This fall I'll be writing a piece for the Rice Standard that will analyze the similarities and differences between China and India. That article will be considerably longer than this blog post, but I thought I'd post a "sneak peak" of what that article will look like.
In a 10 month period I've been through countries that represent over 42% of the world population (China, India, United States, and South Korea). The largest of these, China and India, both contain over a billion people, and the two Asian supergiants are both emerging as major players in the world economy. The differences and similarities between the two are fascinating, and after visiting both countries and seeing the major similarities and differences, I wanted to post an examination of where the two nations currently stand, and where I feel like they'll be in the future. Certainly this is a very important issue to us as Americans, because the way the two countries interact with us defines how our economy runs.
First, I might mention some similarities. First of all, it's unbelievable to see the amount of construction going on in both countries. Especially as you go out from the cities, construction cranes dot the horizon. The difference seems to lie not so much in the amount of construction, but in what is being constructed. China specializes in the production of cheap goods. Indeed, whole cities are often devoted to the production of a single product. India produces products as well, but as we're all aware, it's probably more likely to here the thick Indian accent on the other end of the phone when calling for customer support for your electronics than it is to see "Made in India" on the back of that same device. Conversely, few of us have heard a Chinese voice answering tech support, whereas "Made in China" is ubiquitous on all our products.
China and India are both trying to eat up market sure in all sorts of ways. They have both had varying degrees of success, but with very different methods. Both countries have very different but very ancient pasts, and both have had difficulty in coming to terms with the West. However, they both have come to their present success in very different ways.
Indian civilization dates back to the Indus River valley civilizations, but its history has long been a history of various civilizations encroaching on the subcontinent and establishing foreign rule over the land. This history of foreign occupation dates back to the time of Alexander the Great and moves forward through various other occupations all the way up to the time of the British. In 1948, India became a sovereign state, but it took almost a half a century for it to establish the strength to assert itself as a world power. China, on the other hand, has long been a sovereign nation, and the second half of the 20th century was more or less spent trying to figure out how a communist government could still assert itself with the West.
Today, the Indian economy is free market, capitalist, and in many ways, out of control. The market has complete control over the Indian economy, and it looks like utter chaos. Aside from a small minority of Indian businessmen who have been able to raise substantial capital, most Indians are limited to the little capital they can afford, forcing them to go into a business that infringes on an already saturated market. After all, how many cloth stores can one possibly have on one street? The Chinese economy, by contrast, is one of forced order. The Chinese have become exceedingly efficient (though not perfect) at identifying market forces and capitalizing on success and stamping out failure.
The mindset between the two nations is markedly different. The Indians value the individual (much as we Americans do), such that if someone wants to try something, they have the right to try and do it, no matter how it negatively affects that market as a whole (or at least, how it's perceived to negatively affect the surrounding market). The Chinese value society as a whole, seemingly at the expense of the individual, such that they pick and choose where to place their capitalization.
The question that follows is, "Which one is better?" It's not an easy question, and at this point I'm going to make a shameless plug and leave you hanging--I'll delve much deeper into this question in the fall and further analyze the nations of China and India.
Sunday, August 2, 2009
Friday, July 31, 2009
Home, sweet home
After 36 hours of traveling, a really good burger, and 13 hours of sleep, I am back in the United States. I suppose there's not a whole lot to this post--travel went smoothly, though it was a bit long. I'll post a couple more reflective thoughts to this blog, so this isn't my final post. I had a fantastic summer, but it is really good to be home.
Tuesday, July 28, 2009
Religion in India
In a single blog post there is no way I can do justice to the topic of religion in India. India is very rich in religious tradition, and without a doubt is a defining part of Indian culture. Both the United States and India are effectively pluralistic with respect religion, though they are dominated by very different religions. Instead of churches and steeples dotting the landscape, little Hindu shrines are omnipresent. Almost completely absent are any signs of Christianity, and despite being the second largest religion in India, we rarely saw an Islamic mosque (and I only heard the muezzin's adhan once in a predominantly Muslim slum).
Hinduism is the most dominant religion in India, but we've found that it largely tends to be a religion of culture, rather than a religion of ideology. In other words, while other religions are often bent into a philosophical worldview, Hinduism does not seem to be perceived in the same way. I don't pretend to understand the nuances of Hinduism, so I'm not going to even try, but it is interesting to see the effects of the religion on India. When the nation of India was formed, it was largely on religions boundaries. As I've noted previously, Pakistan was formed as the Muslim part of British India and India was the Hindu part (with areas like Kashmir being the notable exceptions). Unlike Pakistan, which became an Islamic state, India was officially a secular state from the beginning (the Indian Constitution guarantees religious freedom).
Hinduism originated in India (or rather, it originated in ancient India, since it is essentially the world's oldest religious tradition), but it certainly wasn't the only religion that originated in India. Sikhism, Jainish, and Buddhism all have their roots in India as well. Hinduism is by far the most dominant of the four, but their is little conflict between them, perhaps due to the fact that unlike Islam or Christianity, none of these four religions are proselytizing.
Islam is the country's second largest religion, making India by some counts the world's largest Muslim country. Yet Islam in India is different from the Middle East. Muslim women still dress with the hijab and sometime even more coverings, but by and large, Indian Islam is not of the extremist brand that plagues many Arab countries. Indian Muslims do not seem to have latched onto the extremist terrorist groups that America is in an ideological war with. Perhaps this is a result of a tolerant majority population as well as a relatively stable government and economy. Muslims in India are not driven to hatred of the West, because the West comes to India bearing gifts of call centers and fiber optic cables.
One of the things I personally miss the most about America is the presence of Christianity. There are no churches to be seen here (save for trips to Goa), and I miss going to church. Only about 2% of the population is Christian (making it the third largest religions group in India), and many of those Christians are concentrated in certain areas (e.g., in Goa) where European missionaries had a greater impact. India is also unique in its treatment of Jews. India was one of the first countries to recognize Israeli independence, and was also a haven for those fleeing the Holocaust. As a result, while there isn't a large Jewish population in India, there is a significant enough of one to merit mention. I find it a bit ironic that India maintains such a close relationship with Judaism and Israel when the swastika features prominently on everything from the front of trucks to the doorframes of people's homes. In fairness, the swastika existed in India long before Hitler adopted it and made it forever associated with genocide.
Like most pluralistic countries, India has had its share of religious troubles. For example, the Mumbai riots in 1992 (featured at the beginning of Slumdog Millionaire) aren't exactly a bright spot on India's history. Hinduism is still evolving to adapt to a 21st century world with its concept of the caste system (also made illegal by the Indian Constitution). Yet the dalits (untouchables) are still often left out to dry in this system, and many have converted to Buddhism or Christianity as a way out of their suffering. Mother Teresa was famous for her work in Calcutta (now Kolkata) working with the poor living there and for her work on behalf of the Christian Dalits.
No state is perfect in its treatment of religion. India is a very religious country--very few people are professed atheists or agnostics (none that we interviewed for our study at the hospital), which perhaps reflects the idea that religion reflects your personal identity rather than your concept of how the world works. As I've written previously, your profession helps define your identity as well. It will be interesting to see how India adapts to the Western mindset of a more philosophical form of religion and a more diverse set of moral values. I wonder how Hinduism will change in the future and whether other religions will start to rise in Indian society as the world gets smaller.
Hinduism is the most dominant religion in India, but we've found that it largely tends to be a religion of culture, rather than a religion of ideology. In other words, while other religions are often bent into a philosophical worldview, Hinduism does not seem to be perceived in the same way. I don't pretend to understand the nuances of Hinduism, so I'm not going to even try, but it is interesting to see the effects of the religion on India. When the nation of India was formed, it was largely on religions boundaries. As I've noted previously, Pakistan was formed as the Muslim part of British India and India was the Hindu part (with areas like Kashmir being the notable exceptions). Unlike Pakistan, which became an Islamic state, India was officially a secular state from the beginning (the Indian Constitution guarantees religious freedom).
Hinduism originated in India (or rather, it originated in ancient India, since it is essentially the world's oldest religious tradition), but it certainly wasn't the only religion that originated in India. Sikhism, Jainish, and Buddhism all have their roots in India as well. Hinduism is by far the most dominant of the four, but their is little conflict between them, perhaps due to the fact that unlike Islam or Christianity, none of these four religions are proselytizing.
Islam is the country's second largest religion, making India by some counts the world's largest Muslim country. Yet Islam in India is different from the Middle East. Muslim women still dress with the hijab and sometime even more coverings, but by and large, Indian Islam is not of the extremist brand that plagues many Arab countries. Indian Muslims do not seem to have latched onto the extremist terrorist groups that America is in an ideological war with. Perhaps this is a result of a tolerant majority population as well as a relatively stable government and economy. Muslims in India are not driven to hatred of the West, because the West comes to India bearing gifts of call centers and fiber optic cables.One of the things I personally miss the most about America is the presence of Christianity. There are no churches to be seen here (save for trips to Goa), and I miss going to church. Only about 2% of the population is Christian (making it the third largest religions group in India), and many of those Christians are concentrated in certain areas (e.g., in Goa) where European missionaries had a greater impact. India is also unique in its treatment of Jews. India was one of the first countries to recognize Israeli independence, and was also a haven for those fleeing the Holocaust. As a result, while there isn't a large Jewish population in India, there is a significant enough of one to merit mention. I find it a bit ironic that India maintains such a close relationship with Judaism and Israel when the swastika features prominently on everything from the front of trucks to the doorframes of people's homes. In fairness, the swastika existed in India long before Hitler adopted it and made it forever associated with genocide.
Like most pluralistic countries, India has had its share of religious troubles. For example, the Mumbai riots in 1992 (featured at the beginning of Slumdog Millionaire) aren't exactly a bright spot on India's history. Hinduism is still evolving to adapt to a 21st century world with its concept of the caste system (also made illegal by the Indian Constitution). Yet the dalits (untouchables) are still often left out to dry in this system, and many have converted to Buddhism or Christianity as a way out of their suffering. Mother Teresa was famous for her work in Calcutta (now Kolkata) working with the poor living there and for her work on behalf of the Christian Dalits.No state is perfect in its treatment of religion. India is a very religious country--very few people are professed atheists or agnostics (none that we interviewed for our study at the hospital), which perhaps reflects the idea that religion reflects your personal identity rather than your concept of how the world works. As I've written previously, your profession helps define your identity as well. It will be interesting to see how India adapts to the Western mindset of a more philosophical form of religion and a more diverse set of moral values. I wonder how Hinduism will change in the future and whether other religions will start to rise in Indian society as the world gets smaller.
Monday, July 27, 2009
A trip to the world's largest city
Mumbai, or Bombay as it was formerly known, is a teeming metropolis that is unlike any city I've ever visited. I commented while I was there that it was like New York City in the tropics, but that's only part of the story. Mumbai has an identity all its own, from the slums of Dharavi to the expensive waterfront apartments. Despite its terrible climate and smog-choked streets, people flock to the city in hopes of a better life and a higher income.Getting around the city during the monsoon season is a I don’t think any trip to India is complete without a trip to Mumbai. Formerly known as Bombay, the world’s largest megacity is the epicenter of Indian culture, society, and commerce. We hardly had a chance to dig deep into the city’s underbelly and experience its nightlife. However, we were offered the opportunity to visit the city and get a brief glimpse of what the city looks like.
Mumbai is quite frankly unlike any other city I’ve ever experienced. It’s a far grittier than any Western larger city, with the city bursting at the seams with its massive population grinding out their lives. As soon as we got into the city, it was immediately noticeable by the amount of traffic. The streets of Pune seemed absolutely tame compared with the number of cars and the number of people all trying to get around. The situation has led to a whole host of infrastructure problems. During the monsoon season, the city is prone to flooding, which leaves transportation at an utter standstill. Just going a few kilometers can take hours. Recently, progress has been made in improving infrastructure, most notably with the addition of a 3-mile-long bridge over the Arabian Sea that connects the Mumbai suburbs with the mainland.
