 Hello and welcome everyone to this episode of People's Health Dispatch. Today, we have two very eminent guests, Yogesh Jain and Sara Nabiya. I'm going to introduce both of them in some time. But we are going to discuss a very important, very timely publication, a book, COVID-19, A View from the Margins. It's a volume of essays documenting the experience of people from different walks of life at the frontline of COVID-19 response in India. This volume is the narration of the response as viewed by the by current formal civil servants, doctors working in rural urban areas, journalists from across various parts of the country and other parts of the world, various public health practitioners, some very seasoned, some new, economists, lawyers, and it is about the millions of battles being fought at the margin against COVID-19. Welcome, Yogesh. Welcome, Sara. Hi. Let me introduce both of our guests here. Yogesh is a pediatrician by training and a practicing public health physician. He's one of the founding members of Jan Swasa Sahiyam, where he has worked for 20 years. Based on his lived experience from rural Chattisgarh, state in India, he has advocated from provincial to international levels to highlight the causes and burden of the poorest in the world. He has served in multiple health commissions at the national and international level. Welcome again, Yogesh. We have with us also the co-editor of the book, Sara Navya. Sara studies public health and business at the Bloomberg School of Public Health, Johns Hopkins University. She has previously worked in advocating for HIV prevention for the marginalized populations, especially vulnerable women at the grassroots and national policy space. Welcome, Sara. So let me start with Yogesh. And then we can, of course, all of us can join the conversation. Yogesh, in the introduction of the book, you quoted Amit descent. You say, and I'm quoting it. What we can observe depends on our position, vis-a-vis our object of observation. It seems views from the margin is very central to this book. Why do you feel, why did you feel the need to seek COVID from the margin? You know, the fact that our observations are different, depending upon the position that we have in relation to the object that we are observing, is something which is very common sense. And at least in our Indian tradition, we knew about the provable elephant, where someone felt the different parts of an elephant from different places. But also when you stand a little at the margins, you're able to observe the more complete sort of object. If you were more central to the object of observation, you would only see a part of the whole, if the object was large. So in this case, and this has been also borne out by the fact that the people who ran the services for the, who responded to the pandemic as providers had a different view. There would be celebration about the technology, information technology that was done, or the public health measures, or the law and order measures that were sort of unleashed in a sense as well. But those people who decided often did not serve the consequences of those decisions as it has happened in a place where people are not represented in decision making for themselves. So I thought that this was to get the views of people who were at the margins of society around any axis that we can talk about whether it is in an unequal society, whether it is the gender or the geography or your social class or your pecking orders in terms of food availability and other axes of marginalization to get those views would be a critical thing to see actually what to get the views of the pandemic. In fact, recording of the documentation of the pandemic as it mattered to the people who were away from the position of power. And that would be the, that was the reason why we felt that this was needed to be documented. Absolutely. Sarah, your thoughts on this, anything you want to add here? So you see, at baseline, our society is unequal. Be it for India, where you are placed geographically is a big factor on what you have access to. And then there are other very important factors such as what religion you follow, what gender you identify as, what is your income level. All of these are important determinants of the level of health care and the level of social security that you enjoy. And I feel us as a society are accountable to each and every person in our society, irrespective of where they stand on all of these different indicators. So it is important to document and hold ourselves accountable as to how did we serve the interests of those who were disproportionately burdened. And that is why a view from the margins was so important. Like what do we usually see in peer reviewed literature? We see of the technological advances that have been made, the latest drug, what has been the scale of the testing. But how often do we talk about how access to these things that we are celebrating is actually reaching the people reaching the last mile. And somewhere this book is an attempt to address that gap speak of how we did in that last mile. So in order to prepare for future pandemics, it's important that we remember, record and celebrate not only our technological and scientific successes, but also be mindful of what are the efforts that we made to reach each and every person who all deserve the same level of care. And that is why this view from the margins was important to remind ourselves of how we did and how we can