Even I have to admit that's pretty neat. (If you don't recognize it, that's the Indian tricolor flag.)
Thursday, April 16, 2009
Easter Egg
This is what my sister created for me last Sunday for Easter:
Even I have to admit that's pretty neat. (If you don't recognize it, that's the Indian tricolor flag.)
Even I have to admit that's pretty neat. (If you don't recognize it, that's the Indian tricolor flag.)
Wednesday, April 15, 2009
I Can't Help You
I don't think I've commented yet on the surprising number of people I just can't help. I don't mean the public health project -- I've gotten over the fact that I'm trying to add a small amount of momentum to a rather large mountain of poverty/malnutrition/maladaptive thinking. I mean the individuals I can't help. Pretty much every other day, somebody here comes to me with a request that they think I've got special powers to solve.
The most common is a visa. All the staff want to go study or work in the US, and have asked me at some point to tell them how to come over. Of course, right now, it's basically impossible to get a visa to come work in the US, and student visas aren't much easier post 9/11. At any major university, they're reserved for people who've gone to "name brand" Indian universities. I definitely don't know how to get an entry visa or a green card for the guy who makes the tea, no matter how good his English is (it's not bad -- better than my Hindi).
Next most common is telling them what field of IT to study. I am not sure if there's just something different about Indian PhDs than American PhDs in terms of what's taught, or if there's really not an understanding that the PhD is a research degree, not a commercial degree. At any rate, when I explain that no, I can't teach a class on Oracle databases, and no, I don't know what field someone should specialize in to make the most money, or what are the key things to help prepare for IIT, I get this look that says "Why aren't you sharing your knowledge? Why are you holding out on us?" (Thankfully, the most recent was someone asking me about programs at the University of Pittsburgh. I can answer that one.)
The most heartbreaking, though, are the ones I just can't understand, of which there's one every two weeks or so. These come from the guys who sweep the floor or empty the water buckets or do something else menial. They'll come up, start walking beside me or just standing there, and they'll ask if I understand Hindi. To which they get told (in Hindi), "Only a little, and you have to speak slowly." Of course, I invariably get a torrent of words I don't understand, and after about six repetitions of "samja nahi" (I don't understand), they walk away like hurt little puppies. I think they're asking for some kind of favor for their kids, or at least, I hear the word for "child" in these conversations a lot. I've tried, with the latest one, getting someone else to see what he wanted, but have not had any luck.
I do exploit this illusion of Infinite Knowledge to get work done on my project -- since nobody has any clue about any of the things we're doing, my marginal level of expertise plus the lofty degrees is enough to convince them to go ahead. So, I can't complain when people come seeking wisdom. I just wish they didn't all seem to believe that I'm deliberately being unhelpful. I don't know how to convey that America is a big place, the world of science and medicine is MUCH bigger than they're taught, and no one person can know all the things they're hoping for (no matter how much Dr. Ashok and others may proclaim my virtues).
The most common is a visa. All the staff want to go study or work in the US, and have asked me at some point to tell them how to come over. Of course, right now, it's basically impossible to get a visa to come work in the US, and student visas aren't much easier post 9/11. At any major university, they're reserved for people who've gone to "name brand" Indian universities. I definitely don't know how to get an entry visa or a green card for the guy who makes the tea, no matter how good his English is (it's not bad -- better than my Hindi).
Next most common is telling them what field of IT to study. I am not sure if there's just something different about Indian PhDs than American PhDs in terms of what's taught, or if there's really not an understanding that the PhD is a research degree, not a commercial degree. At any rate, when I explain that no, I can't teach a class on Oracle databases, and no, I don't know what field someone should specialize in to make the most money, or what are the key things to help prepare for IIT, I get this look that says "Why aren't you sharing your knowledge? Why are you holding out on us?" (Thankfully, the most recent was someone asking me about programs at the University of Pittsburgh. I can answer that one.)
The most heartbreaking, though, are the ones I just can't understand, of which there's one every two weeks or so. These come from the guys who sweep the floor or empty the water buckets or do something else menial. They'll come up, start walking beside me or just standing there, and they'll ask if I understand Hindi. To which they get told (in Hindi), "Only a little, and you have to speak slowly." Of course, I invariably get a torrent of words I don't understand, and after about six repetitions of "samja nahi" (I don't understand), they walk away like hurt little puppies. I think they're asking for some kind of favor for their kids, or at least, I hear the word for "child" in these conversations a lot. I've tried, with the latest one, getting someone else to see what he wanted, but have not had any luck.
