Environmental justice podcast

LISTEN: Rupa Marya and Raj Patel on "deep medicine"

“If I was to design public health training and medical training, the first year would just be spent listening to community members.”

Dr. Rupa Marya and Dr. Raj Patel join the Agents of Change in Environmental Justice podcast to talk about how practitioners of modern medicine and public health are trained to be technicians rather than healers.


Senior Agents of Change fellow Kartik Amarnath spoke with Marya and Patel, who are authors of the book Inflamed: Deep Medicine and the Anatomy of Injustice, published last year. Marya is an associate professor of Medicine at the University of California, San Francisco, and founder and executive director of the Deep Medicine Circle. Patel is a best-selling author, award-winning filmmaker, and research professor in the Lyndon B Johnson School of Public Affairs at the University of Texas, Austin.

The three also discuss how the medical system comes into conflict with climate justice, and how colonialism and capitalism impact human physiology and contribute to what is seen in the clinic.

The Agents of Change in Environmental Justice podcast is a biweekly podcast featuring the stories and big ideas from past and present fellows, as well as others in the field. You can see all of the past episodes here.

Listen below to our discussion with Marya and Patel, and subscribe to the podcast at iTunes, Spotify, or Stitcher.

Transcript 

Kartik Amarnath

Okay, we are here with Rupa and Raj for the Agents of Change podcast. Thank you both for being here.

Raj Patel

Thanks so much for having us.

Kartik Amarnath

So I thought we could start off with an intro question for listeners who don't know who you might be or what, what work you're involved in. So, you've both written quite intentionally and beautifully about how you draw from your life experiences and family histories in ways that inform the work that you do. So, to start off with, could you briefly share about who you are, and how that has gotten you to where you're at?

Rupa Marya

Oh, my, okay, here we go. Let's see. I was born to Punjabi immigrants in what is now occupied in unceded Ramaytush Ohlone territory, what has always been, what is now called Mountain View, California. My parents came here, you know, looking for a better life for their children after the damage of colonialism had, you know, set so much in disarray in Punjab, where they're from. My ancestors are farmers and warriors and concubines and, you know, everything in between: artists, mathematicians. And I just grew up very drawn to the beauty of this place where I live, in the what's called San Francisco Bay Area. The smell of the bay groves, the sound of the great horned owls, the feeling of a redwood grove, the beauty of the ocean here—I was watching In the moonrise, it was full yesterday as I was driving over the Bay Bridge, home to Oakland, where I live now. And just really grateful to be a part of this landscape here and to be working in this place amongst so many amazing people. So that's me.

Raj Patel

And goodness, well, that's, that's a hard one to follow. I'm Raj Patel. I'm also a product of empire. You know, my family are born in what, Kenya and Fiji and I was born in London. And we get I mean, I'm very much also a product of that sort of causal vector. I'm, when I first saw hunger in India, I lost my shit, I was, god knows, five years old, but I carried that image back with me to the UK. And honestly, I've been working on hunger issues ever since. So I've pinged around a number of places. I worked at the UN, I worked for and against the World Bank, and even infiltrated the World Trade Organization to learn more about international trade policies and to do some work with groups like La Via Campesina, the International Peasant Organization around food and hunger. And so I've done, I studied and researched food systems and capitalism, and why it is a bad thing. And that kept me in worlds of writing and communication and activism. Over the course of a few books, and now film, till now, where I find myself in occupied Texas, the state that fought for slavery twice, it's important to say that just because our Leftenant Governor here in Texas has been pointing out that there's a new institute here at the University of Texas called the Liberty Institute, the sole purpose of which is to stop people at being free to teach things. So in a tweet, that was one of those spectacular self-owns I've ever seen. The Lieutenant Governor said that, you know, the Liberty Institute was about shutting us down, and shutting down the kinds of conversation we're about to have. So I'm looking forward to having it.

Kartik Amarnath

All right, I appreciate the energy. So both of, both of you are here, at same time, because you both co-authored a book that was released a few months ago. And for listeners who aren't familiar with your book, what, what is it about, what led to its inception, and describe specifically what you mean by “deep medicine”?

