Medical Tourism – Andy Jackson

launch of “Immune Systems”

Yes, another book. I’m humbled and excited to announce the imminent release of “Immune Systems” through Transit Lounge. “Immune Systems” is the result of two trips to India, and a lot of percolating. The first half is kind of verse novella on the uncanny and fraught world of medical tourism. The second half is a suite of ghazals on travel, desire, estrangement and (yes) bodies. For some insight into the process, check the posts here.

The launch is on Tuesday 17th March at 6pm (for a 6.30pm start) at Collected Works Bookshop, Nicholas Building, 1/37 Swanston St, Melbourne. The book will be launched by the multi-talented poet and artist Luke Beesley. I would love to see you there.

Thanks to Transit Lounge publisher Barry Scott for his faith in the poems; and to Anjum Hasan and Ali Alizadeh for these generous quotes:

‘Andy Jackson has made a most delicately probing poetry out of the detritus of urban India. This is a humane and moving book.’

−Anjum Hasan.

‘Andy Jackson writes exceptionally well about India. But, as though unsatisfied with merely writing about one of the world’s most wonderfully complex social scenes, Jackson is drawn to the country’s medical system. This focus perfectly suits his terrific poetic gift for fusing the clinical with the affective. The poems in Immune Systems are succinct and absolutely engaging expressions of a humanity caught between the demands of the body and the vagrancy of the mind.’ – Ali Alizadeh

There’s a Facebook event set up for the launch if you’re that way inclined. If you can’t make it and would like to buy a copy, you can order it through Transit Lounge or of course drop into Collected Works any time after the launch.

what about the poetry?

It’s about time I let you know how I’m going poetically. I’ve been away now for about 7-8 weeks. Which I should say has been a rollercoaster – ie, full of ups and downs, and not something you can just stop halfway because you feel you need a little break. At times, it’s been astounding, sublime or just plain odd (see photos in the previous post!). Other times, mundane, difficult or exasperating. Mostly, India gives you the opposite of what you’re expecting, or at the very least it goes off on its own tangents.

I’d planned to write a suite of poems exploring the personal side of the medical tourism industry. And I think I’m getting there. There’s a lot of roughness to the drafts, but I should end up with 20 to 30 poems. It hasn’t worked out how I expected – making contacts in the industry itself has been hard (with a few exceptions) and sometimes the smallest hurdles have felt like great walls. As many wise people have said, channel it all into the poetry. And I have.

The dilemma has been that I’m very aware that the outsider’s perspective is very clouded by the obvious sensory assault – poverty, rubbish, religious ritual, traffic, etc – and a poetry composed of this risks not only cliche but distortion. India is much more complex. Of course, I also don’t want to succumb to the current demand from (a segment of) middle-class India to “not focus on poverty”. There is an incredible (perhaps understandable) sensitivity within India to how the nation is depicted in the rest of the world, a desire to be seen to be transcending its historical shackles. Which to me is all the more reason to focus on the economic disparities, as well as exploring what might be behind this sensitivity. India is a country that has enough maturity, intelligence, wealth and ingenuity to not only handle criticism but to come up with its own solutions. By the way, I think Australia has its own version of this…

I suspect the other tricky thing will be the redrafting – I’m trying to do the bulk of that here, because I know that a lot of the heart of a poem depends on mood, which is difficult to recreate. Of course, I could always recruit a thousand auto-rickshaws and cars to encircle our house honking their horns, but there’s more to India and poetry than that.

where am I?

Why “where am I?”?. Because I’m assuming you’ve all been wondering why such a delay between posts. And because the last week or two have seen many answers to that question, all variations of the kaleidoscope India.

I’ve managed to talk to the very helpful and warm manager of Wellspring MediTour India, based in the very suburb of Chennai that I’ve been staying in. It’s a relatively small business at the moment, but (as he kept reiterating) he’s not interested in amassing money, wants to let it grow organically. I surmised Wellspring assists around a dozen patients a year, mostly from the middle east, to travel to India for medical treatment. There’s a poem emerging from this conversation, which I don’t want to pre-empt, but I will say that the main thing I got out of it was the genuineness and sincerity of the man. This, of course, is within the context of a very complex business, which requires constant attentiveness (and I would argue, a kind of blindness or turning away from other situations of need).

