Home cookin'

My Australian roommate Molly has been learning to cook incredibly delicious Indian meals, and I've been lucky enough to be a main beneficiary of her efforts. Last night was easily the best bindi masala I've tasted, accompanied by aloo gobi.

The recipe:

- Heat oil and add cumin (jeera) seeds. Shallow-fry the bindi in hot oil; set aside.

For the masala mixture:

- Heat oil and add cumin (jeera) seeds

- Add onion and fry until golden brown

- Add pressed garlic, ginger, and chopped green chili

- Add 2 teaspoons of coriander powder and 1 teaspoon red chili powder

- Add turmeric powder

- Add the shallow-fried bindi (okra) to the masala mixture; let cook on medium flame while stirring constantly

- Add tomatoes

This recipe is the more traditional Punjabi "dry" (ie, no sauce) version. I've also seen recipes where you add the raw bindi straight into the masala mixture, before adding the coriander and chili powder (although the shallow-frying removes the inherent "slimy-ness" of the okra).

But for an incredibly delicious take on the dish:

- After adding the bindi and tomatoes, add coconut milk to make a coconut curry. Et voila!

Grace Model School

My roommate, Priya, has been volunteering at a school in Old City for a few weekends now. So today, I decide to tag along.

Grace Model School is a low-cost private school; tuition is Rs 80/month (a little less than $2). Started about nine years ago, there are currently 350 students enrolled in the school.

The school recently opened a library, which is open three hours a day after classes (school is six days a week). Charging just Rs 10/month (about 25 cents) to interested students enrolled in the school, it became profitable in its first month alone. This library is where we volunteered today. To say we "taught English" is definitely a huge overstatement... but we did have fun with the kids. Separating the group of about 35 by age, we read (and acted and drew) Goldilocks and the Three Bears... followed by singing "I'm a Little Teapot" -- by far their favorite activity of the hour, followed by a close second of *screaming* each letter that was drawn on the board.

One of the star pupils was Riaz (posing below), a very bright 12-year old. Talking to Ember, who is a Fellow working with the school this year, I was surprised to hear that there is a sharp drop in enrollment of boys at around sixth grade. In the communities where our hospitals run, I am used to hearing about the drop in girls enrollment at around age 14. She talked about many of the boys staying home to work with their fathers.

The afternoon was amazingly fun. But more than that, it's a sharp reminder of things we take for granted in the US.

Exploring Accra

Earlier this month, I spent a week in Ghana through our partnership with the Institute of Healthcare Improvement. Our brains were buzzing with learning about statistical tools and models to help support quality improvement projects, as well as frameworks for decision-making and scaling up projects.

While most of the week was spent in a conference room, we did explore the city a bit during the week. Here are some photos around Accra...

The Mausoleum of Kwame Nkrumah, the first president of Ghana and a strong proponent of pan-Africanism in the latter-half of the 20th century:

Obama everywhere!
At the arts market... I became obsessed with trade beads and their history. They were used between the 16th and 20th centuries as a currency to exchange for goods, services, and slaves (so were sometimes called slave beads). Accra is seeped with history related to the Trans-Atlantic slave trade...James Fort was a major slave trading fort (and is currently still used as a prison).

At night, we feasted on amazing seafood and coconut drinks (while ironically enough, watching the Commonwealth Games in Delhi -- complete with a cooking show on Indian cooking).

Camera in my Mind

There have been so many times in India where I wish I had a camera somehow connected to my mind -- such that with an intentional blink, it could store a photo in a digital database. My ride to work this morning was one of those times.

It was just an instant, a split second of staring mindlessly out the window. A bright orange but sun-faded house -- the color of a building you'd only really see in India or Latin America. An old man, white hair, wrinkled and proud face, walking with a wooden walking stick, slowly but deliberately towards the door of the sun-faded orange house. My car stops in traffic -- there's a cow ahead, and the old man stops, facing the door and slowly turning the knob.

Over his white linen clothes, he is draped in a light orange cloth. In the middle of his back, the cloth has a darker orange symbol -- the Hindu swastika sign for good luck, which has none of the evil connotations here that it does in the west.

Sun shining down in mid-morning light, dark orange good luck symbol matching the framed sun-kissed house, proud old man entering his humble abode... this is the photo I'm taking with my mind's eye.

Sadder than Fiction

One of my guilty pleasures while traveling is watching cheesy movies and horrible television shows. I mean, truly horrible. Last night was CSI Miami (yes, they have CSI Miami in Ghana! Even stranger, they have Filipino soap operas!! Globalization works in funny ways.)

