View from my Auto - Part 1

First of a series of video clips taken from inside an auto-rickshaw, zipping around the city... And yes, that's how bumpy Hyderabad roads are!

This is coming back from the FRO, through urban slums in an area of town known as the "Old City."

Making Maternal Health Safer

About a month ago, the NYT published an op-ed by Nicholas Kristof called Crisis in the Operating Room.

The conditions Kristof describes in Karachi, Pakistan highlight why organizations such as LifeSpring fill such an urgent need.  But of course, this is needed not just in India and Pakistan, but around the world.

The problem isn't just about lack of finances -- although that's surely a huge part.  Just as big are challenges relating to cultural norms and ideals -- in this case, views around gender.  This is certainly something I've come across myself in the short time I've been here.

Last year, John and I filmed videos of interviews with low-income Indians, speaking about their views of health and healthcare.  In interviewing the village's local health provider, he himself admitted to feeding his sons more than he fed his daughters when they were growing up!  

When his eldest daughter was pregnant for the first time, the family believed it would be a girl (sex determination by ultrasound has been illegal in India since the 1994).  They took her to the free government hospital. 

For her next pregnancy, the family was convinced the baby would be a boy.  They sold their assets and went into debt to admit her to the expensive, high quality private hospital.  The baby boy soon died upon delivery, and the local health provider talks about how much debt they still have.

What's heartbreakingly amazing is how easy it was to get this village health provider to share his story -- as though of COURSE they would pay for high quality care and go into debt if the baby were a boy.

These thoughts went through my head in reading Kristof's op-ed.  He tells the heartbreaking story of Shazia Allahdita, aged 19, whose baby died during an emergency C-section.  

He writes:

Shazia’s suffering is typically unnecessary. It all would have worked out fine if she had gone to a hospital to deliver her baby. She wanted to. Her husband and relatives all agreed, when I interviewed them later, that she had had her heart set on delivering at the public hospital here. It’s also free, so long as supplies haven’t run out (other times, family members have to rush out to buy supplies).

But Shazia’s female in-laws thought that a hospital birth was a silly extravagance, and a young Pakistani woman is at the mercy of her mother-in-law and sisters-in-law. (In Pakistan, men are little involved in such decisions about childbirth.) It didn’t help that the in-laws resented Shazia because she and her husband, Allahdita, had breached tradition by marrying out of love rather than by family arrangement.

When Shazia went into labor, the family summoned a traditional birth attendant to help with the delivery. Hours passed. Nothing happened. Shazia asked to go to the hospital, but it was far away and would require what for them would be an expensive taxi fare of 300 Pakistani rupees, equivalent to about $3.75.

“If she went to the hospital, then every time the family visited it would be a long way to go and very inconvenient,” explained an aunt, Qamarunnisa. “It was so much easier to go to the local health post. It seemed easier.”

So the family eventually took her to a local clinic, where Shazia struggled to deliver for another 24 hours of labor. The family discussed taking her to the hospital, but the obstacle was the 300 rupee taxi fare. “If it hadn’t been for the money, she would have come here,” said Qamarunnisa.

But nobody wanted to pay. Shazia’s in-laws truly are poor, but it’s hard to imagine that they would have balked if it had been a man in the family who was in danger — or if they had known that Shazia was carrying a baby boy.

“If they had known it was a son, they would have come up with 500 rupees,” said Dr. Sarah Feroze, as her colleagues struggled to save Shazia and her baby.

Full op-ed here.

Low-Level Sniping

ARG INDIA!!!!

As Suketu Mehta writes in Maximum City: Bombay Lost and Found, India won't actually keep foreigners out.  But the country will engage in a sort of daily guerilla warfare -- a low-level sniping, if you will -- designed to drive down your defenses.  The key is persistence and standing your ground.

And so I continue to learn.

This month's goal has been to successfully navigate the visa extension process and get my employment visa extended for one more year.  Score as of August 26th?  India 10, Tricia 0.

The battlefield has been skewed since the beginning.  Despite my best attempts at having all my paperwork just-so and absolutely perfect, my application wasn't even ACCEPTED until my third trip to the Foreigner's Registration Office (our beloved FRO).

That was weeks ago.

Mind you, submission of the application is clearly just the first step.  Next comes submission to the Andhra Pradesh government, back to the Hyderabad FRO, over to the Ministry of Homeland Affairs in Delhi, and only then back to the Hyderabad FRO... with hopefully the final stamp of approval that I can stay (and leave) the country at will for the next year.

