Not Home, Alone

There’s just so much to write.

To provide the context – in the most densely populated city in the world in the most densely populated country in the world, today I feel very alone.

And I am very conscious of the fact that this is by my choice. I chose to come out here and work part time. Trying to support training of paraprofessionals to deliver healthcare in remote areas where it simply wasn’t available before.

Sure, professionally it’s very satisfying. Its been actually a fantastic year in that regards. Forget about year, its been a fantastic week professionally. More on this later (I sense a Practice Gratitude post coming up).

What’s lacking, and what I realized at the soul shaking indicorps reunion, was that while Indicorps has permanently and profusely (much to the dismay of my parents probably) completely changed the professional track, I have not let the process, the spirit of seva, the zest of the Indicorps community, seep into my personal life.

Because if anything those two years in India have done is make me tough. And taught me to not look at life as a series of ups and downs, but rather a series of points of inflection. I’d like to think that this is one such point, because it begets choice. I get to choose where I go from here. Up or down or the same trajectory. And if next year is anything like this year, it still won’t be a bad thing J

This is the start of the ruminations. More to come

LGT Venture Philanthrophy - iCATS fellowship

iCats Program

LGT Venture Philanthropy is proud to announce the launch of the iCats Program: The iCats Program is an answer to the need for professional know-how and resources in many philanthropic organizations and social enterprises. LGT Venture Philanthropy created a web-based platform to match experienced professionals with specific positions in selected philanthropic organizations.

The fellow positions for 2010 are now online on www.icatsprogram.com ! Application deadline is 26^th October 2009.

A fellow works 11 months on-site with a portfolio organization from February to December 2010 and receives regular mentoring from the LGT Venture Philanthropy team. In addition, a 4-day induction workshop brings all fellows together in the Swiss mountains. Go to www.icatsprogram.com to find out more and to apply.

More here:

• iCats program factsheet
• iCats program Article

On giving in India

This article sparked something in me enough to write: India's Rich, Open Your Wallets

It goes into how Bill Gates received the Gandhi Prize for Peace, Disarmament and Development on behalf of the Bill & Melinda Gates Foundation, which has poured a $1bn into India. Clearly, not ALL of this money has been put to the best use (see How Bill Gates Blew $258 million in India's HIV Corridor). There are clearly many many things that I could comment on based on my own experience in rural India. I know there are friends of mine who work in global HIV/AIDS from the public health angle, and they too have quite a bit of criticism.

However, my point today is simply the scale of the spending, and the main point that the first article tries to drive home: India's rich need to open their wallets more

While Bill Gates IS super rich and he DOES have a lot of disposable income, there are many billionaires and multi-millionaires in the new 'shining' India. Adjusting for Purchasing Power Parity (PPP), which roughly stands around 4 times the official exchange rate, these people have significant levels of income at their disposal.

Which begets the question - why don't India's wealthy give back more?

The article does an excellent job of presenting many different reasons and opinions on why this is the case. Personally, I have to agree with Tarun Das that there aren't enough outlets for giving. It makes sense that the rich, many of them corporate titans who have made their fortunes by driving hard bargains and results-at-all-costs, would want the same value-for-money and concrete results in their philanthropy. PR at a large scale is not enough simply because it's not NEEDED. Unlike the US, where a corporation's social commitment and community outreach genuinely factor into how well communities accept and support them, and if top talent chooses to work with them, this is really not the case in India. A new middle class is being minted in India, and the only bottomline for talented youth is the financial one at this point. There is no judgement here - it simply is. It makes sense. There is limited choice. The generation before us, my parent's generation, still teaches us the 'conservative', risk-averse way, and reminds us of our 'responsibilities' to the family.

Another favorite line in India is echoed in this article: "Charity begins at home". The typical argument from parents is that yes, it's a good thing to serve and give back, but why don't you serve and give back your immediate family? It's a strong argument, and perhaps relevant to families rising in the socio-economic totem pole. However, for MANY of the families I have encountered, the rest of the nuclear & extended family is doing a good enough job by themselves. Secondly, this is EXACTLY the mindset that we as Indians need to move beyond. It is a question of identity, and how generous you are in your definition of it. Is it enough to be just a particular family from a particular town? Or a particular sub-caste from a particular region? Or a particular caste from a particular state? Or 'high society' vs. 'low society'? Clearly, if you draw this argument out, the only universal truth is to consider yourself as a being of the larger universal, with responsibility towards all, living or human or not. However, the journey from the intellectual answer to spiritual realization is vast, and for most will span multiple lifetimes. Perhaps due to my upbringing, and definitely due to the Indicorps, I choose to look at my identity as that of an Indian, and choose to revel in the idiosyncrasies of all the sub-identities within that. What's not OK to me, and this is gut not intellect speaking, is to limit charity to home. That's the cop-out answer.

