by Hans Rosling
Now the secretary explained the secrecy: “the trust” was money set aside to offer short-term loans to students who needed to travel to Poland for an abortion. The sum had shrunk because last autumn more women than usual had made the trip and many had not yet saved up enough to repay the loan. I had heard about Catholic Poland’s abortion services and naturally promised to ask no more questions, and to not reveal to anyone what he had told me.
It was only in 1975 that Sweden legalized abortion. Remarkably, that was three years after similar legislation had been passed in India. I learned a great deal more about matters such as this on my study trip to India in 1972: in 1970, since Agneta and I were both growing more intent on satisfying our curiosity about the world, we started planning our great trip to Asia.
My parents did not approve when I told them about our plan. One reason was probably that I would have to take six months off my medical studies. They were upset at the notion that such a fine education be put on hold. Still, their main argument was that the journey might be dangerous, even though they realized and accepted that they had no control over what we did. As my mother said by way of ending the discussion: “For your dad and me, higher education was just a dream. Now, we no longer understand you. You have educated yourself away from us.”
* * *
The War of Independence in Bangladesh broke out in the spring of 1971 and continued almost until the end of that year. The war affected me directly. Agneta and I had by then made detailed plans for our travels. The basic idea had been to drive in a VW camper van along Indian country roads but the war meant that the India–Pakistan border was closed. We had to rethink.
Toward the end of the year, Agneta completed her nursing exams and started her first job. I had finished my fourth year as a medical student and could take up locum posts. We had saved up the money we needed and set out on February 8, 1972.
The word “backpacking” had not yet entered the language but we did check in two very full rucksacks on the flight to Sri Lanka. The package trip included two weeks in a pretty little beach hotel that we really enjoyed. However, our reserved seats on the return charter flight to Sweden were empty. Instead we traveled on, first around the island and then to India by the regular ferry service. When we arrived at Rameswaram in India, we had to go down a short flight of steps and jump into a rowing boat to reach the beach. The customs and border officials were housed in tents. Assisted by barefoot soldiers in khaki shorts and knee-high woolen legwarmers, they kept an eye on us travelers. The soldiers were armed with impressive, old-style rifles. The entry protocol was exceptionally careful. Blood samples were collected and checked to exclude malaria infection. Our yellow World Health Organization cards were examined to make sure that we had been vaccinated against smallpox. Down there on the beach, the Indian state functioned very well.
During our month in Sri Lanka, we had been amazed by the country’s ancient history. It was news to us that the written form of Sinhalese, the language of the largest population group, had been in use for more than two thousand years. Equally humbling was the sight of the several-thousand-year-old water reservoirs and irrigation systems. They were proof not only of impressive engineering skills in the very distant past but also of how ignorant we were. We had not had the faintest idea that the Sri Lankan civilization had been so advanced.
Our sense of shame deepened in India. During our first few days, we visited ancient temples and realized that all the different languages of India had alphabets which had been in use for many thousands of years. This was so different from my travels in Greece. There, I had already been aware of great landmarks and historical events. It was intellectually painful to be a tourist in Sri Lanka and India. And it would get worse yet.
* * *
Part of the plan for our Asian trip was for me to be a visiting student at the St. John’s Medical College in Bangalore. That “elective” period of study completely changed my views about India. The course was good but the effect on me was due less to the content and more to the first hours of teaching on the first day. I gained a brutal insight: the Indian fourth-year medical students knew much more than I did. I had definitely been a keen student, perhaps not always top of the class but usually with marks in the upper range. I admit I arrived in India convinced that I, a high-flying Swedish medical student, would outclass the locals. But, once there, it became instantly obvious that in India I was near the bottom of the class.
On my first day, I was asked to join a group of students for an instructive run-through of yesterday’s X-rays from the medical ward. The first film was a so-called angiogram—an image of contrast-injected blood vessels in a particular organ. This one showed the blood vessels in the kidney. The investigation had been made because the patient had presented with blood in his urine.
I remember my feeling of shock that an Indian hospital was able to do angiograms. In this case, the procedure involved inserting a thin, flexible plastic tube—a catheter—into the large artery in the groin and advancing it up into the aorta. Once the tip of the catheter reached the aortic branch that supplied arterial blood to the kidney, the radiologist injected the contrast liquid. The X-rays of the injected kidney would then show its blood vessels.
The procedure had been distinctly dangerous until 1953, when the Swedish clinician Sven Ivar Seldinger, researching the method at the Karolinska Institute, came up with the idea of the long plastic catheter. It made the investigation easier and safer. My Swedish clinical teachers used to boast about this advancement and point out that it made the technique more widely used internationally. Even so, in 1972, I arrogantly believed that an Indian university hospital surely wouldn’t be ready to handle it.