I do have to hand it to the FRO, they are certainly trying.  There is now an ONLINE registration process (my roommate was the first online registrant and asked to be part of an elaborate opening ceremony with local press, ha!)... and they have fired the evil old guard who kept asking for bribes, in favor of a young, over-eager, and wanting-to-please newly minted bureaucrat.

After submitting my application, I return at the appointed date, only to be told: "It will be ready tomorrow."

I reply, "Really?  Tomorrow?"

"Yes, tomorrow.  Absolutely, definitely.  Tomorrow... Or day after tomorrow."

And so it begins.

I'm back this week and now know the drill cold.  After waiting a few hours with other downtrodden souls, I am once again told: "Not ready yet.  Come back tomorrow or day after tomorrow."

Uh-uh.  This time I won't back down.  After adapting quite a few different personas at the FRO (anywhere from full-out anger to being sickly sweet and docile), I find that well-meaning confusion produces the greatest results.  And always a question about PROCESS (this is India, after all!)

"Huh?  I don't quite understand!  It was supposed to be ready two weeks ago.  Isn't that the process?"

Apparently that's all it takes, for I'm taken to the back room, where there are about 10 bureaucrats surrounded by piles of paper LITERALLY six feet tall!!  My hand instinctively reaches for my camera, but I realize that's probably not the wisest way to secure my visa.

I'm taken to a senior person, who again tells me it will be ready "tomorrow."  I'm learning that focus on process is key.

"So where in the process are we?"  I ask.

Ah, this gets him.  Now he reluctantly reveals: "Papers are here only.  Clerk is not there."  Huh?  He then tells me there has not been a clerk in FORTY DAYS!!!  He points to the six foot high pile of papers -- implying that my papers are somewhere in that crazy pile.  As if on cue, another bureaucrat remarks: "All of your friends' papers are there only."

This is where daily yoga comes in handy... breathe, breathe...

They expect me to leave, but instead I just stand there.  Apparently my patience (or stubbornness) pays off, for they find my stack of papers.  Hovering seems to help, for right then and there, everyone signs my papers who needs to.  I am assured that it will go to the AP government "today only."

And so the game continues... Stay tuned for the final score.

Donald Ducking

Of all the new phrases I've learned over the last year and a half here, perhaps the funniest to me is "donald ducking."

You see "donald ducking" a lot in the villages and peri-urban communities.  This little boy was donald ducking in front of my new office.

Still haven't figured it out?  Little kids running around with only their t-shirts on and nothing else... like Donald Duck!!

Monsoon: A Drama in Two Acts

Act One.  A Comedy.  "Laughing in the Rain."

Monsoon season keeps getting funnier and funnier.  I can't get an auto from work to save my life.  It's absolutely pouring, yet everything around me is absolutely hysterical.  I don't mind getting drenched; I'm completely entertained.

First there are all the men walking around with plastic bags over their heads.  Depending on the type of bag, many of them form two "points", making it look a bit like Halloween.  Then there's the occasional man with tupperware on his head -- absolutely ridiculous!

The men on motorcycles make me laugh the most.  Everyone seems to have their own strategy for staying dry.  Some lift their feet when going through puddles.  Some try to avoid puddles altogether by just driving on the wrong side of the street. 

I see two men on the back of a bike...one friend is holding an umbrella over himself and the driver.  Just as I begin to think this is one of the most ridiculous things I've ever seen, I see another motorcycle driver holding his OWN umbrella over himself AS HE DRIVES!!  

Ah India.  I know I'll miss this all one day.

Act Two.  A Tragedy.  "Home Sweet Home?"

The next day, on my way home again -- this time from one of our hospitals.  Again, pouring.  Again, can't seem to find an auto.  One finally comes, and it's one of the most awful trips back.  The road is absolutely torn up from all the rains, making the ride even bumpier than normal.  It's amazing that they have to repair the roads every year because of the rains!

I look out the auto, and see rows and rows and rows of slum tents and temporary shelter.  With no doors to these "shelters", I'm able to look straight in.  I see families huddled together, the entire floor transformed into mud and water.  

Improving health through higher quality hospitals is one thing, but what happens when you sleep literally in mud for a good portion of the year?  What does that do to your health and self-worth?  For the rest of the journey home, I wonder what can be done.  Clearly there are no easy answers.  

But there has to be something better than this.

A Morning Peep Show

I'm walking back from Hindi class this morning, when I see a small group of giggling school boys.  They surreptitiously look around, pull the curtain covering a stage, and peer in, giggling some more.  They emerge with giant smiles.