Rupa Marya

It is about, it is about the ways in which our bodies and our planet and our societies are damaged through the same processes that brought Raj and I here, to, you know, Turtle Island. It's about understanding the forces that have shaped our world and actually shaped our immune responses and have shaped our cellular responses, and that these things are translated from the social structures around us down into the very, into the very reactions and interactions of ourselves with our own bodies, and with the, you know, with the more than human entities around us that are required for our health, such as the microbes and the viruses and the archaea that live around us and that support and shape, how our bodies respond to the environment. And so this book, “Inflamed,” it was such a joy to write it with Raj. Through the process of writing it, we realized that Raj and I are related through many families, which has been kind of fun. But it's, you know, deep medicine is what's happening right now with the Oakland Unified School District, with two, two educators, two Black educators who've been sitting for 18 days in front of a school on hunger strike. And I've been called to offer my medical support, and the Do No Harm coalition is supporting all the med students and young doctors. Because these teachers know that when you shut down schools, so there were 12 schools on the chopping block, all in the Black, you know, predominantly Black schools, Black and Brown in the flatlands of Oakland, which is the place of Oakland hardest hit by air pollution, hardest hit by COVID, hardest hit by all the toxic exposomes or exposures that have been created to destroy Black bodies in this society. And school closures is just another part of that damage. And so when Moses Omolade and Andre San-Chez sit and put their bodies on the line by starving themselves to bring attention to the fact that closing the schools is a way of further harming these communities, privatizing the public school system is a way of harming these communities. It’s the same colonial tactics that are used to disrupt and destroy those, you know, community-led and publicly owned commons in other countries that the United States still in gages in around the world is happening right here in Oakland, is happening all over the United States with a public school structure. So when they sit there and they do this hunger strike, they are engaging in deep medicine. They are understanding that, that the consequence of closing the schools isn't just that kids have to be moved to other schools. It's destroying a heart of a community. And it's letting those kids know that their education, that their community is not important. And what that leads to in terms of trauma responses, stress responses for the families, for the children, for the communities, is part of that damage cycle that signals inflammation and inflammatory disease by the time these kids are, you know, 15,16, 20. When I was first call to intervene in this hunger strike and support the health of the two hunger strikers that we, you know, check their labs and check their blood and checked everything and you know, they look like healthy, you know, 30 something year old Black bodies. But when you look a little closer, you see already the traces of chronic inflammatory disease in the body, that are, that were unknown to these hunger strikers that made this experience way more perilous. So deep medicine is, is the, you know, stop, to stop thinking about our health as something that is, you can seek solely as an individual. That yes, you must go as an individual to take care of yourself. But if that's where you stop, that's going to, that is the, that is not an acceptable way of moving the needle on health parameters more broadly. And so when we engage in strikes, when we withhold our labor, when we push and force the structures that are damaging us to become structures of repair, and structures of care, when we transform them, then we can have better health outcomes, not just for our one individual self, but our whole community. And not only that, the communities of all the other entities that are interrelated and interwoven in their existences with ours. So it's starting to understand those, the weaving together of our relationships, that still exist, that colonial medicine and colonial capitalism actually forces us to sever those consciousness, that consciousness and, and, and actually purposely sever those relationships. So deep medicine is bringing back those relationships. But this is a, you know, obviously a much longer conversation. But I've just been thinking about Moses and Andre as they've been, you know, as they've been sitting with me every day and talking about this. What it means to put their bodies on the line to get health for their children through keeping a school open.

Kartik Amarnath

So a lot of listeners of the podcast come from the medical field or allied health professions, public health, environmental health sciences, and that sort of thing. And we've definitely been socialized in this country to, to cringe and potentially run away when we hear these buzzwords like colonialism or colonial capitalism. And I was wondering if you could speak to why it is important for us to understand today's maladies from the context of the fact that this country is born out of colonial capitalism.

