Blissful Life

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

Author: akshay

  • The Overcompensating Sociologists of Public Health

    Reflexivity. That’s a word very dear to sociologists. It just means how we look at the world is influenced by who we are. But like many things sociology, you give it a word and then you make a big deal out of it.

    So much that some of the sociologists reading this post are already raising their hand saying “Hey, but you’re talking about ‘positionality’. Reflexivity is actually about how we take into consideration our positionality in our research”.

    Shouldn’t the fact that how we look at the world is influenced by who we are automatically also mean that we should be cognizant of that and take that into consideration in our research? Apparently sociologists can’t do that automatically without having a different word for it.

    Or maybe they can and I’m just stereotyping them. After all, my identities put me in the positionality of an anti-academic-sociologist.

    This post is not about sociologists who don’t care about the world. And therefore I am not going to write about how there are some of them who just keep doing esoteric debates funded by public money in public universities.

    This post is not about the superficiality of academia. And therefore I am not going to write about the publication game.

    This post is about the sociologists who overcompensate for their identities.

    It starts with privilege. By their very nature, there are a lot of people in academics and sociology who come from very privileged backgrounds. For some of them, academics might have led to their understanding of their own privileges. This can probably explain why they keep going back to jargon to describe the plight of the world, because it appears that without the words given to them by academics they find it hard to understand or describe the wrongs in the world.

    My conjecture is that when they look at a subject like traditional medicine in the context of pluralist health system in India, they go “Oh, I’m from a privileged background and therefore I should compensate for my biases against traditional medicine. I shouldn’t be part of the ‘undemocratic’, ‘elitist’, and ‘self-centered’ biomedical field of this country, I should rather side with the ‘downtrodden‘” because I cannot imagine any other reason for one to claim that traditional medicine being sidelined as “unscientific” is because of the “political economy of knowledge production” and that scientific community has to devise ways to legitimize traditional medicine.

    Modern medicine has several problems. The practice of modern medicine is riddled with problems too. Knowledge production in modern medicine has a definite politics. But to use these as arguments to promote traditional medicine is a sophisticated form of whataboutery. And some of these academicians do this as well so as to talk about traditional medicine.

    I call these people “the overcompensating sociologists of public health”. Their “solidarity with the oppressed” is more about their own struggles than about the struggles of the people. They would rather stick to their arguments romanticizing traditional medicine (getting applause from the cult of anti-science orientalists) and have people die eating roots and leaves than have their praxis in the form of advocating for better access to quality healthcare.

  • Does Medicine Need a Paradigm Shift?

    Let’s start with physics

    As my brother’s T-shirt says “The Pulse of the Earth is in Physics”. Physics is a fundamental science. Also called “pure” science. That is a fancy way of saying it is reductionist. When you think of an apple falling to Earth in physics, all you think about is its mass and the forces acting on it. Everything else is immaterial to physics, including the questions like “Is the apple rotten/ripe?”, “What is the probability of the apple falling on a rabbit and killing it?”, “Are there hungry people waiting for the apple who won’t get to eat it?”, and “Is the apple cursed?”

    The question whether apple is rotten can be answered by another branch of science called biology. Physics and biology are called natural sciences. These are branches of science which rely on observation of the universe to reach at inferences on how the universe works.

    The question on probability would fall under mathematics. Mathematics is a bit different from natural sciences. Because it is based on axioms and logic. Such sciences are called formal sciences.

    A hungry class of human beings not getting to eat apples and the reasons behind it would be the matter of study in social sciences.

    The cursed apple is a subject of religion and superstition. These are, by definition, not questions for science to answer.

    What kind of science is medicine?

    Medicine is not a pure science like physics. It is an inter-disciplinary, applied science. Medicine uses several branches of science like biology, chemistry, and mathematics in its own goals.

    A medical practitioner has to know several sciences like anatomy, physiology, biochemistry, pharmacology, and microbiology to be able to practice medicine well. They would also need skills in probability, reasoning, and logic. Also critical are skills like communication, empathy, leadership, and management.

    There are also several other forces in play that influence the practice of medicine – education, medical training, health systems, politics, economics, religion, human resource, war, and so on.

    The question of a paradigm shift in medicine is thus complicated. Which part of medicine would the paradigm have to shift in? In the numerous sciences that make it up? In the way it is practiced? In the way people are trained in it? In the way the systems around it are organized?

    Science is the only way of knowing 

    What is science? 

    The opening statement from Wikipedia is: “Science is a systematic endeavor that builds and organizes knowledge in the form of testable explanations and predictions about the universe.”

    Science is what allows human beings to operate in the world. It is the sum total of all that we know about the universe through thousands of years of living in it and observing it. It is the reason why we know that if I strike a lighter in a particular way with a knob turned on the gas from a cylinder will come into the stove and start a fire. It is how we cook and eat. It is the reason why we know that elephants can lug trees while cats or dogs can’t. It is the reason why we are able to talk to each other over the internet.

    Everything we know about the world is through theories and observations that confirm those theories. When we come across observations that contradict those theories, we are forced to come up with better theories. But till then, we seem to be able to live on earth with the old theories.

    Is there any other way of knowing about the world? Think about it. Everything that you know about the world would come from your own observations and theories, or those by others that you have read about. There is simply no other way to know facts about the world.

    You might say, “Oh, to know whether it is raining, I just have to look out of the window. No science involved”. But hey, what you’re doing is observation. And then forming a theory that it is raining. What if there is a film shoot going on and they’re pouring water with a hose and that is what you’re observing through the window?

    The whole experience of seeing water drops falling down from sky and knowing that “it is raining” is based on science. It is based on human observation since time immemorial of the natural phenomenon called rain. Even when you’re looking out of the window to say whether it is raining, you’re using science. And it is science that allows you to say whether it is actually raining or a film crew pouring water.

    You might also say, “Hey, I know cycling, is that science now?”

    When you say you “know” cycling, the knowing refers to a particular sense of muscle memory that you have developed through practice. But this is not the kind of knowing we are talking about. We are talking about knowing how the universe and everything in it works.

    Read a related post about this question of whether science is the only way of knowing, where I argue that if there is a way to know, then science is the only way of knowing. Consequently, there are some things we cannot know, and this question would not apply at all.

    Queering science

    While indeed science can be seen purely as methods of rationality as above, it is has to be acknowledged that science is ultimately a human endeavor and thereby it reflects all the faults of the human society almost as it is.

    I’ve dealt with this human aspect of science in an earlier blog post and so I won’t repeat those points here. Suffice to say, there is an intersectional approach to the practice of science that’s missing in mainstream science.

    What about applied sciences?

