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!

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.

A scene right out of House, M.D.

For the record, I don't really watch House, but I've seen enough episodes to get the gist of it. Dr. House is confronted with an unknown illness that no one can figure out. He assembles his special team of doctors to brainstorm possible solutions while popping Vicodin. In the course of the hour-long show, Dr. House seems to antagonize as many coworkers as possible in pursuit of the elusive diagnosis, which is usually some bizarre and highly unlikely string of illnesses. Looking back on today, I think Dr. House would appreciate one of the cases we saw.

Today Donna and I made rounds with Dr. Joshi, the head of the pediatrics department at DMH. This was the third day in a row that we've done this, so we got to see how some of the patients progressed. There was one interesting case in particular that we saw today. Several weeks ago, the boy came in with a high fever. After examining his other symptoms and testing his blood samples, the diagnosis was typhoid fever.

They gave the boy antibiotics, which initially started working. However, after he became unresponsive to the antibiotics, they gave him a stronger antibiotics, but without any significant change. In addition, he started displaying other symptoms, including jaundice and abdominal pain. In essence, it appeared that instead of making the boy better, the antibiotics were making him worse! As those of you with medical knowledge may be aware, those additional symptoms are characteristic of Hepatitis (inflamation of the liver). Sure enough, after testing, the boy's results came back positive for Hepatitis A.

There is no cure for Hepatitis A--simply plenty of rest and lots of fruit juice (apparently because having the fructose gives the liver extra stores of sugar). Yet the question remained--how did the boy get Hepatitis? The answer lies in the incubation periods--Hepatitis A has a much longer incubation period than typhoid fever. Thus, the boy was probably only infected once, since both illnesses are contracted through contaminated food. The boy came to the hospital only with symptomatic typhoid, but as his hospital stay progressed, the Hepatitis A became symptomatic as well.

I'm quite sure that Dr. House would have come to the same conclusion. However, I have to say that Dr. Joshi was able to diagnose this boy's problem without a team of internists brainstorming for him and without irritating all of his coworkers!

Sometimes technology is better than tradition.

Going overseas for two months has its share of complications, not the least of which is doing your laundry. We don't have a washing machine in our apartment (which really is more like a hotel room than anything else), and there aren't exactly laundromats anywhere to be seen. In India, your clothes get washed by the dhobi. Thus, every few days, we leave our clothes in the laundry basket and they come back, wrapped in newspapers, cleaned and folded.

The only difference is that some of the results have been puzzling. For example, a good number of my socks and shirts tend to come back folded inside out. One would think that might be self-explanatory, but apparently not. While our dress clothes have been nicely ironed, it seems that our socks (and jeans, apparently) have mysteriously lengthened. The more we wash them, the longer they get.

The reason for the lengthening is how they wash our clothes. My guidebook for India sums it up quite nicely:

The dhobi will take your dirty washing to a dhobi ghat, a public clothes-washing area (the bank of a river for example), where it is shown some old-fashioned discipline: separated, soaped and given a damn good thrashing to beat the dirt out of it. Then it is hung out to dry in the sun and, one dried, taken to the ironing sheds where every garment is endowed with razor-sharp creases and then matched to its rightful owner by hidden cryptic markings. Your clothes will come back from the dhobi absolutely spotless, though this kind of violent treatment does take it out of them: buttons get lost and eventually the cloth starts to fray.

Indeed, that seems to be along the same lines as what my poor socks have endured. It kind of makes me wish for laundry machines back in America. On the other hand, I suppose if the worst thing that happens to me is longer socks, I'll be doing pretty well!

A small look into Indian education

Today Donna and I had the chance to go to the apartment of two of the doctors at the hospital (one pediatrician and one cardiac surgeon). Donna and I were talking to the pediatrician today, and after talking for a bit she invited us over to her house after work for a little bit so we could see he inside of an Indian home. It was really nice to relax a bit after work before heading home, and we were able to learn a little bit more about how doctors are trained here.

Indian doctors and American doctors end up spending about the same amount of time in training. The difference is when they decide to become doctors. In India, students finish 10 years of regular schooling before going off to what essentially amounts to two years of junior college. Already, students have to start deciding what area they intend on going into. Tracks are divided up into several major tracks including commerce and science. For someone who wants to go into medicine, certain courses (such as biology) are required. 

At the end of those two years, students apply for medical school, and spend four and a half years doing course work, followed by a year-long internship. They graduate with MD's, and if they don't get accepted to a residency, they can go into general practice (usually at a more rural hospital). After getting their MD, they do a three year residency program (which is not paid), followed by several more years where they can subspecialize in something. 

Americans have a distinct advantage over this system in that they can make a more informed decision about what they want to go into after college. On the other hand, Indians get much more focused training for a longer period of time, arguably making them more qualified than us. The Indian doctors here are all very good, and while they have limited resources compared to American doctors, I would have no trouble trusting my care to any one of the doctors we've met here.

Work is plentiful, work is cheap

In a typical internship in the United States, it's fairly easy to get involved and get busy. There are lots of papers that need sorting and files that need cleaning. "Intern" is sort of synonymous with "the person that does the stuff no one else has time for." Donna and I sort of expected the same sort of thing coming here to the hospital. So naturally, we started looking for the usual ways of keeping interns busy. However, we found that the usual list of intern chores were not available--some people's entire jobs were devoted to those chores. We felt there were very few specific things we could ask to do that wouldn't put someone out of a job. There is simply a very large number of people working at the hospital.

That seems to be true across India. Kevin and Rachel have reported that at Virgo Engineers, much of the work is still done manually (rather than being automated), because hiring a new laborer has a far lower start-up cost than buying new machinery. And since it doesn't cost much to keep a laborer, there is little incentive to automate things. Indeed, labor is extremely inexpensive, making it seem like the entire country is overstaffed. Security guards are everywhere, from door of some of the smallest shops all the way up to the gates of the largest corporations. If it costs almost nothing to put someone there, why wouldn't you?