The CSI plot was quite silly: four men go up on a spaceship that sells rides to outer space as part of space tourism. While in space, a small meteor hits the ship, and the crew realizes they do not have enough oxygen to make it back to Earth. They weigh the consequences and ultimately decide to kill one of the passengers to get his oxygen (of course, the CSI team pieces this together over many clues).

I don't give the episode another thought until lunch today, when the subject of oxygen comes up in a very different context. I am speaking with Nana, who heads Ghana's "Fives Alive!" project to reduce under-5 child mortality across the country. Funded by the Gates Foundation, the 5-year project is a collaboration between the Institute of Healthcare Improvement and the National Catholic Health Services. I learn that the primary drivers of under-5 child mortality in this country are due to neonatal deaths, as well as malaria. Since the project's inception, they have been able to significantly reduce deaths due to malaria, but Nana was sharing some of the many challenges to reducing neonatal mortality.

Among these: many hospitals do not have enough medical necessities, such as oxygen. Oftentimes, two babies may need oxygen, but the hospital does not have enough. The administrator and doctor may decide to share the oxygen (e.g. one baby gets it for 30 minutes, and then they switch), but ultimately that often results in both babies dying. Instead, the doctor must essentially decide which baby will live and which one will not.

My heart sinks as she tells me this.

Sure, it won't make as entertaining a show as CSI and outerspace, but this is reality. I'm not about preaching, but sometimes I wonder what it would be like to put a television in a place like Babies R Us in Suburban Anywhere, USA -- and have middle class Americans obsessed with "which is the best stroller?" directly witness the reality elsewhere. ABC and 20/20 are launching a one-year focus on global health, with the premiere episode focusing on maternal health. They are looking into LifeSpring, which would be a pretty amazing opportunity to highlight our work. If I were them, I would come to Ghana as well... Nana and her team at Fives Alive! are pretty inspirational and I feel lucky to be part of the IHI quality improvement advisors course, learning from change agents like them.

All Bundled Up

Meet Suleiman Rahimzai, 2 days old in this photo and 10 days old today. He is the newborn son of Mir, a fellow colleague in the Institute of Healthcare Improvement's "Improvement Advisor" course that I'm taking in Accra, Ghana. We are four months into the program, and currently in the middle of our second in-person collaborative and course. One of the most amazing aspects of the program is how diverse the participants are -- 25 healthcare professionals from countries like Afghanistan, Cote d'Ivoire, Guatamala, India, and Malawi, and working on significant quality improvement projects such as reducing maternal mortality, reducing severe acute malnutrition in children under 5, and improving the quality of HIV/AIDS healthcare.

Sometimes the diversity hits in its rawness... like when Mir's colleague spoke about the top causes of mortality for children under 5 in Afghanistan: and fighting/war was one of the top categories (incredible). It's a country I know so little about, except what's portrayed in the news and in novels like Kite Runner and A Thousand Splendid Suns. But it fascinates me, in part because of all the opportunities for improving basic quality of life there, like healthcare. I find myself jealous of friends who have worked there, and think about potential opportunities there, one day.

And so it's with great fascination and intrigue that I learn about newborn traditions in Afghanistan from Mir. His son, like all newborns, was tied up in a bundle as soon as he was born. Babies remain tied up for five months! -- approximately 20 hours each day (when they are not being cleaned or washed). Mir explains that the bundling not only keeps babies warm, but it helps them sleep undisturbed, in an environment that mimics the tight confines of the womb. There is also a spiritual component of "keeping out the evil."

What's interesting here is that apparently bundling up babies in little "baby straightjackets" (similar to Mir's son) is starting to becoming all the rage in the US -- the contraption is said to significantly help stimulate sleep. Yet another example of "tradition" becoming "innovation" through its journey from a developing country to the developed world.

Commonwealth Games

No blog about India would be complete without a post on the Commonwealth Games, being held in Delhi. Today is Day 5 of the games, which last through the 14th of this month.

I remember riding around Delhi at numerous points over the last year, looking at all the construction; Tyler and I talking about how there's absolutely NO way that preparations will be completed in time for the games. And of course, right up until opening ceremony, all the newspapers (domestic and international alike) were a flurry of articles, photographs, and accusations about how ill-prepared Delhi is. The BBC showed photos of the Athletes' Village, complete with floods inside rooms and muddy dog paws staining the beds. Part of the roof of the weight-lifting complex fell. A pedestrian footbridge collapsed. An Australian reporter was able to bring materials to make an explosive through security. And so on, and so on, and so on...