For the wealthy to start their charity at an individual/local level, however, makes sense to me. My experience has taught me that we will only climb over brick walls for things that matter to us, that which we personally identify with, where we have 'skin-in-the-game'. And if I choose to be forgiving and be OK with the fact that everyone is at a different point the spectrum of identity, then that's where they should start. For example, the Piramal Foundation, who funded the Grassroots Development Laboratory (GDL), chose to begin its activities in their ancestral home of Bagar, Rajasthan. It's a great place to start, because there is goodwill in the community, people trust your intentions, and you have room to learn from your mistakes. But many a foundations tend to limit themselves to only their ancestral homes, or where they have factories. Foundations that can afford to have massive scale need to step beyond their places of start. I applaud the Piramal Foundation in learning from their experience in Bagar and working towards spreading their work beyond, and I will be keenly following their expansion over the next few years.

There is one 'gap' in my argument here. Beyond the debate of whether charity is good or bad, I see the 'operational' roles of foundations as one of two. First, they can either try to tackle one particular problem or issue e.g. clean water or AIDS or education etc. In this case, once they figure out the solution, they should expand geographically to the greatest extent possible and spread that benefit (yes, greed is good). The other option is that they 'adopt' a particular region. In this case, they should take a holistic view of development in this region, and try to solve EVERY problem that arises. Again, all of this is a theoretical extrapolation, and I completely understand the complexities and ground realities of scaling organizations, particularly those that are mission-based. Looking at it from a business perspective, we can transpose these two options as (1) Producers of goods / services (2) Distributors of goods/services. Piramal Foundation has taken the role of the first, and are thus pushing market-bases / sustainable solutions to particular issues, great example being the expansion of Sarvajal into different territories. I had a chance to visit a foundation in Hyderabad this past April, and I recommended the latter option to them - their 'identity' and 'mission' was much more to help the people where their factories were located, as well as a couple of adopted districts of Andhra Pradesh. But I did push them to think beyond 'good enough' - Yes, 10 free pyaaus (free water stations during India's blistering summer) are great, but why not a 100 or a 1000 to cover all of your area? And also to think holistically about the needs of that area, beyond the projects that were sparked largely by the inspiration of the foundation's team and chairwoman.

All things aside, I strongly believe that India needs its rich to identify with the poor, and open not just their wallets, but also their influence and tenacity to help those in need. Some of the complacency comes from the hangover of the bygone socialist era - 'it's the government's job'. And as much as I applaud Bill Gates generosity, some of it comes from the money being poured in by international aid organizations.

I have a radical thought for India. Why don't we work towards stopping all international aid? And instead find a way, a call-to-action for our own rich? Perhaps one man in India won't part with $1bn, but 10 Indians together can. Will India's rich rise to the occasion if the national identity and self-reliance was called into question? Would ads reminding us of India's 'beggar bowl' image from back in the early 60s do the trick?

A brief history of c-sections

Read:
http://www.nlm.nih.gov/exhibition/cesarean/part4.html

 Legend of Caesar's birth 

Very interesting read on how c-sections came to become prevalent around the world. It is interesting to note that the c-section rate in the US is a above 31%. The WHO mandates that the optimal levels of c-sections in any country should be between 5-15%. This makes logical sense. It is a known fact that 85% of all deliveries are completely normal. That is someone has to just stand there and catch the baby (preferably with clean hands).

I would never discount the pain that women have to go through childbirth (apparently ranked as the most painful human experience, followed at number 2 by testicular torsion). However, undergoing a surgery that has no health benefits for mother or child, and instead a longer recovery period, more chances of infection, and all around increase in cost just doesn’t seem like that good of an idea.

True testament to why public health is such a socio-religio-politico-technologico-economic(o?) probem with no easy solutions.

BoP reading guide

A friend of mine asked me about a reading guide for BoP / using business to serve the poor.