I do exploit this illusion of Infinite Knowledge to get work done on my project -- since nobody has any clue about any of the things we're doing, my marginal level of expertise plus the lofty degrees is enough to convince them to go ahead. So, I can't complain when people come seeking wisdom. I just wish they didn't all seem to believe that I'm deliberately being unhelpful. I don't know how to convey that America is a big place, the world of science and medicine is MUCH bigger than they're taught, and no one person can know all the things they're hoping for (no matter how much Dr. Ashok and others may proclaim my virtues).
Tuesday, April 14, 2009
Strategic Programming
My time here is rapidly winding down, and by the time you're reading this entry, there'll be only one week of work time before I head to Jaipur, Mumbai, and the mysterious land called America. (I've found myself actually wandering through Pittsburgh streets on Google Maps just to remind myself what home looks like.) The nature of my work in these past few weeks (basically, since about 1st April) has really changed. As you might remember, when I first came here, a lot of what I was doing was data analysis and just trying to get a handle on where the project was overall. Once I realized the level of corruption/error in the data, it turned into an extended effort to just get the fundamentals ironed out. Over the final week or two of March, that's started to sort itself out. The female health workers are almost getting the hang of the surveying, we've gotten data entry up to a reasonable speed[1], and they've hired a new statistician who's helped a lot from an analysis perspective. They're also expecting him to take over as boss, so I'm deliberately turning over to him much of the work I'd otherwise do.
So, if some of my problems are solved and the rest are now in someone else's job description, what does that leave me? Conveniently, our friends at the Harvard Business Review decided to publish an article that advised CEOs to focus on the work only they can do. Having reflected on that, the work that only I can do is something vaguely resembling strategic planning. PS Reddy is now in America, and even though he knows the Hyderabad project well, he's not intimately familiar with the organization or the technology. Dr. Ashok knows the organization, but not the technology or what it's capable of. The staff here know the technology, but visionary thinking is not a common product of Indian higher education.
Thus, I've spent the past 1.5 weeks and will spend the next 1.5 weeks working primarily on laying out a vision for REACH: where is it going to go in the next year or so? I'll share some of those ideas in another post, as they're still being run up the chain of command for feedback. It turns out, though, that what I'm doing is not so much strategic planning as it is "strategic programming". This organization has turnover. A LOT of turnover. As in, my project alone has lost three and gained three staff in my two months, and it's a three-person project. (Thankfully, one of the three positions turned over twice, so I still have one original.) This means that I can't depend on whoever's reading my plan to know anything at all about the project. That, in turn, means that I don't get to just paint with broad brush strokes; I fill in all the little details.
I've said to some of you that this project like using human beings to do computation -- that wasn't entirely a joke. It really does feel a lot like programming, albeit with a serious latency. I have to build detailed lists of everything I want to see happen in the next year, think of all the ways in which someone might do it incorrectly, and then write down instructions to prevent that. The planning document for starting REACH in the next district over is eighteen pages long, and there'll be another document (not quite so long) for continued operations in this district. Reading it would cure any insomniac. It's a semi-futile exercise, since there'll still be mistakes made, but at least they won't be the same mistakes we made here.
[1] By hiring double the number of operators we need at steady-state, which has now left us with an unfortunate quandary. More on that in another post.
So, if some of my problems are solved and the rest are now in someone else's job description, what does that leave me? Conveniently, our friends at the Harvard Business Review decided to publish an article that advised CEOs to focus on the work only they can do. Having reflected on that, the work that only I can do is something vaguely resembling strategic planning. PS Reddy is now in America, and even though he knows the Hyderabad project well, he's not intimately familiar with the organization or the technology. Dr. Ashok knows the organization, but not the technology or what it's capable of. The staff here know the technology, but visionary thinking is not a common product of Indian higher education.
Thus, I've spent the past 1.5 weeks and will spend the next 1.5 weeks working primarily on laying out a vision for REACH: where is it going to go in the next year or so? I'll share some of those ideas in another post, as they're still being run up the chain of command for feedback. It turns out, though, that what I'm doing is not so much strategic planning as it is "strategic programming". This organization has turnover. A LOT of turnover. As in, my project alone has lost three and gained three staff in my two months, and it's a three-person project. (Thankfully, one of the three positions turned over twice, so I still have one original.) This means that I can't depend on whoever's reading my plan to know anything at all about the project. That, in turn, means that I don't get to just paint with broad brush strokes; I fill in all the little details.
I've said to some of you that this project like using human beings to do computation -- that wasn't entirely a joke. It really does feel a lot like programming, albeit with a serious latency. I have to build detailed lists of everything I want to see happen in the next year, think of all the ways in which someone might do it incorrectly, and then write down instructions to prevent that. The planning document for starting REACH in the next district over is eighteen pages long, and there'll be another document (not quite so long) for continued operations in this district. Reading it would cure any insomniac. It's a semi-futile exercise, since there'll still be mistakes made, but at least they won't be the same mistakes we made here.
