In memoriam

N.H. Antia 1922-2007

Dr. N.H. Antia, plastic surgeon, community health lobbyist and health care policy-maker recently passed away after a brief illness. Even as we await more considered assessments of his many contributions to improving our public health system, offered here is a profile in tribute.

Noshir Antia ventured on his first plane ride when he was a small boy in a town in south western India. It was a joy-ride on a small plane at a time when aircrafts were beyond the ken of ordinary people. The ride isn’t important. But his memory of what struck him on his trip into the skies is a pointer to what moved him into the different paths he traversed in his lifespan of 85 years. He said he was struck most by the underlying unity of the landscape – the school, the temple, the dhobi ghat, the hospital and the liquor shop all had a place in the scheme of things. One just had to make an effort to see that larger design.

Years later he recognized the hidden linkages of economic status, living conditions and health in a small postwar industrial town in rural England, and the futility of techno-medical solutions. Writing in The Lancet he pointed out, ‘The workers’ plight, despite the wealth derived from the industrial revolution and the colonies over 250 years, was revealed by the gross manifestation of rickets… Its elimination by vitamin-enriched butter was an equally dramatic manifestation of a medical solution to what was essentially a socioeconomic problem.’ All through his life he chased that ideal of a well-balanced and integrated community that would take care of all its welfare needs. It was only late in life that he came close to realizing the dream in Parinche near Pune.

When I met Dr. Antia he was, one might say, on the threshold of his second career, in health care. His days as a surgeon were by no means past, but something else increasingly took precedence over his first love. It is not surprising that he set up the first office of the Foundation for Research in Community Health (FRCH) in Mumbai in an unused anteroom of the operating theatres of the Tata Department of Plastic Surgery, which too he had begun in 1959 and nurtured to great acclaim. This was 1977. Antia had some years back launched a health project in Mandwa near Mumbai, centred on locally trained health workers. This gave the impetus for him to take on the somewhat thankless task of anchoring the secretariat of the recently set up Committee on Health and Medical Services under the tutelage and blessing of the redoubtable educationist, intellectual and social activist, J.P. Naik.

The committee had an ambitious objective to produce a comprehensive strategy for the development of health care for the Sixth Plan, a plan that would follow up on the Bhore Committee’s radical recommendations of 1947, many of which had been shelved over the decades. The secretariat had to willy-nilly contend with brilliant, if sometimes intractable experts in medical and public health disciplines. Antia was undoubtedly the right person for the task.

Even though many of those who worked under him often found him autocratic, among his peers he could be very persuasive. In the numerous meetings of the committee, formally he spoke little. It was at the lunch table and post dinner discussions that he engaged the well-known and well-lettered public health specialists, including the controversial Dr. Carl Taylor from Johns Hopkins School of International Health, a sometime invitee.

Quite ignoring the past histories of several other reports, the ICSSR-ICMR Committee with V. Ramalingaswami as its chairperson, dared to look at out of the ordinary solutions towards a plan that would ground itself on the newly revived panchayati raj institutions and incorporate a ‘for the people by the people’ philosophy. Health for All: An Alternative Strategy turned out to be a path-breaking document. Indeed many of the recommendations of the committee were incorporated in the Sixth Plan document and Antia fought a quiet battle for decades after trying to push this agenda through.

Antia’s journeys in community and public health had just begun. He plunged into pioneering health care research at a time when few institutions were going that way. The core group of the secretariat underwent a metamorphosis to draw in more young people, in dialoguing and working with whom he probably grew as much as his young colleagues did. Among the early studies of FRCH in that first decade were an analytical study of the NGO institutions in health in Maharashtra, an independently researched companion volume to the HFA document, and a path-breaking study on health expenditure that for the first time estimated the huge out of pocket expenditure that had so far escaped critical scrutiny. For Antia, the crowning achievement of these different labours perhaps was the setting up of a comprehensive development model in Parinche in 2002 towards whose success he devoted his energies and resources.

Although Antia’s public image in recent years is associated with his activities in public health, his singular achievements in plastic surgery can hardly be forgotten. After his graduation in medicine, Antia chose to specialize in plastic surgery, a field that was only then taking big strides in England. He trained under Sir Harold Gillies, a skilled and intrepid surgeon whose name is synonymous with major developments in plastic surgery. Antia and Gillies had a lifelong association and Antia facilitated the latter’s visits to India which helped to put plastic surgery on a firm footing. Perhaps it is those early years with Gillies that prompted him into venturing out from safe harbours. He was among the earliest of surgeons to innovate and perfect skills in reconstructive surgery for rehabilitation of burns and leprosy patients. At a time when the disease was much feared, this young surgeon chose to treat those afflicted, much to the consternation of his family, his community and his friends. Some of his innovative techniques are now textbook procedures and awards and honours came from many quarters.

Antia was a vocal advocate of a people-oriented health policy and a severe critic of what he saw as a West-influenced pro high-tech curative care-oriented health programme. He actively participated in the evolution of the National Rural Health Mission and it is indeed sad that he is gone just when the NRHM is beginning to be implemented.

Antia Saab was by no means an easy person to work with – in the early days he was irascible and many of his juniors and colleagues in plastic surgery will recount his tantrums. And although he somewhat mellowed when he began to work in health care, there were many who would not escape his sharp temper. Notwithstanding this, his outstanding legacy is in the many that he inspired to ‘go where no man has gone’. NHA wasn’t himself a great institution builder, but it is significant that FRCH spawned many institutions, notably MASUM, a women’s cooperative in Pune, and the Centre for Enquiry into Health and Allied Themes (CEHAT) in Mumbai established by those whose formative years were spent with him. The Medico Friends Circle and the Jan Swasthya Abhiyan too have acknowledged Antia’s support and encouragement.

This, in the final analysis, is the measure of the man: that he led so many into discovering in themselves the drive to pursue public spirited missions with zeal, enthusiasm and passion despite the odds.

Padma Prakash