Nextbillion has a great entry on this: http://www.nextbillion.net/blog/bop-101-a-review-of-must-read-literature-for-those-interested-i2

Why maternal mortality is not easy to solve

My manager at GE healthcare and I went to Canje (pronounced Kanj), the "headquarters" of Zanmi Lasante (Partners In Health in Haiti).  It was truly exciting to get an opportunity to visit the place where Dr. Paul Farmer started his inspirational work.

On our way there, we encountered a group of 12 men who were carrying a women on a stretcher. Turned out it was a woman in labor, who also had eclempsia (caused due to hypertension, and one of the leading causes of maternal mortality globally). The lady was from a village on a mountain. She had gone into labor around midnight. Around 6am, somebody recognized the symptoms of eclempsia setting in, probably because they had seen it before: Haitians have a VERY high fertility rate - 1o to 12 pregnancies is the norm. They started gathering the family members and the neighbors, who all mounted the lady on a homemade stretcher (an iron bed with two big logs ran under, and a sheet to cover the lady). They had been walking for 3 hours, and had another hour to go when we ran into them.

The number of challenges that come up in that story are immense: detecting hypertension (cause of eclempsia) and other conditions early, educating the traditional birth attendants, providing a means for communication in case of an emergency, providing an ambulance/means of transportation, and facilities for operating and blood transfusion, etc. Many many things to think about, and that incident has definitely sparked a slew of conversation here.

The story has a happy ending. We turned around, offered the car to the lady and her family, who drove her to the Canje facility. When we got to Canje (after hiking a bit), we learned that the doctors had performed a successful c-section. The mother was being closed up when we last heardc, and was stable. We actually saw the baby being given oxygen. In the words of the pediatrician, the baby "was not crying as vigorously as we like".

I'll let the pictures do the rest of the talking:

Group carrying the stretcher - note the roads

Close up of the group carrying the stretcher - they had to come down moutains like the ones you see in the background

Mother in labor on the stretcher

Lifting the mother out of the stretcher

Loading the mother into the car

The "stretcher"

The baby being administered oxygen

Closeup of the baby boy

Of hummingbirds and mangoes

Pics from the very niceguest house area where we are being hosted for our trip. It is surreal that something this nice exists in rural Haiti.

The building in which we live

The lush greenery

Spring is fruit season

The dining room / patio area

Did I mention the mangoes that we pick off the tree and have for breakfast / night "supper" (there's no dinner in Haiti)

Beautiful hummingbird right outside the dining room

TO DO: Regain childlike wonder

So. A fantastic thing happened the other day.

I was chatting with an Indicorps alum who I haven't spoken to in a couple of years (it's a shame, I know). And as we get talking, she starts talking about how she's doing her PhD on how Australian lizards speciate. And how she keeps the spirit of service alive by teaching math to prisoners. And how she's learning the Banjo, just because.

The banjo. That's right, the banjo! And it totally rocked my proverbial socks off. It hit me right there and then like a burst of inspiration. THAT's what I need to do - I need to keep that childlike wonder alive. I wanna do things SIMPLY because I'm curious about them.

Like her, I can be (and am) serious about what I want to accomplish in this world. But I don't need to be serious all along the journey! I want to take little side tours, just because. I still want to look at the world with the eyes of a child, full of curiosity and wonder. 

Gibran captures this balance between duty and passion beautifully: 

Among the hills, when you sit in the cool shade of the white poplars, sharing the peace and serenity of distant fields and meadows - then let your heart say in silence, "God rests in reason." 

 

And when the storm comes, and the mighty wind shakes the forest, and thunder and lightning proclaim the majesty of the sky, - then let your heart say in awe, "God moves in passion." 

 - The Prophet by Khalil Gibran

First day of ultrasound training!

Yup - we got trained on GE's very cool LogiqI line of portable ultrasound machines today. Here's some videos from our first day of training! Note - these are taken by the two "students", as well as the teacher. a longitudanal spinal one is hard to get.

5/13/09 Update: To clarify, this is NOT my baby (thank you for the confused congratulatory notes, however). These are photos from volunteers who came to the ultrasound training.

