Inspiration

It's now been over two years since I first arrived in India, bright-eyed and hopeful. When I first got here, I was guided by unbridled optimism (we're going to change the world!!!)... which was duly checked within a week of being here, as I struggled with the cognitive dissonance of my daily life - where I worked 100+ hours a week at a social enterprise, yet felt powerless in the overwhelming face of poverty in a city as developed as Hyderabad. As an Acumen fellow, I blogged about my horror at realizing my apartment guard slept in our garage, along with his young son. How naive that post seems now! Yet these still remain the hard questions... do I give to beggars on the street? -- what about if they are mothers with babies, when I'm on my way to LifeSpring?

Still no easy answers, but this week I got a jolt of inspiration when watching Obama's Nobel Peace Prize acceptance speech.

Some highlights, which made me think of the importance of the work we're doing - even those days where it just feels like a small drop in a vast ocean:

"Even those of us with the best intentions will at times fail to right the wrongs before us. But we do not have to think that human nature is perfect for us to still believe that the human condition can be perfected.

We do not have to live in an idealized world to still reach for those ideals that will make it a better place. The nonviolence practiced by men like Gandhi and King may not have been practical or possible in every circumstance, but the love that they preached -- their faith in human progress -- must always be the North Star that guides us on our journey.

For if we lose that faith... we lose our sense of possibility. We lose our moral compass.

...So let us reach for the world that ought to be -- that spark of the divine that still stirs within each of our souls.

...We can acknowledge that oppression will always be with us, and still strive for justice. We can admit the intractability of deprivation, and still strive for dignity. We can understand that there will be war, and still strive for peace. We can do that -- for that is the story of human progress; that is the hope of all the world; and at this moment of challenge, that must be our work here on Earth."

Laughing all the way

Last night I came home to find my whole apartment flooded...

Not the most fun, to say the least... So I thought I'd try to find humor in my commute to work this morning. That's the great thing about India -- you just have to get out of your head, open your eyes, and it's incredible what you notice.

Some highlights from my ride to work:

(1) Whereas in the US, buses pull over and stop to pick up/drop off passengers, buses in India do one or the other (in other words: stop OR pull over)... but never both.

There's a bus "stop" near my apartment, but that's an oxymoron. Instead, buses pull over to the curb, indicating that the race to start running and get onto the bus has started. Buses slow down, but never actually stop moving. Men who make it onto the moving bus reach their arms outwards to grab their buddies who are still chasing the bus.

Alternatively, buses simply stop right in the middle of the road. People board and unboard... all the while cars, autos, and bikes steer around the bus, getting into all sorts of traffic jams from oncoming traffic from the other direction.

(2) One thing I love about our new office is that we're surrounded by elementary schools. So walking to work in the morning, all I hear is a cacophony of little kids literally SCREAMING: "AAAAAA!!!! BBBBBB!!!! CCCCC!!!!" It's the cutest thing ever.

(3) Where else but India are these "normal" sightings in a morning commute? -- a dog riding in the middle of a scooter; a little boy STANDING up behind his father on the seat of a motorcycle; babies bundled like it's the middle of winter... when it's 82 degrees!

The other great thing about India: marble floors and squeegee wipers. Still not sure what caused the flooding at home, but in the end, it's just another day here in Hyderabad :)

A lesson in politics

What a difference a week makes!

This time last week, I returned from a weekend in Delhi to find Hyderabad in its second day of strikes to call for the formation of a new Telangana state. Offices were closed, streets empty, and newspapers reported on the movement's leader on a hungry strike in jail.

Only three days later -- midnight on Thursday -- the Andhra state government, headed by chief minister K Rosaiah, announced it would indeed back the proposal of a new state, thus creating Telangana from the north-western part of what's now Andhra Pradesh.

Of course, this only set in place a *process* for statehood formation, but still -- quite a big deal, to say the least! I couldn't help but think of how strangely easy it seemed for a new state to be formed... not to belittle the movement, but it was literally just a few days of strikes, all of which were announced in advance -- giving Hyderabadis time to stock up on necessities -- whether it be petrol or cash, or in the case of my friends - wine and beer.

In a strange way, last week's situation and the declaration of a new state (at least in process) highlights one key way to get things done here in India: persistence and the willingness to make others around you uncomfortable until you get what you need. As I'm learning, not only is anything possible in India, but everything is negotiable as well.

Returning once again from a weekend in Delhi, I find that the situation has only gotten worse. It's actually turned into quite a political drama, with over 100 MLAs and ministers resigning from state government, causing what many are calling a constitutional crisis. Newspapers report that the chief minister of Andhra is likely to resign, with President's Rule on the state a dawning possibility.

Headlines report that "Chaos Engulfs Angry Pradesh", with both anti-Telangana and Telangana supports becoming more violent. The key question seems what to do about Hyderabad, which is geographically in Telangana but economically, its business leaders mainly hail from Andhra.

Guess we'll have to wait and see! Never a dull moment in India...

A lesson in geography

Hyderabad is eerily quiet today. After returning from a weekend in Delhi, I expect to find Hyderabad in its normal manic Monday state of affairs. But today there are few cars on the roads, all the shops are closed, public transportation non-existent, and all gas stations resemble ghost-towns.

I've arrived to the second day of a city-wide strike, and as such, get a lesson in geography, politics, statehood, and modern-day hunger strikes.

The 48-hour shutdown has been called by the Telangana Rashtra Samiti (TRS), which is demanding a separate state of Telangana in Andhra Pradesh -- which would be the white region below.

The TRS party chief, K. Chandrasekhara Rao (called KCR -- gotta love all the acronyms in India!), began a hunger strike (or "fast-unto-death", as they call it here) a week ago. To avert his fast and the fast's potential to turn KCR into a martyr, the government arrested KCR the day before his strike was set to start.

Instead, KCR began his fasting in jail, and is now in his ninth day of fasting. Over the course of these nine days, there have been numerous suicides by hanging and self-immolation protesting his arrest. Meanwhile, the government gave KCR saline by force to end his fast after 36 hours, although he continued with the fast.

From what I've heard, there have been riots around the city, although everything feels quiet and safe over here in Banjara (although I keep receiving texts saying not to leave my house unless I'm in a car). In fact, the day seems almost happier and more carefree than usual, with a group of schoolboys playing cricket in front of my apartment and girls playing badminton, taking advantage of schools being closed.

Global Thinkers and Local Listeners

This week, Foreign Policy published its list of 100 Top Global Thinkers. Among them were Jacqueline Novogratz for helping build a new generation of social entrepreneurs and Muhammad Yunus for proving that the poor are profitable.