[1] By hiring double the number of operators we need at steady-state, which has now left us with an unfortunate quandary. More on that in another post.
Saturday, April 11, 2009
Mount Abu
The recent hiatus from blogging was due to me being on a bit of holiday. Since I knew the excellent Dr. Ashok would be coming up on the 9th from Jaipur, I made a plan to get away for a few days, then hit Jaipur on morning of the 9th and ride back in his car. Saves fuel, saves the organization some cash, and lets me spend some proper time getting to know better the man I've been working for. The chosen destination for R&R was Mount Abu, Rajasthan's only "hill station". (Hill stations are where anyone with money would retreat to in summer to avoid the heat.) Set off on the 7th from here in the village, spent two days in the mountains, and am thoroughly refreshed from it.
Day 1 was purely travel. We started from Bhorugram by jeep around 7 AM. Originally just me, but no car leaves Bhorugram with empty seats. We picked up two visiting MSW students who wanted to see Jaipur, one staff member trying to get to the Churu bus station, one guy who I never did figure out who/what he was, and one villager just going two towns over. Not much to say about that trip -- same old one-lane roads, scrub, and Hindi-Punjabi mix tapes. (He did finally get a new tape, at least.)
I got dropped at the railway station in Jaipur and had an hour to explore a bit, finding mainly a so-so $6 lunch buffet and a major decrease in my traffic-dodging skills since Hyderabad. The train this time was 3-tier AC, as I was traveling on the cheap. It remains an excellent way to travel, especially with only a small suitcase. The compartment is more crowded than 2AC, but still spacious by Indian standards. You stretch out on your berth, read and nap as you like, and take tea, samosa, omelette, chips, and other such delectables from passing caterers. The only disappointment is the tea, which is bag-based and not worthy of the name "chai". Energy and a little entertainment come from the many little kids running up and down. A lot more energy was added by a discussion that arose between my compartment-mates and stretched to entertain the whole coach for over an hour. The topic, as best I could tell, was the merits/lack thereof of holy men collecting large sums of money for their blessings, although it ranged pretty wide (there was something about hypnotism in there at some point).
As usual, getting off the train is where things went a bit rough, as the train station is down at the base of a 30km mountain road that leads to Mt Abu. Like all train stations, it is surrounded by a mob of taxi/rickshaw predators. Either no buses were running at 9:30 PM (possible) or I got bad directions, but I ended up having to go by (comfy) taxi for Rs 200. Not bad, except when I tell you that my room was Rs 200 per night. (Shri Ganesh hotel, recommended by Lonely Planet and Rough Guide. OK, not as good as the guides make it out to be, great place to meet fellow foreigners.)
Day 2 was for seeing the town, trekking (expensive at Rs 300, but amazing views), and a trip to the much-acclaimed Dilwara temples. No photos of the latter due to their rules, but they are indeed as amazing as the guidebooks say. I cannot begin to imagine the number of man-hours required to carve marble in that level of sophistication/detail. In the meantime, here's a view of what we climbed:
and what we found at the top:
The rest of the town is nice, although not quite something to write home about. It's sort of an Indian version of Gatlinburg, TN: lots of religious stuff, also lots of amusement for kids and random people trying to sell you crap. Among other things, they have an Eiffel Tower in the middle of the market:
Nevertheless, in town it's best to stick to the lake, which is beautiful.
Day 3 ended up with me hitching a ride on the back of a motorcycle, accompanying a Brit (Adam) and a Frenchman (Matthieu) to various temples. They drove, I acted as navigator and guide to various aspects of Indian religion/food. (They now know who Shiva is, why they get given sugar at every temple, what a dosa is, and to order the thali instead of bothering with a menu.) It definitely strengthened my desire to get a bike and learn to ride properly when I get home -- I have my "M" license, but need practice before I'm road-safe. Renting a scooter/bike seems to be *the* efficient way to tour rural South Asia. It was a fast way to handle the very steep 17km up to Guru Shikar, highest point in all Rajasthan. One photo cannot do the views justice, and I'm working on a panorama, but here's me being a tourist with much of the valley behind me:
Highlight of the day, though, was our last stop at Gaumukh, a temple reachable only via about 750 steps along a staircase hidden in the forest. (I counted.) The Gaumukh spring is, by legend, from the same source as the Ganges, and thus bathing in it is equivalent. Gaumukh water being much cleaner than Varanasi gangajal, I got myself fully purified.