Curious, I walk towards them, wondering what they're up to.  They giggle all the more when they see me approaching, and nearly die with laughter when I pull the curtain back myself to take a peep.

Looks like I'm not the only one enchanted by Ganeshas!

Two Servings of Dessert

Never a dull night in Hyderabad, and especially not during the Ganesh Festival.  (Even as I write this, there are loud drums banging nearby accompanied by joyous screams.  Nevermind that it's 11:30pm and pouring!)

I'm walking back from dinner with my new roommate Nate, extremely content with my fig ice cream from Baskin Robbins (I know the flavor sounds weird, but seriously, it's really good...)

We stop to admire our neighborhood Ganesh...it's hard not to be drawn to all the lights and vividly bright colors against the dark night.  While some Ganesh's are pink or purple or blue, ours is bright gold.

And really big.

There's a lot of cheery commotion...men yelling things and motioning us to wait.  Everyone's all smiles.

As we turn to leave, not quite sure what's going on, a woman with a giant smile emerges with an even larger bowl of sugary, creamy dessert rice.  Without really even asking, she nicely shoves an enormous spoonful of the celebratory dessert into Nate's mouth.

I smile and turn to leave, but of course community peer pressure gets the better of me.  Just like a loving grandmother, she feeds me a spoonful as well.

After that, we turn to leave, with a nearby group of men smiling and waving good-bye.

I laugh as I think about how completely unlikely this is to happen in NYC...a total stranger offering me food on the street...much less literally FEEDING me...and me blindly accepting in the spirit of Ganesh and neighborhood cheer.

And this is what makes India so fun.  You think it's just another walk home on a random Tuesday night.  But if you stop for just a moment, it's not hard for something to surprise you and make you smile.

LS in the News!

Full article here.  

It's incredible how much media attention we've received this past year!! -- and not just from the Indian press, but also from international publications like the Economist, BBC, Financial Times, and The Times London (to see these articles, click here.)

When I think back to my business school interviews (crazy to believe that was five years ago!!) -- I distinctly remember how confused my interviewer was when I talked about my desire to apply business models towards international social change (I didn't know the term "social enterprise" then).

In response to my excitement around microfinance, he replied (in the nicest way possible): "Wow, that sounds great.  But in choosing applicants, one thing the school looks at is placeability... do you really think there will be jobs in that field after you finish business school?"

Ha.

So it's exciting that fields like microfinance and social enterprise are now common household terms, and mainstream press cover organizations like LifeSpring.  What a difference a few years makes!  It's exciting to think about what's up ahead.

LSH Vanasthalipuram Turns One!!

Today is the one year anniversary of our fifth hospital opening, in Vanasthalipuram HYD.  It's amazing how quickly time flies.  As I think about my year as an Acumen Fund Fellow last year, our fifth hospital opening was easily one of the main highlights, and one of my biggest I-love-India-and-can't-believe-how-lucky-I-am-to-be-here-and-doing-this!!- moments.

Last summer was a whirlwind of hospital openings, with LSH #2 and #3 opening in June; and #4 and #5 in August.  LSH #5 in Vanasthalipuram was special in so many ways...I loved seeing it transform from an old school to a maternity hospital.  There was such a feeling of teamwork with everyone helping out, leading up to inauguration.  While my team was relatively new to the organization, their passion and dedication shown through when they created a LSH photo history to decorate the hospital.  

It was a big day of firsts for me... the first time I played a key role in the "pooja" (blessing) by breaking a coconut at the hospital.  It was also the first time I was interviewed by Telugu press, which was a bit comical considering my Telugu had not improved much since I learned "thank you" on my first day here ("don-ya-wada-malloo")!

It meant a lot to share that day not only with the LifeSpring team, but with my close friends in Hyderabad as well.  Tyler even played the role of professional photographer, with his photographs all over local press the next day!

Some pics from the event...

Happy Ganesh!

I'm awoken by the beating of drums and insanely loud horn instruments that sound more like a pack of furiously angry bees.  I'm confused...I thought marriage season (where this cacaphony was my daily alarm clock) was over.  And then I realized - the Ganesh Festival has started!!

In Hyderabad, the Ganesh festival is a 10-day affair that ends in the submersion of giant Ganesh statues in Hussain Sagar, the big lake in the center of the city.  To give you a sense of scale, this year there's expected to be 13,000 Ganeshas submerged in the lake, with over a million spectators!

