And now, some work.

So, then, a status update on the project itself. I've been out here 1.5 weeks now, but actual working time is only a week, due to the initial few days being taken up with various Agarwal-related social activities. I also lose about 30 to 60 minutes daily in pursuit of various quality of life initiatives (e.g., the continual pursuit of safe drinking water). That said, I'm starting to get a handle on the issues involved in scaling this project up from 40 villages in an area with decent health statistics to 230 villages in an area with not-so-good statistics (or infrastructure).

First, the good news. I have good staff -- they're pretty smart, and 2 of the 3 speak English well enough that between their English and my Hindi, we can communicate well. Both of them are constantly searching for new jobs, as being posted to the desert is not fun for anyone, but they're mine for the next two months. I also have good resources -- an Internet connection that's working whenever the power is, a new server coming to handle the database load, and soon, a nice room of 10 data entry terminals to feed that survey. Reliable techs to do the data entry remain a work in progress.

Now, the troubles. They really come down to one thing: the Rajgarh Block is BIG. Blocks are set up by population, and so in a sparsely populated environment, you get a big geographic area to cover. This then gets exacerbated by the fact that roads are somewhat lacking out here, case in point:



So, to get from any one point to another is a minimum 30 minute trip, and usually more like an hour, even by car. This affects the three main parts of a database project, namely data collection, data entry, and data checking. As far as collection, we're dependent on women in the villages. Sometimes they fill out the phonebook-size registers we hand them. Sometimes they don't. Sometimes they fill them out incorrectly, in which case we have to send them back as a do-over.

Entry goes OK when the power is on, but is dependent on the hiring of computer-wallahs. When the transport infrastructure fails them, they don't come. When they do come, they're rather tempted to spend their time surfing the Internet for music. They do less of that (and make fewer mistakes) when supervised, but we only have three professional staff, and if they're out in the field, there's not much they can be doing.

It's quality control that I see as my real task while I'm out here, and that's the one that seems like a particular bear. The only way you know if the data are trustworthy is to check them against reality. Reality is a bunch of women and their families in various structures throughout a village. Checking it means going house-to-house. The first REACH project serves 40 villages, and they're small. You can just do exhaustive surveying. This new REACH project covers 230, and about 270 total community centers within them. I'm going to have to figure out a successful technique for sampling villages and households within those villages, and ideally I need to oversample the places where the problems are so that I can start rooting them out. How I think I'm going to do that is the topic of the next work-related entry.

Only In India

I really don't think there's anything more I can add. These were playing cards, originally.

The Way of the Bucket

This is my bucket.
There are many others like it, but this one is mine.
My bucket is my best friend. It is my life.
Without me, my bucket is nothing.
Without my bucket, I am nothing.

In all seriousness, one thing that always interests people about foreign lands is plumbing. Eating and excreting are the fundamental activities of life, and thus it's no surprise that everyone does them a little differently. (The popularity of ethnic restaurants makes me wonder if there'd be any value in opening up a "Toilets of the World" complex where you could experience bathing and toileting in a bathroom from another country. I bet the kids would like it.) Today, we will discuss the Indian bathroom, and its most important feature, the bucket.

All bathrooms come with at least one bucket. You use it more or less depending on your level of wealth, but even in rich peoples' apartments in Mumbai, it's there. If you don't have running water, you use it to get the water to bathe. If you have running water but no shower, you fill it to get the temperature right. If you have a shower, you still need it to rinse the floor afterwards. Your clothes are washed in a bucket, even if it's by servants and not your own hands. (The packet of Tide I bought in Hyderabad actually includes directions on the back for bucket washing, but NOT machine washing.) After using the toilet, your bucket might be your only source of water for cleaning your nether regions. If you're really hard up, the bucket might BE the toilet. Ultimately, every Indian, rich or poor, probably begins and ends his/her day in salutation to a bucket.

A few things in the preceding paragraph might have surprised you, so let's discuss the rest of the bathroom. First, the toilet. They do come in the "squatting" version, but there are also plenty of "European style"; most of them look like the ones you know from home, with a slightly different flush mechanism. What'll get you is when you finish and realize there's no toilet paper. In the bad old days, you'd dip a cup (or your hand) into your trusty bucket, fill it with water, and use your left hand to assist you with some washing. (Hence why the left hand is not polite to touch/pass food with.) Nowadays, most people have a little hand-held showerhead that effectively acts as a mini-bidet. I had one in Hyderabad. I don't have one here. It's taken some getting used to, especially because there is often not soap by the sink. Hand sanitizer has been my friend.