31 weeks - baby "sucking"

31 weeks - foetus wagging tongue

20 weeks - face:

20 weeks - mouth open:

20 weeks - head and spine

20 weeks - hand 

20 weeks - fist

20 weeks - feet

20 weeks - yawning baby

20 weeks - baby moving

20 weeks - beating heart (wait for it)

Tackling maternal mortality

Cross-posted on http://mblog.lib.umich.edu/WDIGlobalImpact/archives/2009/ashish/index.html

As you may know, my WDI internship this summer is with GE Healthcare. I will be supporting GE healthcare's maternal and child health initiative for rural areas. Our goal is to serve the world’s rural poor by providing them access to low cost technologies that improve diagnostic accuracy & public health outcomes. Specifically, I will be working on the maternal and child health initiative, initially focusing on using diagnostic technologies (ultrasound and more) to reduce the maternal mortality rate (MMR). Maternal mortality is the one health outcome that has the most inequality in the world, with 99% of maternal mortality occurring in the developing world. Furthermore, reduction of maternal mortality (Millenium Development Goal 5) has been the most difficult Millenium Development Goal globally to tackle, with only around a 1% improvement on average worldwide.

With ultrasound technology becoming portable and less expensive, there is a definite opportunity to provide Obstetric screening to the last mile i.e. in rural villages of developing countries. To achieve this, GE is currently partnering with MCH groups around the world who have successfully "task shifted" to midwives, nurses & community health workers in order to improve access to maternal healthcare in rural areas. Our partners include Partners In Health (PIH) in Haiti, ISCISA in Mozambique (who started the award-winning midwife-surgeon program), and our flagship partnership is with Grameen Kalyan in Bangladesh.

Personally, it is truly an exciting opportunity to be able to conduct trials with these world-class partners around the world, and to work at a scale that only a corporate like GE can enable. Our approach is that of a social enterprise: we are exploring this opportunity both as directly affecting global health outcomes, as well as becoming a viable business for GE. There are many challenges to overcome: designing a viable technology platform, successfully task-shifting to midwives, nurses etc, completing the "value chain" by providing treatment options after diagnosis etc. I am confident that with a sincere effort from GE and their partners, this problem can be surmounted towards a very worthwhile social outcome.

Fearing death

Is the fear of death a good thing?

 

At a dinner today, a colleague of mine at the MAP was talking about how scared she was of flying, and how that fear has developed over time because of some bad experiences with flying. A random thought went through my mind: is it because she's afraid of dying?

 

And then I thought: if I died today, I'd be completely OK with it. I've had a good life. I've had interesting experiences. I've seen some of the world. I've met many different people with very different thoughts.

 

Is that a good thing though? It just doesn't sound normal to be sitting here in my twenties thinking about how I'm OK with dying. Is it because I have nothing to lose? That's true to certain extent - my friend, she is engaged, has dreams and ambitions. I on the other hand have lived a happy-go-lucky life. Net net, I've definitely taken more from the world than I have given back, and if you do a NPV analysis considering the time value of money, or any sort of input for that matter, I am very very much in the red.

 

Is it because I have no ambition? The words of a former boss went through my mind, who said he's impatient because he doesn't want to die without making a big difference in this world, and that's what gives him his ferocious drive.

 

Or is it because I know now that life is a process, and how you've lived it is all that matters.

 

Hmm, perhaps its time to crack open that copy of Bhagavad Gita I purchased last week and see if any ideas pop into my head.

B-school and the spirit of service

An inflection point in my "b-school" career was in September of last year. About two or three weeks into the MBA program, I was ready to quit. I didn't know if I was learning anything major, and the itch to do something meaningful, primarily a habit from the mode I had been in during my Indicorps fellowship.

By serendipity, the Indicorps re-union weekend happened to right around then. And on a hike through a national park outside D.C., I shared my thoughts with Sonal Shah, founder of Indicorps, who had come to the re-union too.

Two things she said stuck to my mind: One, that I need to stay in b-school, because the world of business needs people who ARE motivated to do something for others. The other thing she mentioned was that because of my experience, I also now had a responsibility to be the voice of the people back in Bagar, who do not have the opportunity to represent themselves otherwise.

This is the responsibility that I now convey to people: that having seen this reality of the world, our responsibility is not necessarily to devote our lives in the service of others. But it IS our responsibilty to speak up and represent the people who don't have voices in conversations where they are misunderstood, to make sure that they have a voice in conversations where they are completely ignored.

I had a conversation with Prof. Jim Walsh tonight about this subject. He said that he uses the following simple diagram when he's trying to help his kids in trying to figure out what to do with their lives:

It makes so much sense. from a practical perspective, I am where I want to be.  I like it, I am good at it (at least i'm not bad at it), I am doing it to "make the world better". I just got to figure out the money / taking care of my responsibilities.

