Caste in the USA, Episode 8: Decoding biases, inherent dominant supremacy in the field of public healthcare

Editor's note: Firstpost is holding a series of conversations with Indians in the US, across its campuses, offices and households, to understand how caste discrimination pervades the community just as much as it does back home in India. Hosted by Thenmozhi Soundararajan, Dalit rights activist, artist, technologist and executive director of Equality Labs, the podcast cracks taboos about caste among Indians in the US. Listen to more episodes here.

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In Episode 8:

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“This incident happened just ten days ago. I want to bring this up as I have talked about a similar incident 14 years ago. The situation is the same now. I always, always avoid Indians at the workplace, Indians in a restaurant, Indians in any place I have to have a conversation with them because the conversation always goes in the wrong direction. So when I had to meet with an Indian physician in the middle of the pandemic, I had no choice. This Indian physician as soon as he entered, he looked at my chart and the first question he asked was, ‘Your name throws me off. Reina doesn’t really come from Hindu name. Your last name is kind of different, I am confused, are you Indian?” I said, “Yes, I am very much Indian." I already knew where this was going. He did not focus on my health but the first thing he is so stuck at is my name and then he asked, “Where does this name come from?" I said this is part of India. And the next question was which part of India? Where does it belong to? I knew which direction this was going, because this wasn’t the first time this was happening.”

The story mentioned above is Reina’s, a guest speaker from today’s episode of Caste in the USA. She has worked for several years as a public health professional in the US. Through her experiences, Reina highlights the bias in the public health field with relationship to caste, given her diverse experience working with Indians versus non-Indians. While the former had her watch an undeserving upper-caste colleague be protected and promoted by a manager of the same community, working with non-Indians got her a successful career instead.

Joining Reina to speak further about casteism within healthcare in the USA is Dr Pradeep.  Both of them, in conversation with host Thenmozhi Soundararajan, reiterate several common narratives - from ignorance and caste pride fuelling dominant caste supremacy in colleagues within healthcare to being able to thrive only in non-Indian workplaces.

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Listen to Caste in the USA, Episode 8 here:

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Read the complete transcript for Episode 8:

Thenmozhi Soundararajan: Jai Bhim and Jai Savitri, everyone. I am Thenmozhi Soundararajan, and this is Caste In the United States with Firstpost. Today’s episode is an exploration of caste in medicine and we are joined by the wonderful Pardeep and Reina who have collectively worked many years in health care as a doctor and as a public health professional respectively. They are going to share with us their experience of caste in this field and let’s just dig in. So welcome everyone.

So Pardeep, let’s start with you. You have been a doctor for many years and I am just wondering what was is it like to experience your time in the diaspora as a Dalit doctor?

Pardeep: I have been directly involved in the healthcare field for the last 5 to 6 years and the experiences I would like to share during this episode. In one incident, they were directly investigating my caste identity based on my last name. And this question was very direct and was coming from a close friend and during the conversation he presumed that my last name is a Jat caste before I answered him. I worried to correct him to escape social isolation and this incident happened in 2015 when I invited him to my house for dinner. So I work in a hospital setting when we getting a chance we take a break in the physician lounge. I happened to be there during break time when I heard this cardiologist, Indian cardiologist, talking negatively about Indian reservation system.

Reservation policy in India is a form of affirmative action very similar to the US. This cardiologist was upset about why second-generation Dalits utilise the affirmative action benefit when their parents have used it once. And you know this is a very common discussion topic almost every day in an academic setting in India in one or the other form. I was surprised to hear from this cardiologist such uneducated reasoning. This is a cardiologist who has been in the United States for over 30 years and I feel pity for him that he has not inculcated the democratic values of the US that embrace affirmative action.

Just like any American would feel proud of the first amendment right I am certainly [unclear 2:18] ‘sir why do you think so? Why should second generation Dalit children in India not avail reservation policy? He reacted before letting me finish to give his answer, ‘oh they are taking the share of scheduled castes who are also known as Dalits, poor Dalit people who can also benefit from the reservation policy.’ This is the reason we hear from every upper caste in India in all disciplines. So I questioned further, probing him, ‘Do you have any data to support your statement? It might be appealing to your emotions what you just said now but do you know how many students have benefitted from reservation policy since India got independence? How many of them were first-generation and how many of them second-generation? So his answer was limited to his personal experience that one of his college friends from lower-caste or Dalit who is a physician in India. His children also utilise the reservation policy, they should not have used it. Replying back to him  I said, “Sir you realise your data is one person I am talking about ground reality, I am talking about 20% of India.” He had no answer. It seemed like he was offended now so probing him further I asked, ‘Do you know where reservation policy is mentioned in the Indian Constitution and what does it say?’ Now he was more irritated that why I am interrogating him so I explained to him, ‘Sir let me help you, reservation policy is mentioned in part III of Indian constitution, it comes under Fundamental Rights. Article 15 and 16 talks about reservation policy for Dalits in case you are not aware of it.’

