Stage Fright

Preparing for my TEDx talk in Delhi next week, and reading the TED Commandments that the organizer just emailed over. The top four:

1) Dream big. Strive to create the best talk you have ever given. Reveal something never seen before. Do something the audience will remember forever. Share an idea that could change the world.

2) Show us the real you. Share your passions, your dreams... and also your fears. Be vulnerable. Speak of failure as well as success.

3) Make the complex plain. Don't try to dazzle intellectually. Don't speak in abstractions. Explain! Give examples. Tell stories. Be specific.

4) Connect with people's emotions. Make us laugh! Make us cry!

Umm.... if I wasn't nervous before, I certainly am now! Looks like I should get started...

"Just doing my job"

For the past few days, we have had a consultant from the Institute of Healthcare Improvement (IHI) working with us to help achieve our clinical quality goals, particularly around reducing caesarean section rates and reducing fetal distress and morbidity.

Given the hierarchy that exists in healthcare in India (and really, everywhere in the world), his training this morning to our nurses on speaking up is remarkably important. His examples related to aviation (he is a pilot, besides being an obstetrician) are particularly sobering. He gave the example of one carrier in the US about twenty years ago: the role of the co-pilot then included reading off how much gas is left in the tank at set times. So that's what he did. Countdown at pre-defined times - 5. 4. 3. 2. 1... all the way down to zero. The plane crashed, but the co-pilot "did his job."

Statistically speaking, flying in airlines is much much safer than checking into a hospital. We've all heard of surgeons operating on the wrong leg. A sobering stat: "Ineffective communication is a root cause for nearly 70% of all patient deaths reported in US hospitals" (Sentinel event statistics, 1995-2003). Really incredible and downright scary: 7 out of 10 deaths are preventable with better communication.

Most helpful was the framework for communication that IHI provides, especially around hand-off, when information is particularly apt for getting lost: SBAR - Situation, Background, Assessment, Recommendation. Really important, considering that doctors and nurses are trained to communicate differently, right from school.

On a lighter note, even when you think you're helping, unless both people properly communicate their goals and play back to one another, catastrophe can occur, as seen in this hysterical video.

Countdown to July

Back in full wedding-planning mode, and I now remember why I stopped in the first place... it's really quite amazing all the messaging you're bombarded with:

• "Happiness is Getting Married" - from the website of a potential videographer
• "Home wasn't built in a day... Relax, take a deep breath, and take it one room at a time" - from the Bloomingdales registry... as though choosing what your guests will get you is the most stressful, important decision of all-time
• (And perhaps the one that made me take a time-out from planning): I don't even remember what the magazine ad was for, but the visual was a marathon race ribbon with the words "Finish Line", spread across the wedding altar

Hello!! And one wonders why the American divorce rate is so high (40% in 2008)! It's as though the wedding itself is the "end", Hollywood's "happily ever after"... when really, it's obviously just the beginning. It amazes me how many people seem to confuse "wedding" with "marriage."

All this energy on the wedding (a wedding planner, the perfect dress, the perfect everything...) Even trying not to get sucked into this maelstrom, I somehow managed to spend this week getting way too stressed out by our RSVP response cards (envelope, postcard, online???) -- it's ridiculous.

Everyone asks about the dress, the registry... there's minimal discussion or questions about the marriage itself: our vision of it, our dreams and our fears. It's easier to ask how I plan on wearing my hair that day.

Don't get me wrong. Of course, it's been incredibly exciting planning for our wedding (we just booked our honeymoon tickets!!) But it's a real shame that in the end, what society focuses all its energy on is a massive party. After all, that's the easy part. What's important is what comes after.

The Case of the Appearing Dog Jackets

It's a mystery: ever since winter descended upon Delhi about a month ago, street dogs have started sporting a new look: winter jackets! Blankets have been strapped on street dogs, who swagger around looking a bit silly, but definitely a lot warmer. It's really a wonder to me who is doing this. The cutest dogs tend to be the ones bundled up, and certainly all the puppies I've seen. Such a contradiction to the way we usually see street dogs treated here; one of the rare animal instances that warms the heart.

And another, seen in Jaisalmer last month:

A litter of puppies pile on top of one another to get warm. Each puppy wants to bury its nose in the middle of the heap... the snuggle pile constantly moves, as each new puppy piles on.

Woof in Hindi

I just had an epiphany. Not one of those paradigm-shifting epiphanies that change the way you view the world. More of the laugh-at-yourself "why hadn't I thought of that before" variety -- the kind that actually make you feel more foolish than smart.

I come back from Hindi class, to be greeted by Bambi, our landlord's good-hearted but completely chaotic and un-tamable/(un-trainable?) Dalmatian. She barks at you when she's happy; she barks at you when she's mad; she barks at you to say she wants to be petted.

