Inspiration for despairing liberals
How to Change the World — The Power of New Ideas by David Bornstein; Penguin Books; Price: Rs.395; 320 pp
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The pathetic condition of schools, colleges and counselling centres in the developing nations of the third world are mute testimony to the failure of government management of social sector institutions. As every new edition of UNDP’s annual Human Development Report and most recently Unicef’s State of the World’s Children 2005 (reviewed on this page in February 2005) graphically recounts, right around the world in Latin America, Africa, Asia, national governments — particularly those influenced by the state-centric Soviet model of development — have conspicuously failed to deliver basic healthcare and education to their unfortunate citizens.
Post-independence India driven by sentimental Nehruvian socialism which has created the world’s largest governing kleptocracy (politicians and bureaucrats) is a case in point. The nation’s government-run schools are so forbidding and uninviting that 85 million children (below 18 years of age) have never stepped through their doors and of the 177 million who enter primary school only 66 million make it into class VIII. Hardly surprising given that the average teacher-pupil ratio is 1:63, 58 percent can’t provide drinking water to children and 70 percent lack toilet facilities.
The condition of healthcare institutions is as bad, if not worse. The nation’s 163,000 primary healthcare centres (PHCs) are notorious for staff absenteeism and lack the most elementary equipment and medicines while government hospitals are a by-word for corruption, maladministration and cross-contamination. Little wonder that while the Union government is one of the contemporary world’s largest purchaser of arms and armaments, it can spare a mere 0.9 percent of GDP for public healthcare. Consequently private household expenditure on healthcare in India which aggregates to 4 percent of GDP is the highest in the world.
Against this backdrop of governments of the perpetually developing nations of the third world conspicuously failing to provide elementary social sector services to their citizens, mass catastrophe has been averted solely by the altruism of non-government or voluntary organisations (NGOs) which have stepped into the breach to supplement, if not completely substitute, government social sector institutions. Driven by compassionate social justice crusaders latterly christened ‘social entrepreneurs’, a growing number of NGOs are beginning to show the way to deliver healthcare, education and related services to hundreds of millions of the neglected but high-potential poor around the world.
Against this backdrop How to Change the World — Social Entrepreneurs and the Power of New Ideas by New York-based social scientist David Bornstein, also the author of The Price of a Dream: The Story of the Grameen Bank which has given millions of forgotten people in Bangladesh access to micro-credit, is a timely reminder of the wonders of societal transformation performed by determined individuals driven by true grit and social conscience.
How to Change the World is essentially the story of a remarkable social innovator, the US-based Bill Drayton, a Harvard, Yale, Oxford alumnus who threw up a job with Mckinsey & Co to promote an enabling foundation under the name and style of ‘Ashoka: Innovators for the Public’ in 1978 named after the compassionate Emperor Ashoka (272- 232 BC) who established the world’s first government social welfare department. Currently the Ashoka Foundation which "works a little like a venture capital firm" seeking "high yields from modest, well-targeted investments", operates in 46 countries across Asia, Africa, North and South America and Central Europe. This global network which Drayton has built over the past quarter century has assisted 1,400 social entrepreneurs (christened Ashoka fellows) providing them direct funding estimated at $40 million (Rs.180 crore).
Unsurprisingly a large number of social entrepreneurs (defined by management guru Peter Drucker as individuals who "change the performance capacity of society") profiled in this remarkably inspiring book are based in India. Far beyond the reach of five-star hotel press conferences and party-hopping journalists, a growing number of social entrepreneurs are changing the status and wretched lifestyles of India’s forgotten poor. Among them: Ahmedabad-based Ela Bhat who has organised self-employed women; Jeroo Billimoria, Mumbai (child protection service); Gloria de Souza, Mumbai (elementary education reform); Nalini Nayak, Thiruvananthapuram (protecting the livelihood of fish workers); Ravi Agarwal and Javed Abidi, Delhi (management of toxic waste and disability rights respectively); Joe Madiath, Orissa (village-based development); and Thara Srinivasan, Chennai (family-based care for schizophrenics).
Presumably to provide a global geographical spread, only a few of these Indian social innovators — Gloria de Souza, Jeroo Billimoria and Javed Abidi — have been profiled in this book. Which is just as well because the wonders that lone social entrepreneurs such as Vera Cordeiro (Brazil) and Erzebet Szekeres (Hungary) among others have performed in their countries not only provide differing contexts, but also insights into other societies with their peculiar problems. How the social consciences of these brave and determined individuals were aroused and how they set about building organisations which brought hope and joy into the lives of the poor and disadvantaged in their societies, is what this catalytic book is all about.
