Thanks Nate! (aka Guy Jesus)

One virtue of being fairly nomadic is that we get good travel advice from other fairly nomadic roommates and friends. Nate's advice for Ghana:

"The most important place to go is my favorite bar in the world, Duncans, run by my favorite bar- owner and his lovely wife, Duncan and Barbara. Ask for the Captain, tell them Guy Jesus sent you and get him to take you to Greece. It's a wonderful little outdoor place with tables on the streets. If you go to Frankie's hotel in Osu and walk down oxford street (away from the circle), and take the first right up the hill its a couple blocks up on your right. Give them my best if you make it there.

Also fantastic is a place called La Tawala Beach Bar. To get there you take a cab to La Polyclinic (where Ring Road meets Labadi Beach Road) and walk down the dirt road toward the coast. Then you kind of go around a stand of trees toward the beach and its back behind there. They have tables on the beach and really great grilled chicken.

Also, for fried chicken in Osu, on the other side of the intersection that leads up to Duncans, there is a place called Papaye that is amazing.

On Thursday night, go to Bywel Bar in Osu. Great live music and a really fun scene

If you have two days to explore outside Accra, there are a few places I recommend. Just to the west of Accra is Kokrobite, a backpackery beach with a backpacker beach resort called Big Millys that's pretty fun, and probably a little less backpacker on the weekdays. If you want something a little nicer, a few hours away is Cape Coast, which has a historic slave castle, and one of my favorite beach resorts, Anomabo - Really lovely spot.

On the other hand, to the east is the Volta region, which ahs mountains and waterfalls and is also awesome. If you go there I recommend Wli Waterfall, Amedzofe, which has a cool though very rustic guesthouse on a mountainside, and Biakpa Mountain Paradise.

On the way to the Volta region (though possibly hard to stop at without a car, is the Volta river bridge, at Akosombo, and right by the bridge is a wonderful spot called Aylo's Bay Resort. If you somehow have a chance to stop here for lunch, its lovely. Right by the side of the river, with a dock and a nice ropeswing in the water. They used to have amazing shrimpburgers too."

Lessons from the past week of IA Training

Take-away: Learning sticks more when you're having fun in the process. While we're quick to jump to "who's a better worker", the reality is often much more complex (above, Patrick is happy he got his "magic touch" back with a different bubble solution). Devising the equivalent of a "one-person randomized control trial" can be useful -- a four factor, 2-level design of experiment can be fairly straight-forward and powerful.

Take-away: Impulse to jump straight to "Act" in the Plan-Do-Study-Act cycle. No one wanted to "study" and learn the current system of coin slides. According to Deming, 94% of variation is due to the PROCESS -- not the specific workers or the teams. Develop change ideas to change the process itself (but only after studying the system!)

Take-away: Amazing teachers make all the difference! Also, there are many more commonalities than differences between India, Ghana, Ethiopia, Malawi, Cote d'Ivoire, Guatemala, and Afghanistan.

Cognitive Dissonance

I must say, it's a pretty bizarre thing to be signing up for wedding registries when you're in a developing country. This must be why I've been putting it off for so long. About ten times during the process, I wanted to just turn off my computer. It's not that I've gotten so anti-materialist or anti-luxury. It's just... how many fancy plates does one really need?

Right now I consider myself lucky to have running water (none right now), hot water (see previous note) and internet (woohoo! - although who knows for how long...)

In our flat in Delhi, Tyler and I have 4 white plates, 4 orange bowls (there really weren't any other color options), one tea mug Tyler inherited from a conference, and about 8 glasses of all different sizes, because this was easier than trying to compromise amidst dozens of pushy shoppers. Sales consultants at Bloomingdale's may gasp, but with these "dining sets" and our two pots and rice cooker, I'm not sure what else we really need!

$1050 champagne ice bucket, anyone?