Yet as I've posted previously, prices will rise, and hiring cheap labor for everything may not be sustainable. For that reason, part of Kevin and Rachel's project is help automate some of the processes at Virgo. It is a wise move, because even though the overhead is high for the equipment to automate, the result is a company that can remain competitive in the West as prices rise.

On the other hand, there is one big advantage to having a tremendous amount of jobs that serve the role of cheap labor. It is, quite simply, the fact that there are jobs available. In a country of over 1 billion, not everyone can be doctors, lawyers, and engineers (in fact, it is extremely difficult for an Indian to rise up to those points). Thus, many people find jobs constructing buildings that in the United States would be undertaken by a much smaller team using bulldozers, dump trucks, cement trucks, and cranes. All of that results in much lower unemployment. China realized the benefit of low unemployment--less civil unrest--and has made sure that everyone living in a city has a permit to work, successfully keeping its citizens occupied.

India's government isn't capable of doing the same thing as China (and even if they could, would they?), but they do have something else that empowers them--jobs from the United States. There's often a concern of jobs being outsourced from the United States. India has become so adept at receiving these outsourced jobs that it has become the source of a plethora of jokes and political rhetoric regarding outsourcing. After all, many of us have complained about having to talk to someone from India when we call technical support, and President Obama himself seemed to oppose outsourcing with his comment "say no to Bangalore and yes to Buffalo" (a comment that was not appreciated by the Indian newspapers over here!). Indeed, many of our IT jobs are now located in places like Bangalore or Pune, and even specialized professions like radiology are starting to be outsourced here.

I believe this is a huge blessing for India. It gives India an educated and rapidly growing elite (though it's still small...for now). Instead of leaving India, they're staying here and expanding the middle class, which as probably been a key to success in the United States. Perhaps more than anything else, the outsourcing has given India English. India was already primed for the move, in large part due to the influence of the British Raj, but having English as a major language makes access to the world market that much easier. In fact, we may have reached a point where more people speak English in India than they do in the United States. In short, India gains wealth, a middle class, better infrastructure, the world's most widely-used language, and a whole host of other things. This indeed will make India an economic force to be reckoned with.

Rupees, Low Prices, and the Indian economy

Rupees, India's currency. Note that Ghandi is featured on all monetary bills.

I think that Westerners are often excited to head to nations with so-called emerging markets for one particular reason: it's cheap. As an example, while it often costs at least $1500 to fly to Mumbai, in many places you can stay here in style for less than $50/night. On the other hand, a round trip ticket to London from New York could cost less than $500. Once you get there, prices are significantly more expensive. Last year, a columnist known as the "Frugal Traveler" attempted to do a Grand Tour of Europe for about £100/day (he wanted to do $100/day, but that's not enough money for Europe). He succeeded, but it wasn't easy to make that budget work.

However, there are a couple things that it took me a little while to get. Eating here is very cheap. Last night's $25 meal for four was by far the most expensive meal we've had yet--we've had a complete meal with desert for about $12 or so. However, that doesn't mean everything is cheap. Almost any brand-name item is the same price as it is in the United States. So you can't come here hoping for deep discounts on Swiss watches and Gucci prices. If it looks too good to be true, it probably is.

The difference in prices comes at the cost of living level. Land values are still low enough that it doesn't take much to find nice accommodations for a very low price (even in areas like downtown Mumbai or Goa). Likewise, since much of India lives on far less than the average American, all the food is priced accordingly. It's perhaps an interesting dilemma that the reason India is so affordable is the vast poverty in the country.

In current US dollars (for convenience), the average Indian earned a little over $450 a year in 2002; now the average Indian earns closer to $850. That's not much in the United States, but remember, prices are still low. Inflation also grew significantly, but not enough to offset the fact that Indians are on average richer and better off than ever before. As another benchmark, four of the top eight richest people in the world are Indian.

What does that mean? It means prices will go up. With money to spend, the cost of living will go up. We saw this in action a few weeks ago when we visited an Indian mall. It felt like a high-end mall in the United States, which meant, of course, that I couldn't afford anything. This is perhaps a hint at what the future of India may be like: it will no longer be the long-term vacation on a budget. There are many reasons for this increased personal wealth in India, but one of the major ones is a realization that wealth and money can be found right at home, not just in the West. Thus, instead of fleeing the country, the educated elite are staying here and prospering. Welcome to the new India.

What is tourism, really?

The last few posts have been fairly intese, so I thought I'd touch on a bit lighter of a topic today. This is my fifth time overseas, and I've begun to get the sense of what I feel constitutes the best possible overseas experience. In a sense, I feel like there are two major approaches to visiting a foreign country. The first is to go as a true tourist and see the big sites in a country. Yet it isn't museums and churches and temples that make up a country. It's the people--their food, their culture, and their way of life. Experiencing that is more difficult, and takes a significant amount of work. On the other hand, to simply go to a foreign country and experience the people and the culture often isn't enough.

Today was an interesting mix of both experiences. This morning we got up at sunrise to go hiking with Dr. Joshi and Dr. Kelkar. They like to walk up one of the hills in the middle of Pune and walk along the top for exercise. After about an hour or so of walking, Dr. Kelkar had to leave for the hospital for rounds. However, Dr. Joshi didn't need to be at the hospital right away, so he treated us to one of the best breakfasts I'd had in a very long time: cheese dosas, lassis, and coffee (weak for American coffee, strong for Indian coffee). We went to Vaishali Restaurant, which has a legendary reputation among citizens of Pune. It was a lot of fun, and yet we never would have been able to do that on our own.

This evening, however, we decided to try out a Greek restaurant on the top of a nearby hotel. The ambiance was incredible, the food was good, and yet I think all of us felt a little out of place. Aside from not being the only foreigners in the restaurant, the place felt so distant from the India we had gotten used to. There were no curries or chutneys, the waiters all spoke perfect English, and everything was clean and well-kept. Hardly the India we've experienced. I realized that while it's a lot of fun to stay in a nice hotel and eat in a nice restaurant, if you go to a country and do that exclusively, you've missed out on the country itself. A Goan resort is a far cry from the slums of Mumbai or even the small Indian diners tucked away down dusty side streets.

