VARANASI IS A MICROUNIVERSE of gods, mystics, and mendicants. An ancient town in north India, it’s home to more than twenty thousand temples. The centerpiece of Varanasi is the Ganges—or “Mother Ganga,” as it’s fondly called. The Ganges originates in the Himalayas—the “abode of snow”—and rages and meanders for 1,500 miles, supplying water to 40 percent of India’s population in an estimated 115 cities.
At dusk, priests and devotees gather for the age-old lamp ritual at one of Varanasi’s ghats—embankments whose stairs descend into the Ganges. Thousands of worshippers watch this spectacle of devotion as priests chant in praise of Mother Ganga.
In an otherwise noisy Varanasi, silence can be found by the faithful. Hindu scriptures have noted that in this insubstantial material world, the water of the Ganges and dwelling in Varanasi are two of the most substantial things. “In religion all countries are paupers, India is the only millionaire,” said Mark Twain, who described Varanasi as “older than history, older than tradition, older even than legend, and looks twice as old as all of them put together.”
I first visited Varanasi when I was eight years old. I decided to go back. With delays, it was a thirty-eight-hour train ride in a second-class compartment from Chennai. The whir of the ceiling fan—and an inquisitive civil engineering student in the next seat—gave me company while the train alternated between electric and diesel locomotives as it traversed five of the largest states in India. From water-starved farmlands to lush green mountains, and from boisterous traffic to persistent chai wallahs—tea sellers—in fake designer boot-cut jeans, every aspect of the country appeared in a state of flux, except for the train’s rhythmic metronome.
Why Varanasi after all these years?
To meet a holy engineer.
1874. SMOKY RIVER PASS in the Canadian Rockies.
It was fifty below zero and the workers’ noses, ears, and toes were frozen. Fatigue and frostbite spared none. Even burning the driest wood produced steam, not smoke. For five and a half months, they had lived off of bread, baked beans, and bacon, while their sled dogs chewed on dried salmon.
After camping near a glacier, when the men set off again, the oldest dog “made a feeble effort to rise, gave one spasmodic wag of his tail and rolled over dead,” noted a journal entry. “A hole in the snow on the bank was the only grave we could make for him.” These pioneers were building a country.
This was Sandford Fleming’s team.
Fleming was born in 1827 in the Scottish lowlands of Fifeshire. After a parish education, he apprenticed his way up to become an engineer. He then moved to Canada and got a job with a railroad company. Years later, he became the chief surveyor of the Intercolonial and Canadian Pacific Railway system.
British Columbia entered the Canadian confederation in 1871. The lawmakers of the growing nation were eager to establish a coast-to-coast railroad system within the decade. But no one had fully surveyed the continental landscape before. That was the task assigned to Fleming, along with his team, under extraordinarily hostile conditions.
Fleming and his crew mapped about a dozen different routes to and from British Columbia through the Yellowhead Pass. Throughout his surveys, Fleming relied on crude geometric calculations based on longitude, as there was no uniform time across the regions.
“There was no ‘system.’ Like the rail lines, the different times touched or overlapped at 300 points in the country,” according to Ian Bartky, a historian of timekeeping. Halifax and Toronto were divided by five time zones, each differing by tens of minutes. One estimate of the number of time zones between New York and San Francisco suggests 144! Even regionally, timekeeping was in disarray. If it was 12:13 in Boston, it was 12:27 in Philadelphia and 12:32 in Buffalo.
In 1832 the United States had about 229 miles of railroads. By 1880, the country had increased its rail infrastructure to close to 95,000 miles. To preserve the sanity of the train driver, each railroad company began to maintain its own time. Clocks had up to six dials, and train stations displayed the times in various cities. A train going from Baltimore, Maryland, to Scranton, Pennsylvania, in those days might follow Baltimore time, creating the danger of collisions when trains operated on a single track. Today, when anyone from Okinawa can easily coordinate a conference call with someone in Ouagadougou, this older “system” of timekeeping sounds crazy.
But none of these issues came under scrutiny until a disaster happened.
