 "Doctor on a mission")
“As a medical intern in India in 1988, I had biked from Delhi to Leh, Srinagar and back. I had dreamed then that one day I would ride from one end of India to the other,” says the doctor. “But life came in the way. So when I completed my tenure with MSF, biking from Srinagar to Thiruvananthapuram seemed like a great way to understand public health issues at the ground level. I would also reacquaint myself with my country.” While it appeared a simple purpose for a journey of this magnitude, Unnicycles, as the expedition came to be called, was not about the journey or the destination. “It was simply about people and conversations,” says Karunakara. The cycle seemed like the most fitting vehicle for this journey. “I’ve always felt it is a very democratic way of travelling,” he says. “In fact, cycling doesn’t have to be a sport. To me, it is a way of life.”
After Karunakara began his odyssey on October 11, 2013, he soon realised that biking in India and in Europe were completely different experiences. “The views of the peaks and pines were incredible, and the heights dizzying. But so were the exhaust fumes! With trucks, cycles and carts jostling for road space, the experience of biking was quite stressful,” he recollects. “Initially, the going was so hard that I wondered if I’d be able to finish my journey at all.” Along the way, he became used to the traffic and often looked for quieter roads instead of the expressways.
“I’d start around 6.30 am and take a break at 9 am to eat, by which time I would have done around 40 km. Throughout my journey, I had excellent food in dhabas,” he says. Dhabas were also great places for striking up conversations and telling people about what he was doing. Many of them would then line up along the road to cheer him on. “This was very inspiring, especially at the beginning when I sometimes doubted my ability to carry on,” he admits. Also helpful were friends like Canadian Olympian Helen Upperton and economist Jyotsna Puri and a number of enthusiastic colleagues who accompanied him on some stretches.
In neighbouring Haryana, Karunakara bumped into the coordinators of Radio Mewat, a community radio service. They invited him to their station where he was struck by the difference that social communications can make to rural society. “I also noticed how backward Haryana was, in spite of its proximity to Delhi. On the road, I saw young women, girls really, with babies. Anecdotal evidence suggested that maternal and infant mortality rates were high here, not surprising if the average maternal age at birth is very low,” he says.
Days later, he spoke at Delhi’s Vardhman Mahavir Medical College about how access to low-cost generic medicine could change the face of Indian, and international, public health. As India is one of the biggest producers of life-saving drugs in the world, the reduction of taxes and duties on them could make them more accessible to poor people worldwide. Later, Karunakara also visited LoCost Standard Therapeutics in Vadodara, Gujarat — a non-profit charitable trust that produces 80 low-cost generic medicines for use by NGOs and social action groups.
Rajasthan really excited Karunakara. Chhavi Rajawat, India’s first MBA-wielding woman sarpanch, joined him for three days as they went from her village, Soda, to Tilonia’s Barefoot College and then to Aruna Roy’s School for Democracy in Bhim. “Though it was a very quick glimpse, these three places helped me see the growing push for accountability and transparency. It gave me reason for optimism,” he says.
Gujarat was a disappointment. Karunakara had heard much about how the state had developed in the past few years, “but Khambat and Bharuch had nothing by the way of public sanitation. Surat was the only spotless exception.” Officials from the Surat Municipal Corporation outlined their meticulous and efficient solid waste management scheme and told him about the 192 pay-per-use toilets they had installed. “I saw how the combination of political and administrative will and public support could transform a town. Surat made me question why the rest of the state, indeed the country, couldn’t follow its example,” he says.
Continuing his epic journey across the Konkan coast via Goa, and then down South, Karunakara had plenty of time to reflect upon the Indian public healthcare system and its lack of “last mile connectivity”. “Across the board, I observed that villagers had to travel miles to get even the most basic health care,” he says. “And whether it was migrant workers in Coorg’s coffee plantations or tribes in Rajasthan and Gujarat, the more serious their condition, the farther they had to travel for aid.” Even in supposedly “developed” states like Goa and Tamil Nadu, Karunakaran found there just weren’t enough doctors.
This fact became frighteningly real to him when a Dutch co-biker fell off his bike and injured his head in Tamil Nadu. “We rode 8 km to a reasonably large town, which didn’t have a single doctor, only a nurse who gave him first aid and a tetanus shot. I was afraid that he may have had concussion, so we drove another 20-odd km to a bigger town. It had a doctor, but no trauma facilities. It was only much later when we reached Tanjore that we could access a proper trauma unit with a CT scanner. It was harrowing for me; I can only imagine what locals undergo every day,” he recalls. And while he says that the east coast road from Chennai to Pondicherry and then onwards to Kanyakumari was beautiful, the route lacked clean drinking water.
There were days when he had cycled in spite of fever. There were days when it was tough for him to just wake up and get on the bike. And there were days when the chaos around him had been too hard to handle. Yet, Karunakara wouldn’t have missed the easy, insightful conversations he had with people across the country. “As I ended my 5,350 km journey in Thiruvananthapuram on Day 112, the immense diversity of all that I’d seen seemed almost too much to digest,” he says. “People asked me what I’d learnt from the experience, and I didn’t know what to say.”
At the beginning of his journey, someone had asked Karunakara what he thought would be the biggest obstacle in his journey. “I thought about it and realised that my biggest fear was that at some point, my journey would become a race from point A to point B. The tour was not about me at all. It was purely motivated by my need to rediscover my country after years of living away from it,” he says. That is why it seems only fitting that when Unnikrishnan Karunakara finally hung up his helmet, he realised that his experience of India’s chaotic diversity had taught him a little more about himself. The good doctor had finally come home.