The image of Varanasi that stays with me is not the chanting and bell ringing while seven saffron-robed priests gesture with incense and flames. It is not the nine clouds of smoke as bodies are cremated on the steps beside the Mother Ganges. It is not the press of dense crowds of people-whom I found to be more comfortable than those in New York City. I am haunted by the lepers.
This is written on a long-awaited trip to India. My invitation came over 40 years ago with a chance meeting with a man from this country. I told him that I was going to medical school because of concern about overpopulation. He responded “Come to India, we need you.”
Varanasi is the heart of Hindu India. Pilgrims have visited there for centuries because of the cleansing water of the Ganges. Believers go there to die, since it is most auspicious to have your soul released by cremation beside this holy river. Perhaps you have seen images of this in glossy magazines. But the pictures leave out an important part of Varanasi.
India’s population more than quadrupled during the twentieth century. Yet during this same period the number of children a woman bears during her lifetime has halved, from 6 to 3. This seeming paradox occurred because of falling infant mortality. In the past, a huge proportion of children died before adulthood. Although medical care has helped, the most important factors for this welcome decline in childhood mortality have been improved nutrition and hygiene.
As a medical student I was curious about Hansen disease, as this scourge is now called. The bacterium that causes it lives in amazing harmony with human nerves, but gradually causes them to fail. Injuries are common because affected people cannot feel pain. Worse, at night rats nibble unprotected fingers and toes.
Cure of the infection is possible, but prolonged and expensive. Often treatment is limited to little more than bandaging and protection of the affected part. Tradition has forced people with Hansen disease to live separate from the rest of society. There is still a strong emotional reaction to the word “leper” even though most people in the USA have never seen one. Perhaps Hansen disease was the first use of quarantine, although the disease isn’t very contagious. What I didn’t learn in medical school is that it is very much a disease of poverty and malnutrition. As proof, well-nourished health workers seldom contract the disease even with constant exposure.
Leprosy still thrives in India because of poverty. Malnutrition is too common here, although less than a century ago. This month the India Times reported the sad results of a national health survey. Only a quarter of newborn babies are given the breast within an hour of birth. This lessens their chances of successful breastfeeding, which could substantially reduce infant mortality. Half of all children under 3 years are underweight, and one in five is stunted by lack of food. Three quarters are anemic, due to parasites or iron deficiency. Another article pointed out that girls are more likely to be starved than boys. In contrast, there are many rich people in India. One woman in seven is overweight. This is a country of contrasts.
To quantify this huge gulf between rich and poor, compare the income of the richest fifth of the world’s people with the poorest fifth. Worldwide this ratio in 1960 was 30 to one. Now it is more than 80 to one. The rich are getting richer-often at the expense of the poor.
Why should we care that this chasm is widening? There are two reasons. First is altruistic-it is sad to have people suffer from poverty. The other is that poverty threatens the security of rich people. Indeed, some feel that the real reason for terrorism against the USA is economic.
The image that sticks with me is of people lining our path to the Ganges. Squatting with quiet, upturned stolid faces, they held empty begging bowls with mutilated hands.
Part of my personal attempt to narrow the chasm between poor and rich has been to help support children in developing countries. For the first 35 years we sponsored a series of boys in Columbia. Filimina Mallik, our current child, lives in a remote part of India, too far from our tour. I believe that she is healthier and better educated for the small donation we make each month through Plan USA.
Â© Richard Grossman MD, 2007
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