In this week’s episode of Fiction/Non/Fiction, co-hosts Whitney Terrell and V.V. Ganeshananthan are joined by author, medical doctor, and Africa Center CEO Uzodinma Iweala and Delhi-based journalists Bindu Shajan Perappadan and Suhasini Raj. First, Iweala unpacks flawed stereotypes about health and healthcare in Africa. Reading from his book, Our Kind of People, Iweala draws parallels between the HIV/AIDS epidemic and the COVID-19 pandemic, and discusses how certain African countries, including Nigeria and Tanzania, have fared over the past year. Then Perappadan of The Hindu and Raj of The New York Times talk about their coronavirus coverage, and explain how past crises have influenced the response to COVID-19 in different Indian states.
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Part 1 With Uzodinma Iweala
V.V. Ganeshananthan: So the first line of the book is “You know this story,” which sets up an expectation for Western readers who already have their own ideas or assumptions about the AIDS epidemic in Africa, and then you subvert that expectation by asking the reader, “Or is it?” Which forces me to ask, how much do I really know and what am I assuming? So I assume that setup was intentional. Can you talk a little bit about setting things up that way?
Uzodinma Iweala: I started writing this book in the mid-2000s, when I was doing a lot of work on health policy, and in many ways, it was written not just to talk about HIV/AIDS, but to talk about the way that people speak about sickness, illness, health care issues, disease on the continent of Africa and the various countries. I think that there is still a narrative about communicable disease and about these things in Africa, where there is no healthcare infrastructure, everybody’s getting sick, everybody’s gonna die. And it’s hard to deal with that narrative, because all of these things, there is some truth to it. There’s a great amount of truth to the lack of health care infrastructure, and you do have to contend with that, but at the same time the narrative ends up—especially in cases where people are trying to use it to help people—actually dehumanizing, and then causing people to lose interest in actually solving the problems, partly because it doesn’t really take a look at why the situation is the way it is. It just takes a look at what people see immediately in front of them, or what they want to see in front of them.
And so writing about the HIV and AIDS epidemic in Nigeria at that time was really a way of saying, there is what you see, there are the narratives that you have been conditioned or programmed to or want to believe, and then there’s a much more complex understanding of the situation that the people who are living this epidemic at the present actually have of the situation. And that’s what I kind of wanted to play with.
Whitney Terrell: And so another thing that we could talk about—Jerome chooses not to go to the hospital. Speaking of infrastructure and how people react to it, I can understand that fear. I think we’re seeing it now, in some cases, with COVID—the apprehension to admit that something is wrong and not wanting to face it, wondering what’s on the other end when you go in… Could you talk a little bit about Jerome making that choice?
UI: I think every society or every culture has a way they deal with disease and a way they deal with health and issues around health, and every individual also has their own way of dealing with it. Some people choose denial. Some people are hypochondriac. You have the whole range of ways that people deal with illness and disease. And I think in this particular case, which was narrated to me by somebody very close to Jerome, this person was in a state of denial. But you look at why. At the time, people didn’t know very much about what was going on. It wasn’t clear that anybody could do anything for you if you went to the hospital, so why subject yourself to that, is the reasoning, when you might just be pushed around from hospital to hospital or you might just be told that this is the end.
So maybe you’ll live in a state of denial and say everything’s fine, I’ll get over this. Again, I didn’t meet Jerome; this was told to me by somebody who knew him very well, so it’s not like I can ask Jerome what his state was. If you map it to the way that people deal with other diseases here or around the world, people wouldn’t tell people when they had a cancer diagnosis, because it was like, well what can you do about it? We’re just not going to tell you so as not to quote-unquote worry you. If you watch Lulu Wang’s The Farewell, there’s an element of that in that story. And so I think it’s about how people deal with this individually, and how societies deal with it, when something that is massive and overwhelming hits you.
WT: In the book, you also talk about how, during the HIV/AIDS crisis, Western doctors and healthcare professionals tended to look down on Africa and assume that only Western medicine is going to be able to fix the problem. I would call this the “We Are the World” complex from the American side. And they only see what you term the “tragic Africa.” What we don’t hear as much about is what African governments did and still do to combat HIV/AIDS. I wonder if you could talk a little bit about that, and specifically talk about Nigeria?
UI: First, to tackle “tragic Africa”—hundreds of years of narrative around that has formed a lot of responses to many different issues on the continent, and many different problems or challenges. Specifically with regard to HIV/AIDS, there are two things to consider. One, you’re dealing with resource scarce environments, and a lot of that has to do with cultures of extraction that were pushed by a lot of these Western countries that benefited from that. So we’ll just put that there and park that. That said, it’s not like people, when they recognize there’s a problem, don’t actually do things to deal with the problem. Sometimes it takes time for people to recognize there’s a problem—we can talk about that with regards to what’s happening now with COVID. But that doesn’t mean that people are just sitting there waiting to be helped, or not trying to figure out what they can do with the resources available to address the problem.
