The Library & Airship of Amerigo da Schio

Recently, an old noble family of Schio opened their private library with antique books for public viewing. The family's name is "da Schio" (literally "from Schio") and they have a big villa in the city centre, in front of the Duomo church.

Count Amerigo da Schio, from this family had made the first airship in Italy and its maiden flight had taken place in Schio in 1905. This was just two years after the the Wright brothers had made their maiden flight in 1903.

This post is about the "da Schio" family's private library and the story of the first Italian airship made by Amerigo da Schio.

Civic Library of Schio

These days, our Civic library in Schio is having a mini-exhibition about antique books and handwritten manuscripts. This exhibition will be on till the end of Dec. 2024.

The tiny town of Torre Belvicino, a few kilometres north from Schio, was one of the first places in Italy where the printing press was started, soon after Johannes Gutenberg had discovered the moveable type for printing in Germany in 1440 CE. The first printed books in Torre Belvicino came out around 1460.

At the same time, the St Francis church had some antique handwritten manuscripts with some exquisitely made illustrations from 13th century. Thus, our library has an eclectic collection of antique old books. I will write a separate post about our library, its history and its old books.

For the inauguration of this exhibition of old books in the civic library, the "da Schio" family also opened the doors of their private library for the public, to show off their collection of old books.

Da Schio family in Schio

The records show that the "da Schio" family house has been there for more than a thousand years. The old pictures from 19th century show 4 houses built together. Around 1875, the building was renovated and a new façade was built, giving it a more dignified appearance, so that the four houses appear as one.

The "da Schio" family had a number of famous personalities in the past. These personalities included Manelino da Schio, mayor of Belluno in 13th century while his son Frà Giovanni da Vicenza was a well-known Catholic Dominican inquisitor (his portrait can be seen in the stained-glass windows of Santa Corona church in Vicenza). The descendents also included a bishop in the 16th century. The title of Count was given to the family in 1530 by emperor Charles V.

The family's royal symbol is a mermaid with double tail, which can be seen at the top of the house and in the family seal placed in the books (image below).

The present Count Giovanni da Schio, was born in the room above the library but today lives in their villa in Castel Gomberto. One of the Counts' son, Tommaso Amerigo, is a trained archivist. Both Giovanni and Tommaso were present during our visit to explain the history of the house and the library (first image at the top).

The remaining parts of the "da Schio" building have been made into offices and apartments. However the family still maintains the library. 

Library of the "da Schio" House 

This library has about 4000 volumes including 2 incunabulum books (the first printed books in 15th century).

The library was (and is still) not organised for subjects or authors, but rather for aesthetic reasons, putting together books of the same sizes and colours in the same shelves. Each cupboard (all are open cupboards), covering the whole length of the wall, has an alphabetical identification and the shelves are numbered. Thus, to find a specific book, one must consult a card-catalogue. There are 10 boxes of card-catalogues (shown in the first image at the top).

However, the family has started a process of digitising the book-archives.

The library room has a few pictures of Amerigo da Schio, who is considered as a famous Italian and world personality. The place of honour, in the centre of the room, is for a model of the the famous Amerigo airship hanging from the roof.

The Airship of Amerigo da Schio

Amerigo was born in Schio in 1836. Though he trained as a lawyer, he had eclectic interests including astronomy. During that period, different persons were discussing how to fly. While the Wright brothers were trying with their aeroplane, it was too heavy to be able to carry passengers.

On the other hand, others were thinking of an airship carried by a big balloon - these were also known as Blimp or Dirigible Balloon. Amerigo was among one of them, though he thought that with time, lighter metals will be found and future will belong to aeroplanes.

Hot air balloon was invented in France in 1783. Two years later, Blanchard and Jeffries crossed the English channel in a hydrogen balloon. In 1852, Giffard flew a steam-powered airship filled with hydrogen, while the Zepplin airship was invented in 1895, which were also used to bomb Britain during the first world war.

Amerigo's airship in Schio, was the first Italian airship. Making it was not easy because the parts had to be built and brought to Schio. For example, its motor was made at the Fiat factory in Turin, while the black plastic sheet fixed at the bottom to allow elastic expansion of the balloon, was made by Pirelli. It was filled with a gas made from burning some metals and other things. Underneath the balloon, a frame made from aluminium tubes was built to carry passengers. The first flight on 17 June 1905, in the area where the old hospital of Schio is located, was successful. After that it was flown a few times.

A book published to commemorate 70 years of Amerigo's airship by Arrigo Usigli, had some information about the challenges in making the airship: "Its total weight should have been around 1000 kg but the initial endothermal motors were too heavy for it. However technical progress helped by reducing this weight and a motor produced by the French Buchet was chosen, which weighed only 80 kg and provided 12 HP." (p. 25)

At one level, we can say that the invention of the airship was not very useful, because over the next few years, aeroplanes were developed and became the principle mode of flying for humans. However, Amerigo's airship innovation led to better industrial capacity in many areas in Italy, including in the Fiat and Pirelli factories.

To Conclude

If Homo Sapiens species arrived some 300,000 years ago. The writing was discovered around 3000 years ago. Till about 500 years ago, books were only handwritten and were thus called Manuscript (from Latin, Manus means hand and Script means writing). The society that reads books, arrived only some hundred-two hundred years ago. Initially, many persons, not used to the easy availability of books for general public felt that books were a bad invention, that they would have destroyed the human capacity for memorising and thinking.

While, today we can only laugh at those fears, already the world is changing. With technologies such as easy video-making with mobile phones and internet, perhaps we are moving towards a post-writing and post-book world. As has happened so many times in the past, new technology does not mean that the old things disappear. Hopefully, books will be with us for a very long time, even if they change form and become electronic or video-story tellings.

The beautiful library of the "da Schio" family is one of the treasures of humanity and hopefully, it can be preserved for future generations. 

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"Eliminating" Infections In India

In today's FirstPost, an online newspaper from India, there is a cover story on Neglected Tropical Diseases (NTDs) by Kalikesh Singh Deo, "a member of the Biju Janata Dal party. He is the Convenor of the National Coalition on Neglected Tropical Diseases and Malaria".

I have some concerns about the use of term "elimination" for reducing the number of certain diseases like Kala Azar and Lymphatic Filariasis, under the guidance of the World Health Organisation (WHO). I hope that bodies advising the Government of India would have discussions with stakeholders to ensure a reduction in the negative fall-out from the use of such terminology.

Let me explain why I think that using terms like "elimination" in such campaigns is a double-edged sword. (The image below presents some ASHA workers from Maharashtra, India - all public health programmes reach people through these front-line workers in India - without them no campaign or programme can work).

WHO's Definitions

In 2016, WHO produced a document about the use of terms like "elimination". According to this document, the following terms have following meanings for the infectious diseases (page 3):

Control: Reducing the number of cases of a disease

Elimination: Reducing a disease to zero new cases (incidence) in a country or an area

Eradication: The causative organism has been eradicated from nature and laboratories so that it can not cause any new infection

In addition, there is a 4th definition, which is called "Elimination as a Public Health Problem" - this means reducing the numbers of cases of a disease so it is no longer a problem for the health services.

Advantages of Using terms like Elimination

In his article, K.S. Deo explains: "By December 2023, the Government of India plans to reduce kala-azar cases to less than one per 10,000 people at the block level and, by 2030, to eliminate haati pao as well."

Reading the strategy and such explanations, the readers feel that the problem is going to be solved. In this article, he does not use the term "elimination as a public health problem" because he understands that this won't make much sense to ordinary readers.

There are different advantages of using words like "elimination", including getting more resources from the Government and greater commitment from health services and health personnel.