From there, it was back to Jaipur by my next adventure: the sleeper bus (Rs 280 one way). Basically, remove the overhead luggage racks on a Greyhound and put in some padded berths. Not uncomfortable, although not as nice as train. I still don't understand how the system works -- the bus stands and stops aren't marked, there seems to be no fixed number of tickets per bus, and no way to know what your bus is like before you board. Still, you get curtains for privacy, and I slept well. Yet again, the only problem was arrival, where my driver was unable to find me. Private buses aren't allowed to pick up or drop off at or near to the main government bus stands, so they tend to go to nearby streets/gullies, and of course there's no road signs to help you direct someone. The wait isn't bad, it's once again the [bleeping] rickshaws. If that system ever gets a little less predatory, budget travel in India will become an extremely enjoyable experience.
On balance though, a thoroughly worthwhile little excursion, highly recommended. Great views (do look at the full photoset), nice cool climate, decent food, and plenty of new friends to meet.
Day 1 was purely travel. We started from Bhorugram by jeep around 7 AM. Originally just me, but no car leaves Bhorugram with empty seats. We picked up two visiting MSW students who wanted to see Jaipur, one staff member trying to get to the Churu bus station, one guy who I never did figure out who/what he was, and one villager just going two towns over. Not much to say about that trip -- same old one-lane roads, scrub, and Hindi-Punjabi mix tapes. (He did finally get a new tape, at least.)
I got dropped at the railway station in Jaipur and had an hour to explore a bit, finding mainly a so-so $6 lunch buffet and a major decrease in my traffic-dodging skills since Hyderabad. The train this time was 3-tier AC, as I was traveling on the cheap. It remains an excellent way to travel, especially with only a small suitcase. The compartment is more crowded than 2AC, but still spacious by Indian standards. You stretch out on your berth, read and nap as you like, and take tea, samosa, omelette, chips, and other such delectables from passing caterers. The only disappointment is the tea, which is bag-based and not worthy of the name "chai". Energy and a little entertainment come from the many little kids running up and down. A lot more energy was added by a discussion that arose between my compartment-mates and stretched to entertain the whole coach for over an hour. The topic, as best I could tell, was the merits/lack thereof of holy men collecting large sums of money for their blessings, although it ranged pretty wide (there was something about hypnotism in there at some point).
As usual, getting off the train is where things went a bit rough, as the train station is down at the base of a 30km mountain road that leads to Mt Abu. Like all train stations, it is surrounded by a mob of taxi/rickshaw predators. Either no buses were running at 9:30 PM (possible) or I got bad directions, but I ended up having to go by (comfy) taxi for Rs 200. Not bad, except when I tell you that my room was Rs 200 per night. (Shri Ganesh hotel, recommended by Lonely Planet and Rough Guide. OK, not as good as the guides make it out to be, great place to meet fellow foreigners.)
Day 2 was for seeing the town, trekking (expensive at Rs 300, but amazing views), and a trip to the much-acclaimed Dilwara temples. No photos of the latter due to their rules, but they are indeed as amazing as the guidebooks say. I cannot begin to imagine the number of man-hours required to carve marble in that level of sophistication/detail. In the meantime, here's a view of what we climbed:
and what we found at the top:
The rest of the town is nice, although not quite something to write home about. It's sort of an Indian version of Gatlinburg, TN: lots of religious stuff, also lots of amusement for kids and random people trying to sell you crap. Among other things, they have an Eiffel Tower in the middle of the market:
Nevertheless, in town it's best to stick to the lake, which is beautiful.
Day 3 ended up with me hitching a ride on the back of a motorcycle, accompanying a Brit (Adam) and a Frenchman (Matthieu) to various temples. They drove, I acted as navigator and guide to various aspects of Indian religion/food. (They now know who Shiva is, why they get given sugar at every temple, what a dosa is, and to order the thali instead of bothering with a menu.) It definitely strengthened my desire to get a bike and learn to ride properly when I get home -- I have my "M" license, but need practice before I'm road-safe. Renting a scooter/bike seems to be *the* efficient way to tour rural South Asia. It was a fast way to handle the very steep 17km up to Guru Shikar, highest point in all Rajasthan. One photo cannot do the views justice, and I'm working on a panorama, but here's me being a tourist with much of the valley behind me:
Highlight of the day, though, was our last stop at Gaumukh, a temple reachable only via about 750 steps along a staircase hidden in the forest. (I counted.) The Gaumukh spring is, by legend, from the same source as the Ganges, and thus bathing in it is equivalent. Gaumukh water being much cleaner than Varanasi gangajal, I got myself fully purified.