Raj Patel

Well, you know, the, there is the temptation to think well, you know, words like “capitalism” and “colonialism” or just the you know, the language of the woke crowd, it really just doesn't have anything to do with what I'm doing in my noble profession as a, as a part of that the, “the frontline workers,” lifting up people's health, and battling all this misinformation on COVID. And so no, you know, don't, don't you just come with your capitalism and colonialism, you have no idea. And of course, Rupa is that frontline medical worker. And it, medicine has always been in the frontlines, but not in the way that you think. You know, there is this idea that Columbus came over, and then after he wreaked havoc and that after the genocide, that there were a bunch of very well meaning medical professionals who wore their white coats and sort of dabbed the brows of the people who've been assaulted and like “were awfully sorry, we're not with him, we're part of what we're proud of. We don't want to believe in colonialism and capitalism, we’re the good guys.” And of course, that is rubbish. And it's important to remember that the medical profession is part of the frontier of colonialism and capitalism, we wouldn't have, we wouldn't have the genocides that we've seen in Turtle Island, without the medical profession. And if you think, well, that was then, obviously it was a few bad apples, but everything's going to be fine. Now, bear in mind that one of the, one of the sort of shocking statistics that we found in our research was just that in 2016, when 56% of white Americans believed the lie that Black skin is thicker than white skin. Now that you know this, this bio myth is part of what allows white folk to believe that Black people don't feel as much pain as white people do, because the skin is thicker. So it's a lie, it's rubbish. And it's a sort of medical artifact of racism. But 56% of white folk believe that in 2016. 40% of incoming white medical students believe that and after four years of medical training, 20% still believed it. Now, you can't have that kind of data, and believe that medic medicine somehow sits above the fray of society. Medicine is not just part of society, but it in fact, in its frontlines, and its worst manifestations, is actually part of the mechanisms of oppression. And, you know, one of the ways that we talk about this in “Inflamed” is to say, well look, the way that medical, that medicine individualizes problems, blames patients for being uncompliant. And not being not, just not taking their bloody medicine when they should, when the diseases for example, like diabetes that they suffer, are ones that are socially generated, and their, and patients capacities to be able to comply, and what an interesting word that is, from, from the medical professional, give patients capacities to be able to both afford insulin and rent and food and care are constrained by precisely capitalism. So I mean, I think that for folk who shudder a little at the idea of invoking the words “colonialism” and “capitalism,” it's really worth asking, ‘Why are you so nervous about this? Where did where does my nervousness come from?’ If capitalism is so great, why is it still weird to say it? I mean, I was at Berkeley teaching, and I said the word capitalism in a discussion of sort of liberal foodies, and it was like, I'd farted in a lift. People were just not interested in saying the word “capitalist” at Berkeley. And you would think, you know, if there is if there is a sort of “temple of wokeness,” it would be there. And even there, the liberals’ skin crawls why? What's so difficult about saying it if it's good, and what's so hard about acknowledging that it's bad if you don't like it?

Kartik Amarnath

Raj, you just mentioned, briefly, just how profoundly embedded the medical system is within capitalism. So, jumping off of that, one thing that I thought might be fun to do in preparation for this conversation was to crowdsource questions from folks who have read your book. And some of them might actually be friends of yours. So the first question I have comes from one of Rupa’s students at UCSF, and she asks: How does medicine come into conflict with local ecology, climate justice, and equity? So for example, if the healthcare sector were a country, it would be the fifth largest emitter in the world. So with that in mind, what are some of the contradictions at play when we say that everyone deserves health care when the health system itself is so deeply embedded within the violent system that is colonial capitalism?

