Caught Between Two Worlds: Navigating a New American's Desire to Give Back to His Homeland

Bapu ji chose to send my father and his siblings to schools primarily reserved for harijans or untouchables.  In India's Jain community, harijans worked primarily as domestic servants.  My grandfather wanted to make clear to his children his belief in Gandhian social equality and serve as an example to others in the community.  Perhaps even more strikingly, he encouraged his three daughters to vigorously pursue education.  In an era when women were educated solely for the purpose of occupying them until marriage, my three aunts became a doctor, research scientist, and attorney, respectively.

Bapu ji's enduring mark on our family was a deep-seated commitment to service to others.  At age 12, he migrated from Phalodi, a forgotten farming village deep in Rajasthan's deserts to Jodhpur, a relative metropolis.  The striking contrasts between the two seeded in him outrage at the social, political, economic, and geographic inequality that marked colonial India.  This outrage, I am told frequently permeated dinner table conversation and manifested most strongly in a feeling of indebtedness to Phalodi—a debt that he hoped his children might recognize and repay.  Though our family had been barely middle class, he marked it with the burden of privilege.

In the summer following my first year of medical school, I spent my days eating and sleeping in Bapu ji's legacy: a 100 bed hospital admidst the Khichaan district of Phalodi.  For the past three decades, it has been a family preoccupation of sorts, involving every member of my nuclear and extended family in some way.  My two aunts, Shanti Auntie, before she succumbed to ovarian cancer, and Kanti Auntie both committed the bulk of their professional lives to planning, building, and, now operating a hospital in our ancestral village.  The name they chose for their efforts—"Human Benefit Services" or HBS—reflects the simple aim of their work.

HBS was founded in 1978 (see box 1) and today collectively includes the hospital whose construction took 10 years to complete; a school for children in Grades K-12; and a women's empowerment program to provide vocational skills to local women.  Unmarried and wholly devoted to an expansive notion of social service, Shanti Auntie and Kanti Auntie wanted to be where their efforts were most needed and led others by demonstrating courage and persistence in the face of obstacles.  Their embodiment of Bapu ji's teaching has since translated into meaningful action.

Arriving in Phalodi in 2003 seemed to me like the fulfillment of a lifetime dream, a phase of transition of a family commitment from generation to the next.  Until that summer, my contributions to HBS had been primarily around writing brochures and raising funds.  Still, I had always felt that I would assume greater responsibility at a time when I had more to offer.  By that summer, I felt that I was no longer a child precociously soliciting family friends and acquaintances with my pitch to "support the care of only one patient," but was a medical student on the threshold of being able to offer meaningful service in a hospital with a short, but proud history.

To the surprise of my extended family, I immersed myself within life in Phalodi and elected to spend weeks sleeping in a hospital bed there in order to fully absorb the vibe of the workers, doctors, and patients who kept it running 24 hours a day.  Starting at 7:30 AM each morning, I rounded with physicians and closely observed the care of patients.  They came in droves with illnesses as severe and different as tuberculosis and clinical depression.  I was always struck by the vivid image of the villagers—some of whom had traveled over 40 miles for care—collected anxiously in the waiting area in traditional Rajasthani garb.  It occurred to me that only a few critical decisions—first by my grandfather and, then, by my father, separated me from them.

With a background of research and coursework in health care delivery, I saw myself as a troubleshooter.  My aunt was already using such innovations as community health workers—but I was trying to understand ways in which we might better serve our patients.  Local residents were thrilled to have care of any kind, but it was apparent that a few simple interventions might help.  In a short time, I observed that our patients—most of whom were illiterate—usually left highly confused about their medication instructions.  Working with Kanti Auntie and the hospital's pharmacy technicians, I implemented a simple system of dispensing medication based on color coding and numerical labeling that would help patients know when and how to take their prescriptions.

Interacting with patients, hospital workers, physician staff, and Kanti Auntie, I felt satisfaction that I was finding my place in our family's undertaking.  There was a simplicity to the life and the work.  I felt part of a rich tradition.  At the same time, I somehow felt that I did not fit in.  While I quickly grew comfortable and felt useful in Phalodi, something entirely unexpected happened.  I started to think about my life in the US—and just knew that my true place was there.

As much as the patients in Phalodi represented my ancestral heritage, and the hospital, my family's deep commitment to the region, I felt more detached than I was comfortable with.  While I cared about the patients in Phalodi, I didn't really understand their lives or the colloquial marwari they were speaking.  I started to feel that my real ties lay elsewhere.

My first impulse was to reject the part of me that felt separate from the village and the institution.  After all, weren't all patients the same in the eyes of a physician?  Couldn't I eventually feel comfortable with the people of Phalodi?  Wouldn't my training be relatively more useful to patients in Phalodi than in Boston?  I reconciled that my more fundamental attachment to life in the US wasn't something to be ashamed of, but to channel as fuel for my work.  It simply meant that my contributions to our work in India would be different—grounded in a life based in the US, not India.

Returning to Boston that fall, I endeavored to find programs and institutions in the US through which we might be able to deliver better services to patients in Rajasthan.  Over the next several years, I would use my network of relationships to form partnerships with various organizations: with DaVita Bridge of Life to create two dialysis centers in rural Rajasthan; with Boston-based Medical Missions for Children to annually bring cleft lip and palate surgery to the region; and with the University of Miami's Global Health Residency program to shepherd rotating residents from Miami to Phalodi.  I also successfully rallied my classmates at Harvard Business School to fundraise for our work.

The cleft lip and palate missions continue and the dialysis centers have now operated for 15 years. In building these relationships and raising these funds, I resolved a tension that many of us who wish to contribute to global health face.  My desire for a career and life based in the US would not be incompatible with contributions to health care in India—but instead be complementary to it.  

....

My Bapu ji led his life as a catalyst for others to recognize problems in the world around him—and to work unrelentingly to address them.  Though I never met him, my father tells me that he emphasized simple things: personal responsibility, hard work, and a commitment to do right.  I hope that I do right by his ideal.

Human Benefit Services 

at a glance

-Founded in 1978 by Dr. Shanti Jain

-Operates with a dual mission of providing health care and education to residents of rural Rajasthan, India

-Hospital and mobile medical clinic model provides medical care to a region with population 300,000; special focus on infant and maternal health

-Hospital furnished with US medical supplies and equipment after US-based volunteers raised funds to purchase and ship equipment from a bankrupt Kansas hospital

-Partnerships with international organizations allow HBS to provide specialty services including cataract surgery, cleft lip and palate surgery, and kidney dialysis

-School provides English-medium education to children in grades K-12

-Women’s empowerment program teaches women basic job skills to allow them to become economically self-sufficient