Upon arrival to central Mumbai, we saw exactly what every tourist coming through Mumbai is supposed to see: the Hotel Taj Mahal and the Gateway of India. Neither of these structures is a particularly remarkable architectural achievement, and they draw their significance from some of the key events that surround them. The Gateway of India was built about a hundred years ago to commemorate the arrival of the British Royalty. Ironically, the last British troops to leave India left through the Gateway of India in 1948.
The Hotel Taj Mahal, unfortunately, bears little resemblance to the famous landmark in Agra, but it is significant in its own right. The hotel is the flagship of the Taj Hotel system, which is known for some of the top hotels in India (the hotel we stayed at in Goa was a Taj hotel), and without a doubt is one of the most famous hotels on earth. Unfortunately, fame in today’s world is not always a good thing. Like New York City’s two most famous towers, pro-Pakistani extremists targeted the hotel along with seven other locations in an act of terrorism against the Indian people. We remember the day the Twin Towers Fell as 9/11. Indians remember the Mumbai attacks, which left at least 173 killed on November 26 of last year as 26/11.
Like the response to our own terrorist attacks, there has been an increased sense of patriotism in the country, as well as a far greater sense of vigilance. Security guards and their metal detectors are posted outside virtually every mall, hotel, and high-rise building. For the most part, their jobs entail stopping camera-happy tourists like myself from taking pictures of “strategic” areas (read: nice office buildings) and using mirrors to look underneath cars. In addition, memorials have been placed in memory of the attacks and the people they killed.
Our next stop was another location of the Mumbai terrorist attacks: Chhatrapati Shivaji Terminus (formerly Victoria Terminus). Fortunately, despite being the location of the brutal terrorist attacks of last year, the railway station is far more well known for another important role: it’s the railway station in Slumdog Millionaire. I don’t think it can fully be expressed in the movie what this station is like—it’s an absolute madhouse. when a train arrives you just see people start pouring out and the previously empty platform becomes a swarming mass of humanity.
Perhaps this, more than anything, sums up what Mumbai is like. Mumbai is overpopulated, choked by poor infrastructure and pollution, and has a stifling climate. Yet despite all of that, Mumbai is in a very real way the crown jewel of the Indian subcontinent. It is the epicenter of the culture of India. Bollywood and the hundreds of movies it makes every year is in Mumbai, and the high rent district along the waterfront is occupied by wealthy Indian businessmen and celebrities just a few miles from some of the largest slums on Earth. It is also the economic center of India, with many of India’s largest and most famous companies based in the city and 40% of India’s foreign trade going through Mumbai.
In conclusion, I couldn’t help but recognize the vast contradiction that Mumbai lives in. It’s a city that is undoubtedly one of the most cosmopolitan in India and certainly seems more “Western” in its attitude (at least compared to Pune), but still has an infrastructure that was outdated decades ago. It’s a city where we saw a Bollywood movie star being interviewed in the shadow of some of the most expensive property in the country just a couple hundred yards from where a young woman with a child was begging for money to feed themselves. However, it is no different in the fact that like all cities, it has its problems that need to be fixed. In spite of this, a trip to Mumbai was well worth the visit, and I’m very glad we were able to do it.
India's gift to me
I sincerely apologize for my brief hiatus. I have lots of half-written posts I'm eager to finish and put online. All it's going to take is a little motivation on my part. Unfortunately, the past few days have been spent fighting some of the nastier little microbes India has to offer. Thus, I've been unable to put the time and effort into my latest post regarding our recent trip to Mumbai.
Aside from the various illnesses we've contracted while we're here, India has had a few other gifts for us. One is compliments of our dhobis--slightly browner and (in the case of my socks) slightly longer clothing. Another is compliments of a different power supply and a cheap power converter: a room that is starting to get more and more full of electronic devices that no longer work (currently on the list of casualties: a DSLR camera, 2 cell phones, and an iPod that seems to be a bit finicky).
I aim to post a few more posts before I leave for home Wednesday night, and then once I get back hopefully I'll have the time (and more importantly, the motivation) to put in a couple final posts with reflections on the trip. It's hard to believe that this summer is almost over, and while we're anxious to get home, it will be a bittersweet departure from India.
Aside from the various illnesses we've contracted while we're here, India has had a few other gifts for us. One is compliments of our dhobis--slightly browner and (in the case of my socks) slightly longer clothing. Another is compliments of a different power supply and a cheap power converter: a room that is starting to get more and more full of electronic devices that no longer work (currently on the list of casualties: a DSLR camera, 2 cell phones, and an iPod that seems to be a bit finicky).
I aim to post a few more posts before I leave for home Wednesday night, and then once I get back hopefully I'll have the time (and more importantly, the motivation) to put in a couple final posts with reflections on the trip. It's hard to believe that this summer is almost over, and while we're anxious to get home, it will be a bittersweet departure from India.
Friday, July 24, 2009
India's Social Class System
There are many things about America that we've come to appreciate while here in India. One thing that I've come to appreciate is America's social dynamics. This has become particularly apparent in the way we approach interviewing patients. There is nothing weird about asking someone what their profession, monthly income, and religion. In the United States, such questions would be patently offensive. After almost eight weeks here, I feel like I've come to realize to a small degree the reason behind this cultural phenomenon.
Part of this is just a sense of cultural openness. In a country of over a billion people, many of whom are clustered into some of the most densely populated urban areas on earth (19 of the world's 50 most densely populated cities are in India). Being in such constant close contact with people is bound to lessen the sense of "personal space," both in the concrete and the abstract. However, I think that this idea of openness runs much deeper than any recent demographic changes in India.
India has long been known for its caste system. While the caste system still persists to some degree (on several occasions people have identified themselves as coming from a particular caste to me), it is by and large absent from the cities. Originally, there were four castes (priests, warriors, traders, and servants) with a fifth un-caste, the untouchables. The Indian Constitution makes the caste system illegal, but the ideas that were driven into Indian society by the caste system are still alive and well today.
The fact is that in India, people really do seem to be identified by their career. In other words, their job defines who they are as a person and what they have done with their life. For example, the role of the driver is to be a driver in life. He may work from 9-5 (or whenever he's needed), but from 5-9, he's still "a driver." He will never occupy the same social circles as the people he drives. It has taken a significant amount of getting used to, because when we first met Vishnu, our driver, we saw him as less of a driver and more of a potential friend (seeing as how he was literally the first person we met in India). However, the driver and the driven aren't ever friends. They serve their respective roles, but never cross paths otherwise. Likewise, the dhobi and the rickshaw driver are identified by being a dhobi and a rickshaw driver, not as being ordinary human beings.
This system means that far more than in the United States, your job defines your past, your present, and your future. Drivers and dhobis are treated like dirt (at least compared to how such corollary workers in the United States might be treated). This isn't perceived as a bad thing, by either the workers or by the people they serve. It is simply the way things are. The system results from a serious lack of social mobility. Someone in America might be the son of a coal miner or the daughter of a cleaning lady and grow up to be a NASA engineer or a Supreme Court justice. In India, something like that is still possible, but it seems that your parents’ relative position in society largely determines what your position in society will be, often irrespective of talent and motivation.
This situation is actually really sad. After all, Vishnu is just as much a human being as you or I, despite the fact that we have more money or education than he does. Yet this lack of social mobility is probably partly a result of the fact that there are only so many economic niches someone can fill. When there are so many people living in so small an area with so few opportunities, there is far less opportunity to rise in the ranks of social classes. Not everyone can be doctors and engineers, and this is reflected in the fact that admission to medical colleges and engineering schools makes admission to Harvard look easy.
The American system has its own disadvantages and advantages. In the United States, where anyone can become anyone, there is a heightened sense of undeserved entitlement. This has led to all sorts of problems (including, for example, health care), but it has also allowed for social mobility. In addition, it also means that whatever someone may do during the week is largely forgotten outside of the workplace. In the evening after work, you’re no longer a salesman or a IT professional, but an ordinary citizen relaxing with friends and family. I think we call this idea of social mobility the “American dream.” India faces an enormous problem in trying to create the level of social mobility achieved in the United States. It will take an immense effort on the part of the Indian government to make high-quality education much more widely available. It will take decades, if not generations, to remove the implicit idea that the worth of a person is encapsulated in their job and salary.
Social stigmas are a big part of any culture, and India is no exception. India has a burgeoning middle class, but in order to keep it growing and increase the status of all Indians, it’s going to have to address the heart of the problems here. To a large degree, that will mean people from higher classes are going to have to reach down to offer a hand to those who they never would have considered looking at a decade ago. I hope to see the 21st century India a country of prosperous growth and social mobility. For those of us in the United States, we ought to be thankful for the social mobility we enjoy as Americans, not feel entitled to something more than we’ve earned.
Part of this is just a sense of cultural openness. In a country of over a billion people, many of whom are clustered into some of the most densely populated urban areas on earth (19 of the world's 50 most densely populated cities are in India). Being in such constant close contact with people is bound to lessen the sense of "personal space," both in the concrete and the abstract. However, I think that this idea of openness runs much deeper than any recent demographic changes in India.
India has long been known for its caste system. While the caste system still persists to some degree (on several occasions people have identified themselves as coming from a particular caste to me), it is by and large absent from the cities. Originally, there were four castes (priests, warriors, traders, and servants) with a fifth un-caste, the untouchables. The Indian Constitution makes the caste system illegal, but the ideas that were driven into Indian society by the caste system are still alive and well today.
The fact is that in India, people really do seem to be identified by their career. In other words, their job defines who they are as a person and what they have done with their life. For example, the role of the driver is to be a driver in life. He may work from 9-5 (or whenever he's needed), but from 5-9, he's still "a driver." He will never occupy the same social circles as the people he drives. It has taken a significant amount of getting used to, because when we first met Vishnu, our driver, we saw him as less of a driver and more of a potential friend (seeing as how he was literally the first person we met in India). However, the driver and the driven aren't ever friends. They serve their respective roles, but never cross paths otherwise. Likewise, the dhobi and the rickshaw driver are identified by being a dhobi and a rickshaw driver, not as being ordinary human beings.
This system means that far more than in the United States, your job defines your past, your present, and your future. Drivers and dhobis are treated like dirt (at least compared to how such corollary workers in the United States might be treated). This isn't perceived as a bad thing, by either the workers or by the people they serve. It is simply the way things are. The system results from a serious lack of social mobility. Someone in America might be the son of a coal miner or the daughter of a cleaning lady and grow up to be a NASA engineer or a Supreme Court justice. In India, something like that is still possible, but it seems that your parents’ relative position in society largely determines what your position in society will be, often irrespective of talent and motivation.
This situation is actually really sad. After all, Vishnu is just as much a human being as you or I, despite the fact that we have more money or education than he does. Yet this lack of social mobility is probably partly a result of the fact that there are only so many economic niches someone can fill. When there are so many people living in so small an area with so few opportunities, there is far less opportunity to rise in the ranks of social classes. Not everyone can be doctors and engineers, and this is reflected in the fact that admission to medical colleges and engineering schools makes admission to Harvard look easy.
The American system has its own disadvantages and advantages. In the United States, where anyone can become anyone, there is a heightened sense of undeserved entitlement. This has led to all sorts of problems (including, for example, health care), but it has also allowed for social mobility. In addition, it also means that whatever someone may do during the week is largely forgotten outside of the workplace. In the evening after work, you’re no longer a salesman or a IT professional, but an ordinary citizen relaxing with friends and family. I think we call this idea of social mobility the “American dream.” India faces an enormous problem in trying to create the level of social mobility achieved in the United States. It will take an immense effort on the part of the Indian government to make high-quality education much more widely available. It will take decades, if not generations, to remove the implicit idea that the worth of a person is encapsulated in their job and salary.
Social stigmas are a big part of any culture, and India is no exception. India has a burgeoning middle class, but in order to keep it growing and increase the status of all Indians, it’s going to have to address the heart of the problems here. To a large degree, that will mean people from higher classes are going to have to reach down to offer a hand to those who they never would have considered looking at a decade ago. I hope to see the 21st century India a country of prosperous growth and social mobility. For those of us in the United States, we ought to be thankful for the social mobility we enjoy as Americans, not feel entitled to something more than we’ve earned.