Rupa Marya

I mean, there is no real contradiction because the healthcare system that we live in is not, doesn't want health care for all. It's health care for some, and it's some health care for some and more health care for others. It's extremely inequitable, there's nothing equitable about it, it's never been equitable. Even within everyone who has access to the health care, once you get into the health care system, and you go for surgery, if you're a woman, and you happen to have a male surgeon, you're going to have a 30% increased likelihood of dying from that surgery just because he's a man who performed the surgery on you. So that patriarchy, which is a part of the colonial project, and then part of the architecture of dominance is, is part of how we understand ourselves and operate within the medical system. So this idea this, you know, very, this very important idea that everyone should have health care, and everyone should have access to a healthy environment that they live in is a very important idea, but it's not a part of the healthcare system. Not at all, as we just saw as the single payer bill just fell flat on its face thanks to the cowardice of Ash Kalra and the California state legislature on the, on the assembly floor. It, there's so many vested interests in keeping the healthcare system based very firmly in a capitalist colonial space. And so if we want, you know, a healthcare system that is a part of the solution of climate justice, environmental justice, working within the local economies and ecologies to uplift people, then we are going to have to fight for it and dismantle, simultaneously dismantle this one and move the power into building a better one. And that is hard, hard work. And it's the work of many different people in sectors and groups. But that absolutely is the work of the day. That is the work of, that is the deep medicine is to restructure the system not to simply try to put a, you know, a climate person in charge of how we recycle at UCSF. That's not it. It is looking at where we source our food from, why when we have so much food we buy through UCSF are we buying it through Cisco, when we have some of the best farms and small farms in the entire country within 150 miles from here. We could support all of their livelihoods of those farmers by simply advancing contracts doing like a giant scale CSA to get that food, you know, brought in to feed the people healthy organic food. But instead I walk into the candy store, to the what do you call it the gift shop at the base of the hospital at the Children's Hospital. And there's an entire wall of you know, cancer producing substances available for children. Highly processed, lot, lots of sugar, lots of high fructose corn syrup, lots of artificial flavors, artificial coloring, that stuff is toxic. It's like selling cigarettes to children, and we do it in the hospital itself. And so the amount of contradictions that are present in, or are apparent, contradictions that are present, just belie the fact that it was never really there for the health of the community, it was never really there for the health of everybody. It's there for a profit for these industries. And that's what it's been constructed for. That's how it operates. And so if we want something that operates differently, we're going to have to fight for it. And we're going to have to keep building the alternatives, which you know, is happening right now.

Raj Patel

Rupa, did you hear this thing about emissions from the, from the NHS? So there was a story about a, well, we began this question with observing that, that medicine is 10% of, of if that 10% of US emissions or something. And in Britain, the NHS did an audit of where its carbon footprint was, and 25% of its greenhouse gas emissions come from medicines. And the two sort of big individual single points of that are one, in anesthetics and the other, in the propellant in inhalers. And so, the, you know, the story is that in one of the things that they want to do to green the NHS is to move people away from propellants driven inhalers to, you know, these sort of powder based diskhalers or whatever they are. And, you know, absent from this conversation, is anything about air pollution? Right, you know, it's not well, why do we have so many bloody asthmatics in the first place, it's all you know, we've definitely got to make sure that these asthmatics’ footprint, right, individualizing, yet again, is shrunk, rather than understanding the sort of structural causes of why it is that these medicines are required.

Rupa Marya

Which is why this book was so much fun to write with Raj Patel. Not just for his utter charm and, and its silliness. But, but…

Raj Patel

We did over zoom, so it was fine. But…

Rupa Marya

But it is, you know, the way that Raj is able to zoom out like that is so, it's, that's the, that's the whole point of deep medicine is to stop fetishizing the individual as the site of disease or the site of the solution and to start looking at how these things are actually built through, through society and through choices that we're making as a society. Or that actually we the people are not making, but that you know, very few people are making and we suffer the consequences of. And so when we say that diabetes is a socially generated disease, that is a very important thing to understand. Because that means that rates are, what, if there's a profi,t if there's, if there's a reason for corporations to gain from that phenomenon, that, that phenomenon won't, it won't stop, it won't, it'll just keep going. And so if we want to be saving our, you know, our eyes, our kidneys, our hearts, our brains from the assault of diabetes, the high insulin levels, the high glucose levels in the blood and the toxicities that these produce, we have to start generating a different kind of social exposure and a different exposome. And that's what we talk about in the book, and deep medicine is really operating on the level of the exposome, let's change the exposome so that we can have less damage to our bodies and to the planet.

