Most people who do community and rural healthcare in India have read or at least heard of a book published in 1984, called "Rakku’s Story: Structures Of III Health And The Source of Change" by Dr Sheila Zurbrigg, a Canadian physician who worked in rural India in the 1970s. As a young medical student in the late 1980s, I was advised to read this book by members of a group called Medico Friend Circle (MFC). Decades before the 'social determinants of health' (SDoH) framework became established, Dr Zurbrigg clearly laid out, using the story of Rakku and her sick child, the social and structural causes of ill health. Today, Rakku's Story is considered a public health classic, as it should. In 2025, I was lucky to meet Dr Zurbrigg in person, and get a signed copy of the book from her!
A 2026 version of Rakku's Story has just been published. "Staying Alive: Dispatches from the Margins" is a new book by Dr Ramani Atkuri, a physician who has spent over 3 decades working in a variety of rural and tribal health organizations in India.
A graduate of the Christian Medical College, Vellore (my alma mater!), Dr Atkuri does a brilliant job of narrating stories of people and families in India's hinterlands, as they struggle to seek healthcare and survive. With every story, Dr Atkuri peels layer after layer of how social and structural factors predispose to illness, and why even the most basic medical care is not easily accessible to millions. In every story and every page, Dr Atkuri's deep commitment to social justice and equity shines through. It is no surprise that CMC, Vellore, honored her (along with Dr Ravi D'Souza, her husband, also an inspiring community health physician and leader) with the Paul Harrison Award, given to alumni for their outstanding and selfless contribution in the field of healthcare.
From stories of people with tuberculosis, to women struggling to get obstetric care, Dr Atkuri uses the power of narrative storytelling to compelling effect. The book explains difficult medical concepts using a simple language, to make sure lay readers can better appreciate the nuances. With every story, Dr Atkuri explains what could have been done better, and where sustainable solutions may lie.
A recurring theme of the book is a call for India to invest more in health. India's National Health Policy of 2017 recommends a government spend of at least 2.5% of GDP on health. However, that figure is currently at just 1.84%. "Our country has one of the lowest public spending on health. The government must be the primary provider of universal healthcare... This can only happen if investment in health is increased manifold," Dr Atkuri writes.
As an academic who has researched tuberculosis for nearly 25 years, the stories of people with TB in this book left me saddned and disappointed. While India has made progress in TB, and has increased domestic spending, and invested in newer tools (e.g. molecular testing and shorter regimens for drug-resistant TB), over 800 Indians still die of TB every day. That is a stagerring death toll for a disease for which have had a cure for over 60 years. "Tuberculosis is arguably the most important public health problem in the country today," writes Dr Atkuri. Her book clearly explains why this is the case, and what can be done to reduce this unacceptable death toll.
I sincerely hope Indian policy makers and politicians read Staying Alive, and do what they need to do urgently: invest more in health, strengthen primary healthcare, address inadequate staffing and health infrastructure in rural areas, pay extra attention to migrants, tribals and vulnerable communities, and tackle critical social determinants such as hunger and undernutrition.
Every community medicine and public health student in India will learn a lot by reading Staying Alive, and find inspiration and hope from Dr Atkuri's life and career.