Speaking of blindspots, I also made the acquaintance of VS Sunder, who has a fortnightly column in The Times of India (Chennai). He’s a mathematician by profession, but the column delves into issues of accessibility and disability in urban India. As you can imagine, if you have any condition that means you can only get around in a wheelchair or even with a stick, accessibility is a purely hypothetical idea in most cases, a chimera which is legislated for but almost entirely ignored. Sunder’s column wittily and insightfully points this out. His website is here. Oh, and yes, in terms of blindspots, just the other week, opposite his column was another essay extolling the virtues of the Indian political system, which is premised on equality. Hmmm.

Last weekend, I attended the 7th Indian Writers Festival, this year at Wardha, a small town near Sevagram, Maharashtra (where Gandhi had his ashram for about 12 years). The Festival is organised by Indian Writers, and included participants from about a dozen states and six other countries. While the majority of the festival was in Hindi, the gentle passionate avalanche of poetry and abstracts of papers, the interaction between people and just the fact of being present in a group of writers, was a tremendous experience. Much of the weekend was taken up with reflections on peace, Gandhi and translation. It occurred to me, observing the audience response to Hindi poetry, to sung ghazals, and other languages, that language itself is a community with deep roots reaching across states and continents. It has been a revelation for me to realise, too, just how culturally-infused my own poetry is, how my Australian-ness is infused in the language of my poems. For those of you who’ve been to India before, you won’t be surprised when I tell you that on the surface the festival seemed quite shambolic and loose, but also everything worked out fine!

Soon – lots of photos….

already?!

So, I’m about half-way through this residency. It’s reached the stage now where I oscillate between blase and alienated. A bit like rowing across a huge lake – you get used to the strain and rhythm of rowing, but now and then you look up and realise how big the journey is. And you run the risk of becoming overly conscious of the task at hand. Because in my experience, poetry is shy – it comes most often when you’re not approaching it head-on but sideways. I can’t help now but wonder how much more progress I’ll make.

Anyway, stocktaking is boring. So, what’s been happening? I spent a week out of Chennai at Mamallapuram and Pondicherry, both gorgeous, charismatic and laid-back towns in their own way.

Mamallapuram is about 2 hours south of Chennai, on the coast – a small little fishing village that is surrounded by 6th century temples carved out of solid rock and by 21st century tourists. Which means almost everyone is a stone carver and will offer to sell you something. It also means there are lots of Ayurvedic businesses. I had a chat with a practitioner, who told me 99% of his work is with foreigners, and most just come for massage. A few seek out the more intense and in-depth treatments, but even then he finds that health success varies greatly with “Europeans”. Apparently, since they’re on holidays, they don’t want to give up things like drinking and smoking (which kind of goes against the whole point of panchakarma…). He also read my pulse – a fascinating process which felt both highly ephemeral and a little mechanical. For the record, I am currently predominantly “vata”.

Pondicherry, being a French territory until the 1950s, and currently a Union Territory, means it’s oddly un-Tamil Nadu in many ways. Apart from the obvious French architectural flourishes, the infrastructure (roads, drains, etc) are a little less ramshackle. The city itself is noticeably more diverse than Chennai, in terms of culture, religion and cultural background.

On a less picturesque note, I’ve just finished reading a fascinating book by Dilip Menon called “The Blindness of Insight”. Basically, it’s a series of four essays about the central, though often ignored or elided, role of caste in Indian society and literature.

there appears to have been [in the 19th century] an intimate connection between the social criticism of subordinated groups and an anguished and persistent engagement with the emancipatory potential of religious conversion (eg Ambedkar). Elite groups too turned to a refashioning of tradition (eg Vivekananda), but for them it was easier to find a habitation within the resources of Hinduism…

Menon, to me, reminds us that caste shapes not only social interactions, but is a crucial element in how people experience religion, family, social support structures and health. There is no monolithic, static experience of these ideas and institutions. He also implies that marginal people, when they manage to find the resources to seek change, look instinctively to revolution rather than to recuperation. This has been an illuminating element in my slow, long education in the complexity of this place.