Kartik Amarnath

Yeah, you both touched on you know how the health system operates, its many institutions and what their institutional priorities are and how those are, in fact, not necessarily aligned with the priority that is health and wellness that we would assume among these institutions. So, someone who works at the NIH and has read your book has asked me to ask you, how can institutions relevant to health and ecology such as the NIH, CDC, FDA, EPA, etc., how in an ideal world, how would they, you know, operate with more of a deep medicine approach? From your perspective.

Rupa Marya

They would move their funding from solutions that, again, hyper-individualize the problem. So maybe spending less money on genetic analysis of each individual and how they will individually respond to an individual therapy that costs $37,000 a shot, for example. And start looking at how the NIH can start shutting down the toxic metal foundry in East Oakland that's causing, you know, air pollution so that the people who live in that neighborhood die 10 years earlier than people who live like five miles away. That the NIH can start mobilizing funding to start dismantling the sugar industry, to dismantling the hold of, of food subsidies going to these mono cropping agricultural projects, to start reimagining the food system to be one that actually heals people instead of harms them. So there's so many levels at which the NIH could move their funding to support community immunity, wellness of people from, from the place in which they live, to empower them to, to mobilize actions on things that most of these communities have already identified are a problem: uranium mines in Navajo territory, here in East Oakland, where I live, there's like, the community knows exactly what's poisoning them and making them sick. So the NIH could just call those communities and say, hey, what do you think would help your diabetes, asthma, and Alzheimer's rates, and they would outline it. You know, our communities are over policed, our communities don't, aren't, you're shutting down our schools, we're forced to breathe toxic air, there's no trees planted in our neighborhoods, we're seven degrees hotter than the rest of Oakland, there's no clean water, there's lead in our paint, in our ground that our children are exposed to. So like, all the sum of all of these exposures are going to drive these illnesses. So instead of obsessing over, you know, the one shot that's $37,000 a shot and how one person will respond to it, let's start looking at population level health and solutions that are really driven by community groups. So that's how I would say, you know, that's how we can move these things in, in forward.

Raj Patel

And, what I mean, that, that's the, you know, that idea of communities holding knowledge is pretty central to, you know, the, the ideas in “Inflamed,” right, that, you know, this book has just a ton of references at the end. And it's because we love science. And we're, you know, in the sort of colonial history of the National Academies in, in the institutions of the university, part of the sort of founding ideas, whether, there are some people who can know things, and some people who can't, just as in the same way that, right, you know, there are some people who can feel things and other people who can't, or whose feelings matter and whose feelings don't, or whose knowledge matters and whose knowledge doesn't. And generally, in the history of the National Academies, the folks whose knowledge doesn't matter are working class communities, are communities of color, are Indigenous folk, and those communities have knowledge. And so you know, what, what we're offering in “Inflamed” is not a kind of burn it down approach, though, that we do appreciate the value of a good control burn. What we're what we're interested in is, you know, first of all, that these institutions should stop the harm that they're doing. Just stop that's, that's actually doing something good, stop it. But also, recognizing that good science comes from good peer review. And many peers have been denied a chance to review, and many peers’ knowledge has been denied the chance to be considered as knowledge even though in fact, it is, and it is science. And so that's, I mean, that I think is really difficult. And I'm in conversation with the National Academies right now around some of the obesity work, and they're in the process of understanding that obesity isn't a disease. It is something that comes as a result of a range of other social phenomenon. And that, you know, understanding that obesity is not a disease, but is in fact something that is, you know, we're gradually understanding as a comorbidity and hopefully, you know, the sort of fat shaming idea that goes behind that gets to be named and recognized for what it is. But then we get to move to think about community power as part of that, that discussion and community knowledge and understanding why, you know, what are the vectors of high BMI. Then all of a sudden, that becomes much more interesting conversation, but it dilutes the power of the academies to, to be, you know, sort of loci of knowledge. And that's a good thing. So, you know, I mean, I think that that's one of the things we talked about in “Inflamed” is how certain kinds of knowledge has always been marginalized under capitalism and under colonialism. And that knowledge, actually, is the knowledge that is required for us to save ourselves.