Ghana livin'

I dare you to walk down the main street of Osu, in Accra, and not smile. On any given night, there's upbeat music blasting from huge speakers every few blocks. My walk back from dinner tonight feels like I'm in a music video. There's a big open bar under a tent; people sitting and swaying along to the music. A little girl about 5 years old, wearing a teeny white mini-skirt, shakes her little hips to the music, a huge smile on her face. Even when her mother grabs her hand to cross the street, her dancing doesn't stop. She sashays across the street, still bending her knees to the music. In front of her are a pair of two mothers, babies strapped tight across each of their backs with a wide strap of cloth, eyes wide and taking everything in.

It's a funny thing to say, but Accra just feels so relaxing after India. I essentially only have to look two ways before crossing the street, and cars actually stop on the road to let you pass. Despite the ubiquitous and quite dangerous drainage holes along the sidewalk, there is essentially, a sidewalk! Delicious donuts and gelato are a stone's throw from Catherine's place in Osu, where I'm staying. Life is good! Akwaaba!

"A Dozen Tips for Working with Executives"

From this week's IHI Improvement Advisor Course and taken from Maureen Bisognano, President and CEO of IHI:

1. Get results before teaching and preaching

2. Keep the burden when giving an assignment to an executive

3. Understand the short-term "hot button" and address it -- what's the burning platform right now

4. Connect to the business case

5. Be helpful - do not whine or complain

6. Improve listening skills for tips and clues about the executive's aim for the interaction and their decisions

7. "Look and act the part"

8. Be grateful and encouraging -- executives are humans too

9. Strive to understand the complexity and difficulty of the executive's world

10. Work within the senior executive's style of learning

11. Be prepared. Design the end of the meeting (what would be the ideal outcome of the meeting)

12. Be succinct and direct (provide succinct communication and direct answers)

Thoughts from Ghana

"Hope is not a plan."

- IHI Improvement Advisor Course, Feb 2011

The Power of Connection

Fesalbon cousin Skype call over the weekend between NYC, Seattle, and Hyderabad!!

Letter, Winter 2011

"And I suppose that is what life holds - seemingly unbearable pain and exquisite beauty, numbing loss and generous new life all mixed in a swirl of hope and anger and possibility and despair, all bound by how much we need one another."

- Jacqueline Novogratz

What did you do on Generosity Day?

Back online after three days of no connectivity in Assam (which makes you realize just how attached we are to our laptops and cell phones -- I was like an addict, continuously checking my phone to see if it miraculously started working!)

I just read the full updates from Generosity Day. Truly amazing. Total tweets surpassed 2,000 -- including tweets from Kevin Bacon and Craig Newmark (founder of Craig's List).

To read a play-by-play in Fast Company, click here.

I love it: "What is the business case for generosity?" (to find out, click here)

Transforming Valentine's Day

My friend Sasha has a pretty cool idea: Transforming Valentine's Day into Generosity Day. You can still eat all your chocolate hearts, but here's the transformation -- or rather, the challenge:

What would it be like to spend one day saying YES to everything?

Here's the background, in Sasha's words:

"About a year ago, I conducted a month-long generosity experiment. It started because, on a cold December day, rushing home on the subway, I passed a homeless person on the street asking for money. As I typically did, I walked by, head buried in my iPhone. The next day I decided that I wanted to change, so I announced a month-long generosity experiment on my blog: I spent the month of December saying YES to everyone who asked me for money (whether a homeless person, a street musician, a nonprofit,….). I found it transformational."

Now I must admit, I've seen this challenge before. In fact, it was homework for me once in business school, when I took a class on Creativity and Personal Mastery. To tell you the truth, I've always stayed clear from it. If anything, I felt that what would bring me peace of mind was starting to say "no" to everything -- to clear my plate of all the should's and nagging obligations.

But for Sasha, I'm going to give it a try on Monday. And you know what? -- I'm actually really excited. There's liberation and freedom in saying yes, especially here in India, when at times it feels like you're always being asked for something by just about everyone. What would it be like to be generous and say yes to everything? -- to beggars on the street (even though intellectually I know this only feeds the problem... or is that just what I tell myself??), to the post-work drink even though I know I should go home and study Hindi.