"Namaste, Bambi" - I greet her. This is met by intense tail-wagging and most amazingly: not a single bark.

Aha! Why didn't I think of this before?! -- all my earlier commands ("Quiet!"; "Sit!"; "Stay!") had all been in English... clearly not her native language! She follows me upstairs and I'm eager to try out all my imperative verbs in Hindi, not-so-secretly wishing this is the key to training her.

"Bayto! Bayto!" I point to the ground. "Sit! Sit" Alas, she's more interested in exploring the flat and the roof. No dice, but I have fun trying. And the landlord's maid (who has become my new BFF) is all but in hysterics watching from afar.

One of those weeks

Sinatra had it all wrong. It's not NY at all, but some place like India: "If you can make it here, you can make it anywhere."

Yesterday I had to email out a proposal before a call. Wireless isn't working. I use my data card, advertised as "speed at your fingertips." It's so slow that Google gives up and simply says that gmail is unavailable. Wouldn't be a problem since work email is just fine, except that every email sent to a non-internal account gets bounced back as "spam." I race around to three places for internet, unsuccessful until I reach my Hindi teacher's place and take the call from there. The company I'm speaking with assumes I'm in the field somewhere, but no, this is Delhi.

This is on the heels of the most successful/unsuccessful apartment shopping spree in memory. Tyler and I spend all of Saturday finally buying apartment items we've been putting off for three months: floor lamps, plants and a heater: 5 items in total (2 floor lamps, 2 plants, and a heater). We also decide to get a small table and chairs made. Toasting to our success, we enjoy a nice dinner.

Less than 24 hours later, one of the light blows (after about 2 hours of use), and the heater just breaks. 2 out of our 5 items just gone. It feels like complete deja-vu. We are back on his motorcycle, floor lamp and heater back in hand to fix and get new ones. Prepared for a fight, the folks at the light store turn out to be completely reasonable and replace the light. Knowing we can't just return the heater, we buy a new one.

Phew. Messed up evening plans to go to the gym, but at least we're all set again.

24 hours later, our new heater breaks and both lights blow. Are you kidding me?!?!

At least there's the table to be excited for. Expecting it to arrive on Tuesday, I work from home to wait for the delivery... which never comes. The carpenter ends up coming at 7am the next morning, with the set completely unfinished. While we asked him to copy an exact table we saw together over the weekend, he decides to take artistic liberty on the chairs, creating two throne-like structures, with the actual seat so close to the ground that you feel like Alice in Wonderland next to the tall table (it's so low that Tyler can't properly bend his knees, while meanwhile, I feel like I'm in 1st grade at the big kid table).

Ah, India. I know there are lessons in all of this, but why does everything supposedly "easy" have to be so frustrating?!

NYT List - 41 Places to go in 2011

I'm reading the New York Times' "41 Places to go in 2011" and almost do a double-take seeing that Hyderabad is #19!!

19. Hyderabad, India
Dynastic grandeur in the heart of modern India.

Even in the 16th century, Hyderabad, in southern India, famous for its diamond trade and sultans’ palaces, was a city with serious bling. In the last decade, a new sort of wealth has arrived — the outsourcing of international companies, which has inspired a boom of sleek cafes and restaurants such as Fusion 9.

The latest buzz is the debut of two five-star hotels, both connected to the Nizam family, rulers of Hyderabad for the two centuries before India’s independence. The first, Park Hyderabad, is a futuristic structure designed by Skidmore, Owings & Merrill, with an aluminum and glass facade inspired by the settings and metalwork found in the Nizams’ jewelry collection. The new Taj Falaknuma Palace, on the other hand, is a window into the past. It’s a wedding cake of a building that still belongs to the Nizam family, and it took the Taj Hotels group 10 years to renovate the European-style castle. “The Falaknuma Palace will complete the Indian palace tour for the south,” said Shanti Kohli, of New Delhi-based Amber Tours. “It makes a trip to Hyderabad worthwhile just on its own.”
— GISELA WILLIAMS

Lessons in Hindi

In studying Hindi, a few fascinating points:

1) The word for "yesterday" (kal) is the exact same word for "tomorrow". This may explain a lot in terms of scheduling and time frames...

2) The verb for "to sleep" (sona) is the same word as "gold". I think they're onto something.

3) The verb for "to be in love" (dil lagana") is the same verb as "to feel at home." I like that.

Mmm...

Looks like my favorite Filipino dish, chicken adobo, has reached the mainstream. From this week's New York Times:

There are more than 7,100 islands in the Philippines, a nation slightly larger than the state of Arizona, and if you could devote your life to traveling through them asking questions about food, you would discover a different recipe for adobo on each one...

