Kerala:

The Beauty Is Skin-DeepBY BACETE BWOGO

Kerala, India 4 June 1995

Peter Bird MartinInstitute of Current World Affairs4 West Wheelock StreetHanover, NH 03755 USA

Dear Peter,

I was completely amazed by the beauty of the land of Kerala whenI arrived Trivandrum on June 3,1995, for the first time.

"One legend, and there are a multitude, is that Kerala was formedwhen the God Parasu Rama threw a chuckram, or ax, as fast as hecould across the sea, and the waters receded from where it fell. TheKerala left in legend, and in reality today, is one of India’s mostbeautiful regions, a land of rice paddies and canals, miles of beachesand rolling plantations of tea bushes.

"Situated along the country’s southwest coast, Kerala is aloneamong India’s states in having almost total literacy, a result of 20thcentury Catholic missionaries, Marxist politicians and the determina-tion of Keralans themselves. Water is a central part of life, from themonsoons that sweep through first in early summer, and then in aless vigorous form in November and December, to the seas that yieldthe freshest seafood in India, to the canals crisscrossing the paddyfields that spread like mirrors across the State." (New York Times,Sunday, March 6, 1994

This is the idealized view of Kerala. But the natural beauty of theland is one thing and maintaining past achievements in education,health and other social services is another. As I traveled through Ke-rala, I observed that some of the past achievements were gettingeroded. And some Keralans could already see that Kerala was fallingfrom grace. This fall from grace was exposed very clearly in an arti-cle in one of the leading national magazines, India Today, November15, 1994:

"Kerala, once a model for the country, seems to have begun slid-ing. downhill. The praise that is showered on Kerala for its achieve-ment should not divert attention from its present crises. There isneed to draw up a new agenda. These words were spoken by E.M.S.Namboodiripad, the state’;s first chief.minister, who was among theoriginal champions of the Kerala development model. But the formermodel supporters are now disowning it in droves. The model hasfailed to rescue the state, Welfare without growth is neither sustaina-ble nor replicable.

"The miracle is well documented. Because of its 95 percent

Bacete Bwogo, a Sudanese physician, is an ICWA Fellow studying primary healthcare delivery in Costa Rica, Cuba, Kerla State in India & the U.S.A.

literacy, population control high life expectancy, thestatus of women or the low infant mortality, Kerala’srecord is not only the best in India or in the Third Worldbut even comparable to the developed countries.

"The ’Kerala model’ had become a showpiece foreconomists and sociologists. But now the underbellyhas started to show: the highest unemployment rate inthe country, a pitiful per capita income, low industrialand agricultural growth and a mounting public debt,all giving rise to social ills usually associated with theWest. The state has the highest suicide rate in India, arecord crime rate, excessive consumption of alcoholand increasing disruption of family life. Every year inKerala, 24 people per lakh [1,000,000] of the populationcommit suicide, against a national average of eight. 20-25 percent are those of whole families cornmitting sui-cide and almost 44 percent of those who commit sui-cide are between 18 and 30 years of age. A few yearsago almost all alcoholics on rehabilitation were abovethe age of 40. Today, half are between 20 and 30.

"A major increase in organized crime, rape and bur-glary reflects the change in the values of society.Women, despite their emancipation, are increasinglybecoming the victims. The society most affected is thefamily, as is evident from the high incidence of di-vorce. Trivandrum family court, which handles casesfrom only two districts, gets about 260 divorce requestseach month. Alcohol is the major villain breaking upmarriages. As for suicide, factors such as the disap-pearance of large families, alcoholism, and economicuncertainty have all played a part in the rise in suiciderates. And the state’s funded programs have bred awelfare dependency culture, leaving the Keralite un-able to cope with even minor crises. While the old or-der has been challenged, nothing new has filled itsplace."

When I was visiting in Munnar, one university grad-uate who works as a waiter told me jokingly that "inKerala we a have 100 percent literacy and 100 percentunemployment." Many educated people appear tohave a dream of going to work in the oil-rich Gulfcountries.