I think as Americans our biggest problem in visiting other countries is a willingness to try new things. We all come armed with our various disinfectants and immediately start establishing the superiority of our way of life. We're too inclined to spend our time in posh hotels, such that we never go outside our comfort zone. It would be a shame to miss out on all that India has to offer--and we haven't let this opportunity go to waste!

"Rational Ethical Medical Service"

The title of this post comes from the mission statement of Deenanath Mangeshkar Hospital: "Rational ethical medical service available to rich and poor alike." Today was another day spent in pediatrics, and I found that some of the issues that doctors face in that department really start to challenge the notion of "ethical" medicine. I have no clear answers for the major ethical questions I saw today, but I thought I'd share some of them here. Feel free to respond with your own comments and thoughts regarding these questions. I feel confident that some people who read this post will have strong opinions one way or the other on these issues. I do not, but I would love to hear the opinions all the same.

The first concerns premature babies. Modern science has pushed the limits of how early a baby can be born. At about 38 weeks, a baby is considered full-term. At 28 weeks, a baby born prematurely can generally survive without major complications. 26 weeks is about the earliest a baby can survive at in India. In the United States, technology has pushed that to 24 weeks. Those 2-4 weeks is where the major ethical question lies. Is there a point at which we stop pushing the limits of survivability and begin to accept the normal course of nature? Babies born before 28 weeks often will never neurologically develop properly, which means permanent brain disabilities for the child. Is it really worth it? It's a hard question to answer, since neither answer is easy. On one hand, human life is precious, especially to parents who love their child the minute it untimely leaves the womb. On the other, perhaps there is something to be said for letting nature run its course.

The second concerns a child that we saw today. The baby had been born normally, and yet soon after birth they realized something was very wrong with the GI tract. They went into operate and found that the girl had an almost completely dysfunctional small intestine. Naturally, the doctor proceeded to perform the required surgery--almost complete removal of the small intestine. They attached what remained to the colon, but as anyone with a cursory knowledge of biology would know, the human body is not designed to function properly without the small intestine. In order to survive, this baby will have a tube in its body that it will be fed through. That tube will be used, every day, to feed the child the nutrients it needs. If there is any hope, it is that if the child survives until the age of 10 (which, in her condition, may not be likely to begin with), the doctors hope her small intestine will finally have grown out enough to be capable of functioning again.

Unfortunately, that hope will never become a reality. The medical costs incurred are already expensive, and the solution they feed her will have to be individually prepared in limited quantities every time she feeds. Such a food source would be exorbitantly expensive, and very few Indian families have the means of fronting such cost for so long. Yet the alternative is obvious. Eventually, the once-proud parents of this newborn child will have to face the reality of the situation and let their child starve to death while they watch. There is simply no conceivable hope of survival for this child. What can you do when you're placed in that situation? Adults can ask that they not be kept alive under certain circumstances, but a newborn infant can make no such decision. How does a parent make that sort of decision?

Modern medicine has allowed us to truly change the boundaries of life and death. We can start life earlier, keep life going longer, and yet to what end? Ultimately perhaps, modern science is simply trying to find an answer for the age-old desire for immortality. The harsh reality, however, is that modern science will never be the ultimate answer. It can surely provide great joy to people affected by it. Yesterday we saw a girl who had had heart surgery and kidney surgery come into Dr. Joshi's office for a check up. After looking at her, Dr. Joshi declared that she was "just as normal as you or I." Today in the NICU we saw premature babies who will undoubtedly go on to lead long and successful lives. While the screaming children may not appreciate it, the vaccines given will protect children from a multitude of vicious diseases. Yet science also provides great anguish and terrible decisions, as the parents of the baby girl we saw today could attest. As medicine progresses further, we will be able to save more lives and help more lives, but we will also have more of these difficult questions to answer.

A Model of Health Care?

Donna and I visited the pediatric ward today, and while we were there we struck up a conversation with one of the residents there. He asked us if the recession had affected health care in the United States. Like most things, the recession has indeed affected health care in many ways. One major way is through the loss of health insurance benefits brought on by job losses. In a very real way, this recession has brought to the limelight the major problems with American health care that have been brooding for over a half a century.

This conversation set me thinking about what the Indian health care system could offer us as we struggle to modify the American health care system. On first glance, I figured that the Indian system wouldn't have much to offer us. After all, the quantity of treatment is abominably low, as most people get as much treatment as they can pay for out of pocket. In a very limited capacity, the government has stepped in to provide basic health care (e.g., providing vital vaccines for the entire population). However, when it comes to full blown treatment, often times there's nothing a poor family can do, even if there is a relatively simple (if expensive) treatment. Yet at the same time, I think there are things to take from the Indian health care system. Though I risk sounding like I'm writing for the opinion page of the New York Times, I thought I'd devote this blog to some of the observations made in light of this idea.

After reading several articles about the state of American health care, I realized some of the blame in our health care crisis rests with the doctors. Some doctors, with the mindset of capitalizing on their "business," often overtreat their patients through unnecessary tests and procedures. I think a better mindset is captured in a specific scene today in the clinic of Dr. Joshi, one of the pediatricians here. A little 10-year-old boy came in this morning having never spoken before. Along with the obvious mental problems, he was short and underweight for his age and had suffered emotional trauma through the loss of a brother. The boy obviously came from a poor background, and had he been born in the United States, doctors would probably already have run a series of tests to identify his problem. Here in India that was hardly possible, and indeed, given the family's limited resources, his disease would probably end up going undiagnosed and untreated without financial intervention. Yet Dr. Joshi referred the boy to another doctor to begin the series of tests to discover his problem and saying, "This boy really needs to have these tests done and I refuse to just sit here and not treat him. If the tests have to be done free of charge, they'll be done free of charge." My first thought was that our health care system might be considerably better off if all doctors shared his passion of putting the patient first.

With that being said, we all know that while ideologically simple, it is practically complex. Insurance companies, pharmaceutical companies and the government are just a few of the players in complicating the system to the point of incomprehensibility. Not surprisingly, the same players exist here in India. Health insurance hasn't really caught on, and perhaps India can find a way to build their growing health care system with a different approach to insurance that doesn't create the massive disparities present in our own system. However, one big problem with health insurance right now here is that it doesn't treat preventatively. So if a patient wants to go in for a series of preventative tests and vaccines, it's all out of pocket. However, if you get the disease that vaccine could have avoided, the insurance company will start chipping in.

