Tuesday, September 27, 2011

In Squalor we live: In search of a ‘Theology of Sanitation’

Published in Eastern Mirror as 'We are a dirty people...'
Nagas look different, eat different, and behave different from mainland Indians, but if there is a similarity between the two, it is that we are both dirty peoples. A sense of cleanliness does not come with university education. This conclusion I arrived at as I see the PhD scholars’ eating behavior in my hostel mess hall. This was an interesting observation as I was doing my studies in Public Health and had the honor of eating with Masters, Mphil and PhD students from various disciplines at JNU, New Delhi. Some of them would ‘plough’ through their plate like a paddy field while some would eat with both feet ‘perched’ like birds on the benches. No amount of teaching could make them throw used paper cups into the dustbins just 6 feet away.
Also a sense of cleanliness does not come with increase in wealth. Many poor families do not have the ‘luxury’ of running taps in their homes while the rich can have surplus to water their backyard gardens. So it is expected that the rich are cleaner, and of course they are. But I also see people throwing banana peels and paper cups out of their SUV car windows into well paved roads, or having parked their car, I see them emptying their bladders on street corners.

The most defining observation of our sense of cleanliness is the fact that India has more cell phones than toilets.

Back in Nagaland, I won’t tell which colony, but there is a latrine in Kohima where if you empty your bowel, your waste fly a good 10 feet in open space before hitting the ground, again in open space. Looking at the fresh ones on top, I guess the family had Dal curry last night. Oh my God!! And this is not the worst. The worst is the thought that flies which have sat on those yellow slimy things might have also sat on my food. Oh my goodness!!

Personal hygiene can be taught but how do we teach cleanliness habits in public places involving public goods? An example in point can be this: I can keep my house neat and tidy, but if I dispose my dustbins by the road side, it can create a public health hazard. How do we prevent our ‘vegetarians-who-spit-blood’ from defacing our government offices? As I said before, this civic sense does not correspond with increase in education or wealth. To deter people from relieving themselves in public places, pictures of Hindu gods and goddesses are pasted in strategic places in Delhi. Should we use the picture of Jesus Christ? No Naga would chew paan and spit on a photo of Jesus.

I believe a brief explanation from history is in place. Every society goes through transitions which take decades, even hundreds of years. Let’s take locomotion as an example. Transition from invention of the wheel to steam engines to air travel has taken thousands of years. Another example is the transition from ‘tom toms’ to postal service to email which also took many years. Not just things but in other areas, say religion, from the church fathers to the papacy ‘rule’ to the Reformation to the charismatic waves to mega church movement, Christianity has come a long way. But here’s the catch, and this is not an original observation but of Prof. Dipankar Gupta: India’s experience of such transitional experiences is short- circuited. Babus who have just come out of ‘Stone Age’ meet with latest mobile phones and they just don’t have the mental set up and manner for proper use of such technology. Using examples from Cricket, Politics etc, Gupta goes on to say that India’s modernity is mistaken, though we own the newest cars, wear designer clothes and live in posh surroundings, we carry along a mental set up which is very backward.

From Gupta, now it’s my turn to see this in the public health context. Even before the discovery of cholera germs, London already had a water supply system. Fine, they didn’t know that dirty water is the source of cholera and required the genius John Snow to study and find out. Even Snow did not know as we know now that there is such a thing as bacteria; forget about antibiotics which came only in the middle of the last century. Now, about 160 years after John Snow, Kohima does not have a proper water supply or a sewage system though we have access to the latest antibiotics, even vaccines for Cholera: Lopsided progress similar to the case of mobile phones vs. toilets.

One major reason for India’s squalor is Caste. To each Caste, specific works are assigned and for the upper Castes, to do manual work is to defile themselves. You will find that those who do scavenging work all belong to some particular jatis. I remember a friend who told me his experience of sharing a latrine with a high Caste Hindu who lives in the same flat. The Hindu guy would dirty the latrine but never clean it up. My friend approached him with the issue and he replied that it is below his dignity to clean toilets. Wise that my friend is, he told him to either hire someone, or tidy up, or vacate the flat.