There are real gains on the ground as well. For example, Deo writes: "10 February 2023, India will conduct Mass Drug Administration (MDA) rounds in Mission Mode in 10 affected states". This means that a large number of people will receive medicines to treat and to prevent new infections.

Disadvantages of Using Terms like Elimination

The first time the term "elimination as a public health problem" was used was in 1991, when WHO had launched its Leprosy Elimination Strategy (LES) - to reduce leprosy by the year 2000. At that time I was a member of the the medical commission of the International Leprosy Associations Federation (ILEP) and many of our members had concerns that people will not understand the term "elimination as a public health problem" and will think that the disease has been eliminated, they will believe that it no longer requires resources and services.

The LES had a huge impact in India. In most of north India very few public health services were reaching leprosy patients and most of them were being treated by older lesser-effective medicines. For example, due to LES, by 1998 even states like Bihar and UP managed to provide almost 100% coverage with newer and more effective anti-leprosy drugs to all those who needed them.

The problem came after India had reached the LES goal (in 2005). Many states reduced their support for leprosy services. It was not only decision-makers or general population who had thought that leprosy will be actually eliminated and there won't be any more new cases, even doctors and public health specialists believed it.

For example, 4 years ago, Dr Madhukar Pai, director of McGill International TB Centre and a well-known and influential public health specialist based in Canada, in his article "Failures of Public Health" wrote the following:

In 2005, India declared leprosy to be eliminated and scaled-back on its leprosy programmes. Today, according to WHO, India harbors 60 percent of the world’s cases, with more than 100,000 new diagnoses each year

I can tell many anecdotes of people coming up to me with questions about why governments had declared "leprosy is eliminated" when they still had the disease. I have even seen a sociology thesis from a country in Africa, which had a theory about the LES declaration and a national conspiracy to marginalise the poor persons for the benefit of the rich.

Conclusions

I think that it will be good if Mr. K.S. Deo and his team will bring together different stakeholders, including representatives of leprosy-organisations to find ways which allow us to use the term "elimination" for the advantages it provides and at the same time, find alternate ways to mitigate the damage caused people's expectations that these diseases will disappear.

For example, it might be important to use some other word and not use the word "elimination" in the local language translations about the campaigns.

18 years after Eliminating Leprosy as a public health problem in India, it continues to be a public health problem and is a part of NTD strategy about which Deo has written. LES had an impact, the number of new cases of leprosy in India has been halved (partly this may be due to covid-related reduction in services, so that many new cases were not detected) but the disease is still there and it requires services. It is crucial to avoid mistakes of the past.

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Celebrating Dalit Struggles & Pride

Ever since the advent of metro network in Delhi and surrounding regions, I have started to explore unfamiliar parts of the city and NCR. Every time I visit Delhi, I try to visit some new places. In 2019, I decided to visit the Dalit Prerna Sthal Park and Okhala Bird Sanctuary, near the eponymous metro station on the Magenta line of Delhi metro.

This post is about my adventures while trying to visit these two tourist venues located in NOIDA (UP) close to the Delhi border. I take this opportunity to also reflect on caste discriminations in India.

While independent India opted for laws against caste-based discriminations and affirmative action for persons from lower and backward castes, I thought that continuing deaths of persons asked to clean the sewers was a big blot on nation's dignity. It is only in 2023 that Government of India has decided to allocate specific funds to stop manual cleaning of sewers - I hope that efficient action will be taken on this point and make sure that no one dies due to this act anymore. 

Rashtriya Dalit Prerna Sthal

RDPS or the National Inspiration Memorial of Dalits was commissioned in 2011 by Ms. Mayawati, a Dalit leader, who was at that time the chief-minister of UP state. The word “Dalit” literally means “Downtrodden” and denotes persons belonging to the so called “lower” castes in India, who have been marginalised and exploited for centuries by persons of other, so-called “higher” castes.

Before Mayawati, dalits have had some other famous representatives, who have left a mark in Indian history. Dr. Ambedkar, one of the most important dalit leaders during the independence struggle, is considered the father of the Indian constitution. Babu Jagjivan Ram, a dalit leader belonging to Congress party, had been a famous minister in the Indian national government for more than a couple of decades. Another dalit leader from Congress party, K. R. Narayanan, had become vice-president of India in 1992 and president in 1997.

After the independence of India in 1947, gradually Dalit population groups had also started organising themselves politically. A dalit leader, Mr. Kanshi Ram, had founded a political party called Bahujan Samaj Party (BSP) in 1984 to represent their political aspirations. Mayawati, a leader of BSP, formed the state government in UP in 1995, the most populous state of India with more than 200 million population at that time. After more than a decade of coalition governments, Mayawati formed her first majority government of dalits in 2007. By becoming a symbol of Dalit power and visibility, Mayawati has represented the collective rise of dalits.

Construction of the Dalit Prerna Sthal (Dalit Inspiration Memorial) in NOIDA close to Delhi, was a way to remind the people about this transformational journey of marginalised dalit people. For this reason, many persons also call it Dalit Garv Sthal (Dalit Pride).

Reaching Dalit Pride Park

The first Delhi Metro station had opened in 2002. Since then it has grown into one of the biggest metro network in the world with more than 250 stations and covering about 350 kms. The Magenta line going to Okhala Bird Sanctuary station had opened in 2017. It connects Janakpuri in west Delhi to Botanical Garden in UP in the east, covering a little more than 38 kms with 25 stations.

Check the latest metro map to see how you can reach Okhala Bird Sanctuary metro station from your home/hotel.

My Adventures in visiting Dalit Pride Park

My first motivation for this visit was the Okhala Bird Sanctuary. It was January and I had read about thousands of migratory birds visiting the Okhala area around the river Yamuna. On the Google map I had seen that Dalit Pride Park was very close so I had decided to visit both these places.

My journey had began in Gurgaon and I had taken the magenta line from Hauz Khas, reaching Okhala Bird Sanctuary Metro Station in a little more than one hour.

Getting out of metro station I had my first encounter with the reality – the exit stairs crossed a wide and busy road, full of fast traffic, and came down to a narrow platform in the middle of the road. There were no signs about how to reach the Bird Sanctuary or the Dalit Pride Park around the Metro Station. Crossing the road to reach the sidewalk was my first dangerous adventure. There was no sidewalk and the shops occupying the area, were not able to tell me how far was the Dalit park, except to indicate the general direction.

A 20 minutes of walk, with an occasional sidewalk that was covered with garbage in places, including a bridge over a canal carrying foul smelling refuse waters, finally brought me to the gate of the Dalit Park.

My satisfaction was short-lived, as the children playing there told me that this gate was locked and to enter the park, I needed to walk to the next gate. Another 15 minutes of walk brought me to the next gate, but it was also closed. Resigned I walked to the successive gate, where a young man selling the spicy fruit-chaat explained to me that all the park gates were closed and the only gate open to public was gate number 5, another half-an-hour of walk away.

By that time, the sun was up and it had become warm. I had been walking for more than one hour and was already tired. I tried looking for an auto but after 10 minutes gave up the idea. Finally, deflated and defeated, I started my walk back to the metro station.

Along the outer wall of the Dalit Park, there were narrow openings from where I could look inside and take a few pictures. It looked green and lovely with a lot of columns in a pink stone, with elephants at the top, which are the electoral symbol of BSP. In the centre of the park there was a monument with statues of Kanshi Ram, Mayawati and other Dalit icons. Through the narrow openings, the pictures have not come out so well and all the statues looked grey or black.

Looking from outside, I did not see any visitors in the park except for a few uniformed men sitting in the shade near the locked gates, looking bored.