    When it comes to an applied science like medicine, the problems seem to compound. Many of the sciences that make up medicine are all super hard to study. The tools we have are limited. And the institutions that we have are very problematic spaces (in terms of patriarchy, violence, oppression, and discrimination).

    When faced with such a complex challenge, many people prefer to run away and find comfort in places that nobody is finding faults with (although they would be riddled with even more issues). That’s why many people turn to Reiki, Homeopathy, Ayurveda, and so on. This gives them psychological comfort. But this is no solution to anyone’s problems. We will talk about that later.

    Applied sciences deal with the real world. One that is filled with uncertainties. One where perfect knowledge is impossible, but action is inevitable. It takes a lot of interdisciplinary thinking to operate in the field of applied sciences.

    Let us look at what some people call Evidence Based Medicine. EBM is misunderstood by many. They give undue stress to the word “evidence” and think that a randomized control trial is the be-all and end-all of EBM. These are the people who assume that medicine is based on a paradigm of large numbers. What they do not know is that there are three pillars of evidence based medicine:

    • Clinical judgement
    • Relevant scientific evidence
    • Patients’ values and preferences

    Clinical judgement is where the practitioner comes in. The validity of medicine rests on the practitioner making the right observations and judgements about a particular situation. Similarly, we need a body of evidence, a body of science before us to be able to make any intelligent observations. And considering all of this is about a patient, it is imperative to keep their preferences in the whole matrix of evaluating what to be done.

    Let us talk about relevant scientific evidence a bit more because that seems to cause a lot of confusions in the world. (Even in an otherwise brilliant talk about integrated medicine, Ravi Narayan equates medicine to controlled clinical trials, for example. (19:30 in the video)).

    It is all about knowing the truth, as we discussed in the beginning. How do we know what to do in a particular situation. When someone comes in front of you with cough, weight loss, and fever, what do you do? What if you also found in the sputum of this person the organism that is known as Mycobacterium tuberculosis? What do you do? How do you know what to do? That’s the important question.

    If you knew magic, you could perhaps try that. You could get rid of all the M. tb from their body magically! That would help them. You might save them from certain death.

    But if you didn’t have the evidence built over centuries of human beings struggling with this disease called tuberculosis, how would you even know that this person would die soon?

    It is only the scientific method of knowing the universe that can guide us to move even an inch forward towards helping those who are struggling.

    The alternative to science

    The alternative to science is the pandemonium of opinions and beliefs. There are people who consider these as ways of knowing the universe. But they don’t critically think about their own philosophy.

    Firstly, whose opinion counts? Who is authorized to make opinions? Is it reserved for people who meditate in the Himalayas? Can you and I do it? Does it have to be done high on weed? How do we measure whether someone is legitimate in claiming that the shit they pulled out of their ass is the correct knowledge about the world?

    Secondly, when you have two people claiming two shits that are contradictory to each other, what do you do? Let’s say person A says eat leaf A, while person B says eat leaf B when confronted with the patient we saw above. Which leaf should the person eat? Both leaves? No leaf?

    The only way to evaluate anything and arrive at an actionable prediction about the universe is through science. If you look at what’s typically called pseudoscience, things like Homeopathy, what you can see is that underlying all these are certain theories that are of very low quality. These theories are sometimes not verifiable. And if at all they’re verifiable, they end up to be false. Proponents of these pseudosciences typically take comfort in the space where they come up with a theory, believe in that theory, and don’t bother verifying those in the real world.

    Paradigm shift in medicine?

    Having said all that, let us come to the question of the need for a paradigm shift in medicine.

    It is easy to speak in vague terms about “holistic” approaches that incorporate a paradigm of being “more rigorously attentive to the individual while keeping in view the larger picture”. But when it comes to practice, we can quickly see how rhetoric like these are hollow.

    Does attentive to the individual mean using genetics and personalized/precision medicine? Does it mean just taking patient preferences into consideration? How scientific and rigorous do you have to be when you say “rigorously attentive”? If a person says “I think homeopathy will work for me” and you diagnose tuberculosis in them, what do you do?

    What about the other question. How many people practicing modern medicine are actually practicing evidence based medicine? How many do rely on science and evidence to manage their patients? How many randomized control trials did people use to prescribe drugs during COVID. How many RCTs are followed when people prescribe platelets and antibiotics for dengue? How many RCTs are followed when people diagnose typhoid with a single Widal test of 1:40?

    Does the “larger picture” include social, political and economic determinants of health? But does it also mean that the focus should only be on distal determinants? Would you not worry about Anti-Tuberculosis Therapy in someone with TB or will you only keep saying “nutrition!”, “nutrition!”, “nutrition!”. Fine, nutrition. But how? Will you feed this person out of your pocket or will you keep saying the government should come with food security schemes? Fine, the government should come with food security schemes. But will you work with policy makers on making such schemes a reality or will you keep writing about it?

    Yes, a paradigm shift is necessary. A paradigm shift that puts people first. A paradigm where sacrificing rationality for practicality and/or sacrificing science for pluralism doesn’t kill innocent people. A paradigm where working on social determinants goes hand in hand with treating now those who are suffering now. A paradigm where paternalism and saviour complex are replaced with solidarity and praxis. Nobody can say no to that paradigm shift.

    ***

    Footnote: There’s a human tendency to come up with alternative hypotheses to explain seemingly miraculous phenomenons. When I was 16 years old, I came up with “ASD rays” to explain telepathy. Thankfully there was a group of people who explained to me that my theory, however “sound” explains a phenomenon that’s non-existent. At that point in time James Randi offered a million dollars to anyone who can demonstrate paranormal claims. And nobody won it, of course.

    As long as people think that things like homeopathy actually are more than just placebo, they’ll come up with theories that go into sub-atomic realms to explain how these work. That’s natural. And they’ll keep struggling to understand why rational people reject their theories. If you are empathetic to them, you’ll realize that to them it is inevitable that these theories must be true because otherwise how do they explain to themselves their “miraculous cure” that others believe is charlatanry?

  • Money Matters

    Warning: This post discusses money. Like, it’s going to talk about my account balance. Now, for some of the people reading this, their account balance might be much lower than mine. And for others, vice versa. So, if you don’t want to compare lives, you’re better off not reading this.

    ***

    Like I said when I was interviewing Shreyas for IBComputing, I don’t believe that we should wait till we grow old to write about the strategies we use to live our lives. The main reason is that what we do today is probably going to get outdated in a couple of years and therefore writing/talking about it 20 years from now is not going to help anyone.