I stared at the beautiful pattern of branching blood vessels on the screen in front of us. The image quality was as good as anything I had seen in my Swedish university hospital. While I pondered the amazingly high standard of care in the Indian hospital, I suddenly realized that the blood vessels in the upper part of the kidney looked unusual—thinner than normal and clustered into a ball shape. It surely signified a tumor, possibly cancerous.
The Indian doctor asked the group: “Why would this patient pass blood in their urine?”
It would be polite, I told myself, to let the Indian students have a go before I told them what was what. In retrospect, I recognize of course that this was just another symptom of my superiority fantasy.
“The reason there’s blood in the patient’s urine must be the tumor we can see here in the upper part of the kidney,” said the first Indian student to answer. “The patient is lucky because it’s a relatively small tumor and discovered early. When we examined him, it was actually impossible to palpate it through the abdominal wall. And he said the pressure didn’t cause him any pain.”
The radiologist asked why it was that the cancer had been detected so early. Another student, who had also been on the ward when the history was taken, said that the patient had gone to the doctor immediately on finding blood in his urine. Unlike many, he hadn’t tried out folk medicine first. The student added that this was likely to be at least partly because the patient trusted modern medicine, given that he was an electrical engineer employed by a local telephone manufacturer.
One after the other, the students answered the follow-up questions concerning other possible early symptoms of kidney cancer. I stopped trying to answer the instructor’s questions and instead tried to work out how the others knew so much more than me.
Walking out into the corridor afterward, I turned to some of the other students and asked why I had ended up in a training session for specialists. I added by way of explanation that I should really have been with the fourth-year students.
“We’re all fourth-years,” they said. “What’s the problem?”
I told them how impressed I had been by their knowledge about all the likely symptoms of kidney cancer and also about other illnesses that had been discussed.
“Which textbook do you use?” I asked.
> “Most of us go for Harrison,” one of them said.
Harrison is the abbreviated name of the biggest existing textbook in clinical medicine: at the time, 1,120 tightly printed pages. I was an ambitious student, and had bought this tome the year before, in 1971. Still unread many years later, it sits on the bookshelf behind me as I write this sentence. To pass the Swedish exams, I mugged up using a condensed manual with bigger print and half as many pages. As we carried on comparing medical studies in Sweden and India, it became obvious that Indian students spent much more time re-reading their big books than their Swedish colleagues devoted to their brief handbooks. The world view that I had grown up to accept unthinkingly—that West was best and the rest would never catch up—had for the first time been challenged and changed.
We had expected to encounter poverty in India and we certainly did. But we had been ignorant of the region’s great, ancient civilizations and also of how advanced the talented young Indians were in the areas of modern academic learning and skills.
* * *
We continued our journey from Bangalore. The Indian train company offered students low-priced third-class tickets and we spent many hours on trains. We passed the time talking and it made us realize the diversity of this huge country. In Nepal, we changed to bus travel and, once in the capital, Kathmandu, we set out on foot, hiking for four days along the paths of Himalayan valleys.
Thanks to a government trekking permit, we were able to find cheap places to sleep along the route, in family homes where we were given lentils and rice to eat. These kind, proud people scraped a meager living from growing maize on the terraced slopes. The communities looked well organized but conditions were tough. There were few schools and healthcare was nonexistent. The women bore an average of six children, of whom one or two usually died: infant mortality was 25 percent. It was also common for girls to be married off in their early teens.
After several hours of trudging uphill with the snow-clad peaks of Mount Everest in sight, we crossed the trail itself. We crossed an alarming suspension bridge and then climbed a final steep hillside. We were exhausted by then and sat down on the ground at a Buddhist place of prayer. A little girl came walking along, saw us and made a “sleep” gesture, leaning her cheek against her hands. She took us home to meet her parents, who gave us their bedroom in the upper floor of their straw-roofed two-story house.
* * *
There was a full moon that night. The village people gathered to play and sing in the moonlight but our host family did not join the others. They chose to stay at home to bathe their not-quite-year-old baby. The little boy was washed in a basin of warm water, dried and rubbed with butter and then given ground cereal mush to eat. All this was done by the couple working together. They did not mind us watching them from where we lay in bed just a few meters away. Agneta—a nurse—started making detailed notes in her diary. Her description of what they did soon grew into several pages of text. Around us, the valley air was clear and resonated with the tremendous organ roar of the mountain streams rushing past the village.
Nepalese suspension bridge
The next day, the family’s great-grandmother took us for a walk to the fields to show us how they cultivated them. We took photos, feeling we had gained real insight into their way of life.
* * *
Just in case we should ever return, we made a note of their names. And in 2014, forty-two years later, we did return. By then, the track to the village was fit for cars to travel all the way. Men in hi-viz vests with the transport authority logo shoveled sand to stabilize the road and clear the ditches. Fish farms had started up for export production. Schools had multiplied, infant mortality decreased and family size was approaching an average of two children.