We Christians ought to know better. Well, did the Bible mention anything about sanitation? Let’s find out. Unlike Caste Hindus, Christians believe that each and every person reflect the image of God and has equal and unalienable worth and dignity (Gen. 1:26, Ps. 139). Work is not a curse (though meaningless repetitive toil is) as it was assigned to Adam in Genesis 2: 15 before the fall in Chapter 3, and in Christ, we are all created to do good works (Eph. 2:10). There is even the imperative that those who do not work shall not eat (2 Thess. 3:10). No task is too high or too low but God blesses all good works. I do not know Greek but commentaries say that in the book of Acts, those who wait at the tables, and so to relieve the apostles to do evangelism works, are also called ‘ministers’. To cook clean food, serve at the tables and do the dishes was also ‘ministry’. So, in whatever we do, we are to work wholeheartedly as serving the Lord and not men (Col. 3:23). This also has a lot to say about civic sense. When no human being is watching, we ought to do the right thing as we do it unto the Lord. When no human being is watching, we ought to not do what is not right before the sight of God. Dumping garbage by the road side in the cover of darkness would not please the Lord, whose vision is not blurred by any amount of darkness. Even when there is no one to praise us, if we keep sweet covers in our pockets until we find a dustbin, God is pleased. To stress the importance of what he is saying, Jesus goes to the extent of saying, ‘do not let your left hand know what your hand is doing’ (Mat 6:3). This is funny if we think of our own hands with one head. So much for a generation which desires instant celebrity status.

Regarding personal hygiene, the most oft quoted Bible passage is 1 Cor. 6: 19, 20 which says, “Do you not know that your body is a temple of the Holy Spirit within you, which you have from God? You are not your own, you were bought with a price. So, glorify God in your body”. Tradition has it that the Church emphasized the importance of cleanliness and it was John Wesley who popularized the famous slogan, ‘Cleanliness is next to godliness’. Amusingly, Christians were said to drink beer because of the hazards of dirty water. Of course, like the crusades, Christians have a stained history in matters of health and hygiene. Many saints and monks were said to celebrate filth as a sign of holiness and some of them didn’t wash their hands and feet for decades. They are also accused of impeding the progress of sanitary science. Along with the Greeks and others, Christians attributed all illnesses to Sin and the wrath of God. During the plague epidemic in the mid fifteenth century called the Black Death when more than half of the total population in England was wiped off and hundreds of millions died in the neighboring countries, about 900 Christian monks were reported to have died in a building complex because of insanitary living conditions. However, it is also true that progress in learning and scientific technology emerged out of Christian monasteries. This debate is beyond the scope of this article but Vishal Magalwadi argued in his book ‘Truth and transformation’ why it was the Christian monks who developed technology and not the Buddhists, Hindus or Muslims who had the advantage of history.

What about public waste and sewage treatment plants, water supply, office and residence design regulations etc? The Bible does not speak explicitly about rape, cloning, space travel, evolution, etc but there are biblical principles which are relevant to guide in all issues of our human existence. And so is the Bible for the above question. We have a God instituted government (Rom. 13:1) to whom we are to pay taxes, revenue, respect, and honor (v. 7). Jesus asked his followers to pay what is due to Caesar. The government however, also is constituted of people who are under the authority of God and are subject to blessing or judgment. Since religion became privatized to personal piety, the gospel has lost its public appeal but the message of Jesus was anything but apolitical, and it alarmed the Jewish and the Roman authorities. The government is put in place with resources, power and responsibility to work for those it governs. There are basic public health needs which cannot be provided by the individuals. Provision of clean and regular water supply is more basic and important than uninterrupted 3G internet signals though we know we need the latter as well. The government is also armed with the authority to make laws to control air and noise pollutions or food adulteration and the legitimate power to penalize defaulters. However, the tendency of people is to stretch or break the law till just before the point where they get caught. When lawmakers become lawbreakers, the government loses the moral right to penalize wrongdoers and situations like this are not unfamiliar to us anymore. Therefore when the Bible says that our battle is against rulers and authorities (Eph. 6:12), it’s not talking about forces beyond the clouds but corrupt systems and evil forces of darkness in our societies that we need to expose.