Wednesday, July 22, 2009
The Language Barrier
Before we left for India, we were assured that everyone in the hospital spoke English just fine. And to be sure, the staff does know English, and indeed, cannot work without it, since virtually all the records are written in English. The only time Marathi (or Hindi--I never know which one they're using) is used seems to be when the patient or the patient's family would need to see it. However, that doesn't mean that we can always understand what is going on. Most of the conversations between people at the hospital is in some language we don't understand, and nearly all conversations with patients is in the patient's native tongue.
India has more English speakers than any other country in the world, so long as you use the term "English speaker" loosely. English is indeed becoming more and more prevalent, but Indian English is much different from American English, to the point where Indian English is sometimes unintelligible. In addition, many people have simply a cursory knowledge of English--enough to read and write patient records and pass their English courses in school, but not good enough to carry on a good conversation with American English speakers like ourselves.
A large component of our research relies on face-to-face interviews with the patient's families. This becomes difficult when the patient doesn't speak English and we have to use a translator. Sometimes we have difficulty communicating through them, which throws a bit of a loop into our study. Even simple questions like "How many children do you have" becomes impossibly difficult. I had a bit of a sick pleasure when I started watching the exasperated doctors try to communicate with the Iraqi family here for treatment, as they share no common language with anyone at the hospital.
The language barrier has been difficult to overcome, because it's hard to get involved when you don't understand what's going on. What it has taken on our part is the motivation to ask what's going on, repeat as necessary, and if they still don't understand, leave it be and move on to the next subject. In the future, I suspect that this problem will become smaller and smaller as more and more Indians learn English better and better. Language is indeed a powerful tool, and it's clear that mastery of it is a key to (or perhaps result of) success. The fact that English is the language of medicine has allowed us to have a far better understanding of what we're seeing than we would otherwise, and the fact that English is not the spoken language of the majority made me painfully aware of my own monolingual-ness.
India has more English speakers than any other country in the world, so long as you use the term "English speaker" loosely. English is indeed becoming more and more prevalent, but Indian English is much different from American English, to the point where Indian English is sometimes unintelligible. In addition, many people have simply a cursory knowledge of English--enough to read and write patient records and pass their English courses in school, but not good enough to carry on a good conversation with American English speakers like ourselves.
A large component of our research relies on face-to-face interviews with the patient's families. This becomes difficult when the patient doesn't speak English and we have to use a translator. Sometimes we have difficulty communicating through them, which throws a bit of a loop into our study. Even simple questions like "How many children do you have" becomes impossibly difficult. I had a bit of a sick pleasure when I started watching the exasperated doctors try to communicate with the Iraqi family here for treatment, as they share no common language with anyone at the hospital.
The language barrier has been difficult to overcome, because it's hard to get involved when you don't understand what's going on. What it has taken on our part is the motivation to ask what's going on, repeat as necessary, and if they still don't understand, leave it be and move on to the next subject. In the future, I suspect that this problem will become smaller and smaller as more and more Indians learn English better and better. Language is indeed a powerful tool, and it's clear that mastery of it is a key to (or perhaps result of) success. The fact that English is the language of medicine has allowed us to have a far better understanding of what we're seeing than we would otherwise, and the fact that English is not the spoken language of the majority made me painfully aware of my own monolingual-ness.
Tuesday, July 21, 2009
Indians and Iraqis
I can't help but be amazed by just how connected our world is. As part of our research, we interviewed an Iraqi couple who had come to DMH so that their baby could have open heart surgery. Since the family couldn't speak Marathi, Hindi, or English, they had an Iraqi student studying in Pune translate for them. After interviewing them for our project, we started talking with the translator, whose name is Ibrahem.
Yesterday he called us up and asked if we could go out to dinner. I couldn't help but smile--here were four Americans and an Iraqi eating Chinese and British food in India. Despite the turmoil going on between our two nations, we had no trouble getting together with him and making friends. I suppose that's one of the joys of traveling internationally--meeting interesting people in unexpected places.
Naturally, being who I am, we started talking about how Iraqis felt about Americans and how Americans felt about Iraqis. There seems to be two sides in Iraq--those who are angry at the American occupation and want them out, and those (like Ibrahem) who are happy that Iraq is a free country now. Without Saddam Hussein, there is, among other things, the freedom of press. It is undeniable that Iraq faces a much brighter future without Saddam Hussein leading the country. It is interesting to note that Ibrahem faced significant difficulties in getting a visa to study English. Thus, he came to India to study English (rather than a country like England or Australia).
In the two years since he left for university here in Pune, Iraq has become more stable, and the link between it and the rest of the world have opened up. Ibrahem told us that someday he wants to visit America. In a very real sense, even though our various governments bicker and fight over various geopolitical issues, we as tourists and travelers are unofficial ambassadors of our respective countries. It is encouraging to know that despite the actions of our governments, there is still an inherent respect between two people, and a common interest in learning more about one another's culture. Perhaps more than anything, I believe this should be the goal of traveling abroad. When I return from India, I'll have a nice paper in hand as well as a nice collection of pictures and souvenirs. But perhaps the most valuable thing I will have developed is an appreciation of India and its culture.
Yesterday he called us up and asked if we could go out to dinner. I couldn't help but smile--here were four Americans and an Iraqi eating Chinese and British food in India. Despite the turmoil going on between our two nations, we had no trouble getting together with him and making friends. I suppose that's one of the joys of traveling internationally--meeting interesting people in unexpected places.
Naturally, being who I am, we started talking about how Iraqis felt about Americans and how Americans felt about Iraqis. There seems to be two sides in Iraq--those who are angry at the American occupation and want them out, and those (like Ibrahem) who are happy that Iraq is a free country now. Without Saddam Hussein, there is, among other things, the freedom of press. It is undeniable that Iraq faces a much brighter future without Saddam Hussein leading the country. It is interesting to note that Ibrahem faced significant difficulties in getting a visa to study English. Thus, he came to India to study English (rather than a country like England or Australia).
In the two years since he left for university here in Pune, Iraq has become more stable, and the link between it and the rest of the world have opened up. Ibrahem told us that someday he wants to visit America. In a very real sense, even though our various governments bicker and fight over various geopolitical issues, we as tourists and travelers are unofficial ambassadors of our respective countries. It is encouraging to know that despite the actions of our governments, there is still an inherent respect between two people, and a common interest in learning more about one another's culture. Perhaps more than anything, I believe this should be the goal of traveling abroad. When I return from India, I'll have a nice paper in hand as well as a nice collection of pictures and souvenirs. But perhaps the most valuable thing I will have developed is an appreciation of India and its culture.
Monday, July 20, 2009
Hillary Clinton and India
US Secretary of State Hillary Clinton is currently visiting us here in India. She's been busy with talks with the Indian government, so we haven't had a chance to talk to her yet. Obviously the big reason for being here is to strengthen the relationship between the United States and India. To his credit, George Bush built up a strong relationship between the United States and India, and I think it is important that Hillary Clinton is making a visit here to India. Perhaps the two biggest issues at hand are emissions standards and India-Pakistan relations.
The former is important because as India rapidly industrializes, it will increasingly output a tremendous amount of carbon dioxide and other pollutants. The pollution of Indian cities hasn’t reached the level of many Chinese cities (apparently 16 of the 20 cities with the worst air quality are in China), but it is still very bad. The air in Pune always has a rancid odor to it, and my lungs rebel every time I try to go running. I don’t care what you think of global warming—India needs to clean up the air in its cities. The United States and other Western powers have been pushing for India to enact emissions standards to help curb the level of pollutants that are output. However, India has dug its heals in and refused to set mandatory emissions standards, under the pretense that they should be able to be able to follow the same path to industrialization as the West did—a path that lacked the emission standards the West wants India to follow.
In the short term, tougher environmental measures will be difficult to implement, detrimental to economic growth, and won’t change air quality overnight. In the long run, however, I think the United States has a point. “Green” technology may prove to be one of the most promising new fields of growth, and if a country is able to be at the cutting edge of that technology, it will make them far more competitive in a global economy. Better air quality has the happy side effect of a healthier and happier population.
The latter issue being addressed here in India is the relationship between India and Pakistan. It is no secret that India and Pakistan are bitter rivals, and there have been several points where war between the two nuclear powers seemed imminent. We are no longer at that point, and since last year’s terrorist attacks in Mumbai, the two countries have come a long way in talks. The United States has a delicate relationship with the two countries. The United States relies on Pakistani support for the war effort, and India is a valuable trading partner. It is obviously in the best interest of the United States that the two countries stay out of a war.
Hopefully these discussions will prove fruitful in advancing talks between the two countries. Pakistan and India have a long history—a history that is not easily forgotten. It is perhaps surprising, then, that along with Bangladesh, the three countries were all part of British India. When India declared its independence, the Muslim parts of British India became Pakistan, and the Hindu parts became India. However, some states had difficulty going one way or the other. The most notable of these states was Kashmir, which had a Hindu ruler and a largely Muslim population. The two nascent nations started quarreling over the rights to the land, and relations between the two countries deteriorated into periodic war.
Since then, several major events have kept the relationship hostile. India backed a rebellion in Bangladesh that led to the separation of East Pakistan from West Pakistan, forming a third nation from the former British India. Despite worldwide efforts to stop the spread of nuclear weapons, neither India nor Pakistan signed the nuclear non-proliferation treaty, and both have developed and tested nuclear weapons. Finally, late last year, pro-Pakistan militants executed a terrorist attack in Mumbai. Such violence has been endemic to the region for some time, but hopefully through mutual cooperation, the two nations can come to an agreement.
In essence, the United States has to walk a fine line in its relationship with India. On one hand, it is important that the strong relationship built over the past decade be kept intact. I’ve said before that India is the natural Asian ally of the United States (unlike China), and that importance cannot be overestimated. On the other hand, the United States has strategic interests to the west of India in Pakistan and Iran. Furthermore, environmental problems will ultimately harm more than just India, but the rest of the world. It is hard to convince a nation feeling the thrill of economic success that it take measures that seem counterproductive to its growth, but that is exactly what needs to happen, and that is why Hillary Clinton is visiting us here in India.
The former is important because as India rapidly industrializes, it will increasingly output a tremendous amount of carbon dioxide and other pollutants. The pollution of Indian cities hasn’t reached the level of many Chinese cities (apparently 16 of the 20 cities with the worst air quality are in China), but it is still very bad. The air in Pune always has a rancid odor to it, and my lungs rebel every time I try to go running. I don’t care what you think of global warming—India needs to clean up the air in its cities. The United States and other Western powers have been pushing for India to enact emissions standards to help curb the level of pollutants that are output. However, India has dug its heals in and refused to set mandatory emissions standards, under the pretense that they should be able to be able to follow the same path to industrialization as the West did—a path that lacked the emission standards the West wants India to follow.
In the short term, tougher environmental measures will be difficult to implement, detrimental to economic growth, and won’t change air quality overnight. In the long run, however, I think the United States has a point. “Green” technology may prove to be one of the most promising new fields of growth, and if a country is able to be at the cutting edge of that technology, it will make them far more competitive in a global economy. Better air quality has the happy side effect of a healthier and happier population.
The latter issue being addressed here in India is the relationship between India and Pakistan. It is no secret that India and Pakistan are bitter rivals, and there have been several points where war between the two nuclear powers seemed imminent. We are no longer at that point, and since last year’s terrorist attacks in Mumbai, the two countries have come a long way in talks. The United States has a delicate relationship with the two countries. The United States relies on Pakistani support for the war effort, and India is a valuable trading partner. It is obviously in the best interest of the United States that the two countries stay out of a war.
Hopefully these discussions will prove fruitful in advancing talks between the two countries. Pakistan and India have a long history—a history that is not easily forgotten. It is perhaps surprising, then, that along with Bangladesh, the three countries were all part of British India. When India declared its independence, the Muslim parts of British India became Pakistan, and the Hindu parts became India. However, some states had difficulty going one way or the other. The most notable of these states was Kashmir, which had a Hindu ruler and a largely Muslim population. The two nascent nations started quarreling over the rights to the land, and relations between the two countries deteriorated into periodic war.