    A few years ago I saw a blog post by Michael Lynch, who had quit job at Google and started out as a solo developer. In that post, M discusses how much money M was making – profit, loss, revenue, everything. M made another post after a year, and another, and another. These annual posts talking about finances were very inspiring to see.

    I am also attempting something like that here. For the sake of completeness, in this post I will do a recap of what’s been happening to my bank accounts till now.

    ***

    Privilege.

    Like I hinted in the warning, each life is different. Someone who has more expenses than I have might not be able to save as much money as I can. Someone who started out with a tougher deal might not be able to make as much money as I can. And vice versa. The purpose of this post is not to tell people that they can follow what I did and make money. Neither do I think that I’m making more money than everyone else. This is not a self-help/advice/moral blog post. This is simply about making my financial life transparent.

    ***

    The first salary I have gotten came from the compulsory internship I did as part of MBBS course at Mysore Medical College. Till then it was only my family putting money in my pocket and bank account to pay hostel fees, eat food, etc.

    So, from 2016 March to 2017 March I was making about ₹20,000 (if my memory serves me right) monthly. When I started earning my dad stopped putting money into my account. So, it was only when I went home my grandmother giving me 5k-10k once in 4 months or so that was my additional income.

    At the end of this internship, I vaguely remember having around ₹1,40,000 in my account.

    March 2017: ~₹1,40,000

    ***

    Then I joined SVYM as a resident medical officer. The rural economy of Saraguru combined with the cheap food and accommodation there meant that I could save almost all of the ₹35,000 I was getting as salary there.

    In the last few months of working there, I was also moonlighting (remotely) in a Bengauluru start-up in an engineering role. I was being paid hourly there.

    In August 2018 I left SVYM and moved to Bengaluru. This is when I started tracking my financial situation seriously. And therefore, from here on I have very good numbers.

    August 2018: ₹4,47,613.61

    ***

    The first house Swathi and I lived in was in Mathikere in Bengaluru. We paid ₹10,000 rent per month. We did have a splitwise group between us that we maintained quite well in those times. (Nowadays we only put large numbers, like house rent, in that splitwise group). We used to eat outside a lot (lots of Kerala restaurants near Ramiah hospital). Traveling was mostly by metro and BMTC buses. Sometimes Uber.

    I have a simple way of tracking money that doesn’t take my time regularly, and can be done whenever I have time. I keep a google sheet titled Vitamin M (see picture)

    The first column is date. Then there are columns for each bank account I have. Then a column for cash in hand. Another for money I’m owed. A couple of columns for totals (one is total liquid cash, the other is total virtual worth (liquid + owed)). I also kept a column to track the difference between the total at any moment and the money I had when I first came to Bangalore.

    There is no rule on when to update this sheet. I used to update it whenever I had a chance, I remembered, or I felt like I wanted my life in order. The procedure to update is also simple. I enter the date. I login to all bank websites and enter the current balance. Then I count the money in my wallet. Then I open splitwise and other trackers to see how much money people owe me. And the rest of the calculations is done by formulae.

    If you can see the picture, you’ll notice that from August 2018 (when I moved to Bangalore) till the end of 2019, my balance was always below the baseline (of 4.5 lakh). But it was also not going too far below. Basically, I was making almost as much money as I was spending in the initial year of being in Bangalore. This was through working as a doctor and also as a developer.

    Around August of 2019 we had moved to a house in Kadiranapalaya which is equidistant from Indiranagar metro, Halasuru metro, and Swami Vivekananda metro. The rent here was ₹14,000. And the living costs were also slightly higher than Mathikere. The startups I was working with were all struggling to pay at that time and by around October 2019, I had dipped to ~₹3,20,000.

    But towards the end of that year I started working with a non-profit as a software developer and that’s how I first crossed the baseline after coming to Bangalore.

    October 2019: ~₹3,20,000

    ***

    As unfair as it is, as I was making more money, more projects were coming to me with even more money attached. I was an investigator in a public health intervention/research study. I was seeing patients. I was developing software for various people. I was getting paid for workshops I facilitated.

    By April 2021, my worth was about ₹10,00,000. I was a millionaire in Indian rupees. And remember all of this was when the world was burning with COVID.

    April 2021: ₹10,00,000

    ***

    About time the second wave of COVID hit I was getting disillusioned by the things I were doing. I quit almost all paid work and sat at home.

    My calculation was that at the rate I was burning money, I could easily float for 3 years, or even 5 years if I tried. So I was under no pressure to make more money. 

    I did various things from around May 2021 to May 2022. Lots of different experiences. I stretched myself in all possible directions and figured out my limits and possibilities.

    May 2022: ~₹7,50,000

    ***

    In June 2022 at the compulsion of my friend I started another paid, part time role as a software developer at Kinara Capital. Coincidentally on the day I joined there I also took up the responsibility of leading an archival effort through SOCHARA who also decided to pay me against my wishes. And many tiny projects/workshops as earlier still keep coming.

    While I’m writing this, I updated the Vitamin M sheet. And it tells me that I’m a millionaire again.

    November 2022: ₹10,78,646.30

    ***

    Addendum: It is not just Michael Lynch who has inspired this post. The financial life of Pirate Praveen is also public information because Praveen has disclosed it as a candidate in many elections. Between those and the financial reports of various non-profits, I do not see any reason why I shouldn’t be writing this blog post.

    I’m also the director of an LLP and I assure you that the numbers in that bank account changes nothing in this analysis. If you know what I mean.

  • By Doing “Government’s Work”, Are We Making It Easier for The Government and Worse for the People?

    At the end of the CHLP session today Akshay (not me) asked something like: “When we do work that the government should be doing, are we making it easier for the government in some ways, and also making it more difficult to hold the government accountable?”

    This is a question that only someone who is truly invested in community work can ask. They are worried that the government is going to invest less in that particular problem, that in the long run it becomes harder and complicated because of the reliance on “bespoke” solutions. (The example given was how government relies on the voluntary effort of data by covid19india.org / covid19bharat.org to get COVID related counts and how there is no other system to track these counts)

    I do not claim enough experience to answer this question.

    But if we break down this question, the concerns we have are:

    1. How sustainable are such bespoke solutions? If we could keep doing it forever, then why should we not do it forever? Should government ever take over?
    2. Are such bespoke solutions less effective than more universal solutions? If yes, are we causing a less than optimal outcome? If no, are we preventing a scale-up of these solutions by the mere fact that it came from outside the government?
    3. Does access to and/or existence of such bespoke solutions make it difficult to demand more universal solutions from the government? (Either by making people reticent or by making the demand look less urgent)

    A few counter points are:

    1. But how long should I wait for the government to do the right thing?
    2. Who is at the receiving end of our desire to wait for a universal solution? Who suffers when we wait?
    3. Let’s say I don’t attempt the bespoke solution. What do I do now? Should I now force the government to build a solution?