Perhaps one of the reasons they're such great thinkers is that they're amazing listeners. Each time Jacqueline visits LifeSpring, I'm inspired by the extent to which she wants to interact directly with our customers -- not just talk to them superficially, but really learn about their needs, how they make decisions, and what matters most to them. During her last visit to LifeSpring earlier this fall, she and Catherine spent time at our new hospitals, went to visit our customers in their homes and in our communities, and spent time at a nearby government hospital to see the vast gulf that exists, yet is often hard to communicate with hard metrics and figures.

Additionally, when I met Muhammad Yunus at this year's World Health Congress in Washington, D.C., I was humbled by how interested he was about LifeSpring's model -- asking numerous questions and asking how our lessons learned can be applied to Bangladesh.

During our first few days of the Acumen Fund fellowship, Wangari told us an African saying: "There's a reason you have two ears and only one mouth."

Looking at the Foreign Policy list, maybe this crucial skill of asking the right questions and truly listening is one of the key determinants to being an effective global thinker.

The Turkey that went to India...

... is the name of a recipe I found last week on my third of six flights in ten days!

Sounded pretty delicious (and appropriate), so thought I'd pass along, in case anyone has leftover turkey they don't know what to do with :)

Being home and celebrating two Thanksgivings in NY and LA was amazing... incredible food, warm company, and the feeling of being "home" with family and friends who are so close that we can just sit and watch paint dry (point illustrated below!)

The big joke all week was how much I'd eat...never before was I the human trash bin that ate everyone's leftovers! So it seems appropriate that food remains the topic for discussion...

Here's the recipe I found in the NY Times for turning leftover turkey into an Indian culinary delight:

"There is something important about the question of what to do with Thanksgiving leftovers...we've got all this stuff, what are we going to do with it now? Sandwiches may be delightful, but those happen Thursday night. By Friday, you may have had enough traditional American food and may be craving something on the opposite end of the spectrum, something with a bit of spice. Something, perhaps, with curry powder and coconut milk: a turkey curry"

TURKEY AND SPINACH CURRY

Time: about 20 minutes

2 tablespoons oil (the recipe calls for peanut; I think coconut would be really yummy and Trish-friendly)

1 small onion, chopped

2 cloves garlic, minced

1 tablespoon minced fresh ginger

1 teaspoon ground cumin

1 teaspoon ground coriander

1/4 to 1/2 teaspoon cayenne or to taste

1 cup tomatoes, chopped (if canned, include their juice)

1 cup coconut milk

Salt and freshly ground pepper

1/2 pound fresh spinach, roughly chopped

2 cups leftover turkey, roughly chopped

Freshly chopped cilantro for garnish

1. Heat oil in a medium saucepan over medium-high heat; add onion, garlic, and ginger and cook until they begin to soften, about 2-3 minutes. Add cumin, coriander, tumeric, and cayenne and cook, stirring, until spices are fragrant, about another minute.

2. Add tomatoes and their juices and coconut milk and sprinkle with salt and pepper; bring mixture to a boil and reduce heat to medium. Simmer for another 8 to 10 minutes, or until tomatoes break down.

3. Add spinach and turkey to pan and continue to cook until spinach wilts and turkey is warmed through, another 3-5 minutes. Adjust seasoning, garnish with cilantro and serve.

Yield: 4 servings

Delicious!!! Or as they say here, SWADEESH!!!

Happy 70th Birthday Mom!!

The cousins toast to 70 years young! ...

... while everyone's grateful to spend early Thanksgiving together as a family.

There's no such thing as free

I'm often asked why low-income women pay to come to LifeSpring, when government hospitals are free. Over and over, the primary reason we hear from our customers is that they want to go somewhere that's higher quality. Of course, "quality" means different things to different people, but low-income or not, we all want the same thing: a good doctor we can trust who answers our questions; a clean and safe environment; and to be treated with dignity and provided with information about our own health.

The second answer we hear most frequently is: "Well, everyone knows that government hospitals aren't free." The first time I heard that, I was shocked to hear of all the bribes that occurred at government hospitals, naive Westerner that I am. While we continuously hear this from our customers, it's a hard thing to talk to outsiders about or present at a conference when asked about the value LifeSpring provides -- primarily because there is little hard data and published evidence to support this, although everyone knows it's going on.

We just got a little help from The Times of India, who last week published two articles around this very topic. As they write in a Nov 9th article entitled "Your baby delivered by staff for a price!" reporting from Hyderabad:

"You can get a glimpse of your baby boy/girl only if you cough up Rs 500/Rs 400 respectively; at some hospitals it costs even more."

There are so many things wrong with that statement, I don't even know where to start! First off, the very idea of charging people with virtually no money to pay sums (around $8-10 USD) to "receive" their baby from the hospital feels so incomprehensible. And then the gender disparity is absolutely heart-breaking.

The article continues: "Humilitated parents have been unwillingly bending to the diktat ("fee") out of fear that the Class IV staff -- who routinely deny them the right to have their babies unless they grease the palms of aayas (housekeepers), operating theater assistants, and sweepers--may harm the baby."

It talks about how the rates at Government Maternity Hospital (in Petlaburj) is Rs 500/Rs 400, but the rates at Gandhi Hospital (which is nearby our hospital and which many of our customers had gone to previously) is anywhere between Rs 100 and Rs 1000.

Says one father: "My wife delivered a baby boy today. The hospital attendants and aaya refused to give me my child unless I paid. They refused Rs 200 that I offered and, in the end, I was forced to shell out Rs. 500".

Bargaining for your baby?!?! If I didn't hear about it nearly every day, I wouldn't believe it either.

A little reminder

A crazy day at work and it's barely 10am. As I rush to my next meeting, a note falls to the floor. It's from someone I just met last week, who came to visit LifeSpring Hospital to learn more about our work. It takes just a second to re-read, but instantly my mood shifts. It reads in part:

"I know you must know this at some level, but in case there's room for a reminder, you're doing truly inspiring stuff that others can only dream of. Enjoy it!"

Amazing how just a small shift can totally change your attitude. Also a good reminder of how powerful a simple note of gratitude can be, and just in time for Thanksgiving!

Star-struck

Maybe, just maybe, LifeSpring is being talked about in the White House...

Over the weekend, a product manager from Google came to LifeSpring to see how he might get involved in our IT Steering Committee. I think both sides were a bit star-struck... us wanting to learn more about his work with enterprise applications at Google, and he wanting the complete tour and story of LifeSpring's growth.

In fact, upon arrival, he talked about how excited he was to finally see LifeSpring. I figured he had heard about our hospital through the pre-TED visit a couple of weeks ago, where two Google senior managers came to visit our hospital.

But instead, he said that he had heard about LifeSpring from Sonal Shah -- previously at Google.org and now...

...heading Obama's recently-created Office on Social Innovation and Civic Participation! -- essentially the White House's office on social enterprise.

