I was in India for nearly six weeks early this year mostly in Coimbatore in Tamil Nadu, a second tier Indian city with a long history of natural enterprise built without too much support from either federal or state government. In and around Coimbatore, you need to drill deeper than 300’ to get water, and still, you see small-scale farming all around. That is how enterprising people there are.
The economic, social, and cultural impact of old-time established enterprising social groups — the Naidus, Gounders, and Chettiars, and others — is everywhere in Coimbatore. They prime the economy of the region. In addition, their well-known philanthropic institutions are scattered all over the city in primary and secondary education, and in all branches of higher education in the sciences, liberal arts, management, engineering & technology and healthcare. Gujaratis, Marwaris and Keralites in the last 30 to 40 years are recent entrants. But they are mostly only in trade abd business.
In the main shopping streets most of the signage for shops are only in the Roman script. Only rarely the boards are in Tamil. In the only small newspaper/bookstore at the small Coimbatore airport, not even one Tamil magazine or newspaper is on display. Only US publications or India’s English dailies/weeklies. What Macaulay and the British could not accomplish in their 150 years of Indian occupation, Indians themselves have done in sixty-four years since independence.
Multi-storey apartment complexes are fast replacing single-family houses in coimbatore and in many other second-tier towns. Four- to 6-storey apartment complexes with 16 to 24 apartments with up to 1500 sq. foot living area are fast replacing single-family homes. Nobody seems to worry about the bad societal and public health consequences on the population density going up 20 times with the same infrastructure intended for a much smaller population density.
The affluent live in expansive gated villas in luxurious lifestyles, including separate housemaids for cooking and cleaning. The villas look like haciendas in the Southwest. But when you step outside, the familiar Old India (which has become only worse) stares at you: Dusty roads with potholes; open sewers; maddening traffic with buses, trucks, vans, cars, motorbikes, scooters, and bikes all using the same lanes; with everybody blowing horns and nobody caring for traffic rules; water and air pollution; garbage piling up with plastics strewn all over the place… …
Another trend in places like Coimbatore, Mysore, Nashik is relatively affluent retirees from other places settling down in exclusive old-age communities. Their children live far away in India or overseas. This structural change in family arrangement has far-reaching social implications for India.
In Coimbatore bakeries are everywhere selling rich cakes and cookies in addition to halvas, jilebis, jangris, and a variety of deep-fried savories — all bad for your cardiovascular and endocrine systems. With a large section of the population having become sedentary and affluent, not surprisingly, in between the bakeries you see pharmacies and doctors’ offices specializing in heart diseases and diabetes.
People in India overwhelmingly seek English-medium private schools for their children. Some of the schools, such as the International Boarding Schools are for the really affluent, cost a fortune – several hundred thousand rupees per year. Even ordinary private high schools run into several tens of thousands of rupees per year. College education too is prohibitively expensive, in hundreds thousand rupees per year, way beyond the reach of the bottom half of the population.
Elective surgery is big business in Coimbatore. Some of the private hospitals for orthopedic and cardiac care are well known in many parts of India. For people with their own resources, these hospitals offer affordable care compared to what costs in Mumbai or Chennai. Patients come from all over India, and even from neighboring countries.
I went to a well-kept eyecare clinic where my mother had cataract done. The place was overflowing with hospital staff. Upon discharge, they send you home with flowers and fruits. The outpatient cataract removal for one eye costs around Rs. 30,000, a significant amount in the absence of medical insurance for working-class Indians earning in rupees and spending in rupees. This is way out of reach for nearly 75% of the population.
With no medical insurance for large sections of the population, which is unaffordable even when available, and no equivalent of Medicare for the elderly or Medicaid for the indegent, 100% of the hospital expense in private hospitals is out-of-pocket.
The unregulated private-sector-driven healthcare industry has retained the worst of India’s native healthcare practices and superimposed on it some of the worst US medical practices. While this serves the interests of the Indian healthcare industryy extremely well, this is the worst arrangement for patients needing care with limited resources like the working-class framilies earning in rupees and spenging in rupees.
It is common for physicians ordering tests – blood work, echocardiogram, and scans and others – to get commissions — they can be also called kickbacks –  up to 30% of what the labs charge the patients from the labs for ordering the tests. Specialists give commissions for GPs (general practitioners) for referring patients to them. And doctors get kickbacks from hospitals for admitting patients into their facilities.
 Not surprisingly, often the interactions between the patients and their doctors become testy when they order more tests or refer them to more specialists since 100% of the costs of the tests are borne by the patients. I personally know many families that called themselves “middle class†only a few years ago, now staring at bankruptcy on account of unmanageable healthcare cost in senior years.
The conditions in, and the resources of, the government hospitals are so bad that they are only meant for the abjectly poor.Â
We constantly read about India’s 9% and 10% growth rates in business magazines and anecdotal stories on India Shining: McDonalds and KFCs in urban centers, shopping malls coming all over, fashion shows with emaciated models swinging down the catwalks, auto dealership for BMW, Saabs and Porches, obscenely extravagent weddings, showrooms of upscale European fashion merchandise… …
But these stories gloss over serious underlying structural problems in the ever-widening socioeconomic inequities among people with and without access to resources, bad infrastructure, the poor quality in education and basic healthcare for the disadvantaged, and massive corruption at every level in government.
Tamil Nadu and Karnataka, the two states with phenomenal economic growth in the last 20 years, are also states where corruption is widespread and rampant.
The Indian elite is well aware of this even though it does not want to acknowledge this in public. It is no wonder that affluent and powerful Indians – and this includes many politicians – in large numbers have bank accounts valued at hundreds of billions of $s in Switzerland, London, Singapore, and Persian Gulf Sultanates.
And notwithstanding India Shining, even the most powerful and the upper crust sections of India still want to educate their kids in the West, even as they are proud of their fancy English medium schools, IIMs, IITs, their Med Schools, their IT prowess, and even as they assert in conversations that Indians are no more enamored of the West.
In earlier centuries, only the poor Indians in large numbers migrated out trying to eke out a living to countries such as Malaysia (to sweat it out in rubber plantation), the Caribbean and Suriname (as indentured workers in the sugarcane fields), to South Africa (as poor workers), to England to work as cab drivers and bus conductors, and recently to the Persian Gulf countries (as hardworking blue-collar workers working and living in subhuman conditions).Â
A relatively recent trend now in India is that sons and daughters of a large number of India’s ruling elite — powerful politicians, senior bureaucrats, military officers, high court judges, and others belonging to the upper economic classes — have migrated to Europe, North America, Singapore, Australia, New Zealand. India’s Prime Minister Manmohan Singh’s daughter, for example, works in US State Department as an attorney.
As news stories reported in The Hindu and the New York Times, sons and daughters of midlevel bureaucrats and military officers are given admissions with scholarships in US universities under circumstances that give room for a lot of suspicion.
One wonders how the decisions of India’s elected officials, senior bureaucrats and business managers will not be clouded by their filial affiliations, especially when they are widespread.
Notwithstanding the stories of Shining India in the Indian and global media, these trends suggest that at a visceral level, among India’s ruling elite there is a lurking suspicion, if not fear, that what the Shining India hides is not quite reassuring to their own long-term self-preservation in India.