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In our second episode, we meet a tribal rights activist who dedicated his life to working on rural healthcare and livelihoods. Dr Hanumappa Sudarshan is the founder of the Vivekananda Girijana Kalyana Kendra and the Karuna Trust.
Dr Hanumappa Sudarshan was born in 1950, and it was being a helpless witness to his father’s death at a young age that made him realize that while everyone should have easy access to good healthcare, the most vulnerable and marginalized communities in our country do not. This led him to dedicate his life to seva for the first mile.
In 1973 he graduated as a medical doctor from Bangalore Medical College, and instead of following many of his peers into lucrative urban private practice, he began what would become a long career in social work, first with the Ramakrishna Mission. In 1979 he moved to the Biligiri Rangana hills of Karnataka that are home to the Soliga tribe, where he has since worked for the upliftment of these marginalized tribal communities.
Dr Sudarshan shares with us his personal philosophy, one that is rooted in service and science, with a deep sense of spirituality and heightened self awareness. His work is based on a practice that brings with it a boundless love for humanity and oneness – with people, with nature and with the universe.
Dr Hanumappa Sudarshan is in conversation with his friend, and fellow leader in social entrepreneurship Sunita Nadhamuni, Chairperson of Arghyam foundation.
To know more about Karuna Trust visit https://www.karunatrust.org/.
Additional Resources:
– ‘India’s Tuberculosis Program Provides Hope to Millions’ by the World Bank
– Accredited Social Health Activist (ASHA) Program
– Ayushman Bharat – Health and Wellness Centre
– Declaration of Alma Ata 1978 by World Health Organisation
Archival Audio used in this episode:
– Gorukana – a film on tribal development by Karuna Trust
– World Leprosy Day 2021 by Health and Family CC BY 3.0
– Famous Quotes of Swami Vivekananda by Swami Vivekananda’s quotes
– 2006 Alma Ata recollections by Jack Bryant and Carl Taylor by Henry Taylor CC BY 3.0
– Karnataka’s indigenous tribes, like, the Soligas need solid support systems, not mere slogans
– R Gandhi CC by 3.0
Transcript:
Welcome to Grassroots Nation, a podcast from Rohini Nilekani Philanthropies, a show in which we dive deep into the life, work and guiding philosophies of some of our country’s greatest leaders of social change.
In our second episode, we meet a tribal rights activist who dedicated his life to working on rural healthcare and livelihoods.
Dr Hanumappa Sudarshan was born in 1950, and when he was very young, he witnessed his father’s death. The incident made him realize that while everyone should have easy access to good healthcare, the most vulnerable and marginalized communities in our country do not. This led him to dedicate his life to seva for the first mile.
In 1973 he graduated as a medical doctor from Bangalore Medical College, and instead of following many of his peers into lucrative urban private practice, he began what would become a long career in social work, first with the Ramakrishna Mission. In 1979 he moved to the Biligiri Rangana hills of Karnataka that are home to the Soliga tribe, where he has since worked for the upliftment of these marginalized tribal communities. He is the founder of the Vivekananda Girijana Kalyana Kendra and the Karuna Trust.
He is the recipient of the Padma Shri, the Rajyotsava award for the state of Karnataka, the Right Livelihood Award.The Karuna Trust has been awarded the Ashden award for health and energy.
Dr Sudarshan shares with us his personal philosophy, one that is rooted in service and science, with a deep sense of spirituality and heightened self awareness. His work is based on a practice that brings with it a boundless love for humanity and a oneness, with people, with nature and with the universe.
Dr Hanumappa Sudarshan is in conversation with his friend, and fellow leader in social entrepreneurship Sunita Nadhamuni, Chairperson of Arghyam foundation.
SUNITA
Hello Doctor Sudarshan. Such a pleasure to be here in the Karuna Trust office.
SUDARSHAN
Thank you, Sunita. Thank you for accepting for this dialogue and I look forward.
SUNITA
This is a privilege for me. You’ve had such a remarkable life journey. Our moving back to India in 2002 was partly inspired by our interactions with you in the US. So can you tell us a little bit about what were the childhood events that triggered and motivated you to take up this profession of medicine?