...Husbands argue with wives about adobo. Friends shoot each other dirty looks about the necessity of including coconut milk or soy sauce in the recipe. There are disputations over the kind of vinegar to use, over the use of sugar, over the inclusion of garlic and how much of it. Some use chicken exclusively in the dish, others pork, some a combination of the two.

The article talks about Purple Yam restaurant in Ditmas Park, Brooklyn - which is now on my ever-growing list of restaurants to check out on my next trip home. The owners used to run Cendrillon in SoHo -- kindda chi-chi Filipino food.

Chicken Adobo Recipe from Purple Yam Restaurant:

1 cup coconut milk

¼ cup soy sauce

1½ cup rice vinegar

12 garlic cloves, peeled

3 whole bird’s-eye chilies or other fiery chili

3 bay leaves

1½ teaspoons freshly ground black pepper

3 to 4 pounds chicken thighs

1. Combine all of the marinade ingredients in a large, nonreactive bowl or resealable plastic freezer bag. Add the chicken and turn to coat. Refrigerate overnight or for at least 2 hours.

2. Place chicken and marinade in a large lidded pot or Dutch oven over high heat and bring to a boil. Immediately reduce heat to a simmer and cook, stirring occasionally, until the chicken is cooked through and tender, around 30 minutes.

3. Heat broiler. Transfer chicken pieces to a large bowl, raise heat under the pot to medium-high, and reduce the sauce until it achieves almost the consistency of cream, about 10 minutes. Remove bay leaves and chilies.

4. Place chicken pieces on a roasting pan and place under broiler for 5 to 7 minutes, until they begin to caramelize. Remove, turn chicken, baste with sauce and repeat, 3 to 5 minutes more. Return chicken to sauce and cook for a few minutes more, then place on a platter and drizzle heavily with sauce. Serves four.

If I just...breathe!

For no apparent reason, as I was sitting in a panel session today, I stopped and noticed that my entire body was tensed up. In a funny way, I think this full-body tension has been 24x7 since mid-way through our vacation in Rajasthan... funny, because it was happening not because I was stressed, but because I was so COLD (in the frigid 50-60 degrees!). They say it takes 28 days to form a habit, but in this case, seems like it was just a few days. Even back in warmer Hyderabad, my body wasn't sure how to relax.

I started breathing deeper, which prompted me to remember the abdominal breathing that my yoga teacher here in India taught me. As I started to breathe deeply and abdominally, all the tension in my body started to fade. And it occurred to me that never, outside of yoga, do I breathe this way!

Later at night, I started googling "proper way to breathe." All the articles say the same thing: human adults are the only animal species that generally do not breathe properly. Babies and animals all breathe with their tummies, their stomach puffing up during inhalations and dropping down during exhalations, with their chest staying still. Pretty interesting. Most adults breathe exactly opposite: with their chest moving up and down -- at least, I certainly do.

When I went on a yoga retreat to the Himalayas last spring, our instructor kept honing the importance of the breath as the single most powerful tool to achieve presence, clarity, and calm.

Feels odd to make a mental note of the process of breathing "correctly", but here it is:

1) Please your left hand on your abdomen and your right had on your lower chest.

2) Breathe in by inhaling through your nose: your left hand should move up, while your right hand stays the same.

3) Exhale fully through your mouth, like you are blowing on hot soup.

Et voila!

What Amjed has taught me

The first time I saw him, he reminded me (very non-politically-correctly) of a Muslim Santa Claus: bearded, with a belly, and always laughing.

For the past nine months, Amjed has been my driver. But much more than that, he has been my colleague and my friend. For reasons beyond either of our control, he's recently been replaced; unfortunately for him, with only a couple of days notice, no explanation, and no severance.

Since all of this happened while I was away--punctuated by mad phone calls and emails trying to reverse this,--I met him for coffee this evening to chat. Far from being angered by office politics, he was his old self: smiling, laughing, and knowing everything works out for the best.

I wasn't quite sure what we'd talk about, but turns out, a lot. He told me of his 22 years working at a solar energy company, where he was in charge of putting up solar panels in remote villages in Andhra Pradesh. In typical Amjed fashion, he became extremely animated as he spouted out the company's business model and why it ultimately failed. He told me of his two years working in Saudi Arabia, and about his brother working in Kuwait. I learned that he's the seventh of seven siblings; four boys and three girls, the children of an army officer. He himself has five children (three boys and two girls), ages 9-23. He proudly talks about his eldest son, who just graduated from computer engineering and is hoping to work in the Gulf.

