Public health specialist Dr Unni Karunakara cycled over 5,000km across India to raise awareness about medical humanitarianism.
WHAT started out as a personal journey turned out to be a life-altering mission for Dr Unni Karunakara. In 1998, while on a medical internship in New Delhi, Dr Unni decided, on a whim, to join the National Himalayan Cycle expedition, a journey of about 2,600km through parts of Northern India.
“I joined 11 others to bike from Delhi to Leh and Srinagar and back to Delhi again on a single-speed Atlas bicycle. I wasn’t ever athletic in school or college, but the experience of cycling through the Himalayas, crossing several mountain passes and reaching Khardung-la (located in the Ladakh region of Jammu and Kashmir) at an altitude of 5694m was exhilarating.
“As I reached Delhi (at the end of the tour), I decided that I was going to carry on and cycle all the way to the southern tip of India – Kanyakumari,” recalled Dr Unni in an e-mail interview from New Delhi, where he now resides.
Unfortunately, an acute bout of hepatitis derailed his ambition.
For the next 25 years, Dr Unni devoted himself to his professional work as a public health specialist with medical humanitarian organisation Médecins Sans Frontières (MSF) or Doctors without Borders.
“I have spent the last two decades as a public health professional working mostly to deliver health care and humanitarian assistance to people affected by conflict, disasters and neglect. I have done that together with thousands of other volunteers of MSF,” he explains.
Dr Unni joined MSF in 1995 and went on to serve as its international President from 2010 to 2013. While with MSF, he set up a tuberculosis control programme in Ethiopia, and was the medical coordinator for the MSF programmes in Azerbaijan, Brazil and the Democratic Republic of Congo. He also worked in MSF’s public health department in Amsterdam. In 2007, he was part of the medical emergency response team that treated victims of cyclone Sidr in Mathbaria, Bangladesh.
“With the corporatisation of health care, the pursuit of profit has overshadowed concerns about equity and affordability. (But) doctors have a larger responsibility to their patients in advocating policies and environments that enable health and well-being and by being a bulwark against excessive corporate interests,” he says.
As a young boy studying in Indian boarding schools, Dr Unni had no clear sense of what he wanted to do.
“I thought of architecture and journalism at some point but with some persuasion from family, I decided on medicine. As a medical student in Manipal, I had a linear career trajectory in mind and considered specialising in neurology or radiology. Soon I began to realise that health and well-being are determined by factors other than and larger than medicine, such as the environment, economy and politics,” he shares.
This greater understanding of his role led to him leaving his clinical practice for public health service.
“The decision to leave clinical medicine for public health was not an easy one to make. Reading public health at Yale opened my eyes to the determinants and politics of health care. After an internship in South Africa in 1994 and a year-long stay in eastern Ethiopia setting up a MSF tuberculosis control programme, there was no turning back,” he says.
After completing his presidency with MSF, Dr Unni decided it was time to revisit his dream of cycling through India. But by now, his purpose for the trip had taken on new dimensions.
“I decided to complete the journey I started in 1988. (But) I wanted to combine cycling with raising awareness about medical humanitarianism and the work of MSF,” says the doctor who holds a Masters in public health from Yale University and a doctorate in public health from Johns Hopkins University in the United States.
Have wheels, will travel
Riding through the country on a bicycle made him more approachable to the strangers he met along the way. This, says Dr Unni, enabled him to speak to people about his cause.
“In India, a land of extremes, a cycle is perhaps the least threatening and the most sustainable mode of transport. You can stop whenever and wherever you want to,” he shares.
Dr Unni set out from Srinagar in Kashmir last October with the objective of cycling to the southern-most tip of mainland India and then on to Thiruvanathapuram, Kerala – a total distance of 5673km.
A custom “Unnicycles Tourer” bicycle was made for him by German company Schindelhauer and the medical humanitarian was joined by other riders along the way, such as Canada Olympic silver medallist Helen Upperton and Indian poet and author Jeet Thayil.
Dr Unni was able to share his experiences as a medical humanitarian worker with members of the public he met along the way, as well as medical students.
“I could write a book (about my experiences with MSF) and perhaps I should. Working with MSF has been a morally challenging and an emotionally draining (or rewarding) experience. I have travelled to and worked in far too many countries to recount. In all instances, the magnitude of needs and the necessity of assistance left indelible impressions in my mind. On many occasions, MSF teams have been the only source of health care for miles. Though I have had many soul-sapping experiences as a humanitarian worker, I continue to believe that humanitarian action saves lives and affirms humanity,” he says.
Bringing health care to the worl’d most remote communities has tremendous challenges.
“The main challenge today is the ability to reach those who are most in need and provide assistance safely and effectively. In Myanmar, the Central African Republic, and in many other countries, safe spaces do not exist for people to receive or to deliver humanitarian assistance. Medical workers are increasingly being targeted for doing their job or delivering assistance to those in need.
“Another challenge is to provide assistance that is appropriate and effective. In many poor countries today, those who suffer from life-threatening diseases do not have access to life-saving medications due to structural barriers such as unjust patent monopolies, and unfair trade treaties. Humanitarian assistance cannot and must not be just a charitable gesture, but action that affirms the right of all individuals to live in dignity and have access to quality health care,” asserts Dr Unni.
Back in the saddle
Dr Unni’s “tour” lasted 112 days – he stopped in 64 cities, towns and villages in 10 states and spoke to students from 10 medical colleges (including his alma mater, the Kasturba Medical College in Manipal) and participated in nine film screenings about medical humanitarian action.
The toughest bit, Dr Unni confides, was adjusting to being in the saddle for such long stretches of time.
“The biggest challenge was to wake up every morning and to get back in the saddle. I was constantly on the look out for small country roads to ride on as I found the air and noise pollution on Indian highways tremendously difficult to deal with. Looking back, I find it astonishing that I survived the tour with no major mishaps,” he confides.
Cycling through India was also nostalgic for Dr Unni – though he was born in Kuwait (where his father worked), he spent much of his student life in India.
“I was keen to see how India had changed in the 20 years I was away, and to hear from people about how they experienced health. These conversations where highly enriching,” says the doctor who now resides in Delhi.
This August, Dr Unni will be at the First Global Manipal Alumni Health, Science and Technology Convention in Kuala Lumpur where he will speak on medical humanitarian action, its principles and challenges faced in its delivery.
“This will be a great occasion to share professional experiences, personal stories, and catch up with friends. In addition to this convention being a serious scientific forum, it is also a social occasion and I am looking forward to meeting friends and alumni from Manipal in KL.
“Also, Malaysia was recently listed among the top five countries that provided the best health care in the world.” He says: “I look forward to learning more about the Malaysian health care system.”