Blissful Life

When you apply skepticism and care in equal amounts, you get bliss.

Author: akshay

  • Don’t Shoot Your Colleagues

    Over the course of my life a realization slowly dawned on me about feedback. Negative feedback rarely worked. And positive feedback worked magically!

    I started noticing this in myself first. I was learning rapidly and growing in environments where all I received was positive feedback. And wherever people were very cynical, I was just lost in thoughts and not growing.

    Then I took this observation seriously and did experiments. In JeevaRaksha trainings, for example, instead of giving the recommended “sandwich feedback” (in which you start with a positive feedback, then talk about something to be improved, and then wrap up with another praise) I switched to a “positive-only feedback” technique. And it worked well. People who were not very confident as trainers and made a lot of mistakes where becoming very confident and trying really hard and staying on as trainers. Over time they fixed their mistakes on their own.

    I have to admit that I was very hesitant to do this. I used to think I was “lying”. When other people did this to me I considered them “manipulative”. And I used to pride myself on being very balanced with my views — talking about positives and negatives — sometimes even balancing others’ positive views by talking more about negatives.

    And I still find it insincere when people are just praising an act in general without being specific on why they are praising it. “Great job”, “Great news”, “Fantastic” — all of this sounds insincere to me.

    And therefore I wasn’t sure about what this observation-experiment-result meant. That all changed today.

    I was watching videos of button pressing dogs and then a response video by KP, in which KP recommended this book called “Don’t Shoot the Dog”. That book confirmed everything I was vaguely thinking about feedback.

    It is written by Karen Pryor who used to train dolphins. The thing about dolphins is that it is really hard to punish dolphins. If you try to do anything, the dolphins will just swim away. So, to get dolphins to change their behaviour and do something that you want it to do, your only option is to give them fish. Reward. Positive feedback is all you have with dolphins.

    This, apparently, works very well for dolphins. And dogs. And cats. And all kinds of animals. Including humans. Including adult humans.

    In fact, the book makes no distinction between dogs and humans in its chapters. It gives you lessons on positive reinforcements, shaping, negative reinforcements, and a lot of theory on how to think about all this. Including on why this is not “manipulation”.

    I won’t spoil the whole book, but it basically says that positive reinforcements are much better than punishments. It forces you to switch away from the “traditional” training style of shouting at people or punishing them, and move to a style that actually works.

    The book was written much before “like” buttons were invented. But, if you read it carefully you can see that it explains much of how technology has been shaped to harness this kind of “manipulation” as well.

    If you are a “manager” of anything, or a parent, or a pet-owner, you should read this book. In general, if you want to change others’ behaviour, this is a must-read.

    It blends well with a theory of anarchic organizations which I’m developing. I think a theory on semantics which I want to start experimenting with will also connect. Those will be future posts.

  • Everyone is Everything (To Varying Degrees) – How Binaries Suck

    Yesterday in a journal club at SOCHARA, we were faced with many challenging classification questions.

    The paper we were discussing was titled “Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17)“. The second classification question was in the title. What is a “metabolic NCD”? Are there non-metabolic NCDs? The paper was only discussing diabetes and pre-diabetes, hypertension, obesity, and dyslipidaemia. What about things like stroke? MI? Cancer? Does the paper mean that these are not metabolic?

    My explanation was that the study started out as a diabetes study, but expanded to others, and, to fit the word restrictions that journal format puts out, they came up with a word called “metabolic NCD” to refer to the subset of NCDs that were studied.

    I searched on google scholar for any other reference to metabolic NCD and couldn’t find any other place where such a classification was being made. But on the WHO website, they classify the risk factors into two:

    Modifiable behaviours, such as tobacco use, unhealthy diets, physical inactivity, and the harmful use of alcohol, all increase the risk of dying from an NCD.

    Metabolic risk factors contribute to four key metabolic changes that increase the risk of NCDs: raised blood pressure; overweight/obesity; hyperglycemia (high blood glucose levels); and hyperlipidemia (high levels of fat in the blood). In terms of attributable deaths, the leading metabolic risk factor is elevated blood pressure, followed by raised blood glucose and overweight and obesity.