Now I'm the one star-struck!! It's amazing to me to think that the head of this office not only has heard about LifeSpring, but has told others about it as well...the power of word of mouth...

Now I'm wondering how to get Obama to come to one of our hospitals! -- maybe it's not so far-fetched after all...

Changing Landscape

Sunday, 5pm

Gurgaon

While working on a Sunday isn't usually a matter of fun, this weekend it's not so bad. Tyler and I are working at his office, the 2nd floor of a mid-rise modern building in Gurgaon, in the northern state of Haryana. I'm catching up on work and we're working on a paper on microfinance, which is actually really fun.

We stop to get lunch nearby -- about 10 minutes on his motorcycle. Yesterday it's McDonald's inside a mall, followed by dessert across the way at TGIF's (YES, TGIF's!!), which blares American music from the late 1990s. Today it's Pizza Hut, across the street.

What's amazing about all this is that I can be describing pretty much Anywhere, USA. But we're in Gurgaon, which a few years ago was nothing but complete rural farm land. The Central government then set up a special economic zone (SEZ, ahem, pronounced "zed" here, thank you) -- over an area of 300 acres. With all the tax incentives, FDI poured in and development accelerated. On my way to a meeting in here earlier this summer, I passed about 20 Fortune 500 firms -- companies like GE, Unilever, and Microsoft are all here.

From the back of Tyler's bike, it all just looks like an alternate universe made up completely of dust, grey, and construction -- "a bit like the apocalypse", we always joke. But it really is amazing to think of how much the landscape of this small area has changed in the last decade -- and to think that this is what's happening across India, and what will continue happening as development ensues.

A few months ago, the Wall Street Journal published a photo essay: click here -- which talks about Indian farmers who have become millionaires overnight by selling their land to developers here. As the Journal talks about, in recent years tens of thousands of villagers across the country have sold fields to developers building malls and suburbs for the New India. One of the most poignant photos is of a villager who sold milk for $250 a month before selling his land for $180,000 to a developer. While some are happy with their fortunes, others regret selling their land in the first place. Another memorable photo is of a 75-year old villager at the local courthouse, asking how he can reclaim his land that his nephew stole and sold.

It's a complex story, and one happening all around the country as the New India gets built.

A land of extremes

Even though I see it in my daily life every day, the incredible disparity between rich and poor here in India never ceases to shock me. Nowhere is this more true than in healthcare. Earlier this summer, LifeSpring was invited to attend The Economist's Healthcare Forum, put on by its intelligence unit. It was a fascinating conference, focusing primarily on what the future of healthcare in India is likely to look like.

For me, one striking aspect was how the dichotomy of healthcare challenges seems to be growing. For instance, you had experts talking about the growing prevalence of obesity, diabetes, and cardiovascular diseases, particularly among Indian women. Speakers talked of middle and upper-class women who sit at home all day, get no exercise, and have their servants do their errands.

Then in the next breath, we would hear of the abysmal conditions in urban slums... and how one couldn't talk about exercise there, when the real challenge is getting clean water and proper sanitation.

At this week's recent India Health Summit, an underlying implicit theme was similarities and differences between India and other countries' healthcare systems. Perhaps the most striking opposition was when the Programme Director from Singapore's Ministry of Health spoke. As he spoke of his country's healthcare system, I couldn't think of a more stark contrast!

One of India's biggest healthcare challenges is accessibility for its vast rural population; Singapore is only urban -- and one city at that! He, too, cited the statistic that almost 50% of India's population must travel over 100km to access care; while adding that the entire country of Singapore is 40km across! I found their solution to healthcare interesting -- a compulsory medical savings program for its citizens, coupled with voluntary medical insurance. (In India, fewer than 10% of citizens have health insurance, so the vast majority of healthcare spend is out-of-pocket.)

Of course, references to the US healthcare system abounded. It was interesting to hear so many questions asked around "What lessons can America learn from India in healthcare?" -- particularly around affordability and efficiency. Speaker after speaker talked about America's failed healthcare system, and while I don't necessarily disagree, I do think it's a matter of degrees and reference points. When someone from the Economist Intelligence Unit cited a recent survey showing the vast majority of people in most countries were unhappy with their healthcare options (including the biggest spenders, like the US, UK, and Germany), another speaker chimed in and stated quite forcibly: "With all due respect, there's a big difference between being unhappy and a system being totally lacking."

I thought of this comment later in the day, when a physician addressed the middle and upper-class audience (all primarily senior management and government officials) and said:

"I'm sure all of us, at one point or another, have faced a situation where a medicine necessary for a loved one's surgery was not available at the hospital itself -- so you've had to run out and find the critical medicine elsewhere, while the surgery is going on." I looked around the room, stunned to see such a large number of nodding heads. It certainly makes you aware of the incredible challenges in healthcare, not only among low-income Indians, but across the entire income spectrum.

India Health Summit

It's always a bit surreal to be sitting in an amazingly nice five star hotel with glass chandeliers and intensely high security... talking about development and "helping the poor." I've been in Delhi for the past two days attending the 6th India Health Summit, whose focus this year is on "Taking Quality Healthcare to the Masses."

I attended the same summit two years ago, when I first arrived in India and was a complete wide-eyed novice about the industry (two years later, there's clearly still so much to learn!). What struck me then was how black-and-white the spectrum of healthcare seemed to be -- with government hospitals on one end and private for-profit hospitals on the other end. Any private sector initiative towards serving low-income people was under their Corporate Social Responsibility umbrella, and there was almost a defensive feeling in government officials, who felt that government hospitals just needed to be strengthened with more resources to adequately serve the nation's poor.

Two years later, there's such a strong sense that government and the private sector need to work together to truly tackle India's healthcare challenges of accessibility, affordability, and quality. You couldn't escape a discussion on PPP's (public-private partnerships) in each of the sessions.

For me, it was so refreshing to hear government officials talk about the need for change in extremely unqualified terms. Said a Cabinet Minister who directly reports to the Prime Minister of India: "Just visit one of our government hospitals and you will see the mess."

One of the most heated debates of the Summit was the Q&A regarding Preventative Health. One of the speakers had chided India for being the world's largest producer of tobacco, as well as the world's largest consumer. His point, of course, was that Indians needed to be more aware of the unhealthy decisions they make regularly, such as smoking, unhealthy eating, etc.

This sparked a fascinating debate on health versus economic growth, with delegates citing chief ministers who urge their states' farmers to grow more and more tobacco. On the one side, you had people urging a tax on tobacco similar to the West; on the other, you had people citing the importance of economic growth - reminding the audience of all the farmers in Andhra Pradesh who committed suicide due to a decrease in their tobacco yield.