Since then, several major events have kept the relationship hostile. India backed a rebellion in Bangladesh that led to the separation of East Pakistan from West Pakistan, forming a third nation from the former British India. Despite worldwide efforts to stop the spread of nuclear weapons, neither India nor Pakistan signed the nuclear non-proliferation treaty, and both have developed and tested nuclear weapons. Finally, late last year, pro-Pakistan militants executed a terrorist attack in Mumbai. Such violence has been endemic to the region for some time, but hopefully through mutual cooperation, the two nations can come to an agreement.
In essence, the United States has to walk a fine line in its relationship with India. On one hand, it is important that the strong relationship built over the past decade be kept intact. I’ve said before that India is the natural Asian ally of the United States (unlike China), and that importance cannot be overestimated. On the other hand, the United States has strategic interests to the west of India in Pakistan and Iran. Furthermore, environmental problems will ultimately harm more than just India, but the rest of the world. It is hard to convince a nation feeling the thrill of economic success that it take measures that seem counterproductive to its growth, but that is exactly what needs to happen, and that is why Hillary Clinton is visiting us here in India.
Sunday, July 19, 2009
Hard Rock Cafe: Pune and another hike
I should start by mentioning the fact that my last post requires a correction. As such, this post is going to be written in reverse chronological order, which should be interesting. Despite my claim that we had no plans to see a Bollywood movie, we saw a Bollywood movie tonight: Dil Chahta Hai. We went to Ajay's house for dinner tonight, and they offered to show us a Bollywood movie. Bollywood movies are long, unrealistic, and follow the same basic plotlines. On the other hand, the music and dance numbers are fun and the actors and actresses are insanely beautiful.
Dinner tonight was from Smokin' Joe's, a local pizza place. According to Thomas Friedman's book The World is Flat (which I just finished), pizza is now the world's most popular food. After all, any culture can take a flat piece of dough and put "toppings" on it. Not surprisingly, our pizzas were not sausage and pepperoni, but supreme veg, tandoori paneer, chicken tikka, and the special (a mix of chicken, onions, and spices). Pizzas are culturally adaptable, unlike Big Macs and french fries. The fact that pizza places exist in India is evidence of cultural exchange, and the way pizzas are made is evidence of cultural adaption.
This morning we woke up after about 6 hours of sleep to go on another hike with Dr. Kelkar and Dr. Joshi. This time it was at a farm about a half hour south of Pune. Despite the rain, wind, and lack of breakfast, it was a good time--climbing hills certainly affords a good view of the surrounding area. Rural India is really quite beautiful and offers a nice break from the smog-choked streets of Pune. I've found that one of my favorite things to do abroad is simply go walking and hiking (preferably with a camera, which is unavailable thanks to the Indian Ocean). While it shouldn't be the only thing you do, it does allow you to see a lot without having to pay for any transportation or sightseeing.
Last night we got back to our apartment after a wonderful evening at Hard Rock Cafe, Pune. This is my first time going to a Hard Rock Cafe, and we had a lot of fun going with Vinita and her friends. When we walked in, we were shocked by the number of foreigners there. After 7 weeks of seeing almost no tourists, it was a bit of a surprise to see...white people. Then again, we don't live in an area frequented by tourists, nor is Pune known as a tourist hotspot (the top three tourist hotspots in India are probably Delhi/Agra, Mumbai, and Goa). In all, we had a fun weekend, even if it is short, as we worked all day Saturday. None of us enjoys the idea of six day workweeks, since it means making a choice between resting over the weekend and doing something over the weekend.
I apologize for not having pictures with this post. First, because I do not have a working camera, I'm not able to post pictures immediately. Second, my internet connection is currently too slow to upload anything. Thus, for those of you following on , you'll just have to check back later (hopefully I'll have pictures--and maybe a new post if I can get it done--within the next 24 hours or so). for those of you following on Facebook or another external site that imports the blog, you'll probably have to go to my actual blog to see the pictures: http://summerinindia2009.blogspot.com.
[Edit: pictures now included]
Picture credits to Kevin Schell.
Dinner tonight was from Smokin' Joe's, a local pizza place. According to Thomas Friedman's book The World is Flat (which I just finished), pizza is now the world's most popular food. After all, any culture can take a flat piece of dough and put "toppings" on it. Not surprisingly, our pizzas were not sausage and pepperoni, but supreme veg, tandoori paneer, chicken tikka, and the special (a mix of chicken, onions, and spices). Pizzas are culturally adaptable, unlike Big Macs and french fries. The fact that pizza places exist in India is evidence of cultural exchange, and the way pizzas are made is evidence of cultural adaption.
This morning we woke up after about 6 hours of sleep to go on another hike with Dr. Kelkar and Dr. Joshi. This time it was at a farm about a half hour south of Pune. Despite the rain, wind, and lack of breakfast, it was a good time--climbing hills certainly affords a good view of the surrounding area. Rural India is really quite beautiful and offers a nice break from the smog-choked streets of Pune. I've found that one of my favorite things to do abroad is simply go walking and hiking (preferably with a camera, which is unavailable thanks to the Indian Ocean). While it shouldn't be the only thing you do, it does allow you to see a lot without having to pay for any transportation or sightseeing.Last night we got back to our apartment after a wonderful evening at Hard Rock Cafe, Pune. This is my first time going to a Hard Rock Cafe, and we had a lot of fun going with Vinita and her friends. When we walked in, we were shocked by the number of foreigners there. After 7 weeks of seeing almost no tourists, it was a bit of a surprise to see...white people. Then again, we don't live in an area frequented by tourists, nor is Pune known as a tourist hotspot (the top three tourist hotspots in India are probably Delhi/Agra, Mumbai, and Goa). In all, we had a fun weekend, even if it is short, as we worked all day Saturday. None of us enjoys the idea of six day workweeks, since it means making a choice between resting over the weekend and doing something over the weekend.I apologize for not having pictures with this post. First, because I do not have a working camera, I'm not able to post pictures immediately. Second, my internet connection is currently too slow to upload anything. Thus, for those of you following on , you'll just have to check back later (hopefully I'll have pictures--and maybe a new post if I can get it done--within the next 24 hours or so). for those of you following on Facebook or another external site that imports the blog, you'll probably have to go to my actual blog to see the pictures: http://summerinindia2009.blogspot.com.[Edit: pictures now included]
Picture credits to Kevin Schell.
Saturday, July 18, 2009
Indian cinema
The title of this post is really a misnomer, since we have seen no Bollywood movies while we've been here, nor do we have any plans to see one. The reason is simple--we don't understand Hindi. When you get the films in the United States, they're subtitled. Without the luxury of subtitles, we felt that sitting in a movie theater for several hours watching something in a language we don't understand might be a little much.
That being said, we have been to the movies--three times. The first was for Angels and Demons, the second for The Hangover (since Transformers 2 doesn't come out until August in India). The third was for Harry Potter and the Half-Blood Prince. We decided that since we were going on opening day, we mind as well make the best of it and dress up. Despite the difficulty in acquiring costumes, we managed to throw together something that looked halfway reasonable and succeeded in garnering the stares of virtually everyone we passed walking into the theaters. The four of us dressed up as Hermione, Harry, Cho and Dobby. We were certainly quite a sight!
Watching an American movie in India is a bit of an experience in its own right. There are a couple big differences between watching a movie in America and one in India. When you walk into the theater, your seat is assigned, so there's no need to get to the theater early. When the movie starts, there are no previews to get you ready for the movie, so if you're a few minutes late to the movie, you'll miss the beginning. Before watching Angels and Demons, they played the national anthem before starting the movie. We thought that was a bit odd. Finally, halfway through the movie, they have an intermission. It sounds great in principle, but they usually stop the movie mid-scene, such that you're not really wanting an intermission when they give it to you. Such is the joy of watching a movie in India!
Note: Picture credits to Rachel Jackson.
That being said, we have been to the movies--three times. The first was for Angels and Demons, the second for The Hangover (since Transformers 2 doesn't come out until August in India). The third was for Harry Potter and the Half-Blood Prince. We decided that since we were going on opening day, we mind as well make the best of it and dress up. Despite the difficulty in acquiring costumes, we managed to throw together something that looked halfway reasonable and succeeded in garnering the stares of virtually everyone we passed walking into the theaters. The four of us dressed up as Hermione, Harry, Cho and Dobby. We were certainly quite a sight!
Watching an American movie in India is a bit of an experience in its own right. There are a couple big differences between watching a movie in America and one in India. When you walk into the theater, your seat is assigned, so there's no need to get to the theater early. When the movie starts, there are no previews to get you ready for the movie, so if you're a few minutes late to the movie, you'll miss the beginning. Before watching Angels and Demons, they played the national anthem before starting the movie. We thought that was a bit odd. Finally, halfway through the movie, they have an intermission. It sounds great in principle, but they usually stop the movie mid-scene, such that you're not really wanting an intermission when they give it to you. Such is the joy of watching a movie in India!Note: Picture credits to Rachel Jackson.
Friday, July 17, 2009
Our tax dollars at work at a government hospital
Until this point, our work has been almost exclusively at Deenanath, which is a private hospital. It strives to provide good service to people from all backgrounds, but it remains a private hospital. There are, however, state-run government hospitals in India, which provide care at virtually no cost. One such hospital in Pune is Sassoon Hospital, which has over 1500 beds. We had the opportunity to visit that hospital on Thursday. The hospital was founded in 1869, so it's a very old hospital--and it shows.
The campus of the hospital consists of a bunch of buildings. Some are old, and others are older. Nothing looks remotely new or particularly well-kept. The building pictured to the left dates back to the British Raj. It holds the unique distinction of being the location where Mahatma Gandhi had his appendix removed. Since we have been working primarily in the Pediatric NICU and PICU at DMH, we decided to take a visit to the pediatrics department there.
Government hospitals are overcrowded, understaffed, but at Sassoon, there are several things that are still important. The doctors know they are understaffed, but they work hard and do the best they can with the resources they have. Sometimes they take the healthiest patient out of the PICU and put them in the wards so they can put a sicker patient in their place. The other thing that was recently implemented is a state-wide computerized record system. Each patient has a single identification number that a doctor can use to access their records from any government hospital in Maharashtra. After dealing with a dizzying assortment of identification numbers to try and track down patient records at DMH, the idea of a single ID number seemed like a brilliant (though seemingly obvious) idea.
Aside from seeing the expected overcrowded clinics and dingy facilities, we came across something quite unexpected--a specialty clinic for HIV-positive children. The room was much cleaner, renovated, and far less crowded than the rest of the hospital. The reason is because the room is sponsored by grants from Johns Hopkins and NIH for testing new HIV drugs. The people at the hospital are delighted to have the facility in their hospital. In looking at the facility, I realized--as an American, these are my tax dollars at work, right here in Pune!The NIH is one of the largest funders of medical research in the world, so it is no huge surprise that AIDS research in India is being sponsored by NIH. It is a bit surprising to run across it so unexpectedly. It's hard to know what sort of results come out of Sassoon Hospital from this program. However, it is easy to see the excitement that the chair of the Pediatrics department had in showing us this area. Seeing that excitement and knowing just what kind of effect HIV has on the population of India, I felt that there really couldn't be a much better use of my tax dollars than this.
I'll refrain from making any devisive comments regarding goverment-sponsored health care. Sassoon Hospital's free care is the standard at all government hospitals in India, and it's been successful in providing health care to anyone--barely. Anyone with the means to go to a different hospital will certainly do so. Even those who do not have means will seek a way to get treatment at a private hospital. Overcrowding and poor care are endemic in government hospitals, so only the very poor come to the hospital. Quality health care is still unavailable for most Indians. On the other hand, our government has the resources to do incredible things around the world in medicine--and has done so. I'd like to think it's possible for the government to use those resources to fix a broken health care system back home in America.