Occasionally during Dr. Joshi's clinic, pharmaceutical representatives would line up outside the door to try and sell their products. One by one, they file in, make their case for whatever drug they're trying to market as the doctor listens. Often, the doctor simply waves their product off, leaving the rep emptyhanded. However, the usual calendars, posters, and pens emblazoned with drug logos are always left behind in the clinic as friendly reminders of the proper drugs to prescribe. Drug reps perform a similar role in the United States, as their companies seem to alternate between the life-saving angels and the money-sucking demons of the health care system.

Together, drug companies, insurance companies, doctors, and many others are important players in our health care system, and each of their needs will have to be addressed in any new system we implement in the United States. Ultimately, I hope that whichever system we move towards finds its highest goal in doctors giving patients the best possible care. With all the competing parties, that often seems impossible, but perhaps we as (aspiring) doctors can take the attitude exemplified right here in India. The United States probably won't want to adopt the Indian health care system, but certainly we can be inspired by the way these Indian doctors treat their patients.

A brief update

I seem to be running out of new and unique topics to post about (though I've got a library of half-finished posts that I've started for this very reason), so forgive me if I post somewhat less frequently in the future. Hopefully in the next few weeks we'll start some new things at the hospital and go on a future adventures. It looks like we'll taking a few trips around Pune, and probably heading to Goa for a weekend as well. All of us are hoping to end the trip with a bang by spending 24 hours in Mumbai before flying out next month.

However, it's been amazing to see how much time has flown these past two weeks. Two weeks is the longest I've ever been abroad before, yet it hardly seems that long ago when we were flying out of Newark. For the most part, we've all adjusted (certainly to the time zone, evidenced by the difficulty of getting out of bed each morning), and seem to be getting into a routine.

At the hospital, Donna and I have spent most of the mornings in the Outpatient Department (OPD). This morning we went to endoscopy, which I can now categorically say I won't be doing in my career (over the past few years I seem to have become exceedingly good in eliminating possible careers--today was no exception). Quite frankly, stuffing tubes into the GI tract does not seem like a fun job. It was, however, very interesting to watch.

As Donna and I get more comfortable with the hospital, the different contacts that we've met in different departments will allow us more flexible in deciding what sort of things we want to do and see. In addition, we should start a research project here in the next few weeks (though we still don't know what it will be). The weekends should get slightly more interesting than the past two, as we begin to make more plans for the weekends and get out and see more of the city and (hopefully) the rest of India. This weekend should be interesting, because Donna and I will be heading back to the slums to watch an immunization drive. Based on my last experience in the slums, I'm sure this will be quite the experience. In all, things are going well here, and now that we've settled in, we're looking forward to the next month and a half.

A Walk in Pune

With no parties to go to, no way to get anywhere in the city other than by walking, and little knowledge of what to see anyway, our weekends to be pretty laid back. Usually that means doing some reading, sleeping in a little bit (all of us managed to get up in time for breakfast...just barely). Instead of sitting in our room all day, we decided to walk around Pune.

My last blog post was about the people living in India's slums. It's no secret that their lifestyle lacks some of the most basic living conditions, but they're still better off than a very significant population of the country. Today I realized that firsthand. As we were walking beneath an overpass, a young girl with her baby was walking in and out of traffic (pictured right), knocking on windows of cars there asking for money. A few yards away, a small family was spread out on a blanket on the sidewalk under the bridge (pictured left).

A few minutes later, as we continued walking, a young boy who couldn't have been much older than 4 or 5 came up to me and started tugging on my arm and putting out his hand. After initially saying no, the little boy pointed at his mouth and again put out his hand, asking for money. It was difficult to tear myself from looking into his light brown eyes and walk away. What kind of life is that? To live under a bridge from the time that you're born and begin from the time you can walk to ask for money from strangers? Humans aren't meant for that! After seeing that, you have to wonder what there is that can be done. These people aren't the same as those living in the slums, who can be reached by various programs and immunization projects. These also aren't the bums you typically find on the streets of major US cities, so you feel a lot worse turning them away.

Our next stop was a Hindu temple (pictured right). Given the fact that we didn't really know the customs, nor were we with any Indians, it certainly was a bit awkward for us. However, the temple is situated on one of the several knobby hills in Pune, so we climbed up to the top of the temple, and found a path that wound its way to the top of the hill. The view from the top was totally worth it, as we had a panoramic view of Pune and the mountains that surround the city. Away from all the traffic and noise of the city, we were able to catch a glimpse of the city spreading out to the mountains that border it (pictured left). Truly a wonderful sight!

The Reality of Slumdog Millionaire

Today is a day I won't soon forget, because it was the first day I went to visit the slums here in Pune. Deenanath Mangeshkar Hospital runs a community health project that visits the slums in Pune and educates them about basic health care (hygeine, family planning, immunizations, etc.), and Donna and I had the opportunity to tag along with Asha, another American student working at the hospital (pictured to the left). Needless to say, there really isn't any way you could experience what we did today back home in the United States. Our country is virtually absent of what could really be called a slum, so today's visit was truly a foreign experience.

India may be undergoing tremendous economic growth, but that hasn't stopped the expansion of some of the world's largest slums. Mumbai's Dharavi slum is perhaps one of the largest and best-known slums in the world, and its lifestyle is also typical of many Indian slums. To give you a picture of what Dharavi looks like, it boasts upwards of a million inhabitants in about 0.67 square miles. For reference, that's about the size of Hermann Park and the Houston Zoo right across the street from Rice. There are no hospitals, disease is rampant, and there is an average of one toilet for every 15,000 people. Dharavi isn't the only slum in Mumbai, either. Estimates put the slum-dwelling population at around 7 million (the total population of the city is just under 14 million).