And for me, the idea of generosity extends beyond just saying yes to everything. It's also being generous to the people around me -- to giving everyone the benefit of the doubt, to being patient in airports even if I think their processes are redundant and designed to be the most customer un-friendly as possible (post to come on my trip back from Jharkhand).

As Sasha says: "This is a semi-crazy idea, but I think it could be great!"

So come join us! Help spread this semi-crazy idea and try it yourself on Monday!!

...And have a chocolate heart for me too, while you're at it.

Rural Jharkhand

Earlier this week, I spent some time in rural Jharkahnd, in the eastern part of India. LifeSpring had been invited by KGVK to provide recommendations on how to improve their two hospitals, called Shalini, which had both been built in the 1980s with USAID funding. They are looking to see how best practices at LifeSpring related to quality and efficiency can be applied to Shalini.

For me, it was an eye-opening experience. The context of both of our hospital chains are vastly different. LifeSpring, based in urban Hyderabad, serves a city with an institutional delivery rate approaching 90% (Andhra Pradesh as a whole has an institutional delivery rate of 69%, based on the latest National Family Health Survey in 2006). In terms of institutional delivery, Andhra is fourth from the top, after Kerela (100%), Goa (93%), and Tamil Nadu (90%).

Jharkhand, on the other hand, is third from the bottom in terms of institutional delivery. For the state as a whole, institutional delivery is 19%, and I'm told it's much less in rural Jharkhand -- somewhere between 10-15%. The only states lower than Jharkhand in institutional delivery are Nagaland (12%) and Chattisgarh (16%).

The reasons, I learn, are of course multi-faceted. First, there's the poverty and lack of infrastructure. Accessibility is a huge challenge; the hospital cited that some women travel over 40 kilometers to deliver there. There are cultural reasons as well, with tribal communities distrusting hospitals and preferring traditional birth attendants. Of course, nothing is inherently "bad" about home deliveries. But it is about quality and health of the mother prior to delivery. In Jharkhand-- a relatively newly-formed state-- maternal mortality is 371 per 100,000 births, as compared with the national average of 301 per 100,000 births.

There are some great initiatives happening to improve the quality of care happening at the community level, such as MANSI, the Maternal and Newborn Survival Initiative.

At the same time, there is also much more than can be done to integrate community programs with hospitals themselves, which is where KGVK comes in. Through their Total Village Management approach, they target key villages to provide holistic services -- not only in health, but in education and livelihood as well.

It's an incredible opportunity to both share learnings of our hospital to a region much in need of innovations in maternal health, as well as learn more about the multi-faceted challenge of converting need into demand, in the most challenging of settings.

Night Life in Ranchi, Jharkhand

Deliciousness

Had the most incredible dinner last night. "Restaurant Week" has found its way to Delhi, and Tyler and I made reservations at Indian Accent, which we only discovered a couple months ago and took Giselle to when she was visiting.

Ironic that it's called "Indian Accent", since by far the most common accent in the restaurant were American...

We ate the most incredible "nouveau"-Indian food, including stuffed naan filled with blue cheese for complementary appetizers, masala wild mushroom dosas for main course... and ending the meal with melt-in-your-mouth banana caramel cheesecake.

Easily the restaurant I'd recommend most to anyone visiting Delhi!

The Fun Theory

I recently read a great book called Nudge: Improving Decisions about Health, Wealth, and Happiness by Richard Thaler and Cass Sunstein. At the core of the book is the notion of inertia and the power of the default -- and knowing this, what can be done to gently nudge people towards decisions that are ultimately better for them and their health (while still leaving them power to make whatever decision they want). For example: they note the significant change in outcomes and purchasing decisions when fruit is placed at eye level with children in school cafeterias, rather than candy and dessert.

Peter, an obstetrician working with IHI who spent a week consulting with us at LifeSpring, talked about something similar: devising an overall system so that the easy, default option is the also the safest option in a hospital setting.