What about love for God and love for our neighbor, the two greatest commandments? We have discussed that the love of God enables us to do good even when no one is around, to respect all work as God ordained and to take care of our bodies as it is his dwelling place. Love for our neighbor enables us to look for the good of our fellow human beings and even the non-human environment. In our case here, love for our neighbor (Lev. 19:18, Mt. 22:39) should inspire us to construct our houses and toilets which does not harm our neighbor. Our love for our neighbor should drive us to work for the lesser privileged people, even in our own state. In the area where I worked before, pigs still roam freely in the villages. Though there are clean streams flowing down the mountains overhead, there is no proper water supply because the pipes are too small or leaky. Sanitary latrines are rare to find. Majority of the children have bloated abdomen, not because of overeating, but because of worm infestation and malnutrition. I hardly saw any case of Measles during my studies or practice, but there, it was a very regular encounter; and diarrheal deaths were not uncommon: diseases which thrive in insanitary conditions.

Our neighbors may not only be other people living close by (in space), neighbors can also be our future generations (neighbors in time) and we are responsible to hand over to them clean conditions to live in. Some Christians think that we have the right to drain the earth of its resources and pollute it as we will be flying away one day and this planet will be burnt to ashes. That would be the defeat of God; who delighted in his creation, sent his only Son to redeem it, yes even the non-human creation (Rom. 8:18-25), and made the promise of a new Jerusalem coming down to earth( Rev. 21). The hope of creation is not a return to the primeval Eden garden nor an escape into a disembodied realm, but a new heaven and a new earth, the garden city of New Jerusalem. In this city, there will be no more tears, no more evil, and of course, no more filth or diseases. As Christians, we are to be signposts of this hope to come.

Well, there we have a draft of what we might call a ‘Theology of Sanitation’ which might be expanded to a diploma course which Bible colleges can offer through distance education. Not quite. But this is a serious matter and we need to pool in resources to devise ways to tidy up our society.

Friday, September 23, 2011

Stopping by Woods on a Snowy Evening

Whose woods these are I think I know.
His house is in the village, though;
He will not see me stopping here
To watch his woods fill up with snow.

My little horse must think it queer
To stop without a farmhouse near
Between the woods and frozen lake
The darkest evening of the year.

He gives his harness bells a shake
To ask if there is some mistake.
The only other sound's the sweep
Of easy wind and downy flake.

The woods are lovely, dark, and deep,
But I have promises to keep,
And miles to go before I sleep,
And miles to go before I sleep.

Robert Frost

This is one of my favorite poems... studied it for exams in Pre-University days. Then after several years, I revisited it and thoroughly enjoyed discussing it with a friend next door in medical college. That was about 5 years ago. A few days back, I was stopped by in my life's journey to enjoy it again. I still have miles to go before I sleep.

Wednesday, September 21, 2011

Cruel and Extremely Funny

The football ground in one Sema village is so bad that the two goal keepers can't see each other :-).....Yesterday in the office, we were privileged to have our hands on a photocopy of an official correspondence on the matter; written by one IAS officer in the office of the Principal Secretary of the Concerned Department. 
It reads:
'The existing playground at Naghutomi (old) Atoizu Sub-division, Zunheboto district has the story of the goal keepers not seeing each other and needs to (be) rectified. In fact a new playground has to be made. Hence it is requested that allocation of fund be made for....'

Tuesday, September 20, 2011

Tea drinkers more likely to go to heaven (Edited)

 Thought of publishing in the local newspapers but I didn't

 There was a study conducted by the Faith Research Institute, Notown which showed that tea drinkers are more likely to go to heaven. Tea drinkers have a higher percentage of having ‘Born Again’ experience than the control group which does not drink tea. It is probably because religious people have a higher tendency to meet over a cup of tea and talk, where the gospel is preached and more people experience being ‘Born Again’.

The above study is a hypothetical study done with questionable methodology from a non-existent research institute in a non-existent place called Notown. But I wouldn’t be surprised if there is a research done on such a topic showing similar findings. 

One must be careful in interpreting the research findings that we see in newspapers and journals almost every day. There is already a study which found that sitting is injurious to health. In health, strictly speaking, every human activity is injurious to health. Because of ageing, even Time can be said to be injurious to health. Jogging, although proven to be beneficial, can also be injurious to health. There are bacteria and viruses lurking in the grasses which may pounce on morning joggers and infect them.

In the above hypothetical study, one may have to ask the sample size. Say, 80% of tea drinkers reported having experienced ‘Born Again’ compared to 43% among those who don’t drink tea. But if the sample size is too small, the responses of a few will significantly affect the result. In our local newspaper polls here in Nagaland, I would like to know the number of total responses and not simply how much percent said Yes or No. For any research finding to be valuable, the study population should be large enough and should be made known.