    This language is repeated in Table 2 of the paper too where it refers to the prevalences of diabetes, prediabetes, hypertension, etc as: “Weighted prevalence of cardiometabolic risk factors among the study population”

    What becomes clear is that categorizing NCDs into binary categories (like metabolic, not metabolic) is next to impossible. After all, nature doesn’t fit into neat categories. Every disease has metabolic risk factors. Every disease has behavioural risk factors. All things contribute to a disease to varying degrees. Rather than categorizing, it is better to think about how much the contribution of each is.

    The next discussion was on the BMI cut-off used. In Europeans, only BMI above 30 is considered obesity, with BMI between 25 and 30 considered only as “overweight”. But WHO Asia-Pacific region recommendation based on studies from China, Singapore, India, etc is that cutoff 25 and above should be “obesity” in India. Above 23 can be considered overweight.

    It was unclear why the cutoff of overweight could not have been used in this survey. At least, like “prediabetes” is quantified in the study, overweight could be quantified too such that we can anticipate an increase in obesity in the future.

    Similarly for abdominal obesity, waist circumference of 90 cm above for “males” and 80cm above for “females” were used.

    All these cut-offs are creating binary categories. The challenge with binary categories is that it does not account for the differences between people. By using different cut-offs you can account for some differences. (Like they account for race and sex above). But, those are not the only differences.

    (more…)

  • Ambedkar and Gandhi — They Couldn’t Have Been Friends

    For plenty of reasons, Ambedkar never considered Gandhi as “Mahatma”. And “naturally”, Gandhi rarely understood Ambedkar. In my experience of understanding how my privileges influence how I act, I believe that I’ve been able to appreciate where the difference between Ambedkar and Gandhi arise from. This is perhaps obvious to many scholars. But it was a shower-thought for me.

    Gandhi comes from privilege. Gandhi’s thoughts and ideas are all related to those privileges. That Gandhi chooses to wear lungi is because Gandhi wants to shun those privileges to be able to be able to feel right. I had/have the same thought process when it comes to clothing. I don’t like dressing up smart. Because I think from the privileged position of Gandhi. For me, losing my privilege is what gives me mental satisfaction. 

    When mfc was organizing the annual meeting on discrimination in healthcare, there was this debate on whether to put “Dr” prefix on people’s names. The philosophy that drives mfc is mostly Gandhian. They consider calling each other by first name and stripping titles as natural. I also think like this. I never put “Dr” next to my name. Shunning privileges.

    In another group, in Dalit History Month, there was a poster shared about an event related to remembering Ambedkar. It referred to Ambedkar as “B. R. Ambedkar” and not as “Dr. B. R. Ambedkar”. And some people rightly pointed out how stripping Ambedkar of the “Dr” title is a deliberate act. Ambedkar has to be referred to as “Dr”. And Ambedkar will always appear well dressed with a suit and a tie. These are revolutionary acts with immense meaning to Dalits.

    When there is no privilege to shun, what point is shunning privilege going to make?

    The same philosophy appears in a few other places too. At the mfc meet Anoop Kumar spoke about their life journey and gave incredible examples on how to change things for Dalits. Among the questions posed was a mediocre one as to what his thoughts on “Dalit Capitalism” were. Anoop brushed the question aside saying how not every battle can be fought at once and how Dalits should also get a chance to oppress now — obviously exposing the caste insensitive framing of the question.

    On the next day, the moderator of the concluding session, out of nowhere, made a comment saying how they disagreed with Anoop’s point. And Gandhi was quoted for assistance — “An eye for an eye will leave everyone blind.” Setting aside the fact that this was a misrepresented position being argued against, one can look critically at non-violence as Gandhi professed.

    Fasting, one of the most used “weapons” of Gandhi, makes no sense to people who are already starving. Imagine people being denied PDS through Aadhaar going on a fast unto death! They’re already starving to death. In non-violent methods, essentially, one can see people with privilege converting the every day violence faced by others into a method of protest.