My friend Chris takes this one step further. During our Acumen fellowship, he was always known for asking: "How can x be more fun?" -- whether "x" is going to the doctor for an antenatal care checkup, buying glasses, or marketing an ambulance. He recently sent this great video on "The Fun Theory," asking what if taking stairs can be made more fun?! To watch, click here.

What's interesting is that in the end, these are all ultimately design challenges and solutions -- makes me think back to our design sessions with IDEO all these years back. One thing's for sure: I wish someone would install something like these musical steps in Hyderabad!

Then again, I think I'd settle for sidewalks.

The strategy of hope over despair

I'm sitting here in a coffee shop at Khan Market, reading all sorts of depressing statistics about maternal and child health in India and Africa: in Ghana, where I'll be going in a few weeks as part of our partnership with the Institute of Healthcare Improvement, 40% of deaths in children under 5 years old happen in their first month of life. Of those, 50% of deaths happen on the first day of life, with another 25% happen within the first week of life. The situation is similarly bleak in countries like Malawi, where half of all births happen without a skilled practitioner, and one out of seven women face the risk of dying due to complications during pregnancy.

Suddenly, Shakira's "Waka-waka: It's Time for Africa" blasts on the stereo, and I can't help but sing and bop along, all the while conscious of the dichotomy between reading bleak health statistics, and hearing a song about the vitality and vibrancy of Africa.

It reminds me of a TEDx talk by Melinda Gates, given in New York last year and which was shown during the recent TEDx event in Delhi earlier this week. In it, she talks about what non-profits can learn from Coca-Cola.

Her three main points of what Coke does, which leads to its success in a continent like Africa:

1) Utilizing data in real-time to make continuous improvements, as opposed to post-project evaluation (which is basically akin to a post-mortum)

2) Leveraging local entrepreneurs and local talent

3) Effective marketing

In fact, what was exciting to realize as I listened to her talk is that LifeSpring does each one of these, through our use of SalesForce and HIMS; hiring outreach workers from the communities they work in, and utilizing marketing strategies that translate need into demand. But without a doubt, there's always more that we can do.

The area of Melinda Gates' talk that really hit home was her discussion around marketing. At TEDx, she showed K'naan's video, "Wavin' Flag"- discussing how Coca Cola was the official sponsor of the World Cup. As the camera panned to the audience, nearly everyone was uplifted by the video -- bopping along with smiles on their faces.

And that's exactly her point: The strength of Coca-Cola's marketing is that it is inspirational and aspirational. It makes people want to be part of the community (like the Coke commercial when we were younger: "I'd like to teach the world to sing, in perfect harmony.")

Contrast this to the messaging that non-profits in global health tend to bombard communities with: "Don't deliver your baby at home"; "Don't have unprotected sex"; don't, don't, don't... And we wonder why people in the community shut us out.

It reminds me of going to a foundation in New York City. Their walls were covered in black-and-white photographs of homeless people around NY -- clearly the beneficiaries they're serving, but looking at all the photos made me so depressed that I just wanted to lay down.

Contrast this with Acumen Fund's offices in New York -- painted in loud, vibrant colors, and filled equally vibrant, hopeful photographs of people their investee companies serve -- photos that fill you with hope and inspiration, and make you want to be part of the change.

The difference is huge. And potentially can impact thousands of lives.

Running by moonlight

Maybe it was the amazing weather, maybe it was the desire to do something new, but last night, I jogged around our neighborhood with Tyler (incroyable mais vrai, n'est-ce pas?)

Sometimes it's the little things that remind you how lucky you are. We jogged inside a park right behind our apartment, with two gorgeous old domed Mughal structures in the middle, lit by the moonlight, surrounded by trees swaying to the mild evening breeze.

Outside the park wasn't nearly as peaceful, but I did have to smile when we separated to let a group of four white cows pass through us on the road, as we made our way to our usual roadside vegetable stand -- with all the vegetables neatly displayed on a blanket right on the sidewalk.