Rupa Marya

Yeah, take, for example, the work of Tiny Gray-Garcia, a poverty scholar in East Oakland, with Poor Magazine, and how you know, she's formally unhoused. And it works with other unhoused and formerly unhoused people to advance solutions of poor people, like basically building their own housing. Take that versus here at UCSF, Marc Benioff, billionaire, gives, bestows upon the university, a $30 million fund to start a, you know, study of homelessness, you know, instead of just like buying those people, houses, the 8000 people on the streets of San Francisco. Though, we know that, you know, we don't actually need to study it, and it almost becomes obscene to study it. Like, let's study the impacts of how colonialism and capitalism crushes the body and see what we get as an outcome with this, you know, destroyed humanity and dignity of a person on the streets of San Francisco. So that's where the, the you know, the problem is thinking that the solutions will come from the top, that the solutions will come from the academy, people who have no lived experience, but are studying it, as opposed to the people on the ground who can tell you exactly what they need. They need wraparound services, they need mental health services, they need a home where they can lock the door and be safe. They need a community to live with, you know, the things that our community members say, are the solutions, they're not the thing that needs to be studied. Those are the solutions. And so that's how, you know, that's the work of decolonizing is understanding that, you know, power must be redistributed. It's been purposefully kept away from those people who are suffering the most from the impacts. You know, when we think about, you know, fat shaming, there should be capitalist shaming, there should be like, let's shame the real, you know, the real source of the pathology, not the body's response to that pathology that the body is just doing what it does in the face of such violence.

Kartik Amarnath

To that and, you know, really identifying the source of pathology, being able to meaningfully listen to the very people who are in question for a particular research project or health related investigation—clinical practitioners, public health practitioners and practitioners, you know, aren't trained in, in any of these skill sets. So what kind of curricular changes would you see in terms of how practitioners are trained in an ideal world, and Raj, Rupa mentioned that, you know, the asset you provided to the book was really providing that macro view understanding the political and economic systems related to the physiological outcomes. And given your career investigating, you know, system, food systems, farming capitalism, and how they can cause social harm, do you have any recommendations on like, particular social theorists or anything in the humanities that might be legible for people who might be invested in this kind of approach, but don't have the access to where to start?

Rupa Marya

Oh, can I just say, if I were to design, public health training and medical training, the first year would just be spent listening to community members. So if you're going to school in San Francisco, you go sit with Tiny Gray-Garcia, you go sit with Corrina Gould, the Indigenous Ohlone elder, you go sit with Cat Brooks, with Anti Police-Terror Project, you go sit with Moses Omolade who's sitting in front of Westlake Middle School starving himself, that you start, you go to those places where people are suffering, and you just sit and you listen. Because doctors are terrible at listening. We interrupt our patients within the first 11 seconds. We are not there to listen to what people are experiencing, we are there to enforce our agendas and just get you know, get on with the next thing. And so that, that art of listening is lost upon us in colonial medicine and, and in public health as well. So I think that assuming that you are not an expert and starting to listen to the real experts is what I would design the first year of curriculum. And then in terms of reading, there's so much good reading to do. I think everybody right now should, you know, you know, there's like, people used to go do like a year of service, right public service. I'd say every single person coming out of high school should go and be on a pipeline, frontline resistance camp with Indigenous Grandmothers, because they are the most effective people at lowering greenhouse gases. And if we want our youth to understand what is happening, what has happened, and where we need to go, that would be the boot camp I'd recommend for every you know, graduating senior before they go to college, just go and you know, serve some time, cook some meals, take out some trash, do whatever the grannies tell you. That would be probably the most useful thing that I think people could do. But in terms of reading, I know Frantz Fanon is a, is a great place to start looking at some of the work of Linda Smith in decolonizing methodologies, understanding, you know, how to think about these things in different ways. There's a lot of incredible Indigenous authors and writers who are doing this decolonizing work also out of Africa.