    Non-violence also requires infinite tolerance of the status quo. If you’re frustrated with the way things are and lash out, that’s not Gandhian. If you are tired of the bullshit and call out the crap, you’re being violent. Again, the methods of patience are easier for those who aren’t mentally or physically affected by the problems.

    Ambedkar and Gandhi could never have been friends. Because Gandhi spoke the language of privilege. And Ambedkar spoke from the lived experience of oppression. If Gandhi would acknowledge privileges and own up the influence of those in the Gandhian methods, Ambedkar might have been okay to be friends. But Gandhi’s insensitivity towards caste would never make that possible. And neither would Ambedkar’s methods be okay for Gandhi. And that’s why they couldn’t have been friends. Because of Gandhi’s ignorance.

  • Repeated Names in NSQ Manufacturing

     There’s a 2014-2016 survey of drugs.

    That’s followed up with smaller surveys by CDSCO.

    We will compare with March 2023 report.

    Let’s look for repeated offenders.

    Skymap Pharmaceuticals Uttarakhand. In the old survey they had 14.04% samples NSQ. In March 2023, they’re NSQ again in 2 samples. (We do not know how many samples from Skymap were tested, so we cannot reproduce a percentage).

    There are two samples without manufacturer specified (of Ritonavir and Rivastigmine).

    There is Karnataka Antibiotics & Pharmaceuticals Limited coming up 4 times within the March list.

    Ridley Life Sciences Delhi shows up twice. They were in the 2014-16 list for 11/52 samples (21%) being NSQ.

    Neon Laboratories Maharashtra shows up once. They were in the 2014-16 list for 2/42 samples, that is 4% being NSQ.

    Preet Remedies Himachal shows up once. They were in the 2014-16 list for 2/47 that is 4% being NSQ.

    Shiva Biogenetic Himachal shows up once. They were in the 2014-16 list for 25/62 that is 40% samples being NSQ.

    Let’s take the October 2022 list to see if we can find more common names.

    Ridley is there once in this list too.

    Zee Laboratories of Himachal Pradesh makes one entry. Zee has an entry in the 2014-2016 list for having 40/222 (18%) samples NSQ.

    Mercury Laboratories Gujarat makes it to the list too with one entry. Mercury Gujarat was the topper in 2014-2016 list 

    Shiva Biogenetic Himachal Pradesh is back here too.

    Pure & Cure Healthcare Uttarakhand makes one entry. They were in the 2014-16 list with the misname Pure & Care for 3/38 samples (7.8%) NSQ.

     

    This is emerging to be a good tech project to track each pharma and their NSQ detections. Maybe for another day. 

    One challenge is that we do not know the denominator on the smaller surveys.

  • Engaging with the System – A Visit to IISc

    When Prasanna heard John and I were leaving Hari’s farewell party to join Ravi in the trip to Indian Institute of Science, PS let out a characteristic sigh and said “all the best”. It probably comes from experience of how incorrigible people in elite institutions are when it comes to thinking about broader determinants of health and communities.

    After all, I wasn’t wearing my usual grey short pants either. I had to dress for the “vibe” of the place. I was wearing a long pant and a full sleeve shirt. Even Ravi was wearing a shoe. And when we reached the place, we were welcomed by Dr H Paramesh who was wearing a suit. The only person who was under-dressed (relative to their usual) was Pruthvish who was at the venue too, but didn’t wear a suit today.

    Places and events like these have a way of making you uncomfortable in your skin. There’s a level of “sophistication” that’s expected in the way you carry yourself. Is it written down anywhere? No. It’s just the air. You won’t be able to breathe if you’re not walking and talking the way everyone around you is.

    Gender non-conforming people have stated how in public places, it is sometimes overwhelming for them when everyone is looking at them like “they don’t belong here”. Trans women feel unwelcome in healthcare clinics for similar reasons. 

    Perhaps what I feel is a bit like what they feel.