These are the moments of everyday magic I know I'll miss.

In the news

In exciting news, there was an article on LifeSpring in my favorite Indian newspaper, Mint, which partners with The Wall Street Journal.

In an article that came out yesterday called "How Services Firms in India are using Disruptive Innovation", the reporter writes:

“If price is to be the basis of competition—as it so frequently is in emerging markets—first establish the competitive price and create a rough cost structure. Then work backwards to determine what processes and resources are needed to meet the price requirement. Careful observation of customer needs will allow you to offer unique value tailored to the local market, even at low prices,” wrote Matthew J. Eyring, president of Innosight, a consulting firm started by Christensen, in a Financial Times blog in January.

This is what was done at LifeSpring Hospitals Pvt. Ltd, which tries to bridge the yawning gap between the substandard maternity services offered by underfunded public hospitals on the one hand and expensive ones available in private hospitals on the other.

Anant Kumar, chief executive officer of the Hyderabad-headquartered company, was working at Hindustan Latex Family Planning and Promotion Trust, selling condoms and pills to stop unplanned pregnancies, when he came face to face with “the crumbling government infrastructure” where the supposedly free maternity services could be accessed only after paying “bribes to security guards and nurses”.

Kumar had the business model of low-cost airlines in mind when he sought help from audit and consulting firm KPMG to offer low-cost and high-quality maternity services. The nine LifeSpring Hospitals in Andhra Pradesh charge Rs4,000 for a normal delivery, compared with the Rs6,000 charged by small nursing homes and Rs30,000 by large corporate hospital chains, he says.

Acumen Fund, which invests in businesses that focus on their social impact, has invested $1.9 million (around Rs8 crore today) for a 50% stake in LifeSpring Hospitals. Funding from Acumen and 50% ownership by HLL Lifecare Ltd(formerly Hindustan Latex) has helped the firm grow from its opening in 2005 to nine hospitals today.

For full article, click here.

Some Thursday Inspiration

To change one’s life: Start immediately. Do it flamboyantly. No exceptions. — William James

Cab ride meets Alice in Wonderland

The advantage of something like "getting water" being a huge challenge is that, when you finally get it, it's a huge achievement!!

The funny thing about living in India is how days are so up and down, and for the littlest things at that. The other funny thing is how often in a day I still think, "Only in India..."

For instance, yesterday I hop into a cab. I'm in a rush, as the Ghana High Commission in Delhi is about to close, and I need to pick up my visa for my trip there later this month. I take the first cab I see; as it's parked in front of Khan Market, I know I'm about to be taken for a ride.

"Where do you work?" -- the driver asks when I'm inside. He speaks perfect English, but I'm in no mood for chit chat.

"Hyderabad," I reply in a one-word answer, hoping to stop conversation.

His reply stuns me: "Oh, Hyderabad! Do you know Sofi? She's Swedish?"

Of course I know Sofi; she was one of my first friends in Hyderabad, but how does he know Sofi?!

"She left her cell phone in my cab once. And she just came back from Indonesia."

Somehow, only in India!

The rest of the cab ride we're yapping away, though it feels pretty surreal.

First, he keeps insisting on taking me to the Philippine Embassy. He doesn't quite understand why I'm going to the Ghanian one. Finally he asks, "So are you from Ghana? They have a football team!"

Then later on, he asks me about my family. I tell him that my parents are in Long Island, but he wants to know about my "personal family." I tell him I'm getting married in July, and he immediately wants to know my name; then my fiance's name.

"OH!! Very good marriage. Very happy happy marriage."

"Oh ya? -- why's that?"

"Because!! Double T!! T and T!!!!!" -- he is so excited about this point that he turns around to look at me; meanwhile, we are driving literally on the sidewalk to avoid traffic!

He continues: "Means you are very compatible. AND he is here in India too, even though he is not Indian. Very happy, very happy."