Raj Patel

You know, and it's, it's not as if I have the monopoly on systems thinking. I mean, Rupa, I mean, that was the joy of, of doing this book is that we sort of melted into each other in a, in a, in a beautiful, Zoom sponsored way, with, you know, in terms of our sort of knowledge and expertise and ideas. And so that's…I mean, if people are looking for something to read, I’d recommend “Inflamed” by Rupa Marya and Raj Patel. I mean, honestly, we, you know, this book is designed in part for folk in the healthcare community to be able to hook through what y'all already know about health care and understand where it sits in broader worlds of social science. And, yes, I mean, we drew on just so much in terms of poetry. So Allison Adelle Hedge Coke’s beautiful poem, “Pando/Pando,” is, we had permission from her to have it in the book. But you know, there's there's poetry, there's Indigenous history. “Our History is the Future” by Nick Estes is something we, we particularly enjoyed, as we were reading the book. And yes, Franon, Frantz Fanon’s work is just required reading for health professionals because he was a health professional, engaged in the work of decolonization. And, you know, it's worth just looking to him. But also, you know, “The Condition of the Working Class in England,” Engels, it's an epidemiological textbook, but it's also readable enough to break your heart even now. And it's, it's a really lovely book. And it was, it comes at the same time as you know, Rudolf Virchow. And so there's a lot in the medical world that provides the bridge for social science, but just you know, we have it all in “Inflamed,” and, you know, which is available from all good, independent bookstores, I'm contractually required to say.

Kartik Amarnath

Thanks for that. So, this question is sort of particular. But let's, let's give it a shot. So everyone in this conversation is of South Asian descent, we’re a part of numerous South Asian diasporas, at least within an American context, but not limited to the American context. South Asians are overrepresented in the medical field, along with other occupations that you know, professional occupations, and sustain the systems that impact our health. So examples would be finance and law. Your book covers debt and the health impacts of debt for example. Do you see any value in organizing South Asian clinicians and other professionals given our overrepresentation and as a colonized peoples ourselves in terms, especially with the fact that, you know, these professions are so essential to sustaining the systems that make us sick?

Rupa Marya

Yes. Especially because some of the, my South Asian colleagues are like the worst behaviors, when it comes to medical racism. So just because everyone's brown, skin folk ain't kinfolk, right? So just because everyone's brown doesn't mean that everyone is down with understanding how systems of racial hierarchy and caste play a part in, in, in those power structures today. So I think that this work of education and unlearning is something that we have to do together as, as South Asian community. And for me, that's been, some of the most beautiful connections I've had are with people fighting, you know, caste-ist violence and, and dynamics and people fighting for, you know, fighting anti-Black racism, here in Oakland and meeting other South Asians who are involved in this work is, is for me, probably one of the most… I mean, this is what happened when I met Raj and his wife, Minnie, I just felt like I found my family. Like, this is my, you know, these are the people who make sense to me, and I like to work with and be with and sit and break bread or roti with. And so that, that, that is, that is actually extremely important that we bring our aunties and uncles and our cousins and our community along in this work. Because our presence here as settlers in, on stolen land, it's important to become aware of who we are in where we are and what the presence of our diaspora does, and how we carry with us our caste violence and our, and all those things that are, they don't just disappear from us, as we, you know, end up ceding other territories. So absolutely, this is very critical work.

Raj Patel

Yeah, I mean, I'm at, I met my partner through the Alliance of South Asians Taking Action, it’s a group. And I'm not saying this is like, you know, woke Desi Tinder. But I'm saying it because it, it was an organization that's very actively took a side in class divisions in the South Asian community, right. This is an organization that fought for the rights of trafficked women against a powerful and politically, politically-connected Desi landlord in in Berkeley, and that was how it started. And then through understandings of how race is the modality through which classes lived. And understanding that class privilege needs to be consigned to the pyre that we use to get engaged in a process of class suicide. But that modality will always involve some sort of inflection through race, and through the ways in which we're interpolated here, in this particular part of the world, in this moment. That activism matters, so that we can call out, you know, upper class Hindutva family members, because, you know, I want to bring my aunties and uncles along, I also recognize that they are part of the problem. And, you know, many, many of my family are Hindu fascists. And that's, you know, I mean, I think organized, one has to recognize what the lines are in this battle. And as Rupa’s saying, you know, that this is a battle line where you do have people who are pretending that caste doesn't exist. And certainly pretending that class doesn't exist, and that we're driving these kinds of divisions around, you know, Hindu supremacy in the South Asian community that are absolutely vile. And ultimately, you know, that there's, they're picking aside in the class struggle, and that's really important to remember, because purely identitarian organizing is, you know, is a sort of death sentence here. And that that's why I liked ASATA is because it was an organization that really picked a side in this class battle. And this, that side was not accidentally the side of workers, of exploited women and trafficked women, and women surviving domestic abuse. So that's, you know, that this is to say, yes, there is definitely a role here. And that many, many South Asians and part of the part of the diaspora are enemies in this in this pool.