Those persons wanting to work in the Gulf coun-tries have borrowed substantial amounts of money,from 30 to 50 thousand rupees, to pay for visas andemployment. The money is given to agents who lookfor jobs for their clients in the Gulf. There is no guar-antee that all those who get visas will be employed injobs which they applied for. Some people end up asdomestic servants after they reach the Gulf countries,even if they have the qualification for other jobs. Ifthey complain that this was not the job promisedthem, they are asked tO take it or leave it and risk theloss of the money they borrowed to find a job visa. Iam told that some women job-seekers end up withbad luck too. Some are mistreated and kept in homesas domestics, though Kerala nurses are respected for

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the good service they provide in hospitals there.

HEALTH CARE IN KERALA

Kerala health indicators are impressive, but what Isaw in health centers and public hospitals suggestsomething else.

In Ambullappuza district, one concerned commu-nity health doctor invited me to attend a clinic wheresome tribal women were having their body weightsmeasured. He handed me a list to read through: awoman 35 years of age weighed 35 kilograms and an-other 50 years old weighed 38 kilograms. These werenot sick women. I saw them walking around and chat-ting with friends. I was told they were healthy. But byinternational standards, their body weights were toosmall for their ages. Many of the women looked shortand thin, even when compared to the fellow womenwho were measuring their weights. You could com-plete a circle if you put your hands around the waistsof some of these underweight women.

The Medical College Hospital in Alleppey has about900 beds, but the congestion is unbelievable. Some peo-ple in the casualty ward lie on the ground. Some generalmedicine wards are so large that the place looks like agarage. In the obstetric ward women who had just givenbirth shared common beds or doubled up. The paywards are better. For 50 rupees a patient has a privateroom and bath, and an additional place for a relative tostay. Other pay wards charge 30 rupees for a room. Therooms are clean, though not as comfortable as the 50-rupee rooms. Most patients buy their medicines fromprivate pharmacies, but some of the medicines are ad-ministered by the hospital nurses.

There are general complaints that doctors do notgive good attention to patients at public hospitals andthat interaction is usually impersonal. You will be bet-ter cared for if money is given (illegally) to the doctor, Ihave been told, though doctors are expected to providefree services to patients at public hospitals. Now evenmany poor people seek medical care in expensive pri-vate clinics called Nursing homes or in privatehospitals where fees for consultation are about 25-50rupees, an amount too expensive for the poor to afford.I have observed that many doctors are involved in pri-vate practice because government salaries can not meettheir needs.

In rural areas, primary health centers, once a goodsystem for health care in rural Kerala, are now facedwith the problem of a lack of doctors and other healthpersonnel to work in them.

There are exceptions. In Tirur, in Malapuram district,I found a medical doctor working in a small village.This was because the village was his birth place, and hehad returned there to work among his people. Somedoctors in the public health system operate small pri-

vate clinics in their homes after official working hours.This helps them earn additional income and preventsthem from going private full-time.

Although there are many Ayurvedic (traditionalHindu medicine, involving, yoga, herbs, oil massagesand special diets) clinics in Kerala, I have been toldthat people use these clinics only for chronic illnessesthat require long-term treatment. For acute illnessesthey prefer to see a Western-type medical doctor. SomeAyurveda-trained graduates practice in Ayurveda hos-pitals public or private. Around Trivandrum, youwill find many pharmacies selling Ayurvedic medi-cines only.

TRAVELING & AROUND INDIA

You have to travel by bus, train or on foot to see the’real’ India, This may not be fun, but it will bringhome some realities about what life is like. As thetrain goes through Kerala and Tamil Nadu, the land-scape changes as you head north to the state ofAndhra Pradesh. There are fewer trees and arid landbegins to emerge. Along the railway tracks you willsee peoples’ dwelling places and wells near standingpools of stagnant dirty water, where water-buffaloesrest in the hot day. Also you see young children defe-cating around the houses in the open air. These scenesoccur again and again, all the way up to up to Delhi,and from Calcutta to Surat.