Mumbai may have the largest slum population in India, but the rest of the country hasn't been immune. About 1.4 million people live their daily lives right here in the slums of Pune, just a couple miles from the gleaming new industrial complexes that have money pouring into the Indian economy. Clearly that wealth only goes so far. People here in Pune literally live right besides the animals, waste water is poured out into the narrow alleyways, and the air is thick with the smell of smoke and refuse.

Our trip began with a trip by rickshaw from the hospital. After a wild ride through the streets of Pune, we arrived in a part of the city that looked as if temporary housing had been erected on top of decades of refuse, crumbled housing, and hopelessness. A walk down the street and up several side streets took us to darkened alleyways with children peering at us three Americans and our cameras. That proved to be quite the attraction, as I repeatedly snapped pictures of the kids and proceeded to show them the result on the screen of my digital camera. I emerged with a small horde of 5 year-olds bursting with curiosity about the light-skinned foreigner with a camera.

We visited several sites that the community health workers were leading while were there in various health-related topics (pictured left). Many of the people here have very little knowledge of how to raise a healthy child, so diseases like hepatitis B, tuberculosis, tetanus, and other communicable diseases are rampant and claim the lives of many children here every year. These health projects have gone on for about four years in about 13 different slum pockets here in Pune (out of a total of close to 600 pockets in the entire city). In that time, the workers have seen significant improvement in both the knowledge and practice of people living here, which is certainly encouraging for the future of these people.

There were two major things that still struck me as I was there. Walking around in the slums was certainly nothing short of an experience, yet as slums go, the ones we visited are known to be some of the better ones in India (there is running water and electricity available in some areas, for example). It's hard to imagine what other slums might be like if these are deemed "good!" I also found it interesting how we treat our trip to the slums. I took medication to try and avoid any ill effects of the small bit of food I had while I was there. We both liberally doused ourselves in hand sanitizer. The first thing we did (after eating) upon arriving back at our flat was to shower and wash away the grime and dirt that we had collected in a day's trip there. Even in walking through the slums for a day, we are fortunate to never have to live in it. While we had a shower, a nice meal and air conditioning waiting for us after a few hours in the slums, these people live their entire lives in these conditions. And I complain about the water not being warm enough in my shower. Such injustice is absolutely mind-numbing.

The newly-elected government of India has made an ambitious (and at this point, probably unachievable) goal of having a slum-free India in 5 years. While it sounds good, it probably isn't something that can be fixed by government mandates or state-sponsored housing. The problems are rooted much deeper along cultural and ideological lines. The aforementioned Dharavi is famous not only for its poverty, but also, ironically, its riches. By effectively "recycling" items thrown away by the rest of Mumbai (among other industries), it manufactures items sold around the world to the tune of over $650 million. That's quite the lucrative business for one of the poorest neighborhoods on earth! The idea of foraging in dumps is hardly new in India. For years, the lowest caste in India, the dalits, have served as trash foragers and other unsightly jobs in Indian society. Indeed, I suspect it may be hard to uproot the slum-dwellers, as badly as it needs to be done, just because it goes against the grain of societal norms.

In addition, as is hard with any type of government assistance, some suspect that to the average slum-dweller, the illegal housing provided in slums like Dharavi is preferable to the legal, government-sponsored housing (which, of course, is taxable). How the government plans to move over 150 million Indians out of the slums is beyond me. Moreover, recent estimates project the number of slum-dwellers worldwide to double to 2 billion by 2030 as a result of both increased urbanization and lack of adequate infrastructure (especially in the developing world--like India) to accomodate that trend.

Slumdog Millionaire is a feel-good story of how a pair of former slum-dwellers fight against all odds to reach success. The sad reality, however, is that billions of impoverished people will never hope to have a chance at life the way it is portrayed in the movie. There is simply is no upward mobility among the people who live in these places. For me, visiting the slums here in Pune put faces to the urban problems facing our world. This is not just an Indian problem; alternately, it is a problem that America cannot ignore. In concluding this rather long post, I'm reminded of a verse from the Christian New Testament that I find personally inspiring when thinking about what to do for the people living in these slums:

And the King will answer them, 'Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.' Matthew 25:40

Pune, the Queen of the Deccan

Most people with a cursory knowledge of India have heard of the nation's three largest cities: Mumbai, Delhi, and Kolkata (the fourth, sixth, and twelfth largest urban areas, respectively). In fact, in terms of municipal population, Mumbai is the world's largest city with about 14 million people living inside the city proper. However, in a country that is still almost 70% rural, India has 44 metropolitan areas with more than a million people, and 8 with over 5 million. Yet of all those other cities in India, I doubt many of us could name very many.

Yet the eighth largest city and metropolitan area in India is Pune. Admittedly, before January of this year, when I applied for SME, I had never heard of Pune. Pune has over 5 million inhabitants, and is about the size of Houston, though it is overshadowed by its much larger Maharashtran neighbor to the northwest, Mumbai. Yet Pune is a distinctive in its own right, a growing metropolis with a rich history.

The city of Pune (Poona) was founded well over a thousand years ago, and gained prominence in the 18th century as the capital of the Maratha Empire. The British took control of the city and made it the monsoon capital of the Bombay Presidency. Since India gained independence, it has established a reputation as "Motor City" and a center for Information Technology. Not only that, but Pune boasts more schools, universities, and colleges than any other city in the world. The University of Pune is perhaps the most well-known here, and we were able to visit it briefly last week (pictured).

Pune is located in the state of Maharashtra, where the local language is Marathi (not Hindi). In terms of food, Maharashstran cuisine is more similar to northern India in nature, with of bread and some rice as the staple. The state is the second largest in India, and is the most urban in nature. This is mostly due to the limited agricultural ability of its montainous regions, most notably in the Western Ghats, the highlands separating the Deccan Plateau from the Arabian Sea. Pune sits comfortably in the foothills of those mountains, somewhat protected from the intense monsoon season that Mumbai experiences.

As Pune continues to grow, the majority of major industry and residential growth seems to be to the northwest, roughly in line with the Mumbai-Pune Expressway. Because of the massive growth Pune has experienced (and indeed, continues to experience), it is not hard to imagine the city of Pune recentering itself around these brand new technology corporations. After all, Pune lacks a recognizeable downtown, at least in the same sense as other major cities. There is simply the new section and the much older section.