Kartik Amarnath

If you can leave us with some takeaways, especially during these unprecedented—the buzzword everyone's using these days, unprecedented times, challenging times. There's a lot of darkness out there. Where do you both draw inspiration from and where, what are your suggestions for folks who are aligned with you, interested in your approach to these issues? What would you suggest they do in terms of determining where they belong in these bigger decolonial struggles for, for justice?

Raj Patel

Um, so the, look, if you want to figure out where you are, you just need to find the right psychiatrist and lie down on the bench. Obviously not. So this whole process of figuring out where you belong in the struggle is something you only find out by trying to fit, trying your hand in struggle. This is not the sort of thing that you can figure out with a notebook and a long walk on a beach. This is practical and engaged work with other beings. So, actually, you know, I lie. There are ways in being on a beach puts you in touch with so many powerful forces and powerful beings. And that's and that's a good thing. But ultimately, here we are holobionts that call ourselves human. And here we are trying to figure out how it is that we relate to one another. That's work that you can't do on your own. And in any case, you are not a single being. So the advice here is to get involved in the struggle, to roll up your sleeves, and start engaging in finding these movements. So, you know, if you're in, you know, in what is currently called the United States, then, you know, look at the kinds of organizations that are trying to reconstruct and build through this, like the Deep Medicine Circle, an organization that Rupa founded on which I'm honored to be the treasurer. So over to you.

Rupa Marya

Yeah, that's what's bringing me a lot of joy is the work with the DMC the Deep Medicine Circle. So we are women of color-led, worker-directed nonprofit that is healing the wounds that we've identified in our book. Healing the wounds of colonial capitalism, through food, through medicine, through story, through learning and unlearning and restoration. Our work right now, we are, our cornerstone project is this farming as medicine work, where we work to get land back to Indigenous people through our land back solidarity program. We reframe farmers as health stewards not only of the nutritious food they grow, but through how they take care of the soil. We de-commodify food and we reframe food as medicine or, I should say, we reassert it because it has been in all of our cultures before those things were purposefully separated. And so that work in, in our collective has been so inspiring, working to get back a 38 acre parcel of land back to Ramaytush Ohlone elder Cata Gomes. She formed her land trust recently with the help of our land back solidarity program director Hasmik Geghamyan and that, that is just beautiful to hear the elder sit and talk about, let's get those cows off that land across the way and bring the Tule elk back, let's bring the beaver back, let's bring the salmon back. The assertion that she and her family with 200 words will start learning their language. It's just magical. It's beautiful. It's inspiring. It's so healing on every level, it's healing. So every time we're down at the farm, and I get to hear the flicker or hear the mountain lion or see the lynx or watch the hawks giving birth to the next generation, we had four hawks last year, there's you can see there's clearly more babies in that nest coming. It's just beauty and all the food will be growing will be just giving away to our community members in San Francisco who are oppressed by the manufactured crisis of hunger. So this is, this is the work, this is the exciting opportunity and, and we all must find ways to do this kind of work. What we'll be doing over the next three years is creating a toolkit to share with communities around Turtle Island to share what we did so that people can apply what, what they can to their communities to construct similar or, or take what they can and leave what they don't want to help move land back into a thing that heals not a thing that harms and so that's what, that's what we're working on right now. It's, and that brings me tremendous joy.

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