All Marketers are Liars

Going through all my old books in my office... a line from Seth Godin's book popped out:

"An idea in a book or on a whiteboard has no impact. Just like a virus, an idea needs a host, a brain, to live in."

Hello world!

I met someone recently, and when I told her where I worked, she said, "Wow, you must have seen hundreds of deliveries!"

While definitely not the case, witnessing deliveries take place and seeing babies in their first moments of life definitely rank high in my long list of memorable moments here at LSH.

In the first c-section I observed, I stood in awe as Dr. Vasantha, our first doctor at LSH, pull the baby out of his mother's womb... all the while clutching for dear life to his umbilical cord!

In each of the two I observed this week, I learned more and more about the medical aspects of c-sections and deliveries (albeit from a very low base!) The baby girl I saw was incredibly active from the get-go. When the doctor placed oxygen over her head, she kept clutching the sides of the oxygen tent, opening and shutting her hands, and kicking her legs and feet. She reminded me of the baby boy I saw in rural Jharkhand, who at ten minutes old, kept kicking his blanket off as though to say: "Let me out in the world! I'm ready!"

The most incredible moment is seeing the newborns blink their eyes, and slowly start to open them. Witnessing that moment feels like such a miracle to me. You just wonder what they're seeing and thinking -- and how different their lives were just five minutes before.

I also love watching the pediatrician wrap up the baby and take it to its new family -- the happiness of the grandmother, and the awkwardness of the new father.

This morning, I observed my first normal delivery, performed by Dr. Radhika. Let's just say I have a new-found respect for all mothers out there!

Some pictures of the c-section baby I met this week, at about five minutes old:

Tiny fingers!! The baby weighed 2.7 kgs. She is the second child of her mother, who delivered her first at Gandhi Government Hospital.

This baby could not stop moving!! -- constantly moving her arms and legs, and looking all around the room, trying to make sense of her new world.

What's a "useful" purchase after all?

Just read a fantastic article that Tyler forwarded to me from Foreign Policy entitled: "More than 1 billion people are hungry in the world: But what if the experts are wrong?", written by Abhijit Banerjee and Esther Duflo, the founders of J-PAL.

The article is essentially about the reasons that the poor don't make the purchasing decisions that we think they should -- for instance, more food to feed their families.

They write: "In Udaipur, India, for example, we find that the typical poor household could spend up to 30 percent more on food, if it completely cut expenditures on alcohol, tobacco, and festivals. The poor seem to have many choices, and they don't choose to spend as much as they can on food. Equally remarkable is that even the money that people do spend on food is not spent to maximize the intake of calories or micronutrients. Studies have shown that when very poor people get a chance to spend a little bit more on food, they don't put everything into getting more calories. Instead, they buy better-tasting, more expensive calories."

This certainly resonated with my visit to the communities today. Above the four story buildings that the government set up for low-income families (where families live free of charge, with the exception of paying for electricity), other families have set up corrugated tin shacks, covered with tarp and other materials. Walking up to the roof and peering into these tents, I was quite surprised to see that this one, below, has a large television set. Clearly development tools such as Grameen's Progress out of Poverty Index, which measures the poverty of households based on the presence of certain goods, do not tell the whole story.

As the Foreign Policy article points out, these tend not to be impulse decisions, purchased on credit. Rather, decisions to buy something like a television set are carefully thought up, with money saved over time. And these purchases may not be so illogical after all. There's boredom, after all -- the desire for entertainment and perhaps to escape one's surroundings. This phenomenon doesn't seem to be restricted to suburban Americans.

The article ends with the authors speaking with an Indonesian farmer: "We asked Oucha Mbarbk what he would do if he had more money. He said he would buy more food. Then we asked him what he would do if he had even more money. He said he would buy better-tasting food. We were starting to feel very bad for him and his family, when we noticed the TV and other high-tech gadgets. Why had he bought all these things if he felt the family did not have enough to eat? He laughed, and said, "Oh, but television is more important than food!"

I'd bet that the woman living in this shack would agree, as well.

Shades of Grey

Just got back from the communities with Priya and Grace, one of our outreach workers. We had recently found out that a couple of our Foundation cases ultimately delivered at home, despite having their delivery sponsored, and we wanted to better understand why.

The resulting conversations confirmed what three years living here have taught me: a) there are no easy answers, and b) it's never just about the price.

Theory would say that given the chance to deliver at a high quality private hospital, very low-income women with no alternatives other than delivering at home or at a government hospital would jump at the chance. But reality is not so straight-forward.

Of course, many low-income women do jump at the opportunity and are thrilled to deliver at our hospital, speaking to us about their dreams for their babies.

But others are not. We spoke to one woman today who is pregnant, but not interested in birth sponsorship, although she lives in a small shack given by the government as free housing. When asked, she said that her neighbor will come and deliver the baby at her house for her. Is her neighbor any sort of clinician or nurse? "No, she is poor and uneducated" was the reply... "She is in her 80s" -- her age, then, makes her a key influencer and decision-maker in the community. She has delivered other babies here, in a community where delivering at home is what's considered "normal." To shift the paradigm, then, "normal" must be redefined.