    Would you expect a trans woman to speak about “Health for All” at Indian Institute of Science? Or a garment factory worker? Or a manual scavenger?

    I wouldn’t. Because they would always be under-dressed. No matter how expensive their clothing is.

    It affects the content of the discussion too. There are certain “sophisticated” ways you would give a talk in a place like IISc. You can talk about things like “equity”. Even “gender equality” is fashionable. But words like “caste”, “transgender”, etc would not pass the vibe check.

    That’s the trouble I frequently have when “engaging with the system”. The system has certain methods. And certain taboos. It is often the taboos that are at the heart of the problem. 

    It is only if we talk about the terrible lived experience of the caste oppressed, or the gender minorities, or the poor that we can start to expose how unjustifiable the position of scientists in ivory towers are. When lived experience of discrimination and oppression and ill-health is put on the table, people will have only two options – either turn their faces away and ignore it, or accept how they are part of the problem. They can no longer sleep comfortably saying “we’re also doing our bit”. Because nobody is doing their bit as long as people are suffering.

    And those who are suffering will never be invited to talk to the system.

    The responsibility then falls up on those who are invited. To give a second hand account from their experience of the lived experience of suffering. To amplify the voices of the marginalized. To pass the recording, when they can’t pass the microphone.

    But that won’t pass the vibe check.

  • A Community for Online Action in Community Health

    Today Guru, John, Swamy, Ravi, and I met in the Health for All – Learning Center workspace at SOCHARA. We discussed an action plan for the next 3 years (with a focus on 2023-24) for the Digital Archives Platform unit at SOCHARA. The archives becomes a core activity for a community of community health activist-scholars and activist-professionals to do study, reflection, action, and experiment online towards “Health for All”. 

    The larger hypothesis is that when we flood the internet with content related to community health, the second order and third order effects of that will lead to a massive movement by narrative building and discourse shaping towards community health.

    The DAP at SOCHARA is going to focus on SOCHARA’s own reports, publications, presentations, videos, audios, etc for the first year (along with medico friend circle’s archive). This comprises items from Appendix A of Silver Jubilee Museum Archive Project that happened between 2016 and 2022. The year after that we will focus on Appendix B (which includes networks and organizations SOCHARA is connected to) and Appendix C (which has special focus themes and topics). What to do in year 3 will emerge by the end of 2023.

    While this is just the Digital Archives part of it (which many organizations are now entering – NCBS, AICTU, APU, WIPRO, etc), there are many many other activities that this community can do:

    • Communications for community health with things like podcasts, memes, reels, and so on need to be built.
    • Stories of people and organizations need to be captured on wiki.sochara.org (which communityhealth.in now redirects to).
    • A public discussion forum needs to be created (either as part of something like Azad Maidan or independently).
    • Content of high quality and relevance like mfc bulletins and health taskforce report need to be modernized by conversion into web pages with hyperlinks.
    • Effective sharing of resources with other similar efforts in the network has to be accomplished.
    • The team at SOCHARA itself has to become comfortable with and active on these public documentation efforts.
    • … (your idea here)

    There’s plenty of interesting work that lies ahead. This month we will be focusing on the website and SOCHARA’s evolution story, physical clean up of the unused sections of the library, and getting “systems of sustainability” available for use of the team.

    Two tables put together with half a dozen chairs around it. Bookshelves filled with books are all around.
    The workspace in HFA-LC, after the meeting. I forgot to take a photo while the meeting was happening. The empty chairs symbolize the space for anyone reading this to come in and be part of the community.

  • Non-violence Wasn’t Gandhi’s Only Message

    I have read only one book of Gandhi – “My Experiments with Truth“. I read this when I was 13 or 14. I haven’t re-read the book after that. But Gandhi’s thoughts influences me to this day.

    “I have nothing new to teach the world. Truth and Non-violence are as old as the hills.”

    Today Gandhi is remembered whenever there is violence. Gandhi is used as a symbol of peace and love. We remember Gandhi mostly for non-violence.