India has experienced rapid urbanization in recent years, which helps explain the population explosion in Pune. Indians are better educated, drawing them towards the industry and technology present in cities like Pune. The same is true in Mumbai, whose urban area population is expected to grow to well over 20 million in the next 15 years. Since Mumbai sits on the Arabian sea, it has nowhere to grow save for inland, in the same direction of the Mumbai-Pune expressway. As the two largest cities and Maharashtra continue to grow over the course of the century, it does not seem inconceivable that the two cities will form a single urban megalopolis, with the Mumbai-Pune Expressway serving as the main artery serving this area of India. Indeed, it may ultimately prove to be very similar to the I-95 corridor between northern Virginia and Boston or the Tokyo-Yokohama-Kawasaki conglomerate in Japan.

The economy of Pune is certainly moving towards high-tech industry, yet it will take significant initative to develop the infrastructure necessary to maintain that industry and the burgeoning population that has come with it. Its upper class has money to spend, and that will certainly benefit the regional economy in years to come, but much of the population still lives in squalor, and the future of Pune lies in how they will sort through the social problems in their continually expanding economy.

"Whatever You Like"

As we get to know the hospital better and better, Donna and I have sort of realized our roles. Essentially, we have the freedom to do whatever we like (aside from actually treating patients). Our badges let us go anywhere, look at any medical records we like, and interact with all the patients and doctors. Patient confidentiality in India isn't nearly as big a deal as it is in the United States.

Our job description is limited to "Observer," which means that we spend a lot of time watching surgeries and clinics. However, that only goes so far before we start to get bored of this. Thus, we decided to start taking a more active role in what we do. Instead of simply observing, we decided t start working on our research project. We started flipping through medical records (which are at our disposal--no questions asked), and then went up to the library to further our search of a decent topic. While we're still not sure what we'll end up doing, we will probably end up focusing on something unique to India or specific to India.

The lack of patient privacy laws here in India is, I believe, indicative of a larger sentiment among Indians. India is simply not a very individual country. There is simply not the idea of "rights" in the same way as there is in the United States. If you're the sort of person who values your personal space, India would feel claustrophobic. There are simply people everywhere. Because of that, I think Indians sort of take the presence of other people (even complete strangers) for granted. Thus, I can walk into an exam room and the patient barely gives me a second glance (and even then, it's probably more because I'm white than anything else). For Indians, privacy just isn't an option, because there are just too many people living too close together.

It would be interesting to see how this translates into the Indian feeling of self-worth and individuality. In a country where marriages are still often arranged, your caste determines your lot in life, and your next door neighbor probably sleeps about 10 feet away, where do you find the drive and motivation to find the "Indian dream?" Quite frankly, it just isn't there in the same way.

We're finding the different ways that the Indian and American cultures differ, and I think a lot of that boils down to the fact to the vast number of people in India. Because Hinduism, practiced by four out of five Indians, is a very accepting religion, there seems to be an implicit trust of strangers, which seems to simply manifest itself as indifference. Because of that, Donna and I can walk in and out of an examination room without any formal introductions with anyone. No one minds. Likewise, we're free to walk into any operating room and watch the operation going on there. The rigid structures we're used to in the United States simply don't exist here, and it's going to take quite a bit of getting used to!

Deenanath Mangeshkar Hospital and Research Center

I thought I'd post a bit on Deenanath Mangeshkar Hospital, since it's where I'll be spending a lot of my time this summer. It was built and opened back in 2001, and tries to offer top-of-the-line (for India) health care to all levels of the population. They offer a certain amount of free and reduced price services for people in India, run community health projects, and while they perhaps don't have state-of-the-art equipment, the equipment they do have is adequate. If I got sick here, I wouldn't have any qualms with the health care provided by this hospital--you won't get much better care in the United States.

Donna and I pretty much have free reign as to what we want to do here. That means that we can basically observe anything we want--today we went in and saw Dr. Kelkar (the hospital administrator--who deserves a post all to himself) perform a surgery on a lady with esophogial cancer. I've posted a picture of Donna and I scrubbed in for those surgeries.

A couple interesting notes about the hospital itself. First, it's divided up into four wings, each of which goes up eight floors. All eight floors look down onto the atrium, making the hospital look like a beehive from the inside. I've included a picture of the hospital looking from the ground up. As for air conditioning, one would think that a hospital would be air conditioned. And indeed, some places are (e.g., the Lasik area and the Operating Theater). However, the ICUs and most of the rest of the hospital just use fans going at full blast all the time.

One thing that's kind of interesting is that since the floors are so dirty (lots of dust and dirt getting tracked in from the city), whenever you walk into a special room like the ICU or OT area, you have to take your shoes off and put special slippers on. It's easy for nearly all women (who wear sandals the vast majority of the time), but not so easy for me and my laced black dress shoes. In any case, when you go into the actual OT, you have to take those off and put a third pair of shoes on. It makes sense, of course, since the floors of the regular hospital are utterly filthy. It's just a hastle.

Things are, in all, going well here. I hope to keep this updated fairly regularly this week with more posts and pictures.

A few pictures

I haven't done this much, but I thought I'd go ahead and share some pictures with you on the blog. First, when we went to the mall yesterday, we saw a couple rather interesting T-shirts. Here they are (if you can't read them, click on them for a larger image. They are, at the very least, interesting).

The links to the right will take you to full albums of my pictures. You'll find lots of duplicates in the full album, since it includes literally every picture I've taken here, since I'm using it as a backup to my files on my hard drive. I've also included several more pictures directly here, but refrained from adding too many pictures on my blog, since I plan on using some of them in later posts for various reasons. In any case, enjoy!

Flora in India is colorful, so I've included several examples of some of the flowers we've seen. The red ones are all over the place, whereas the white ones we found on our long walk Sunday afternoon. We decided that our day was better spent walking around Pune than it was sitting in our apartment on Facebook (especially since Facebook is pretty dead at that time of day).