SUDARSHAN
OK, first of all I would like to say my life and my work are not different. They are connected very much part of it. So that’s why I have to tell my life story also. I was born in a cow shed. My mother was in a village near HAL in Bangalore. She decided to deliver in the home. And as usual in the villages, when they deliver at home, you are put in a cow shed. They won’t deliver inside the house. So I was born there. Probably I have better immunity than others being born in a cow shed. That’s what I see.
But why I’m narrating this is last year we were instrumental in providing safe deliveries to 10,000 deliveries. So that triggered. So since of birth my motivation to do this type of work has come. Secondly, I was in a village school and they gave me double promotion and I came to Jayanagar and started my education in a Kannada medium school.
And when I was 12 years old, we went to a village, my aunt’s place, and my father literally died on my lap without medical aid. I was the only son with him and I had to helplessly watch him die. I didn’t know what to do. There was a quack. He came very late. I could not do anything. So that day I decided I didn’t cry much, but I made a Sankalp firm decision that I should become a doctor and rest of our life, I should not waste my I mean helplessly watch people dying close to you.
So that’s the motivation to become a doctor. And after I studied hard in the Bangalore Medical College, I had good percentage. But they caught me. I had underaged. I was underaged by. I had to complete 16 by October 30th. I was completing on December 30th.
So they said you have to join next year. This year we cannot give. So I joined to earn money. My mother had to bring up four children. So I worked in a flour mill. I used to cycle from Jayanagar to Sheshadripuram and I used to earn ₹110 and two and half months salary was my entrance fees to Bangalore Medical College. It was a joy. I mean I came up that way and oriented myself to. That was also the transition period when I came in contact with Ramakrishna mission. Read about Vivekananda and Gandhi.
So the motivation to become a doctor was the family catastrophe which happened. But the motivation to do a passion to do selfless work to reach the unreached, save lives, came from Swami Vivekananda and Gandhi.
SUNITA
Just listening to your story again, very, very inspiring. And think of how many people in India go through these kinds of challenges and the fact that you decided to take it up, make it your life sankalpa and journey is really remarkable.
So your choice of working with the Soliga tribes, can you tell us a little bit more? Why did you think it was important to work in that region? What were some of the really insurmountable challenges that you faced at that time? And what was the environment that helped you go deeper into that?
SUDARSHAN
So after my graduation I had equipped myself in the medical education to work in remote areas. So I had heard. I wanted to work in tribal areas. As a medical student, I had visited tribal areas in Nilgiris, Todas and others. So I had a passion to work in very remote areas. I heard about BR Hills
[AUDIO OF BR HILLS]
I came there started working for the tribal people, started with the medical work. Initially as I said, snake bite cases, mauling by bears and all those emergencies I could manage very well. It gave me some satisfaction. But I also found very soon great advantage I had was I wanted to save lives was the most important thing, but I also wanted when I started living with the soligas there. I understood I should also understand what are their needs, what are their main problems and how I can address that. So I found that their health need was 3rd in category.
The first two important were access to the land rights and forest rights. They were very important. So I had to change my strategy and education also was not there. So then the concept from health which started with curative health, it became community health. From community health to community development, I had to fight with them for their land rights. I was in the jail fighting for their land rights upto two days. It was a good experience the Gandhian way and went on fast and finally release and we got the land back to the tribals. So the land rights issue became important.
Then the Forest Rights Act also ultimately, which I think happened 10 years ago when we got land for all the tribal people as part of the Forest Rights Act. So it was a development. Now we call it sustainable development. My strategy, I was also influenced by Marx and I believe in dialectical process of confrontation, thesis, anti thesis and then synthesis.
Now I have gradually changed over to bringing in harmony, dialogue and all of that. But I was a fighter. That is how I fought. I went for the jail and fought with the system for rights of the tribal people. It was a good process. I learnt a lot and after doing that tribal work I wanted to expand and that is how I scaled up.
HOST
In 1981 Dr Sudarshan established the Vivekananda Girijana Kalyana Kendra or VGKK in BR Hills, an organization that works for the betterment of the Soliga tribal communities, through education, empowerment and livelihood programs.