Thursday, July 16, 2009
AIDS in India
Today was the third caesarian section we've seen while we're here. Each one has been a somewhat unique case. In the first, the baby had respiratory distress upon birth and had to be resuscitated. The second c-section was a high risk pregnancy: the woman was older, carrying twins, had gestational diabetes, and the two babies were significantly different in size. The babies were delivered fine and are now in the NICU.
The third c-section was also high-risk, since the mother was HIV-positive. As you may know, babies born to HIV-positive mothers are at a significant risk of acquiring HIV (the virus causing AIDS). Without any treatment, about 25% of babies acquire HIV. Even by taking every measure possible (a c-section, antiretroviral medications, no breast-feeding, etc.), about 8% of babies end up acquiring HIV from the mother. All the doctors and nurses participating in the surgery wore extra gloves, a plastic face shield, and other extra layers to prevent contact with the virus.
The topic of HIV is taboo in India, since Indian society is fairly conservative. There is no mandatory HIV testing, and unless you're an HIV doctor, you often can't even bring up the topic with a patient. Unfortunately, this poses a bit of a danger to the caregivers in the hospital, since the extra protection taken for known HIV patients is not taken normally. This also leads people who know they are infected with HIV to stay silent about it. Thus, some people will get married, only to find out that despite being in a monogamous relationship, they have acquired HIV.
The danger of HIV cannot be underestimated in India. As many as 5.7 million people are infected with HIV in India. No other country in the world has that many people infected with the virus. This is partly the product of a very large population, so that the actual percentage of people infected is about half of one percent. The reason for a relatively low rate of HIV infection is primarily due to the fact that most Indians still follow the traditional social norms regarding marriage. As Indian society becomes more progressive, hopefully people will become better-educated about the dangers of HIV while keeping HIV from spreading.
Fortunately, the past 20 years have seen tremendous progress in the treatment of AIDS to the point where quality drugs have been cheap enough for many HIV-infected Indians to lead a normal life. AIDS is no longer a terminal illness; rather, it is a chronic illness that people have to deal with. AIDS has not decimated India’s population like it has in a country like Botswana, and with increased education and better medical care, it may be possible to largely stop the spread of HIV here.
The third c-section was also high-risk, since the mother was HIV-positive. As you may know, babies born to HIV-positive mothers are at a significant risk of acquiring HIV (the virus causing AIDS). Without any treatment, about 25% of babies acquire HIV. Even by taking every measure possible (a c-section, antiretroviral medications, no breast-feeding, etc.), about 8% of babies end up acquiring HIV from the mother. All the doctors and nurses participating in the surgery wore extra gloves, a plastic face shield, and other extra layers to prevent contact with the virus.
The topic of HIV is taboo in India, since Indian society is fairly conservative. There is no mandatory HIV testing, and unless you're an HIV doctor, you often can't even bring up the topic with a patient. Unfortunately, this poses a bit of a danger to the caregivers in the hospital, since the extra protection taken for known HIV patients is not taken normally. This also leads people who know they are infected with HIV to stay silent about it. Thus, some people will get married, only to find out that despite being in a monogamous relationship, they have acquired HIV.
The danger of HIV cannot be underestimated in India. As many as 5.7 million people are infected with HIV in India. No other country in the world has that many people infected with the virus. This is partly the product of a very large population, so that the actual percentage of people infected is about half of one percent. The reason for a relatively low rate of HIV infection is primarily due to the fact that most Indians still follow the traditional social norms regarding marriage. As Indian society becomes more progressive, hopefully people will become better-educated about the dangers of HIV while keeping HIV from spreading.
Fortunately, the past 20 years have seen tremendous progress in the treatment of AIDS to the point where quality drugs have been cheap enough for many HIV-infected Indians to lead a normal life. AIDS is no longer a terminal illness; rather, it is a chronic illness that people have to deal with. AIDS has not decimated India’s population like it has in a country like Botswana, and with increased education and better medical care, it may be possible to largely stop the spread of HIV here.
Tuesday, July 14, 2009
A few hospital stories
Many of the patients we run across have fascinating stories behind them. There is no shortage of people suffering in situations that are hard to imagine, yet there are also stories of hope--stories that seem to make working in a hospital much more worthwhile. I thought I'd share a few of them.
When doing rounds, we met a woman with her daughter. When her daughter was born, she was feeding her when a piece of paper caught fire and flew into the baby's face. Having been burned on the cheek, the mother took her child into the hospital to have the plastic surgery performed. When the baby got there, they underwent cosmetic surgery to fix her cheek. The mother also asked Dr. Joshi to do a check-up on the baby at the same time. What they found was that the baby had severe, life-threatening jaundice. In addition, the baby had severe liver failure, which of course required a liver transplant. In India, transplants from a cadaver are illegal, so the liver transplant had to be done by the mother. The mother and daughter went to Bangalore and they successfully performed a partial liver transplant from the mother to the daughter. Today the daughter is perfectly normal, and the mother continues to have a smile on her face.
Other stories are not quite as uplifting. It's admirable to see the lengths parents will go to save their children. Yet here in India, there is still a sense of male superiority. One father had brought his son into the hospital to get treatment. We interviewed him and asked if the treatment would be a financial hardship. He said that it would be, but that it would be worth it because he's a boy. He went on to say that he wouldn't have brought a daughter to a private hospital, but would have taken them to a government hospital (where while treatment is free, the quality of care is abysmal). In India there is a huge emphasis on carrying on the family name, especially among the lower classes. Parents have lost their jobs and emptied their life's savings in order to get their children treated. The good thing is that most of the children end up doing very well.
Payment in India is also a bit different. Only the wealthy have any sort of medical insurance, so families often have to dig deep into savings. The first child has traditionally been the financial responsibility of the mother's parents (perhaps another reason why women are not prized here--they end up being a lot costlier than sons). Often the family will have to ask relatives for money, which nearly always will be paid back (at much lower interest rates than a bank loan would be). Each family has its own financial responsibility, and among sustenance farmers whose monthly income is usually around a few hundred rupees (i.e., just a few dollars a month), they just simply cannot afford to be paying for someone else's health care.
Our project has allowed us to get to hear some very personal stories from the different patients. One girl was born to a family, and right after delivery had some sort of respiratory distress. Unfortunately, the hospital where the baby was born did not have the facilities to treat the child, so the child came to DMH. By the time the baby got to DMH, there was a high chance of suffering severe brain damage. The baby spent several days in the hospital and was improving, but the parents weren't so sure. Both of them had disabilities, and in the end they just weren't willing to take the risk of raising a severely disabled child. They cut off support for the girl and she died. Fortunately, for every child that doesn't make it, there are ten others that do make it. Often Donna and I are disappointed when a patient has been discharged before we are able to interview the parents, but on the other hand, a discharge means that the patient is well enough to go home. How can you better quantify success?
When doing rounds, we met a woman with her daughter. When her daughter was born, she was feeding her when a piece of paper caught fire and flew into the baby's face. Having been burned on the cheek, the mother took her child into the hospital to have the plastic surgery performed. When the baby got there, they underwent cosmetic surgery to fix her cheek. The mother also asked Dr. Joshi to do a check-up on the baby at the same time. What they found was that the baby had severe, life-threatening jaundice. In addition, the baby had severe liver failure, which of course required a liver transplant. In India, transplants from a cadaver are illegal, so the liver transplant had to be done by the mother. The mother and daughter went to Bangalore and they successfully performed a partial liver transplant from the mother to the daughter. Today the daughter is perfectly normal, and the mother continues to have a smile on her face.
Other stories are not quite as uplifting. It's admirable to see the lengths parents will go to save their children. Yet here in India, there is still a sense of male superiority. One father had brought his son into the hospital to get treatment. We interviewed him and asked if the treatment would be a financial hardship. He said that it would be, but that it would be worth it because he's a boy. He went on to say that he wouldn't have brought a daughter to a private hospital, but would have taken them to a government hospital (where while treatment is free, the quality of care is abysmal). In India there is a huge emphasis on carrying on the family name, especially among the lower classes. Parents have lost their jobs and emptied their life's savings in order to get their children treated. The good thing is that most of the children end up doing very well.
Payment in India is also a bit different. Only the wealthy have any sort of medical insurance, so families often have to dig deep into savings. The first child has traditionally been the financial responsibility of the mother's parents (perhaps another reason why women are not prized here--they end up being a lot costlier than sons). Often the family will have to ask relatives for money, which nearly always will be paid back (at much lower interest rates than a bank loan would be). Each family has its own financial responsibility, and among sustenance farmers whose monthly income is usually around a few hundred rupees (i.e., just a few dollars a month), they just simply cannot afford to be paying for someone else's health care.
Our project has allowed us to get to hear some very personal stories from the different patients. One girl was born to a family, and right after delivery had some sort of respiratory distress. Unfortunately, the hospital where the baby was born did not have the facilities to treat the child, so the child came to DMH. By the time the baby got to DMH, there was a high chance of suffering severe brain damage. The baby spent several days in the hospital and was improving, but the parents weren't so sure. Both of them had disabilities, and in the end they just weren't willing to take the risk of raising a severely disabled child. They cut off support for the girl and she died. Fortunately, for every child that doesn't make it, there are ten others that do make it. Often Donna and I are disappointed when a patient has been discharged before we are able to interview the parents, but on the other hand, a discharge means that the patient is well enough to go home. How can you better quantify success?
Sunday, July 12, 2009
The return from Goa
Our ride back from Goa was about as painful as the ride to Goa. At least this time we knew what we were expecting. We decided that despite the allure of an overnight sleeper bus, spending the money for an extra night in our 5-star hotel followed by an early start to the 10 hour bus ride during the day would be preferable. However, such bus rides do not exist. None of us are quite sure why this one is the only one available.This whole day has been quite eventful. A rogue wave ruined my camera and soaked everything else we brought to the beach (so from here on out it seems that none of the pictures will be mine—I’ll still try to have as many pictures as possible), the room service brought spaghetti with mayonnaise instead of marinara, and to top it off, the ocean was too rough to swim in. The bus ride was also quite eventful. I saw something that in a way plays out the stereotype of India perfectly. We were stopped at a rest stop for a few minutes, and the bus next to ours has obviously broken down. For whatever reason, about fifteen Indian men had gotten to the front of the bus and started pushing. That is the Indian solution: if it’s broken, just throw more people at it!
The rest of the bus ride, while uncomfortable, was relatively uneventful. We even managed to get a couple hours of sleep (sort of). It was still dark when we got to the final stop, when the lights went on in the cabins and they started yelling something that sounded like “last stop.” Rachel and I were the last ones off the bus and stepped onto the unfamiliar sidewalk, where a horde of rickshaw drivers clamored for our business. We had arrived about a half hour early, so the driver hadn’t arrived to come pick us up. As the bus sped off, we began to realize that we may have made a big mistake.
The rickshaw driver started to explain to us where we were, and through the language barrier, we realized that we weren’t in Pune at all—we were in Satara, which is about an hour and a half from Pune. You can see Satara, Pune, and Goa all marked on the map with red dots. Somehow we had misunderstood the people on the bus and instead of getting off on the last stop, we got off a long way from the last stop. Given the fact that we were so early and the surroundings looked unfamiliar, our misfortune continued. We phoned Ajay with the message that we were stuck, and handed the phone to the rickshaw driver to let him know where we were. After getting a hold of our driver to let him know where to pick us up, the rickshaw driver and his pals drove off, disappointed that they didn’t get our business.
Two guys were standing a little ways off, and we went to go talk with them in an effort to better understand where in India we were. We mentioned that we were trying to get to Pune, and one of the drivers had a quizzical look on his face and said that we were in Pune. In fact, we were at the same bus stop we had left three days earlier—just around the corner. The rickshaw drivers had flat-out lied to us in an effort to get business. Undoubtedly, they would have driven us around in circles for hours before taking us to our final destination. After a couple quick phone calls to Ajay and many thanks to the guys who happened to be standing there, our driver Prakash pulled up to the station. Five minutes later, we were driving past DMH, and an hour later we were all resting in our apartment, showered, exhausted, and still missing America.