From there, it was back to Jaipur by my next adventure: the sleeper bus (Rs 280 one way). Basically, remove the overhead luggage racks on a Greyhound and put in some padded berths. Not uncomfortable, although not as nice as train. I still don't understand how the system works -- the bus stands and stops aren't marked, there seems to be no fixed number of tickets per bus, and no way to know what your bus is like before you board. Still, you get curtains for privacy, and I slept well. Yet again, the only problem was arrival, where my driver was unable to find me. Private buses aren't allowed to pick up or drop off at or near to the main government bus stands, so they tend to go to nearby streets/gullies, and of course there's no road signs to help you direct someone. The wait isn't bad, it's once again the [bleeping] rickshaws. If that system ever gets a little less predatory, budget travel in India will become an extremely enjoyable experience.
On balance though, a thoroughly worthwhile little excursion, highly recommended. Great views (do look at the full photoset), nice cool climate, decent food, and plenty of new friends to meet.
Friday, April 10, 2009
Teaching the Children
Occasionally, in between work (there will be another work-related entry soon, honest), I do get to have a bit of fun and do something emotionally/mentally stimulating. Safe Water was one of those. Even better was one that happened just before that -- I got to teach some of the local schoolkids.
As I've mentioned before, my project office is actually embedded in a school. It's a K-12 campus, both boarders and day students (mostly day students transported by private bus network), with affiliated vocational campus. This means that I spend my day surrounded by students and teachers, and of course the teachers are aware that there's an American doctor who also happens to have an IT degree. I've mentioned before that "foreigner" carries a pretty high social standing around here, so it was only a matter of time before someone realized that they should have me teach a class or two in order to bump up the prestige.
(The school is English-language, so by 10th grade, the kids are pretty decent.)
In this case, it was the principal's wife, and I was asked to talk for an hour on how to become a doctor and why the kids should consider this as a career. (Apparently, just as in the US, they have a problem with potential docs opting to do IT or business because it's more money for less work. Of course, the US doesn't have a problem with its doctors fleeing to India.) My skill at this was limited by the fact that I had no clue about the Indian medical education system, but since nobody at the school does either, half an hour with Wikipedia and a good poker face was pretty much enough. We got some good shots of Dr. Alik expounding on the virtues of medicine, including this one:
I focused mainly on the theme that in order to be a successful doc, you have to have three things: love of other people, love of science, and love of learning. It's an arguable doctrine, but I do think it characterizes the physicians who I look up to as good role models. Plus, if you've got those three, the need to memorize piles of useless crap does tend to take care of itself. I definitely painted a rosier picture of medicine than is really justified, but the developing world does need more doctors, and especially more doctors who'll care about the villages.
Of course, I also got to talk about my project, and the process of doing that was remarkably therapeutic. You'll recall my prior post where I wondered if I was doing any good here. Over the course of prepping for this talk, I pulled up the example of one infant death in a neighboring village. I was able to trace back the cause of death (stillbirth/low birth weight) and the mother's status (no tetanus shot or supplemental nutrition), which gives me a pretty decent picture of what might have happened here. More importantly, I do know that if a mom like this happens in the coming year, there'll be someone watching who can at least try to get her that antenatal care. That's a pretty concrete example of a kid who could have been saved. Thinking about that and telling the story really renewed my faith in the meaning of the work I'm doing. Now, I'm mainly hoping it inspired some of those kids to do the same. They seemed more focused on my descriptions of mental illness (how do you explain schizophrenia to a fifteen-year-old from another culture?) than on my big-picture point. But, you never know what might stick in the back of someone's brain.
There's not much time left for me in Bhorugram, but at least now I can leave here with the feeling that my work made a difference. That's about the best anyone can hope for on a problem of this size.
As I've mentioned before, my project office is actually embedded in a school. It's a K-12 campus, both boarders and day students (mostly day students transported by private bus network), with affiliated vocational campus. This means that I spend my day surrounded by students and teachers, and of course the teachers are aware that there's an American doctor who also happens to have an IT degree. I've mentioned before that "foreigner" carries a pretty high social standing around here, so it was only a matter of time before someone realized that they should have me teach a class or two in order to bump up the prestige.
(The school is English-language, so by 10th grade, the kids are pretty decent.)
In this case, it was the principal's wife, and I was asked to talk for an hour on how to become a doctor and why the kids should consider this as a career. (Apparently, just as in the US, they have a problem with potential docs opting to do IT or business because it's more money for less work. Of course, the US doesn't have a problem with its doctors fleeing to India.) My skill at this was limited by the fact that I had no clue about the Indian medical education system, but since nobody at the school does either, half an hour with Wikipedia and a good poker face was pretty much enough. We got some good shots of Dr. Alik expounding on the virtues of medicine, including this one:
I focused mainly on the theme that in order to be a successful doc, you have to have three things: love of other people, love of science, and love of learning. It's an arguable doctrine, but I do think it characterizes the physicians who I look up to as good role models. Plus, if you've got those three, the need to memorize piles of useless crap does tend to take care of itself. I definitely painted a rosier picture of medicine than is really justified, but the developing world does need more doctors, and especially more doctors who'll care about the villages.