    The way I avoid these questions are by thinking:

    • The government is a huge, inefficient, highly hierarchical organization with not much capability to build innovative solutions. Therefore, expecting government to come up with a good solution is pointless.
    • I should do things that give me joy, not what brings joy to the world. If bringing joy to the world in certain ways brings me joy, then so be it.
    • The second-order, third-order effects of our actions are very very hard to predict. No matter how much we “calculate”, not much is going to come out of the calculations. We have no way to say that any particular action is what is going to help the world. We just do what we want to do and hope that it turns out to be a good thing. Often, there is no way to actually say whether something turned out to be good either.
    • If we are creating value, putting value out into the world, it is more likely than not that we’re doing something right. The value will compound in ways we cannot anticipate. Always.

     If you are reading this and you have answers to some of these (existential, sorta) questions, let me know.

    Update

    I sent this to Tanya and Prashanth. Prashanth tried to add a comment and failed. That comment is:

    “This is an important question to “struggle” with especially for those
    (like me) who are involved in such “solutions” that are often not only
    outside-the-box, but also as rightly pointed out, being designed outside
    the “public” system. For an individual like me for whom, working with
    indiviudals/communities/populations is coming from an ethical
    imperative and from wishing to move our society towards health equity,
    there is – I confess – no other way. What do we who do not wish to work
    within governments for various reasons do? I think what we can do is
    build coalitions, networks and allies which nudge/push/critically
    demonstrate the need for public services and systems to do more. And for
    me, such efforts are ways of showing that more can be done. Another
    reason to do this is to address the inertia that sometimes develops at
    middle level institutions (like districts) where the glamour of
    word/jargon based policy vocabulary is not there and the fatigue of
    under-resourcedness is a daily reality. So, I believe such efforts can
    hopefully spur creative thinking within public systems, build allies
    within the system and who knows…knowing the complexity and unintended
    effects these things have…some things stick…some things
    flourish…improve? But, certainly there ought not to be a claim that
    such accomplishments (if they are such) will automatically result in
    “systems change”….these are some of my thoughts. “

     

    Prashanth also got Werner Soors involved. You can read W’s comment below this post. To me, W has more or less arrived at the crux of the dilemma. The struggle is related to the dichotomy created by the ideal government and the real government. But as W points out, it maybe worth trying to become part of the government through becoming part of the people.

    Coincidentally, I saw this video by The Ugly Indian today

  • What Can An MBBS Doctor Do?

    In the protest surrounding suspension of Dr Saibal Jana and Dr Dipankar Sengupta, a debate has emerged around what an MBBS doctor can and cannot do, especially in rural settings. This is a very complex question that requires a complex legal answer.

    There are several relevant case laws and even acts like Clinical Establishments Act which talk about some aspects of this debate. But let us look at it from a more fundamental and fresh perspective.

    Law is not static. It is subject to continuous change. Law is not blind either. It is acutely aware of context. Therefore, there is no need to frame a universal, absolute, strict law regarding a nuanced question like this.

    What are some of the considerations that must be kept in mind when framing a law on this question?

    – How to bring equitable healthcare to the people of our country?
    – How to protect people from harm?
    – What is the situation with respect to human resource availability in rural healthcare?
    – How do referral pathways work in our country?
    – How does medical education work?

    What makes a rural place “rural”? Places are considered rural when they have small population and consequently very few markers of urbanization (like large buildings that accommodate many people in a small area and huge roads that accommodate heavy traffic). Many rural areas won’t have a movie theater. Because there are so few people that it would be difficult to run a cinema and make profit. Similarly, the economics of small numbers do not allow a “specialist” doctor to practice only their specialty in rural area. It also makes it difficult for them to invest in equipment that might be required for specialty practice. In many ways, specialist practice is economically impossible in rural areas.

    On the other hand, a generalist is able to successfully practice in rural areas. Someone who is willing to see a large number of people with many different health conditions can survive in a rural economy rather comfortably.

    Is it possible to have multi-specialty hospitals in rural areas, if the rural economy cannot sustain specialists? Yes! This is possible through team work. There are many rural hospitals which work by association with specialists who might be present only on one day a week or available over phone calls. This unique symbiotic arrangement has organically developed in many rural places in India. The reason is that just because a place is small, the health needs of the people in that place will not be small. (To paraphrase Dr Yogesh Jain). Rural places also require specialized care. The demand is there, but the volume is low.

    If you can have one specialist come on one day and manage all the cases that require that specialist’s care, the rural hospital can club many patients together on that particular day and make it an economically feasible day for the specialist. If the specialty is something like surgery which requires post-op care and follow-up, rural hospitals can manage with generalists who work with the guidance of specialist in arranging that follow-up care.

    What specialists typically tend to do in such arrangements is also empower the rural generalist in being able to handle more complicated cases. This happens in many ways. The availability of specialist guidance increases the confidence of the generalist. Doing things with a specialist transfers necessary skill. And working under these arrangements for a while makes them able to work independently as well.

    That is how medicine is. Medicine is not something that you finish learning in a specific number of years in a medical college and then go out and practice forever. Medicine is something that you learn every day. Even the specialists learns on the go. They hone their skills day by day, with every new patient.

    Now, let us imagine the same rural area without this delicate arrangement in place. Imagine a doctor who has just finished MBBS has come to practice in a rural area and have started a small clinic or are in a PHC. What are they supposed to do there? Can they treat pneumonia? Can they manage someone with schizophrenia? What about deliveries? Can they conduct a delivery? How about I&D for abscesses? Can they prescribe Morphine for palliative care? Would it be alright for them to stabilize a poly-trauma patient? Someone with an Acute Coronary Syndrome? What happens when a patient comes to them with long history of cough and fever? What about someone with chronic headache? How about someone with loss of balance? Or someone with a distal radius fracture?

    In a world focused on specialties and urban model of care, many of these patients would have to be referred to the average specialist in the nearest urban setting. But there is not a lot of insight into how many of these referrals are successful. How many reach the right kind of “specialist”? How many decide to suffer than seek inaccessible care? How many settle with an alternative medicine practitioner who decides to take the risk of handling the condition with the knowledge and confidence they have? How many die lost in the referral pathways? How many die at home?

    In a world that’s person-centered, we would encourage the MBBS doctor to take all of these factors into consideration and take a calculated risk in cases where that would be in the best interest of the patient. In cases where the patient is otherwise going to not receive any care, it is often in the best interest of the patient that the MBBS doctor, even if they do not have the skill of an average specialist, attempt something risky. 