He went on to found the Karuna Trust, which is associated with the VGKK but focuses on healthcare. Karuna Trust began their work with leprosy and tuberculosis. Both diseases are classed as neglected tropical diseases, as they affect the most impoverished and marginalized of communities. Although India declared itself leprosy free in 2005, there is a renewed surge of leprosy cases across India and in many parts of the country it is endemic.
Over time, the Karuna Trust began working with the government to run local primary health centres, turning them into model care centres, with high quality cost-effective primary healthcare.
SUNITA
So if you can tell us about Karuna Trust because your work in with VGKK. In the tribal areas, like you said, that was the first part of your journey, but at some point you decided to then expand your work into Primary Health and that’s when you started Karuna Trust. Can you tell us a little bit more about Karuna Trust?
SUDARSHAN
Yeah, the leprosy, which was not there in amongst the tribals. We started finding recent infections in the tribal area. Then we discovered that Yellandur and Kollegal at the foothills of BR Hills was hyper endemic for leprosy.
So we wanted to work with those rural poor also and I was also inspired by Buddha. That’s where the Karuna came. So Karuna Trust was found with the idea of eliminating leprosy in Yellandur taluk. I went to CMC Vellore, Karigiri it’s called, got trained myself in leprosy work and came back and started the leprosy.
[AUDIO OF LEPROSY PSA]
So we eliminated leprosy that was the first project of the Karuna Trust. Then we found similarly we should do for tuberculosis and we started tuberculosis control program and we evolved nowadays called as DOTS program. We were doing similar without naming it DOTS program we were doing it. But we didn’t publish it. But the World Bank got the credit for DOTS program WHO and program. I also found that we are doing all this work.
And the government is also has its own infrastructure and they are spending and all our good results are shown by them as their achievement. So I met the health secretary and said why don’t we partner with each other. So wherever you are unable to deliver services so we will do the work for you and you pay the this thing. Otherwise I have to rise my own dona- beg money and do it and duplicating things which you are doing and your people will lazy around.
So finally it was accepted and first time a Primary Health center was given under public partnership, the Gumballi PHC. And we started with that and the health secretary at that time said I have to convince our finance department the only way they listen to a new project is by telling them that there is a saving to the government.
So he said we will pay only 75% of what we are spending on that Primary Health care for 30,000 population. I agreed on that. It was difficult for us to rise the 25%, but we took up that partnership, let us make a beginning. That’s how the partnership started. And later on we could negotiate for 90%. Most of the states now give 90% when we add 10%, but in Karnataka now they are giving 100%, but we add new innovations and all of that is through our own funds.
That’s how the public private partnership started. So started with two Primary Health centers. Now we manage 70 Primary Health centers in seven different states. Started in Karnataka, then scaled up to Orissa, Arunachal Pradesh, Meghalaya, Manipur and now recently Nagaland and Assam. And last has been in Assam that are also my favorite to reach out to the island tribes there. We have a boat clinic where we reach out to the tribal people there. And provide them Primary Health care to those people.
SUNITA
To me, this has always been a very good example of how your strategic thinking has made a structural difference in the sector, right? So the way that you were able to, with your credibility and your record, able to convince the government and opened up this doorway for PPPs which is now they are not just Karuna Trust, but organizations across the country are doing it.
And that is a very important step that happened, a structural change that happened in the sectors. I want to switch tracks a little bit and I want to talk a little bit about your spiritual journey, right. I remember 20 years ago when we met in the US, you were saying that it was very important for anybody who is going on this social development path, on social change path to also ground themselves in spiritual practices.
Because you can easily be, you know, blown off the path if you are not well grounded and you’ve shown this. When you were young, you wanted to give up your studies and become a monk. You join the RK mission and then you found your path in service. So tell us a little bit about your spiritual journey.
SUDARSHAN
OK, so when I met Ramakrishna mission Swamis and my guru, he influenced my life and I had decided when I was a medical student that I should realise God by the age of 30. I have even fixed that target and I was convinced that God realization was my goal. But Vivekananda gave me a mantra. They only who live for others rest are more dead than alive. And he also gave me my philosophy of life, that is as long as millions live in hunger and poverty, I hold every man at traitor who having been educated at their expense pays not least heed to them. Government spends about several lakhs of rupees on the education. For my education at least 20-30 lakhs is.