In Madras, some rivers have been converted literallyinto sewers and would be surprised if fish still survivein them at all. On the way to the Hotel Ambassador Pal-lava (where I stayed a few nights), you cross the riverCooum. The water in it is dark and smells foul. At first Ithought it might be an open sewer system, but when Ilooked at my city map, it was a river in fact! The beachfront just behind the Saint Thome church is littered withhuman feces, which make swimming a risky affair andeven walking a skipping exercise. In November, during

one cyclone, streets were water-logged and cars, hu-mans and cows had to wade through the muddle ofmud and dirt. Despite the rain and mud, the fruit andflower market was worth a visit.

When I walked around the beach near Saint Thomechurch, I heard children (and sometimes adults too)calling, "negro, negro" and sometimes I felt some smallpieces of stone fall in front or behind me. Someonemay have been teasing me, or trying to strike up a con-versation in a strange way. It is not uncommon to becalled "kali," or black in Delhi too.

During rush hours, the Ana Salai or Mount Road be-comes congested, with many cars polluting theatmosphere.

However, there are also interesting things to see inMadras. I visited a Hindu temple, the first time I hadseen one. The architecture is amazing. In Tamil Nadu,nonHindus are allowed to enter Hindu temples; in Ke-rala, they are not. My impression was that Madras was acleaner and nicer place than Bombay or Delhi, and ofcourse, than Calcutta, which seems to sum up all ofIndia’s problems.

CONCLUSION

Before leaving India, visited the "Taj Mahal,"which is truly a world wonder, and Ghandi’s magnificent Ashram in Ahmedabad. It was rewarding being inthe same place where the great Mahatma Ghandi hadonce taught peace, love and dignity for all mankind. Ifelt peace in my heart and I feel I am a ’new man’ acreation of the Institute of Current World Affairs. Mysincerest thanks to all the Trustees of the I.C.W.A. Andto you, Peter Martin, que Dios le bendigas.

Yours para siempre,

Bacete

Institute of Current World Affairs 3

TRAVEL SCHEDULE IN INDIA (MAY 28, 1994 TO FEBRUARY 27, 1995)

May 28. > Arrive Delhi (from Cairo, Egypt)

June 03 >

June 11

July 17 >

August 02 >August 09 >August 26: >

October 02 >

October 17 >October 19 >October 24 >October 25 >October 30 >October 31 >

November 03 >November 05 >November 16 >November 28 >

December 01 >December 07 >December 14 >December 16 >December 19 >December 21. >December 23 >December 27 >December 30 >

January 12 >

January 24 >January 28 >

FebruaryFebruaryFebruaryFebruaryFebruaryFebruaryFebruaryFebruary

15 >17. >20 >21. >22 >22 >23 >24 >

TrivandrumDelhi

Trivandrum

BombayTrivandrumDelhi

Trivandrum

CochinTirurCochinAlleppeyTrivandrumMadras

BangaloreTrivandrumCochinMunnar

CochinTrivandrumMadrasColomboKandyNuwara EliyaNuwara EliyaColomboDelhi

TrivandurmMadrasTrivandrum

DelhiCalcuttaAgraJaipurAhmedabadSuratAhmedabadDelhi

February Arrive Cairo (from Delhi, India)

March Arrive New York (from Cairo, Egypt)

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AFGHANISTAN

0 Miles 300

CHINA

PAKISTAN

Ahmedabad

New Delhi

Kanpur

INDIA

Varanasi

BANGLADESH

Ledo

Vijayawad

Bangaloe

Institute of Current World Affairs 5

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NOTES

Institute of Current World Affairs 7

Author: Institute of Current World AffairsTitle: ICWA Letters South AsiaISSN: 1083-4257

Imprint: Hanover, NHMaterial Type: Serial

Language: EnglishFrequency: Monthly

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