On my walk home, I thought about what Amjed has taught me over these last nine months. As it turns out, a lot:

(1) True peace comes from within. I was always amazed by how calm Amjed always is -- navigating the crazy streets of Hyderabad, picking me up for the airport at 4am, being stuck in traffic. He never became anxious or worried, but rather, spread the feeling of calm to everyone riding along with him.

(2) The value of taking ownership. Amjed is one of the few people outside the corporate office who says "we" when talking about our hospital; many of our doctors and administrators don't even speak as a team, saying "you people" when they mean the corporate office. One question Amjed would often ask is: "How many births did we do at the hospital today?"; or ask how "we did" in an important meeting. He always posed intellectually-stimulating questions ("Why did we choose the hospital locations that we did?") -- but more than that, would follow-up after thinking about it. Shortly after our conversation about hospital locations, he picked me up from the airport and exclaimed that he had some ideas for potential locations for our new hospitals and when can we talk about it?! He's one of those rare people who you know would have been a CEO of a company, had it been for different circumstances. In an environment that often focuses on the quick win and sacrifices quality for speed, Amjed takes true pride in his work: getting anywhere he needs to be ten minutes early, being dependable, steady, confident, and calm.

(3) The strength that comes from faith. Amjed is one of the most devout people I know. He goes to the mosque each morning and on the afternoons and evenings he can, as well as all-day on Sundays. A strong component of his sense of peace is his knowledge that everything happens for the best, as everything happens from Allah's will. The only times I ever experienced him speeding was when I'd leave work late during Ramadan and he rushed to make it to mosque before sunset.

I know whatever he does next will be great, but I will certainly miss our daily interactions.

Dreaming of the Pink City

Caught!

Yes, that's me, blackberrying on vacation...

The "Blue City" of Jodhpur

India in the New Year

In his op-ed entitled "We are all in this Together" published in the Hindustan Times this weekend, Nachiket Mor writes:

What is well known is that we are a nation of 1.2 billion people growing at among the fastest rates in the world, with an economy of $1.2 trillion. What is less well known is that, of these 1.2 billion people, fewer than 20% have an income in excess of $2 (about Rs 30, using a purchasing-parity rate of Rs 15) a day and that the poverty line in India is set at approximately $0.80 (about Rs 12 in purchasing parity) a day while the developed world defines it at over $10 (about Rs 150 in purchasing parity). This 80%, meanwhile, continues to struggle with very poor, if any, access to quality primary healthcare, elementary education and basic financial services.

Despite these facts, however, it is an optimistic article that focuses on the reasons he sees inclusive growth occurring in India:

1) There is a strong desire for change

2) We have the necessary tools

3) The right leadership

4) New operating models

Within new operating models, he writes that:

"We are also seeing some powerful new operating models emerge, which are using these new tools for the delivery on a large scale of critical services that we have long struggled with. For example, the LifeSpring hospital chain is showing that a high quality normal delivery can be done for Rs 3,000 and a Caesarean section for Rs 9,000; the IFMR Trust, which seeks to broaden access to financial services, is showing that it is possible to deliver well designed wealth management services to the poorest households in Uttarakhand and still offer loans at half the rates prevailing in the market with no subsidies; and Educational Initiatives, which works in the field of assessment, benchmarking, teacher training and curriculum services, is showing that it is possible to test at scale how well children have actually learned the underlying ideas as opposed to just mechanically memorising what they have been taught in school. All this makes me hopeful that the next 10 years will be the decade of inclusion."

For the full article, click here.

Nachiket Mor visited LifeSpring this past summer, as part of his research on innovative models around healthcare for the poor. I was extremely impressed by his approach: he listened more than he spoke; he asked more than he declared, and when questioned on his opinions, he was extremely articulate, data-driven, and outcomes-focused.

When I asked why he is now focused on healthcare, he noted that the three key items that low-income Indians need access to in order to spur growth are finance, education, and healthcare. Having made his career in finance, he sees exciting innovations happening in education, but a dearth of progress in healthcare. He speaks with optimism and excitement about the possibilities of focusing on a micro-level on the holistic healthcare of one village: each and every villager being tracked and treated, beginning with preventative care. They are doing this now in one village in Karnataka.

It's an exciting initiative, and I look forward to watching them scale.

Naya Saal Mubarik!!

Cheers to 2011! -- a year that looks excitedly ahead with new beginnings and looks fondly backwards as well (I have my ten year college reunion and five year business school reunion this April and May). It's a year of reconnecting with my favorite people, as well as introspection around personal legacy, passion, and how best to truly make an impact.

In Hindi, the New Year is congratulated: Naya Saal Mubarik! (Congratulations on a New Year!) Seems a bit presumptuous now, but talk to me again in a year: it's an exciting road up ahead, and each year just keeps getting better.