which they return “gobsmacked” by what they witnessed, saying they would otherwise have had never known “that this is the condition in which this person lives.”

Temple detail in village center

I am beginning to understand what Dr. Sara means when she writes about the holistic integration “of the biological and clinical, socio-economic and behavioral, emotional and spiritual aspects of life.” Her stories reveal just how personalized this approach is, in which: “the individual is valued, the family history is known, the patient is involved in making decisions and the relationship between that individual and the staff is one of trust and friendship...In our outreach work we’ve gone beyond just the typical family medicine approach...We’ve seen enormous amounts of generosity, people helping each other in the midst of violence and chaos...we see a force and a resilience among people who are actually facing very great odds against life itself...we feel that we are not the keepers of health and life, it has to be in the hands of people but we can encourage, lift up, support, if we are sensitive...being aware, to feel it.”

Government-provided house to paraplegic villager (cost Rs. 37,000/-)

All this in India, among the poorest of the poor where, as it is with plant and man-made materials nothing is wasted: every encounter is examined for what it teaches, where choices are not made between "either/or" but seen instead as "both/and", where nothing is discarded and everything holds possibility in another time frame, if not this one. This means that sometimes results may not become visible for years and that patience and being intensely present supplant the demand for immediate gratification.

Wonderful inspiring stories but I still didn’t understand how all the elements come together in what felt to me a magical, mystical way, beyond simply the result of enlightened, patient leadership. How does it actually happen?

This is what Dr. Sara told me: “I look at it like this: people are in webs of relationship and sometimes we don’t know where we are and who is connected to us and suddenly it all lights up and people hold hands and it may light up and it may fade away and somehow you find another network...there are people who in themselves are saying I want to help somebody or I want to make life better for myself and others but I don’t know what to do and suddenly across their path comes this volunteer or somebody from the hospital and they say ‘ok we’ll join into that’..or they say ‘we have this problem, can you help us?’ Certainly it’s not one way. I have, and sometimes my team has, gained more than we have given.”

Dr. Binayak Sen
As we ended our conversation, Dr. Sara told me about her friend and colleague, the physician-activist Dr. Binayak Sen, whose work with mineworkers and tribal people displaced by the building of dams in Chattisgarh led him “to stand up and speak for the rights of people, not just for health but to look at health as a human right and approach health from the human rights perspective.” Using nonviolence, discussion and writing, Dr. Sen was openly critical of the government, who labeled him as Naxalite and put him in jail where he has been since May 14, 2007. His arrest has sparked worldwide condemnation and protest.

Does it make sense to think of the giving of health care as a human right too?

On May 25, Binayak Sen was granted bail and released after spending two years in jail.

This interview, broadcast on Tidings from Hazel Kahan on May 9, 2009 on WPKN 89.5 Bridgeport and 88.7 fm Montauk, is available as a half-hour podcast. Tidings from Hazel Kahan is produced by Tony Ernst.