    Of course that shouldn’t come at a cost to the patient. This has to be a careful decision that’s discussed with the patient. A shared decision has to be made between the doctor and the patient as to the risks and the alternative options. But it is these informed risk taking that’s going to help that doctor level up. 

    A progressive outlook at medical education should think about what resources can be made available to this isolated doctor to be safe in the risks that they’re taking. What kind of guidance and resources can be made available to them to increase their chances of success and increase their level of competencies. 

    It is when we are able to create such empowered generalists in rural healthcare that we can start bridging some of the huge gaps in rural healthcare. The law should not become an obstacle in this mission. The law should be progressive enough to encourage these possibilities. The law should be promoting this decentralization of healthcare. The law should be focused on people and their well-being.

    The question should not be “What can an MBBS doctor do?”. The question should be “What should an MBBS doctor do?”

  • Essential Digital Literacy for Community Health Folks: Part 1

    Whether one likes it or not, everything is getting digitized. And it is often a good idea for human beings to keep abreast of changes. This is a series of posts designed with community health folks in mind to help them develop mental models around the technologies that make up the digital world.

    In this post, we will look at certain foundational terms like “information”, “data”, “communication”, and “computer”. Then we will connect it to words like “internet”, “server”, and “cloud”.

    ***

    Information / Content / Data

    Anything that is meaningful is “information”. Emails, videos, textbooks, numbers, anything that you can imagine and represent or store in some form.

    “Content” is just another word for information used in specific contexts. Like if I’m sending you an email, the body of that email would be called “content”. An article has content. A youtube video has content. An instagram post has content. A tweet thread has content.

    “Data” is yet another way of looking at information. If you collect information about 50 people while doing a research project and put it in a spreadsheet, you might call it research data. If a hospital keeps a medical record of a patient who was admitted there, that would be called health data. If you write a brief bio of yourself and share it with someone, it might be called a biodata. 

    ***

    Communication

    Human beings have been communicating forever. We can talk to each other. Or we can draw something on the wall which someone else can come back and read later – perhaps after a day, perhaps after centuries. We can write letters. We can write emails. We can message people.

    Communication is just transfer of information/data from one place to another, from one mind to another.

    It need not always be one-to-one. It can be one-to-many. Mass communication.

    We will come back to the term ‘communication’ in a while.

    ***

    Computer / Computing device 

    A computer is a machine or a device which can be used to view, store, transmit, receive, and manipulate/transform data or information.

    Is a physical book a computer? It can be used to view, store, transmit and receive information. But it cannot manipulate or transform that information.

    What about a calculator? Is it a computer? A calculator can be used to view, store and manipulate/transform information. But it can’t really transmit or receive information, can it?

    What about a smartphone? You can send and receive data/information via smartphone. You can store it and view it. You can also manipulate and transform it. A smartphone is a computer.

    So is a laptop, or a desktop.

    Computer as a Communication Technology

    You might have noticed that in the above section, I am referring to the computer as a machine that can be used in receiving/transmitting information, or, communication. In the past people might have called a calculator a computer. But today, computers are almost universally able to communicate and therefore it is ideal to view computers as machines useful in communication technology.

    What kind of communications do computers allow?

    Email, WhatsApp, YouTube, Instagram, Twitter, research publication, reading journals, reading news, writing blogs, reading blogs, putting things on a website, viewing a website, so on.

    (Remember – your smartphone is also a computer!)

    ***

    Internet

    The Internet is the simplest and most powerful creation of human beings in the past few decades.

    It is super simple. Imagine I (A) connect my computer and your (B) computer with a cable that can transmit information. Now I can send messages from my computer to yours and vice versa. A—B

    Imagine now that you connect your computer with that of another friend (C). Now, I can send a message to C through your computer.  A—>B—>C

    If D connects to C’s computer, D can send a message to me. D—>C—>B—>A

    Imagine most of the computers in the world connected to each other through each other. Like a huge “net”. That’s internet.

    This connection need not be through a physical cable.

    It can also be through the electromagnetic spectrum. 4G, 5G, WiFi.

    You might have a question here. You have only one computer in your place, and it is not connected to any other computer. How are you able to browse the internet, then?

    Well, actually, when you’re connected to internet (be it through wifi, be it  through mobile data), what you’re actually connecting to is a computer. That computer would be in the office of your internet service provider (Airtel, BSNL, Jio, etc). And they connect their computer to the rest of the world through massive underground cables.

    Basically, the whole world is connected through cables and electromagnetic spectrum. And that’s how internet works.

    ***

    Server

    A computer is not a magical device.

    If your computer is switched off, you cannot read your emails from it.

    If your computer is not connected to the internet, it cannot send or receive information from the internet. If your wifi is switched off, or your data pack is over, you cannot receive whatsapp messages or emails.

    But if that’s the case, what will happen to the WhatsApp messages others send to you when your phone is switched off? Where does it exist? Where is it stored? 

    Let’s say B’s phone is switched off. A sends a WhatsApp message to B. A then switches their phone off. Both phones are now switched off. Does the message exist anywhere?

    B switches their phone on now. (A’s phone is still switched off). Will B receive the WhatsApp message sent by A?

    The answer is yes. And the answer is “servers”.

    A server is just a computer that is kept on and connected to internet all the time.

    When A sends a WhatsApp message to B, A’s message is not directly send from A’s phone to B’s phone. Instead, A’s message is send from A’s phone to a computer owned by the WhatsApp company. This computer is always kept on. This computer might physically be located in California, or London, or Mumbai. We do not know for sure. But WhatsApp knows. And “server” is just another word for this computer that is always on.

    This server sends the message then to B whenever possible. If B is online, it will immediately send that message. If B is switched off and later comes back online, the server will send the message to B then.

    That’s what a server is. A computer that’s always online.

    It is not just WhatsApp. Almost everything in today’s internet works through servers. If you’re reading this through an email, you are probably getting that email off your email providers’ server (Gmail/Yahoo/whoever). If you’re seeing this on a blog, you connected to Blogger company’s server to download this post to your computer.

    ***

    Cloud / Cloud server

    Cloud is just a fancy name for servers run by big companies like Amazon/Google/Microsoft. When I run a computer at my home and keep it always online, it is called just a “server”. But when a capitalist company runs a computer at their air-conditioned, high security, custom built buildings, it is called a “cloud server”, or sometimes simply “cloud”.

     ***

    We will look at some related words like “client”, “database”, “website”, “protocol”, etc in the next post.

  • Analysis of v-safe response data

     Amar Jesani shared in mfc group link to an article about v-safe data release.