And where does money come? Every matchbox if a tribal buys the tax, commercial tax, most of it comes from the commercial. It’s people’s money. So what Vivekananda says is so that education, that knowledge I have got, it should be given back to the people and I believed in it 100%. So I had a passion to do this work and in the end I also had some self-awareness as a spiritual quality through which I could detect all my defects also.
You become aware of your selfishness, whether you are doing this work for name and fame, or whether you are egoistic and you want to promote yourself or your teamworker. All this I was fully conscious. I had all the weaknesses. But that’s where the work. This is called Karmi Yoga. I dedicated myself to working for the poor. By doing that, the tribals and the people have given me much more valuable to me. And that transformation was my expansion of my own identity.
I was myself, Sudarshan alone, then my family. Then when I identified with the Soliga tribes, I literally for 20,000 people. I worked with them and they were part of my life. And I worked like that for about 15 years, 20 years. Then I scaled up my activity to other tribal areas. Then it became one lakh population. Then suddenly I was called to become the task force chairman in Karnataka Health Task Force.
So there I identified with six crores of people. I just handed over VGKK to all my second line of leadership. Then they managed well in a way it was good for me to detach from that and I identified with them. Then I had opportunities to work at the national level. Then I really identified with all the poor 1.2 billion people and how to do the health care for them. So I was in that.
And the ultimate expansion of that was I had an opportunity to sit in the United Nations. At that time, I felt I was a citizen of the world and I should also look at the entire all the people. Now I feel I am a citizen of the world. So this also expanded my own expansion of my love and my connectivity connectedness to the entire humanity. That evolution happened in me and.
Of course, the final culmination happened recently, where I felt that I am one with the universe, one with the entire cosmos, and that’s why my lifestyle is I am totally detached from my work, but the work is going on very well. I had a lot of attachment to whatever I gave worth to. But this transformation detachment came.
Now I believe in others the second line of leadership including Venkat who is now the secretary. I am the president just advising them wonderful work is going on and this year’s budget is about 95 crores for Karuna Trust which just money is also coming. Human resources are coming. Thats when I sort. Every work is part of the divine, the cosmos, the nature, nature. For me nature and God are not different. So you you can call it nature but that nature is feminine. So I am a worshipper divine with her that nature is divine and she does everything. And I am just participate in it. I participate in this. So when you are participating, there is no question of hierarchy, there is no question of egoism. And things happen, and the latest has been.
I could partner with Srikant Nagamani and the instrumental in taking 10 bedded ICUs in 200 hospitals in Taluka and district level in 8 different states. That has also given me. It just happened things are happening, falling in place and that so I feel you say divine work. So more and more my work is happening spontaneously with the right forces, right ecosystem, you can call it ecosystem right people coming together and effortlessly is it is happening. Social workers having stress and burnt out is something antithesis of real Karmi Yoga. So real Karmi Yoga should give us joy, fulfillment should be more love. And that’s what has happened to me. I discovered the inner source of my joy, love and happiness and I’m ever fresh. And now my service, I call it loving service.
SUNITA
This is really fantastic. Thank you for the honesty because I think so many people are going through this journey and to hear you. Say how your evolution happened because nobody, you know, people look at you and everything that you achieved and they assumed that it all just came easily. It all just happened. But when you walk through and talk about how you had to overcome both external challenges, but more importantly internal challenges and how you had to fight your weaknesses and how you reach this space, I think that’s huge learning for, you know, people who are on this journey to listen. Because this part of the journey is not visible, it’s not visible to everybody.
So very inspiring. Thank you. I wanted to talk about, you know, along the same lines actually one of the things that has all of us have admired so much is your personal lifestyle, the way you live your life. There is a harmony, there is a simplicity, almost Spartan living. You had a house, they wanted to build a house for you and you insisted that it should just be 50 square feet, not more than any of the Soliga tribal people were living in.