    But Gandhi’s life was devoted to truth. Truth is a very important (if not the most important) message from Gandhi. “Devotion to this Truth is the sole justification for our existence. All our activities should be centered in Truth. Truth should be the very breath of our life.” wrote Gandhi.

    Gandhi teaches us that truth has great power. And in this post I will draw a direct connection between the power of truth and how a culture of dishonesty is ailing our society.

    ***

    Sonali Vaid had posted a thread with tips for people starting off in a public health career. The points 6 & 7 are especially illustrative of how many of us stray away from truth in our daily lives.

    7. We can be polite & respectful without being deferential. You don’t have to put yourself down – even if its someone senior.
    On the flip side some tend to disrespect boundaries if someone is friendly & not imposing seniority – don’t be this person!

    — Dr. Sonali Vaid (@SonaliVaid) March 21, 2023

    If I were an academic sociologist, I would do a paper on this topic connecting how the misguided Indian notion of “respect” is at the root of all things evil in India. Here is what happens. At a very young age, Indians are indoctrinated into “respecting” various things including elders, religious stuff, ancient stuff, and in general anything and everything. Now, there are two kinds of respect. There is the actual respect defined in dictionary as “A feeling of appreciative, often deferential regard; esteem” which is a deep emotion. And then there is a fake respect which is an act of showing someone “respect” by calling them honorific titles (like “sir”, “madam”) or by bending in front of them, touching their feet, etc. When young Indians are forced to “respect” people whom they do not respect in reality, they imbibe and internalize the fake respect. They touch the feet of the old relative while hating them. They call the teacher they hate “sir” or “ma’am”. They go to the religious institutions without knowing why. 

    This causes Indians to be greatly separated from truth in three very dangerous ways:

    1) They learn to ignore their feelings
    2) They learn to lie through their teeth
    3) They learn that truth does not matter

    When one learns to ignore their feelings, they can no longer be struck by conscience.
    When one learns to lie, it becomes easier for them to cover-up the truth.
    When one learns that the truth does not matter, truth dies.

    This affects us in every single field.

    India’s elite scientific institutions engage in scientific fraud (and retract papers when caught). Nobody keeps these institutions accountable for the sub-standard work they do. And truth doesn’t matter.

    India’s health system is not interested in Indian’s health. Hospitals are the most violent places. Nobody keeps our healthcare system accountable for poor quality healthcare. And truth doesn’t matter.

    Judiciary, engineering, social science, film industry, sports, infrastructure, urban planning, environment, finance, … Take any field. Truth doesn’t matter.

    Every Indian knows that Adani is just the most successful among businesses that do the same kind of unfair business practices in India. Everyone knows that there is a great deal of corruption in Indian politics and money is made by corrupt politicians and bureaucrats in various corrupted ways. Everyone knows that Indians are lying. And we gladly join the lie. Because truth doesn’t matter.

    And it all starts with us learning to lie by showing “respect” to people.

    ***

    It is possible to reverse this dishonesty in our individual lives. We need to follow just one principle:

    A radical commitment to truth

    Truth is very much misunderstood. What is truth? Is it something written down somewhere? Is it the same for everyone? Are there multiple truths?

    Gandhi can be helpful here too: “WHAT…is Truth? A difficult question; but I have solved it for myself by saying that it is what the voice within tells you”

    I concur with Gandhi on this. Truth is a very personal thing. Truth is when your thoughts, your speech, and your action are in 100% agreement with each other. Truth is when you don’t lie.

    Let me make it more practical. A radical commitment to truth requires the following:
    1) Being in touch with your emotions and feelings, and showing commitment to try to label them accurately.
    2) A commitment to yourself to not invalidate your own feelings. To not act in ways that go against your feelings.
    3) A commitment to follow-up on things that you are uncertain of – so that you can arrive at the truth.

    We often fail in all the three.

    When we feel sad or annoyed, but don’t recognize that we are so, we are being out of touch with our emotions.

    When we tell ourselves that we should be grateful while we’re actually disappointed, or when we act calm while we are furious, we are invalidating our feelings.

