The story begins in the late 1920s with Betta Singh's return from his medical studies in Dublin to Guyana and the opulent chaos of his mother's household. Mrs. Singh, a curiously vulnerable widow and fiercely possessive mother, wears pants and gives orders like a man. She wants her son to stay with her and open a private practice, but Betta is determined to devote his expertise to those who need it most - his own people, the destitute descendants of immigrants from India.

He rejects the insulated world of his mother's home and once again leaves her, accepting an appointment as a Government Medical Officer on a sugar plantation run by British expatriates.

In the midst of battling both the malaria that is widespread among the workers and the corruption of the plantation manager. Betta marries - a step which further antagonizes his mother, who has now allied herself with the Pujaree, an influential Hindu religious leader. Ultimately, the myriad of family, religious, and racial conflicts escalate, with consequences that are brutal and far-reaching for all.