VARANASI TRAFFIC is shambolic. It’s a humbling reminder that the British drive on the left side of the road and we (Indians) drive on what’s left of the road. “The traffic is not terrible at all,” wrote novelist Geoff Dyer. “It is beyond any idea of terribleness. It is beyond any idea of traffic.”
I took a rickshaw pedaled by a lean, muscled man in his thirties. My destination was Sankat Mochan—the temple of Hanuman, the monkey god and dispeller of troubles—where Veer Bhadra Mishra was mahant, or high priest. Sankat Mochan is a significant religious institution, started by the sixteenth-century saint-poet Tulsidas, who wrote Ramcharitmanas—one of Hinduism’s most venerated works. Priests enjoy a special status in Varanasi, and devout pilgrims take their rituals seriously. However, Mishra led a paradoxical life. Being a priest was just one part of his identity.
That evening, on the walk to Mishra’s home in Tulsi Ghat, dark clouds descended, and a slanting rain began. As I rolled up my Levis to escape Varanasi’s slush and dirt, which flowed fast over my feet into the Ganges, my recorder slipped from my shirt pocket and into the river.
I climbed a steep stairway of seventy-odd steps and arrived at Mishra’s door drenched. The priest welcomed me with a warm smile. “I thought you wouldn’t be able to come,” he said. I walked into his hushed and peaceful visitors’ room, which some have called the “throne room.” Mishra, silver-haired and mustachioed, was in his early seventies. He radiated calm.
My recorder had been liberated, my camera’s battery was dead, and my notebook was soaking wet. My technologies had failed.
Mishra laughed.
“Let’s just talk.”
MISHRA WAS BORN to an orthodox Brahmin family. His father was then the mahant of Sankat Mochan. When his father died suddenly, Mishra was elevated to the position of high priest at age twelve, and his uncle became his guardian. Per tradition, Mishra learned Sanskrit, music, and wrestling.
Mishra also had a bent for science, though he was not adequately prepared for eighth grade. The local school was reluctant to admit him, but the young Mishra convinced the school principal to do so. Mishra excelled. Later in college, he majored in civil and municipal engineering, and fluid mechanics—the study of liquids and gases in motion—became Mishra’s passion. He eventually acquired a PhD in that subject and became a professor and department head at the top-ranking Banaras Hindu University—now a branch of the Indian Institutes of Technology.
Mishra’s engineering background combined with his priesthood to give him a deep understanding of the causes and possible solutions for the serious pollution of the Ganges. Through a combination of facts, faith, and activism, Mishra began working on cleaning up the river. “Ganga is not the mightiest of the rivers, nor is it the longest,” Mishra said, his hands flitting as he spoke. The Ganges supports the livelihood and traditions of one-twelfth of humanity. “Please tell me if there is this kind of relationship with any other river in the world.”
JULY 1876. Sandford Fleming was traveling in Ireland. He reached the Bundoran station around 5:00 p.m. to catch a train to Londonderry. The ticket said simply “5:35,” so Fleming assumed the train would arrive shortly, but eventually he realized that the train was not to arrive until 5:35 a.m. Fleming stayed overnight in the station and missed his ferry connection to England.
A contemporary of Fleming wrote with exasperation, “The traveler’s watch was to him but a delusion; clocks at stations staring each other in the face defiant of harmony either with one another or with surrounding local time and all wildly at variance with the traveler’s watch, baffled all intelligent interpretation.” This confused practice was the norm until a universal twenty-four-hour construct, championed by Fleming, came into existence.
Fleming developed his idea out of modular systems thinking. Time zones were systematically separated into one-hour modules for easy coordination across countries. Every 15 degrees of longitude was equivalent to one hour; thus, by circling the globe in 24 hours, one could cover 360 degrees. The zero-degree prime meridian was later placed at Greenwich, England. Railroads began adopting Fleming’s idea and putting it into practice in 1883. The establishment of time zones spawned new possibilities for those working in astronomy, meteorology, power production, army, and navy—all of which needed a way to systematize time.