    When we are uncertain of what our inner voice is telling us and we give up on reflecting, without experimenting to understand the truth – we’re breaking our commitment towards truth.

    Psychotherapy often helps with 1 & 2 above. It helps us to label our feelings. And it trains us not to invalidate our feelings. Although the very act of therapy can be a pursuit of truth, point 3 is deeper than that. A commitment to follow-up on things that we are uncertain of – is essentially about what we do with our lives. It is about deeply engaging with questions and finding “truth” through our engagement. 

    Gandhi did this through politics. “To see the universal and all-pervading spirit of Truth face to face one must be able to love the meanest of creation as oneself. And a man who aspires after that cannot afford to keep out of any field of life. That is why my devotion to Truth has drawn me into the field of politics; and I can say without the slightest hesitation, and yet in all humility, that those who say that religion has nothing to do with politics do not know what religion means”

    It is why I’m committed to interdisciplinarity and generalism. If you’re drawn to truth, you can no longer visualize the world in isolated subjects and topics. The curiosity will make you read, listen, travel, experience, and understand people. The commitment will make you a truth-seeker, a “scientist”, it will make you devise your own methodologies. The positive energy of truth-seeking will force you to build, create, teach, write, and share.

    Truth is as spiritual as it is science. It is as abstract as it is real. It is as hard as it is simple.

    It takes nothing to start seeking truth, it takes everything to start seeking truth.

  • Book Review: Everything is Obvious – Once You Know The Answers

    I first saw this book in the Internet Freedom Foundation thread on which books people there were reading. Then I saw it on Scott Young’s blog which I have been following since childhood. I never got around to reading it till yesterday when I got into a 19 hour train ride to reach Sevagram for medico friend circle’s annual meeting.

    There was no better time to read the book because mfc’s meeting this year is on caste; caste is one of those sociological phenomenons that defy common sense thinking every day; and this book is about “how common sense fails us” and why sociology is not  merely common sense.

    What Duncan Watts has done is write a book specifically for a particular niche of people. This niche includes those people who become so used to straightforward deterministic sciences that they start seeing the limitations of it and look at larger and more comprehensive studies of human kind. Duncan went from learning physics to becoming a sociologist. This is exactly the route that Nihal is taking (from law to policy). And the route I’m taking from medicine to history. And the biggest issue that we face when we take this route is this unprecedented predominance of uncertainty.

    That sociology is more complicated than rocket science. That there are no grand rules waiting to be discovered which will solve all questions. That there are no silver bullets. This is a hard realization. Not one that’s impossible. With enough interdisciplinary exploration and generalization people like Nihal and I do discover that the world is full of uncertainties. But it’s just so difficult to settle for that. “It feels wrong”. 

    And this book makes it feel right. Well, not exactly. But at least it makes it a palatable truth that the world is extremely complicated. It also protects us from common sense thinking that makes us settle for simplistic explanations that push us into silver bullet solutions. This book, you must read, if you have asked this question “What on earth does a sociologist do?” Once you read it, you’ll feel like the contents of the book itself is obvious. And that’s the whole point of the book. Everything is obvious, once you know the answers.

  • Personal Is Political in Professional Practice

    “Should a doctor treat an alcoholic who is injured due to drunk driving? Would your opinion change if it were just a solo accident v/s injuring/killing other people on the road?” asked @arshiet. The regular controversy. Should doctors judge their patients? Is it ethical to even ask the question of whether it is ethical for doctors to withhold treatment to anyone? What are the social determinants of alcohol use?

    The issue is straightforward in the emergency room. You save life first and worry about alcohol and justice later.

    But what about elective issues? If you are an obstetrician and you are pro-life, do you avoid elective abortions? If you are a pediatric surgeon and you consider circumcision as genital mutilation, do you avoid ritual circumcisions? Conscientious Objection – apparently that’s what it is called.

    One of the solutions offered is that the healthcare provider can be upfront about the moral position and arrange a different provider. This helps the patient to retain autonomy and the provider to retain moral clarity.