In Nigeria specifically, when folks finally woke up and decided, at the governmental level, that there was a problem, you’re dealing with a country that doesn’t have, given the size of its population, that much money to spend per person, but that didn’t stop people from locally grown awareness campaigns. Everyone’s like, well, they’re not talking about it, not thinking about it. That’s not true, necessarily. Internally, there was first a big push in the military to raise awareness about this. And then also looking at how you could take some of those lessons and use that for the wider society. There were a whole slew of doctors and nurses, healthcare professionals, who were very aware of what was going on and very much trying to spread the word and spread knowledge about HIV/AIDS, even if they didn’t necessarily have the access to treatment that would have helped to prevent the spread.
And there were local activists who were marching, coming out and telling people their status, trying to get people to understand that you need to combat the stigma associated with the disease. I interviewed a few of these folks in the book. You need to combat the stigma in order for people to feel comfortable going to seek treatment and seek health care, and figure out a way to actually find solutions to this health problem or health crisis they were facing on an individual level, and that we were facing on a societal level. And so that’s what I mean by looking beyond that Joseph Conrad mode, where you just see disease and starved bodies, looming figures, all of which are faceless and formless dying, left, right and center, to see people with agency who are faced with a really incredible and devastating challenge, but who are doing what they can do to shape their lives and to meet the challenge.
* Part 2 With Bindu Shajan Perappadan & Suhasini Raj
Whitney Terrell: Bindu, one of your early stories was about the first confirmed infection for COVID-19 in Kerala, which was one of the states where COVID protocols ended up being the most successful. Can you talk about how Kerala got that done, how it compared to other states, and how the Union Health Industry coordinated this?
Bindu Shajan Perappadan: The first COVID case of India was reported in Kerala. This is a state which has been known world over as a success story. But currently Kerala and Maharashtra, which are two large states, have more than 74 percent of the active COVID cases in India, which is a large number. So, India is seeing a spike in cases again, with the Ministry now directing Punjab, Jammu, and Kashmir, and Madhya Pradesh to increase their testing and surveillance. Going back to Kerala, Kerala is a state which has 35 million people. It has 100 percent literacy; it has a state government which is extremely proactive. It is a state government which has learned to be prepared for emergency from the 2018 floods, 2019 Nipah virus outbreak. So those lessons have been learned well; they have worked on testing, tracking, they have invested systematically in their healthcare. These are really the key pillars, which has helped the state survive COVID. And like I said, it’s a state which is seeing a large number of active cases, it is seeing a large number of recoveries. And it is also seeing a lot of travelers coming in, a lot of foreigners, a lot of Indians who were settled abroad coming back home, which is bringing the virus back home.
V.V. Ganeshananthan: Oh, is that the reason that the cases went up there? Because I remember at the beginning of the pandemic—my family’s Sri Lankan, and of course, I think there are a lot of Sri Lankans who like to think, Kerala is like Sri Lanka, look at the literacy rate—
BSP: Yeah, it really is. Because geographically, we aren’t very far away. So it really is the same. Our literacy rates are roughly the same. We have a lot of people from Kerala who were settled abroad who came back once COVID struck. COVID doesn’t know boundaries. COVID travels with people. So when you come back, the virus comes back with you.
VVG: And so speaking of this, in India, there’s an enormous number of migrant workers who are migrating from one Indian state to another. And that also was a challenge. And Suhasini, you wrote about how the prime minister’s strict lockdown early on left these laborers who had migrated from one state to another stranded and how the train setup to return them to their home states ended up spreading the virus across the country. Can you talk a little bit about that?
Suhasini Raj: So at the beginning of the lockdown, the prime minister was widely praised for taking charge, and his approval ratings had hit close to somewhere around 83 percent, his highest ever. But that’s where he saw himself to be vulnerable, on the migrant front. And there was this growing storm on social media and there was rising criticism from India’s opposition parties. The optics of the whole thing were turning out to be really nasty for Mr. Modi and his government. And so they went through this whole thing when they started the lockdown. They said that they were going to follow this economic theory where they’re going to do a complete lockdown, like the strictest ever. And then they were going to be heading for the worst, basically. So although they had expected that there’s going to be some migrant movement, what they weren’t expecting were the optics that they saw—all these migrants dying on the roads of hunger and of heat, coming for the trains. So, it was a knee jerk thing; they were reacting to a situation basically.
And that’s when they decided in April that they were going to be starting these trains, which are going to be running from the affluent parts, like Maharashtra, where the migrants traditionally migrated in Gujarat, and they’d be coming back to these rural hinterlands where there were no cases. So the virus was in fact being carried from these highly infectious places at that point in time, to those which were like green zones. So the lockdown, in fact, ended up spreading the virus via these migrant trains, versus the whole idea of trying to contain them where they were. You couldn’t keep these guys holed up in these really small rooms with nothing to eat. The infection was there when we started researching the story, and we were trying to get at the missteps that the Modi government followed, starting with the pandemic and the lockdown. And one of them was the timing of when they started the trains and when the infection had spread really deeply into these pockets, these urban pockets in Surat, Gujarat, where the maximum number of laborers from Odisha traveled. So what it ended up doing, in effect, was spreading it from the most infected to where there were no infections at all.
