Dr. George (1) clearly points out the problems in medical education and health delivery system, and concludes, ‘All these ills are part of an overall drift in medical education in India’. The solution suggested is ‘change the entire focus of our planning in the health field’.

A change of focus is unlikely to remove the ills unless we address deeper questions of our culture. This is evident even from his letter. He states: “For most doctors today, success means working in a city hospital in a speciality. One cannot blame them.” Why not? Are they not part of the society with its “currently accepted definition of success” which he blames for the ills? Why protect them but accuse the politicians and bureaucrats for their lack of concern? Obviously, he expects someone other than a doctor should be “willing to blow the whistle”.

Blaming others for our ills

It is strange that we blame others for the ills in a profession whose quality is at stake because of the attitude of the professionals themselves. This, of course, is a general malaise. We see it in education, science, technology, industry, sports to name a few. It has sinister implications and suggests that a Darwinian selection of values in our historical contingencies has evolved a mentality in our culture which ensured survival with minimum cost to the individuals. The cost is giving up independence of mind and acceptance of unjust authority of a dominant group. It is perhaps embedded in the core of our culture. Three well documented episodes in our intellectual history that I discuss below, support this perspective.

Debiprasad Chattopadhyaya has persuasively argued that the ancient medicine system, Ayurveda, encodes a knowledge – a proto-science as he calls it – which was the first serious ‘scientific’ attempt in the modern sense (2). Though a remarkable beginning, far ahead of those in other civilisations then, it could not bloom into a proper science in more than 2,000 years!

The reason was the entry of religious doctrines into the substance of the knowledge (3). The practitioners succumbed to pressures from other sections of society and could not preserve the criticality in the growth of that knowledge. It is the same reaction today; only the modern forces are different.

Another instance, this time in the 18th century, was a serious but abortive attempt to pump new life into astronomy which had reached a stalemate since Bhaskaracharya II (12th century). This is the famous effort of Sawai Jai Singh recently analysed by V.N.Sharma (4). The Raja built five observatories without incorporating telescopes, though he possessed one. He was, of course, unaware of the existence of telescopes with a hair line in the view, which improved the accuracy of measurement over the naked eye. These improved telescopes were already a few decades old when he began the masonry work to build what were obsolete structures which depended on the naked eye for viewing and measurements.

The Raja depended on information provided by a Jesuit, Father Manuel de Figuerdo, who was in India primarily to preach his religion. The delegation led by the Father was sent to Europe to collect information on contemporary developments. In his report the Father did not mention ongoing revolutionary changes sweeping Europe from the contributions of Copernicus, Galilio and Newton, because the Heliocentric solar system was heresy and forbidden by their religious leaders. We remained in the dark simply because of the ‘religious stigma’ of certain knowledge within a section of scholars in another society.

More relevant to this discussion, the Raja’s interest seemed to mainly concern the position of the moon in order to predict the solar eclipse (5) with greater accuracy. It is intriguing that though the Raja had a team of about 30 astronomers, no Hindu astronomer was, apparently, a member of the delegation sent to Europe. Sharma suggests that the Hindu astronomers were probably under the threat of being socially ostracised if they left the shore. It is, however, possible that the Hindu astronomers were not sufficiently enthusiastic about gathering new knowledge from other civilisations to cross the barrier imposed by the stigma back home. It could also be that the higher accuracies of prediction were unnecessary for their social recognition as astrologers, which any way assured substantial pecuniary benefits. The rot in our intellectual tradition may be gauged by the fact that no Indian astronomer of the time was aware of the Copernican revolution which was then nearly 200 years old! Astronomy had yielded to astrology and, presumably, the Raja’s interest was simply to provide more accurate data to astrologers.

Destruction of education

A similar development occurred earlier in this century. It destroyed the rigour in the pursuit of higher education. Students were drawn into politics to actively participate in the freedom struggle. The architects of our independence movement, like Lokmanya Tilak, Gopal Krishna Gokhale, Mahatma Gandhi, Pherozshah Mehta, Muhammed Ali Jinna, Pandit Nehru, Abdul Kalam Azad, Subhas Bose and innumerable other leaders, had completed their education before entering active politics.

However, several of them did not object to, and actually sanctioned, the participation of immature students into the movement long before their academic accomplishment. This was in spite of the warning by a visionary like Sir Asutosh Mookerjee, the then vice Chancellor of Calcutta University, who was building the base of the future nation, and who brought to eminence such personalities as Raman, Saha, Radhakrishnan and several others. When a call was given to boycott classes, he addressed the students thus (6):

“You want a swadeshi (national) university. Is not Calcutta University your university? Senate and the Syndicate are in the hands of the Bengalis. It is fostered by the donations by the sons of Bengal. Everyone is in native dress. There is no foreign influence here. Should you insult this noble patriotism, this generous self-sacrifice?”

However, the support from other intellectuals of his time was missing, presumably, because stronger political support would reduce their burden in the struggle. That it would be at the cost of education of the younger generation did not seem to matter. And now it has become a tradition that political parties depend heavily on the active participation of the leaders of student unions. Potential leaders certainly must give most of their time to union activities at the cost of their studies. Therefore, the outlook of today’s politicians, in contrast to those in the earlier era, is depressingly unenlightened.

Perhaps, like doctors who wish to stick to cities, we cannot blame politicians their pragmatic but unenlightened outlook. If giving up education halfway was for a just cause to involve young students in the struggle for independence, then, by the same token, giving up city life to develop an efficient rural health delivery system by the doctors is their moral obligation today. But elders protect them from its hazards instead of leading them through it.

An ancient sickness

The current ethos as diagnosed by Dr. George is, therefore, a natural consequence. We laid our own trap. The vital question is why do we not struggle to come out of this trap which seems essentially due to an ancient sickness: a lack of concern for the future generation of the society as a whole.

The answer, in my view, is the following: Our culture evolved to protect relatively small groups or tribes within the subcontinent from ancient times. Any internal clash of interest of smaller groups could easily be left unresolved because these conflicting groups could move out to newer localities, there being enough land and resources available. This may have also encouraged our unconcern for environment as reflected in the prayer in Rigved (7) to ensure clean air, water, soil and other requisites of good living. The verses can easily be interpreted as a caution to protect the environment rather than a simple prayer in the modern sense. Perhaps our ancestors were casual and indifferent towards their own environment and settlement the way we perpetuate our slums and poverty today, and erode the environment unconcerned about the well being of the future generations. Those who are unhappy, and capable, also leave the land of their dwelling in modern times looking for greener pastures elsewhere – and the old habit continues to serve, but now on a global scale.

This trait is indeed the most significant one that comes to our rescue to adapt to social changes in the modern times which Sudhir Kakar infers from his classic exploration of Hindu psyche (8):

“As when the extended family take over the maternal care taking role during the period of narcissistic crisis in the Hindu boy’s life, individuals may be impelled to seek those wider groupings which, above all, promise to take encompassing care of their members.”(emphasis original)

No wonder our teachers, professionals and political leaders while being lenient towards the selfish or unethical behaviour of a sub-group to which they belong, cannot gather enough courage to set their own house in order and want others to come to their rescue!

If the history does repeat this time, as would appear from the arguments it will not be the politicians, but we, the so-called intellectuals, who would be quite justifiably held responsible by posterity for missing the current opportunity to come out of the coma into which our culture is gradually entering.