Fleming’s idea was an instant hit among policy makers. Some critics called him a communist—the same reaction that greeted ZIP codes. An unexpected, but influential champion of Fleming’s idea was the president of the United States. Under Chester Arthur’s leadership, the International Meridian Conference was held in Washington, DC, in 1884. In 1885, standard time was implemented worldwide.
Time may well be a “bloodthirsty savage”—in the words of Fleming’s biographer, Clark Blaise—but standard time was introduced as an idea and implemented nonviolently. It didn’t take a war or even a dollar to install a universally relevant system. Indeed, Fleming’s idea was as profound as some of the other creations that mark our lives: 7 days, 12 months, 24 hours, 365 days. Standard time is our “culture’s time.”
SHE WAS WAITING to die. An abandoned widow probably in her late seventies, she had a funereal look and what appeared to be Parkinson’s. A diagonal crack fractured the right side of her coke-bottle eyeglasses. I was at a makeshift hospice in a nondescript, dilapidated building in Varanasi.
The concrete floor was dark gray and cracked in several places. Smoke residue coated the walls. I knelt down to ask the woman’s name. She harrumphed but didn’t speak. I gave her three hundred rupees—about six dollars—so that when the time came, she could purchase wood for her own cremation. She put aside her prayer beads and placed her trembling palms on my head. “May Mother Ganga bless you,” she said in Hindi.
For many people, Varanasi is just a place to visit. For some, like this woman, it is their final destination. Manikarnika Ghat—the “great cremation ground”—is the last stop. Many Hindus believe that being cremated here interrupts the cycle of birth and death, offering a fast track to salvation. “Death in Kashi [Varanasi] is not feared,” as Diana Eck, a Harvard scholar on divinity and comparative religion has written. “Death in Kashi is death known and faced, transformed, and transcended.”
SHIVA IS AN UNDERTAKER at Manikarnika Ghat. He has seen it all—corpses of every type. I met him near the cremation grounds by happenstance. He had a sooty complexion, and his teeth were stained by tobacco. He was probably in his midforties—maybe early fifties—and he walked barefoot. He spoke Hindi with his gravelly voice and managed to squeeze in a word or two of English that he had learned from visitors. He agreed to give me an insider’s tour of the operations at Manikarnika Ghat.
“That body draped in white cloth is that of an old man,” he said, pointing to the pyre burning about 10 feet from me. “Older women are covered in gold-colored clothes, young women in red,” he added. “Dead babies, renunciates, pregnant women, and cobras are dropped directly into Ganga,” he said. “Water cremation. Direct salvation.”
As I followed him, looking left and right, he described how long it took for the bodies to turn to ash. He gave me a tutorial on how he and his coworkers managed the queue of salvation-ready corpses. The ashes and charred remains of bodies are slipped into the Ganges. “Everything goes into Ganga. We all end in Ganga,” Shiva said with the comfort and confidence that the rituals over these years have given him. Up to four hundred people are cremated every day, he said—dawn or dusk, rain or shine, in flood and in drought.
Shiva then led me past the stacks of firewood. If the woman I met at the hospice can collect enough money before her death, she might be cremated using mango tree wood—the economy-class journey to salvation. Neem (Indian lilac) is business-class, and sandalwood is first-class cremation. Her other option would be an electric crematorium located half a mile upstream, but who knows what might happen there, with the daily power outages. This was the river she has been living to die for. I recalled poet Dean Young’s lines:
This is not the river,
it’s an explanation of the river
that replaced the river.
Shiva then took me to the small shrine of an eternal fire. “This fire has been burning for thousands of years,” he said, adding the word “nonstop” in English. A bare-chested, middle-aged man with shaved head was stepping out of the shrine holding burning dry grass to kindle his mother’s pyre. Shiva took some ash from the fire and smeared it right on my forehead.
“May you get your Mukti in Manikarnika Ghat,” he said.
LATER THAT AFTERNOON, back in Tulsi Ghat, Veer Bhadra Mishra introduced me to his friend G. D. Agarwal, saying, “He has dedicated his life to the protection of Ganges.”