WT: That’s really interesting. So when you say migrant workers, you’re talking about Indian citizens who are moving from one state to another within India.
SR: That’s right. It’s these workers who are coming from these back and beyond villages of rural India. Traditionally they were farmers, and as the economy opened up and liberalization happened, they started traveling. So the story in this one particular place I zeroed in on, in Ganjam, they used to be working there three, four decades back when these contractors came to these villages looking for cheap labor. And Odisha has widespread poverty. So that’s when they started migrating to these big hubs of textile and diamonds like Surat. That’s how the maximum number of people employed in these industries and industrial hubs like Surat are from poor places like Ganjam in Odisha.
WT: We were talking to Uzo, our previous guest, about Africa. And I’m really curious about how nationalism plays a role in the way that the virus has been dealt with. Modi is a nationalist leader that we’ve talked about on this podcast before. Leaders like Bolsonaro in Brazil, and President Trump in my fair country, were big virus deniers. And that seemed to be part and parcel of their nationalist rhetoric. That does not seem to have been the case with Modi. I’m really curious why he seems to have taken the disease so much more seriously. Maybe both of you have opinions on this.
BSP: India understands diseases; we’ve had a very checkered history with diseases. COVID is not the first kind of virus to strike the country. Going back to the plight of the migrant laborers, I would like to say that it was there for everyone to see. And similar stories were echoed from across the globe. It wasn’t country specific, it wasn’t state specific. So the lockdown and the virus affected us all. It forced women to give birth alone, it forced people to die alone, it forced families to say goodbye to their people without a proper grieving process, without a formal goodbye. It snatched away the rights of families and friends. And people have lost their jobs. People have suffered pay cuts, factories have shut down. We’ve had mental and physical illnesses. So COVID is a very, very isolating disease. And I think India saw very early on that the devastation it can cause is tremendous. But it has also brought out the country’s resilience. Leaders’ quick thinking, the Indian population’s ability to adapt, our zeal for survival. And what COVID has really taught India is that the threat is real. It is lethal. And it can happen again.
WT: All those things about the isolation of COVID are obviously true. We had a situation in our country where half of the country thought that this disease didn’t really exist, still kind of thinks that it doesn’t really exist, doesn’t want to wear masks, doesn’t want to socially distance. It doesn’t seem, to us anyway, that there’s been a breakdown along political lines in India in the same way that happened in the United States. I’m curious if you could speak to that.
SR: Sure. I think what Modi got right was in the way he started out with these public messages about wearing masks and about maintaining social distancing. And then soon after came the lockdown. And there was a dry run for it, and the chief minister said that they had not been taken into confidence. So it was in a very quintessential Modi kind of way in which he came down with a lockdown without taking people on board. Because officers close to him say that “had we tried to deliberate, we would have never come around to doing this perfect lockdown, in trying to keep the country safe.” So I think that’s where he got it right, the narrative, in trying to spread that message by his radio programs. And we’d pick up the mobile and call and the first thing we hear is like “wash your hands” and “wear your mask.”
And that was way back in February. So I think he was trying to prepare the population, but not in that alarmist kind of way. It was when the lockdown came when people started getting alarmed. And what we saw was vigilantism. We did a story on how these virus vigilantes would jump at people who they thought were the carriers of virus, for instance, somebody traveling from urban India to rural India; they were lynched. And there was a whole lot of narrative that was built around Muslims at that point in time. Because there was a congregation that was happening here in Delhi, which turned out to be a super spreader of sorts within that community of Muslims. And this whole narrative was spread that Muslims were spreading the virus all over India. So we saw that hatred against Muslims spike up during that time, with the lockdown slowly opening up sometime at the end of May and mid-June. So we saw a lot of ups and downs as we went along trying to control the virus here.
Bindu Shajan Perappadan
“The Virus Trains: How Lockdown Chaos Spread Covid-19 Across India” by Jeffrey Gettleman, Suhasini Raj, Sameer Yasir and Karan Deep Singh, with photographs by Atul Loke, New York Times · “I Covered Coronavirus Victims. Then My Family Members Became Victims, Too.” New York Times
Crisis in the Red Zone by Richard Preston · The Hot Zone by Richard Preston · The Farewell (film) by Lulu Wang · “The coming of age of the Africa Centers for Disease Control” by Aloysius Uche Ordu, Brookings · “Africa’s COVID-19 Denialist-in-Chief” by Lynsey Chutel, Foreign Policy · National Covid Memorial
Transcribed by https://otter.ai. Condensed and edited by Andrea Tudhope, Izzy Curry, Audrey Seider, Pyrindaria Riley, and Shashank Murali.