Speaking the Same Language, Across Miles...

By Divvy Kant Upadhyay, Alabama, USA

(Formerly a medical graduate of Kasturba Medical College, Mangalore, Manipal University)

Doctor's Day, 2011

July 1: "Are you aware you are going to the Bihar of the US to study?" said the professor who was interviewing me for a prestigious scholarship. For a few moments, that question pierced through my soul, only intensifying my anxiety and apprehensions of what lay ahead of me. I was being interviewed as a result of my desperate attempts to be self sufficient in seeking funds (loans) for my higher education in Public Health in the US. That was almost a year ago. I lost out on that scholarship, but I was still headed to Birmingham in Alabama, USA where I was going to train myself in the area of Public Health Policy and Organisation.

The professor interviewing me knew I had acceptances from four equally well reputed places. In my response, I told him, for one, the University of Alabama at Birmingham (UAB) has a great reputation and standing in health sciences and the areas of healthcare policy and organization are strengths of this University, and other, being a state or public university the tuition fees there was slightly less than the expensive private universities like Emory or Tulane which had accepted me as well.

Southern Veg Food - Fried Ocra (ladies finger), fried green tomatoes, corn bread, beans, butter. (Nikkis West, Birmingham)

At the statue of Dr Martin Luther King Jr opp the Birmingham Civil Rights Museum on MLK Day

With pre-school kids at an elementary school in Birmingham

Promoting safe sex at the University to fight HIV/Teen pregnancies

At the School of Public Health gathering

At the School of Public Health gathering

With a young friend, Peter

As bewildered as I was at his question, I understood why he referred to Alabama as the Bihar of USA. The health indices in this south-eastern part of USA are perhaps the most worrisome when compared to national statistics in the US. This region is sometimes referred to as the "Stroke Belt" or the "Diabetes Belt" and there are several health disparities in this region when it comes to cardiac ailments, obesity, diabetes, cancer and sexually transmitted diseases. Even in some other parameters of development, it is trying to catch up with some of the progressive states in the US. But that does not mean in any sense that Alabama is a totally ‘backward’ state on which people have given up. ( Infact the way it is, Bihar is doing an impressive turnaround too trying to get rid of the backward or BIMARU tag.)

Traditionally this region in the US has been referred to as the "bible belt" or "black belt", black here referring both to the soil and the African-American population which faced serious challenges not too long ago. Birmingham, Alabama is part of this "Southern" USA. It was the hotbed of the civil rights movement which fought for equality and justice in the 60’s. It is tough to make generalizable statements about the community or people in any place in the world, but for most part of it, I was easily able to find my footing here – thanks to kind hearted people who genuinely help without expecting anything in return.

People in the south here love the good food, love their expression of emotions (hugs and more hugs) and know what struggling in life means – just like millions in India. In fact at one event, I suggested to my friends here that I saw similarities in an area like Punjab in India and Alabama in the US. Both regions have a distinct touch to family relations, people go the extra mile and frankly express their love (or disgust), they love good tasty food – fried ocra (ladies finger), fried green tomatoes, fried fish, fried chicken, casseroles, beans, corn bread, lots of butter, the famous sweet tea – great food in short and for most part of the lives lived here, family as well as social life is loud and chaotic sprinkled with strong sentiments. To me, personally, it reminded of Punjab and the Punjabi community.

The point I am trying to make with the above example is – contrary to much popular beliefs, even in the US there are large number of middle class families with their own culture and traditions that are struggling to make ends meet, worried about the future of their kids and passionate for doing hard work and doing good in life. The economic recession and employment opportunities have had a big impact but even otherwise – families and people here too deal with daily ups and downs – from worrying about the next paycheck and rising price of petrol to the dynamics between mother-in-laws and daughter-in-laws.

In general, it’s the same for healthcare too. Even in the US, the policy makers are struggling to get their act right in areas of access, affordability and quality of healthcare provided – the very same issues that have been brought to the forefront in India which is witnessing rapid economic transitions and growth. Public Health in simple words is a logical, organized and scientific way to research, plan and improve healthcare as a whole - for the community at large. The issues it addresses can range from climate change to obesity and statistical genetics to health insurance.

One of the biggest questions to hit my mind while I study here is – why did I not learn more about this while doing my MBBS? To me that’s the biggest take-home point. To be able to think about the system that doctors work in. To see the bigger picture while we are still young and our minds still moldable. It is good that this fact is being recognized and Public Health seems to be getting a new impetus in India over the last decade. What was earlier thought only to be a domain for doctors is now opening up for students from other sciences.

I am glad my alma mater, Manipal University has set up a Department of Public Health where the curriculum is designed to address local / national needs with expertise shared from the University of Alabama at Birmingham. Infact it was this collaboration and my interest in health journalism that first encouraged me to look at public health as a focus area. It is a field with immense scope in India, especially for medical students who wish to see the bigger picture of the world they would be working in. This Doctor's Day, I hope public health as a field in practice and in science witnesses rapid growth and due significance in India.