On the eastern fringe of Bengaluru lies Yemalur, a village long since absorbed into the restless expansion of Karnataka’s capital. It was here, on 30 December 1950, that Hanumappa Sudarshan was born — a man whose working life would be spent almost entirely away from cities, in forest settlements where the nearest hospital lay a day’s journey off and where the people he served had, for generations, been counted by the state only when it was convenient to count them.

Little in Sudarshan’s early biography hints at the direction he eventually took. He studied medicine at Bangalore Medical College and qualified as a doctor in 1973, at a moment when a fresh medical degree in urban India opened a straightforward road to private practice, a clinic of one’s own and a comfortable middle-class life. He turned away from that road almost at once. Instead he attached himself to institutions of the Ramakrishna Mission, working at its health centres in the Himalayan foothills, at Belur Math in Bengal, and later at Ponnampet in Karnataka’s Kodagu country. Those years shaped an understanding of medicine that he carried for the rest of his career: that a doctor’s responsibility does not end at diagnosis, and that sickness is usually only the visible end of a much longer chain of poverty, dispossession and official neglect.

The forest at Biligiri Rangana Betta

In 1979 Sudarshan travelled into the Biligiri Rangana Hills — the B R Hills — in what is now Chamarajanagar district, a forested range in southern Karnataka that is home to the Soliga people. The Soligas are among the oldest forest-dwelling communities of the region, their life built around shifting cultivation, the gathering of honey and other forest produce, and an intimate working knowledge of the plants and creatures around them. By the late twentieth century that world was under severe strain. Conservation law increasingly treated forest communities as trespassers in the very landscapes they had inhabited for centuries; tuberculosis and leprosy went undetected for years; few children completed school; and the terms on which Soliga families sold what they gathered were set entirely by outsiders.

What Sudarshan began there was not a visiting clinic but a residency. He settled among the Soligas, learned how they thought about illness and healing, and in October 1981 founded the Vivekananda Girijana Kalyana Kendra, usually shortened to VGKK. Its stated purpose was the sustainable development of tribal people through a rights-based approach spanning health, education, livelihood security and the conservation of biodiversity — a formulation that deliberately refused to separate a community’s wellbeing from its claim on the land. In practice VGKK grew into a residential school in the hills teaching several hundred children, a vocational institute offering training across more than a dozen trades, a hospital, and a set of cooperative arrangements that allowed Soliga households to process and sell honey, herbs and other produce on far better terms than before.

Two convictions ran through everything. The first was that tribal knowledge was an asset rather than an obstacle: traditional healers were consulted rather than displaced, and Soliga ecological expertise was treated as evidence worth recording. The second was that welfare without legal standing is fragile. A great deal of VGKK’s later effort therefore went into securing recognition of Soliga rights over the forests they lived in — a campaign that made the community one of India’s better-known examples of forest dwellers winning formal tenure inside a protected area.

Karuna Trust and the reach of primary care

The stubborn persistence of leprosy in the Yelandur area convinced Sudarshan that the problem was larger than any single hillside. In 1986 he founded the Karuna Trust, at first to run a leprosy control programme and then, far more ambitiously, to take over and revive government primary health centres that existed on paper but barely functioned in practice. The model was unusual for its time. Rather than build a parallel private system, Karuna Trust entered into partnership with the state, staffed and managed existing public facilities, and set out to prove that they could be made to work. Over the following decades it came to run dozens of primary health centres across Karnataka and in Arunachal Pradesh, extending care to well over a million people and adding mental health services, epilepsy treatment and community health insurance to the standard package. The approach — public facilities, public accountability, non-governmental management — became a widely studied template for partnership in Indian rural health.

Public office and reform

Field experience drew Sudarshan into policy. He chaired the Government of Karnataka’s Task Force on Health and Family Welfare, whose report became an influential audit of what had gone wrong with the state’s health system and what might be done about it. He served on a World Health Organization working group on macroeconomics and health, on a National Rural Health Mission task force examining public-private partnership, and on a Planning Commission steering group concerned with the empowerment of Scheduled Tribes during the Eleventh Five Year Plan. He later served as Vigilance Director in the Karnataka Lokayukta, the state’s anti-corruption institution, where he pursued malpractice in health and education services — work that earned him a good many opponents and which he pressed on with regardless.

Recognition and legacy

The honours accumulated steadily. Karnataka conferred its Rajyotsava Award in 1984. In 1994 Sudarshan and VGKK received the Right Livelihood Award, often described as an alternative Nobel, in recognition of the way their work showed that tribal culture itself could underpin a process securing the basic rights and needs of indigenous people while conserving their environment. The Government of India awarded him the Padma Shri in 2000. He was named an Ashoka Fellow, and further recognition followed in the years after.

What endures, though, is less the list of awards than a method. Sudarshan demonstrated that a doctor could stay in one place for decades rather than pass through; that a community’s own institutions, knowledge and language could form the backbone of a development programme rather than a decorative addition to it; and that the failing machinery of public health could be repaired instead of abandoned. From an ordinary village on the outskirts of Bengaluru came a physician who chose, at the very beginning of his career, to make the hardest available geography his workplace — and who never left it.