Quite obviously the author’s purpose in reciting the stories of social entrepreneurs around the world is to inspire despairing liberals in developing nations who want to make a difference but are put off by the sheer scale and complexities of the problems of their poor, to get up and just do it. And with the racy case histories included in How to Change the World, he has substantially attained this objective. The truth born out of the bitter experience of third world people is that even the most incompetent educated liberal is more effective than inveterately venal and uncaring government clerks. It’s easier than you think.
Dilip Thakore
The indigenous alternative
Challenging the Indian Medical Heritage by Darshan Shankar and P.M. Unnikrishnan; Centre for Environment Education and Foundation Books; Price: Rs.300; 241 pp
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Every time the union or state governments announce ambitious plans — such as the ‘Health For All’ scheme slated to be achieved over a decade or two — they evoke a big yawn and are taken with more than a pinch of salt. These plans tend to remain on paper, forgotten in the archives of health ministries.
In the light of India’s dismal record in public healthcare, policymakers should consider new alternatives. Challenging the Indian Medical Heritage offers some new and useful perspectives on medicine and health. The authors argue for revaluation and revival of India’s medical traditions, which run contrary to governmental ideas of medicine and health. But given the formidable challenges conventional healthcare systems face, they are worth considering seriously, argue the authors.
Actually, the book is less a plea for government policy than a case for greater acknowledgement and awareness of our indigenous medical traditions. It tries to answer questions that have been long dormant in the Indian consciousness. How ‘legitimate’ are our folk/ indigenous medical traditions? What relation do they bear to the (codified) systems of Ayurveda, Unani and Siddha? What are their origins and what space do they occupy in the modern context?
The authors cite instances where traditional medicine has superceded western medicine (allopathy), but credit has not been given because most people consider indigenous medicine quackery, and not a knowledge-based, disciplined system of healthcare.
"In terms of epistemology, Indian knowledge systems are different and unlike western science, and in that sense may perhaps be labelled unscientific. The western scientific knowledge system, however, is only one cultural way of knowing nature," argues Darshan Shankar in his prologue, setting the mood for a strong defence of indigenous systems.
The book is a collection of essays divided into three sections. The first is an evaluation of Indian systems: their philosophy, practices, their relation to the ‘codified’ stream of Ayurveda, and their ancient and recent histories. The second section describes the status of indigenous medical systems today, projects documenting and reviving these traditions, and case studies of various healers. The final section is an argument for reviving these systems.
The burden of the book seems to be that indigenous/ folk systems are as effective, if not more, than western medicine; they have their own theoretical structures which conform to Ayurvedic and not Western standards; that these systems are best suited to Indian needs and hence deserve government support. The examples given can silence any sceptic: there is Bommu Shivu Ganga Gowda or Ankola, who heals paralysis; Thirumalaiah of Urdigere, Tumkur, who cures poisonous bites with a herbal concoction; Nagaraja Mudaliar of Olapagapuram, Tamil Nadu, whose family has been curing eye diseases for ten generations; and a Namboothiri family of Palakkad, Kerala, renowned for treating mental illness. There are other stories, of bonesetters, poison specialists, and even an "eminent Ayurvedic physician from Pune" who was "publicly felicitated for curing leukaemia". Apart from these spectacular examples, the book details instances from everyday Indian life — food and lifestyle habits — derived from folk beliefs of health and medicine.
But for the credentials of the authors, these illustrations may be dismissed as fictitious. Darshan Shankar, together with telecommunications wizard and entrepreneur Sam Pitroda, established the Foundation for the Revitalisation of Local Health Traditions (FRLHT) in Bangalore in 1993. The foundation has been building databases of traditional knowledge, medicinal plants, and has initiated projects such as the Kitchen Herbal Garden programme to revive folk medicine.
The book warns that India’s medical traditions are dying and are in need of revitalisation. Their decline is traced to the modern belief that Western systems are preferable because they are more effective. But the book seeks to prove not only the efficacy of traditional systems, but advocates them because of their economic viability and because they are being practised in the vast rural hinterland where post-independence India’s pathetic public health services have not reached. Therefore, the public health policy cannot afford to ignore these time-honoured systems which have been in use for thousands of years. Unfortunately, says the authors that’s exactly what is happening. "To begin with, non-codified traditions are hardly treated as medical traditions. Here, the issue is clearly one of failure of our public health policy. Given the size and spread of folk tradition, a thorough investigation of its roots and practices is essential in the public interest," write the authors.
The research invested in this book and its presentation is quite impressive, though it is likely to interest only researchers and students of medicine. Challenging the Indian Medical Heritage doesn’t quite make the grade of a popular science text. Its chief virtue is that it manages to answer questions about our indigenous medical traditions and their relevance today.
Dev Sukumar