It reminds me how interlinked health and poverty is -- one statistic that kept coming up was that every year, 3% of Indians are pushed below the poverty line due to health care costs. Another quite incredible statistic: nearly 50% of Indians have to travel 100 kilometers or more to access quality care. Just goes to show that accessibility is a much bigger challenge than just affordability.

Baseball Fever

Tyler calls me an addict. I'm now in the business center of an amazingly nice hotel "watching" what I hope is the final game of the World Series. And yes, by "watching", I'm still referring to seeing the baseball icons move around the bases, with the photos of batter and pitcher smiling out at me.

I'm in Delhi for the 6th India Health Summit, hosted by the Confederation of Indian Industry. Turns out getting to a conference two hours early has its advantages when baseball is on!

Over on this side of the world, of course cricket is the rage. I've gone to a couple of games in Hyderabad, but I'm sure massively annoyed Indians I was with by trying to understand the game in relation to what's similar and different about baseball.

India is playing Australia in cricket today -- in Hyderabad, actually. Both teams arrived Hyderabad two nights ago and checked into the Taj Krishna, coincidentally where I was meeting Catherine so we could go out for dinner and drinks. We quickly decided that staying at the Taj would make for the more interesting evening!!

The very nature of their players probably says a lot about the countries' cultures -- or at least the cultures of the celebrity and the elite. The Australian cricketers came down in plain white t-shirts and work-out pants, having low-key drinks at the bar... while the Indian cricketer we saw was decked to the nine, with sunglasses and a host of fans pushing us out of the way for his autograph inside the hotel!

But meanwhile, back to baseball... Yankees up 7-3, top of the 7th....

TEDIndia

TED breaks into India this week, with Day 1 of TEDIndia starting tomorrow and the TED Fellows pre-conference starting this morning. It's really exciting that our CEO, Anant Kumar, has been chosen as a TED Fellow this year. Looking through the TED Fellows list, it's incredible how many fellows are part of my "world" here -- LifeSpring, Acumen Fund, Katzenbach, Columbia and SIPA... it's one of those things that is easy to take for granted but makes me re-remember all the opportunities that come from living in a country as dynamic as India.

Many of the events on the first and third day (November 5th & 7th) will be webcast live; you can view them here. Besides the "big names", I always love seeing the descriptions of speakers. For instance, the first session -- "Fast Forward" -- has speakers that include: global health expert, data visionary, mythologist, dancer/actor/activist, and singer. Love it!

I'm excited to hear back from Anant about the sessions on "Reinventing Development" and "Redesigning Communities" -- which perhaps unsurprisingly are somewhat frequent discussions and debates over food and copious wine here in the Hyderabad social-enterprise "scene". Stay tuned!

Marriage of the Gods

"Beautiful" is not a common word used to describe my commute home... but it was exactly that last night, with dozens of candles lined up in front of houses and fireworks happening through the night.

The occasion? The marriage anniversary of Lord Shiva and Goddess Parvathi. It's considered by Hindus to be a very auspicious day. As my co-worker explains: "Devotees celebrate this day and do pooja (religious ceremony), and it is considered that whatever we wish, it would be granted."

The "everyday" lives of gods here never ceases to fascinate me. Gods "wake up" and bathe in the morning (e.g. their statues are washed by devotees), celebrate anniversaries, and even have their own bank accounts! People naturally have "favorite" gods.

Tyler and I joke about the temple in Delhi that was built on the side of a highway... people do "drive-by" prayers, where they turn, bow to the god and give praise... ALL while still driving their motorcycles along the insanely busy road!!

And people say Americans multi-task??

Exporting LSH

Our CEO, Anant Kumar, recently came back from speaking at the World Health Summit in Berlin.  The Summit merged many different sectors and was held under the "patronage" of French President Nicolas Sarkozy and the German Chancellor Angela Merkel.  Comprised of panel discussions, working sessions, and stakeholder meetings, the Summit was an opportunity to have a global discussion and debate on tackling all the tough questions in healthcare -- such as access, affordability, high quality care, and the use of technology.

I was fascinated by many of the panels -- topics like Evolution and Disease of Modern Environments.  "Darwinian Medicine" was a big theme of the conference; in other words, looking at modern epidemics like asthma and obesity through the prism of evolution.  One way to look at these sorts of modern epidemics is the notion that they've resulted from changes in the environment which our bodies cannot evolve quickly enough to.  Fascinating.

Of course, healthcare delivery and accessibility on a global scale was another key Summit theme.  Anant spoke on a panel around global health, joined by senior directors from organizations like the World Economic Forum.  A question that Anant was continually asked was: "Is LifeSpring replicable outside India?"  I was asked more bluntly at the World Health Congress in DC: "When will LifeSpring open in the US?"  

While there's clearly still so much to do here in India, I often think about the lessons that LifeSpring can teach the rest of the world around areas of access, affordability, and high-quality patient-centric care.  The need is certainly there.  The question of scaling internationally is definitely an interesting one to continually revisit and explore.

Hyderabadi Halloween

Strangely, I didn't get any more stares than usual being dressed in a hot pink dress, matching pink hat, and a snake around my neck than usual, walking around Hyderabad. (And in case you're wondering, my costume at various points of the night was: Indiana Jones with my roommate Nate (remember the opening scene??), air hostess on acid, and finally: "snakes on a plane")  

Most creative costume of the night was our friend who dressed as Hussain Sagar Like, with a Buddha on her head and fish taped all around her body.  

HYD certainly impressed me last night, staying open until 2am (gasp!) instead of the usual midnight.  Turns out, Halloween is fun pretty much anywhere in the world...especially when many locals have no idea why crazy westerners are dressed the way they are (although I suppose that's what many people think every day!)

As an aside: SUCH good baseball!  So weird to wake up early and watch the World Series on my extremely slow internet... It's too slow for radio and certainly for video, so I make due with little icons on the bases on Yahoo Sports, refreshing every few minutes.  Wish I were in NY now watching at a dive bar in Hell's Kitchen!!  To make up for it, the loud drums banging outside at 10am seem to be celebrating the Yankees' recent victory :)

Alert Alert!!

It's official: Swine Flu mania has gripped Hyderabad.  True, the first reported case of swine flu in India was in Andhra Pradesh earlier this summer.  But thankfully, no reported deaths in the state yet (although there was a controversial death earlier this summer, where the Telugu press wrote in shockingly huge red blinking letters across the screen: "swine flu death reported!!"...only to be rescinded the next day).

Everywhere I looked this summer, people were wearing surgical masks.  Drugstores reportedly sold out of them, so some enterprising street vendors came into the picture.  When I saw children jumping up and down, begging their parents with huge smiles to buy masks as though these masks were ice cream, I couldn't help but think of "Tipping Point" and the next big craze.  (see pictures above!!)