Back at the metro station, frustrated and tired, I half-heartedly asked persons about the way to the Okhala Bird Sanctuary. They pointed vaguely towards the bridge on the river. To reach that part, I needed to cross a wide road full of fast-moving traffic without any place for pedestrians. In the end, I thought that it was time for me to lick my wounded pride and retreat from this visit. My only consolation was that I had seen some parts of the park from the outside.

Need for Dalit Pride Parks

Caste is a huge and deeply rooted issue in Indian society. Caste related reservations in educational institutions and government jobs are sources of resentment among persons of "higher" castes. Proposed as a temporary measure at the time of India's independence, it has now grown into a multiple-headed hydra with different caste groups claiming backwardness and right to reservations.

On the other hand, in spite of the equality guaranteed by the Indian constitution, marginalisation and oppression of Dalits continues to be a serious issue in many parts of India, especially in small towns and rural areas.

Yet, there is no systematic way of promoting discussions on this theme in India. During my school years, the only mention of caste discriminations had come during discussions on Mahatma Gandhi and perhaps during the lessons on medieval bhakti poets of India. There was no lesson on how caste discriminations work systematically across our daily lives and nothing about continuing inhuman treatment of specific "lower" caste groups even today. For example, manual scavenging was declared unlawful long time ago, yet there are still places where human beings are forced to carry excreta on their heads and unprotected men are forced to go down in the gutters and manholes to clean them manually, even in the national capital. Many educated Indians growing up in big cities feel that caste discriminations was something belonging to the past because they do not believe in caste distinctions, and have no idea of its continuing terrible impact.

In such a situation, I feel that Dalit Parks can play important roles in promoting public discussions on castes and its negative impacts. For example, they can help in informing public about the reality of caste discriminations through testimonies, films, art and sculptures. They can also showcase important contributions made by dalit leaders to create positive role models. School children should be taken to these Dalit museums, to learn about India's history, its continuing social disparities and to make a vow to fight these.

To Uttar Pradesh Tourism Board

Metro is an accessible public transport that brings tourists to different parts of the city. UP Tourism Board should make an effort to make it easier for persons reaching the Okhala Bird Sanctuary Metro Station to visit the Dalit park and the bird sanctuary. It will be good if a tourism department official actually travels by Metro to understand how difficult it is for people to come out of the metro station and to visit these 2 places.  

Allowing only one gate of the park to be open and choosing that gate which is most far away from metro station for this purpose, seems not only illogical, but also against poor and middle class persons, who do not have their own cars or vehicles for travel.

The tourism board should also put relevant sign boards at the metro station to guide the interested persons. Finally, if they can also make arrangements to facilitate visits by persons with disabilities and old persons (like me), it would be wonderful.

I can guess that the reason why only one gate of the Dalit Park is kept open for public, is to sell tickets and control entry. However, if you check how much money this park is earning from the visitors and if it is a small amount, make the entry to Dalit Park free so that more persons can visit it, experience what it means to be Dalit and face caste discriminations and learn about the pernicious effects of caste-system in India.

Conclusions

I believe that visiting Dalit park and learning about discriminations and inhuman treatment of dalits in India is a great idea – similar to visits to holocaust sites and genocide museums in Europe and monuments to Black-resistance sites in the USA. Often, people and government seem embarrassed to accept that India still has caste-related discriminations. Instead, we need to openly talk about it, make it a prominent discussion point and highlight all that which has been done by national and state governments as well as, by activists to fight it. I hope that UP Tourism Board and Government of India will wake up to its importance and make it an essential part of visits for tourists coming to India.

 

 

Hiding our difficult past and the uncomfortable parts of our present reality because we feel ashamed of it, does not help us in tackling it. We need to talk about it openly, so that we can understand it better and find ways of overcoming it.

There are still many aspects of caste-related exploitation that are not well understood. For example, while oppression and exploitation of “lower” castes by “higher” castes is a big problem, I feel that hierarchies and intra-caste inequalities and discriminations among the “lower” castes is also an issue. Unless we talk about these aspects, how can we hope to transform India into an equal and progressive society?

Our Upanishads, the ancient Hindu sacred texts, say that there is the same universal consciousness in all living beings. Similar messages from all different religions of India also need to be celebrated in the dalit parks to promote a change in mentality.

Like the queer communities across the world celebrating GLBTIQ pride parades, perhaps one day all cities of India will have colourful and joyful dalit parks and dalit pride parades, where people can learn about our social history and express our pride in our identities.

Note: Post originally written in 2019 and updated in 2023

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Wonderful Magic Realism of Jacquet

I have always loved art ever since I can remember. As a child, I loved painting with water colours. In early 1990s, while living in Imola (Italy), I had done a short introductory course on oil paintings. At the same time, I love looking at art and knowing the artists.

This post is about a French artist called Philippe Charles Jacquet, whom I discovered some time ago and whose art-style I like very much. Apart from talking about Philippe Charles Jacquet and why I like his art, this post briefly touches on some other artists whose work I like. 

Philippe Charles Jacquet

Here is some information about Jacquet which I have gathered from internet:

Jacquet, born in Paris in 1953, studied architecture at the Ecole Nationale Supérieure des Arts Décoratifs. After working as an architect for about 20 years, in 2000 he decided to focus exclusively on painting. His background in architecture is reflected in his artwork in the symmetrical and geometric landscapes as well as in the way he sculpts rocks and designs houses. Brittany coasts and estuaries feature commonly in his works.

He did not have any foral training in art. He works with industrial gloss paint, an unusual medium for artists, which gives a sheen to surfaces as it dries. He begins by painting his plywood surface with a uniform base of an off-white color. Creating a variety of textures is an important part of his paintings, for which he uses different techniques such as creating several transparent layers and using a razor blade to scratch the surface.

Jacquet currently lives and works in Pantin, a suburb north of Paris, in France.

What Captures Me in Jacquet's Works

I prefer traditional approaches to arts and I am not much of a fan of the concept art. Liking or not liking an artist's work can be very subjective - something which touches me very deeply, may leave you cold or indifferent, so I don't know if looking at Jacquet's works would affect you the way it does to me - I can look at his paintings literally for hours.

Jacquet's art calms me down and sometimes they draw me into a meditation-like trance. Looking at some of his paintings make me feel as if I am in a tunnel, going deep inside myself. Some of his works make me experience a kind of silence - I love books and words, and perhaps because of that, the voices in my head are always talking, thus, I love this experience of silence.

I love the colours he uses - a lot of pale colours, a lot of greens and blues and an occasional red. I like the early mornings or late evenings of his paintings where a lighted window, often with a vague presence of someone inside, calls me like a beacon. I like the pebbled surfaces underneath the water and along the sea-shores, and the thousands of blades of grass which seem to be moving in a gentle breeze. I like the boats anchored or floating gently on still water. I like the lonely figures standing still, lost in thought, waiting for something or someone. I like his lone bicycles moving along the edge of the water. And, I like the stairs cut into the rocks which come down towards the water.

There are some of his paintings which I wish I could have on a wall in my room, so that I can look at them when I fall asleep or when I wake up. However, I love the fact that I can find a lot of images of his paintings on internet, so that I can have them as backgrounds on the screens of my computer and tablet and I can keep on changing them.

So thank you Mr. Philippe Charles Jacquet for your wonderful magic realism and for giving me so much joy. I am glad that in 2000 you decided to follow your passion and devote full-time to paintings.

My Other Favourite Artists

Philippe Charles Jacquet is not the only artist whose works I like!