Next week, I hope to meet a doctor who works at a Medical Tourism Agency. Should be fascinating. But I’ll leave you with this thought…

form and content in India

No particular reason for this including this photo – it just says Chennai to me. It’s my local train station. 10 rupees gets me into the University and back. There was a little panic in the news in Melbourne a while ago that some of the doors on our metropolitan trains could be forced open. Here, the doors are always open, passengers leaning out of them as we hurtle through the city…

Anyway, back to poetry and medicine. I just finished reading a fascinating book on “modern Ayurveda” by Jean Langford, called “Fluent Bodies: Ayurvedic Remedies for Postcolonial Imbalance”. The title is good enough, but the exploration is brilliant. To truncate its broad scope, basically she looks at how Ayurvedic training, knowledge and practice have responded to the modern world. She concludes, among other things, that Ayurvedic practitioners have been torn between imitating the “scientific” and standardised approach of biomedicine and establishing Ayurveda as a valid and separate alternative. The former seems to have predominated, but it is still haunted by the indefinability and mystery of the body as Ayurveda imagines it – this especially comes out in the (now fading) practice of pulse reading. Anyway, a quick quote –

The modern state in its various brances cannot it seems enframe and enclose the social ethos. Similarly, many practitioners seem to feel that modern Ayurvedic institutions cannot enframe and enclose the practices by which Ayurvedic knowledge is actually transmitted… In modern Ayurvedic institutions, the illusion of an alignment between form and content seems to be less fiercely sustained than it would be for instance in the U.S…. Could the difference be partly that in modern India the dualism of form and content is more a syntagma to perform than an episteme to protect?…

Now, when I read this, apart from having to go and look “syntagma” up (it’s a linguistic arrangement), I really felt like Langford touched on something really crucial about the contemporary Indian mindset and way of being. I’m still thinking what that exactly might be and mean, so any of your thoughts (or examples) will be welcomed with open arms.

So, while my project does revolve around medical tourism, there is also a lot of interest in Ayurveda from foreign travellers (certainly in the massage, a little less in the blood-letting and purging…). That angle is fascinating to me – the sense that Indian people are giving Westerners what they believe we want – there’s some kind of “feedback loop” going on here I’m interested in unravelling. I’ve just arrived in Mamallapuram, which has a little tourist enclave, so I’ll see what I can find out.

Last week I also gave a poetry reading at the English Department of the University of Madras. After being generously and capably introduced by Professor Armstrong, and by Assistant Professor Ms Supala Pandiarajan, I read a series of poems from “Among the regulars”, interspersed with a few words about my background, the themes I’m drawn to, publishing in Australia, as well as pre-emptively translating some Australianisms.

I have to say, something about this event made me feel at home. I’m very glad to have been able to read poetry to a group of intensely thoughtful (and thoughtfully intense!) young students/writers/academics. What was particularly interesting to me is that there was a lot of questions about the creative process and about how a poem is worked on, shaped, finished, and how it can be assessed. These are perennial questions, yes, but I suspect this is related to the University system also, how institutions baulk at marking creative work, leaving students to pursue those avenues externally (or not at all).

One more tiny thing I want to mention is my “Steripen Adventurer” – a little battery-powered UV wand that kills bacteria in water. I’ve been using it for about a month now, which is a lot of plastic water bottles I haven’t been responsible for leaving behind. I totally recommend it. It comes with a solar charger, which I haven’t used, as my room hasn’t had sunlight coming in (probably a good thing that), but you can still charge it (slowly) from the wall. The only real down side is that in some places and times, you can make the tap water safe to drink, but it still tastes awful. After so many years of being separated, welcome back into my life – “Tang”!

“how can you write poetry about medicine?”

A few days ago, I met Dr Rajan from Dr Smilez, a dental clinic in Chennai. There was a brief article in the Times of India about a happy UK man who’d travelled to India to get some work done on his teeth. So, how could I not call? They agreed to meet me, even though the receptionist and the doctor both seemed a little perplexed at my explanation – that I was writing poetry about people who travel for medical treatment. “How can you write poetry with a medical theme?”, he asked. Fair question really.