do better. Absolutely. And this pandemic time we have seen how inequities and the structural inequities in the society, how they have come out in open so glaringly. And when I am looking at the book, it's such a mammoth task bringing so many people together at this very crucial juncture. And it's really incredible work that you all have done. Sarah, let me start with you here. How did it all started and how was your experience in doing this? It was definitely a mammoth exercise and an amazing learning experience. But I think one of the main, for me as an editor, one of the X factors of this book is it brought together something around 70 odd authors. We have 35 chapters and a total of 70 odd authors. And I think being able to mobilize and get people to rally around the cause that credit solely goes to Yogesh sir's ability to kind of be the pipe-piper and get people to believe in what we were doing. Yogesh, your thoughts, your experience, how did you manage to bring all of this together? Well, this book took birth at the end of the first year of 2020. When we had already seen the whole of society response, at least through the print media and through other discussions that were happening. And if you remember that was a year that we used to all have so many webinars going on almost every day. And this was a time that we realized that what you heard from people or even this webinars was largely the mentioning of what the state was doing. Or what the other so-called people in power, whether it's technical power or socioeconomic power were doing. When we decided to get the views of the people or the impact of the people at the margins, we decided to look at for authors, those people who we feel, who we felt had a connection with the people. Often it's because the English, the language, the medium was considered to be English for the writing. We had to have people who would speak up for the people at the margins and not only the people who were at the margins. So thus we took people from who had connect at a physician level with their patients or with public health managers or administrators who were dealing with their own departments. Or the people, economists who are doing field level research or trying to collate views as well as a lot of health journalists were also contacted. Because we felt that they had an eye in the ear to the ground and therefore those were the things that we put together. We had brought up a list of 45 odd authors or a few of which finally did not so-called deliver their pieces, which happens in most books. But I think it was, I would say it was a matter of great happiness that almost everyone whom we had contacted agreed to very graciously and I would say the enthusiasm, participate in writing of this thing. And to accept changes that we suggested and we did propose to them specific questions that they should focus on in their chapter and I think most of them measured up rather well. It shows the commitment, it takes a lot of effort to bring in rigorous evidence at this very challenging time. Let us now get into a bit of content of the book. We have limited time, but one of the ideas that you have put forward here, you give us this term, syndemic approach to understand COVID-19. Yogi, would you like to elaborate on this because this becomes one of the very central theme of the book I feel. So we know that the pandemic or the epidemic across the different continents of COVID-19 was only one stream of thing that was happening. But it was its impact and its form was determined by the other socio-economic and political forces that govern any disease manifestation as mentioned in the first, as a quotation from Virko, who said, epidemics are manifestations of mass disturbance in our lives. And so the syndemic approach which Richard Horton of the Lancet has also said very strongly for that to be able to understand the impact of this pandemic, we cannot sort of just discuss the biomedicine of this pandemic or the responses to that. But we need to understand the underpinnings of the non-COVID illnesses that affect us but also the social and economic and political inequities and forces that determine how COVID pandemic would manifest itself and impact on people. So this approach, you reuse the word syndemic to explain this pandemic, if I may say. Absolutely. And in terms of method also, you have mentioned it very categorically that you wanted to bring in people's history or historical narrative into this. And at a time within our governments across the world, particularly also in India where there is a lot of effort from the state to change our history. Here is some of the historical facts when you bring in such a grounded method, it speaks a lot. I think this is a very important element of the book. I'm quoting here, often recorded history is the memory of states, perhaps meaning the memory of those people in power. States and nations are not people and communities. Accounts in the book are meant to create the people's history of the COVID-19 pandemic, seen from their point of view. How did you think about it? Why did you find it's important to bring in people's history here? So I would say here again, and Sarah might add later, who's a student of history. But for me, history is basically a struggle of memory against forgetfulness, so that we can use that in our future. And we felt that the memories of this pandemic that may be useful for people who study the problem later, would require the