Finally, I've included several pictures of daily life in Pune. Nothing spectacular--just a few pictures here in there. To the left is a picture of Pune with the foothills of the Sahyadri Mountains in the background. As a side note, the Sahyadri Mountains form the geographical boundry Deccan Plateau (where Pune is located) and the land next to the Arabian Sea (where Mumbai is located). As I mentioned before, India is quite colorful, and even their trucks show it. This one is not unusual in the decorations its owner has placed all over the truck. The picture on the right is one of dogs taking shelter from the Indian heat. Dogs are everywhere here, and the heat at midday makes us feel like we're back in Houston.

The end of the first week!

It's hard to believe that our first week of work is over. Of course, we still have over seven weeks to go, but it's incredible to see how fast time goes. Indians work six-day workweeks, so while we're here in India, we'll probably be following suit and working Monday through Saturday. Tomorrow will be our day off, and as none of us are capable of driving and we've been cautioned against using the notoriously poor mass transit, we'll probably end up staying in our flat and resting. Ajay has plans to take us around Pune on the weekends--perhaps going away and visiting other places in Maharashtra (the state that both Pune and Mumbai are in). All of us are secretly hoping that we can work in a trip to Goa (and, if the stars align, a trip to Delhi and the Taj Mahal) on one of our free weekends.

In any case, today was the first time Donna and I got to see where Rachel and Kevin are working. Virgo Engineers (a valve corporation) is situated on the outskirts of Pune, amidst a plethora of other industries and Information Technology companies. Nearly all of the buildings in the area look like they've been built in the past five years, with many more on the way. We dropped them off at work today on our way to work (sort of--DMH and Virgo are really in opposite directions from one another). We also went straight from the hospital after work today to pick up Rachel and Kevin from Virgo. Unfortunately, I'm pictureless, since I don't bring my camera to and from work every day. At some point this summer, I'll bring my camera both to work and on our promised tour of Virgo, and hopefully I'll have some really good pictures of Pune's brand new industry.

Today we started to slide into what will end up being our routine for the next week. Our day turned out to be a half day, and I basically did observing for the majority of the time. In India, "Internal Medicine" is known simply as "Medicine," and today I went to the outpatient clinic to watch the doctor see patients. Because the majority of Indians are relatively poor, the doctor has limited means of diagnosing a problem. Practically, that means that imaging devices such as CT scans, MRI's, and even X-rays are virtually unused except when absolutely necessary. Within five minutes, the doctor usually is able to do a clinical examination, figure out the problem, and prescribe some sort of treatment. I'll save a post on some of the medical problems in India that are seen regularly for a later post. This one is going to be long enough as is!

After finishing work and picking up Rachel and Kevin, Ajay took us to the mall in Pune. Immediately we felt the effects of reverse culture shock. European and American models were wearing name-brand items. Hindi and Marathi were nowhere to be seen, and American pop music was blasting over the stereo system. Prices were comparable to what they'd be in the United States. Honestly, if you took the people out of the store, that mall easily could have been in any major American or European city. Apparently the new educated elite in Pune have cash to burn. In talking to Ajay, it seems like the people who would be shopping there comprise mostly the top 2% or so of the population. However, in a city of 5 million, that still leaves a significant portion willing to go out and by their Chanel perfume and Italian leather shoes. Donna and I splurged on gelato there (ice-cold food and drinks tend to be a rarity in India), and we ended up going home after that.

Our final episode of the day came with dinner. We chose a restaraunt called Taareef's, which happens to be right across the street. We managed to have one of the best meals we've had so far there, even if we managed to botch up on choosing deserts. The restaurant specializes in kebabs and other related foods, so we had a wonderful meal out of that. Rachel and Kevin decided to be daring in choosing a desert, though after tasting what Kevin described as "plain yogurt mixed with salt water," they regretted that decision a bit. In any case, pictured above is our group waiting to eat our dinner. It's been a good week, and a great start to our trip to India thus far. If it keeps going this way, we're in for a fantastic summer!

The Monsoon has started!

Presumably as we get into the swing of things, I won't post every single day, but our daily schedule is pretty relaxed after work. After all, it's not exactly like the four of us carry busy social lives over here (not yet, at least!). However, as things are still new and as I begin to adjust, I'll continue to post as things happen.

Today was our first full day working in the hospital. We met Dr. Kelkar, the hospital administrator, for the first time this morning. After talking for a bit, he helped to begin organizing our schedules for the summer. It looks like we'll be doing a lot of observing, as well as participating in some sort of clinical research and some community health. For the rest of this week, we'll simply be observing and really just figuring out how things work and the way things are done. However, the morning was a bit awkward for the two of us, with Donna spending time in the OT (Operating Theater) and myself in the ICU. This was fine, except I wasn't sure what to do when I got there. I ended up talking to one of the residents there for a while, who explained how the ICU worked there and described one of the diseases they had there. Since it was a respiratory infection (not TB), the lady had to be put into a walled-off room, whereas the rest of the ICU patients were separated by curtains.

After lunch, Donna and I both went back to the OT, where we were able to observe several operations. The first was the end of a C-section, and the second was the beginning of a laproscopic surgery on the gall bladder. We obviously weren't able to participate at all, but it sure was fascinating to watch.

As Donna and I were walking out of the hospital, the sky was overcast for the first time, and we wondered whether the imminent monsoon would start today. Sure enough, as we started driving home, the rain started pouring down. By the time we got back to our flat, the rain was pouring down, complete with thunder and lighting. We're still not quite sure what the monsoon season will entail, other than a lot of rain. Hopefully it won't be pouring down rain nonstop all day long. We are in for some wet two months, I'm sure!

First day of work

The four of us arrived here in Pune late Monday night (or early Tuesday morning, depending on how you look at it), and proceeded to take the first two days off. Both of them have been quite useful, as it's taken a little while to get over jet lag. Both days have been rough come late afternoon, and it's been no problem getting to bed early. The problem is getting up. The past two mornings have both been spent waking up before the crack of dawn and wondering whether or not I'd fall back asleep (today was successful after three hours of staring at the ceiling; yesterday notsomuch). We're still obviously feeling the effects of some jet lag.