Agarwal, an octogenarian, had earned a PhD in environmental engineering from the University of California, Berkeley, decades earlier, before returning to India. He had gone on to become a professor and department chair of civil and environmental engineering at one of the Indian Institutes of Technology. A few years before, Agarwal, a bachelor, had renounced material possessions and become a hermit. He wore an ocher robe, and prayer beads hung around his neck. Protesting the government’s decision to build a massive hydropower project in the Himalayas, Agarwal had made national news in India by embarking on a fast until death.
The silence between Mishra and Agarwal was palpable. With some hesitation, I began talking about what I had experienced at the Manikarnika cremation complex that day. Agarwal agreed that cleaning the Ganges was a big challenge. “It’s a very complex system,” he said in his earthy voice. “One has to think globally but act locally.”
Mishra explained that depositing bodies into the river didn’t pollute it that much. According to him, these nonpoint sources are relatively minor contaminants, but you can’t ignore them. “It’s easy to blame these people,” he said, but he agreed that behavior change was essential. Between sixty thousand and seventy-five thousand visitors use the Ganges in Varanasi each day. For those who live there, the Ganges is “the medium of life.” As a boy, Mishra contracted polio, as well as typhoid, jaundice, and gastroenteritis—all waterborne diseases—but he maintained that “Ganga is our mother. Ganga is our goddess.”
Mishra and Agarwal began to explain point sources—those causing 90–95 percent of the river pollution. Throughout the course of the river, several outlets discharge millions of gallons of domestic and industrial sewage into the Ganges. It’s estimated that at some points in Varanasi, fecal coliform levels in the Ganges are as much as three thousand times higher than the acceptable level. The World Health Organization confirms that the Ganges has been a source of cholera epidemics since antiquity. Between the rituals and the sewage deposits, “neither the society nor the government is serious about change,” Agarwal lamented, describing the intricacies of achieving behavioral change in a consumerist culture. “It may take fifteen years. It may take twenty years. It may take twenty-five years,” to achieve what’s needed. But from a technical standpoint the cleaning is “not a difficult problem,” Mishra attested.
People do, however, get emotional about or disgusted at the state of the Ganges. They often view cleanup of the river as an urban infrastructure improvement project, pouring lots of money into it without tangible results. In 1986, the Indian government launched the multimillion-dollar Ganga Action Plan. As part of the plan’s first phase, sewage treatment plants were built on the banks of the Ganges in Varanasi and a few other cities to tackle point-source pollutants. But frequent power outages rendered these electricity-dependent plants dysfunctional. When there was no power, discharges went directly into the Ganges. This still happens today. Mishra was disappointed at the government’s narrow thinking. Along with the staff of his foundation’s research lab, Mishra began to document the failure of the government’s efforts. Technicians monitored and reported daily water quality, which seemed only to get worse.
Scores of independent reports confirmed that the water in Varanasi is unsuited for drinking. Mishra was even more upset—because the scientific commissions and reports were restating the problem without offering solutions. He began a legal battle with the government and spearheaded a mass movement to correct mission drift within the Ganga Action Plan. The government dismissed Mishra’s concerns and launched a second phase of the plan in 1994, without dealing with the failures of the first phase. Frustrated, Mishra began collaborating with Varanasi’s municipal corporation to make progress. Unfortunately, that partnership soon succumbed to political pressure and collapsed.
Mishra had long proposed the installation of nonelectric, gravity-fed interceptor sewers between the buildings along the ghats. These sewers, in concept, would collect the waste and convey it to a treatment facility supported by an Advanced Integrated Wastewater Pond System—a technology pioneered by the late civil engineering professor William Oswald at the University of California, Berkeley, who was also Agarwal’s PhD adviser. In Oswald’s technique, wastewater is passed through a series of interlocking ponds where algae fuel photosynthesis, and oxygen helps break down bacteria and other contaminants. The water is then recirculated for use. For Varanasi this is an appropriate technology, but it has yet to be implemented.
Mishra kept organizing community events. He told less educated villagers who visited his temple not to throw waste into the Ganges. Hearing this from a priest was like a message from the gods, and people listened. The effect could not be achieved by technology alone.