Our first full day in Goa was fantastic—we visited two beautiful churches, rode an elephant, danced with Indians on a riverboat, went to a spice plantation, dove into the Indian Ocean, took lots of photographs, and went out to dinner with the Desais. The last day in Goa will go down as D-Day (compliments of Ajay’s text: “...How was d day?”). It seemed that in a 24-hour period, everything that could go wrong did go wrong. Such is life—it has its ups and downs, but at the very least the memories we have from this weekend will ultimately make it all worth it.
Saturday, July 11, 2009
A little about Goa
Going to Goa was definitely one of the more interesting experiences we've had while we've been here in India. As I said in my previous blog post, Goa is very different from the rest of India. While most of India (as well as Bangladesh and Pakistan) were under British control, Goa was predominantly under Portuguese control. That influence has profoundly affected Goa to this day.One of the first things that we noticed when we came into Goa was the prevalence of churches. It's been the first time in about six weeks that we've seen any churches, and the presence of crosses dotting the landscape made Goa feel distinctly un-Indian. The Portuguese first colonized Goa in the 16th century and missionary activity by the likes of Jesuits like Francis Xavier began soon thereafter. As part of their evangelism, the Portuguese instituted the Inquisition, destroying Hindu temples and replacing them with Catholic churches, effectively establishing Catholicism as the dominant religion.
The Portuguese influence also extended to the cuisine. We've found Goan food to be significantly different from food elsewhere--with a focus on more coconut, palm vinegar, and far more seafood. Also prevalant is alcohol--alcohol is regularly on the menu, and is much cheaper than it is back in Pune due to the lower taxes and looser culture.In all, the culture of Goa makes it feel like a different country. Clothing is more relaxed, tourists are more prevalant, and the pace of life is slower. Goa is separated from the rest of India by uninhabitable alluvial plains and mountains, which perhaps explains the discrepancy between cultures, and also the fact that Goa didn't become part of India until 1961, almost 15 years after the rest of India declared independence. Goa remained a Portuguese colony until the Indian government invaded Goa and absorbed it into the rest of India. Despite the Indian takeover, Goa remains somewhat of an enclave, harboring a unique culture that has been a welcome break from the pace of Pune.
Friday, July 10, 2009
A couple days in Goa
Goa has been a welcome change of pace from the busy weeks we've had. It's still been really busy, but in a far more relaxed, low-pressure way. Goa is a popular tourist destination in India, but since it's the monsoon season, most of the major tourist attractions aren't very busy this time of year. I'll reserve a later post describing the state of Goa, but for now, suffice it to say that Goa has a very distinctive flavor from the rest of India. Goa feels like Central America (or so I'm told by Kevin and Donna, as I've never been to Central America), and perhaps the best way to describe its culture in relation to the rest of India is to compare it to the continental United States and Hawaii.
In any case, yesterday was primarily spent in Goa's capital Panjim (pictured above right). With a population of only about 100,000, it seems like a tiny village when compared to some of India's megacities like Mumbai or Kolkata. Even Pune, with a population of nearly 5 million, dwarfs the city of Panjim. As a result, the suffocating smog and overwhelming traffic that is omnipresent in India's major cities is largely absent from any of Goa's cities. Instead, Goa is a place where the alcohol flows freely and the pace of life is just much different. While not actually on the Indian Ocean, Panjim sits on a large bay that dumps into the Indian Ocean, so it has a beach that we walked to yesterday.
During the afternoon we explored the different things our hotel had to offer and walked around Panjim. The city is very green--thanks to significant amounts of monsoon rain--and fun to walk around. The Desais are also in Goa right now, and they took us to visit a couple temples here in Goa. That allowed us to see a bit of the Goan countryside as well as a closer look at some of the distinctive Hindu architecture. The temple pictured here was actually moved from its original location when the Portuguese colonized Goa. Had it remained at its previous location, the Portuguese would have destroyed it as part of the Inquisition.
Today was a full day of touring. Goa is known for its churches, which is a bit surprising, considering India as a whole is only about 2% Christian. However, the Portuguese and Spanish influence is quite strong in Goa, and St. Francis Xavier, one of the founders of the Jesuits is actually buried in the Basilica of Bom Jesus (pictured left). This Spanish basilica sits adjacent to a Portuguese cathedral, and together, the two cathedrals are the most prominent fixtures of the ruins of Old Goa, the former capital of the Portuguese Colony.
After visiting Old Goa, we took a trip to a spice plantation. Along with touring the plantation itself, we were finally able to take our long-awaited elephant ride! Despite being here during the monsoon season (which has manifested itself by relatively brief, though very sudden and very intense rain showers), the sun broke through long enough to give us a chance to head to the beach for a brief dive into the Indian Ocean.
Our final tourist stop of the day was to a promontory south of Panjim. It gave a wonderful view of the bay and the Goan coastline right before sunset. While we were there, an Indian came up to me and asked if I could take a picture. I said yes--and wished I hadn't when I realized that their intention was for me to be in the picture! Of course, I suppose I should be thankful, since at least this group of Indians asked. I suppose after that trip I know a little bit more of how celebrities feel with the paparazzi following them!
Thursday, July 9, 2009
The "Night" Bus to Goa
This weekend will hopefully turn out to be a nice change of pace from 6-day workweeks, seeing as how we're spending it in Goa. Last night we took an overnight bus from Pune to Panjim, Goa, which turned out to be quite the adventure. Our driver took us to the bus station in Pune at about 8:30 last night, which I can honestly say is probably the sketchiest bus stop I've ever been to. Basically it consisted of a bunch of buses lined up on the side of the road across the street from a group of what appeared to be very seedy travel agencies. The other side of the road looked strangely like a dump, complete with a herd of pigs rummaging through the trash.On the bus we were led to the back of the bus, where there were four bunks waiting for us. We proceeded to get into the four bunks, until we were informed that we only had two of the bunks--we would be sharing them between us. It was going to be a long night. There are some things that can be said about the bus: it seemed relatively clean, and it didn't smell too bad. On the other hand, in lieu of having bathrooms, there were four extra bunks. Not helpful. It was also freezing. The entire experience is best summed up in a single word: sketchy. We arrived in Panjim at about 7am in the pouring rain, and bleary-eyed, were directed to our hotel.
What hadn't registered with us was that we would be staying in a 5-star hotel. After a restless 10 hour overnight bus ride, the soft pillows and hot showers couldn't have been more appealing. To top things off, the complimentary breakfast was amazing (complete with real coffee--not the coffee-flavoured milk and sugar we're used to being served). I can't afford to stay at a hotel remotely like this in the United States, but for the equivalent of $40/night in Goa, staying in a 5-star hotel is absolutely worth it!For perhaps the first time this summer, I seem to be running a bit behind with blog posting (by about 12 hours, to be exact). I apologize, and I'll post as much as I can regarding Goa over the next few days. Also, because I maxed out my Google account with India pictures, I've started a second album here. There are lots more pictures from Goa coming soon!
Wednesday, July 8, 2009
Our national reputation abroad
It perhaps goes without saying, but the United States has a complex relationship with the rest of the world. Our reputation has evolved over the course of the past century of American involvement of international affairs, and a rapid increase in globalization has made the perception of the United States abroad change significantly even in the past several decades.
The previous generation saw the rise and fall of Communism, which in many ways kept the rest of the world at bay in terms of economic and political power. European countries were battered from two world wars and quite simply didn't have the manpower to challenge the United States economically. The rest of the world was neatly divided up into Second and Third World countries, which showed they couldn't keep up. America had a wonderful system going: by being so far ahead of the rest of the world, they were able to attract the top talent, and by attracting the top talent, they were able to stay ahead of the rest of the world. Donna and I were talking to Dr. Joshi, and he said that he felt that most of his graduating class in medical school went to America to practice, and that he himself felt that the United States was where he ultimately belonged. Mr. Desai, the CEO of Virgo, came from a very modest Indian home and has expanded his Indian business to the United States. For Indians who made it to the United States, they were able to achieve that were guaranteed upward mobility and a way of life far beyond what they could hope for back at home.
Yet this mindset has significantly shifted. Communism is largely gone, and the world is no longer neatly divided into First, Second, and Third World countries. The chief ideological battle we are fighting in the United States is against terrorism, which has had mixed results abroad. To date, India has been largely free from any suspicion of harboring terrorists (despite having the world's second-largest Muslim population, no known member of al-Qaeda has ever come from India). However, the war in Afghanistan and the search for bin Laden has led the United States to soften its stance towards Pakistan. Given the enmity between Pakistan and India, it is no surprise that many Indians feel a bit of consternation over this friendship. It seems common knowledge in India that many of the weapons America has given to Pakistan to fight the War on Terror have been shipped off to the Kashmir region to fight India.
On a more individual note, there is a significant shift in attitude among Indians from our generation. The education system here in India, while still falling far short of educating all its citizens, still manages to churn out some of the smartest and well-educated graduates the world. India's Technology Institutes are known for the intensity of their curriculum--a curriculum that would make any American university look like high school. On top of that, opportunities for these new engineering graduates are becoming more and more plentiful in India. Several times while we've been here, we've seen brand new malls that are available to a newly educated elite. And an educated elite that is content to stay right here in India, enjoying the benefits of an upper-class lifestyle brought on by outsourced jobs from the United States.
We've found that many of the Indians here have little interest in going to the United States, unlike their parent's generation. The United States is no longer the dream of the Indian elite--not when a comfortable lifestyle is easily had here in India. And indeed, this makes sense. If you can have a top-notch education, a comfortable lifestyle, and upward mobility without leaving behind your culture, cuisine, and family , why would you move to the United States? In other words, the rest of the world is catching up...
The previous generation saw the rise and fall of Communism, which in many ways kept the rest of the world at bay in terms of economic and political power. European countries were battered from two world wars and quite simply didn't have the manpower to challenge the United States economically. The rest of the world was neatly divided up into Second and Third World countries, which showed they couldn't keep up. America had a wonderful system going: by being so far ahead of the rest of the world, they were able to attract the top talent, and by attracting the top talent, they were able to stay ahead of the rest of the world. Donna and I were talking to Dr. Joshi, and he said that he felt that most of his graduating class in medical school went to America to practice, and that he himself felt that the United States was where he ultimately belonged. Mr. Desai, the CEO of Virgo, came from a very modest Indian home and has expanded his Indian business to the United States. For Indians who made it to the United States, they were able to achieve that were guaranteed upward mobility and a way of life far beyond what they could hope for back at home.
Yet this mindset has significantly shifted. Communism is largely gone, and the world is no longer neatly divided into First, Second, and Third World countries. The chief ideological battle we are fighting in the United States is against terrorism, which has had mixed results abroad. To date, India has been largely free from any suspicion of harboring terrorists (despite having the world's second-largest Muslim population, no known member of al-Qaeda has ever come from India). However, the war in Afghanistan and the search for bin Laden has led the United States to soften its stance towards Pakistan. Given the enmity between Pakistan and India, it is no surprise that many Indians feel a bit of consternation over this friendship. It seems common knowledge in India that many of the weapons America has given to Pakistan to fight the War on Terror have been shipped off to the Kashmir region to fight India.
On a more individual note, there is a significant shift in attitude among Indians from our generation. The education system here in India, while still falling far short of educating all its citizens, still manages to churn out some of the smartest and well-educated graduates the world. India's Technology Institutes are known for the intensity of their curriculum--a curriculum that would make any American university look like high school. On top of that, opportunities for these new engineering graduates are becoming more and more plentiful in India. Several times while we've been here, we've seen brand new malls that are available to a newly educated elite. And an educated elite that is content to stay right here in India, enjoying the benefits of an upper-class lifestyle brought on by outsourced jobs from the United States.
We've found that many of the Indians here have little interest in going to the United States, unlike their parent's generation. The United States is no longer the dream of the Indian elite--not when a comfortable lifestyle is easily had here in India. And indeed, this makes sense. If you can have a top-notch education, a comfortable lifestyle, and upward mobility without leaving behind your culture, cuisine, and family , why would you move to the United States? In other words, the rest of the world is catching up...