Next, your water supply. Running water is pretty common these days (don't try to drink it). The central hot water heater, on the other hand, is almost unheard of. Hot water comes from a little just-in-time gizmo called a "geyser". Flip the switch, wait five minutes, and your hot tap is suddenly working. Try to remember to flip it back off when you're done.

Then, the shower. The shower itself is pretty much the same, albeit minus the various modes and gizmos we have. If you're lucky, the hot water line from the geyser connects to the showerhead as well as to the hot water tap. If not... well, say hello to Mr. Bucket again, as I do each morning. What we haven't mentioned is where all that water goes. There usually is neither tub nor shower stall. The entire floor is slightly tilted, and water from showering or clothes-washing simply runs downhill to a drain in the floor. Said drain is usually near the toilet, and is inevitably unable to completely dry the floor. Thus, answering nature's call almost always means wet feet, one of many reasons why most Indians go barefoot in their own homes. Given the almost-ubiquitous fine dust, it also means that it's impossible to enter the bathroom without producing muddy footprints on the floor. Hence, the usefulness of a bucket of water to re-rinse the floor every so often.

Power outages are frequent, the rains come and go, but the bucket endures forever.

Dramatis Personae

I thought that it might be helpful in decoding the prior entry if you had a list of some of the major players here:

• Dr. PS Reddy: Cardiologist from Pittsburgh, runs the SHARE NGO in the rural area around Hyderabad. This whole thing is sort of his fault, since he's the one who arranged the trip for me.
  
  
• Agarwals: Broadly, a clan of Indians hailing from an ancient city called Agara (distinct from current-day Agra, I think). In my case, a particular family of wealthy brothers descended from a single entrepreneur, all of whom fund various charitable projects.
  
  
• Bhoruka Charitable Trust (BCT): The primary vehicle through which the Agarwals do most of their philanthropy, which is heavily biased towards trying to help a single village of particular importance.
  
  
• Dr. Ashok Agarwal: On behalf of the Agarwal family, runs the Bhoruka Charitable Trust and the Indian Institute of Health Management Research. Sort of my "boss", since everything I'm provided comes out of his money.
  
  
• Amitava Banerjee: The guy Dr. Ashok employs to take care of anything related to BCT. Amitava himself has the usual staff of various functionaries, drivers, and other "The doctor sahib's problem is now your problem, go fix it" sort of people.
  
  
• Bhorugram: The village where the original ancestor, PD Agarwal, was born and grew up. (Originally called "Nangal Badi", but renamed in honor of Bhoru Ram, PD's father.) Isolated in the middle of nowhere, poor water supply, and mostly subsistence-level agriculture. Thanks to BCT, it now has a school, an adequate (if narrow) road, and a small "hospital" (mostly a birthing centre).
  

Bhorugram Arrival

I've been out at Bhorugram for three or four days now, but it's taken a while to write this entry due to an absolute whirlwind of stuff happening (and one or two days of dysentery that was pretty much inevitable). I arrived on a Thursday evening in the company of Amitava, and had basically an evening and a morning to try to understand what was in place as far as the existing REACH project and try to gather some data. At about 2 PM Friday, Dr. Reddy showed up, and I had perhaps five minutes to tell what I'd found before he'd seized on something, made his own plans about the next step in analysis, and corralled the staff into gathering that data.

Saturday, we had again until just after lunch to try to make some useful sense out of very preliminary data, at which point Dr. Ashok and the other Agarwals also showed up. As it turns out, my timing of arrival was either very fortuitous or very much not. Once a year, the entire Agarwal clan, with kids and grandkids, converges on Bhorugram for a family reunion/review of BCT's work. Since that point, it's basically all been a blur of Agarwals. (Dr. Reddy is here by virtue of having been semi-adopted by the Agarwals along the way. I get to sponge off the fruits of his labor.) They seem like very nice people, albeit from a much higher social stratum than I usually get to talk with. It's also really nice to get to know the people for whom I'm technically working.

Bhorugram itself is what you'd expect for a place out in the Indian desert, six hours by car from any major city. Life for most of the villagers does not include electricity or running water, and is spent on the traditional activities: grow crops, dry camel/cow dung for fuel, cook food, wash and clean, and if you get some relaxation time (i.e., if you're a man), smoke hukka and play some cards. All around the village itself, all you see is empty -- a few scrub trees, the fields of chickpeas and mustards, and maybe someone in the fields. The rest is sand.

