Wednesday, 27 March 2013

Mumbai: Philanthropists and Historians

Experiencing the philanthropy and history of this city through leprosy
I ended my October 2012 Indian trip with 5 days in Mumbai. My Sudanese student Omer is doing a project on neuropathic pain in leprosy patients here and I needed to have a supervisory visit and was joined by Andrew Rice, my Imperial college collaborator, he is new to India. I visited Mumbai on my first visit to India in 1975 so i have observed huge changes as Mumbai has transformed into a colourful megapolis. Over the last twenty years i have been staying with Doreen and Supi Krishna but they have now relocated to Ipswich to join their children. I felt acutely adrift from my usual routes to their flat in South Mumbai and nearly went in the wrong direction. Omer was keen that his supervisors should not slum it so we stayed in a fine art deco hotel on Marine Drive. This is one of the nicest vistas Mumbai looking across the huge bay to the peninsula with the governors house. AT night the chain of lights looks like Manhattan. In the morning lycra clad runners (male and female) pound along, plugged into iPods and heart rate gadgets, but behind them people sit on the sea wall meditating and doing complicated nose breathing exercises.
Omer is working at the Bombay Leprosy Project (BLP) which is an NGO based in Dharavi, Asia’s largest slum and caters for patients with leprosy. The clinic was founded by the late Dr Ganapati, an inspirational and passionate leprosy doctor. His successor Dr Pai has looked youthful for 25 years and has a quiet passion to improve the lot of leprosy patients. The clinic is deep in the slum, over one of the main drains. Patients wait outside and many are seen in the semi open air under a huge awning. That day many had come specially to be seen by the London doctors and had either neuropathic pain or other immunological complications. These patients came inside with their families and we saw then in a large crowded room with little privacy. Andrew had previously only seen patients with me in London so this was an introduction to leprosy in the field. I saw several patients with severe recurrent inflammation (ENL) because the BLP is one centre in a global collaboration that i am trying to establish. I sat with one of the younger doctors at BLP seeing these complicated  patients. He had trained in Russia but is now back in Mumbai training in dermatology and working in leprosy.  I was interested in the slum because  I have just read Kalpana Sharma ‘s book “Rediscovering Dharavi” where she describes how people migrate to the slum. They are well organised and provide a vital part of Mumbai’s industry and services, including making  all the sweets and chikri in Mumbai.
The next day we gave a seminar on leprosy at Mumbai’s oldest medical school but before we started we had a historical tour from Shoba Pandya  a retired parsi neurophysiologist and one of our  collaborators. She is a wonderful guide, she breathes Mumbai history and we walked around the medical school looking at the parsi benefactors with their sculptures on the buildings. A vast Italianate bronze of the founder Sir JJ broods over the entrance hall. This is a government hospital and the conditions are reasonably clean. The BLP has been focussing on educating medical students in Mumbai and we had a surprisingly good turn-out of students and trainees on a Saturday morning. Afterwards we lunched in the simple hospital canteen and everyone reminisced about their time as a student- which covered about 40 years.
 Omer has found living in Mumbai difficult; it takes a long time to get projects going. Finding somewhere to live without commuting vast distances is also difficult and the Mumbai landlords are rapacious.  On Saturday we went to The National Centre for the Performing Arts to see stand up comedy. The performers called themselves “not the East india Company” and instead of telling Irish jokes joked about the Sindhis, one of Mumbai’s immigrant groups who are fat and hairy.  It’s a mark of Mumbai’s affluence that there were jokes about man boobs. Skin colour was also joked about, notably vagina whitening creams.  On Sunday morning we walked around Bombay Fort area, one of the oldest parts of the city and we spotted a couple of old Methodist churches, in one the women were singing a Swedish carol that Andrew recognised. The Maidan is a large grassy area in South Bombay and since Mumbaites are used to coping in small spaces they can play about 50 simultaneous cricket matches on a space that elsewhere would hold two matches.  It was another eye opener for Andrew, a cricket enthusiast and he sat watching the matches and gave Omer an introduction to cricket. That evening he knew at least three ways of being out, only 4 or more to learn! So we may have left Omer with some tools for increasing his enjoyment of being in Mumbai.
I had Sunday lunch with Jehanghir Sorabjhee, physician who worked at HTD many years ago and now provides an infectious disease service in Mumbai. He is also passionate about Mumbai and has photographed the city from the air and gave a spellbinding talk in London comparing old and new photographs of the city and documenting change. He must have amazing mental maps of Mumbai. He is now researching a book on the hidden green spaces of Mumbai and so is now travelling at ground level. Also at lunch was a Parsi retired child psychologist, Dr Barucha, who trained at the Tavistock clinic in the 1960’s and there met and married an Irish psychologist. Since then they have lived and worked in Mumbai and their younger daughter Temi worked for me as a foundation doctor in UCH last year. So it was nice to talk to her father who is still working and full of zest.
It was interesting being with someone seeing India for the first time. Andrew is a well read live wire who poses streams of questions. He had also lectured on pain at the Tata cancer hospital, part of corporate India and with world class standards. So he saw the range of health care in India from NGOs through government to corporate private. We explored what motivates doctors to work in the Indian NGO sector, why does Dr Pai work in The Bombay leprosy project without a huge salary. In India gurus such as Dr Ganapati and Dr Antia are inspirational and influence the course people take in the professional lives and people will make deliberate career choices to live out  . Before we had the NHS there would have been similar figures such as the doctors working in the East of London who served an impoverished population with little financial reward. I am very lucky to be working in the NHS without the burden of tuition fees and able to follow my muse.  
Mehta describes Mumbai as a “maximum city”, an appropriate epithet for a city that is tough to live in but also has citizens that are passionate about their city and so promote its development in industry, education and culture. Even the public gardens are full of elderly citizens walking and keeping up. In Mumbai one also experiences the contrast in India between the poverty of Dharavi and the wealth of Colaba.
Jan 2013    
Rediscovering Dharavi. Kalpani Sharma. Penguin India  2000
Maximum City: Bombay Lost and Found  Suketu Mehta  Headline Review 2005

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