Ganesh is the elephant god, known as the Remover of Obstacles and the bearer of auspicious new beginnings.  He adorns most houses I know (our flat included!)  I like when Indians describe him as the most "naughty" of the gods.  The festival is a time to pray for inner strength and success in all new endeavors.

The lead-up to the Ganesh festival is fun in and of itself.  One of our hospitals is located in the area where most of the Ganeshas in Hyderabad are made.  I would pass literally hundreds of half-painted Ganeshas lining the street on my way to work -- some half-purple, some half-pink, some half-blue... All insanely large -- over 6 feet tall and appropriately wide for the elephant god.

On my last day in Hyderabad last year before returning to the States for two months, Tyler and I went on a Ganesh "safari" around Hyderabad on his motorcycle -- with me on the back trying to capture the festival on video.  We went all around different neighborhoods, on the hunt for their Ganesh on display (it's a huge community affair...lots of money is raised by each community to put up the Ganesh... I couldn't walk home a single day last week without a throng of eager little boys asking for money for the festival)

Khairtabad, where my "colony" is, traditionally has the largest Ganesh in Hyderabad.  The same awe surrounds its "opening ceremony" as the Christmas tree at Rockefeller Center.  And this is just the beginning...there's Durgashtami, Diwali, Eid... Festival season has started here in India.  Excited to be part of the celebrations!

It's a Girl!!

LSH Bowenpally celebrated the delivery of its first baby this past Thursday, just one day after the hospital opened!  Her name is not known yet...this only happens at the Naming Ceremony weeks later.

I went to the hospital yesterday to meet mother and baby, and see how they're doing.  Both grandmothers were beaming with pride (one early insight is our true customers are really the mother and mother-in-law of the pregnant woman, who makes all decisions about her daughter's maternal health).

Our last two hospitals celebrated its first delivery on the second day of operations (and about 20 outpatients its opening day)... what's incredible is comparing this to our very first hospital -- which opened in December 2005 and had its first delivery three months later, in March 2006.  This hospital now does nearly 150 deliveries per month.  It's exciting to think about how much faster in the curve these new hospitals will be, and the resulting impact on the community.

Monsoon Magic

It's monsooning in Hyderabad today, which is a good thing.  I never thought I'd love the pouring rain, but there really is something magical about waking up, laying in bed, and just listening to the rain pound down all around you.

This year, I couldn't wait for the monsoons to start.  With a daily temperature easily over 100 degrees in May, monsoons meant massive cooling down...in addition to the promise of resuming showers rather than bucket baths from strategically saved water when the faucets did run.  I also feared a repetition of last year, where lack of rains also meant lack of power for around 4 hours a day! (Hyderabad, like many Indian cities, relies on hydro for much of its power).

What makes me laugh about the monsoons here is how they seem to absolutely disrupt all forms of daily activities.  There is even more blatant disregard to traffic "rules" than normal -- as though the rain gives everyone ample freedom to veer around the imaginary lanes, stop in the middle of the road without pulling over, or drive against traffic to avoid massive puddles.

Canceling meetings or appointments because of monsoons is a city-wide occurrence.  So is stopping your motorcycle and huddling under a covered bus stop or any small piece of roofing.  Driving around with a plastic bag covering drivers' heads is a common site.  Autos?  Forget about it -- auto-rickshaws are completely impossible to find, and often get stuck in the rain anyway.

Now, I'm not at all saying it's fun driving in the rain...I was once in an auto-rickshaw last year that literally started filling with water -- that's how high the water level on the street was!

But it amazes me how much the city seems to be at a standstill EVERY time it monsoons -- like it doesn't know what to do with itself!  I remember my college friend telling me New Orleans is like this with a single snowflake -- the city itself shuts down.  But this is Hyderabad and monsoons are an ENTIRE season!  It's not like it comes out of nowhere, yet everyone behaves as though it's a surprise.

My parents ask me how I deal with the monsoons.  They've sent me two pairs of galoshes -- you know, the kind that New Yorkers have oddly convinced themselves are somehow fashionable.  I alternate between a pair that is bright pink and a pair that is lime green with dark green cartoon turtles on them.  Sure I get stares here in Hyderabad (more than normal!) - but at least it means I can go about my day, unencumbered by the torrential downpours.

And jumping in puddles is always fun!

Our 8th Hospital Inauguration!!

It's our eighth hospital opening and it never gets old...the adrenaline build-up to opening, the nervous anticipation that everything will be done in time, the excitement and pride that happens when the first customers enter the hospital.

