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Appa (or Dad in my mother tongue Tamil) was a man of deep Hindu faith. Mr. Ramanathan Subramaniam, a math teacher of over 4 decades, was known by many names. His students in Oman – where he taught for over three decades – would affectionately call him Ramadan (rhyming with the Muslim holy month of Ramazan). His parents (my grandparents) when they were around, called him Ramukutty (baby Ramu). Recently retired only 2 years ago, he and mom were hoping to spend their remaining years in the home they had built in our hometown of Chennai, India but never really got to live in before retirement.
It was around July 4th of last year that Appa, was diagnosed with Acute Myeloid Leukemia during a trip to visit my sister and me in California.
The diagnosis of a loved one with Leukemia is the kind of event that will make enemies, if you have any, stop and put their arms around your shoulder. It will make hard-nosed corporate honchos show they have a gentler side that you hadn’t noticed before. Even an ever-assertive colleague would pause in their line of questioning on learning that my family is facing such a grim and uncertain predicament, a ruthless enemy such as Leukemia.
Dad with my sister at my apartment in San Francisco
For these reasons, one would also imagine that the government of the United States will attempt to show its subjects, if not assistance, at the very least, a refusal to place deliberate road blocks for American residents trying to get care for their cancer stricken family members.
Hope, turned heartbreak
Our family quickly figured out that the treatment options for this particular condition are limited in India. And if my dad were to return to his home in India, his chances of survival were much lower by less than half what the treatment options in the United States would provide him. A key factor was the availability of a chemotherapy drug called Venetoclax, produced by the pharmaceutical firm, Genentech. This drug costs around 15 thousand dollars per month. A recent invention, this patented drug is not yet available in the Indian market. Stanford Hospital very thankfully approved dad for full financial assistance for hospital services, per their financial assistance guidelines. It would, however, not cover outpatient drug costs. Even with a well-paying job in the technology industry, 15 thousand dollars a month of drug costs will quickly vaporize my life savings in a few months.
The initial hope of getting advanced care in the United States, with Stanford’s financial backing, quickly turned into a hopeless heartbreak. My mom with almost watery eyes, and in a somber mood, placed her hands on my shoulders, with my dad standing next to her and said to me in my native language, Tamil, “We know you want us to stay here, and appreciate all the efforts you are doing to make it happen. But we cannot allow our situation to ruin your finances. We did not raise you, so that you could fall back into the poverty that we started in.”. With those words, there was no convincing my parents to stay in the US, even as my sister and I tried very hard in vain to convince them to stay and get care at Stanford Hospital for Appa.
The flights were booked in two days’ time. A hospital in India, in our hometown of Chennai was identified by our family members. Doctors reference checked with our extended family. The plan: My parents and myself would fly home to India, where we will start the treatment. I would be with them through starting the chemotherapy, before returning to the US to continue my life and career. At least, that was the hopeless bottom-line. Hopeless, because deep down, we all knew that by returning to India, we are not only separating the family at a time of a serious illness, but also seriously jeopardizing Appa’s chances of recovery and living. Yet, it appeared the system with its exorbitant and unbearable medical costs did not give us any other viable alternative.
Hope again and then terror strikes: Trump’s Executive Order on public charge
Even as I proceeded to India, with my parents, and began the treatment there for Appa, it became abundantly clear, what we already knew: The limited treatment options in India and their inability to offer a bone marrow transplant given my dad’s advanced age, which is the only possible final cure for Appa’s Leukemia [See Attachment Y]. Even as dad underwent chemotherapy, from his hospital room, I quietly continued to research California’s healthcare laws on the internet and on the phone, with US immigration lawyers, and with the financial counsellors at Stanford Hospital. And it led to hope again: California appeared to have laws in place, that will allow new immigrants (even those whose permanent residence is still in process), under certain extreme conditions like Cancer, to obtain state medical insurance. With this knowledge, my faith in humanity was beginning to be restored. I spent the remaining days of that trip, working with local Indian authorities to get the paperwork for my parent’s permanent immigration to the United States. The normally slow and opaque Indian bureaucracy, welcomed me with humanity and kindness on learning of my dad’s condition, and processed the documents needed for my dad and mom (who would be his primary caretaker) for their eventual journey back to America. I headed back to San Francisco, temporarily leaving my parents in the care of the local hospital and doctors. There was more I was unsure how exactly this would pan out, but felt a sudden gush of hope on that flight back home after many weeks of fear, that there are still institutions in America that gave hope to people who are suffering like my dad. 