    The actual data could be downloaded from this website called icandecide.

    The 5GB file can be extracted with p7zip to a 25GB CSV file.

    $ md5sum consolidated_health_checkin.zip
    53ff7a8153f44eaab4166f722b726fe1  consolidated_health_checkin.zip
    $ md5sum consolidated_health_checkin.csv
    345cf6ca148832141260aab8638bf0dc  consolidated_health_checkin.csv

    $ wc -l consolidated_health_checkin.csv
    144856044 consolidated_health_checkin.csv

    (That’s 144 million records in this CSV file)

    $ head -n 5 consolidated_health_checkin.csv
    SURVEY_STATIC_ID,REGISTRANT_CODE,RESPONSE_ID,STARTED_ON,STARTED_ON_TIME,DAYS_SINCE,ABDOMINAL_PAIN,CHILLS,DIARRHEA,FATIGUE,FEELING_TODAY,FEVER,HAD_SYMPTOMS,HEADACHE,HEALTH_IMPACT,HEALTH_NOW,HEALTH_NOW_COMPARISON,VACCINE_CAUSED_HEALTH_ISSUES,HEALTHCARE_VISITS,ITCHING,JOINT_PAINS,MUSCLE_OR_BODY_ACHES,NAUSEA,PAIN,PREGNANT,PREGNANCY_TEST,RASH_OUTSIDE_INJECTION_SITE,REDNESS,SITE_REACTION,SWELLING,SYSTEMIC_REACTION,TEMPERATURE_CELSIUS,TEMPERATURE_FAHRENHEIT,TEMPERATURE_READING,TESTED_POSITIVE,TESTED_POSITIVE_DATE,VOMITING,DURATION_MINS,PREFERRED_LANGUAGE
    vsafe-0-day-dose1,222-10271-84782,s244305050865137831057660547899056617007,12/31/2020,4:55:13 PM,0,,,,,Good,No,,Mild,N/A,,,,,,,,,Mild,,,,,Pain,,Headache,,,,,,,,English
    vsafe-0-day-dose1,222-10325-02776,s258811629454233188277362395339553379505,05/19/2021,3:16:15 PM,0,,,,,Good,No,,,N/A,,,,,,,,,,,,,,None,,None,,,,,,,0.85,English
    vsafe-0-day-dose1,222-10368-05218,s256518678527351061889187968276580937945,04/27/2021,4:11:31 PM,0,,,,,Good,No,,,N/A,,,,,,,,,,No,,,,None,,None,,,,,,,0.72,English
    vsafe-0-day-dose1,222-10453-23273,s245552707728162053684731534374544736656,01/12/2021,3:31:16 PM,0,,,,,Good,No,,,N/A,,,,,,,,,,No,,,,None,,None,,,,,,,,English

    As you can see there are many columns, which we will have to decode.

    Combing through the whole file again and again is taking a lot of time on my computer. So I decided to write a python script that’ll do all analysis in one pass of the file.

    But that was taking even more time.

    So I decided to put this data into postgreSQL to do the analysis.

    $ sudo -u postgres createuser health

    $ sudo -u postgres createdb vsafe -O health

    $ cat load.sql
    SET datestyle TO dmy;
    CREATE table if not exists checkin (
            SURVEY_STATIC_ID varchar, — eg: vsafe-0-day-dose1
            REGISTRANT_CODE varchar, — eg: 222-10271-84782
            RESPONSE_ID varchar,
            STARTED_ON DATE,
            STARTED_ON_TIME varchar,
            DAYS_SINCE int,
            ABDOMINAL_PAIN varchar,
            CHILLS varchar,
            DIARRHEA varchar,
            FATIGUE varchar,
            FEELING_TODAY varchar,
            FEVER varchar,
            HAD_SYMPTOMS varchar,
            HEADACHE varchar,
            HEALTH_IMPACT varchar,
            HEALTH_NOW varchar,
            HEALTH_NOW_COMPARISON varchar,
            VACCINE_CAUSED_HEALTH_ISSUES varchar,
            HEALTHCARE_VISITS varchar,
            ITCHING varchar,
            JOINT_PAINS varchar,
            MUSCLE_OR_BODY_ACHES varchar,
            NAUSEA varchar,
            PAIN varchar,
            PREGNANT varchar,
            PREGNANCY_TEST varchar,
            RASH_OUTSIDE_INJECTION_SITE varchar,
            REDNESS varchar,
            SITE_REACTION varchar,
            SWELLING varchar,
            SYSTEMIC_REACTION varchar,
            TEMPERATURE_CELSIUS varchar,
            TEMPERATURE_FAHRENHEIT varchar,
            TEMPERATURE_READING  varchar,
            TESTED_POSITIVE varchar,
            TESTED_POSITIVE_DATE varchar,
            VOMITING varchar,
            DURATION_MINS FLOAT,
            PREFERRED_LANGUAGE varchar
    );

    COPY checkin FROM ‘consolidated_health_checkin.csv’ DELIMITER ‘,’ CSV HEADER

    $ psql -U health vsafe -f load.sql
    …
    COPY 144856043
     

    That took about 25G space as well.

    Beautiful. Now we can do all kinds of querying.

    Actually, not yet. There’s one more thing we have to do. Create some indexes for making queries easier.

    CREATE INDEX checkin_health_impact_idx ON public.checkin USING btree (health_impact);

    Now, there are some issues with this data. For example:

    ERROR: could not create unique index “checkin_pk”
      Detail: Key (response_id)=(s252082802016465320050574992159464366472) is duplicated.
      Where: parallel worker

    response_id is duplicated, although it looks like every response might be unique.

    But let’s ignore that now for an interesting query result:

     

    That’s the distribution of the Health Impact column. 81 million responses say N/A, 56 million responses include no value (null) for this column  and the tail kind of begins there.

    When I do select count(distinct(registrant_code)) from checkin; I get 9,552,127 which means only 9.5 million registrant_codes are included in the dataset. Since v-safe allows adults to respond on behalf of children, it is probably likely that there are more individuals in the dataset than the registrant_codes.

    Then I ran select count(distinct(registrant_code)) from checkin where health_impact like ‘%Get care from a doctor or other healthcare professional%’; and it returned 797,396. Which means at least 797K people checked this option (with or without other options)

    Now let us look at the variable of interest, healthcare_visits. The query I ran is select healthcare_visits, count(*) from checkin where health_impact like ‘%Get care from a doctor or other healthcare professional%’ group by healthcare_visits ;

    The result is

     

    Note that I haven’t deduplicated by registrant_code here. 

    So I tried a different query: select count(*) from checkin where healthcare_visits  like ‘%Hospitalization%’; the answer to which is 83,690.