And everything that you lived on, you said, had to come from the love of people. People gave to you, even your toothpaste that you used in the mornings. I mean, these are all things that you know. These are legendary stories that people talk about you. And you have continued that your entire life has been your message that way. And today, when I look at the way you live and you practice your simplicity, how important is that to giving you the strength, the focus and the guidance to do your external work.
And also going to talk a little bit about the exercise because that is something, again, I find remarkable. You walk 8 kilometers every day, you swim a kilometer every day, you do yoga, all these spiritual practices, meditation, and you do that with hundreds of things that you need to manage. So can you talk a little bit about your lifestyle? And why you think that is important in helping you do your work?
SUDARSHAN
As you rightly pointed out, I started ₹5000 budget and I also made this because of Vivekanand experience that I will not take any salary all through my life and I committed to that. So I had to depend on others for even my maintenance. Raising funds. So either my sister and my brother sometime my friends they would stitch my clothes and keep it in my room.
I would not spend money on my clothes. Food I eat with the tribal children, that type of lifestyle. So in the Cauvery lifestyle I tried to do it with one and half dollars a day, but I found now I have to increase it to $2.00 a day. So and I’m surviving on that. Of course my travel and all that is taken care of by the organization, but my own food, my all that I am able to do and they live very happy life.
Very content, happy life, all the luxuries I have with 2 to $3.00 a day. I think I have understood a lot about my own self knowledge. I call it understanding my body, my prana. Prana is the metabolic system, the physiology which I learned all that prana and the next is the mind, my own mind, my unconscious mind, my conscious mind. I studied psychology to understand myself.
So understanding all the various problems, we have repressions, we have the masks we wear, the fragmentation of the self which happens we watertight compartments we live and the drives we have the passions, how to flourish that and unfold yourself. These are the two levels, 3 levels which is known. But there is what is another dimension faculty in as the spiritual dimension.
Divinity in us, the Athman, as it is called, unfolding that discovery of that and which is the source of all what I was seeking. I always have been seeking something and I have finally discovered that is within and that only can give us. With the discovery of that the flood gates of my microcosm expands itself to the macrocosm. At the physical level I feel I am part of the entire universe. In fact I also discovered that my iron and copper I was just looking at the from Big Bang to present history one video and there it came out. But my copper and iron, or manufactured in the supernovas which became the stars. And the stars came from the earth of the sun and the sun the earth came. It was manufactured. I feel that those molecules are now remembering that they have the inheritance of the supernovas and my origin there physical level and I feel oneness with all plants and animals. Genuinely.
And I discovered a new meditation, of course walking meditation, working with awareness. All these are well known, but I have discovered a swimming meditation. Really it is a one hour meditation for me to swim across. I feel I am one with Cauvery and it’s a wonderful experience. And all this is happening with a. I have established a harmony with the cosmos. So it happens in a rhythmic way and only thing there is this selfishness wants to take too much from the macrocosm, doesn’t want to give it back, but I consciously give it back. That is my passion to give it back to the society.
Give it back to the nature, to the environment. Take what little you want and give it back. That was called Yagna. Now I discovered that the Yagna was the concept of sacrifice is not a punishment. It is willingly joyfully giving back to the nature. What you take, give it back to nature. I have established that harmony. It is called Reetha. And once you establish this harmony, your life is full of joy.
SUNITA
That Is really nice, so talking about your work. You’re one of the few people I have interacted with who operates at 2 levels very easily, very seamlessly, right. You have a strong visionary sense. You are able to look very clearly at exactly what you think the sector should go towards. But you are also extremely involved as an implementer. You know, when we worked together in Gumballi on the healthcare project, I remember you would sit with us, hours every week to actually look at every piece of data that was being captured and give inputs, right. So you’ve never been, I’m just going to state this is the plan and then the people implemented. Nor have you been buried down here and you straddle both quite seamlessly. And I think that’s an important part of your success from early on. So I wanted you to talk a little bit about your work ethic and maybe give us some examples of how you’ve straddled both of these.
SUDARSHAN
Yeah, I wanted first of all grassroot level worker. That was my passion to help directly treat patients and do that. Then very soon I discovered some of that it gives me personal joy and all of that if you want to have a real impact, help more people as a genuine concern.