The British logician Alan Turing once said, “Science is a differential equation. Religion is a boundary condition.” His impression was probably that religion is nothing more than a constraint—or even an impediment—to scientific progress, just as a bridle restricts a freely running horse. But in Mishra’s view, science and religion were like the two banks of a river, with both essential for its flow. “My campaign has been like a game of snakes and ladders. When it has gained speed, a snake has swallowed it up,” he said. “But one day I’ll dodge all the snakes. Mother Ganges will help me to save her.”
Mishra’s persistence began to garner international attention. He was named in the Global 500 Roll of Honor for Environmental Achievement by the United Nations Environment Programme. The New Yorker ran a ten-page profile of Mishra in 1998. Shortly after, he was recognized by Time magazine as a “Hero of the Planet.” Mishra shared the stage with Bill Clinton during Clinton’s presidential visit to Agra, home of the Taj Mahal. Clinton was so impressed with Mishra that during his next stop, in Hyderabad, one of India’s tech hubs, he said, “There is much to do to protect our planet and those who share it with us. I talked to an engineer who is doing his best to clean up the Ganges River that he worships as an important part of his faith and his country’s history.”
Despite these accolades, Mishra’s foundation still faces challenges. “We started working when our hair was black, and we are still working for a clean Ganga at Varanasi when our hair has grayed,” Mishra said several times. There was something melancholy about him. “I pray that I should be able to be intimately connected with my mother my whole life, and that means that I should be able to go to the river, touch her, and offer my prayers,” Mishra once said in a documentary. “This is just the reality of the world in which I live.”
As he inscribed a copy of Ramcharitmanas to me, I asked Mishra whether he would still recommend that I take a “holy dip” in the Ganges. His eyes brightened. “Most certainly. Nothing will happen to you. You can bathe right here in Tulsi Ghat,” he said, adding quickly, “Just don’t use soap!”
IT WAS A NEW DAY in Varanasi. I passed kids playing cricket with a tennis ball turned the color of coffee. Launderers were washing and slapping clothes on rocks at the edge of the river. The adjoining temples were reverberating with Vedic chants that reminded me of my grandfather’s Vishnu temple in our village. Watching buffaloes, cows, dogs, pigs, and human beings share the Ganges revealed a new dimension. The spirit of cleanliness in Varanasi is not about soaps and sanitizers. It is raw and elemental.
One of Mishra’s assistants met me at Tulsi Ghat. “Just watch your step,” he told me in Hindi, advising me to walk carefully. “The water is shallow here but gets really deep farther out.” Standing chest-deep in the water, I looked at the sun and began to repeat a Sanskrit mantra. I then immersed myself completely and took five dips in that dynamic, dark-green water of honesty.
FROM TRAPEZE ARTISTS to thoracic surgeons, constraints affect everyone. Yet one person’s constraint is someone else’s liberty. People diet and try out beach-body boot camps. Governments sequester their budgets and try to find meaning in frugality. Institutions are bound by their protocols and orthodoxies. Religions prescribe and practice constraints. We even apply constraints to get refined results from a web search engine. Yet the goal of these constraints is to reconsider and reevaluate our position in life.
Aeronautical engineer and former president of India A. P. J. Abdul Kalam likes to tell a story from his junior year in college. Kalam and six other students were asked to design a light attack aircraft for a semester project. “I was responsible for [the] aerodynamic and structural design of the project. The other five [members] of my team took up the design of propulsion, control, guidance, avionics and instrumentation of the aircraft,” Kalam recalls.
The project was due on a Monday morning, and Kalam’s team hadn’t made much progress until the Friday before. Kalam received a warning from his professor that he would lose his scholarship if he didn’t pass. As a student from a disadvantaged family, Kalam couldn’t afford to lose his scholarship. “There was no other way out but to finish the task,” Kalam said. This pressure was crucial to finishing the work on time and on target.
Decades later, Kalam considers this experience a lesson in systems design, systems integration, and systems management, carried out under a rubric of constraints. “If something is at stake, the human minds get ignited and the working capacity gets enhanced manifold,” Kalam added. His reflections parallel the words of eighteenth-century British essayist Samuel Johnson, who once remarked, “When a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.” Deadlines and constraints don’t suppress innovation; they direct it. When properly used, they may be a gateway to new possibilities.