Of course, I also got to talk about my project, and the process of doing that was remarkably therapeutic. You'll recall my prior post where I wondered if I was doing any good here. Over the course of prepping for this talk, I pulled up the example of one infant death in a neighboring village. I was able to trace back the cause of death (stillbirth/low birth weight) and the mother's status (no tetanus shot or supplemental nutrition), which gives me a pretty decent picture of what might have happened here. More importantly, I do know that if a mom like this happens in the coming year, there'll be someone watching who can at least try to get her that antenatal care. That's a pretty concrete example of a kid who could have been saved. Thinking about that and telling the story really renewed my faith in the meaning of the work I'm doing. Now, I'm mainly hoping it inspired some of those kids to do the same. They seemed more focused on my descriptions of mental illness (how do you explain schizophrenia to a fifteen-year-old from another culture?) than on my big-picture point. But, you never know what might stick in the back of someone's brain.
There's not much time left for me in Bhorugram, but at least now I can leave here with the feeling that my work made a difference. That's about the best anyone can hope for on a problem of this size.
Friday, April 3, 2009
Everything Comes Down to Poo
(The title of this post is a 2-point reference. Search engines are cheating.)
I also spend a lot of time thinking about poop. Some of this is because I often end up eating/drinking something a bit dodgy and wondering if it's going to come back and bite me the next day. The other reason is that it pervades my life, and I'm not talking about the fact that (I am not making this up) every street in Bhorugram has an open sewer running right down the middle. See also, previous post about water supplies.
Poop pervades my life because of two factors. First, as the book has taught us, Everybody Poops. And, as I've mentioned in a previous entry, toilet paper is not common here, in the same way that diamonds are not common. So, you wipe with your left hand. Another thing that is not common is soap. Or, since we are in a desert, copious amounts of water. The net result is that most people are wandering around with a left hand covered in a microscopic (hopefully) film of poop and no way to wash off said poop. Some of them are involved in food preparation, and I pretend to myself that they wash their hands and the school provides them soap. Others are involved in the constant fetch-and-carry that keep India going, which means that eventually, they WILL touch something that I'm going to touch.
The second factor is that, in a resource-poor society, you waste nothing that could be used. You are thinking "fertilizer", but that only applies during the rainy season (when poop can be kept moist long enough to compost). The correct answer is "fuel". In villages throughout India, but especially here, a major source of fire for cooking/heating/etc. is the burning of dried dung, sometimes mixed with straw/sticks. There are piles of the stuff everywhere, looking like this:
If you look closely, you will notice that every one of those is covered in handprints. That's how they're made; pick up a lump of droppings and get to work. See above about handwashing.
So, basically every surface, and every standing body of water, has a nice batch of friendly fecal coliform bacteria on it. In a very real sense, every bite of food, every piece of furniture, every drop of water, contains a small bit of someone/something's poop. This, in turn, is why it's almost impossible to avoid getting sick -- the contamination is everywhere. As the saying goes, poop happens. Sometimes, it happens a lot.
The fact that I am now able to drink village water and eat pretty much anything in Rajgarh town without incident tells you exactly how much poop I've eaten in these three months. Pretty much world's best probiotic regimen. I'm sure I've been well-colonized with C. difficile after two years working in a hospital, but the bugs here are going to give those spores a run for their money.
I also spend a lot of time thinking about poop. Some of this is because I often end up eating/drinking something a bit dodgy and wondering if it's going to come back and bite me the next day. The other reason is that it pervades my life, and I'm not talking about the fact that (I am not making this up) every street in Bhorugram has an open sewer running right down the middle. See also, previous post about water supplies.
Poop pervades my life because of two factors. First, as the book has taught us, Everybody Poops. And, as I've mentioned in a previous entry, toilet paper is not common here, in the same way that diamonds are not common. So, you wipe with your left hand. Another thing that is not common is soap. Or, since we are in a desert, copious amounts of water. The net result is that most people are wandering around with a left hand covered in a microscopic (hopefully) film of poop and no way to wash off said poop. Some of them are involved in food preparation, and I pretend to myself that they wash their hands and the school provides them soap. Others are involved in the constant fetch-and-carry that keep India going, which means that eventually, they WILL touch something that I'm going to touch.