Expansion also may be for name and fame. Oh, I have this project. I want to expand my project itself and get more name and fame and all that Recognized all that is one idea. But it happened spontaneously that I should also to have impact on larger number of people I have to work at different levels. So that’s how this expansion came spontaneously. I didn’t struggle for that jumping from a small project of VGKK into state level and doing it, I found certain things.
Governance, especially the courage to stand up and tell as a lokayukta ombudsman. Also this inner having worked at the grassroots level and working with the moral force of integrity and what Gandhian principles that gives us tremendous courage to tell the truth. I think I’m the first person to openly talk about corruption in health services. I used to make PowerPoint presentations.
And including World Bank once said how can you talk about corruption. So they complained to our health secretary that doctor is talking about corruption and all that. So I said it’s a loan money and if you don’t tell anybody how is it and secretary took me to task how can you discuss about corruption issues with the World Bank team?
That’s our right. But World Bank is also changed now. They are also looking at corruption index and all that and looking at good governance as a major issue. So it needs tremendous courage. I use that in policy making, making right decisions, giving importance to Primary Health care more than tertiary care. Where are the loopholes in procurement and a policy to have transparency, accountability mechanism. All that, I had that governance thing and I want to use that at the state level and the impact has been unbelievable, of course. Earlier I used to, I had very strongly believed in Gandhi and this thing and said I would eradicate corruption. But later on I had to say it’s a like tuberculosis, chronic illness. I have to control. We say control of tuberculosis. Now of course government is talking about elimination of tuberculosis, but certain illnesses you can only control, you can’t eliminate.
SUNITA
Absolutely, yeah. So in this very rich journey of your life over, you know, 4 decades, obviously with all these successes, there must have been failures, right? There must have been. Tell us about your philosophy towards risk, towards failures.
SUDARSHAN
For me. It was a gift given to me, the failures and also obstacles which come in my work. Failures or whatever obstacles, sometimes bad criticism, many things and funds are not there. There are so many of those things. But I always had faith that it is a passing phase and it will come out. And what lessons we can learn from the failures, converting failures and obstacles into stepping stones for a new adventure. Somehow I could convert most of them and that’s why I do not see failures. They are part of my journey. Whatever I achieved, they are part of it.
Fortunately, we didn’t have major failures in that sense because we would do the risk calculation and do it, and we had the openness to make midterm corrections, that openness and also not going with fixed ideas and then dump it on the people at their expense. Participatory planning has been, and though I understood the participatory planning and participatory teamwork and all of that participatory processes, as I call it.
But in fact, it’s a spiritual quality. It comes spontaneously. I had to force myself to participate because I was a typical leader, dominating others and then pushing through bulldozing things and all of that. But that also is needed when we have that passion. You want to achieve that and at any cost and do it. A type of madness. But that madness can be converted into a participatory process of service. That’s a discovery I have.
SUNITA
That’s a very, very important, nuanced input I think. And any example of really difficult challenge or a failure that you can share with us and walk us through how you are dealt with it?
SUDARSHAN
One is that I thought first thing was health is the main entry and I should force it. First lesson I learnt is for the people health is not the first priority. That itself was a conceived that they would all welcome. So I had to work for other fields. I openly accepted that challenge.
So the concept of integrated tribal development, instead of focusing only on health and then doing it so I could change over. I understood I should help them in what they want. My passion to do something should coincide. My passion then, I discovered, was to help people, to bring them out of suffering. And that’s the way we need to do it.
SUNITA
This is really something that a lot of people need to listen to and hopefully it inspires. So Doctor Sudarshan, you have seen the whole social sector change over the last 40 years, right. So can you talk a little bit about how this change has happened from the 70s when you started working to now? What were some of the policies that have actually driven the strategies by which the social sector started taking on challenges, specifically in the case of health, right. How has that changed the way the NGO’s are now working on specific topics? How are they constructing their strategy? So you could talk about that a little bit.