I can tell that he was Brahmin by caste, based on his last name so to change the conversation towards him I said, “You know doctor, the judiciary in India is full of Brahmins, almost 60% of judges in the Supreme Court of India are from Brahmin caste and you know because of such incompetent judges, Indian justice system is in danger. More than 100,00 cases pending and since Indian independence, they have not produced any landmark judgements that have the utility of public good. Moreover, to increase your knowledge there is no competitive exam for them despite the recommendation at the time of adoption of the constitution. They have got those positions merely on the basis of nepotism, and you already know their performance. Such incompetent performance is not a concern to you and you are more concerned about second-generation Dalits taking the benefit of reservation policy.’

Now you can imagine he was so infuriated and he said ‘oh you are out of your mind, where did you get this data?’ So I quietly answered ‘sir you are a cardiologist, you know cardiology but please get some basic knowledge of Indian constitution and reservation policy before you say so in the future.’ And no further altercation since that one episode. Since then he would try to avoid me in the hospital corridor. I was very shocked you know upper-caste doctors even when they move to the United States or any other country the caste-based hatred in their mind is still alive after decades.

Thenmozhi Soundararajan: Yes I think it’s interesting. Our previous guests all talk about how dominant castes often reduce the conversation of caste to solely to one of reservation. Why do you think this is Pardeep?

Pardeep: That’s a very good question. I think it has to do with how upper caste people in India narrate their own conception about reservation. As I mentioned this particular cardiologist who was Brahmin by caste has no idea why the need for reservation policy. This is all manipulated by their politicians, by the media how it portrays to the public these people with lack of any background knowledge about reservation policy they have emotional appeal without any background data to say this is bad happening to them or this is misusing this. I think it is a lack of knowledge which attributes more to such a narrative. And obviously, they don’t want to see any Dalit rising up to their level. They are happy when you are cleaning the street or when you are working as manual scavenger or tanning dead cow it’s okay for them, they are happy but as you see you are competing with them in every field of life, in every discipline that’s when this hatred becomes very obvious and very blatant.

Thenmozhi Soundararajan: You know another thing that you shared just now also struck as quite interesting to me and that is that you know I think a lot of people in the diaspora think that casteism always happens between Brahmins and other castes. Brahmins are the only perpetrators of casteist experiences but really in your case, for example, a jat person was asking you what your caste may have been, and seems like what we are seeing is a lot of casteism between different castes, like even the middle castes.  Do you have any thoughts on that Pardeep?

Pardeep: Sure, in terms of jats, they are mainly concentrated in the North part of India especially in Punjab and Haryana. And they are in the traditional Hindu system, they fall under the category called Shudras or nowadays they are known as Other Backward Class. Some of them because they were economically well-off based on the land distribution policies so they were moved to forward castes they never went into so-called upper-castes, never promoted to that level but they were moved to forward castes or general category and they have embraced this sort of mindset because now the notion of superiority based on caste from Brahminical structure is driving the caste system especially in Jats. Most of them, if you were to talk to them, are not aware of their own background or history.

Thenmozhi Soundararajan: And you know Pardeep, this is such a big thing in the diaspora because you have a very, very strong Punjabi and Sikh Jat community that is constantly creating content whether it is youtube videos or hip hop songs it’s all about flashing Jat superiority. And for a lot of the Punjabi kids that I know, for them, they are leaning into this mode of casteist culture because they see it as a means of resistance to white supremacy. They want to be their culture and I met kids that were Jat, it’s like a tribal identity we used to be the tribes in power, and I was like where is this nonsense and miseducation happening. Because they are all earnest kids who are struggling with a lot different economic and racial discrimination but at the same time they don’t realise that they are taking up the mantle of deeply casteist positions as well. So there is miseducation happening on both grounds of this.

