Exploring health care and medical tourism in a modernizing society: journey in Chennai, India.

The Start of a Journey I am riding in the front seat of a tiny Ford Icon, taking in the leftsided passenger view as we bump along narrow dirt roads. The driver is cheerfully unperturbed as he navigates various obstacles in our path: children, motorists, stray dogs, cycle rickshaws, carts of bright red tomatoes. By the end of my trip, my mind—and stomach—will be desensitized to the labyrinth of vehicles, pedestrians, and animal life constituting traffic in Chennai. But today is my second day; thus, I still shut my eyes in instinctive terror as our car swerves to avoid the mammoth trucks lurching toward us. Chennai, India: A city in which I have never lived, but whose ancient culture shapes my roots. My memories of this south Indian city centered on its role as default destination of onerous family vacations. Back then, the sweltering summer weeks of bumpy rickshaw rides, obligatory extended-family visits and inevitable digestive woes felt more like forced medicine than my parents’ claim of “relaxation.” Yet these trips nurtured my subconscious appreciation for Indian culture, as I studied Sanskrit literature and trained as a student of Indian classical vocal music. Over the years, summer trips lessened in frequency, but my connection to Chennai grew tenacious as I pursued its art forms. That connection had planted the seed for this trip. As an almost-physician, I was returning to Chennai with two specific goals: to provide medical service, while immersing myself in the culture inspiring my cherished hobbies. Since my last visit (nearly a decade earlier), both of us had changed rather substantially. I’d moved across continents, worked for a behemoth investment bank and a tiny nonprofit agency, studied economics in England and parasitology in Texas—and now, months away from medical school graduation, was embarking on a future career in preventive medicine and public health. In India, transformation permeated society. A patriotic, protradition movement had sparked a nationwide flurry of renaming Indian cities in indigenous language (Bombay to Mumbai, Calcutta to Kolkata, Madras to Chennai) even while popular media captured evidence of India’s resolute modernization: humble tea stalls replaced by Internet cafes, expansive rice fields now home to gleaming “tech parks,” mobile dosa-poori-masala stands juxtaposed near freshly painted Pizza Huts, bright yellow auto-rickshaws lost in the roar of sporty Honda Citis. And so it was thus, on this occasion of visiting a home I secretly feared would seem rudely foreign, that I found myself cowering in the passenger side of a Ford Icon. A Snapshot of Daily Life in Chennai Chennai operates in a chaotic, stubbornly functional context. First, people are everywhere. Chennai’s 7 million people share a space of 180 square km, representing a population density of 24,231 people per square kilometer. (Los Angeles, one of the most population-dense cities in the US, has a density of 3170 people/km). Life in Chennai splashes boisterous color on the seemingly mundane. On the road, trucks groaning with loads of cargo are festooned with painted curlicues and canary-yellow paint jobs; shifting into reverse gear, they emit tinny renditions of various bhajans, Hindi film songs, or the national anthem. On nearly every corner, stores sell milk and pistachio (“pistha”) biscuits along with artists’ paintbrushes, crochet kits, an array of sketchbooks, and Fevicol-brand craft glue. Street vendors wheeling carts of fresh vegetables, sugarcane juice and customers’ folded laundry advertise their wares by shouting at the top of their lungs, creating a collective vocal cacophony that only a professional mother-in-law cooking in apartments above can interpret. Everyone loves music, and fittingly, every street in Chennai pulses to a perpetual soundtrack: Bollywood, classical, bhajans, instrumental mandolin/veena/violin, drum beats Exploring Health Care and Medical Tourism in a Modernizing Society: Journey in Chennai, India