SUDARSHAN
Yeah, overall, I think the 1970s, 79, 80 is the period when lot of NGOs got into social sector and wanted to work in the tribal areas. It was a big moment and I had the also opportunity to interact with them and all of that. Of course the ideology at that time was more of. Even I was influenced by leftist ideology for the rights issue, taking up rights issue and the marginalized people how they can be. Actually, I started my work with the health as a entry point. Then I found the second most important was organizing people for their rights.
So we had two wonderful social workers, Krishnawali and Sachin Shetty from our MSWs. That’s when we started organizing the entire tribal people and they themselves ultimately fought for the land rights and all that. But overall I would say things have changed a lot. Government is not a monolith. We sometimes in the NGO sector, we feel whatever we NGOs are doing is the best. Everything in the government is corrupt and they don’t do. Everything is bad and private sector is entirely those multinational companies exploiting people. But things have changed. What I have discovered now there are good people in all the three sectors, I had a unique opportunity to work with some very good bureaucrats, especially in Karnataka one Madan Gopal I can mention honest to the core and working with them and transforming. So we have to liaise on all people. I feel there are 15% inborn corrupt people in the government but there are 15% honest to the core.
Other 60% are I call them fence sitters. If the leader is good, they become good, if the leader is bad, they join them. So it all depends on the good leadership and I could see that. So the government is also not a monolith. They are willing to change and they want to learn and help us and we need to coordinate and in the private sector, actually I would say in the private sector people like Devi Shetty helped me to open up myself because we planned the health insurance thing with them and he was the first person to come forward as a package rate. I will do bypass surgery for this health insurance program, Yashaswini program at ₹60,000 cost. I think the unique thing is to get all three people together. Then you can do wonders without more of dialogue and more of positive energy, instead of in lack of trust and fighting and antagonizing.
You doubt everything even the good people do in the government or in the multinational companies. So we have to be open for these things. I find I am now attended the World Economic Forum. There are good people in even in World Economic Forum. Earlier my concept of World Economic Forum is like a bunch of multinational companies and they plan only to exploit people so that things are changing. And I think with the changing world in the country like India also, we should not be hang up with the old this thing.
The new things which are emerging, we should hug them and move forward. And I am a born optimist. I feel India is progressing. We will become a great nation. I have full faith in that. Not only that, we are all evolving. So socioeconomic evolution, ultimately we all become divine. We all evolve towards the divinity and what Aurobindo called gnostic beings. Everybody is evolving towards that spiritual.
SUNITA
So if I look back in the health sector over the last 20 years, we have seen some really remarkable, you know, developments that have actually changed the way primary Healthcare is delivered. So I wanted to hear your thoughts on that. You know the Asha program started about 20 years ago, then the whole approach towards Ayushman Bharath Health and Wellness Centers which was announced about 4-5 years ago and comprehensive primary healthcare offered at health and Wellness centers. It seemed like it took its time, but to me these are very important things that have happened.
SUDARSHAN
Very true. So we signed the Alma-Ata Declaration for comprehensive primary healthcare.
[AUDIO ABOUT THE PRINCIPLES FROM ALMA ATA DECLARATION]
That was a wonderful decision. So and our primary healthcare structure and all of that is one of the best we have. The balanced view of preventive, promotive, curative and palliative rehabilitative care is one of the best. Only there are problems. I have been fighting that the budget should be increased in Karnataka level. The health budget should be increased. It has stuck at 4 to 5% but our recommendation is for 8%, minimum 7-8%. Similarly, the Primary Health care we should be spending 70% of the health budget on Primary Health care.
And very little goes. And I was part of the WHO Commission on macroeconomics and health. There we all said India was spending at that time only oh .9% of GDP on health. So it has to be increased to 2 to 3%. Manmohan Singh was also part of that and India committed itself to that. It will increase it. It hardly gone up to 1.6 or 1.7. It’s not enough. We have made some progress.
But my dream is we spend at least 3% of GDP on the national healthcare level and 70% should come to primary healthcare. Those dreams are still not fulfilled, but I have patience. I think we will work. People are realizing it and the way in spite of all the limitations. See nobody talks about when the immunization started, but I had full faith that we will deliver immunization in our Primary Health center because we have been delivering 10 vaccines, not one.