Pardeep: That is so true if you visit any village of Punjab you will see the same arrogance, the same Brahminical mindset of Jat people. Even people from Shudras and OBC which falls under the umbrella of shudra in the Brahminical structure, they have never been the narrative setters so they follow the books or the system of Brahmins and they are the ones who have created this narrative of superiority. Now since they are a little bit well-off so they followed this blindly and that is one of the inherent biases in a caste system there is a graded system where one feels better than others because they are not discriminated by someone superior to them. Especially, in Punjab, especially from Jat community I have not seen any intellectual so far who has come into prominence at the national or international prominence level that has depicted their exact history like Dr Ambedkar from the Dalit community. He had brought Dalit history, shudra history to the forefront at the national and international level. That component in the Jat community is lacking so I think their whole narrative is what the Brahmin has force-fed them in the schools or in their religious temples or Gurudwaras.  I think that has to do with how they perceive this notion of Brahminical superiority and them.

Thenmozhi Soundararajan: I really want to bring Reina into this conversation. Reina I know you are a public health official and you have been in this field for many years and from my previous conversation, I know that you actually had a very challenging time with your managers who was dominant caste. Can you share what happened and how that sheds light in terms of the bias in the public health field with relationship to caste?

Reina: Hi Thenmozi Jai Bhim and thank you for giving us this platform to talk express caste bias in the medical field and public health field. So yes when I was working in a laboratory in a hospital and I had this coworker and manager who belonged to the same community. My co-worker was always depressed because she was not treated the way she is treated in India and she was very vocal about it. The words were exactly the same as what I am saying she used to say how people here don’t treat her higher or superior the way she was treated in India. In India she was treated so highly people would bow in front of her and nobody would question her because she belonged to a higher caste and here people don’t care. People talk on her face or point her mistakes out in her face. So she was very depressed about that and she was very vocal about that, not that she was trying to find the caste of other Indian people but she was very depressed as to why she was not being treated higher here and she would always throw her caste here. We had a very diverse working group but we had mainly or more Indians but at the same time, we had others who were white/Caucasians, Afro-Americans and Hispanics. When she was throwing her caste to all these co-workers or her superiors too they would just have a face that they are disgusted and they would try to inquire about her so they would find another India to understand what the caste system is to understand why she is behaving that way. And since I was not from the same community as my manager and my this coworker that I mentioned, they would particularly catch me during lunchtime to learn more about it and they would question me but why is she always flaunting her caste on us we have nothing to do with her caste, who is she, why does she do that, what is the psychology behind it. Most of my time would be spent in explaining to them what the caste system, and that she comes from the upper-caste and they do atrocity on others and nobody has the guts to question them. And especially the particular co-worker comes from a village where the caste system is deep-rooted and practised to the core. So after learning that they would say but that’s India why can’t she keeps that mind in India and work as a team because American values are about teamwork and respecting the diversity here. So this happened and also she was always backed by the manager who was from the same community as her. It was very depressing and I worked there for close to five years and as soon as I left that workplace I was never given a raise there, I was never given a good evaluation score there and this co-worker was promoted and her patient care skills were really, really bad. Patients would complain, some patients went to higher levels, to the CEO to complain against my co-worker’s patient care skills and this co-worker would get very upset how dare they question me or how dare they complain about me. They don’t know what caste I belong these are words she used to use. And as soon as I left that workplace and I moved to another very, very up-scale hospital which comes in the top-ten hospitals I moved to this hospital I was promoted within four years. So that experience made me feel wow I was facing casteism there in America. So this was my experience over 14 years ago. This was my first experience and I was very new to the US and I was still learning the culture here, still learning everything and I was in the mindset that in India they have normalised the caste discrimination so much that even when you come to the US you don’t question it. I was very young so I never really questioned it but I did feel the difference when I moved to a new hospital and I was promoted and I was appreciated for my work and I had no Indian co-workers there or managers, the group was very diverse.

Thenmozhi Soundararajan: This is again a common thread that we have been hearing from other Dalits on our podcast is that when Dalits are being supervised by anyone of non-Indian origin they succeed, they thrive but when you are under dominant caste supervision there is always some problem particularly if they find out that you are Dalit you know and in many cases often goes back to your educational environment. And this is what I am curious about, we have heard a lot about how casteist the tech universities are but is the field of public health casteist? What was your training like?