Of course, this isn't to belittle swine flu (and indeed, pregnant women appear to be particularly suceptible -- prompting many maternity hospitals around Hyderabad to rework their visitors' policy)... but it's just interesting that with all the public health issues plaguing the state (HIV/AIDS, for one, has reached WHO-defined pandemic levels here), the focus is on swine flu. 

You can't blame the media, for the public seems to be eating it up.  It just makes me wonder how media and "hype" can be used to draw wider attention to some of the more silent but deadly issues here.

The British are Coming!

Directors from the UK's National Health Service (NHS) are visiting LifeSpring this week.  The visit is run by the NHS Institute for Innovation and Improvement and its purpose -- as you can imagine from the title -- is to help spur innovation, both for NHS and for its leadership.

After taking a tour of our newest hospital in Chilkalguda with our head of Clinical Quality, the LifeSpring/NHS team gets down to business.  A few colleagues and I make fun of "development tourism" -- well-meaning but surface trips to see social enterprises "in action" in developing countries.  This trip is far from that.  I am impressed by how genuinely the group wishes to learn LifeSpring's best practices for delivering quality care in resource-constrained environments and apply these to their own programs.

At the same time, LifeSpring identifies key challenges we're facing in the realm of clinical quality improvement, creating a quality-driven culture, staff engagement, and IT.  On the first day, we discuss these with the folks from NHS at a high-level.  It's clear the next day that they've done their homework, for they come back with lots of practical, applicable ideas.  Among these is a performance and quality scorecard for our hospitals, which blends not only the key indicators of quality, but efficiency and financial performance as well.

When I first moved to India, the underlying assumption of development seemed to be: "What can the West bring to developing countries, by way of resources, ideas, and best practices?"  Western consultants came to developing countries to advise social enterprises on exactly this, and there seemed to be a clear line between teacher and learner.

What's so exciting about working in Indian healthcare in general and LifeSpring in particular is the growing recognition that Indian healthcare has something to teach the West about how to do things efficiently and affordably.  High quality, affordability, and patient-centered care are clearly central to the debates happening in the US about healthcare now -- and it's what LifeSpring's entire model and mission is around.  

And more than that, there's such a focus here on *doing* rather than just talking and debating.  As someone from the NHS said: "What an incredible opportunity to be working on this now, in a country like India that's growing so quickly and with so much unmet need that LifeSpring can tap into and serve."  Cheers to that!

Quote of the Day

Earlier this month, former Indian Health Secretary Prasanna Hota visited LifeSpring Hospital at Moula Ali -- the hospital he inaugurated almost four years ago.  The furthest thing from your stereotypical Indian bureaucrat, he regularly uses words like "rascal", graduated from Columbia Business School, enjoys discussing Locke, and bluntly speaks his mind in the most refreshing way.  During his tenure, he pushed through widespread reforms increasing accessibility to healthcare, especially in rural India.

During the middle of his talk to the LifeSpring staff, he turns to me and says:

"Time flies so quickly.  Before you know it, you'll blink and be 70, telling your grandchildren about all the LifeSpring Hospitals you helped open across India and the world."

That was at once one of the scariest and nicest thoughts I've heard in a while.

Spirituality and Business

Last night, I had dinner with a good friend and her fiance, a banker from London with a sharply analytical mind.  The talk turned to yoga and meditation, and he was completely incredulous that I did a 10-day Vipassana silent meditation shortly after I first moved to India.  Like many people who hear this, "I don't understand...so what exactly did you DO all day?" is a question that keeps cropping up in the same conversation -- amidst lots of laughter: "Seriously, I just sat in an ashram and meditated and thought."  They were shocked to hear that the silence was the easy part.  The hard part is being alone with your thoughts until they drive you so crazy that at some point, your mind just shuts off.  This is when the internal work and spiritual "cleansing" really gets started.

The conversation made me think about the intersection of spirituality and business -- or at least the possibility of the intersection of spirituality and business.  While that may sound like an oxymoron, I think it happens simply when you're passionate about what you do, and pursue it in a sincere and honest fashion.

It recalls a recent interview I read in Forbes India with the Dalai Lama:

Forbes: "Your Holiness, what would Buddha tell the world of business if he were in our midst today?"

The Dalai Lama laughs at the idea.  He is like an amused second grader who thinks every adult question is a fruitless exercise.  But in the next moment, the Monk takes over.  "Perhaps one thing," he says.  "Businesses must pursue their activities with humanity.  I think Buddha may insist that modern business be more altruistic and be truthful.  With truthfulness and honesty, you can be transparent.  Transparency is very important to build trust.

Forbes: "Your Holiness, how do you feed your own soul to keep the idea of Tibet alive?  Leaders in business are also required to promote ideas but faced with the smallest adversity, we simply give up."

"If I am involved in the business field, I may also give up," he says with a mischievous glint in his eyes.  Then the Monk returns.  "I think people carrying on with their work just for money, name or out of plain curiosity have a greater chance of giving up when faced with a small adversity.  If a scientist is at work for the benefit of humanity, then he will not give up.  So we need a larger sense of purpose to be able to draw from a larger source of inner strength."

I remember hearing the Dalai Lama speak in New York City, right before I left for India in 2007.  Above all and beyond anything he said (much of which was so spiritually above-my-head!), I was blown away by simply his being -- he personified such an aura of compassion, gratitude, and optimism that was contagious to everyone around.

It's a good reminder of what's really important when getting caught up in the inevitable grind of the day-to-day.

A legal resident!

Every time I think I know the process at the FRO, they change the rules.  

I arrive at 2pm as instructed last time, only to be told TODAY it opens at 3pm.  Pointing to the new "Open at 2pm" sign is a futile exercise, so I sit near the registration desk for the clerk to arrive from lunch.  Once he does, his desk is literally flanked with people, and I'm pushed around as passports from all nationalities are shoved into his face.  

The scene is unfolding with such intensity and raw emotion that it oddly brings to mind scenes of the Americans pulling out of 'Nam and the Vietnamese trying to be pulled into American choppers.  I laugh at myself at my ridiculously melodramatic mental parallels, but I've learned that amusing yourself is the only way to survive the FRO (a former roommate recommends just going drunk).

FOUR hours later with the sun starting to set, I'm still waiting to be called into the room next door.  As I complain to the clerk, he cooly replies, "This is India."  

There's nothing to say in response.

It's not all bad though; I have a good book and meet interesting people -- the German girl who's randomly spent time in Little Rock, Arkansas; students from Kenya and Vietnam coming here to study; and a young American with a strong southern drawl, here teaching Indians at call centers to speak with American accents.  His wife just delivered at an amazingly nice maternity hospital in Delhi, which I recently visited to learn more about the spectrum of maternal health in India.

