My first sitar lesson

One of the highlights of Bombay was sitar shopping, and in the process, getting my first sitar lesson. I kept trying to compare it to other stringed instruments, like the harp or guitar, but it's totally unique...and really difficult to learn!

First even just holding it is a process. You must sit cross-legged on the floor, and the sitar is balanced between your left foot and right knee. Considering how hard it is for me to even sit Indian-style, this was quite a challenge ;) The entire instrument is balanced with your legs, so your hands are free to move freely.

My instructor, a third-generation professional sitar player (whose cd's lined the music stores walls), was the epitome of patience. Sitting across from me, he demonstrated a riff on the sitar, and then I was expected to mimic back. Definitely a case of a professional making something look easy! The thumb stays anchored on the fretboard, and your index and middle fingers are used for pluck. What's pretty incredible is the range of sounds you get from the strings. The most basic is just plucking. But then you can also literally "pull" the string out, and get a sound almost resembling the human voice. Pulling the string out while playing was a definite psychological barrier for me, as anything remotely resembling that on a harp would just break the string in two. But for the sitar, that's all part of the playing.

After one lesson, I was hooked. Now I just need to find a teacher in Hyderabad...

This made me laugh and laugh!!

From a Facebook post of a friend who now lives in Bombay:

When a friend from Singapore saw me bring my phone closer to read the rickshaw meter in the dark, he said: "Oh, you guys have e-payment too?"

HA. I'll settle for meters that work.

Ah India and Singapore... I can't think of a more stark contrast.

I heart Bombay

It's been a strange few days here in Hyderabad. The city feels combative and on edge. Just this morning, I saw a police officer beating a cowering man on the street while other officers stood around in a circle, silently watching. No clue if it was related to the Telangana movement, but lately it feels like everything that happens out on the street is. Most of Hyderabad was shut down last Saturday, with streets barricaded across the city in preparation for a Telangana storming of the Assembly. My driver must be constantly cajoled to go anywhere, especially at night, constantly citing "curfew."

Work is the reason I stay in Hyderabad. It brought me to India and it keeps me here. I've never been so passionate about a job before, so the trade-off makes sense. But there's no doubt about it: my heart is in Delhi and my (India) soul is in Bombay.

I spent five days in Bombay earlier this month and fell in love with India all over again.

Bombay has this magnetic energy that's difficult to describe but impossible to ignore once you're there. It's the same magnetic energy you feel in New York - when you just feel so alive and every cell is stimulated. There's culture and there's history and there's electricity in the air; the city exudes confident sophistication with nothing to prove. The energy is contagious and makes you want to do everything all at once.

From sitar shopping to feasting on the most delicious butter garlic crab I've tasted to strolling along Marine Drive under the moonlight -- the weekend was incredible. In many ways, the visit was a Tale of Two Cities -- the first was up north, where I stayed with a friend in Santa Cruz, a really cute neighborhood with a strong family feel, where everyone seems to know everyone else. It's just next door to Bandra West, which is hip and edgy and feels a bit like Brooklyn or Fitzroy in Melbourne.

The "second" part is just past the new SeaLink -- an architecturally impressive bridge that lets cab drivers release their inner (and outer) speed demon.

I spend the rest of my stay down south in Colaba, staying with a friend right next to the Gateway of India and the Taj Mahal Hotel.

It's amazing exploring the city with her. A lawyer by training, she is also deeply creative and artistic. There's something to be said about exploring just a bit of the city -- a small "neighborhood" in the heart of the Kala Ghoda area, and learning it intimately well. The french have a word for this walking and strolling...which is so much more than just walking and strolling: "le flaneur."

I begin to see the city through her eyes -- the architecture of buildings I hadn't noticed before, the hidden gems you can easily miss when you have a "destination" you're focused on. For instance, there's the bright blue synagogue we tried to sneak into after-hours. And the cute little church down a small alleyway, which was built in 1815.

By far the most magical find is the David Sassoon Library, which I must have passed numerous times before, as it stands right on a major road in downtown Bombay. But inside, past the "members only" sign, stands a beautiful Gothic structure that I doubt has changed must since the days of the Raj and when Sassoon opened it, in the turn of the century.

There's an impressive mahogany staircase lined with hundreds of books, which leads to a large but cozy reading room, lined floor to ceiling with antique hard-covered books. Past the reading room, there's a deck with antique lounge chairs, and a "staircase to nowhere" that's the stuff of fairytales and feels like a magical door to Narnia.