My confidence was short-lived. I had barely landed in San Francisco, when I learnt of the Trump administration’s latest executive action on Immigration – this time against family members who could seek any form of public assistance, including health insurance, without any exceptions.  [Also Attachment Z]. What this meant in my family’s case was that with this regulation now in place, my dad would have to choose between living in the US with dignity and rights as a permanent resident or get treatment for his Leukemia but not both. This action of extreme cruelty of the Trump regime, authored by its adviser Stephen Miller – yes, Trump’s very own Goebbels – created terror in my mind and would have surely crushed my parents if I had mentioned it to them. But for their own well-being, I decided to keep the details between the US government and myself. Until now, that is.
State protection for billionaires, ‘self-sufficiency’ for everyone else
The Trump administration cannot be accused of not explaining their rationale for passing measures that could severely impede the ability of dad to get the life-saving treatment he needed and could get only in the United States. Rachel Martin, host of National Public Radio, challenged the USCIS director Ken Cuccinelli. She sought to know whether their rationale of demanding such extreme degrees of “self-sufficiency” from immigrants, concur with America’s values. The same values represented by Lazarus poem etched in the stone of Lady Liberty:
“”Give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!”
Mr. Cuccinelli, had a readied response: “Give me your tired and your poor who can stand on their own two feet and who will not become a public charge” 
In other words, immigrants who are cancer patients – and cancer patients cannot be expected to stand on their ‘two feet’ – can choose to die, or stay away from their families. In other words, cruel state policy inflicted on families of severely ill immigrants, like cancer patients. Family separation as a state policy of the Trump regime, is not limited to cancer patients alone, as the reader may immediately note. Another important topic of grave concern that sheds light on the racist underpinnings of the Trump/Miller regime – into which I will not digress – is how their policies impact refugees and others freeing horrific violence.
But bravado encased rhetoric and policies against immigrants – while cruel – can help the Trump regime, gather votes by appealing to people’s baser instincts and prejudices. However, one would be mistaken to think that this is an attack against immigrants alone. This is effectively also a long term attack on the healthcare rights of all people of the United States. If one needed proof, take a look at the number of US Citizens killed during the ongoing Coronavirus pandemic. With nearly a quarter million Americans dead, the Trump regime rightly can qualify to be the government that leads the world in harvesting the death of its own citizens. And much of it can be tracked to the sheer negligence of the regime in acting on the advice of its formidable panels of doctors and specialists. Of course, the rationale is not publicly announced with much fanfare in the case of US citizens, but it’s not hard to decipher where Mr. Trump and Mr. Miller, are coming from: The dead US citizens and their families may just not have been self-sufficient enough to warrant the attention of our dear leader.
One can contrast this with the tax breaks and following the pandemic, the immediate rush to further reinforce the coffers of the airline and fossil fuel industries. Self-sufficiency of course, cannot be demanded of everyone, certainly not the struggling billionaire class – whose wealth has increased by 29 percent during the pandemic – and the fossil-fuel industry, that are so critical for funding the Trump regime’s continuity in office.
Fading flames of freedom in the world
The harassment and disregarding the right to life of cancer patients, to be fair to President Trump, is not the forte of his administration alone. We happen today to be living in a world, run by dictators and extremists. Take India for instance, my country of birth. Today, in the name of democracy, people in the northern province of Kashmir, are being subjected to an unprecedented and more brutal occupation with its entire elected bureaucracy and political leadership placed in detention, while cutting off all phone and internet connections to prevent the outside world from knowing about the ongoing Indian crimes there. Cancer patients in Kashmir can’t get their chemotherapy because of the severe restrictions on their movement imposed by the government that prevents them from reaching their hospitals . Elsewhere in India, critics and human rights activists have been rounded up and arrested using the Pandemic as a cover for repression .