While it's fascinating to learn about people's backgrounds and what they're doing here, we're all getting antsy and frustrated and bored.  I sit and wait and wait some more, contemplating the fine line between acceptance and complacency.  It's a delicate balance that I find myself constantly navigating and re-calibrating in India.  When do you just take a deep breath and let things go, and when do you speak out and insist things are done differently?

My thoughts are cut short, for I am finally called.  After more formalities, my waiting is finally rewarded.  I breathe a sigh of relief -- my three-month visa extension and residential process is now officially over!  

My co-workers think I should start a consultancy advising others on the visa process.  I think I may have a new career! (just kidding, LifeSpring ;)

Happy Diwali!

Over the weekend, Indian newspapers happily reported that Barack Obama is the first US President to observe Diwali.  He lit the White House diya while a Sanskrit scholar and Hindu priest chanted Asatoma Sadgamaya.

As an American living in India, I was really quite proud of the celebration of faiths exemplified by his Diwali wishes (which you can see here), where he talks about celebrating the triumph of good over evil and quotes Sanskrit verse: "lead us from falsehood to truth, from darkness to light."

Returning from Goa, it was so nice to see my inbox filled with Diwali wishes from just about everyone -- co-workers and friends here, of course -- but also random people I've met once in a conference, and the best surprise: Diwali wishes from many friends from home! -- many forwarding Obama's speech with remarks like: "I've never seen anything like this."

Diwali is a time of reflection and contemplation, which seems the perfect precursor to Thanksgiving up ahead...

I think I can get used to this seemingly never-ending celebrations and festivals!!

Goan Paradise

You can tell a lot about cities from its dogs.  Hyderabad's dogs are insecure and loiter in packs.  Delhi's dogs are highly aggressive and have something to prove.  Goa's dogs, by contrast, are friendly, welcoming, and laid-back.

There must be something in the air or in the water, for it hits us too.  My layer of daily frustrations start to instantly melt away amid the ubiquitous palm trees, warm tropical air, salty sea water of the Arabian Sea, refreshing pina coladas, and deliciously fresh seafood.  Oh, and did I mention the seafood? :)  From a culinary perspective, the four-day vacation can be seen as a 96-hour long fest, with king fish and pomfret and swordfish and shrimp and squid and mussels in white wine sauce and and and!!  It almost makes it worth it to live in landlocked Hyderabad to make weekends like this all the more incredible (almost).  It's already my fifth trip to Goa in two years, and I have a strong feeling I'll be back again soon! (with paradise 1.5 hours away by direct flight, can you blame me??)

Besides our incredible scuba adventure (see below), one of the most magical aspects of our long Goan weekend is being there during Diwali.

It's my first Diwali in India -- in many ways the highlight of festival season.  The Diwali holiday celebrates light over darkness, good over evil... It is also a time to pray to Lakshmi, the goddess of wealth (I find this confluence celebrating "good" as well as "wealth" fascinating).

Celebrations are already underway even before leaving Hyderabad.  The city is decorated in light; it looks like Christmas in the US, although about 50 degrees warmer.

We aren't sure how widely Diwali, a Hindu holiday, is celebrated in Goa, which was colonized by the Portuguese who left the Roman Catholic legacy.  But Goa doesn't disappoint.

Riding around Saturday night, we see candles lined outside houses and lights strewn and brightly shining.  All through the night, fireworks light up the beach and waterfront.  Absolutely magical.

The rest of the weekend is just as incredible.  Ajey our rockstar scuba instructor (last picture above, on our dive boat) keeps us busy with scuba certification, but after class, it's time to go out and explore.  

We lounge at beach shacks along the shore and dance in the sand.  Not a bad way to spend a Monday night!

In what's beginning to exemplify Goa for me, Tyler and I spend our last day exploring on the motorcycle (with helmets on, Mom!!), riding along winding roads lined with palm trees and lush greenery, punctuated by brightly colored colonial houses and white-washed beautiful churches.  We find a relatively hidden beach and jump into the Arabian Sea, before finding a picture-perfect beach shack for pina coladas, bloody marys, and fresh seafood nearby.

Turns out Goa ain't so bad.

----

PS: For anyone planning a trip soon, some recommendations and favorites:

Lodging: Silk Cotton Resort

Diving: Dive Goa

Eating: Brittos in Baga Beach

Diving Adventures

Underwater in the Arabian Sea.

Tyler looks at me and crosses his hand over his throat -- the universal diving sign for "out of air."  He reaches for my alternate regulator and replaces the fluorescent yellow reg for his, as we slowly ascend and reach the surface of the sea.

Not to worry though -- this is only a drill (unlike the time I really ran out of oxygen diving in the Galapagos Islands -- a story for another time!)  We work through dozens more underwater drills like this, such as recovering a lost regulator, filling our masks with water and subsequently clearing it, underwater navigation, and probably my favorite -- the controlled emergency ascent, where you raise your arm like Superman while swimming to the surface, singing "AHHH" along the way.

We are in Goa to become certified open water scuba divers, and it's an absolute blast.  Our teacher is Ajey Patel, who has logged over 1100 dives and owns and runs Dive Goa (which I'd wholeheartedly recommend to anyone!!)  He's incredibly competent, confident, intellectually curious and smart...we feel safe under his care and have fun the whole way.

After drills in the controlled safety of a pool (conveniently in the same resort/B&B we stay at), we quickly move onto diving in the open sea.  We do four dives over the course of two days, all from a small dive boat that picks us up from a nearby beach and takes us to dive sites named things like Bounty Bay and The Jetty.

After putting together our diving equipment on the boat, we receive a brief of the dive site and learn one of the most fun tricks -- falling backwards from one side of the boat and flipping into the water below (2nd picture!)...before donning our scuba gear that's thrown into the water after us.

Descending under the water is always a trip; there's something exhilarating about your field of vision moving from the water's surface to below... while there's something relaxing about hearing your breath through your regulator and seeing all the resulting bubbles around you.

Goa is known to have poor visibility, which ironically becomes a great place to learn, as it leads to increased confidence underwater.  And despite visibility ranging from 2-6 meters, we still see tons of sea life: coral gardens, eels, schools of trigger fish, sergeant majors (because of their stripes!), lion fish (see pic below) and even a jellyfish! (full disclosure though: the jellyfish was dead, but still pretty!)

By far the hardest skill to master is buoyancy control -- in other words, actually staying at the depth you want to stay at during the dive.  Tyler and I would signal down, and we'd go down down down CRASH into the rocky bottom below... Or point up and ascend up up up until we'd almost have to be physically pulled down so we wouldn't actually surface.

But hey, it's a start, and a good one at that!  It's amazing how steep the learning curve is and how confident we already feel on our fourth dive compared to our first.

And best of all, we're now certified scuba divers!  Our next underwater adventure awaits... here we come, El Nido, Philippines!