I can't get enough, so I'm back the next night, Economist in hand. I never realized a deck overlooking the crazy Bombay streets could be so relaxing. Upon leaving the library, I stumble across a book reading in the outside courtyard -- three Indian authors on a panel talking about the genre of writing about Bombay. Called "Bombay Then, Mumbai Now," the authors talk about the city as their muse and what it means to capture the city of Bombay in literature.

It's not like events like this are fully absent in Hyderabad. But when they happen, they're talk of the town for weeks and happen in the auditorium of the Novotel. Just "stumbling" across some incredible cultural event is something I miss about NY, and which I hadn't experienced in India until the weekend in Bombay.

In fact, the entire weekend is an amazing rush of culture. The Kala Ghoda Arts Festival opened the weekend I arrived, and the entire neighborhood is filled with large street art installations and street fairs with stalls selling everything from local tribal art to antiques.

Tuesday morning, I stop at my new favorite cafe to pick up delicious banana bread with caramel and head to the airport - equal parts happy and sad. Sad to be leaving Bombay, but happy it's just a one hour plane ride away.

Festival of Colors

The big topic of today's lunchroom conversation revolved around Holi, the Festival of Colors. Since it falls on Monday this year, there was lots of talk on where people were going to "play" Holi...or where people were going to escape it. Holi is quite big in northern India; in the Braj region, people celebrate for up to sixteen days!

The day is celebrated by everyone throwing colored powder and colored water at each other. It's celebrated at the end of the winter season on the last full moon day of the lunar month. Some say the color represents the advent of spring and the end of winter. One of my favorite explanations: "Holi is the festival of radiance in the universe."

I laugh every time I think about Holi last year. There I am, sitting innocently at my desk at work, when three of my colleagues rush into my office to throw colored powder on me! As I run to the other side of our office with them closely behind, I get great advice from our Director of Projects: "Once you stop resisting, you'll have a lot more fun." (good advice for Holi, as well as real life!!)

Of course, Holi or not, there's still work to be done. My favorite scene is passing our conference room and finding staff members there, hard at work and engaged in quite a serious debate -- with their faces and hair covered in blue, purple, and yellow!!

The next day, my friends and I randomly find ourselves on literally the set of a Telugu movie, which was set to be torn down the next day... but not before it becomes the backdrop of a pretty intense Holi party!

Some pictures below commemorating last year's Festival of Colors:

A lot of work and a bit of play! All in preparation for...

... the following day of festivities!

Tigers oh my!

I've become recently obsessed with Aircel's new campaign, made in conjunction with the World Wildlife Foundation (WWF). Ads like the one above are plastered all over Hyderabad, as well as the rest of the country. It's all part of the "Save Our Tigers" campaign to save India's Royal Bengal tiger population from extinction. My favorite is a picture of a baby tiger sleeping on a log, which I pass every evening on my way home from work. (See that photo here, which also links to a short awareness film.)

The "Just 1411 Left" tag-line is tragically powerful. Yet the ads, for me, are also bittersweet. The bitter is obvious. But the sweet is this: each time I see one of these ads, I'm reminded of tiger trekking with Tyler almost exactly a year ago... in Jim Corbett reserve 300 km northeast of Delhi.

The trip was, by far, one of the most incredible and amazing experiences here in India. Expectations were certainly set early: at the first day at our lodge (which fully felt like a hunting lodge during the British Raj), we meet another guest named Gautam - who had been on 46 tiger trekking trips and FINALLY saw his first tiger setting that weekend...after a three hour stakeout!!

Our first hike gets us close...we see tiger tracks on the sandy trail we're on (and I wonder whether we really should just be walking! ;)

We're up early on Day 2 for the safari ahead. We see amazing animals: wild elephants ("tuskers"), black-eyed monkeys, and sambar deer. Unfortunately no tigers, but not all that surprising... we're closely following other open jeeps, filled with noisy Indians with their cell phones and music blaring... perhaps not the best strategy for tiger-sighting. ;)

We're up even earlier on Day 3, determined to be one of the only jeeps in the reserve grounds. We go to the area called Bijrani - which feels a bit like an enchanted forest, with lush greenery and the morning fog.

Our guide is Prashant, who has seen 242 tigers in his 9 years as a guide in Corbett -- clearly a bit of an expert in tiger trekking! To successfully track tigers, he teaches us to listen to alarm calls from deer, who sense the predators nearby...

...Unfortunately for us, the deer are quiet as can be. Somewhere around lunchtime, Prashant grows despondent: "Never in my nine years has the jungle been this quiet!"

After lunch, we try a new approach and continue our trek atop Lalita, a 17 year old elephant. We're pretty sure we won't see a tiger after all, so we enjoy the ride, which is absolutely incredible. Trekking through the jungle, atop an elephant... a pretty magical experience.