We chatted for a while, and they both laughed and relaxed when I told them how shocked I was at my hotel the first night. The good people at Dr Smilez try to convince patients to not cut any corners financially, to stay at the best hotels, ideally allowing the clinic to facilitate their travel while here, too. I, of course, was not staying at the Park or the Hyatt.

Of the many fascinating things that came out of our chat, I just want to mull over this one – there seems to be a peculiar paradox going on with overseas patients when they come to India. I keep reading and hearing that they want the absolute best treatment, which I’m sure is true – we all want to save money, but not of course at the cost of our health. Still, the other theme that keeps coming up is how anxious non-Indians are about hygiene, how when they see the overflowing rubbish bins, the plastic and sewerage in the streets, these images risk spilling over into and upsetting their faith in the medical profession here. As Dr Rajan said, the clinics are sterile and clean. But it seems some kind of fear haunts them or their experience.

I’m keen, of course, to talk about this with a real live patient, but all things take time, especially here.

Over the weekend, I also attended some of The Hindu newspaper’s “Lit for Life” festival – a weekend of literary talks and interviews. The Hyatt’s function room was absolutely overflowing for the session with Bollywood star Shabana Azmi talking about the translation of her mother’s memoir (Shaukat Azmi writes in “Kaifi and I” about her partnership with the famous Urdu poet, about activism, art & poetry in 20th century India). The organisers chalked it up to Chennai’s literary enthusiasm, but I could cynically say it would have something to do also with their love of film and fame. Looks like a fascinating book, though. Anyway, the highlight for me was the session with Karukku Bama, K Sivakami and Susie Tharu. The former two are Dalit writers, poets and activists. There is much for me to learn about India, a lot of which I feel has to do with caste and its power and persistence. I know very little. But what blew me away was the strength, insight and courage of these writers. Bama at one point said “who decides how human I can be? who says, this far, no further?!”. In a more gentle tone, Sivakami said something to the effect of “I follow my words and they take me to interesting places”. Interesting indeed.

What’s interesting too is the response. One audience member asked why they have to keep writing about the negatives, why can’t they write about all the good things that are happening to Dalits? Hmmm. Questions like this are often thrown at many oppressed people, variations of a desire for silence, to not be reminded of ongoing suffering and inequality. It also reminds me of the backlash against “Slumdog Millionaire” in India… As we were often reminded in this session, society needs the broken perspective, the outrage, and militancy is a healing movement.

Speaking of pleasant surprises, I also found Oasis books – 29 Kutchery Rd Mylapore, run by the gentle, informed VRJ Prabalan. Oasis stocks some fascinating political books, left-wing philosophy, books on caste, feminism, ecology, organics, poetry, and a lot more. It’s not a huge store, but it’s very rich, and to me an affirmation that there is counter-cultural thinking going on. If you’re thinking of dropping in, best to call in advance – it’s not always open (ph 044 2461 3445).

It hasn’t all been wondrous though – I’ve been sick, bored, frustrated, sweaty, drenched with rain, and homesick. Reliably, India, in all its enigma, contradicts me as soon as I think I know it, infuriates me as soon as I’m getting comfortable, and embraces me just when I’m about ready to run away.

the queue (if you could call it that)

Two weeks in, and I have yet to step foot inside a hospital. Well, ok, I did walk into the Apollo, but more on that later. For now, let’s just say the mood is ambivalent. I’ve been writing poems, and I think some interesting things are coming out, but they’ve mainly been about the initial frisson of arrival, the spectacular differences and the struggle of bridging cultures. Nothing yet about “medical tourism”. All the contacts I have either don’t get back to me, or are in meetings, or want me to send them emails… But, as India teaches you, you have to keep pushing – with a soft fluidity as well as a vigour.

The staff at the University of Madras have all been gracious and welcoming. I have a room set aside for me on the rooftop of the main building, which overlooks Marina Beach and fills up with the sea breeze. They’ve also continued to reassure me that the extent of my involvement at the University is up to me; that my poetry-writing is the priority. We’ve organised a few things though, all at the University’s English Department –

Poetry Reading – Thursday 3rd November, 1pm
Creative Writing Workshop on Embodiment – Monday 5th December, 10am.
Lecture/discussion on Recent Australian Poetry – Tuesday 3rd January.