Looking Within

In yoga this morning, we are led through a meditation where we are forced to think through our fears.  We are asked to keep gathering more and more fears and worries in our heads (which gives me the WORST headache ever, seriously).

With our heads sufficiently filled with worries big and small, the facilitator begins counting backwards from ten to one... at one, your BIGGEST fear is supposed to come up.  Of course, all I feel is anxiety during the whole countdown... "Oh no, hurry up!!  We're already on 4... now 3!  What's my PERFECT worst fear??"

Ah, so maybe this is why I need yoga... :)

Ah HYD...

From the City that Never Sleeps back to "Gypsy" Hills.  Frank Sinatra had it all wrong though... "If you can make it here, you'll make it (drum, drum) ANYWHERE" is incredibly more applicable to India than New York, which is so efficient that my 3-month visa ordeal in India was solved in one day in NYC...complete with an apology for making me wait ten minutes upon pick-up and an email follow-up requesting customer feedback!

But of course, India wouldn't be nearly as fun if everything worked out exactly as you expected.  Case in point: I head (yet again!) to the Foreigners Registration Office this morning to register on my glorious new visa.  By now, I'm feeling rather self-assured and confident that I know the drill -- SO confident, in fact, that on the way I email our incoming Acumen Fellow instructions and advice for registering once she arrives.  At the FRO, a sign in giant letters warns that foreigners are ***ONLY*** allowed between the hours of 10:30am and 12:30pm, and I'm there exactly at 10.29am... only to be told that I must return at 2pm to complete my registration.  Huh??  And to top it off, they actually mean TOMORROW at 2pm...So much for my premature self-assuredness! :)

By now, I've learned to laugh at this (kindda).  After all, you come to be prepared for all sorts of hurdles around registration and visa.  What still continues to shock me, though, are things that "don't work" that defy all logic and reality.

Case in point: technology.  Clearly a strength of India and Hyderabad, with all its IT and tech companies.  In fact, when I was back in NY last week, I was laughing at how 1990s I was without a cell phone and internet... trying to find virtually non-existent internet cafes and making calls on phone booths -- remembering like an old granny how "when I was a little girl, there was a phone booth on EVERY block!"  (In fact, I remember practicing case study questions as a college senior such as: How many pay phones are there in New York City?  Answer in 2009: 5.  And I've made calls on all of them :)

But I digress... In India (as I suppose, everywhere), there are things you expect NOT to work, and there are things you expect to work.  Internet and technology is something I expect to work.  Mind you, not reliable internet, but logical internet.  Some samplings of my recent experiences that defy logic and are "fascinating" on good days and "ARG!!! -- why doesn't anything here WORK?!?!" on bad days:

(1) When my MacBook is plugged in for internet (as opposed to wireless), the ONLY websites that work are Google related... Google works, gmail works, Blogger and Picassa work... but when I click on any other site (e.g. a link found on Google), it says "You are not connected to Internet."  This happens regardless of where I plug in!  Tyler and I joke that I have a Google-only laptop.  Seriously though, that's just WEIRD.

(2) I can't go on certain sites at work (like the FRO site!), and this is NOT due to security -- which I've triple-checked with IT and also called our vendor.  Even when I bypass work internet and use a data card, I *still* can't access those sites, while friends in other locations can.  The only explanation I was given yesterday is this is due to Airtel, which is like hearing Verizon randomly doesn't let you call ONE number out of millions (OH, and don't even get me started on the phone companies here! ;)

(3) Emails get sent out from my work address and are received by SOME people and not others... even though other emails reach those same people on the same day.

Odd I tell you.  My yoga teacher (and very good friend) advises that I stop focusing on what's wrong because I'm bound to find it (as if on cue, at that instant a car begins honking its horn for what feels like an eternity!).  She instead reminds me to appreciate and give gratitude for everything good around me.  And really, that's what this blog is all about.

But once in a while, you just have to vent! :)

Good Morning Hyderabad!

Watching the sun rise at my apartment's terrace... As I'm learning, getting up at 6am for yoga does have certain benefits!  In a weird way, the view of Banjara Hills below reminds me a bit of San Francisco will all the buildings atop hills -- but as I write this I can almost see my west coast friends cringing and saying I've been away too long!  My favorite part of our view is the mosque in the foreground, whose amazingly loud call to prayer infiltrates our entire apartment and sounds wonderfully exotic and romantic on I-love-India days...and a little less so on I-hate-India days.

Central Park South & Broadway

Even though my apartment is rented out, it still feels like home sweet home (especially napping in the building's common area in my unsuccessful attempt to ward off jet lag) ... I suppose staying on Indian Standard Time has its benefits for a short one-week trip!

Waiting for the F Train

Or: Reason #76 I love NYC.

A little bit of India in NYC

Fall in New York is just about perfect... cool, crisp weather; Yankees in the playoffs; leaves starting to turn amazing shades of amber, orange, and yellow... And of course getting to spend time with my family and friends.

And lest Hyderabad starts to feel too far away, a little reminder on Park Avenue:

Back Home in NY

I left The Home so long ago now
that I would not recognize my own face.
I constructed the Boat of My Life
and I set out
into the open sea
waving to all who knew
that the seas would give me
everything I could handle
and everything I could not
and yet they waved, and I set out
into the open sea
in the Boat of My Life:
built from Soul, crafted by Heart
and with great innocence I pushed off
into the open sea
and have been away from my Home
so long now that I would not recognize my own face
but I know that Home--
Home
remembers me.

"Long at Sea", Em Claire

Clinton Global Initiative

It's been really exciting reading all the updates from the Clinton Global Initiative, which started yesterday in NYC.  President Obama kicked off the event, highlighting the importance of what we can all do as individuals, saying:

"This week, even as we gather at the United Nations to discuss what governments can do to confront the challenges of our time, even as we're joined tonight by so many presidents and prime ministers -- this Global Initiative reminds us what we can do as individuals: that you don't have to hold public office to be a public servant."

Of course, he wasn't addressing any old individuals -- there are about 60 current and former presidents and heads of state, and hundreds of CEOs and leaders from the private sector and NGO worlds in attendance.

I was excited to learn what a large role global health and investing in women & girls would have in this year's event.  In fact, it was a huge honor that LifeSpring was invited to speak on a panel about enterprise-based strategies in health and education, moderated by Madeleine Albright. While it didn't work out this year, it's really quite incredible that a one-and-a-half year old organization was asked to speak at an event like this.

What's cool about the CGI is that conference attendees are expected to make concrete commitments and articulate clear steps they will take to tackle global challenges that include health, education, energy and climate change, and economic empowerment.

And my favorite part?  Those who don't follow through on their commitments are not allowed to return.