    Basically, doctors can’t simply cancel patients.

    If we refuse to see the doctor-patient relationship as special, we can see that what’s at play here is the tension between “personal is political”, cancel culture, etc on one side and the practical realities of the world on the other side. I’ve personally gone through the self-isolation of ideological purism and come out with the ideology that it is okay to be altruistically pragmatic.

    The world is full of people with incompatible ideas, values, and norms. If we start cancelling, we end up cancelling almost everyone. If we don’t cancel, we become an apolitical mess. The point is then about finding alternatives to canceling everyone. You cancel some, you strategically avoid some, you engage sincerely with some others.

    That intelligent, “nuanced”, intersectional approach to politics is called life.

  • History is to Practice

    I’ve been in many debates where “science” is accused of being wrong. As if science is a set of things written down in a book or a set of ideas that are arrived at by a group of people. Something that has to be consumed by others. I’m baffled by this argument because, to me, science is a tool available for every human being to practice. It is my use of science to understand the world that matters to me. When I say “scientific method” I am talking about the method *I* use to arrive at the truth. It might be the same method that a professional scientist used, but I have to replicate that method and arrive at the truth on my own.

    When chatting with Ravi Narayan (RN) yesterday about the SOCHARA archives, I had a very interesting realization. The way I used to look at history was the way these people looked at science. I thought about history as a set of facts written down in many books, as a scholarly consensus available to those who are in the elite universities. The thought I had was this: What if, like I practice science instead of consuming it, I start practicing history instead of just cataloguing it?

    I can’t say that this thought had nothing to do with the discussion I was having with Upendra Bhojani about a Masters in History that UB was pursuing. History is a science. It is the science of the past. And without knowing the methods of studying history, I was basically being less effective as a historian.

    And without being a historian, it is difficult to be an archivist!

    So, I’m doing two things now:

    1. Take on the identity of a health historian seriously and consciously.
    2. Start practicing history.

    Another insight I had about myself was that I learn a subject the best when I have a framework that fully encapsulates the topics in it. The more there are unknown unknowns in a subject, the less I’m interested in studying it. But when I have a complete and comprehensive “table of contents”, my brain feels comfortable in taking on that skeleton, slowly going through all of the actual contents and attaching things one by one into that skeleton. I need to first have the big picture before I let in even one of the finer details.

    So, I made RN sit down and help me build that framework of how to think about the history of community health in India. After the discussion there’s a rough framework that is now emerging in my mind:

    • Prehistoric times of British India
    • Bhore committee and the first 25 years of independence. 
    • The search for alternatives in the 70s and 80s
    • Whatever happened in the 90s towards “Health for All by 2000”
    • People’s Health Movement
    • NRHM and NHM
    • Ayushman Bharat and so on…

    Much of the discussion with RN yesterday was about the 70s and 80s. RN took out 4 books on to the table:

    • Health for All – An Alternative Strategy (ICMR/ICSSR)
    • Alternative approaches to meeting basic health needs in developing countries (UNICEF/WHO)
    • Health and Family Planning Services in India (D Banerji)
    • Community Health – In Search of Alternate Processes (CHC)

    I swiped them into my bag for weekend reading.

    The NRHM bit was interesting. In my mind, the people’s health movement, the alternatives, all of these were failures. But, RN was like, “25 people out of this movement, who had by then (by NRHM formation time) formed the Jan Swasthya Abhiyan, are (were) consultants to the NRHM”. That was a light bulb moment for me. NRHM, in the biomedical colleges is taught like just another chapter, without giving it the emphasis that it deserves. That ASHAs who represent the shift into decentralization came through NRHM and how significant that is, is kind of forgotten. For me who started medicine in 2011, the idea of ASHA that was passed on to me was that of a healthcare worker like nurse or doctor, working with a very small population. But that’s totally missing the spirit and heritage of ASHAs and NRHM.

    The story of ASHAs and the story of NRHM is thus the story of evolution of community health in India. And that’s the story we’re interested in.