Apart from the Uni, all my contacts with people have been accidental. I met a lovely guy from Hyderabad who was staying at my hotel, who shouted me lunch (“it’s our duty”) and asked me what I hate about India the most, and what I love. For the record, I said its poverty and its strength. Which made me wonder about the relationship between the two… While I was at my room at the Uni, Syam Sudhakar waltzed in to meet me. He was actually at the Queensland Poetry Festival in 2009 (I was there in 2008 and 2010!) – he’s a fine poet, too – while we were chatting, he got mail, a copy of a journal with two poems of his in it. Oh, and I was also (gently) harrassed for money by a group of hijras, laughing as one of them took my hat and wore it…

Anyway, so, as I was saying, I did walk into the Apollo Hospital the other day. I took a long, tiring walk to Thousand Lights (a few suburbs away from my hotel) to get a sense of what this renowned hospital is like – who goes there, what surrounds it, etc. At a distance, I thought I saw it, but it was actually a luxury hotel – oops, Andy, don’t get carried away. Apollo is of course a large medical complex, and it clearly has some money behind it, but it looks more like a standard country hospital. The main difference being the huge crowds. Hundreds of bikes and motorbikes are out the front. Autorickshaws cruise the exit for customers. Families wait in groups outside. In the waiting room, it’s hard to move – dozens and dozens of people sit, stand, lie, pace, all without much apparent distress or frustration. I can’t imagine everyone would be seen on the day they come. But it seems accepted that this is just how it is. In the corner is a sign that directs “international patients” to a separate cubicle. Which reminds me of the time I went to a doctor in Kalimpong, West Bengal, three years ago – I was rushed to the front of the (albeit small) queue, and felt acutely relieved and ashamed.

The other thing I’ve noticed is the number of gyms here (which I didn’t notice in the north or centre of the country). Wondering what that implies…

Oh, and where I’m staying – Sangeetha Residency in Mylapore – is pretty good. It’s got all the basics you need and the buffet breakfast is part of the deal (mmm, idli…). The choice you have to make is between a room with a window onto the inner car-park, which makes it feel like a cell, and a room that overlooks the road, which is almost always a cacophony of vehicles honking (and now that it’s Diwali, so many crackers and fireworks exploding through the night, which makes the air look like a thick fog and sounds like a small war!). I prefer the latter. You may prefer neither.

And below, some important places for Deepawali – temple, and a shop for fireworks…!

not your typical…

No, this is not your typical writer’s residency. It’s in India. So, having been in Chennai – the bustling, matter-of-fact capital of Tamil Nadu – for just over 3 days now, I’m still adjusting. Having done a few residencies in the last few years, I’d gotten used to the idea of just turning up and sipping coffee while writing, then going for relaxing walks. Not that I thought it would be like that here… I think I was just so focussed on the content of my project – the personal and inter-cultural dimensions of “medical tourism” – I’d forgotten that travel always implicates the traveller. You are no neutral observer.

A few examples. I was on my way to an internet cafe when a man, about 60-ish, approached me, and started walking with me. He said he worked at the airport and recognised me from when I arrived – he gestured to his lower lip to where my facial hair is, then stooped over to imitate my posture, smiling. We chatted in broken English for a while, until he stopped, leaned towards me, and whispered “can you help me?”. He had a bag from an eye hospital and a print-out of the costs of some procedure or prescription, running to the thousands of rupees. I am not proud to say I gave him a tiny amount, then refused when he pleaded for more. I still don’t know how to feel. I can still hear him saying “I don’t ask anybody!”, then myself saying “but you’re asking me…”. I still don’t know how I feel about how I responded, or even what exactly happened, or what problems this man has, if any.

Who is responsible for the health of the Indian people? What happens when someone’s social circle can’t help or support him (or her)?

Example two, a little less significant. Just after this encounter, I popped into a little supermarket to buy a few supplies, and thought I may as well buy a few oranges as well. Only after I got back to the hotel, did I notice the sticker on them – grown in Australia. Does India actually need Australian oranges? I don’t think so. I don’t either. But they’re here.