Emergency Zen

Granted, there's plenty to laugh at along Hyderabad's streets.  But this never grows old: the "Zen Ambulance Service".  While I often feel that much of my time in Hyderabad is an ever-growing search for Zen amidst sheer craziness, this is the LAST thing I'd want rushing to save me in case of an emergency!!  Can you just imagine?!

Patient's loved one: "Hurry, we need to get to the hospital!"

Zen Driver: "We'll get there when it's time to get there... Whatever happens is perfect" ;)

Don't get me wrong, I think there's an absolute need for more emergency vehicles on the streets (and perhaps more importantly, a reliable way for them to speed through traffic, instead of honking their horns in a traffic jam, like everyone else).

But I'd like to have been part of the brand meeting for that company!

As a side-note, this name/service disconnect plays out quite a lot in India.  Another favorite example: "XCEED" tutoring services, which is right near my yoga studio.  Clever, I suppose, but if the point is convincing parents that they can teach their children to excel, shouldn't they first demonstrate that they can properly spell? :)

With my eyes to the skies...

I may or may not have work tomorrow.  It depends on the presence of the moon tonight.

Toto, we're not in NYC anymore! ;)

I'm a Telugu star!

Ha, not really...but LifeSpring is!

Pictures from our opening are all over today's Telugu press.  Bottom right photos show the Commissioner of Family Welfare, who inaugurated our hospital; along with Anant (our CEO) and I.

9th Hospital Launch Today!!!

Getting Ready!!!

Beauty

Hussain Sagar Lake and the Buddha Statue at sunset last week.  One of the perks of leaving work "early" -- around 6:30pm...

Taking a step back

Overheard in the Indian School of Business (ISB) elevator: 

"This isn't India, it's the ISB."

In many ways, one of the most refreshing aspects of today has been the ability to take a step back and think about my experiences here from an academic lens, away from the craziness that is day-to-day India.

We ended today's workshop with a discussion on India trends and dynamics.  While it's a bit nerdy to share my class notes on this blog, it definitely helps answer questions I'm often asked regarding changes occurring in India. (Besides: when have I ever been accused of being too big of a nerd?!)

So without further ado, trends we talked about included:

• Growing differences within India's rural population
• Increased hunger for education
• "Sudden Wealth Phenomenon"
• Migration from the villages & youth increasingly disinterested in agriculture
• Migration from public to private health care
• Shift in entrepreneurial mindset from survival entrepreneurship to more creative and long-term
• Coming of age of post-liberalization youth, with 100 million 17-21 year olds in India

And of course, a discussion of the Base of the Pyramid itself, particularly the shift from BoP 1.0 -- "selling to the poor" to BoP 2.o -- one of co-creation and business co-venturing.  Rather than purely focusing on creating a "cheap" or affordable product, a successful venture must create authentic value.  For BoP (and I'd argue, for all of us!), "value" means:

• Productivity improvement
• Ability to create independence and empowerment
• Increased income generation
• Social and aspirational fulfillment

As much as my Type-A personality found satisfaction in these neat frameworks and bullet points, my favorite aspect of today has been the multitude of debates and arguments stemming from the workshop (those who say that Asians are conflict-averse should come to India!)

Among the debates:

How can we truly meet BoP consumers' needs -- rather than trying to sell them folding IKEA tables because their homes look cluttered to us?  And for that matter, what does "Base of the Pyramid" even mean?  Why should it surprise us that base of the pyramid consumers own fridges, have cable television, and have drawers full of gold jewelry? 

And lest the debate turn much too philosophical or ivory tower-esque, the "real" India is still out there waiting, just outside the campus gates.

Happiness

Design Thinking for Base of the Pyramid

I'm surrounded by post-it notes and dozens of photos from yesterday's field work.

It's 9am on a Sunday, and I'm a student again -- sitting in a beautifully modern classroom at the Indian School of Business (ISB).  I'm participating in a workshop on "Consumer-Centered Innovation for Emerging Markets."  We were warned beforehand that it would be intensive, and they weren't kidding: 9am - 11:30pm yesterday, and all-day again today.

The design task: Identify a business, product, or service innovation opportunity in housing for base of the pyramid.

To do this, we split into teams of two and spent eight hours in urban slums in Hyderabad.  Rather than traditional market research techniques of surveys, interviews, and focus groups, we took an ethnographic and anthropological approach... Basically a fancy way of saying: we became flies on the wall inside a family's house throughout the entire course of their day.  We got into their lives, studied their ecosystem, and at least tried to put aside our assumptions of how to improve low-income housing.  The basic assumption is that surveys and focus groups tend to result in incremental improvements, while a more immersive approach can lead to transformational and non-linear innovations.

I am paired with Priya, a current ISB student who was previously a reporter in Bombay.  We drive to Shivaji Nagar and spend eight hours with Iqbar Khan, his wife Sajeeta, and their family.  While Priya speaks to them in their living room to learn more about their lives, I spend time with their daughter-in-law, Altheea, who is eight months pregnant.

While I am first extremely frustrated by my inability to communicate, I quickly find that this actually enables me to observe more.

Altheea looks about 18.  Eight months pregnant, she's doing all the cleaning and cooking for her family-in-law.  In fact, she spends three hours doing laundry.  What's particularly interesting about this is that they own a washing machine (which was part of her dowry).  After taking the clothes out of the machine, she hand washes the clothes again!!

Indeed, one key insight is that although some base of the pyramid consumers own the same technology as higher income consumers, they often use this technology in different ways.  For instance, for the three mobile phones I observed, the family still uses the community pay phone outside.  Another team's family owns two fridges, yet do not use them in order to save energy.

The list of observations that struck me goes on and on, so just a few highlights:

• Creative use of space; one room served multiple functions (e.g. kitchen tripled as kitchen, bedroom, and dining area)
• Little to no space for children to play within the household, which often results in children playing on the roof with few safety precautions (I even see this outside my Banjara Hills balcony -- this morning I saw a little boy riding this bike (!!!) on the building's roof!!
• Extreme distrust of doctors (the mother is not feeling well, but does not want to go to the doctor, instead making home remedies)... yet at the same time, ensuring daughters give birth in private hospitals because government hospitals are "poor quality"
• Water storage extremely important, with huge water drums outside each household and multiple buckets in the kitchen
• Perhaps unsurprisingly in India, education is a key priority.  When forced to prioritize, education was placed on a much higher level than even food.  One team talked about spending time with an auto rickshaw driver who was putting his son through engineering college.

Some photos (notice the satellite dish!):

My brain has been on fire over these last couple of days -- I can't stop thinking about ways to apply this design thinking process to LifeSpring.   In fact, John sent me this design toolkit for base of the pyramid, designed by IDEO.  Really excited to apply this to my day-to-day work!