During times when we see systems being jeopardized for selfish motives, there comes this public health memoir which shines as a beacon of hope. Written by public health interventionist Dr Rakesh P. S., the book ‘Echoes from the atoll’ documents one of the rare public health successes in India: the story of TB-free Lakshadweep islands.
It is a narration of true events from the eyes of Dr Rakesh, who arrives in the island territory of Lakshadweep in the year 2018, as part of a public health systems strengthening assignment of the National Tuberculosis Elimination Programme (NTEP) of India. The account has a beautiful back-and-forth from the current time point to the time when Dr Rakesh was there, which gives the readers a wonderful exploration of the islands and their journey towards TB elimination through a people’s movement.
Story of the island, and its people
Sitting in air-conditioned offices on the mainland, Lakshadweep seems to be an ‘easy-to-achieve-TB-free-status-geography’, provided the limited population, better healthcare-seeking behaviour, cohesion between people, and advantages of being a union territory. But the realities strike once you set foot on the island and realize that the ocean and the weather are the two big determining factors of success or failure of any public health intervention.
The islands are only accessible by boats operating on a weather-dependent schedule, and emergency evacuations require helicopters sanctioned by the island administration. As Dr Rakesh rightly says in the book, you need ‘nature’s approval’ for any plan you make. This is why my favourite chapter in the book is ‘The Fishing Boat’.
In this chapter, Dr Rakesh writes about an overconfident officer from Delhi on a supervisory visit who sharply criticizes the NTEP personnel for not meeting some targets and draws up ambitious plans to complete supervisory visits of all centres within an unrealistic timeline, even when the local team expresses concerns about its practical feasibility. Nevertheless, he is eventually humbled by nature, getting stranded by adverse weather and stricken by seasickness.
The incident resonated with me because many of us in the early days of our careers, in the zeal to be change makers, have often failed to see the struggles on the other side, and have deeply criticized others for ‘not doing things properly’. It reminded me that the lived realities of each part of the country, each population, are different.
The memoir’s first few chapters familiarize readers with the 36-islands of Lakshadweep and its unique people, from the eyes of a ‘mainlander’. It describes how amenities like the availability of milk, fresh vegetables and fruits, and even access to a petrol pump, all the things which the ‘mainlanders’ take for granted, are different in the islands. The most striking instance of how the island people perceive distance is an eye-opener.
Since the population follows a matrilineal system in families, women have significant agency in all matters, and this is especially shown to be of help in health-related activities. The warm interpersonal relationships within the people of the island, their hospitality, their collective onus-taking, the challenges from nature, the success amidst these deep struggles, and how eventually ‘the-mainlander-on-a-public-health-mission’ becomes one among the islanders achieving India’s first TB-free geography, are what Dr Rakesh describes in further chapters. The camaraderie and the support extended by the local healthcare delivery systems, the politicians, and the community towards the TB elimination goal are heartwarming, and every public health person’s dream.
Why is this memoir important?
The book is an excellent read for public health enthusiasts, especially young public health personnel. It is important for several reasons.
First, it reminds us that public health achievements rarely happen overnight. They require sustained investment, persistence, and effort over long periods. This book documents a rare success in TB elimination and, importantly, shows the crucial role that a people’s movement played in making it possible.
It also shows how a few bold decisions by people in positions of power can lay the foundation for success. And sometimes, the real heroes are those who work tirelessly to convince them to take an unconventional step. (This may sound cryptic, but it will make sense when you read the book!)
The memoir repeatedly reminds us why public health solutions must be context-driven and rooted in community participation. A one-size-fits-all approach cannot work in a country as diverse as India. It also captures how lasting human relationships can develop in the most unexpected ways and in the most ordinary settings. And, of course, it reminds us of the ultimate power of nature. No amount of technology or planning can override its plans!
In a nutshell, this genuine account of public health success, in an era of PR-driven ‘success stories’, is a treasure for generations to come. More than anything, it leaves you with something public health desperately needs: hope to keep striving for better.
Edited by Parth Sharma