One of the first artist whose work I loved was B. Prabha, whose paintings of peasant-women and fisher-women with elongated bodies were published in the Hindi weekly Dharamyug during 1960s. I think that her art-style was somewhat inspired by the Mannerism school, which had developed in post-renaissance Europe in 16th and early 17th centuries. During renaissance, artists had developed techniques focusing on realistic representations of human bodies, ensuring life-like proportions and perspectives. In Mannerism, artists started to move away from realistic towards more emotional representations, giving rein to their imagination and fantasies. Perhaps, she was inspired by the works of Italian artist Amedeo Modigliani (1884-1920) who had used similar elongated bodies in some of his portraits.

Through my father, who was active in Socialist Party of India under Dr Ram Manohar Lohia, I had met some well-known Indian painters such as Makbool Fida Hussein and J. Swaminathan, whose works I used to like. I remember sitting as a child with Hussein saheb at India Coffee House in Connaught Place in Delhi in early 1960s, which was located in those days where today there is the underground Palika Bazar - at that time, it had the coffee house in the centre surrounded in a semi-circle by the different state emporiums in wooden buildings. I also remember walking towards Triveni Kala Sangam with Hussein saheb to see his exhibition and meeting Dr Zakir Hussein, who was then the vice-president of India. I also remember the dismay of all the socialist friends of my father a decade latter, when Hussein saheb had defined Ms. Indira Gandhi as Durga and painted a whole series of paintings on that theme.

In Europe, I have been absolutely smitten by the paintings of Caravaggio and the surrealism of Salvador Dalì, both of whom do not need any introduction and have enormous fan followings. At the same time, in more recent times, I like many lesser-known water colour painters, some of whom I follow on Instagram - I love to watch their Reels where they show the development of a painting.

In The End

I hope that through this post you can understand why I like the art of Philippe Charles Jacquet. If you also get a special feeling when you look at these, do share about it in the comments below.

I am passionate about water-colours but they don't affect me like the art of Mr Jacquet. I think that to be so affected by art is a gift, a special way of communication between me and the nature through its forms and colours.

I dream of having time to dabble with water colours though I suspect that I like expressing myself more through words than through colours, so that dream will continue to be only a dream. But I can imagine the kind of art I would like to make even if the reality never matches that fantasy. In the mean time, I can enjoy the works of artists like Philippe Charles Jacquet!

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Importance of Alternative Medicine

Over the past couple of years, ever since we have broadband internet with unlimited use, I often watch some YouTube video channels including lessons on cooking and about the use of specific software. I also like some channels on politics, health related issues, Indian classical music and dances.

One of health related channels which I often watch is Medlife Crisis by Dr Rohin Francis from UK. Recently, I came across one of his older videos, which was about "alternative medicine". In this video he had explained about the importance of evidence-based medicine and how this scientific approach ensures that we can truly understand the efficacy of treatments and make rational choices about medicines. The other aspect of his intervention was that alternative medicine lacks this evidence-based approach and thus for him it was mostly hogwash.

In his intro on this channel he also says that "There's a lot of bad science on YouTube, especially medicine, with quacks and clowns peddling garbage", which probably also refers to alternative medicine, apart from other conspiracy theorists and No-Vax groups. The image below shows a person receiving a traditional treatment in Mongolia.

In another tiny video titled "How does Homeopathy work?", he has a short no-nonsense answer to this question - "It doesn't".

Rohin Francis is not the only one who speaks out against wasting money on alternative medicine. Some of my other doctor friends have been very active against quacks and untrained persons masquerading as doctors in India. Some doctors on Twitter regularly rant against homeopathy and alternative medicine practitioners.

I understand from where all these persons are coming from. However, I do not agree with them that alternative medicine is all about non-evidence based quackery. In this post I want to share some personal experiences and some opinions regarding the role of alternative medicine in today's world.

Disclaimer: Quacks & Clowns Peddling Garbage

I know that there are persons who claim to have miracle-powers and who can cure all kinds of conditions. They prey on people when they are most vulnerable and psychologically fragile and they do it to earn money and gain power. Some of these frauds may be mentally ill and may actually believe in their supernatural powers. This post is not about justifying any of them. They do need care and treatment for their delusions and if needed, deserve law-suits and prisons.

I also do not wish to say that alternative medicine can cure everything such as conditions like high blood pressure or diabetes or cancer. People who give up their blood pressure or diabetes medicines because of their beliefs in alternative medicine, often end up with irreversible body damage to their vital organs like kidneys or eyes. Conventional (western) medicine is a better choice for most such persons.

Origins of Alternative Medicine

For thousands of years, ancient humans have tried looking for treatments for common health conditions. They did it mainly by looking for plant-based treatments. The plant-based medicines they identified, did not have the backing of double-blind studies on random samples of carefully chosen groups, but to call those "non-evidence based" would be a bit of stretch. Many of our common modern medicines from Aspirin to Quinine and Artemisia come from those traditional experiences. Guys looking for the next blockbuster drugs have often stolen the knowledge of plants and herbs from traditional healers. Scientists carry out experiments with synthetic derivatives based on those same plants and herbs and then do scientific trials to show their effectiveness. Many of them call as quacks the traditional healers in villages who are using those same herbs, simply because they base their knowledge on the oral transmission of experiences and tradional learning.

In countries like India, China and Mongolia, people practicing traditional medicine, study in their medical collages just like students studying modern medicine. For example, in Ayurvedic medical collages in India (I have visited 2 of them), students study for their medical degree for 6 years and their curriculum includes all the subjects such as anatomy, physiology, pathology and pharmacology, taught in conventional medical colleges.

However, a part of their studies is based on beliefs which modern science does not accept. For example - the Chinese beliefs about meridians running through the body with the energy points and the balancing of Yin and Yang forces; or the Indian beliefs about the three body humours (vayu, kaffa and pitta); or the homeopathy belief about using "like to counter like" and the power of dilutions of medicines. These beliefs do not fit with the understanding of modern science, because they do not follow the logical-thinking paradigm but follow some other esoteric or intuitive paradigms.

Shaping of Our Beliefs - Personal Experiences

Our beliefs are predominantly shaped by our own life experiences. Scientists say that our experiences are anecdotal evidence and are unreliable and usually biased. So we should only believe in what scientists and experts tell us. However, from personal experience I know that if I have experienced something, I may accept scientific opinions but I will also find a way to keep my own opinion based on my experience, even when the two are contradictory. This seems to be a common human trait.

Let me share a few experiences regarding alternative medicine, which have shaped my ideas on this theme.

My first experience with alternative medicine was with homeopathy in 1980s, when I was a community doctor. I had developed a strong pain in my left shoulder and had difficulty in lifting that arm. For many days I had taken anti-inflammatory and pain-killer medicines. In those days my paternal aunt had high blood pressure and I often visited her house for her check-ups. My aunt's husband, my uncle, had retired and taken up homeopathy as a hobby. He gave free homeopathic medicine to anyone who came to him. During one visit, after checking my aunt's blood pressure, I told my uncle about my shoulder pain and that I was tired of taking pain-killers as they were giving me gastric problems. He asked me numerous questions about the pain and then gave me a small dose of small sweet-tasting pills. He also wrapped in an old newspaper, two more doses of those pills and told me to take them after some hours. In less than 15 minutes after the first dose, my shoulder pain had disappeared and I had no difficulty in raising my arm. It was like a miracle and it changed completely how I felt about homeopathy.

My second experience of alternative medicine was more recent. In 2015, while living in Guwahati in India, I developed a severe knee pain. It became so bad that it curtailed my walking. I stopped going out for walks and took frequent anti-inflammatory and pain-killing tablets. In 2016, back in Italy, I went to an orthopaedic specialist for a few visits. A scan of my knees showed myxoid degeneration of Cruciate ligaments. I was given Hyaluronic acid injections in my knees, wore knee supports and took pain-killers. But nothing seemed to help me. After a few visits, the orthopaedic specialist told me that I had to learn to live with the pain as I was too young for knee replacement surgery. I was also told to reduce weight and do physiotherapy. I shared my scan results with an orthopaedist friend in USA and even his opinion was the same. Talking about it with a Catholic priest, who had become my friend in Guwahati, he suggested that I should try Ayruvedic treatment in a hospital in Kerala.