The second factor is that, in a resource-poor society, you waste nothing that could be used. You are thinking "fertilizer", but that only applies during the rainy season (when poop can be kept moist long enough to compost). The correct answer is "fuel". In villages throughout India, but especially here, a major source of fire for cooking/heating/etc. is the burning of dried dung, sometimes mixed with straw/sticks. There are piles of the stuff everywhere, looking like this:
If you look closely, you will notice that every one of those is covered in handprints. That's how they're made; pick up a lump of droppings and get to work. See above about handwashing.
So, basically every surface, and every standing body of water, has a nice batch of friendly fecal coliform bacteria on it. In a very real sense, every bite of food, every piece of furniture, every drop of water, contains a small bit of someone/something's poop. This, in turn, is why it's almost impossible to avoid getting sick -- the contamination is everywhere. As the saying goes, poop happens. Sometimes, it happens a lot.
The fact that I am now able to drink village water and eat pretty much anything in Rajgarh town without incident tells you exactly how much poop I've eaten in these three months. Pretty much world's best probiotic regimen. I'm sure I've been well-colonized with C. difficile after two years working in a hospital, but the bugs here are going to give those spores a run for their money.
Wednesday, April 1, 2009
How Pepsi Might Save the World
It's really been seriously non-stop excitement since I returned to Bhorugram from Mumbai. Some of that I've detailed in previous entries. The latest bit was a visit of various high-ups from the Safe Water Network. I'm still working on fully understanding what SWN does, but it involves having a lot of cash. No, more than that. A large (not totality, but large) chunk of their funding comes from Pepsi and the Pepsi Foundation. They also have a board of various well-connected business and political figures, which means they've got a lot of opportunities for global reach. The website doesn't tell much about what they do, but I can say that at least in the Churu District, it's about building water structures. Specifically, a kind of rainwater-harvesting setup called a khund. I've taken some photos that I'll try to composite together to show you, but it's essentially a covered tank with a few inlets to let in rainwater. The fancy ones have gravel to filter the water a bit and maybe some pipes that let them collect runoff from nearby rooftops. SWN is giving BCT money to build them, both large-scale community ones and smaller household ones, and this is apparently the beginning of a project that's expected to scale up a lot.
Anyway, aside from meaning that I got to enjoy upgraded food for a day, the SWN visit also turned into my chance to play tour guide. I'd met one of their India-side execs at breakfast on my very first day in Jaipur, so when we ran into each other at breakfast again, it was inevitable that I'd be invited to join their fieldwork. So, after giving them a bit of a tour of my own REACH project (which potentially could measure the health outcomes of their water activities), I got packed into one of their SUVs and ended up serving as tour guide to the local landscape and the experience of being an expat in India. Can't say as I was sorry to go -- it really is nice to be able to just talk to someone in English without having to worry about the complexity of sentences or reducing my accent. Plus, trips like this are always educational.
Sadly, the village experience waiting for them was more song-and-dance than actual experience of village life. Once the cameras came out (they were trying to get some shots for the brochures), it mostly became everyone showing off their camels/children/whatever for the foreigners. There was what purported to be a meeting with village leaders to assess needs, but even my poor Hindi skills told me they were being taken for a ride. (Thankfully, so did the much better Hindi skills of their board member who's a former Pepsi India executive.) When they tried to ask the village spokesperson about things like average income levels, it was always "Oh, everyone here is very poor, we need your money," but somehow he could never tell exactly how much he or anyone else made for a day's work, or how they all afforded recharges for their mobiles, or how it was that they were still alive if it cost Rs 5000 per month to have water trucked in. The worst was when he got asked about illness in the village. He flatly denied that any children had died in the village that past year, and as far as ailments, the biggest concerns were sore backs and heart trouble[1].
So, for once, yours truly got to be a bit of a hero by steering our visitors in a new direction. Namely, offering them a chance to come five minutes down the road with me to the anganwadi. (Not that they couldn't have done it on their own, but it wouldn't have been on the normal itinerary, and I'm legitimately a semi-expert on the dang things now.) There was more song and dance here (literally -- the anganwadi worker basically made the kids dance for photos like circus animals[2]), but after that, I was able to show them something real -- the registers full of data that our project requires the workers to keep. The ones that show that yes, there were both infant deaths and stillbirths the prior year. Along with the health worker who can tell that yes, diarrhea is a very frequent problem here, and is sometimes fatal. They had video rolling the whole time for their PR work, so who knows? Maybe I'll be in a future Pepsi-sponsored video.