While none of this was good news, of course, I guiltily exhibited a sense of schadenfreude, for in a way, it was good for all the corruption, shoddy practices, and sub-quality output to be displayed -- although perhaps embarrassingly so (especially compared to China and the Olympics).

So in a way, it has shocked me that since Opening Ceremonies this past Sunday, all news has been good news. International press has called the ceremonies "India's coming out." And indeed, Delhi was at its best Sunday night. Roads were empty of traffic, and the nearby market displayed the ceremonies on a giant outdoor big screen television. Tons of people crowded around to watch, some sitting on top of their cars across the street. From Tyler's apartment, we could hear the roar of the crowd and the flurry of fireworks ending the event.

Our friend Tomo went to the Opening Ceremony and said it was pretty impressive. He took some incredible photographs of the event, worthy of a media kit (click here).

And while I want to be riding the wave of Indian pride and patriotism, it all feels bitter-sweet. Perhaps it might just be the media I'm reading, but it's almost as though all the shoddiness and corruption has been tossed aside, given that the games themselves have been a hit.

And there's also the darker side of "Delhi at its best." The flip side of having no beggars come tugging at you at traffic lights is that the city has literally thrown out all these people. Beggars, itinerants, and slum dwellers have all been forcibly moved in the weeks leading up to the games.

These images from Boston.com's picture slideshow show a slum dweller standing on the spot where his hut was demolished, while the next photo shows slum children searching for their belongings amidst the demolished slums in Gurgaon.

They are scenes straight out of A Fine Balance, except of course, that this is not fiction (Rohinton Mistry would however likely say that while his book is technically fiction, it is actually all true). I'm reminded of the core of the book -- the challenge of maintaining a fine balance between hope and despair.

And I suppose that's my problem with the Games right now: that there's no balance... at first it was all horrible and corrupt, and now it's all amazing and patriotic.

We could all use finer shades of grey.

Amritsar in Technicolor

Last month, Tyler and I spent a weekend in Amritsar, going to the India-Pakistan border and seeing the Golden Temple (previous post here). While I was initially more excited to witness the border ceremonies, the Golden Temple held surprising grip on me. It's difficult to describe the feeling of peace and awe I felt within the temple's compound, even in the midst of thousands of others. It's trips like this that remind me of the magic and serenity that lie beneath the surface in India... if only you're willing to do a bit of exploration.

For more pictures, click here.

Tribes

A recent post reminded me of Seth Godin's visit to LifeSpring earlier this summer. This was his second trip to LSH (after the first of which he blogged about our hospital's quality policy, to the delight of the then one-year old hospital).

His visit was energizing, inspiring, and thought-provoking. We spent the morning in the communities, speaking to customers served by our hospital. After lunch, he and Jacqueline addressed the corporate office, hospital branch managers, and doctors.

What struck me was not only the content of his talk to our staff, but perhaps more importantly, the power of how he got this content across. He set a tone of urgency, but coupled this with positive momentum (the kind that makes you impatient to even be sitting there instead of out working to grow the organization) -- rather than pessimistic undertones that one usually hears when dealing with the crucial issue of maternal mortality.

He democratized "marketing" as part of everyone's job at the hospital, stating: "Your mission is not just about healthy babies -- it's about many healthy babies... We have to hurry. We don't have a lot of time."

He talked about the community visit, saying: "And this is what we discovered... Women who are pregnant have friends who are pregnant. What would happen if they each tell five other people? That's when something interesting happens. Delivering more babies leads to delivering more babies."

He ended by putting our work in greater perspective: "And the bottom line is this: This is not just a hospital. It is a movement." And challenging the entire staff: "What can we do to make people talk about us? ... We're creating a movement that changes lives."

Later on in the evening, Seth gave a speech at the Indian School of Business, where he talked about the power of tribes, creating a movement, and inspiring change. Really made me reflect on being part of the "tribe" that's working to change the world, and grateful for who's on my corner.

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From Seth's blog this week:

Needs don't always lead to demand

One of the accepted holy grails of building an organization is that you should fill a need. Fill people's needs, they say, and the rest will take care of itself.

But... someone might know that they need to lose some weight, but what they demand is potato chips.

Someone might know that they need to be more concerned about the world, but what they demand is another fake reality show.

As my friend Tricia taught me, this is brought into sharp relief when doing social enterprise in the developing world. There are things that people vitally need... and yet providing it is no guarantee you'll find demand.

Please don't get confused by what the market needs. That's something you decided, not them.

If you want to help people lose weight, you need to sell them something they demand, like belonging or convenience, not lecture them about what they need.