The caste system is thriving in medicine in the U.S.

On my morning commute as I read this NPR article, memories started flooding my brain. I could not control myself and had to write this.

My last name “Theetha Kariyanna” has its origin from a small village Theetha and added to it is my dad’s name Kariyanna (a local folk god). Back in my school days, the name was weird to my friends as the name Kariyanna also literally translates to “black brother.” As a kid who was hesitant to loudly say his name clear and loud, I have grown up to say my name loudly with pride as I often do: “Hello there, I am Dr. Kariyanna, your heart doctor today.” I was likely hesitant to say my name loudly because of its literal translation and the fact that it easily discloses my roots in the Kuruba community — sheepherders of south India who fall into the shudra category of the caste system. The fear and hate for the caste system started very early on in my life.

With the rise of right-wing radical forces both in the United States and India, the two democratic giants will face challenges in their founding principles of equality for all. The caste system is an age-old, unjust and skewed social strata in India and its neighboring countries, such as Pakistan and Nepal where people are differentiated based on the caste they are born into. Caste-based differentiation has a history going back thousands of years, and it inflicts same wounds as that of race-based differentiation. Rules related to caste-based differentiation are largely lacking in the United States. In this land of liberty, it is high time to make caste-based differentiation illegal and punishable by law.

International medical graduates of Indian and Southeast Asian origin have historically topped the stats as immigrant doctors. Such immigrants add new cultures to this melting pot. And in time, it brings in cultures’ worst practices too, such as female genital mutilation and the caste system. The majority from Southeast Asian origin are very tolerant yet the minority who propagate the caste system and caste-based discrimination in the U.S. are enough to keep the demon alive and propagate it. I’ll share a few experiences I personally had in America with the caste system:

Incident 1: Once a friend of mine made me meet a clinical psychologist of Indian origin who took no time to make fun of my last name. This was followed by, “If you don’t mind me asking which caste do you belong to?” The man himself “belonged” to a so-called higher caste. All I did was blank out for a few seconds, felt disgusted and answer his questions.

Incident 2: I was casually talking to an attending of Indian origin who had recently graduated from residency. Upon asking him as to how he prepared for ABIM exams, he mentioned “reading the MKSAP thoroughly”; that was expected part of the answer, but then came “well the majority of residents of Indian origin in my program belonged to a caste X. I was constantly differentiated, I wanted to show them caste has nothing to do with one’s performance and ability to be a good physician. So I really wanted to do well in exams.” I was clueless as to how I should respond.

Incident 3: It did not take a long time for a colleague of Indian origin who immigrated to the U.S. approximately 35 years to ask which caste I belonged to. When I replied with my caste, a sort of sympathetic words followed from her, “Well, you are a physician now despite being born in a lower caste. This makes you higher instantly.” I had little time to respond as I was expected to scrub in for the next procedure. But as I washed my hands, I thought, “What if I was not a physician, will that make me less of a human being based on my caste?”

Recent research has shed light on challenges faced by dalits (the “untouchables”) in United States. The trends of intolerance, violence, physical and verbal abuse towards people of lower castes are much higher and in alarming rates, all in this land of freedom and equality America. It is the right time for federal and state governments of the United States to make caste-based discrimination illegal and punishable by law. American hospitals perhaps can be role models by initiating this timely and just action first. Until then many from “lower castes and Dalits” will continue to suffer in silence.

The birds which escaped the shackles and chains called the caste system and caste-based discrimination should not be enslaved by the same especially in the light of Lady Liberty and on the land of the fathers who wrote: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their creator with certain unalienable Rights, that among these are life, liberty and the pursuit of happiness.”

Pramod Theetha Kariyanna is a cardiology fellow.

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