In January 2017, I went to the Ayurvedic hospital suggested by my friend for a one week of treatment. The treatment consisted of daily massages with oils containing different herbs. After a week's treatment, I was advised to rest for a few days. After that one week of treatment, my knees improved greatly and I could again walk without pain. I went back to that hospital for a week in 2018 and 2019. However, in 2020 and 2021, because of Covid-19, I have not been able to go there and lately, I have again started to have some knee-pain after walking for a few kilometres, though the situation is yet not as bad as it was in 2015. I am hoping to go back for this treatment later in 2022. The image below from 2019 shows Dr Vijayan, the chief Ayurvedic doctor of this hospital, together with his 3 students from the Ayurvedic Medical College who were doing internship with him.

A couple of years ago, I had talked to an orthopaedist friend to explain what had happened, to try to understand why I had responded to the Ayurvedic treatment. His answer was that it was possibly a placebo effect. According to him, another possibility was that the effect of medicines taken in Italy had arrived after a few months.

Perhaps it was indeed a placebo effect, but I would like to know why I didn't have this placebo effect after treatment in Italy and after the injections in my knees? Are traditional treatments likely to induce more placebo effects? If yes, why?

Finally, a friend from Mongolia told me about her experience with traditional Mongolian traditional medicine. We are working together for a project and communicate frequently. Last week she told me that her mother was very unwell due to Biliary colic caused by stones in her gall-bladder. Her mother is quite old and she was in a great deal of pain. However my friend was hesitating to take her to hospital due to Covid-19 fears, so she was visited at home by a doctor and was given pain-killers. He had suggested that if the pain would not pass, they might need to do surgery for removing the gall stones. After 3 days of injections, her conditions had continued to be serious, so the family invited a traditional healer to visit her. The traditional doctor visited her and wrote some herbal medicines. Due to Covid-19 restrictions, it was not easy to buy the traditional medicines but somehow they managed. That night, after taking the herbal medicine her mother slept well after many days of pain. The morning after, it was the day of Lunar new year, she woke up completely pain free - she got up from bed as if she had not been seriously ill till the previous evening. My friend who had been so worried was overjoyed. She said that it was like a miracle. Once again, I am sure that if we ask, most doctors in the hospital will explain it as placebo effect or some kind of psychological effect.

These are all anecdotal stories without any scientific value, they do not prove anything. But if any of these had happened to you, will you be able to forget them? Such experiences illustrate why so many persons, especially in traditional and rural societies, continue to go to traditional healers even when experts tell us that there is no proof regarding their usefulness.

For persons like me, strongly anchored in the Western Medical Paradigm, alternative medicine may not be the first line of treatment for any problem, but I will seek it if modern medicine are not able to resolve my health condition.

A Role for Traditional Medicine

Even for persons who feel that alternative medicine is not effective or is illogical, I feel that in today's world there are some functions for which it can be very suitable. For example, think of illnesses like flu and viral fevers. Doctors say that these should be given only some symptomatic treatment and not treated with antibiotics because they are not useful. Still a large number of people take antibiotics for such conditions. I think that taking alternative medicines for such illnesses is a good strategy to discourage the antibiotic abuse.

There are so many chronic non-infective conditions accompanied by pain, like the ones I had in my knees or in my shoulder, where long-term treatment with conventional medicines can have many side-effects. So if persons can feel better with alternative medicines, why not encourage them to try?

When modern medicines can do little because we have not found treatments for some conditions, I feel that people should be given the option of trying alternative medicines. The image below shows a modern pharmacy plant for making Ayurvedic medicines based on herbs and oils in India.

I know the situation in India - alternative medicine is usually cheaper and is much more accessible to persons. Unless it is a life-threatening condition, often alternative medicine can provide psychological support and even serve as placebo and reduce suffering. In many villages, traditional medicine is all they have because modern medicine is costlier and located far away.

I feel that demonising alternative medicine as fraud and quackery and to think of people preferring it as gullible or stupid, is not the right approach towards it.

(An earlier version of this post was first published on my blog in 2021)

Failures in Global Health?

Three years ago, in July 2019 Dr. Madhukar Pai, Associate Director, McGill International TB Centre in Canada wrote an article on "Failures of Global Health". In this article he had written:

In global health, we love to talk about success stories and publish interventions that seem to work. Eradication of smallpox, dramatic decline in polio incidence, reduction in child mortality, etc. But we also know global health deals with huge, complex, challenges. And involves several agencies and stakeholders with their own agendas and political instruments. So, failure is guaranteed. Failure is a powerful tool for learning, and we can always learn from failed interventions and projects.

Then Pai went on to list some of the major failures in Global Health: "I do not see a similar openness about failure in the global health arena. To be sure they are discussed in hushed tones in the corridors of global health agencies in Geneva, New York and Seattle, but not quite publicly, in a way that facilitates learning."

I think that Pai was a little superficial for at least 2 of the failures (leprosy elimination in India and the goal of health for all) on his list. I feel that it is simplistic to give summary judgements of success or failure without taking the time to go and study what had really happened and the documents from that period. IMO, such views could have been understandable in past but in the internet age, so much information is openly available, such a judgement from Pai is less defensible.

Background

During the 1990s and 2000s, I was active in the discussions about Global Health at international level, for example, in the People's Health Movement (PHM). In that period, I was collaborating regularly with the World Health Organisation (WHO) in Geneva. Around 2004-05, for a couple of years I was also the president of ILEP, the international federation of organisations fighting leprosy. Thus, I witnessed firsthand most of the things about "Health for All" and "Eliminartion of Leprosy", I am writing about in this post.

The Failure of Leprosy Elimination in India?

Point number 9 on Pai's list of Global Health failures is about leprosy control in India. He says that it was a failure because, "In 2005, India declared leprosy to be eliminated and scaled-back on its leprosy programmes. Today, according to WHO, India harbors 60 percent of the world’s cases, with more than 100,000 new diagnoses each year." He links his judgement on this point to an article from New York Times, "In India, a Renewed Fight Against Leprosy - Health workers thought they had vanquished the disease in 2005. But it lived on, cloaked in stigma and medical mystery."

I believe that this is an unjust and superficial judgement about the leprosy services in India and its achievements. The "failure" in this case, if we can call it that, should be attributed to the World Health Organisation (WHO), which had set up the "Leprosy Elimination Goal - to reduce the prevalence of leprosy to less than 1 per 10,000 population by the year 2000".

The WHO goal was actually for "reducing the leprosy burden" but it was called "elimination goal" for political reasons. In 2000, WHO had declared that the elimination goal had been reached at the global level, but India was not included as a success at that time. India had managed to reduce its leprosy burden to the level of WHO's elimination goal only in 2005.

Declaration of "Global Leprosy Elimination" did lead to premature closure of many leprosy programmes around the world, but fortunately not in India.

Instead of asking about the "failure of India's leprosy programme", we should be asking - "What is the impact of setting international disease-control targets and what can we learn from the experience of WHO's Leprosy elimination goal?" I want to answer that question in this post.

I am writing this post from my memory of the events, but a lot has already been written about it, as can be seen from a simple literature search.