Reina: So while I was going to school for public health I made this Indian friend because when you come from India you are always looking for the same culture people, at least from India so that you can speak your language because you are still not fluent in English.  You can experience the same food, the same culture so I made this friend who came on a student visa and was doing the same degree at that time and she was looking for a job in order to afford her tuition sp she was working in an India restaurant nearby. While she was working one time we had this conversation about where she comes from in India because she was Punjabi but she comes from a different part of India where the Punjabis are not higher in percentage so she was mentioning, she was from Indore, India and I had never heard any Punjabi coming from Indore so I was wow I never heard any Punjabi coming from there and as I said that she said ‘you know I am not just a Punjabi I am higher caste Jat Punjabi. The way she flaunted her caste kind of pushed me away from keeping her in my friend circle I was like wow I need to stay away. As soon as she flaunted her caste and then she was having trouble because she was working in an India restaurant where she had to pick up as a waiter and she did not like her job. Not because there was an issue with coworkers, her main issue was ‘I belong to a Jat community, a rich community, higher caste and I don’t like to pick up people’s dirty dishes from their table and serving them that’s not my job’. That was her comment and she quit her job as soon as she got another job. She was never happy in that job because it was not her caste work to do. So that experience was while I was getting training. I was in Public Health training so that was during school time.

Thenmozhi Soundararajan: Yeah and you really see that this is also a trend that you see a lot of dominant caste Indians like starting to settle and think differently good or bad because once they are outside the caste hegemonies of India and they come to the diaspora they are confronted with what it feels like to be put into another hierarchy and some people take it as a challenge to change and also you know to drop their caste privilege while others really use it to sediment and really lean into their caste dominance. So it is really interesting to see how that impacts you because these alumni networks are powerful particularly if you are leaning on them to get jobs. But Reina I know that you have worked with other medical professionals with your role in public health and the casteism amongst medical professionals is also pretty damning and you have a friend Lalita who is a nurse who works at a boarding cure facility and she had some pretty intensive casteist exchanges as well. I am wondering if you talk a little about that?

Reina: Sure, so I have this friend of mine she is also very close to me. We happened to discuss our caste and she mentioned she works in a boarding care facility and I was asking her are you open about your caste at your workplace amongst the Indian people and she said no I cannot even if I want to. I was like why, you are living in America why can’t you open up about caste because I do have some Indian nurses working with me as co-workers and they are always flaunting their Jat caste and their communities are so rich and they are upper caste and they are so good, they have their own movies and everything they dominant and the other comment that these nurses had made was always talking down about the schedule castes or Dalit people. In Punjabi community the Dalits are mostly addressed as chamars, so  she said  they always say chamar is this, charm are disgusting, chamar that. So she said even I want I would never open up about my caste because they would be discriminating against me and the next thing I know we will be eating food I would always feel uncomfortable because they would never share their table with me. So this the current work environment in public health.

Thenmozhi Soundararajan: I have heard this story from Punjabi Dalits from all across California, where fields you don’t anticipate caste being in - the assembly line of a canning company, or as you were saying in medicare or even like mom and pop shops - this question of Jat dominance and also the usage of chamar as a slur and negative comments seems to be so prevalent. Without caste as a protected category, we are not able to create the kinds of remedies we need in the workplace or in our educational institutions to protect people’s basic rights because again if they were saying things from a racial lens those people would be fired, you would have a clear pathway for HR grievance.  But in this scenario, you don’t really have anything.

Reina: That is very true, yes. We need that system where are community feels comfortable to bring this issue to the HRs so you are very right we need that.

Pardeep: Thenmozi I totally agree and I think unless caste discrimination is added as a protected category in the US statues unless that’s there in law there is no deterrent to these casteist people. If this is there as a break on their notion of superiority then they would definitely feel that pushback that might act to some extent that they are not open and they would at least respect other people’s individuality and as a profession or asl co-worker.

Thenmozhi Soundararajan: And really the law is there for where people’s political will fails right. Like dominant caste people have the right to be casteist if you want to be but what they don’t have the right is to do it in public institutions where it’s against the law and against the policy. So be casteist in your own home but don’t bring it to the cafeteria, don’t bring it to the message boards, don’t bring it to the place of work where the impacts the effectiveness of people to be able to do their jobs and really the human potential. That’s just the basic that we need to agree and move on from because the no longer we allow casteism to continue in these institutions the more we see the diminishment of our people and it’s unacceptable. But I also think Reina there was another point that you made about the damages of casteist medical professionals because you yourself on the client-side and on the patient side you had casteist doctor and that was very jarring. I am wondering if you could share what your experience was with our listeners.

