Penn docs: New India leader expanded health care

When Narendra Modi became Prime Minister last week, after his pro-business, Hindu-backed Indian People's Party (BJP) won a smashing popular mandate  against India's long-dominant, socialist-leaning Congress Party, it was a familiar face in the news for Dr. Aseem Shukla, a surgery director at Children's Hospital of Philadelphia and associate professor at Penn's medical school.

Shukla and his colleagues have visited Modi in his prior office as Chief Minister of India's Gujarat state as leaders of an Indian-U.S. children's surgery team. Shukla last year spoke out on Modi's behalf during debates on Penn's campus about whether Modi should be allowed to participate via satellite in a student-run Wharton conference despite Modi's then-ban by the State Department. Modi was invited, then un-invited. Obama has since asked Modi to visit Washington; Modi hasn't accepted.

Dr. Shukla, who besides his medical duties is co-founder of the Hindu American Foundation (www.hafsite.org), an advocacy group with an office in Washington (his wife, Suhag Shukla, is Executive Director and General Counsel), and Dr. Rakesh Joshi, professor and head of pediatric surgery at the 2,000-bed Civil Hospital in Ahmedbad, Gujarat, sat with me for an hour to talk about the Modi they know and prospects for India and India-U.S. collaboration. They later added observations by e-mail. Their comments are consolidated here: 

Joshi: Since Modi became Chief Minister of Gujarat in 2001, we have experienced that the entire government machinery is working in a proper manner. There is a real efficiency...

He has announced many [health plans] for poor patients, working patients, lower-middle income patients. Under one state plan, called MA Yojna, for 4 million 'lower middle' income families, [each is] allotted 200,000 rupees per family [about $3,400, with no co-pays] per year, [to use at] private sector and government sector hospitals.

This is a unique scheme for which people in Gujarat give much credit to Modi. Because of these initiatives, we have been able to substantially upgrade our facilities and provide much-improved care for no cost at our state-supported public hospital.

(And poor patients get basic care free?) Yes. We have extensive private-sector hospitals, but the cost is too much for many people. Overall, only 10 to 20 percent of our population is properly insured. The rest of the public lacks insurance and is forced to pay out-of-pocket. Our Civil Hospital is full all the time as a result. We have been pleased by the support extended by the state government under Mr. Modi.

(Who are your patients in the state hospital?) Our hospitals reflect the entire population of Gujarat and surrounding states. We have large numbers of Muslim, Hindu and Christian [patients] as well as people comprising the lowest socio-economic strata in India. We are open 24/7 for everybody.

(How has this changed, under Modi?) You can see a difference in the last 10 years. Ahmedabad is progressing. There is immigration from Uttar Pradesh, from Bihar, from other states, to Gujarat. They are looking for opportunities for jobs. Also safety, education, progress, healthcare -- this is all available in Gujarat. But the biggest draw to Gujarat is the economic opportunity created during Modi's government. The prevalent peace in the state has allowed business to thrive.

Shukla:  We have had discussions with Narendra Modi personally. I have met with Modi several times, and in January of this year, with Dr. Douglas Canning, my colleague and the chief of pediatric urology at CHOP, we had the opportunity to sit down with him for extensive discussions.

[Prime minisiter Modi] has a very strong interest in the healthcare sector. He's very conversant in it, and intellectualy curious about it. He is well aware that our team of pediatric urologists from CHOP and [hospitals in] Seattle and Cincinnati has been coming to Ahmedabad for the past six years to do the most complex pediatric reconstructive urology surgery [including day-long bladder exstrophy corrections.] Dr. Joshi and his team of surgeons in Ahmedabad diagnose and identify appropriate patients and then collaborate with the American team to complete the cases.

The Indian doctors are very capable; they invite Americans because they are very invested in sharing the educational aspects. As an order of comparison, in January, our team did 15 bladder exstrophy surgeries in two weeks [among other complex cases the group treated]. At CHOP we see maybe three [bladder extrophy surgeries] a year.

When we meet Narendra Modi, he is spot on: 'How many operations will you do? What will you need?'  Our experience with Modi has been, whether it's a Muslim patient or a Hindu patient or a Christian patient, it doesn't matter. Take care of them all.

My experience has been that Modi is a decisive, responsible, approachable leader. We called Modi during a busy election [season] in January, and he immediately assented to see us.

He meets us at his home in the state capital. He is known throughout Gujarat for his probity, he is not known to indulge in the corruption that has claimed too many political leaders in India. Swami Vivekananda's picture is the only adornment on his wall. In 1898, the swami delivered an address at a Parliament of Religions in Chicago, and stirred the audience with the West's first exposure to Hindu philosophy that would blossom into the West's acceptance of yoga and meditation, among many other spiritual exports.

(So it's significant that Modi chose as a model a Hindu monk who believed in engagement with the rest of the world?) Exactly.

The United States became mired in the Modi story in 2005 when our country denied a visa to him, based on alleged failure to do enough to control the infamous communal riots that occurred in Gujarat in 2002. When his visa was denied at that time, most observers did not protest that denial, as the details of who was responsible or not for the 2002 riots were not available to us.

But as Fareed Zakaria recently wrote (here in the Washington Post, the Modi visa ban) was "arbitrary and excessive." No one had ever had his visa to visit the U.S. denied for attacking the freedom of religion before. Persecution of Sunnis in Iraq didn't stop the president of Iraq from getting a visa. Persecution of the Ahmadiyas in Pakistan has never stopped leaders from visiting. Leaders of Saudi Arabia (where practicing non-Muslim religions is restricted) have not been denied visas.