WHO's Leprosy Elimination Goal

The goal of "Eliminating leprosy as a public health problem by the year 2000" was decided by the World Health Assembly (WHA) in May 1991. This goal was aimed at a reduction of leprosy-prevalence to less than 1 case per 10,000 population and was not aimed at reducing the incidence of leprosy (number of new cases). Thus, in this goal, the word "elimination" did not mean how ordinary people understand this term. Everyone involved in setting up the "elimination goal" knew that it was not possible to actually "eliminate" leprosy in the sense of "not having any new cases of the disease".

What was the rationale behind the decision of setting up this goal? The official reason was that if we could reduce the prevalence of leprosy in a population, the pool of infected persons would decrease and gradually the disease incidence will also decline. People and organisations working in leprosy control such as ILEP had opposed the "elimination goal" but were over-ruled (some of those discussions never really stopped and even today continue in some form on LML, 30 years after the decision of WHA).

Need for the Leprosy Elimination Goal

There was another reason, a more important one, for setting the Leprosy Elimination Goal. MDT, a new combination of drugs for treating leprosy was recommended by WHO Expert Committee in 1982. A review meeting organised by WHO on the progress in the implementation of MDT was held in Brazzaville (Congo) in 1990. It had shown that after 8 years of recommending and promoting MDT, globally less than 15% of the leprosy patients were being treated with it, while the remaining persons were still taking only Dapsone (in many endemic countries, the percentage was less than 5%).

I believe that this situation was linked to 2 other issues - (1) most of the leprosy programmes were being run by NGOs and missionaries, while the governments played little or no role in them; (2) the programme decisions were made by clinicians, who focused on individuals and not on the collectivity. Thus, while the WHO had been pushing for the adoption of MDT, doctors working in leprosy programmes felt that MDT administration needed their personal supervision and were hesitant to start it in rural areas where doctors were not available.

The "Elimination goal" was targeted at the governments, asking them to assume greater responsibility and, simplify and expand the use of MDT without requiring supervision of doctors and it achieved great success in reaching both these objectives - MDT coverage increased across the world and national governments took over the responsibilities for running their leprosy programmes from the NGOs and the missionaries.

International Pressure to Reach the Leprosy Elimination Goal

Fixing international targets and goals can motivate governments and people but it also has some side-effects. For example, for the leprosy elimination goal, once the  target was fixed, there was a lot of pressure on countries to reach the goal. If a country did not reach the goal then this meant that their programme was not good or their health staff were not working properly. On the other hand, there were insufficient discussions about the strategy itself, that reducing the numbers in high endemic areas within that period was not feasible because the other instruments to control leprosy (such as a simple serological test for diagnosis or a vaccine for its prevention) were missing.

When it became clear that many countries like India and Brazil would not reach the elimination goal by the year 2000, there were other effects. So, under the new WHO guidelines, treatment duration was reduced, active search for new cases was stopped and countries were encouraged to quickly integrate vertical leprosy programmes into their primary health care systems. All these measures helped in reducing the identification of new cases, the numbers decreased and India could reach the goal in 2005.

I remember the press-conference during WHA in Geneva in 2005, during which the announcement about "elimination of leprosy as a public health problem in India" was made as a triumph of the global health.

Impact of the Leprosy Elimination Goal

As explained above, the "elimination goal" was actually a "reducing the disease burden goal" and its objectives were to expand MDT and to improve government run leprosy control services. The elimination goal was successful in both these objectives. Expansion of MDT had a huge impact and millions of persons could be treated effectively and a large number of complications such as disabilities were prevented. Thanks to the goal and expansion of MDT, individuals affected with leprosy could be fully treated in 6-12 months and avoid most of the complications. Finally, for the health workers leprosy was like any other disease.

Once it achieved those results, ideally WHO should have clarified it and explained to the countries that we had not eliminated leprosy, we had only reduced the disease prevalence. However, that was not possible due to political reasons. Many persons involved with this issue in WHO had also started to believe that with reduction of disease burden, the disease transmission will be interrupted and the number of new cases will start deceasing, and were very optimistic. Unfortunately that did not happen and the fall in the number of new cases over the past 20 years has been much slower. The image below shows the participants in a WHO meeting in 2005 (Dr Lee, DG of WHO is in the centre, while I am the first on the left ) to talk about the leprosy elimination goal.

Reaching the "leprosy elimination goal" had consequences. Thus, in different countries across Asia, Africa and South America, reaching the goal led to many countries to scale-down their leprosy control programmes, even when they still had many new cases. Fortunately for countries like India, Indonesia and Brazil, their health professionals knew that leprosy was still a big issue and they could continue the leprosy programmes, but for many smaller countries, especially in Africa, achieving the elimination goal led to elimination of their leprosy programmes for many years.

This leads us to the question of the need for goal-setting and international pressure for reaching numerical targets. When your country is lagging behind in reaching an international target, what happens to its health workers? The answer is easy to guess - if they do not show the required impact on the disease condition in their work areas, they will be labelled as a bad workers and their programme will be called a badly-run programme, without looking at the real situation on the ground. So what are the options for them? In many leprosy programmes across the world, when their new cases did not decrease, many of them stopped registering new cases and therefore, manipulated their data.

For example, at the African Leprosy Congress held in Johannesburg in 2005, it had come out that Tanzania which had apparently reached the elimination goal in 2000, had actually manipulated its data for achieving the goal and the actual number of cases was still high. 

Unfortunately, the negative impact of the term "leprosy elimination" for this goal continues to create problems even today, because countries and health workers start beliving that do not have a significant leprosy problem.

For example, in 2016, I was involved in the evaluation of a leprosy programme in a couple of districts in central India. The evaluation showed that eleven years after reaching the WHO goal, district health officials were still confused about its meaning and many health workers complained that if they find "too many new cases" it created problems for them because the districts with higher number of new cases were seen as "bad districts".

Over the years, WHO keeps on finding new goals for the leprosy programme but the confusion created by "leprosy elimination programme" continues to exist and to create problems.

Let me now touch briefly on the "Impact of Health for All" goal of WHO. 

Failure of Alma Ata Declaration

Pai's list of failures of global health also includes the failure of the Alma Ata declaration and the goal of "Health for all by the year 2000". In his article, he had written that, "Failure to deliver on the Alma-Ata declaration: Despite the 1978 Alma Ata declaration on "Health For All by 2000", nearly half the world's population lacks access to essential health services."

Alma Ata declaration on the Primary Health Care in 1978 with its goal of "Health for All by the year 2000" was one of the biggest utopias which has motivated and mobilised the health activists all over the world for almost five decades. Even today, the echoes of that call continue to reverberate among us. I think that a summary judgement that the goal of Health for All was a failure, does not take into account the impact it had and continues to have even today, for example its influence on the discussions about the Universal Access to Health.

Fifteen years ago, I had some opportunities of talking about Alma Ata with Dr Halfdan Mahler, who was the director general of WHO during the Alma Ata conference and one of its main inspiring figures. Dr Mahler, originally from Denmark, had been working in the TB programme in India, before taking up the role with WHO (in the picture below, from left - Hani Sareg/Egypt, Armando/Brazil, I and Dr Mahler in Geneva during a World Health Assembly).

Some Achievements of Alma Ata Declaration

I think that Alma Ata declaration was an impossible dream but it was an important ideal at that time because it was so inspiring. I would not call it a failure, I think that it was and continues to be one of the most successful ideals of Global Health. It helped in achieving some important services - from my personal experience of working in international health programmes, three elements are mentioned below as an example:

(1) Alma Ata declaration and health for all was not a single goal. It had many elements in it, and many of them were implemented successfully. For example, the essential medicines and the programmes for fighting against different infectious diseases, both of which had a huge impact.