I laugh. He keeps telling me how white my teeth are, which he says is another good sign that I am happy. (this starts to feel like a Colgate commercial)

Then he goes into my numerology, which you get by adding up all the digits of your birthdate until you get to one single digit. "Ah, 9" - he says. "This means you are very idealistic. Gandhi was a 9."

Needless to say, a very eventful cab ride, and I didn't even mention the accident we got into (and yes, we were literally driving on a sidewalk).

As I get out of the car, he hands me his business card, telling me to call him anytime I need a ride. "You can call Sofi and get her opinion of me." A cab driver giving references -- now that's good marketing!

And just like that, some peace

Still irritated at all things India, I pick up a book written by a mentor of mine, Marshall Goldsmith. He writes:

It's not that bad.

If you step back, you'll discover that you're still in control of your life and destiny. You have the power to create significant positive change.

Which begs the next question: What can you change? The answer is simple: You can change either You or It.

By You, I mean how you think, how you feel, what you say -- basically everything about you that's under your control.

It, on the other hand, refers to any influencing forces in your life that are not you...

It's a stark unambiguous binary. Yet a lot of us make the wrong choice. We try to change It when we should be changing something about ourselves -- and vice versa.

And just like that, a shift.

The battle for water, part 2

Three hours later, and still no water.

I take a walk to the shop to see what's happened. Turns out, after all that, someone came to deliver and then the family's maid downstairs said I wasn't home and sent them back. Then they sold their ONE 20-liter jug to someone else, and was surprised that I showed up at their shop.

Ah, India. Why does it feel so often like you're conspiring against us?

The battle for water

As context: we are out of water in our 20 liter-jug at home. One of the benefits of India is that absolutely everything gets delivered to your house. The disadvantage:

Me: "Hello, I'd like to order one 20-liter water to B-5."

Pooja Store: "Not possible. Call back at 11am tomorrow." (hang up)

Me: "Hello, we got disconnected. I'd like to order water."

Pooja Store: "Water is not here."

Me: "We order from you all the time."

Pooja Store: "Water is not possible." (hang up)

Me: "HELLO, we got disconnected, why are you saying there is no water?"

Pooja Store: "Water is not possible." (hang up)

Me: ring, ring, ring... clearly now avoiding me

(3o seconds later)

Me: "HELLO!! Why are you saying water is not possible? I would PLEASE like delivery tonight."

Pooja Store: "Delivery?"

Me: "Yes, delivery to B-5."

Pooja Store: "OK, water will be there in 15 minutes."

Seriously?! Just another example of the country's low-level sniping, designed to wear on your defenses... I'd laugh, if it weren't just so tiring.

Not so bad... and actually, really fun!

As my last post suggests, I've really never liked public speaking. Actually, that's putting it mildly. I've always downright dreaded it! Of course, I've learned to get past this, since it's obviously an important skill. But I never actually had fun speaking to a large audience.

That all changed with TEDx yesterday. Drawing from coaching lessons from the Ariel Group (an incredible firm that focuses on leadership presence and is so much fun to work with), I took a few deep breaths and set my intention: to inspire.

Then I got on stage and had fun. As I learned: a fundamental shift starts to happen when you stop being consumed with how others are perceiving you, and instead, let your passion shine through.

Not quite sure it was the best talk I ever gave (as TED inspires this to be!), but I certainly was more present than ever before. I was even able to laugh when a stand-up comedian came on long after me, and said to the audience: "Is Tricia here?" -- when he didn't see me wave my arm, continued with -- "OK, good, we can talk about her now." Ha. I'm learning it's a big relief to stop taking myself so seriously.

Here's a short snippet from the end of my talk, which sometimes I can use some reminding of myself:

My point here is this: in finding what you're passionate about, you may very well feel like you're disappointing people you love, or feel like you're letting down people who have very different expectations for you. But let me assure you, this is only temporary--

Because there's nothing like the light that shines from people who live their life passionately, deliberately, and courageously.

An incredible mentor, Jacqueline Novogratz, often says: "To whom much is given, much is expected."

That inspires me.

What inspires you?