THE WORLD OF ENGINEERING is full of constraints. Negative constraints are imposed by the physical limits of matter. From hardware engineers to airline chefs, and from tennis players to closet organizers, anyone who has worked within a defined space knows what I’m referring to. Even within the sheer constraints of nature, engineers pack in new features and functional capabilities while respecting the physical boundaries of technology.
The opposing concept is positive constraints, self-organized scenarios that permit new possibilities without the limits of negative constraints. Kevin Kelly, cofounder of Wired magazine, discusses these concepts in his insightful book What Technology Wants, adding that these “two dynamics create a push in evolution that gives it a direction.” Here Kelly is discussing biological evolution, but the idea holds for engineering design as well.
The negative constraints on Mishra stemmed mainly from the politics of vested interests and human behavior that continue to destroy the health of the Ganges. There are three other constraints: the physical constraint of laying an interceptor sewer line that might introduce new congestion in an already ancient infrastructure, the economic constraint of financing these projects, and the psychological constraint of people hesitant to use recycled wastewater for their religious rituals. Traditions often trump logic.
With Sandford Fleming, the constraints were positive. His solution for standard time emerged while he was doing something different: surveying tough terrains for a possible railway infrastructure. His constraint was a brand-new time architecture whose implementation became possible because of politics—thanks to the International Meridian Conference. As a lead architect of the Canadian railway system, Fleming presumably faced a number of negative constraints in his other projects. Time and money are obvious and unavoidable negative constraints in our lives. They tend to make their presence known more forcefully than the positive constraints. But in Fleming’s example, hard negative constraints like time and money were treated as relatively softer positive constraints, with the outcome being regularized time that could help people save money.
Consider instead the Olympics. The plethora of negative constraints in such a large-scale systems engineering project outweigh the positive constraints. For Sir John Armitt, chairman of the Olympic Delivery Authority for the 2012 Summer Olympics in London, the challenge was to complete the project on time and preferably under budget while managing thousands of subcontractors. For Armitt, the Olympics was more like a lunar mission than, say, running a car company. “In the former case you have the President saying that in ten years we’re going to have a man on the Moon. Likewise, in our situation we were told that in five years the 2012 Olympics are going to take place. That focuses the mind entirely on meeting that date and physically creating what is necessary to create,” Armitt declared. Time might have been Armitt’s principal negative constraint, but London’s physical infrastructure surfaced as another—just as Stockholm’s layout challenged IBM’s approaches in constrained optimization. The business brand and aesthetics of the Olympics were also well established, restricting flexibility.
Software engineers offer yet another view on constraints, using a special exercise called constraint programming. If a programmer can reach an expected solution without following a prescribed recipe or algorithm—akin to a jazz concert leaving room for extemporization—then it’s an open, or declarative, constraint. If the sequence is boxed and defined with explicit rules for the programming approach—as is often the case with performances of formal classical music—it’s a closed, or imperative, constraint.
In the same vein, computer engineers practice a concept called denormalization, which is to think about constraints in reverse. “It’s like starting off with an ideal world,” says N. R. Narayana Murthy, founder of the technology and consulting firm Infosys. “You design the system as if there are no constraints. Then step by step, you start introducing your constraints and trade-offs.” Murthy explained this concept of backward reasoning from the standpoint of new software development, which often has the inevitable constraints of memory, processing power, and final design requirements. The initial condition may look like the vast expanse of the Great Plains, but with the layers of constraints, the landscape is reduced to the pedestrian realities of Fifth Avenue in Manhattan.
JOSEPH WILLIAM BAZALGETTE was a Victorianera civil engineer. He had no medical background, but as British historian Gordon Cook points out, Bazalgette “arguably did more for the health of Londoners in the mid-nineteenth century, than anyone before or since.”