(2) For 30 years, I was involved in Community- based Rehabilitation (CBR) programmes (also known as Community-Based Inclusive Development or CBID) aimed at persons with disabilities in rural areas of lesser developed countries. The CBR approach was a part of the Alma Ata dream, which had developed independently because PHC approach was struggling for its own implementation. CBR also had a positive impact on thousands of lives of persons with disabilities and their families all over the world.

(3) Another related programme, which was inspired from Alma Ata and has been finally realised in the past couple of years is that of Priority Assistive Products list, which brings assistive technology to persons with disabilities and elderly persons.

I am sure that others can come up with many other examples of successful programmes which were inspired by the spirit of Alma Ata declaration. May be they were not fully achieved in 2000. Certainly, a large number of people still do not have access to essential health services, even in rich countries like USA. But a lot has been achieved since the Alma Ata declaration as shown by the evolution of global morbidity and mortality data across countries.

Impact of Other Factors

In terms of learnings from the Alma Ata declaration and the "Health for All by 2000" goal, for me a key take-away point is that health services and related goals can't be seen in isolation, they need to be looked at against the background of everything else happening in the world, including wars, famines and the role of international institutions.

I remember many discussions in People's Health Movement during which one reason had come up repeatedly for not having achieved a full primary health care (PHC) services approach across the countries - the decision by UNICEF to implement selected elements of child care because they felt that countries did not have sufficient resources for a full implementation of the PHC approach. Looking back, I don't think that UNICEF was to be blamed because in any case, the idea of providing free primary health care to everyone everywhere was an impossible dream in a world which was controlled by forces that did not see this as important or feasible.

During the debt crisis of the 1990s, the International Monetary Fund (IMF) and the World Bank, by promoting austerity policies, had hammered a big nail in the PHC's coffin. Since then, over the last 30 years, looking at health services purely in terms of numerical calculations of costs-benefits, cost-cutting and privatisation across countries, including those which had a good model of universal health care such as UK and Italy, has further taken us away from the Alma Ata trajectory.

A second Alma Ata conference was held in October 2018, which agained called for universal health coverage and sustainable development goals. However, I doubt that it is going to stimulate the dreams of activists around the world like the Alma Ata declaration had done in 1977. This may be also because today we live in a different world, a world of climate change, AI and internet, where new goals are set and forgotten all the time. The Millennium Goals have gone by, the Sustainable Development Goals are coming and setting international goals is a business strategy and not an exercise in idealism.

Conclusions

Pai's list of "global health failure" provoked me to write this post. As my explanations about leprosy and Alma Ata show, each of these points can be subjects of debates, and the answers may not always be negative. I think that similar provocative statements can be very useful to stimulate us to go deeper, study what had happened and reflect on the lessons we can learn from those expereinces.

A key point of Pai's article was that we don't learn from our failures. I am not sure if it is true. I think that the professionals involved in each of these "failures" must have debated and reflected on what happened and why for a long time, like we did about leprosy elimination. However, as time passes, all those discussions are forgotten and unless one takes the trouble of going back and reading through different point of views, the lessons learned can be easily lost.

(Note: an earlier version of this article was published in my blog in October 2021)

Liberal Dilemmas

I have always thought of myself as a liberal. However, increasingly I feel confused when I am faced with competing liberal values. Often, I am not sure, which values should be chosen and why. Most of the times, the more I try to read and understand about these issues, the more complex they seem to become. In the end, it leaves me frustrated because I can’t make any decision.

Even a decade ago, if somone had told me that I will be confused about my liberal values, I would not have believed it. It is not just me. Many others I know, face similar dilemmas, while some others, wh seem to have taken a positio, can't really explain their choices in a logical way.

So, lately I am not very sure, what kind of liberal I am or if I am really a liberal! One thing is sure, compared to some people’s certainties, I feel like a sand-castle whose walls fly off in all directions at the first sign of the wind.

Liberal Struggles in the Past

The identity struggles in the past were simpler. For example, fighting for the LGBT rights used to mean that countries and societies had to accept persons who identified themselves as LGBT, and that they were citizens like everyone else. Those struggles are still not over in many parts of the world. For example, in some countries, to be gay or lesbian or a transgender person can lead to blackmail, rape, prison, torture and even death. In addition to the specific anti-LGBT laws, in some countries, it is socially accepted that families and communities can force individuals into marriages, undergo conversion therapies, get raped or even be killed.

Countries which accept the individuals with different sexual orientations, might have other struggles. For example, their right to live with or to get married to the persons of their choice or to adopt children.

Often, most of our liberal struggles were framed in terms of limiting the role of religions and traditions in our lives. For example, when these impacted the lives of women and other marginalised groups such as "lower" castes in terms of where they could go, how they could dress or the professions they could choose.

New Directions of the Liberal Struggles

Over the past couple of decades, in the developed world those fights for the rights have branched out into new directions. Often, in these new fights, the rights of one group of persons start competing with another, and we have to decide which rights and whose rights are more important.

One big arena of fight is about the words we use to talk about things, especially in English. Thus, it is no longer about the intentions of the persons, or their histories of work in challenging the oppression and marginalisation of people – the moment they use some “undesirable” or "politically incorect" words and terms, they can be attacked, sometimes viciously, even to the point of destroying their reputations, jobs and lives. Every time this happens, it leaves me dismayed. People playing victims because their "dignity has been outraged" by the politically incorect terms are full of rightous anger and can be extremely unforgiving and vindicative. However, this article is not about the use of politically correct language.

Instead, in this post I want to share some of my doubts about some other liberal values - gender identities, religious/cultural identities, women’s rights and the rights of the persons with disabilities. Let me start with the dilemmas about gender identities in sport.

Identities and Sports

In the 2021 Olympics held in Tokyo, the New Zealand’s women’s weight-lifting team included Laurel Hubbard, who is now a transgender woman. 43 years old Laurel had transitioned to become a woman in 2013. In the past, she had participated in other Olympic games as a man. Many women weight-lifter teams from other countries protested against her inclusion since they felt that Hubbard will have unfair advantage. However, she failed to win any medal and in the end the polemics died down.

Lia Thomas, a transgender woman swimmer from Pennsylvania university has been in news in 2022, for her repeated wins in free-style swimming events. Thomas had previously competed in the men's team for three years before joining the women's team, the last time as a man was in 2019. Many persons had expressed anger at her success in the women's swimming events and called it as "unfair advantage". According to the local rules a trans woman must complete one year of the male-hormon suppression treatment before she can take part in women's events in Pennsylvania University.

Another story was that of Santhi Soundarajan, a middle-distance runner from Tamil Nadu in India, who had grown up as a female. In 2006, when she was 25 years old, her silver medal in the Asian Games was revoked because her DNA test had shown that instead of the “XX” chromosomes of women, she had “XXY” chromosomes. It didn't matter that Santhi had no idea about being genetically an intersexual person.

How do you feel about the stories of Laurel, Thomas and Santhi? Should they be allowed to take part in the women's events? In 2006, when I had read about Santhi, I had felt that the organisers had been cruel and unjust towards her. However, when I looked at the pictures of Hubbard and Thomas, I saw broad, tall and muscular bodies, and I could understand why the other women in the championship had felt that it was unfair. 

We have separate sports competitions for men and women, because men and women have different bones and muscles because of their hormones. Somewhat similar logic is used for the participation of persons with disabilities in sports – separate sport events are organised for them and they are asked to compete against other persons with disabilities, for example in Paralympics.

So, a person who has grown up with male hormones with a certain kind of bones, muscles and bodies, and who decides to transition to become a woman, should compete against other women or men? Women protesting against Laurel’s inclusion should be seen as persons’ fighting for women’s rights or as trans-phobic?