That's the downside. The bright side is that as a temporary retreat, it's beautiful. Like all Indian villages, wildlife wanders freely anywhere it wants, which means that there are peacocks and peahens strutting and calling right outside my door each morning. At night, the lack of electricity means one of the most incredible views of the stars that I've ever seen. It is definitely lonely, especially if you don't really speak Hindi well, but there are plenty of worse places to be spending two months.

Jaipur Arrival

Made it to Jaipur and am spending Wednesday and part of Thursday at IIHMR, the Indian Institute for Health Management Research, just outside the Jaipur airport. This is the home base of Dr. Ashok Agarwal, who's technically the patron of my work here in Rajasthan. It is LARGE, the size of a small college campus in the US. It's also clearly a high-powered place; over the breakfast table, my companions were discussing one of Obama's administration picks (NASA head, I think) because he was also a recent co-worker of theirs. They're part of a group called Safe Water Network, over here to work on a new rainwater collection scheme. I'd trust their capacity to do it, too -- one of the guys with them is an engineer who was telling me some of his war stories, which include making a Pepsi bottling plant work with the highly-suspect Indian water and designing a sewage treatment plant that produces zero sludge. (If you don't understand why zero sludge is impressive, go to my Flickr and leaf through the public health photoset.)

I mostly spent the day soaking in the place, chilling in the computer lab, and meeting a few faculty. Mainly, I managed to define better in my head what's going on with the relationships here -- the initial project info talked about working for the Bhoruka Charitable Trust, but most of my contact has been with people from the Indian Institute for Health Management Research. The basic story is that both derive from the late Shri PD Agarwal, who is as much a rags-to-riches as you'll ever hear. See the websites for the full story, but the basic deal is that the dude came to a small town from an even smaller village, busted his butt alongside his brothers, and eventually bought a truck. From that, he became the magnate of the Transport Company of India, and the resulting wealth established the BCT to attempt to de-suckify the area of Rajasthan where he grew up. His sons run various parts of the ensuing megacorp, which handles transportation, power, mail, and other infrastructure needs.

One son, however, went to the US to do an MD (and an MPH? I'm not sure) at Johns Hopkins. That's Dr. Ashok Agarwal. Dr. Ashok returned to India and realized that the concept of "health systems management" didn't exist here, and promptly decided to start what is basically the equivalent of a healthcare MBA program. That same Institute also does a lot of training for NGOs, hospitals, and anyone else who wants to make their staff manage better. Practically, as the son who's least involved in running corporations (although he does manage a few), Dr. Ashok is also the one most directly involved in keeping BCT going. So, the two organizations share a building, though the lion's share by far is IIHMR. They divide up the work such that IIHMR does planning/research and BCT does actual work involving slogging through deserts.

Have not seen much of Jaipur the city as yet (and probably won't before I ship out for Bhorugram tomorrow), but the weather is lovely here -- feels about like Pittsburgh in mid-March. We even had a brief thunderstorm the night I arrived. Summer will show up in April, and then we'll be baking, but for now it's nice. Dr. Ashok's house in particular is very nice. It's not large; in fact, it's smaller than most doctors' houses I know in the US. It is, however, extremely well-decorated. Not lavishly, but everything is of genuinely well-executed craftsmanship, from the perfectly arranged vases of flowers to the inlaid marble all throughout to the hand-painted paisleys on the ceiling. In a country where labor is cheap but quality work is a constant struggle to find, that might be the ultimate statement of wealth. It's making me feel a little bad that all I'm able to give the guy in thanks for 2.5 months of taking care of me is a measly bottle of blended Scotch.

Made it to Jaipur and am spending Wednesday and part of Thursday at IIHMR, the Indian Institute for Health Management Research, just outside the Jaipur airport. This is the home base of Dr. Ashok Agarwal, who's technically the patron of my work here in Rajasthan (even if I've yet to meet him as of this writing). It is LARGE, the size of a small college campus in the US. It's also clearly a high-powered place; over the breakfast table, my companions were discussing one of Obama's administration picks (NASA head, I think) because he was also a recent co-worker of theirs. They're part of a group called Safe Water Network, over here to work on a new rainwater collection scheme. I'd trust their capacity to do it, too -- one of the guys with them is an engineer who was telling me some of his war stories, which include making a Pepsi bottling plant work with the highly-suspect Indian water and designing a sewage treatment plant that produces zero sludge. (If you don't understand why zero sludge is impressive, go to my Flickr and leaf through the public health photoset.)