    Let us try deduplicating by registrant_code on that:

    select count(distinct(registrant_code)) from checkin where healthcare_visits  like ‘%Hospitalization%’; returns: 71,911

    Which means, there’s some amount of duplication in the row data as to registrant_codes and reports. In other words, from the same registrant_code, you can have multiple reports of Hospitalization.

    This data is rather messy and I’m not exactly sure how icandecide is arriving at “individual” in their numbers because all I see are registrant_code.

    Now, on to some more interesting stuff. What is the distribution of systemic_reaction in registrant_codes who reported Hospitalization?

    select systemic_reaction, count(distinct(registrant_code))from checkin where healthcare_visits  like ‘%Hospitalization%’ group by systemic_reaction ;

    That turned out disappointing because the result was 68,170 NULL fields.

     

     But among the non-null fields, “None”, “Fatigue or tiredness”, “Headache”, etc are leading. (Do note that this is a multi-value column and there could theoretically be a symptom that appears in the tail of this column multiple times thus occurring more number of times than these ones.)

    I also looked at the other files available for download.

    It seems like the Consolidated_health_checkin_u3[1].zip must be under 3 children. The consolidated_registrants[1].zip file makes me think that each registrant_code actually uniquely identifies an individual. Because children are having separate registrant_code with guardian registrant_code mapped in this file. The other files are about race/ethnicity and vaccine that was administered.

     

    The under 3 file includes 116394 reports. Some of the discrepancies in number between my analysis and ICAN’s dashboard probably comes from them adding both these together. 

  • Intersectionality, Queering Science, Lived Experience, and Rationality

    Plenty gets written about intersectionality. I have a feeling that my repeated use of the word might be giving some of my readers nausea by now. Yet I feel like there’s plenty that’s not written about intersectionality. Questions like the following: What’s the relationship between intersectionality and science? How does intersectionality validate lived experience? And what’s the role of rationality in an intersectional world?

    Queering science

    Firstly, if you have not heard Sayantan Datta speak about this topic, you should first do so. YouTube search for “queering science sayantan“. Watch 4-5 topics Sayantan has already delivered on this topic.

    There’s an (unsettled?) debate in cognitive science about whether human beings can think without language. Can we think about things if we don’t have words for it? If I didn’t know the word “chair” in any language, would I be able to think about chair?

    There probably are several instances in our lives where we had a concept that we had in our mind and on a random day we find a term for what it is called. The name for that concept. Let’s take the word “intersectionality” itself. One can see the concept addressed in Ambedkar’s pre-dated work on caste. But perhaps Ambedkar would have felt like “ah, that’s what I am talking about” when/if Ambedkar came across the word intersectionality. One might argue that these are instances of us thinking without words.

    Yet, we can also probably argue that words help us think clearer. Having a word for a concept makes it possible to refer to that concept more frequently. It allows us to give that concept its own dedicated space and examine its *cough* intersection with other concepts. When we have a word for something, we are able to think about that concept more concretely than when it was an amorphous, ambiguous, vague undertone to our thoughts. Perhaps if Ambedkar had a word like “intersectionality”, Ambedkar could have written a couple of volumes about it.

    A closely related concept is “reification“. I don’t fully understand it. So I’ll rely on others’ definition of it. “Reification is when you think of or treat something abstract as a physical thing.” Now in Marxist terms there is probably a different meaning also for reification. But in the book “The Social Science Jargon-Buster” Zina O’Leary gives this example: 

    Consider the following statement: ‘Mother Nature cares about all her creatures.’ Here we’re reifying Mother Nature by treating an idea as a real
    thing… with a name (note the capitalization), a gender (her), a relationship
    (mother) and a human characteristic (caring). The same is true when we say
    something like, ‘Religion tries to repress sexuality’.

    In some sense, coining a word for a concept similarly reifies it, gives it a certain concreteness. And that concreteness which words provide is the way in which human beings communicate with each other things that are far more complex than what other animals can communicate.

    Footnote/aside: This also makes words very powerful. Words, especially the ones we coin from existing words, can have strong associations. Which is why many opposing movements coin different terms for the “same” concept. Aside on aside: If you haven’t read this elaborate, gripping article called “Hiding Behind Language” by Vijeta Kumar, you should.

    Words also categorize things. By giving something a label, you’re creating a box. There are some things which will fit inside that box and some which are not allowed inside. These categories are often very helpful for human beings because it allows them to think through things. Is this “kind”, “cruel”, or “neutral”? Is this “lavish”, “minimal”, or “thrifty”? Is this “love”, “hate”, or “indifference”?

    And such categories form the basis of most of science too. The whole of biology is one big categorization exercise. Kingdom, phylum, genus, species, blah blah blah blah. Chemistry has the periodic table and element groups. Even sociology divides people into cultures and groups and classes and so on. Categories make it easier to observe things and make useful predictions about the world. Categories are abstractions that allow humanity to function.

    But categories (and classification of entities into categories) have as much limitations as powers. Categories tend to be binary. Rigid and “all or none”. And categories tend to create a pressure of conformity. To see everything through the lens of those categories. To label things that don’t fit as “exceptions”.

    Binary is not intersectional. Binary is reductionist. Binary tends to erase differences and falsify conclusions. Binary forces us to see a lesser truth where reality could be far more grander and complicated.

    That’s why science needs to be queered. To queer is to question categories. To queer is to mix and match. To queer is to think intersectional. To queer is to see truth as it is without being colored by labels and labelled expectations.

    Science is indeed picking up intersectionality here and there. Not necessarily expensive stuff like individualized medicine or precision medicine. It is also simple things like viewing sex as a spectrum.

    The book x + y by Eugenia Cheng is a brilliant exposition of the role of mathematics (category theory specifically) in all of this. That book connects society, science, and intersectionality all together in a way that truly forms a manifesto of our work forwards.

    Intersectionality and the lived experience

    If intersectionality doesn’t do so well with categories, what does intersectionality rely on to draw inferences and make decisions about human life and society? When you apply an intersectional lens, what do you look at?

    Lived experience is one of the main things that you look at. Lived experience is the sum of all realities that pertain to one individual or entity. With an intersectional lens, one doesn’t try to categorize and draw causal inferences. One doesn’t jump to reductionist conclusions like, “Ha, this person is so because of their childhood trauma”, “Ha, this person is poor and that’s why they’re unable to attain healthiness”.

    Instead an intersectional approach forces one to think about how different life experiences have contributed to a particular situation in a particular individual (or anything) in that particular point in time with respect to their surroundings. It is a complicated causal web that intersectionality is interested in.