Even with the village numbskull, I'm still very glad they visited. They learned something, and I found out a few ideas along the way. I certainly got another example of how the REACH public health database model could be put to good use. Beyond that, it was interesting to hear about how Pepsi's starting to rebrand/rethink itself for the developing world. They've still got their traditional recreational beverage line, but they're also starting to realize that pre-packaged foods could have a very positive effect here. For one, anything Pepsi makes is an order of magnitude cleaner than any other available food. Second, most people here are undernourished. Supplying large numbers of calories (and maybe even some micronutrients) in a compact, well-distributed package is basically a core competency of soda companies. So, they might actually be able to help these villagers (in the short run) with just a slight twist on the formula that's rapidly putting Americans into an early grave. It's quite innovative and also mildly ironic.
[1] And this is why, despite the fact that women already do too damn much work in this part of the world, we run our project on the backs of female health workers. In anything having to do with children, village men have zero concern. Some of them can't even name all the children in their own family.
[2] You may be detecting a bit of an aggrieved tone here. I don't know why I was so bothered by the amount of photography that day. It's good that the level of poverty was being documented. I think it's that a lot of the human beings were being trotted around like showpieces. It's the same reason you might find it offensive that people around were snapping pictures of you just for being a white person in India. It's not the visitors' fault exactly, it's just that the whole thing got a bit distasteful despite their efforts towards cultural sensitivity.
Anyway, aside from meaning that I got to enjoy upgraded food for a day, the SWN visit also turned into my chance to play tour guide. I'd met one of their India-side execs at breakfast on my very first day in Jaipur, so when we ran into each other at breakfast again, it was inevitable that I'd be invited to join their fieldwork. So, after giving them a bit of a tour of my own REACH project (which potentially could measure the health outcomes of their water activities), I got packed into one of their SUVs and ended up serving as tour guide to the local landscape and the experience of being an expat in India. Can't say as I was sorry to go -- it really is nice to be able to just talk to someone in English without having to worry about the complexity of sentences or reducing my accent. Plus, trips like this are always educational.
Sadly, the village experience waiting for them was more song-and-dance than actual experience of village life. Once the cameras came out (they were trying to get some shots for the brochures), it mostly became everyone showing off their camels/children/whatever for the foreigners. There was what purported to be a meeting with village leaders to assess needs, but even my poor Hindi skills told me they were being taken for a ride. (Thankfully, so did the much better Hindi skills of their board member who's a former Pepsi India executive.) When they tried to ask the village spokesperson about things like average income levels, it was always "Oh, everyone here is very poor, we need your money," but somehow he could never tell exactly how much he or anyone else made for a day's work, or how they all afforded recharges for their mobiles, or how it was that they were still alive if it cost Rs 5000 per month to have water trucked in. The worst was when he got asked about illness in the village. He flatly denied that any children had died in the village that past year, and as far as ailments, the biggest concerns were sore backs and heart trouble[1].
So, for once, yours truly got to be a bit of a hero by steering our visitors in a new direction. Namely, offering them a chance to come five minutes down the road with me to the anganwadi. (Not that they couldn't have done it on their own, but it wouldn't have been on the normal itinerary, and I'm legitimately a semi-expert on the dang things now.) There was more song and dance here (literally -- the anganwadi worker basically made the kids dance for photos like circus animals[2]), but after that, I was able to show them something real -- the registers full of data that our project requires the workers to keep. The ones that show that yes, there were both infant deaths and stillbirths the prior year. Along with the health worker who can tell that yes, diarrhea is a very frequent problem here, and is sometimes fatal. They had video rolling the whole time for their PR work, so who knows? Maybe I'll be in a future Pepsi-sponsored video.
Even with the village numbskull, I'm still very glad they visited. They learned something, and I found out a few ideas along the way. I certainly got another example of how the REACH public health database model could be put to good use. Beyond that, it was interesting to hear about how Pepsi's starting to rebrand/rethink itself for the developing world. They've still got their traditional recreational beverage line, but they're also starting to realize that pre-packaged foods could have a very positive effect here. For one, anything Pepsi makes is an order of magnitude cleaner than any other available food. Second, most people here are undernourished. Supplying large numbers of calories (and maybe even some micronutrients) in a compact, well-distributed package is basically a core competency of soda companies. So, they might actually be able to help these villagers (in the short run) with just a slight twist on the formula that's rapidly putting Americans into an early grave. It's quite innovative and also mildly ironic.
[1] And this is why, despite the fact that women already do too damn much work in this part of the world, we run our project on the backs of female health workers. In anything having to do with children, village men have zero concern. Some of them can't even name all the children in their own family.
[2] You may be detecting a bit of an aggrieved tone here. I don't know why I was so bothered by the amount of photography that day. It's good that the level of poverty was being documented. I think it's that a lot of the human beings were being trotted around like showpieces. It's the same reason you might find it offensive that people around were snapping pictures of you just for being a white person in India. It's not the visitors' fault exactly, it's just that the whole thing got a bit distasteful despite their efforts towards cultural sensitivity.
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