And then... just as we're on our way back, the most incredible thing happens: we spot a tigress and her three cubs!! The tigress eyes the elephant... the elephant eyes the tiger... we're absolutely captivated and can't believe our luck. While the jeeps need to stay back a ways, the elephant gets way up close -- so close, in fact, that one of the cubs hisses at us. We don't need a second signal to back up a bit. We sit, transfixed and enchanted, for what feels like an hour.

And so we continue to learn again and again: "Anything really is possible in India."

Ivory Tower meets Real World

Was a pleasant surprise seeing LifeSpring written about in academic circles... A recent piece (published 11th Feb 2010) in Knowledge@Wharton featured a story entitled "Compassion vs. Cost: Improving the Prognosis for India's Health Care Sector". The article discusses the tremendous growth and opportunity in the India health care space, as well as the challenges.

Some thought-provoking stats:

• Currently, 70% of beds in the country are in government hospitals, but 80% of the population seeks private health care
• Unlike in developed countries, more than 70% of health care expenditure in India is out-of-pocket (in the case of LifeSpring, fewer than 10% of our customers have health insurance)
• Patients are served by a fragmented hospital system, with more than 80% of hospitals having fewer than 30 beds and only 1% managing more than 100 beds

In discussing low-cost, affordable health care solutions, Knowledge@Wharton discusses Acumen Fund's investment in LifeSpring Hospital:

"With more than half of the US$18 million that Acumen has invested in India going towards health care, one of its most successful investments is its joint venture with private-sector Hindustan Latex to develop the LifeSpring Hospitals network. Providing high-quality, bare-bones maternity and child health care to low-income Indians, LifeSpring has cared for more than 70,000 patients and has delivered 4,500 babies. By 2012, LifeSpring expects to have set up 30 hospitals across the country and it plans to use a franchising model to greatly expand the number and geographic coverage of its hospitals.

Relentless cost control has, and will continue to be, key. LifeSpring only spends between US$150,000 and US$200,000 to set up each of its nine hospitals, rents its facilities instead of owning them, and has standardized processes. But perhaps more critical to keeping a lid on costs, said Sahni, is avoiding the temptation to branch out into other areas of health care and staying focused on what it does best: providing maternal care."

A Magical Sunrise

Indo-Pak relations and maternal health

Had a really interesting meeting earlier today. A large foundation based out of Karachi came to LifeSpring to learn more about our model and see how it might replicate this idea across the border in Pakistan.

The need for high quality institutional care is certainly great. Their CEO cited a study whereby a well-meaning NGO promoted institutional delivery... with the unfortunate unintended consequence that maternal mortality actually INCREASED -- because the quality of institutional care available to low-income women in Pakistan is so poor!

As they think about opening their first maternity hospital, we talked about lessons learned from LifeSpring's first few years, as well as how we think about where to open our hospitals. We talked about how need doesn't always translate to demand -- and how demand is crucial when thinking about scaling a social enterprise. It was certainly interesting to think about how our model can be replicated abroad -- to a place that is similar to India in so many ways, yet also drastically different.

For instance, clearly the political environment is vastly dissimlar between the two countries. We spoke about how the ambulance service there (called 1122) literally had to change its focus to RESCUE 1122 -- from its earlier emphasis purely on health emergencies -- due to all the bombings in the major cities.

We talked about the attacks in Mumbai last year, and how even liberal Indians are coming to blame Pakistan -- when really Pakistani citizens are victims too. This was particularly interesting as I had just attended a book reading on Monday night in Mumbai, where one author (who lived just blocks away from the Taj Mahal Hotel) read from her book on the blasts last year - giving the perspective of a Mumbai citizen coming to grips with the events.

But back to maternal health... Discussions such as these are certainly exciting, and we're seeing more and more organizations coming to our hospital to see how the model can be replicated. I had an interesting conversation with someone from Monitor Group's social impact team yesterday - who came to our hospital to see our work around media training videos. They work with large foundations, such as Gates and Rockefeller -- where increasingly the question is: within the social enterprise space, in the next 5-10 years, what industry will be the next microfinance? -- With that space becoming increasingly more mature (especially here in India), what industry will be the next socially investible space?

Who knows, that just might be healthcare. Traditional private equity firms have traditionally shied away from hospitals here in India... the start-up costs are too high and take too long to recoup. Debt can be hard as well; as an investor told me over the weekend in Bombay: there's too much negative publicity that can happen if you're forced to close a hospital because they can't pay back their loans.