Anyway, here’s a few photos that somehow reflect my first impressions of Chennai – well, of Mylapore anyway, the suburb where I’m staying. The traffic is a self-organising cacophony, the people are gentle and subtle and (for the most part) leave you to your own devices, it’s hot as hell (an overnight low of 25 is considered “pleasant”), and the locals love their little oases (the beach, parks, AC restaurants, the mall…).

the river is rising

A quick post from an air-conditioned internet cafe in Banglamphu, Bangkok, two metres away from a coffee machine (I wasn’t planning on finding one, I just must have a Melbournian magnet for them). Bangkok and other parts of Thailand are facing the worst floods in decades. The Chao Phraya River here is swollen and heavy – banks, jewellery stores, hotels and a few other businesses are quickly building little 1-2 foot high concrete barriers, or building barriers with sandbags at the storefront. You step over them to get inside. Unsurprisingly, no-one seems put out or panicked or angry about it. It’s Thailand after all.

My hotel – Bhiman Inn – is a modest, reasonable small-ish mid-range joint about 10 mins walk from Khao San Rd. Luckily. That infamous strip is everything I’ve heard and worse. Neo-colonial consumerist brothel. Staff hold up signs that say they don’t ask for ID; every few steps someone is offering to sell you something (though they do tend to back off when you say no…); men of all ages and backgrounds walk around blankly arguing with their Thai “girlfriends”. Fascinating to walk down, but I wouldn’t want to be there.

Bangkok is a mystery. All cities are of course. But this one feels experienced in presenting itself and hiding itself at the same time. The typical pan-Asian concrete blocks and advertising hoardings, franchises, footpath traders, sizzling food-stalls, dogs and cats and motorcycles and more makeshift powerlines than you can imagine. Pedestrian traffic-flow is smooth, polite and calm. As are the roads. And the parks are mysteriously meticulously clean. There is a long history of cross-cultural engagement and tourism here; people of all backgrounds are here; Thais rarely bat an eyelid at outsiders, they just go about their lives.

I’ve visited a few temples, parks, the National Museum, bustling streets and back-streets, and missed a few things. It’s only a 2-day stop really, so there’s not much I can see or understand in that time. Today, I’ll try to find the Forensics Museum (!), and prepare for Chennai. Speaking of medical tourism, an ad in the Bangkok Post (english-language) Classifieds offered breast enlargement, liposuction and other procedures, and said foreigners are charged the same as Thai people. One of Bangkok’s local tourism magazines devote an entire column to medical travel. How visible is it in India?

PS I found the Forensics Museum. Truly fascinating on many levels – gruesome to the point of stomach churning, but haunting, mysterious and just plain odd.

“medical tourism” from the inside…

In October this year, I’m travelling to India to find out what “medical tourism” is all about. You may now have visions of me in surgical robes, nervously waiting to be anaesthetised, but no, this isn’t a kind of “method acting” in poetry.

Asialink (along with the Australia Council for the Arts and the Australia-India Council) have been generous enough to grant me a 3-month literature residency, based at the University of Madras. This is an opportunity to draw together into poetry two themes that have long fascinated me – the human body and how we experience it, and India – the interplay of ancient tradition and globalised entrepreneurialism, as well as its vigorous energy and sheer complexity.

My plan is to write portrait poems of people who are in some way involved in what is commonly called “medical tourism” – the travel of patients outside their home country to access medical treatment. This treatment ranges from cardiac surgery to dental work, orthopedic surgery to reproductive technology, gender reassignment surgery. They travel for many reasons – personal, legal, technological and/or financial (to obtain treatment that is too expensive at home). There’s a huge and growing amount of literature on the broad social impact of this very complex phenomenon, but very little in terms of personal stories.

I’m interested in talking with doctors, nurses, cleaners, and other ancillary staff, but also with patients and their families – both Indian and non-Indian. I’m also interested in talking with people who may have had experiences with the medical systems of other countries – Thailand, Malaysia, South Africa, for example. How do two cultures interact around one human body? What are the emotions, contingencies, complications, victories, insights and relationships that are brought up?

If you or someone you know is planning to travel to India any time between October 2011 and January 2012, please contact me through this blog. Any comments on my project, suggestions for reading or other contacts are also very welcome.