In remote parts of India and adding one more was not a challenge. I don’t know but lot of doubts were expressed. That’s why in our PHCs we had no problem, we could immediately COVID vaccination was no problem at all and it happened and we have proven to the world that with our background of primary healthcare and the vaccine strategies, we had the covishield we have wonderfully it worked and we have been able to deliver very well. As activist we always look at negative what is not being done.
I think all activists should also acknowledge and talk about what good things have also happened. And very often what I feel is as an exercise, all the activists who do this type of work should sit back and say how many people we are able to help. Some of the new program. The concept of health and Wellness Center is a unique program and we are all part of that in planning and there are participatory processes. I have unique opportunity to participate at district level, state level, national level. Even international level, WHO and even everywhere.
I have only MBBS degree. But people listen to me not because of my the professional this thing but my grassroot level experience that is where the I think grassroot level experience makes you unique person. You can contribute at the policy level changes and people who talk policy level changes only without grassroot level experience they are usually they don’t know the reality. Reality check is in working in the grassroot level. That’s why both have to be balanced. Otherwise we will not have right policies and right implementation.
SUNITA
But it is commendable also that there is a space and there is a recognition that grassroots voices are very important. And that is why people like you have been able to shape policies. Your leadership principles and your organizational sustainability right. You have been the face of VGKK Karana Trust for all these years. It is your leadership that has brought it to this level and achieve the scale. What do you believe are the principles that need to be established for the organization to be sustainable over time and how have you implemented that in your organizations if you could talk a little bit about that?
SUDARSHAN
No, this is based on Gandhian things. I think the leaders. There are some leaders. Hierarchically. We can start with the team itself. One person has a passion, but if that person leader has a quality of what he believes and what he tells others, he himself practices. That’s an important quality, which is very important. And 2nd, of course with that you still bulldoze and do all those things but the participatory teamwork and participatory recognizing the talents. And one thing I learned from Marx is the labor, the work we do he used the word labor, should transform us, should give fulfillment and joy. It’s not only the money which we get.
So the difference between a capitalist society and a socialist society is in capitalist society you work for the boss. Five days you work for the boss, get that money and with that money you enjoy 2 days of your own life. But that’s a disaster. Very often you also end up in doing that. But.
That work which you do those five days should also be creative work and it give us you’re not working for the boss but for your own. It should become part so in my work also. That’s why we are decentralized. Each one, each medical officers are in these 70 health centers not 1 Sudarshan doctor. All 70 doctors should feel that same fulfillment. And I’ve seen all those people who have worked with us they come back and say oh we still remember that. When I worked there. We could save this life that all that is there. So immediately they may be seeing other things and then forget it. But that will remain with you. Our pay scales are very very low and but now highest paid is the 60,000 rupees for the doctor and nowhere. Sometimes doctors in working in our Bangalore office pay get very little but still.
I cannot compensate in terms of what the corporate sector can give you, but the fulfillment is a package. That fulfillment is worth much more than the what you get in terms of money. Of course. That Marx would say if you don’t pay them properly. He calls it opium by telling that you will get fulfillment. But it is. But Marx also agreed on that if it is doing for himself. Not to please Sudarshan if he is doing for his his 30,000 people and derives that is what Marx wanted. So the work you do should give you joy and fulfillment. It should empower. It is enriched me tremendously.
SUNITA
So last words of advice to young social entrepreneurs who are beginning this journey. Think of yourself, you know, 40-50 years ago. So people who are beginning the journey now, what would your words of advice be?
SUDARSHAN
Have faith in yourself and become mad and have that passion to do it. How to get that, I don’t know, but it’s it comes from human touch. So find such people. I went in search of such people when I was a medical student. I found one or two and they inspired me. Of course I had a spiritual master who also gave me that, so somebody may do it, but ultimately it should become our passion and our madness to achieve it.
SUNITA
Thank you so much, Doctor Sudarshan. Such a pleasure.
OUTRO
[THEME MUSIC]
HOST
Grassroots Nation is a podcast from Rohini Nilekani Philanthropies. For more information go to rohini nilekani philanthropies dot org or join the conversation on social media at RNP underscore foundation.
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