One also may question the underlying parameter of using ‘Born Again’ experience as a ticket to heaven. Hidden agendas while framing the research objectives and preconceived ideas while preparing the questionnaire can be masked in research language. You already want a particular result and you do research to prove it. The interpretation of research findings is also tilted towards that end. If we have a medicine to sell, let’s invent a disease and do some research to prove the benefits of the medicine. 

One may draw inferences out of some finding which the research is not intending to study. What if the above research is interpreted as, ‘Drinking tea causes people to go to heaven’. Then, people start to drink tea in order to go to heaven. Causality and Association are not the same. Association of two factors doesn’t mean one is causing the other. There was instance when research in Homosexuality was presented in the media, something like, ‘we have finally found the gay gene which causes homosexual behavior,’ while it was only association of factors. 

For the sake of the next question, let's say that drinking tea causes people to go to heaven. Now, the question is, 'What is the use of the research?' Will the result educate people to change behavior (start to drink tea) and shape public policies (investment in tea production) or increase human knowledge (of the properties of Tea or the concept of Heaven?) If not, what is the utility of a research linking tea drinking to going to heaven? Some researches seem to be done just for the sake of availability of research grant. Our newspapers ought to be more selective in choosing medical research findings to publish.

Fellow doctors need to be wary of many so-called research findings that pharmaceutical companies provide in the OPDs. There are reportedly so many bogus drugs and questionable claims of drug properties. They may refer to research studies published in some ‘International Journal’ but that doesn’t make them authentic. This is when Peer Review and reputation are very important. The Lancet, for example, is a reputed journal and will not publish just any study without fulfilling certain scientific criteria.

Is using mobile phone injurious to health? The answer is still not clear. Some researchers say it is harmful while others say it is not or the risk is minimal. To Telecom companies, I guess that is literally a billion dollar question. If a telecom company does a study and says it is not harmful while a study by an NGO found it to be harmful, I wouldn't be surprised. Such things do happen. Some of the health programs and disease control initiatives are politically charged territories where vested interests clash with genuine concerns for reduction of human suffering. Research is extremely important to decide which side the course of Health programs will take. What we get to read in the newspapers are bits and pieces of these underlying wars and agendas mixed up with valuable health tips and news.

In the guise of medical treatment, research institutes can make guinea pigs of us. India has overtaken China as the number one destination for drug trials. Even before proper animal trials, there are reports of studies done where new drugs are tried on human beings without explaining the purpose and the risks involved. This does not mean that we should be closed to researches altogether. In the past, I was told that we refused to give blood samples for fear that it may be used against us. So, when we read the National Family Health Survey, we find that some health statistics are missing for Nagaland. If the researchers had sinister intentions, there are thousands of us staying outside the State who are visiting hospitals and giving blood for various tests. Nevertheless, we need to be careful that we are not taken for a ride. For a few incentives, we should not sell ourselves as laboratory materials.

You see a TV commercial of a toothpaste which promises extra and long lasting shine, and the evidence is certified by a dentist in white apron. A sunscreen lotion prepared by using some German technology gives extra UV protection. 51% of the people who used a health tonic (for Rs. 499 only) felt younger in 7 days. And we buy such stories without a second thought. We see a product with a 70% discount and buy it not knowing that the original price was hiked. We see a good offer but forget to notice the asterisk indicating ‘Conditions Apply’. Advertisements backed up by cooked-up researches such as the Notown study are on the rise. Think again. Nagas can be gullible and be easily taken for a ride. For instance, many people from other parts of the country have disappeared with our money after false promises.

Saturday, September 3, 2011

Walking in the air

"Walking In The Air"

Walking in the air, floating the sky...
Floating in the air...

We're walking in the air
We're floating in the moonlit sky
The people far below are sleeping as we fly

We're holding very tight
I'm riding in the midnight blue
I'm finding I can fly so high above with you

Far across the world
The villages go by like dreams
The rivers and the hills
The forest and the streams

Children gaze open mouthed
Taken by surprise
Nobody down below believes their eyes

We're surfing in the air
We're swimming in the frozen sky
We're drifting over icy
mountains floating by

Suddenly swooping low on an ocean deep
Arousing of a mighty monster from its sleep

We're walking in the air
We're dancing in the midnight sky
And everyone who sees us greets us as we fly