But we recognized where we were when we arrived at the home of our old hosts. The house still stood, but in modernized form. Tin had replaced straw as a roof covering, just as in the other houses in the valley. The baby we had watched being washed now lived in the house with his own family: his mother had died twenty years earlier but his wife was as hospitable as his mother had been. His elderly father had gone to live in India. We had brought with us photographs from our first visit and showed them to friends and relatives from their neighborhood.
During the meal, we were told that all the local children were vaccinated now and they all went to school. Family planning was much better and the village health center offered the morning-after pill. Infant mortality was now only 4 percent. However, there were still problems—many of the girls left for the city to work as sex workers.
It rained that night but instead of leaving a sour, stale smell behind as had been the case during our last visit, the water poured off the tin roof. “Still, the straw roofs were surely prettier? Do you really prefer tin?” I asked the villagers. One of the men stepped closer to me.
“Listen, a tin roof lasts for twenty years. No maintenance for twenty years! We had to renew the straw roofs every second year: every two years we had to go out to cut the grass, take it home and dry it.”
“And now the house is dry inside and that stale smell is gone,” many of the women insisted.
I stood looking at the tin roofs for a while. The move from straw roofs and teenage brides to decent living conditions can often involve very ugly periods of transition—prostitution, slums, exploitation. And tin roofs. But simultaneously the forces of progress are at work, creating economic growth, better health and education, smaller families and increased individual rights. As you observe societies in transition, it is easy to focus on the ugliness. But the people I spoke to in Nepal knew where they were going and they were happy to be on the journey.
Before we left the village after this second visit, Agneta opened her old diary and read aloud the story of how the young parents had washed and fed their baby one night in 1972. Everyone was moved. The grown man who was once that baby wept. We wept, too, and gave him a photo of his mother. He put it away in a box kept for important papers and mementos. It was his only photo of her.
* * *
Back in 1972, we traveled southeast from the mountain villages of Nepal, first back to India, and then on to Burma (now Myanmar), Thailand, Malaysia, and Singapore. We ended our grand tour with a month in Indonesia.
Our Asian adventure had lasted for six wonderful months and we had learned a lot. Better still, we had made a significant decision: back home, the first thing we did was get married. We agreed that a full-on wedding ceremony would feel awkward since we had lived together for so many years already. Besides, we had spent all our savings. Instead, our marriage was registered at City Hall where the presiding judge read a poem that made us both burst into tears of happiness. We shared a peach in the park afterward and then picked up our bikes to ride to my parents’ home and tell them we were properly married now. My dad was delighted that he hadn’t been forced to face a formal wedding but my mum never forgave us for ruining her chance to throw a party. Agneta’s parents learned the news from a postcard sent to their summer holiday house in southern Sweden. They phoned to congratulate us.
Four photographs of the Nepalese family, two from 1972 and two from 2014
* * *
An important event took place on April 25, 1974: Portugal’s fascist regime fell. A couple of days earlier we had brought our first child home from the maternity hospital.
We lived near the hospital. That morning, we strolled home through the city park, pushing baby Anna in her pram. It had been a trouble-free birth and our daughter was in excellent shape. The delicate blue squills that always told us spring was here were flowering in the brilliant sunshine and we loved watching Anna sleep peacefully.
At one point that afternoon, I sneaked away to listen to the news and heard of the successful, bloodless coup in Portugal. Later, Agneta and I listened together to the evening news roundup and got the impression that the takeover of power had been expected. What Eduardo Mondlane had once predicted with such certainty had actually happened. And it seemed
to me, remembering my promise to Eduardo, that one happy young family—mine—would soon be able to set to work in a soon-to-be-independent Mozambique.
After our trip to Asia, and throughout my final eighteen months of medical training, my obsession with the world had grown more practical. Agneta and I had decided we would work for a few years in one of the poorest countries in Africa. Agneta had applied to join a training course in midwifery as a useful addition to her nursing skills and we had begun to plan in earnest for living and working in Africa as a family.
During Agneta’s pregnancy, we had agreed that I should be at home with the baby from October. Agneta took the idea of shared parenthood very seriously and was planning to complete her midwifery training during that autumn of 1974. As October came around, I was working at the Uppsala pulmonary medicine clinic as a locum and was hoping for a permanent post there for when I returned from Mozambique.
I kept hanging back from speaking to the head of the clinic but one day I knew this could not be postponed any longer. I explained that my wife had to finish her training in the autumn, and I wanted to take time off, from October to February.
“Time off? But you’re the locum. I can’t hire a locum for the locum,” he said.
“I see but … is there no chance that you could do precisely that?”
“If you leave now you can always come back in February if there’s a job up for grabs. But you have to stay on if you want to keep the post you’re in.”
“But next year they’ll legislate for rights to paternal leave,” I said.