When asked if she was fearful of delivering at home, she replied: "Why would I be fearful? All my family will be with me."

In the public health space, a lot is always talked about regarding "education." Information is clearly important. But there are also considerations based on some degree of logic, which also must be addressed. For instance, why travel to a hospital if your neighbor can deliver your baby? -- AND she has experience doing this with people you know and love? -- nevermind she has no medical background.

And thus the tip of the iceberg, in the challenge of converting need to demand.

Systems Theory

I am finding systems theory more and more fascinating each day. Originally introduced by my mentor in business school as a way to explain the "whitewater world" we live in, I find it increasingly applicable not only in professional terms, but life as a whole.

This morning, I was reading an article on systems thinking called "Leverage Points: Places to Intervene in a System" by Donella Meadows. While the entire article was applicable professionally, its conclusion expanded beyond just that.

She writes:

There is one leverage point that is even higher than changing a paradigm. That is to keep oneself unattached in the arena of paradigms, to stay flexible, to realize that no paradigm is "true"... It is to "get" at a gut level the paradigm that there are paradigms, and to see that that itself is a paradigm, and to regard that whole realization as devastatingly funny... If no paradigm is right, you can choose whatever one will help to achieve your purpose... It is in this place of mastery over paradigms that people throw off addictions, live in constant joy, bring down empires, found religions, get locked up or "disappeared" or shot, and have impacts that last for millennia...

You have to work at it, whether that means rigorously analyzing a system or rigorously casting off your own paradigms and throwing yourself into the humility of Not Knowing. In the end, it seems that power has less to do with pushing leverage points than it does with strategically, profoundly, madly letting go.

Inner Bureaucracy

Lately, I feel like many of my conversations have revolved around the sometimes-painful disconnect that can exist between an organization's incredible goals about impacting the world, and the culture that can exist in the organizations themselves, which can, at its worst, be nothing less than soul-crushing.

So this blog post particularly resonated with me. The author writes:

I have to admit, my yearning for control often outweighs my yearning for a better world. My visions are large, but my daily interactions are laced with an urge to put things in nice orderly lines and boxes...

Struggling with my need for control -- my inner bureaucracy -- in this way makes me wonder how social purpose organizations can work on keeping their own rigid and controlling tendencies at bay. Control always involves reinforcing things as we know them, quite the opposite of the energy that is needed to craft the world anew. Social change requires a certain wildness of spirit.

She and her colleague from "Organization Unbound" will be coming to Delhi this weekend, and I'm really looking forward to having coffee with them on Monday. Her post and reading more about their organization have re-reminded me of what I came to India to learn, inspired by my work with Katzenbach: helping social enterprise organizations become more effective organizationally. This need was a hypothesis I came here with. But after working here over three years, it has become very clear that talent -- much more than money -- is the critical gap in enabling social enterprises to scale.

Showered with love and advice

I was recently looking at tours of Hyderabad -- Tracy had recommended a fantastic tour guide named Jonty. There was an entire eight hour tour dedicated to Indian marriages -- learning about the customs, symbolism -- with the lure of potentially crashing your own Indian wedding!

My own learnings of Indian weddings and marriages have been through dabbles here and there... the Delhi marriage education workshop that specified which cousins you're allowed to marry and which cousins you're not... dinner with a colleague where he spoke of meeting his potential bride-to-be at a wedding; then interviewing her with all his cousins the next day to see if they were a match... but his cousins asking all the questions so he couldn't get a word in edge-wise! (they were married a few months later)... of course the bio-data (or "resumes") that parents carry for their children. The one that I still can't get over are the marriages that are already planned for the current year; insert spouse here: "He'll be getting married this July. We just have to find the bride."

I have to say, though, that I do love all the traditions, the history of each wedding I attend. Far less than just a party, there's also centuries of tradition in every step, with knowledge being passed along the way. Take the Sangeet, for instance. Traditional Sangeets were comprised of the bride-to-be's mother and other female relatives singing and dancing to the bride-to-be about marriage, and through this, giving advice on marriage and what it means to be a wife. More modern Sangeets now include men, as well.

Maybe it wasn't singing and it certainly wasn't dancing, but I had my own American version of this a couple weeks ago, in my bridal shower in NYC. Thrown by my parents at the Waldorf, it was the perfect way to see so many people who are important in my life. Held appropriately in the Marco Polo Room, Susan also ensured it had an Indian air through a sitar player who played throughout the event.

Perhaps the most meaningful, as well as most fun, part of the event came with my mother asking each woman in the room to write advice for me on a piece of paper given at the tables, thus "showering" me with their "recipe" for a successful marriage (with cooking a key theme of the event).

Elizabeth and Jeanne collected these, and three were selected from the bag to be read out loud. Katie advised remembering how you feel on your wedding day -- all the love, the butterflies, the way you feel about the person you've just married.