But then again, there's nothing traditional about some of the new players in the BoP healthcare space. That's what makes working here so exciting.

Thank you Susan & Sue!!!

I have the most incredible friends!! Got an amazing care package that only took two months to get from New York to India ;) Never have I ever devoured a People magazine as thoroughly, nor got as excited by postcards from NY and Obama-land!

The best part? The picture says it all...

Here's to an amazing 2010!! -- filled with fun, adventure... and most of all, incredible friends.

Cross-continental learnings

A sizable Swedish government delegation is here in Hyderabad this week, learning more about the Indian health care system. The objective for the delegation -- made up of top government officials from the Ministry of Health and Social Affairs, as well as CEOs of hospitals and heads of foundations -- is to learn about innovative solutions and opportunities for both inspiration and collaboration with the Indian health system.

Once again, I'm reminded by how lucky I am to be working in health care delivery in a country changing as rapidly as India -- where delegates from much richer countries are coming to observe innovations and the amazing potential in areas such as health care technology, public private partnerships, and increasing access to quality care. In just the couple years that I've been here, there's already been such a shift, particularly in the rise of private sector solutions as viable agents of change. It's exciting to think about what's up ahead...and even more exciting to think about being -- in my own small way -- part of that change.

Attitude is everything

As can be expected, living and working in India is not without challenges. The power goes out for hours right before a major deadline. There's no running water for days. Checks do not clear because they do not match the signature the bank has on file (this is my personal pet peeve).

The flip side, of course, is that any small accomplishment becomes a major milestone -- especially when first moving here: I crossed Road #1!! I paid my electricity bill!!

The other aspect that never ceases to amaze me is how different people respond to the various inevitable day-to-day challenges.

"Problem is there" is the typical reply... this is a general catch-all, from pizza not being available at Pizza Hut, to money not available at an ATM. While the sentence structure is a literal translation from Hindi, the overall passivity of the statement irks me to no end.

More and more, I'm realizing how many people look out and see nothing but challenges and problems. Even for people who are exponentially more proactive than the "problem is there" worker, challenges seem insurmountable. Midway in my Acumen fellowship, I remember Jacqueline saying: "Of course there are challenges and of course this is hard. But the important question to ask yourself is: are these challenges inspiring you or are they weighing you down?"

Perhaps it's simply human nature, but more and more I'm finding that people are focused on the negatives -- why it won't work, why it can't happen, and all the challenges along the way on the small chance that it does.

Maybe that's why it's so inspiring to work so closely with an entrepreneur. By definition, they see opportunities where everyone else sees doom and gloom (one of my favorite anecdotes is the one where two shoe salesmen go to a rural community... one comes back dejected: "There's no market; no one wears shoes..."-- while the other comes back elated: "What an amazingly huge market!! No one wears shoes!!"

Of course, there's nothing Pollyanna or naively optimistic about this. Good entrepreneurs obviously also carefully analyze the risks and mitigate these to the extent possible. But for me, what's most inspiring is the mindset. It's about taking a leap, confidently and passionately... rather than sitting on the sidelines and highlighting problems, fearing failure.

In our old office, I had a JFK quote up, for last year's anniversary of the moon landing:

"We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard...

...because that goal will serve to organize and measure the best of our energies and skills

...because that challenge is one that we are willing to accept, one we are unwilling to postpone."

Maybe it's not the moon. But in our everyday challenges, this choice, this willingness to do things that are not always easy -- seems to make all the difference in living a life you're passionate about, or wading through life as a constant struggle.

100 Deliveries x 2!!

LifeSpring has much to celebrate today: its newest two hospitals, located in Bowenpally and Chilkalguda, both celebrated their 100th delivery this morning!! What's especially exciting is that Chilkalguda, which opened mid-September and is LifeSpring's newest hospital, broke all previous hospitals' records for number of deliveries.

To put this all in perspective, LifeSpring's first hospital in Moula Ali took three months just to get its first delivery! After all, a lot of community trust needs to develop before business picks up. Add to that people's skepticism that a hospital can actually be high quality by charging such a low price (Rs 1500 when LifeSpring first opened).

So it's amazing that just a few years later, the first three months of a hospital have it well on its way to celebrate 100 deliveries by month 4 or 5. Congratulations to the hospital teams of LSH Bowenpally and Chilkalguda!

Paradise, Found

Over a month later and still on a high from the Philippines! Looking at photos from the trip never gets old... here are some favorites from El Nido, tucked away in the southern island of Palawan (considered by many Filipinos as the "outback" and "wild west" of the Philippines):