As I get to know the Indian way of life more intimately, I notice three potential cultural barriers to implementing a National Indian Deceased Donor Transplant System. Such a system needs to embrace the values of efficiency, transparency, and accountability. The three peculiarities of Indian culture that I’ve identified may hinder the achievement of such values. Please note that I in no way intend to be judgmental about these deeply ingrained cultural behaviors. They are simply different, not necessarily good or bad.
First of all, the many Indian religious belief systems are NOT cultural barriers to the Indian public’s acceptance of organ donation and deceased donor transplantation. All major religions support an individual’s intention to be an organ donor. India has a strong tradition of eye and blood donation (the latter more recently due to effective education and public relations). Also, in Tamil Nadu the organ donation consent conversion rates (actual # consented/all potential donors) are as high as 65%. The Indian people get it when good education is provided, especially when spoken by religious leaders and other figures of public trust.
Here are the three potential cultural barriers:
1. Indians are systems- and processes-averse.
I’ve been told that Ayurvedic medicine has floundered because of the absence of strict documentation such as with allopathic medicine. Indeed, the father practitioner teaching his son will not tell him everything that he knows. It’s good to be forced to find your own way, it’s good to be lost, but it is not an efficient way to pass on knowledge of what really works and what doesn’t.
Despite this, things get done (like tiffin system in Mumbai). I believe India is perfectly capable of building an efficient nation-wide transplant network. Success is likely given the spectacular achievements of the Indian Railroad System. Also, there are many smart and capable engineers and computer scientists throughout India, so this is really achievable.
2. The notion of bribery permeates every aspect of Indian society.
If the average Indian citizen expects an incentive to provide any premium service, how do ordinary tasks get done, I wonder? Narendra Modi has taken on the Aam Aadmi anti-corruption theme because he knows a country cannot prosper economically if middlemen are always taking cuts. This is especially true for infrastructure projects like roads and buildings. If 60% of the budget of, say, a road project goes up in bribes, there’s only 40% left to build the road. And it ends up being a crappy road.
There is some reasonable hope that every day corruption will decrease with the digitization of processes (e.g, purchasing online). Direct business-to-consumer transactions need no middlemen. So, hopefully the amount of blatant corruption will lessen over time. A National Transplant Network must be completely transparent and accountable, otherwise the public will not trust the system.
3. Indians are sometimes too polite.
Indians are taught from a very early age that it is impolite to say no. Politeness, however, can result in ambiguous behavior. In the West, this can be perceived as being duplicitous or flakey. In an efficient, transparent, and accountable National Transplant Network, you have to say what you mean and mean what you say.
Participants can’t be afraid to say no (for example, to requests for exceptions to priority on the transplant waitlist, or if a transplant center needs to be shut down, etc.).
I think that all three of these cultural idiosyncrasies are surmountable with appropriate education and commitment to the values of efficiency, transparency, and accountability.
I understand the “it can’t be done” is an all too often refrain in India. I have great faith in the Indian people that a National Transplant Network can be built and, more importantly, sustained. It is absolutely possible. It will require a herculean effort and appropriate funding from the Centre and State Governments, Transplant Hospitals, and Corporate India, but this can and must be done.
Although this entire post has been one big cultural note, I’ll throw in one more: Indian hospitality. If you’re invited to a meal at your Indian friend’s home, come hungry. The host takes great pride in being able to offer you more than enough food of many varieties. But don’t eat every last bite; you wouldn’t want them to feel that they did not have enough food to give you. Indians like to treat their guests like kings, or if you’re lucky, gods. So, be sure to return the favor of respect by eating only with your right hand!