The older generation, perhaps not surprisingly, had a lot more practical things to say: "Be nice to your mother-in-law"; "ALWAYS ALWAYS ALWAYS have a separate bank account that he doesn't know about"; "Give your parents grandchildren ASAP."

A few pictures from the event:

For the love of the game

There's definitely something about being back in the US during baseball season. Seeing all the familiar faces, all the anticipation that the beginning of each season holds... I even won Yankees tickets in a benefit raffle, but alas, am now back in Hyderabad too soon to watch my team.

I gotta say, though, as much as I love the Yankees and the thrill each time we beat the Red Sox... it doesn't hold a candle to the visceral national ecstasy that filled the air when India not only beat Pakistan in the World Cup semi-finals, but then, against all odds, went on to beat Sri Lanka in the finals earlier this month!!

Priya makes fun of me and Tyler for sitting in a Chinese restaurant while madness ensued all around us. But despite that, we definitely caught the euphoria walking back home. Hyderabad let loose in a way that I've never experienced: men waving huge Indian flags on the back of their motorcycles, speeding down Road 10; dancing in the streets; local fireworks galore.

The excitement, passion, and national pride were palpable. One billion fans celebrating.

Some incredible pictures of the sub-continent living and breathing cricket during the World Cup from Boston.com. As Dan says, it's pure passion to play on a staircase, on the tracks, on a roof... and the green hair is pretty cool too!

Memory Lane

In New York for my five year business school reunion this weekend. Going through old pictures, and came across notes I took during SIPA graduation, which still resonate so much today:

I hope your life is truly satisfying--
But that you are never fully satisfied.

May you have the courage to take great risks to do what is right.

And as you go out into the world,
May you be accepting without being complacent.

Above all, may you have the courage to be true to yourself.
Because before you can make the world a more peaceful place,
You must first find the peace within.

Perspective, again.

9am, stuck in traffic that's bad even for India. I'm stressed about just about anything: work that's waiting for me at the office, wedding tasks that I feel I've been slacking on, and to top it off, we haven't moved in the last five minutes. I continue to stare straight ahead of me on the right side of the car.

Something makes me look left. And just like that, I am bolted back to the present. A completely disheveled little girl, around age 7, carries her naked brother, similarly disheveled. They live in a tented community right along the road -- the families of the construction workers who have migrated to Hyderabad to work on the massive building being constructed.

The tents are thin blue tarp; laundry hangs on lines connecting the tents; a police officer nearby kicks at their few possessions. I'm told that this community are a group of "Lambada" - a large tribal group, whose members speak "Lamani".

And that's what India does to you, time and time again. Just when you start to get obsessed about your own internal dramas, something makes you look around and see the reality of the here and now, which puts everything in perspective.

Stuff stuff and more stuff!

Today is Ugadi: New Year's Day in the Deccan region of Andhra Pradesh and Karnataka. "Uga" means "era", and "aadi" means "start", so today is the "start of an era."

And what better way to start off an era than to clean out the old, to make room for the new. Sitting on the floor of my office, papers strewn around me (thank goodness today is an office holiday!), I've started to spring clean and organize all of my "stuff"... almost four years of it!

Inevitably, it's a trip down memory lane... binders from my visit to Baptist Hospital in Pensacola, Florida, in many ways the inspiration for exceptional customer service at LifeSpring... the blown-up photo of our original marketing team on a retreat near our coastal hospital... due diligence reports of potential sites, when a hospital there was only a thought on paper.

It really does boggle my mind how much "stuff" has been collected... books that I intend to read "someday", photos and cd's that I will file "eventually." I've been doing a lot of research on Lean recently, and my filing system certainly does not fall into that framework! In the "Happiness Project", the author writes about how much satisfaction and happiness result from just reducing clutter; she is proud of her ensuing "empty shelf."

I can barely keep my own New Years resolutions, so I'm hesitant to make one for Ugadi. But since it is a start of an era, I commit to spring cleaning once a quarter, continually making room for the new.

Ganesh, the Hindu god of new beginnings, is going to need to help me a bit on this one...

Perspective

It's like the Indigo Girls song: "They published your diary, and that's how I got to know you... And here's a young girl, on a kind of telephone line through time."

For the past 24 hours, I haven't been able to get Julia Rusinek out of my mind. One of Brian's best friends in high school, she died tragically the summer of our sophomore year in college.

Recently, Brian sent me a link with her letters home from camp: http://juliarun.org/campq.html

She must be one of the most mature nine-year olds I know! (and boy, does she like candy!)

Her website pulls you in and haunts your mind, wondering why tragedies such as this need to happen. Her parents have started a fund, now 12 years old, to celebrate her life and to honor the ideals for which she lived: http://juliarun.org/fund.html

Her eulogy is beautiful:

"For between when we live and when we dream, when we dream and when we hope, and when we hope and when we love, there is Julia."