version of what happened in the pandemic of the people, rather than of the people who were the providers or the people in power. And thus, like Howard Zinn did it for the people's history of the indigenous people's history of the United States was different. And the history books are written by people who are in power, that goes down the lines. So we thought that it was our onerous task and I would say something that we did with pleasure, that we get the history as the people of the pandemic, as people saw it on their own or as people wanted to record it for posterity from their point of view, rather than what the governments and the so-called technical establishment would be explaining the, so about vaccines or about testing or about treatment or about the laws that were unleashed on us, the changes in the welfare programs that we had all had to be seen from the point of view of the people, rather than from the people who made those changes. Sarah, over to you. Yeah, so I think I pretty much concur with what was just said, but I'd also like to add that for me, I see the value of history increasing as time passes, right? The more ancient it becomes, the more valuable it becomes, because when you're in this very unusual, high-paced situation that COVID-19 has been, how much are we really dissecting, synthesizing and learning from? I'm not sure a lot. I'm not sure how very well we are introspecting right now, but the reason why it was important to have this historical record is, we would be doing a disservice to ourselves if we don't learn from this. And this is an attempt to create that record so that we would think that the books really served its purpose. If somebody 10 years later picks it up and says, you know, this is what we did right and this is what we did wrong. And, you know, we have to learn so and so from it and take this forward. So we want this book to serve as that account that will help people introspect and push us to kind of think and also accept things which may at times be uncomfortable, but what has really played out from this entire pandemic experience. So, and you'll see the last section of our book, which is more like field notes from COVID-19. That's why we've made a very intentional attempt to include people's stories. You know, the first two sections, the first two or three sections are more technical that way. You know, though we've taken, you know, people's perspective as to how they experienced testing, what was their experience with treatment. But the last section typically caters to stories because stories can be very powerful when you're trying to take a historical record. So that is why probably recording of people's history was so important. And we hope that its value will increase. You know, the further we move away from this. I'm sure thanks for bringing also bringing in the structure of the book, but I'm very sure that as public health students, we have to practitioners, we have to refer to your very well documented historical narrative from people's perspective of COVID. Any thoughts? How are you planning to like launch the book and have the release? What are your discrimination ideas? Sarah and Yogesh, anyone, please. Let me go on first. I would say the book is already there in circulation and we did not go for any formal release in a sense. We might have some sessions where we can probably read some sections from the chapters together with some of our co-authors, as time passes in different sites of the different places in the country as well as internationally. This book is going to be useful for people outside India also since, you know, I don't think other countries are rolling in equity and justice. So, you know, those would be useful there also. I'm sure that our authors are also looking forward to discuss and, you know, publicize the book among their ecosystems. Thanks. Sarah, any last thoughts? Anything you want to add here? No, just that I think pretty much everything on the, you know, how to get the book is covered. But to everybody who listens to this, I think when reading the book, you know, I would encourage readers to keep in mind that it is a first of its kind attempt not only to document a people's history, but it's sort of an off the people for the people by the people book on COVID in India. And that is an incredibly special thing about this book, you know, it's about the COVID experience in India written by Indians, you know, for Indians. So it's, you know, it's an attempt. It's a humble attempt to kind of, you know, kind of be our own storytellers and not have the story told by, you know, other people because our experiences have been very different. So when reading the book, you'll see that we've tried to kind of retain a lot of that ethos. A lot of times intentionally, we did not want an overly sanitized version of it, because ultimately I feel that is what kind of makes it so special to me as an editor. So yeah, just just that's kind of just one thing about the book. Indeed, it's very, very special and the way you put it off the people by the people and for the people. I think with that note, let us close today's conversation. Thank you so much for your guest Sarah for speaking to us and giving your time. It was such a fascinating conversation. Thank you. Please read the book and also please subscribe to People's Health Dispatch newsletter. We are producing every fortnight and we are all almost completing one full year. So thank you again to all of you.