Bazalgette implemented the intercepting sewer system that helped release London from the clutches of a cholera epidemic in the 1850s. His design of the pumping station and sewage treatment systems prevented the future contamination of the River Thames. Thanks to him, the Victoria Embankment is now a tourist destination, and not an exposed gutter.
Sewers have become an integral part of the planning and development of the industrialized world, and they are among the most significant and understated public health technologies. Bazalgette’s engineering mind-set helped him overcome the challenges of bureaucratic pressures, financial constraints, and a potentially disastrous health epidemic. Ultimately, Bazalgette’s ideas resulted in a broadly expandable new public infrastructure that had never existed before.
The Thames and the Ganges can be considered public health hazards at different points in time. To compare the works of Bazalgette and Mishra, let’s explore some of their common negative constraints. Bazalgette’s deliverables were mainly structural. He was very hands-on and methodical. As the head of the Metropolitan Board of Works, he had a politically sanctioned goal. He led the installation of sewer treatment pumps and the expansion of subterranean networks.
Mishra’s challenge required a change in public attitude, arguably a supremely difficult thing to engineer. Mishra’s challenge was also to promote a serious form of ecological awareness in a place held together by faith and religion. Though Bazalgette and Mishra approached from different angles, they both strived to create a system of infrastructure that was needed to improve public health.
The worlds of engineering and public health are deeply intertwined. In fact, “the core of public health emerged from engineering,” says Harvey Fineberg, past president of the Institute of Medicine of the National Academy of Sciences. “Engineering is the action arm of public health.” Of course, clinical medicine and public health are very different in their objectives.
With public health, the concern is the health of the entire population. It’s about being proactive—preventing something before it manifests. Individual medical care is reactive. If public health is about society at large and medicine is about the individual, do they add up to the same outcome? Yes and no. Let’s consider first the origins of public health.
Public health has a mixed ancestry. It has deep roots in engineering—sanitary engineering, to be specific—but over time the profession has distanced itself from engineering and moved more toward the medical sciences, especially after Louis Pasteur and others proposed the germ theory of disease at the end of the nineteenth century. If engineering led the “design” aspects of the solutions, then the microbial revolution brought to the fore the “causes” of disease, eventually establishing a scientific knowledge base for the practice of public health. In recent years public health has allowed itself to be influenced by sociology and humanities in an effort to promote community wellness, but this approach may seem nebulous from an engineering point of view.
The constraints in public health are exceedingly complex, since a majority of preventable diseases are a function of human behavior—the very factor that vexed Mishra for decades in Varanasi. One reason for this complexity might be, as with engineering, the very invisibility of public health. There’s a “lack of drama” in public health, as Fineberg likes to point out. “There are television shows about emergency departments, but will there ever be a show about prevention? Think about the plot line: nothing happens.”
In our society, drama garners attention. Bazalgette had the drama of the Great Stink of 1858, when the foul smell from the Thames began to upset the lords in Westminster, but for Mishra it was the centuries-old drama of steadfast beliefs and practices. Creations engineered for public health—like curved roads, sidewalks, dynamic road signs, shatterproof windshields, reduced braking distance, speed displays, air bags, brake lights, radial tires, heat exchangers, and seat belts—were all shaped by constraints. Whether they came about with or without drama is a different question, but they all resulted in dramatic changes to public health and human behavior.
VEER BHADRA MISHRA passed away in March 2013. I returned to Varanasi to meet with his eldest son, Vishwambar Nath Mishra, the current high priest of Sankat Mochan. Once more it rained, and I was drenched as I entered the visitors’ room at Tulsi Ghat. I told Vishwambar about my conversations with his father. We then began to talk about the cleaning of the Ganges. “Nothing is impossible,” Vishwambar said. With faith everything can be accomplished. “It’s a matter of time. That’s all.”
Vishwambar’s optimism is also fueled by his qualifications as an engineer, which he said he’s proud to have inherited from his father. An engineer “knows how to transform and how to introduce new things in a tradition,” said Vishwambar, who is also a professor of electronics at the Banaras Hindu University. “I represent my father. My son will represent me. This is how traditions keep on moving,” he added. “Basically, we are in a relay race, aren’t we?”