    Footnote/Aside: Realist evaluation is one of the few “scientific” methods that I see closely related to all of this. (Coincidentally, there’s a realist evaluation workshop being hosted by IPH, Bengaluru this month).

    Rationality

    How does rationality fit into all of these? Does rationality become unnecessary when intersectionality enters the scene? Does it become obsolete? Is rationality a thing of the “categorical” sciences? Is there any utility for rationality in the intersectional scene?

    Before we answer any of this, there’s one important article about reasoning that I would like my readers to read, if they haven’t. It is called the “Unraveling the Enigma of Reason“, written by Scott Young. It tells us – similar to Thinking, Fast and Slow – how our brain makes decisions and then justifies them with a reason rather than the other way round. It is something that truly underlies all of what I’m saying.

    The brain is the ultimate intersectional equipment. It computes millions of lived experiences and inferences (which get encoded as biases) every moment when we’re interacting with the world – to come up with decisions. On what to wear, what to eat, how to respond to traffic, and what to do in the presence of someone who looks a bit different from the people who the brain is used to seeing.

    A lot of that power is unused in routine situations though. We tend to drift to extremes. Binary thinking is easier for us. All or nothing. And we slip into such patterns. 

    We can avoid such binary stereotypes and biases by being actively aware of our biases and stereotypes. When we’re constantly reflecting on our actions and evaluating the reasons for our behaviour, we tend to see the patterns that we’re used to. And once we see the patterns, our brain autocorrects some of those. And then we see some new patterns. And then we autocorrect some more (sometimes in the opposite direction). And so on.

    When we start thinking at extreme levels of intersectionality, life becomes unlivable too. If we need decisions, choices to be made; we will need a way to discard irrelevant lines of thought, prioritize one thing over the other based on arbitrary and normative moral principles, and arrive at some actionable path forward.

    And that’s where rationality comes in. Rationality is what demystifies things and allows us to focus on what’s important. Rationality is a tool to connect the infinite possibilities of intersectionality with the pragmatic needs of the real world.

    Rationality is what allows you to call a spade, a spade. To call out bullshit. To cut the crap. And to focus on praxis. On stuff that matters.

  • Love is Enough

    “You need power only when you want to do something harmful. Otherwise love is enough to get everything done.” ~Charlie Chaplin

    Judah (JP) sent me that quote in response to a question that I had posed JP. The question was something like this: “You need power to do things and attain change. But power is the root cause of all the wrong that you’re trying to change. How do we reconcile between these?”

    In hindsight, it is the conceptualization of power that was the problem. I was thinking about hard power earlier. It is perhaps enough to have soft power. Power to “shape the preferences of others through appeal and attraction“.

    Love is an excellent framework. There are many contradictions that the power framework gives rise to. Love makes those contradictions disappear.

    Take redistribution of power, for example. When we try to gain power, we have to grab power from someone else. Sharing power weakens power. Yet if our aim is to redistribute power for a more equal society, we can’t keep on grabbing power forever. When do we start redistributing power? That’s a contradiction which the power framework cannot solve.

    Another issue is that of collaboration. The power framework forces you to think of others as your competitors. Every meeting becomes a negotiation. The stress of holding on to power forces one to sabotage collaborations. Only equal powers can collaborate without fear.

    A third contradiction is with respect to “the means to an end”. Using power to change the world feels like using an illegitimate force to pressurize the world into change. It doesn’t feel like the change will sustain.

    And what are the practical ways to gain power in today’s world? It seems to me like the path to power is riddled with compromises far greater than an altruistic pragmatist would be willing to make.

    In all, power is riddled with contradictions. And love makes them disappear.

    Sharing is built into love. Love doesn’t shrink when shared. There’s enough to give everyone love.

    Collaboration is how love operates. Love encourages sincere engagement. Love assumes good faith.

    Love is a lovely means to a lovely end. Love does not feel illegitimate.

    When you operate through love, you can remain rooted in your principles. There is no compromise required because you have nothing to gain by making compromises. You love your enemies just as you love your friends. And you stand by your values while you explain to them with love why they should embrace those values.

    There are several advantages that the love framework has.

    It is low on emotional overhead. Because you respond to hate with love, you turn anger into love, you tackle resistance with love, you push inertia with love, you find energy in love. Everything becomes love. Simple. Of course, all the other emotions are valid too. That’s where self-love comes in 😀

    It sets up opportunities for engagement. Because you don’t have enemies anymore, the number of people you can work with becomes very very high and the number of things you can do becomes uncountable. (Of course, that’s what I wrote in “giving up ideological purism” too. Seems like love is a framework to regain the certainty of ideological purity).

    When it comes to changing individuals, love has a pretty disarming charm. Love makes calculations easier in making complex decisions. It is overall more productive.

    There could be disadvantages too. I’ll probably come across them when I’ve explored this path more. I’ll write about those then.

  • The First Feminist in My Life

    As usual on mothers’ day, my WhatsApp is filled with images that romanticize the systemic oppression of people who become mothers. Photos of mothers who are at work with children, of “caring”, “loving”, and “sacrificing” mothers, of mothers carrying children on their back (including photos from animal kingdom), and so on.

    While I find it fair to thank those people for such forced “selfless service”, I find it arrogant and violent to continue stereotyping and socially enforcing such gendered and oppressive practices.

    I often think of the privileges I must have had to enable me to see systemic oppression as it is. And one of the greatest privileges I’ve had is to have a feminist mother.

    I’ve never heard the word “feminism” from my mother. And that’s probably why it took me forever to realize she is a feminist. Fortunately for me though, the lessons of feminism did come through all my childhood albeit without the label.

    To begin with, my mother is a teacher. And she puts work at par with, if not higher than, family. She has a very clear idea of her role as a teacher and very meticulously carries it out. She has withstood social pressure to ignore her profession or to ignore becoming better at it.

    The way she deals with my father is more illustrative of her feminism. She never backs down in an argument. And there are plenty of arguments that she has with dad. When I was younger, I didn’t really understand who was right in those arguments. And because I was closer to dad, he would often convince me that he was right. But today I realize that my mom was right and continues to be so in many of the arguments that she has with the dad and with society. She still speaks up, unweathered.

    She has always demanded better and just treatment from others. Because she sees the injustices that are being meted out to her. But more importantly, she never waits for anyone to treat her better. She is independent and continues her own life with not much regard to all that. She does not let people develop a savior complex.

    There are far too many details in my childhood. But to summarize, there are many privileges of being male in a patriarchal society and my mother “exposed” many of them to me all throughout my childhood. 

    That’s why I call my mother the first feminist in my life. And I’ve got to thank her for that every day.