As a liberal, what should be my position on this? I have to confess that I am not so sure. For sports where body strength is not the most important variable, for example for playing tennis or badminton, I think that transwomen athletes won't have unfair advantage, but for something like the javelin throw, it can be an issue. While reading about Thomas's own behaviour at a swimming meet where she had won the title, I think that she herself is also conflicted about it. 

I have not seen similar discussions around trans-men's participation in sports and they seem to be accepted more easily, which is understandable because other men do not see them as "unfair advantage". For example, Moiser (Lake Zurich, USA) had taken part in the women's team of triathalon in 2009. A year later, he decided to transition to become a man and in 2016 became selected in the men's team.

Trans-men usually take the male hormone (testosterone) as part of their transitioning and on-going therapy while its use is prohibited among male athletes. So, I am not sure how does that work when they try to qualify for Olympics and Paralympics.

Defining the identity

There are many on-going debates around the issues of gender and sexual identities. For example, in some countries, transgender persons when they transition, can ask to be legally recognised as a man or as a woman.

In many countries, women transitioning to become a man must get operated to remove their uterus before they can be legally recognised as a man, while men transitioning to become a woman must get their testicles removed before they are legally recognised as a woman. This is done to avoid that a legally recognised man can become pregnant or a legally recognised woman can father a child.

However, many transgender persons feel that they have a right over their bodies and being transgender is more about how they feel in their hearts and not about compulsory removing of their body parts. Thus, there are trans-men who have their uterus and trans-women with functioning male genitals, and both these groups are fighting for the right to be legally recognised as men and women.

On the other hand, some other trans-men and women, who have been through surgical operations and have got legal recognition, feel that it is problematic if for being recognised as a trans person it is enough only to declare that you are one.

There are also debates about “real woman” versus “transgender woman”. Last year, in June 2020, a huge controversy had erupted about an essay written by the writer J. K. Rollings, who was called trans-phobic for differentiating between biological women and trans-women. Some weeks ago, Nigerian author Adichie Chimamanda has also been criticised for the same reason.

For not discriminating against the trans-women, some persons are advocating the use of more "inclusive" terminology, such as "chest-feeding" instead of "breast-feeding", and "birthing parent" instead of "mother". Many women have spoken out against these terminologies as they seem to negate women's rights and spaces.

 

I feel that these discussions about trans-women and biological women have implications for another liberal value – the respect for diversity. When we ask for trans-women to be seen as women, are we asking for negating the diversity of their experiences? The struggle for recognition of diversities has become very complex over the years. For example, many groups feel that the term “LGBT” is restrictive. Some ask that we should use the acronym LGBTQIA (Lesbian, Gay, Bisexual, Trans-sexual, Queer, Inter-sexual and Asexual), others prefer LGBTQ+. Some persons do not feel comfortable in any of these labels, they feel that they are somewhere in between. Some feel that their gender identity is fluid and can change, so occasionally they might fit one label, but not always.

Thus, on one hand we are advocating for increasing recognition of our diversities. On the other, we are asking of cancelling the diversities of terminologies between trans and cis women (many men and women do not like the term "cis"). As liberals, which value should be considered more important - equality or diversity? I am confused.

Religions, Traditions and Modernity

I grew up surrounded by discussions about patriarchy and women’s rights. In those discussions, the traditional Hindu wife, her face covered with her sari or a scarf, walking two steps behind her husband, was a symbol of women’s oppression under the guise of traditions. We agreed that women have a right to dress as they wish, choose the profession or work they like and marry the person they wish to. In those discussions, fights against the traditions were not seen as fights against the religions and in my mind, those discussions applied to all the religions. Thus, the fight for a common civil code, a uniform law that applies to all the persons of different religions in multi-religious societies, was seen as an important liberal value.

Over the past decade, suddenly such discussions have become more problematic. For example, the ban on wearing of full veil covering the face among Muslim women in some countries of Europe. The liberal position has sided mostly with the more orthodox groups by insisting that “Hijab and veils are cultural symbols and a free choice of Muslim women”. However, discussions with the cultural mediators working in the immigrant communities show that peer, family and community pressures and expectations play a large role in use of veils and hijabs, and sometimes, young girls face violence for rebelling against those pressures.

For example, Italy has a large Pakistani immigrant community. Last year, a young girl of Pakistani origin went missing while she was rebelling against family pressures. Police suspects that she was killed while the rest of the family went back to Pakistan. Debates among the Pakistani community on this theme underline the difficulties of talking about women's attempts to escape the social control on how they dress and the persons they wish to marry. Some girls insist that modest dressing including hijab is their free choice; others, usually men, at best talk of "not washing our dirty laundry in public because there is already so much discrimination against us" and at worst, threaten the few dissenting Pakistani women's voices about the perils of not obeying the "fundamental values of our religion/culture".

Sometimes, even in a European town you can find very young girls from Muslim background being covered from head to feet, while some see it as "sexualisation of young girls". The community spokespersons often talk of veils and hijabs as important for their faith. Recently in Afghanistan, the Taliban authorities have made maindatory the use of full veil by the women. So in such a situation, can hijab and veils be seen as "free choices"? Liberals refuse to talk about this because they see it as reinforcing the negative stereotypes about Muslims. 

Similar dilemmas face immigrants from Africa. Black persons in Europe are often stereotyped as drug peddlers and criminals. At the same time, many black women face domestic violence. Liberals often refuse to raise the issue of violence experienced by black women for not reinforcing negative stereotypes against the black communities.

Thus, how do we talk about the negative stereotyping faced by Muslims or blacks in Europe, without closing our eyes to the rise in conservative Muslim forces which increasingly force women and LGBT persons into silence or the black women victims of domestic violence? Is there a way to talk about one without negating the other? While talking about patriarchy is encouraged among Christians and Hindus, in relation to Muslim women it may be seen as Islamophobia.

The Right of Choice and the Right to Life

The women’s right of choice to say no to unwanted pregnancies and to have safe spaces for abortion was another of the progressive struggle with which I had grown up with. When I read about conservative groups, which oppose women’s right to have safe abortion, because their church says so or because Bible says so, I have no doubts about which side I am on – I support women’s right to make the choice.

However, over the past decade, increasingly there are groups of persons with disabilities, which fight is for the right of children with disabilities to be born and not be aborted. For example, one of the common reasons for abortion is when tests show that the child will be born with a disability such as Down’s Syndrome.

So, should we continue to support women’s right over their bodies and their wombs and only they can choose if they wish to go ahead with a pregnancy or should we be on the side of persons with disabilities asking for life for children with disabilities?

In the End

There are no easy or blanket answers to these dilemmas. At the same time, I feel that it is important that we continue to talk about them, without being trolled or called names by those who feel that they already have the answers.

Let me conclude with a couple of additional issues, which I believe are important liberal values – (1) not labelling people, and accepting nuances and complexities of peoples’ beliefs and affiliations; and (2) freedom of expression.

The moment we say something, there are people waiting to stick labels to our foreheads – right wing, left wing, fascist, communist, follower of this or that. I find this extremely tiring. I refuse to label people and I try to have a dialogue with everyone - when I find that I don’t like some of their positions or opinions, I can always ignore them. My motto is "the world is big and there is enough place here for people who don't think like me."

Finally, I believe in freedom of expression, even of people with whom I do not agree, as long as they are not actively inciting violence. I believe in people’s right to raise questions about every thing including religions, gods, and prophets. I do not agree with trolls and fundamentalists who want to cancel all the voices they don’t like.


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Notes

01: The images used in this post are from the Guwahati (Assam, India) LGBT Pride Parade in 2015.

02: An earlier version of this article was published in my blog in June 2021