It always amazes me to look at the finished hospital and think about the first time I saw the site...whether an old and "sick" hospital, a former school, or an empty lot.  In its past life, before its current reincarnation as a maternity hospital, the Bowenpally site was a giant warehouse used to store pharmaceutical products.  And now it's pretty in pink! -- and poised to make a real difference in the community by offering high quality maternal health services at extremely low prices (Rs 2000 or $40 USD) to Hyderabad's low-income population.

I don't want to say our inaugurations run like clockwork, but due to the rock star team and frequent post-opening debriefing sessions, we're getting pretty darned close.  The community's District Medical Health Officer inaugurated the hospital and officially cut the flower-adorned ribbons.  Her advice to LifeSpring?  "You must grow.  We need more of you."

I couldn't agree more.

My favorite part of the morning is easily this:

I'm walking down the halls, admiring how spacious and luxurious our new hospital is, compared to older locations.  Pictures of LifeSpring babies born in other hospitals adorn the walls, and I can't help but smile when I see how big our first Moula Ali baby has now gotten.

Walking towards me is Perimala, a spunky nurse with a contagious smile, who's Indian yet somehow looks Filipina to me.  She pulls my arm and says almost breathlessly: "Isn't it beautiful?" -- she beams, "This is OUR hospital!!"

This one interaction completely made my day.

From the beginning, we've been struggling with how to build more ownership and empowerment at the hospital level to end the "corporate vs. hospital" distinction and build ONE LifeSpring.  This gets all the more challenging as we scale up.

While we certainly don't have all the answers, the enthusiasm, ownership, and pride beaming from Perimala made me certain that we're well on our way.

And just in time, too! -- for the delivery date of LSH #9 is now less than a month away.  Mark your calendars - September 16th.

You're all invited :)

Happy 62nd Birthday, India!

Days later, Hyderabad is still dressed in saffron and green.  Small Indian flags adorn just about everything you can think of, celebrating the anniversary of India's independence from British rule on August 15th.  While you may be tempted to associate this holiday with fireworks, BBQs, and beer, things are done a bit differently here...

Sure there are fireworks, but any random Tuesday night is likely to have fireworks as well.  BBQs...well, haven't had one of those since July 4th at the American Embassy in Delhi (which amazingly felt like we had been parachuted into Suburbia, Anytown; USA)... And beer, ahem.  Independence Day is a dry day in Hyderabad! (after all, too much fun can lead to trouble...)

So instead, Tyler and I make our way to Jagadgirigutta, about 45 minutes away from Banjara Hills.  There, the non-profit BHUMI is conducting its annual "Freedom Under Construction" mass initiative.  Each year beginning at the stroke of midnight on August 15th, hundreds of people come together for a 24 hour marathon of construction...building schools, classrooms, toilets in urban slums or other economically distressed communities in Hyderabad.

This year, the goal is to construct two classrooms at Qutbullapur Zillaparishad High School.  We arrive around noon, speak to the soft-spoken but clearly passionate head of BHUMI, and proceed to work.  No set roles, just everyone lending a hand.  We join the human chain of brick transporters, moving bricks from a giant pile in the middle of the lot towards the soon-to-be classrooms.

Mixing mortar is the next task, and again, is a giant group activity.  A large circle is semi-spontaneously formed to transport sand in buckets from the side of the lot (where it was dumped), to the middle of the lot, where it gets mixed with water and magic gray "stuff" that turns sand and water into mortar (you can tell what an experienced construction worker I am!) 

Midway through, upbeat Bollywood music starts blasting from nearby huge speakers.  Everyone's singing, dancing, hollering, laughing, smiling... I catch Tyler's eye and it's clear we're both thinking the same thing -- what an incredible I-love-India moment!

The actual building goes slower than expected, between all the breaks for eating, dancing, and eating some more.  This is India, after all...

But the little brick-laying we do get to do is incredibly fun... there's something so viscerally rewarding in patting the mortar down between the bricks, making sure everything's aligned just-so, and seeing your work grow literally brick-by-brick.

And just like that, I'm reminded of how lucky I am to be in India right now... which I suppose is what starting this blog is about.  I've now been here a year and nine months (but who's counting?)  The family of five on a motorcycle and goats/cows/camels/chickens on the street no longer faze me.  

In a way, I'm grateful for this -- it means I've somehow managed to acclimate to this wonderfully crazy place, where every moment is sensory overload in both the best and worst ways.  But at the same time, I don't want India to lose its magic and its "newness."  I'm excited to share these "you'll-never-believe-it" moments with friends and family back home, who have been extremely patient with my lack of correspondence.  And you know what they say -- better late than never!  So stay tuned...