Monday, July 6, 2009
Culture Shock and looking forward
The past week has been a bit rough for the India cohort. Kevin and I are both attempting to recover from our respective illnesses, last week's 6-day work week felt longer than usual, and the American Independence Day came and went without any break. All that has made us a textbook case of foreign travelers experiencing culture shock. We all still have really enjoyed the trip--don't get me wrong--but sometimes we just miss America a little bit. So to feel better about ourselves, we came up with a list of things we're looking forward to when we return to the United States. Without further ado, here it is:
- Hamburgers
- Hot showers
- Coffee with caffeine
- Driving my car
- Bathrooms that don’t stink
- Sandwiches that are actual sandwiches, not just two (small) pieces of bread
- Fast-loading internet videos
- Being understood the first time I speak
- Communicating with waiters properly
- Serving yourself at restaurants
- Not being the only girl in either a sari/salwar kameez
- Wearing shorts
- No more head-wobbling
- Soft bed
- Air conditioned gym
- Air conditioning everywhere
- No more 6 day workweeks
- Understanding what’s going on around you/being able to eavesdrop on people’s conversations
- Being punctual. Enough said.
- Drinking tap water
- No more converter plugs
- Being able to straighten your hair
- Traffic laws.
- American cable news networks
- American newspapers
- Not having to convert money
- Not having random power outages
- Other people understanding your humor
- Transformers/Megan Fox
- My own room
- Waking up in the morning and not aching
- My own pillow
- Swimming
- Not having to avoid all dogs
- Family & friends
- Social life
- Not being stared at all the time
- Not having hacker guy at work
- Receiving phone calls
- Being on Facebook when everyone else is on Facebook
- Food that isn’t predominately in sauces/American food
- Steak.
- Fresh fruit
- Not having to take malaria pills
- General health
- American television
- Normal malls
- Movies that don’t have intermissions
- Pandora & Netflix & streaming online TV
- Not having cricket dominate your sports stations
- Church.
- Going out in the sun
- Clothes that stay the same size
- Doing your own laundry
- Having a larger wardrobe
- No more hand sanitizer
- Cold cut sandwiches
- Larger living space
- Not having to lock stuff up every day
- Being able to keep my keys
- Mobility
- Independence
- Honey Bunches of Oats
- Real American breakfast
- Variety in food
- Not having to eat out every night
- Home-cooked meals
- Cookies (chocolate chip)
- Swirll
- Normal text messages and phone plans/having my own cell phones
- Not having advertising calls in Marathi
- Not being constantly compared to Brandon and Neil
- Toilet paper
- Real bathrooms
- Normal night life
- Music that we can sing along to on the radio
- No more freaking car horns
- Stop lights
- Cleaner air
- Taking a leisurely stroll on the sidewalk
- Being able to run outside
- Being alone
- Being able to see more than just three other Americans
- Not having to deal with the saturated drum-selling market
- Being able to call people without thinking about the time difference
- Not having to use Skype to call anymore
- Not having to wake up as early
- Not having to sit in the car for over 2 hours every day
- Not having to monitor water supply every day
- Bath rugs
- Not having toilets scream at us
- No more mothballs
- Not having to wear dress clothes every day
- Not having to be on the look-out for mosquitos
- Fountain drinks/free refills
- Knives
- Not having to lug around heavy briefcases every day
- Trash cans/recycling
- Racial diversity
- Normal/memorable names
Saturday, July 4, 2009
Celebrating the 4th abroad
I suppose one of the times that makes you most miss the United States is on days like Independence Day. After all, while people back at home were grilling burgers yesterday and today while having a break from work, we went in for two full days of work. Aside from a couple comments from fellow workers, wearing red, white, and blue and eating dosas, we didn't really get much in the way of a Fourth of July. My time in India, while it's been absolutely wonderful, has made me realize what a wonderful country we live in. There are many reasons for that (perhaps the first thing that comes to mind is American food--specifically, American hamburgers--which I've had a craving for since the day I left), but I just want to touch on a couple.
The first is the framework our government is built on. The United States boasts the world's oldest Constitution (even if said Constitution is applied very differently than when it was first written in 1787)--something we can truly be proud of. America was an experiment in democracy--an experiment which was challenged in its day by absolutism and later by totalitarianism and communism, but has in every instance adapted and succeeded. Indeed, that idea of democracy has become the basis for nearly every modern democracy, including India, which is the world's largest democracy and a couple months ago demonstrated the largest display of democratic involvement in history (400 million voters in the last election).
Yet aside from the sheer durability of our government (or perhaps because of it), Americans really do trust their government. That might seem like an odd thing to say--after all, Americans are always fighting over partisan divisions, and our president doesn't exactly have unanimous support. But as inefficient and bureaucratic as it might get, Americans trust their government to work properly. We expect--and get--law and order without too much deviation. Here in India, there isn't the same sense of the government having that sort of legal control. For evidence, all you have to do is look at the streets--cars writhing in a orderless mess without regards to any traffic laws or regulations. And naturally, the police force isn't pulling anyone over for that sort of thing.
After a half century of essentially mishandling the country, the Indian government has turned the country around and has set it on a course for a much stronger nation. The government is gaining credibility, and with that credibility it's become able to be more effective as a national government. Indeed, it seems that India looks to become the south Asian United States. Since our system seems to be a model for India and a plethora of countries around the world, I think it's not without justification that on this Independence Day, I'm proud to be an American!
The first is the framework our government is built on. The United States boasts the world's oldest Constitution (even if said Constitution is applied very differently than when it was first written in 1787)--something we can truly be proud of. America was an experiment in democracy--an experiment which was challenged in its day by absolutism and later by totalitarianism and communism, but has in every instance adapted and succeeded. Indeed, that idea of democracy has become the basis for nearly every modern democracy, including India, which is the world's largest democracy and a couple months ago demonstrated the largest display of democratic involvement in history (400 million voters in the last election).
Yet aside from the sheer durability of our government (or perhaps because of it), Americans really do trust their government. That might seem like an odd thing to say--after all, Americans are always fighting over partisan divisions, and our president doesn't exactly have unanimous support. But as inefficient and bureaucratic as it might get, Americans trust their government to work properly. We expect--and get--law and order without too much deviation. Here in India, there isn't the same sense of the government having that sort of legal control. For evidence, all you have to do is look at the streets--cars writhing in a orderless mess without regards to any traffic laws or regulations. And naturally, the police force isn't pulling anyone over for that sort of thing.
After a half century of essentially mishandling the country, the Indian government has turned the country around and has set it on a course for a much stronger nation. The government is gaining credibility, and with that credibility it's become able to be more effective as a national government. Indeed, it seems that India looks to become the south Asian United States. Since our system seems to be a model for India and a plethora of countries around the world, I think it's not without justification that on this Independence Day, I'm proud to be an American!
Thursday, July 2, 2009
Doing research at the hospital
As part of our time at DMH, Donna and I have started a research project. Since neither of us is particularly proficient in a lot of the medical terminology, doing a project exploring treatment options or something like that is simply not feasible. We also wanted to do something that would be both beneficial to the hospital and that would be useful for us as we return to the United States. To cap things off, we really wanted to work in pediatrics (ironically, since neither of us were too keen on pediatrics coming over here), simply because everyone in pediatrics has been enormously helpful to us.
Thus, after talking to Dr. Joshi, we came up with our project idea--examining the socioeconomic profile of the patients coming through Deenanath's Pediatric Intensive Care Unit (PICU), Neonatal Intensive Care Unit (NICU), and Hematoncology wards. Essentially, what we'll be doing over the next few weeks is interviewing the parents of the patients in the various wards and asking them about their backgrounds. What it boils down to is asking questions that would be unthinkable in the United States ("What is your monthly income?" "Is the treatment going to be difficult to pay for." "If so, how are you going to come up with the money for the treatment?"). Yet the doctors have all assured us that the patients won't mind any of the questions that we'd be asking. Sure enough, 20 interviews in, everyone has been more than happy to oblige and answer our questions (usually through one of the nurses acting as an interpreter).
Our goal through this project is to see whether there are any trends of how the people approach paying for their child's health care, especially when the procedures are extremely expensive (sometimes upwards of $10,000--this for a hospital in India that strives to provide affordable health care for as many people as possible), and in a country where health insurance is virtually non-existent. Do parents show any preference for particular children, such as being willing to pay more for the care of their son? Hopefully through this we can make recommendations to the hospitals in ways they can better reach certain parts of the populations to maximize the amount of need the hospital can provide for.
I'm quite certain that there will be plenty of stories that we'll gain from this, but here's just one. We talked to the father of one boy in the cancer ward, who is an engineer here. However, because his work requires him to be on site, he lost his job because he was tending too much time staying with his son at the hospital. He told us that he hoped that the chemotherapy would be done by October or November, or he would have to sell their house to pay for treatment. We'll surely come back to the United States with a better perspective on the pain that people have to go through and hopefully with an idea about how we can somehow do something about it.
Thus, after talking to Dr. Joshi, we came up with our project idea--examining the socioeconomic profile of the patients coming through Deenanath's Pediatric Intensive Care Unit (PICU), Neonatal Intensive Care Unit (NICU), and Hematoncology wards. Essentially, what we'll be doing over the next few weeks is interviewing the parents of the patients in the various wards and asking them about their backgrounds. What it boils down to is asking questions that would be unthinkable in the United States ("What is your monthly income?" "Is the treatment going to be difficult to pay for." "If so, how are you going to come up with the money for the treatment?"). Yet the doctors have all assured us that the patients won't mind any of the questions that we'd be asking. Sure enough, 20 interviews in, everyone has been more than happy to oblige and answer our questions (usually through one of the nurses acting as an interpreter).
Our goal through this project is to see whether there are any trends of how the people approach paying for their child's health care, especially when the procedures are extremely expensive (sometimes upwards of $10,000--this for a hospital in India that strives to provide affordable health care for as many people as possible), and in a country where health insurance is virtually non-existent. Do parents show any preference for particular children, such as being willing to pay more for the care of their son? Hopefully through this we can make recommendations to the hospitals in ways they can better reach certain parts of the populations to maximize the amount of need the hospital can provide for.
I'm quite certain that there will be plenty of stories that we'll gain from this, but here's just one. We talked to the father of one boy in the cancer ward, who is an engineer here. However, because his work requires him to be on site, he lost his job because he was tending too much time staying with his son at the hospital. He told us that he hoped that the chemotherapy would be done by October or November, or he would have to sell their house to pay for treatment. We'll surely come back to the United States with a better perspective on the pain that people have to go through and hopefully with an idea about how we can somehow do something about it.
Wednesday, July 1, 2009
An Indian Wedding
Today was definitely one of the more interesting experiences we've had thus far in our trip to India: an Indian wedding. The people at the hospital organized it for us, as they felt it would be a good taste of Indian culture. And indeed it was!
It was a bit hard to understand everything that was going on, given that none of us speak any of the local language, but it was obviously very different from any wedding we've been to. It's quite the spectacle, and it seems that it's the chance for as many people to get together at possible. It didn't matter that we didn't know the bride or groom--or anyone else at the wedding, for that matter. Weddings in India seem to be an event that is shared with as many people as possible.
Like in the United States, the actual ceremony is only a small part of the day's festivities. There seems to be a wedding procession to the wedding hall, which was situated on one of the hills overlooking the city. Another wedding was going on at the same time next door, and we were able to watch part of the procession as they made their way up the street to the wedding hall. The procession was complete with funny looking hats, dancing, and music. They really do make a big deal out of their weddings!
The ceremony lasted for about 30 minutes, where the wedding party gathered around the bride and groom chanting a song in Hindi (or Marathi). At various points during the song, the people in the audience threw grains of rice in the air. After the ceremony was over, the audience members came through a line and congratulated the bride and groom and posing for photographs. Unlike in the United States, they took photographs of the bride and groom and nearly everyone in the audience, rather than just the wedding party. Thus, despite never having met the bride or groom, it seems as though we will be part of their wedding album.