Reina: Yeah, sure. This incident happened just ten days ago and I bringing this incident because I have talked about an incident that happened 14 years ago and this is the situation now. Where I needed a physical with a physician because of the Coronavirus pandemic going on everything is delayed. Whatever physician was available I chose that physician. As soon as I got to the physician’s office I learnt that it was supposed to be physician assistant and I requested for a physician because this is the only appointment I am getting so I would rather see a physician than a physician assistant. And my physician assistant happened to be very busy that day so the only physician we have available was so and so and I said that’s fine and I always, always avoid Indians at the workplace, Indians in a restaurant, Indians in any place I have to have a conversation with them because the conversation always goes in the wrong direction. So this  Indian physician I had no choice here so I said it’s fine if there is an Indian physician I am okay. So this Indian physician as soon as he enters he is already looking at my chart and the first question he asked me ‘your name throws me off because  Reina doesn’t really come from Hindu name. Your name throws me off and your last name is kind of different, I am confused are you Indian? And I said ‘yes, I am very much Indian’. I answered that and I already know where this is going. He is not focused on my health or looking at my chart but the first thing he is so stuck at is my name and now he started, ‘where does this name come from?’  And I said this is part of India. And the next question was which part of India? Where does it belong to? And I was like this is going in the very wrong direction and I cut the physician to say that how were my reports and what are we going to do. So I cut him very short in a very blunt way to show him that I am not interested in that conversation, let’s get to business. So then the good thing he got the idea and this is a very, very old physician he was from the older generation. The other question he mentioned was very derogatory and discriminatory not towards caste but they are always patriarchal too.  The question of birth control came up so he asked me are you interested in birth control and I said sure I would like to have one, and so you already had a boy and that question really annoyed me. First of all, you ask me a question about my caste and then you show yourself to be a very patriarchal person, very annoying question and then after that I just cut that meeting short. I don't need a physician that’s it and I walked out and I ended the visit there.

Thenmozhi Soundararajan: Sorry so he was saying that you have already had a boy because…

Reina: He didn’t even go through my chart because my chart mentions I have a daughter so I only have one child. So in Indian community, they mostly have two children because they want to make sure they have a boy. This is your patriarchal mind, so he questioned me so you already have a boy meaning you need birth control because you don’t need any more kids, your boy will run your family, your generation.

Thenmozhi Soundararajan: That is just so sick, so sick.  You know what I am so struck by listening to Reina and also to Pardeep this maybe like episode 10 that we are doing and we have interviewed many Dalit people from different origins. Some people are born and brought up in the US, some people are immigrants from Punjab, Orissa, Kerala and wherever it is. And I am just struck by how we have had so many similar experiences, thoughts and feelings. When Reina was saying that she didn’t want to be around any Indian origin people I can relate to that you know. I did not want to work under any professor in my graduate school of Indian origin. I was just avoiding that. So it strikes me how similar our experiences are even though we are such different people. My last question for Reina actually is, you know all of these difficulties, how do you think it affects our social and family life?

Reina: It’s very, very depressing. I choose not to meet Indians even when we travel, we travel a lot out of the country, to learn more about different countries, their cultures, their food we are so interested in learning about the human evolution going further. How people are different. So even when I travel outside the country I don’t want to face any Indians anywhere I go which has also brought us in a very socially isolated environment, where I do force myself, sometimes the isolation gets to a point, where I am okay to adjust, to accommodate, okay I can tolerate some of the things of these casteist or Indian people because I need that social environment especially for my child to grow as well. But every time I get slapped and I have learnt this lesson the hard way and I am still learning that it's just never worked with Indian people. I avoid Indian in every place and this has really pushed us into social isolation.

Thenmozhi Soundararajan: And this also a very important call to action I think for Savarna listeners is that if the diaspora is so toxic that Dalits would rather be alone than engaging with you that really calls for self-reflection and to change because we shouldn’t have to do that we are not in our homelands we are in the United States we have many issues for which we can unify in terms of bringing racial equity and challenging white supremacy. And instead of doing the work, we need to do and in a unified way, people are still just talking about reservations as if it is the 1960s I mean it is stupid. At a certain point, people have to recognize that the talking and maintaining of caste privilege is actually holding us all behind if we really want to exhibit the fullness of our human potential they need to drop their privilege. And we as Dalits get to heal and we get to live our best lives and take up spaces that they have kept us out of many years. And when we start to exist within equity who knows what is possible for our people because that’s really the goal. We want see a society where caste is annihilated and often times when we say the annihilation of caste people focus on the destruction part but I actually think we need to focus on the powerful, revolutionary possibility of what it means to truly see each other as humans without these inhibitor that destroys, diminishes and exploits and that’s really the taste of what Dalits start to feel when they left India and what we want is for everyone to feel that. So I know it feels like we have just started to scratch the surface of caste in medicine. We would love to have you guys back on a later episode. But Pardeep and Reina we want to thank you for sharing your experiences so candidly and we look forward to hearing more about how you guys plan to take this analysis further. So thank you for joining us.

Pardeep: Jai Bhim

Reina: Jai Bhim

Transcription by Pritha Bhattacharya