I mostly spent the day soaking in the place, chilling in the computer lab, and meeting a few faculty. Mainly, I managed to define better in my head what's going on with the relationships here -- the initial project info talked about working for the Bhoruka Charitable Trust, but most of my contact has been with people from the Indian Institute for Health Management Research. The basic story is that both derive from the late Shri PD Agarwal, who is as much a rags-to-riches as you'll ever hear. See the websites for the full story, but the basic deal is that the dude came to a small town from an even smaller village, busted his butt alongside his brothers, and eventually bought a truck. From that, he became the magnate of the Transport Company of India, and the resulting wealth established the BCT to attempt to de-suckify the area of Rajasthan where he grew up. His sons run various parts of the ensuing megacorp, which handles transportation, power, mail, and other infrastructure needs.

One son, however, went to the US to do an MPH at Johns Hopkins. That's Dr. Ashok Agarwal. Dr. Ashok returned to India and realized that the concept of "health systems management" didn't exist here, and promptly decided to start what is basically the equivalent of a healthcare MBA program. That same Institute also does a lot of training for NGOs, hospitals, and anyone else who wants to make their staff manage better. Practically, as the son who's least involved in running corporations (although he does manage a few), Dr. Ashok is also the one most directly involved in keeping BCT going. So, the two organizations share a building, though the lion's share by far is IIHMR. They divide up the work such that IIHMR does planning/research and BCT does actual work involving slogging through deserts.

Have not seen much of Jaipur the city as yet (and probably won't before I ship out for Bhorugram tomorrow), but the weather is lovely here -- feels about like Pittsburgh in mid-March. We even had a brief thunderstorm the night I arrived. Summer will show up in April, and then we'll be baking, but for now it's nice. Dr. Ashok's house in particular is very nice. It's not large; in fact, it's smaller than most doctors' houses I know in the US. It is, however, extremely well-decorated. Not lavishly, but everything is of genuinely well-executed craftsmanship, from the perfectly arranged vases of flowers to the inlaid marble all throughout to the hand-painted paisleys on the ceiling. In a country where labor is cheap but quality work is a constant struggle to find, that might be the ultimate statement of wealth. It's making me feel a little bad that all I'm able to give the guy in thanks for 2.5 months of taking care of me is a measly bottle of blended Scotch.

Air Travel in India

As part of the Hyderabad->Jaipur transfer, I had my first experience with Indian domestic air travel in over 4 years. Here, the class distinction really shows itself. Once you get through the airport doors, the ubiquitous dust is gone. All the signs are in English, most of the business is conducted in English, and personal technology is everywhere. There's a McDonalds, a Subway, and more coffee shops than you could shake a stick at. There's even a wi-fi network (free for 45 minutes if you have a mobile phone to which they can send an SMS). It feels pretty obvious that you've left the street behind and entered a separate world.

The flight itself is pretty much identical to US domestic air travel, right down to the "Oh, you have more baggage than we expected, pay us Rs 1400." (That's about $30 for those playing the home game, actually slightly *more* than the US rate.) They've even replaced the previous years' complimentary food/beverage with pay-as-you-go. The announcements are in English (and the local language), and all the in-flight rules are identical.

Only big difference is in the boarding process. Jetways seem to be reserved for long-haul or international flights. For anything of only a few hours, you get on a bus, the bus drives you to the plane, and you walk up the stairs. (The space for carry-on baggage is much smaller.) Getting on and off said bus displays the traditional approach to queueing, namely, throw some elbows and get your butt in gear. Oddly, there's still a courtesy norm of giving up seats for women.

It was, overall, a perfectly reasonable experience. It also costs exactly the same as in the US -- my ticket (which I thankfully did not pay for) was Rs 8400, which works out to about $175. (Actual ticket price, Rs 2000; the rest is taxes and fees. I hope that little innovation does NOT make its way west.) Two weeks from now, I've got to get back down to Mumbai to rendezvous with Jennifer and my father. There's plenty of flight room available (thankfully, 21-day advance booking has also not caught on yet), but at comparable prices. The train, if I go absolute highest-class, would be Rs 4000 round trip, about half the price. Assuming I can get a ticket off the tourist quota, here's hoping the next traveling entry is telling you about the joys of Indian train travel.