Over the past couple of days, Ajay Hingne (pictured with the four of us above), the Operations Manager at Virgo Engineers, has been a tremendous help in getting us used to the city by taking us to several restaurants and pointing out some useful places to know. Ajay spent about 8 years in the United States, so he's been very helpful in sort of bridging the gap between Indian and American culture (formidable, to be sure). We've taken a brief tour of Pune, which I found to be larger than I had thought, though for a city the size of Los Angeles, that shouldn't come as too much of a surprise. We had lunch Wednesday on the top of a building in Pune, and we got to take some neat photos from the top of the building. We also visited the University of Pune (main building is pictured), which featured some of the first examples we've seen of architecture from the British Raj.

Today (Thursday) was our first day of work. Donna and I are working at Deenanath Mangeshkar Hospital, so after the dizzying ride through the Pune traffic (Vishnu, our driver from Virgo, took us), we arrived and were introduced to the hospital. It's eight stories high, with four major wings on each floor. I'll post pictures later when I bring my camera to the hospital. In any case, our first day entirely consisted of a tour of the hospital and then eating lunch. The hospital is not air conditioned except in a few areas where either the hospital caters to the upper class (who return the favor by paying extra) or where absolutely necessary. The hospital is bustling with patients and doctors and has a wide range of health care options. It will definitely be a fascinating experience working there this summer!

In world news relating to India, it appears that India-Pakistan relations aren't exactly peachy. The newspapers in Pune seem to be indicating increased animosity between the two nuclear powers, and given the history of violence between the two countries, it perhaps is not surprising that the US State Department issued a travel warning to, well, us. The Indians are indignant and insist that their country is a completely safe country. Also, Hillary Clinton seems to be making plans to travel to India as Secretary of State, presumbably to bolster potential talks between India and Pakistan.

For more photos, click here. This album (and others) will be updated throughout my trip, and I'll provide links here as it gets updated.

American India

As I noted in my previous post, India is not so foreign as to not have signs of our country everywhere. It really is incredible to see the influence that the United States has had on the rest of the world. Our products are everywhere--brands such as McDonald's, Coca-Cola, and Fed-Ex. Our news makes the front page here in India. The elite here are often American-educated. India and the United States are separated by a vast wealth gap, but we aren't horribly different when it comes right down to it. We both are large democracies. Both of us are diverse populations, making it difficult for true democracy. And as for our infrastructure, both of ours are awful when compared to similarly developed countries (e.g., compare India's urban sprawl and dilapidated infrastructure with the perfectly designed and brand-new infrastructure in China; or the pathetic American transit system when compared with that of France). Both of us recognize the dangers of terrorism, and have witnessed it firsthand with attacks in our largest respective cities. In the United States, we have 9/11. In India, it's known in the newspapers as 26/11.

One must wonder what that means for the south Asian superpower. China and India are both emerging onto the world stage, which means that while they may not necessarily compete with the United States for economic dominance, they will surely become a player on the world stage. Yet they have taken two very different paths. China's has been clouded by the methods of an authoritarian government. India has set itself on the path that looks to be like the Asian United States. It will take decades (if not centuries) achieve the western standard of living, and there are cultural and language barriers that will need to be broken down, but the future seems almost inevitable. Fareed Zakaria wrote an article just recently that claims that the recent elections in India may be an important mile marker in the road towards a true Indian power. Often, the talk is about Chinese-American relations. Indeed, that is important, because the government in Beijing is perhaps one of the most powerful on Earth and China holds considerable economic leverage over the United States. However, it seems that India is our natural Asian ally. The similarities between our two nations are too great to ignore. The current administration would do well to put some emphasis on maintaining and improving Indian-American relationship, setting a solid precedent for years to come.

Interestingly, Zakaria's article mentions China's coming out party--the Beijing Olympics. So in two summers, I'll be able to see firsthand the respective "coming out parties" of the two Asian superpowers. Later this summer, after I've had time to digest and explore more of India, I'll have a later post about that.

First impressions and Coca Cola

After about 28 hours of traveling, we made it to our flat in Pune. I managed to sleep quite a bit on the plane (after watching two movies--we had about 350 movies to choose from on the plane, which, even for a 15-hour plane ride, is quite enough) and then on the 3-hour car ride from Mumbai. Our first day has been one mostly of relaxing, fighting jet lag, and starting to aclimate to the new culture, our rooms, and of course, the heat and humidity. It's hotter here than in Houston, and more humid (I didn't know if that was possible!).

We have internet and TV in our flat, so we're not exactly living poorly. Fortunately for us, we have the advantage of a nice exchange rate, so we can eat an upscale meal here in India for less than 5 US dollars. Of course, we have to be a bit picky about the sort of things we eat and especially about what we drink. Our medications only go so far fighting the lovely illnesses coming from eating or drinking the wrong thing.

So, first impressions of India. When we walked off of the (very cold) plane, we felt that instant blast of heat and humidity walking into the Mumbai airport. The smells can be overpowering at times (not always bad--just very different than what we're used to), and the heat is oppressive, even when we arrived last night in the wee hours of the morning. Then of course, there were people everywhere. The area where we came out of the terminal was lined with drivers carrying signs for their customers. Driving through the dizzying maze of Mumbai made me appreciate the civility of Houston drivers. After all, Houston drivers are aware of the fact that only one car can be in one place at one time. Mumbai, on the other hand, focuses on getting through small spaces as quickly as possible, avoiding contact with the rickshaws, motorcycles, and flatbed trucks--barely. Horns are an absolute necessity, and on the expressways at night, flashing headlights seems to be the universal sign of preparing to past someone (a sign that usually indicates the car in front to move over).

Today we went out to lunch with Ajay and Krishna, both from Virgo Engineers. Food here is very spicey, which will be quite a change for me, seeing as how I'm used to comparatively bland American food. However, some things don't change, and one of those things is Coca-Cola. All four of us ordered Coke's at lunch today, perhaps partly to ward off the more obvious effects of jet lag. However, even if french fries and McDonald's change by headed to Asia, Coke tastes just the same as always. I'll have more on the American influence in India in a later post.