We left shortly after that, but there would be plenty of other festivities for the couple's wedding. There was a luncheon after the ceremony (which was in the morning), and then later that evening everyone would come back for a reception. Like much of India, one of the things that is most striking is the vibrant color present in all the sarees and kurtas that people are wearing. Even the rice people threw in the air was colored! As we knew neither the language nor the couple getting married, it was a bit awkward for us. But it is certainly a quintissentially Indian experience we won't soon forget!
It was a bit hard to understand everything that was going on, given that none of us speak any of the local language, but it was obviously very different from any wedding we've been to. It's quite the spectacle, and it seems that it's the chance for as many people to get together at possible. It didn't matter that we didn't know the bride or groom--or anyone else at the wedding, for that matter. Weddings in India seem to be an event that is shared with as many people as possible.Like in the United States, the actual ceremony is only a small part of the day's festivities. There seems to be a wedding procession to the wedding hall, which was situated on one of the hills overlooking the city. Another wedding was going on at the same time next door, and we were able to watch part of the procession as they made their way up the street to the wedding hall. The procession was complete with funny looking hats, dancing, and music. They really do make a big deal out of their weddings!
The ceremony lasted for about 30 minutes, where the wedding party gathered around the bride and groom chanting a song in Hindi (or Marathi). At various points during the song, the people in the audience threw grains of rice in the air. After the ceremony was over, the audience members came through a line and congratulated the bride and groom and posing for photographs. Unlike in the United States, they took photographs of the bride and groom and nearly everyone in the audience, rather than just the wedding party. Thus, despite never having met the bride or groom, it seems as though we will be part of their wedding album.We left shortly after that, but there would be plenty of other festivities for the couple's wedding. There was a luncheon after the ceremony (which was in the morning), and then later that evening everyone would come back for a reception. Like much of India, one of the things that is most striking is the vibrant color present in all the sarees and kurtas that people are wearing. Even the rice people threw in the air was colored! As we knew neither the language nor the couple getting married, it was a bit awkward for us. But it is certainly a quintissentially Indian experience we won't soon forget!
Monday, June 29, 2009
An average day in India
It's hard to believe that my trip is over half over, and in one month I'll be landing back home in the United States again. It's been an amazing trip so far, and I suspect that the next month will be even better. Here in India we've gotten into a routine, and as today was a fairly typical day for me in that it sort of combined a lot of the different things we've done in one day, I thought I'd share what an average day looks like for me. Today started at 7am--at least for the rest of the cohort, since I hit my snooze button several times before getting up. Fortunately, it doesn't take long to shower, since there isn't any hot water (which feels great after exercising, but not so great when you first get up). I'm also not a huge fan of Indian breakfast, so instead of choking down the grilled vegetable sandwich, I asked for toast instead.
The hour and a half drive to Virgo and on to DMH went smoothly, and when we got to the hospital, we went to the clinic of one of the pediatricians, Dr. Gapchup. We've met her before, as she is one of the key doctors in leading the slum projects. At about 11am, we left and went with Dr. Joshi to scrub in and watch a surgery--a C-section. It truly is an amazing operation to watch, since you get to watch a baby take it's first breath in the world. We left from there to go on rounds with Dr. Joshi, which we've begun to do regularly, since going on rounds once means so much less without seeing how the different patients progress and get better. I suppose that's one of the more rewarding things about being a doctor--seeing your patients get better (and one of the things that's easy to miss out on in being an intern).
After lunch in the canteen, we went to go present our small project to another doctor in pediatrics. She had asked us to take a look at their data for a paper they want to publish and look at the statistics. Then we went to the PICU to start our own project--analyzing the profiles of the different patients in the PICU, NICU, and oncology wards. For that, we'll be taking data about the patient's condition as well as their socioeconomic background. Thus, we started surveying parents about their income, lifestyle, and how they plan on paying for treatment (all of which are questions that would never be asked in the United States, but aren't an issue here in India).
Our evening was pretty relaxed--as was usual. We went to the gym for a little while to get some exercise, and then went out to dinner afterwards. After dinner we got into our nightly ritual--checking Facebook, email, and the plethora of other computer-based activities. All in all, it was a pretty average day, but we got to see some cool things as well. I guess that's India for you!
The hour and a half drive to Virgo and on to DMH went smoothly, and when we got to the hospital, we went to the clinic of one of the pediatricians, Dr. Gapchup. We've met her before, as she is one of the key doctors in leading the slum projects. At about 11am, we left and went with Dr. Joshi to scrub in and watch a surgery--a C-section. It truly is an amazing operation to watch, since you get to watch a baby take it's first breath in the world. We left from there to go on rounds with Dr. Joshi, which we've begun to do regularly, since going on rounds once means so much less without seeing how the different patients progress and get better. I suppose that's one of the more rewarding things about being a doctor--seeing your patients get better (and one of the things that's easy to miss out on in being an intern).
After lunch in the canteen, we went to go present our small project to another doctor in pediatrics. She had asked us to take a look at their data for a paper they want to publish and look at the statistics. Then we went to the PICU to start our own project--analyzing the profiles of the different patients in the PICU, NICU, and oncology wards. For that, we'll be taking data about the patient's condition as well as their socioeconomic background. Thus, we started surveying parents about their income, lifestyle, and how they plan on paying for treatment (all of which are questions that would never be asked in the United States, but aren't an issue here in India).
Our evening was pretty relaxed--as was usual. We went to the gym for a little while to get some exercise, and then went out to dinner afterwards. After dinner we got into our nightly ritual--checking Facebook, email, and the plethora of other computer-based activities. All in all, it was a pretty average day, but we got to see some cool things as well. I guess that's India for you!
Saturday, June 27, 2009
When students from America meet students from India
Because we work five or six days a week, weekends become our best chance to experience the culture and see some of the things India has to offer. However, we haven't really had a chance to do much on the weekends since we've gotten here. Last week we went to the slums, but aside from that, we've really only been able to do things that are within walking distance--which isn't much. Thus, we were quite excited to have someone to take us around and see a bit more of Pune. Before work this morning we went on a short walk on the hill that overlooks Pune with Dr. Kelkar and Dr. Joshi. This is the second time we've done it, but this time Dr. Kelkar brought his son, Sagar, and Dr. Joshi brought his 20-year-old daughter, Vinita, along with us. After climbing the hill we went out to breakfast with Dr. Joshi and his daughter, who Dr. Joshi told to take us out at some point (apparently he's found our weekends a bit lacking as well).
Tonight we were looking for some way to spend our evening that didn't involve being in our apartment on our computers, so we called Vinita and asked if she wanted to go to dinner with us. She already had plans, but she invited us to come along with her and her friends to Kiva's, a local restaurant. And thus we were introduced to some of what college life in India is like. In essence, it seems like college students have similar interests around the world. Thus, it was easy to forget that we were in the middle of a developing country, rather than a sports bar in the United States. Linkin Park, Justin Timberlake and Michael Jackson were thundering through the speaker system, and a giant projector showed recent highlights in sports (though of cricket, not football or basketball).
One of the really interesting things I found is that most of the college students here seem to speak primarily in English with one another. This is a real change for us, since at the hospital nearly all the conversations occur in Marathi, the local language. In addition, Vinita and her friends were all wearing stylish Western clothing, and even their slang sounded familiar to us as college students. Ironically, the only time we felt clearly aware of the fact that we weren't at home in the United States was when a group of white people walked into the restaurant. As there aren't many Western tourists in Pune, seeing Americans and Europeans is something of a rarity, so seeing them was made us realize that even though we felt very much a part of their culture, we were essentially still outsiders.
Yet the fact that we really did feel a part of that community is telling. The world is becoming a much smaller (or flatter) place, and perhaps nowhere is that more apparent than in our lives as college students. From our perspective, the lives of people our age seem to be transcending cultural boundaries, as certain cultural identities become less "quintessentially American." In talking to Vinita I was surprised at how much interests we shared in common. We watch some of the same movies, speak the same language, listen to the same music, and even discuss the same things.
These cultural ties are surely strengthed by the fact that our generation has easier access than ever to traveling abroad, as it is both encouraged and feasible. Everyone in my cohort has been abroad several times, and many of the Indians we met tonight had been abroad as well. Thus, we are no longer limited by the narrow cultural box we were born into, having seen a much wider world around us. However there are certainly dangers to this new cultural flexibility, because many parts of our cultural identity may be lost, both widening the chasm between our generation and the generations before us and leaving us drifting without the anchor of cultural ideals.
This begs the question of what makes this generation so different. Sixty years ago, our world was recovering from the shock of being split by facism and world war, and thirty years ago, our world was still deeply divided by communism and cold war. Today, the chains those differences placed on our ability to reach around the world have been largely broken, and my generation now has the freedom to easily communicate and connect with people on the other side of the world. We now live in a world where I can stay in contact just as easily with someone in India as I can with someone in Indiana. The communication barriers of language and distance are slowly disappearing, and along with it, the sense of disconnect with the people of other countries. I do believe that my generation will be unlike any generation before us. We are the generation that will, in a very real sense, usher in the 21st century--hopefully a century where we come together and set aside nationalist and cultural differences to take a giant leap forward in the history of mankind.
Tonight we were looking for some way to spend our evening that didn't involve being in our apartment on our computers, so we called Vinita and asked if she wanted to go to dinner with us. She already had plans, but she invited us to come along with her and her friends to Kiva's, a local restaurant. And thus we were introduced to some of what college life in India is like. In essence, it seems like college students have similar interests around the world. Thus, it was easy to forget that we were in the middle of a developing country, rather than a sports bar in the United States. Linkin Park, Justin Timberlake and Michael Jackson were thundering through the speaker system, and a giant projector showed recent highlights in sports (though of cricket, not football or basketball).
One of the really interesting things I found is that most of the college students here seem to speak primarily in English with one another. This is a real change for us, since at the hospital nearly all the conversations occur in Marathi, the local language. In addition, Vinita and her friends were all wearing stylish Western clothing, and even their slang sounded familiar to us as college students. Ironically, the only time we felt clearly aware of the fact that we weren't at home in the United States was when a group of white people walked into the restaurant. As there aren't many Western tourists in Pune, seeing Americans and Europeans is something of a rarity, so seeing them was made us realize that even though we felt very much a part of their culture, we were essentially still outsiders.
Yet the fact that we really did feel a part of that community is telling. The world is becoming a much smaller (or flatter) place, and perhaps nowhere is that more apparent than in our lives as college students. From our perspective, the lives of people our age seem to be transcending cultural boundaries, as certain cultural identities become less "quintessentially American." In talking to Vinita I was surprised at how much interests we shared in common. We watch some of the same movies, speak the same language, listen to the same music, and even discuss the same things.
These cultural ties are surely strengthed by the fact that our generation has easier access than ever to traveling abroad, as it is both encouraged and feasible. Everyone in my cohort has been abroad several times, and many of the Indians we met tonight had been abroad as well. Thus, we are no longer limited by the narrow cultural box we were born into, having seen a much wider world around us. However there are certainly dangers to this new cultural flexibility, because many parts of our cultural identity may be lost, both widening the chasm between our generation and the generations before us and leaving us drifting without the anchor of cultural ideals.
This begs the question of what makes this generation so different. Sixty years ago, our world was recovering from the shock of being split by facism and world war, and thirty years ago, our world was still deeply divided by communism and cold war. Today, the chains those differences placed on our ability to reach around the world have been largely broken, and my generation now has the freedom to easily communicate and connect with people on the other side of the world. We now live in a world where I can stay in contact just as easily with someone in India as I can with someone in Indiana. The communication barriers of language and distance are slowly disappearing, and along with it, the sense of disconnect with the people of other countries. I do believe that my generation will be unlike any generation before us. We are the generation that will, in a very real sense, usher in the 21st century--hopefully a century where we come together and set aside nationalist and cultural differences to take a giant leap forward in the history of mankind.
Subscribe to:
Posts (Atom)