An America that is ruled by close-minded commitment to cruelty, like it is today, is proving to be a valuable enabler for such atrocities like those committed by India’s Hindu extremist government.
One of the activists, Professor Anand Teltumbde detained under draconian antiterrorism laws, wrote a letter to the people of India before he was imprisoned. The letter stated “I am off to NIA (national police) custody and do not know when I shall be able to talk to you again. However, I earnestly hope that you will speak out before your turn comes.” 
Ramukutty’s Final Vote
Appa was energetic till the very end. Aided by information and support from Stanford Hospital and the state of California’s humane policies on healthcare, I was able to bring Appa back to California for treating his Leukemia at Stanford Hospital. And with the help of an immigration firm, I was also able to start his immigration paperwork in parallel before the Trump regimes new policies were to start taking effect.
Despite such careful planning and serious efforts by doctors at Stanford – who managed to bring the Leukemia under remission and even start the bone marrow transplant – it was not enough to save Appa’s life. When the moment came, his family – my mom, myself, my sister – was at his side. Appa was a teacher of over 4 decades teaching students from many parts of the world. It was fitting that people from many parts of the world, working at Stanford Hospital, were part of his care trying to save him. He deserved that effort by any measure. And our family is thankful, even in grief, that we were all able to be together toward the end, and not separated by the great seas.
In May of last year, just before my parents made their first visit that year to California, was the general elections in India. They participated in those elections. Appa and mom both voted against the tyranny of the Hindu extremists – against those who were abusing their Hindu faith – much to the chagrin of those around them. Tyranny has unfortunately, at least temporarily, won in my home country.
But we still have a choice here in America, where our global influence means that our actions both as individuals and as a society, will play a very significant role in either rekindling or extinguishing the fading flames of freedom in a world, shaken by disease and Climate Change driven environmental destruction. The ongoing pandemic, just like cancer in a family, is ruthless, but is also a truth teller that doesn’t hide anything uncomfortable we prefer to avoid. It doesn’t hide the cruelty and ignorance of our elected national leadership either, that is now there for all to see.
Will you join my late father in voting against tyranny and the Trump regime, before it is too late?
Karthik Ramanathan is a technology professional based in Silicon Valley and can be reached at firstname.lastname@example.org . His professional profile can be viewed at https://www.linkedin.com/in/karthik-ramanathan-sf/ He has often written about various Human Rights issues outside of his work. Some of his writing can be viewed here: https://countercurrents.org/author/karthik-ramanathan/
California allows for PRUCOL exceptions to applications for Medi-cal health insurance (https://www.dhcs.ca.gov/formsandpubs/forms/Forms/mc13.pdf ) This allows counties to consider making exceptions in extreme situations – like Leukemia – to provide health insurance to immigrants who otherwise may not qualify.
Trump Administraton’s expanded public charge rule: https://www.newsweek.com/uscis-announces-public-charge-rule-immigration-1453780
a. USCIS directors justification of the expanded public charge rule: https://www.whitehouse.gov/briefings-statements/press-briefing-uscis-acting-director-ken-cuccinelli-081219/
b. USCIS Director Cuccinelli’s interview on NPR: https://www.vox.com/2019/8/13/20803621/ken-cuccinelli-statue-of-liberty-public-charge-trump
Kashmir lockdown. https://scroll.in/article/933393/in-kashmir-a-cancer-patient-struggles-to-get-to-hospital-for-chemotherapy-others-cant-get-home
See, Siddharth Varadarajan, “In India, a pandemic of repression”. https://www.nytimes.com/2020/04/21/opinion/coronavirus-india.html
Anand Teltumbe’s Letter to the People of India, before his detention under draconian antiterrorism laws. https://thewire.in/rights/anand-teltumbde-arrest-open-letter