The writer Zahir Janmohamed recently detailed the story of the (Modi) visa denial (here on a New York Times website) when he described how evangelical (Christian) members of Congress (led by U.S. Rep. Joe Pitts, R-Pa., who represents part of Philadelphia's Chester County suburbs) worked with an Indian Muslim group and some far-left radical Indian Americans to deny a visa to a Hindu politician.

In 2012 the Supreme Court of India published the result of a seven-year investigation of the Gujarat riots. They wrote that Modi did much to prevent the riots, and they could not find that he was complicit or let the violence happen. That's when many of us, myself included, said that this is a finding of an independent investigation carrying the imprimatur of the Indian Supreme Court -- we should normalize our relationship with Modi and his visa ban should be lifted.

But the State Department has in my mind an absurd bureacuratic inertia. They said he can reapply and maybe they'll reconsider. Now England and the E.U. had lifted restrictions.

It was a shock to me when the State Department's error was replicated here at Wharton last year. When Modi was invited to speak (remotely), I believed that it was absolutely an appropriate invite, considering Modi's reputation as a business-friendly and pro-investment leader.

While I was shocked that a section of Penn professors actually rather aggressively opposed Modi's video address, it was stunning that the Penn and Wharton administration actually capitulated to those few faculty members and cancelled Modi's address... By alienating the future Prime Minister of India, Penn finds itself having scored a self-goal versus the Indian government. It was a needless capitulation... Free speech and the pluralism of thought were killed.

Now we Americans need to reach out. We need to make a statement that the treatment of Modi was wrong and such an error should not be allowed to recur.

Will Modi visit the U.S., now that Obama has invited him? Joshi: People say Modi should refuse, the first time. He should be an invited guest. The U.S. not giving Modi a visa was a big story back home, and people could not believe that an elected leader of 60 million people was refused a visa by the U.S. because of accusations only.

Most people in Gujarat that I know feel that Modi should not come immediately, just becuase President Obama invited him. There is much work to be done in India, and many nations welcomed him. Perhaps he should go to those countries first.

Shukla: I would like my home institution (Penn) to realize there are consequences to these decisions. This decision to disinvite Modi was capricious and insulting. He was a global leader on the rise. Everyone knew from the opinion polls, if he ran, he'd win.

I feel my colleagues at Penn who opposed him did a disservice to our campus. Not only to free discussion to debate. But to diversity of thought. To me, that's the biggest tragedy. That's the tragic repercussion of 2013, that we have put ourselves on the back foot. That should not have happened.

(Did Penn and Wharton administrators talk to you about their decision?) I put my thoughts out there (in the Daily Pennsylvanian and a New York Times blog item). I think we had a healthy debate.

Joshi: It is important to remember that in the last 12 years (since the riots) peace has prevailed in Ahmedabad. There have been no more riots, which is actually incredible, considering Ahmedabad's sensitive communal history. The thought process has changed. It's now for growth. To upgrade your standard of living. To provide houses. To create good roads for transportation. Nobody's fighting.

(Do Muslims hold positions of power in Gujarati public and private institutions?) There are Muslim professors in the medical college. The state secretary for housing is a Muslim.

(In the private sector are there also some Muslims in charge?) Shukla: There are many Muslims in leadership and administrative roles in industries throughout Gujarat. But there is no doubt that like in other parts of India, there is an inherent ghettoization in Gujarat. If a Muslim wants to buy an apartment in a Hindu part of town, it's very difficult. A Hindu would never buy a place in a Muslim part of town; he's not going to feel safe. That's not Narendra Modi's fault. He's not saying, 'Don't buy an apartment from a Muslim.' That is something that Gujarati society must mend thorugh deep introspection.

(India has job and school preferences for lower-caste Hindus; should it have preferences for the Muslims and other poor minorities?) When you start doling out rewards based on the religion of your birth, where do you stop? India has half a dozen major religions represented in the country. Where does this process of communalization stop, if the government starts according preferences based on religion?

Joshi: Communities have strong characteristics. Hindus, Muslims, Christians, Sikhs and Buddhists may prefer to live amongst their own due to similarities in diet, dress, religiou spractices and the like. There is a comfort level (between the communities). And it's not like they don't have good schools. There is undoubtedly an education gap.

(So if Muslims are less likely to get higher education, if a Muslim does get a professional degree, is he able to get a ranking job at a large (updated) company like Tata or Reliance?) Shukla: India has its struggles, no question. Modi would say, 'The way I can best help improve society, as a politician (not as a spiritual or religious leader), is development.' There is probably more access to capital in Gujarat than in any other state in India. So Modi's mantra is to create a rising tide (that lifts all Indians). That was his entire motivation during the election season.

Joshi: His vision is different than what we had before. He utilizes technologies creating jobs, for the young professionals. And I believe that a Hindu or Muslim, equally educated, shares the same opportunities and access. Can Gujarat do better? Yes. That is our shared, collective responsibility, to improve the plight of the disadvantaged.

See also:

Philly power plant parts CEO Krishna Singh praises new India leader Narendra Modi's business agenda, potential as U.S. ally: http://www.philly.com/philly/blogs/inq-phillydeals/Holtecs-Kris-Singh-praises-Modi-election-as-aid-to-US-India-development.html

Philly law firm CEO Ajay Raju sees promise, understands concerns on new India leader Narendra Modi: http://www.philly.com/philly/blogs/inq-phillydeals/New-India-leaders-pro-business-not-hindu-taliban.html

Penn humanities profs say minorities, secular Indians, world leaders should be worried by ascent of new India leader Narendra Modi: http://www.philly.com/philly/blogs/inq-phillydeals/India-humanities-profs-at-Penn-concerned-new-govt-.html