However, there is still some inner turmoil in me. It started off the week after I came back from my recent trip to Bagar. I went there because of nostalgia. And I came back so proud of where GDL was, and of the things that I had started. That's when it hit me: am I in social service for the right reasons? The entire time I was in Bagar, I never once asked the question, "are we helping people". Am I in interested in social enterprise because of a newer, more relevant definition of "greatness"? Am I just chasing my ego by trying to make a difference in this world?

Where is the 'spirit of service'? Where is that feeling that says that I identify with the people who are less 'fortunate' than I am, and that it fundamentally matters to my liberation what happens to them? Where is the spirit of giving that says no matter the results, no matter the accolades, no matter the success, I simply have to give, to try, to serve, because it matters, because it is the right thing to do?

My professor mentioned that I am simply human, and that ego is simply a part of everyone. I agree. It is. But there is a difference between primary motive & secondary motive. Because when it comes a time to make a tradeoff, to make a decision, my instincts will follow the primary motivation. And in times like these, I want my primary motive to be service, not greatness.

While the diagram says that I'm in the right place, am I doing it for the right reasons? It's a nagging question in the back of my mind, and something that I need to make sure I don't ignore, and keep examining, in the true spirit of self-reflection that was exemplified at Initiatives of Change.

 As for staying in b-school, my former boss at GDL/Indicorps put it in the right perspective. If I am not occupying my time "receiving" at b-school, then it is my responsibilty to occupy the rest of my time to "give".

There is much that I can share. Much that all of us can share with each other.

Classic example - this MAP project. I came to Michigan because of a fantastic program in social enterprise, and not much for MAP, which Michigan touts as a key differentiator. My experience at MAP has certainly made me a believer. While I may have what some may consider an "ideal" background to be working for a social enterprise in India, I am currently working with an investment banker, a consultant to the federal government, a product manager for a major consumer electronics manufacturing company, and manager of a call center. And I know that while I may be the subject-matter expert of the group, I would not have been able to deliver the quality of advice to our client on my own. There is a huge difference when you work with 4 other people that you respect, and that bring in very different perspectives to the same goal. Add to that the fantastic support of the professors who serve as our MAP project advisors, and I can really see why MAP is a fantastic program to add in any MBA curriculum.

Much to think about.

I would like to build things

"...know that your people will judge you on what you can build,
not what you destroy"
- US President Barack Obama, Inauguration Speech

By all accounts, Obama delivered a sterling speech today. While many expected him to strike a balance between 'celebration' & 'difficult task ahead', he focused a lot on the enormity of the responsibility in our hands, and the legacy to uphold.

The quote above was the one that resonated with me. In many accounts, it reminded of a change in my viewpoint over the last two years. Indicorps has a wonderful philosophy of working for things, not against things. It is something that we all lived by in the one or two years in the fellowship. It is a crucial distinction to remember when we immerse ourselves in the community, and choose to dedicate ourselves towards a singular issue from a myriad of complex problems that face the community. It is just functionally necessary for a grassroots fellowship.

My last two years at some point lifted me beyond the stage of a grassroots development worker. We built an organization. We became an institution. We stood for something. And we built programs for the long-run, focusing on areas of livelihood & healthcare, areas where we identified the most need & where we could deliver the most value.

We encountered many roadblocks along the way, and we overcame many of them. It made me realize one thing though: on a long-term basis, you will have to work against something. It is almost by definition of being a community worker. By trying to assist the disadvantaged, you are disrupting the source of power & relative status of the advantaged. The status quo rigidly follows Newton's first law of inertia, and will actively work in the interest of self-preservation.

I realized that societal change comes both from offering a carrot and wielding a stick. The people will remember what you changed, and the future will remember what you built, but behind the scenes, you will have to be prepared to destroy that which holds the people back.

I will always choose to work towards something, building things, leaving something behind. But my time in India has taught me to recognize and respect those who choose to work against today's problems.

Skill Fit vs. Culture Fit: Tallent challenges for social ventures

In this article on nextbillion.net, Univ of Michigan's own Moses Lee presents a common dilemma for social enterprises facing a talent crunch: For a job opening, you have to choose between two candidates. One that fits the job profile, but not the culture, and the other that gets the culture and has the will/passion for change, but does not have the right skillset. Who do you pick?

My response:

During the last two years, I helped found the Grassroots Development Laboratory (www.gdl.org.in) in Rajasthan, India. We finally gained momentum and started growing at the year and a half mark, and the talent shortage was our single biggest impediment to growth.

A few things that I've come to realize:

• NGOs/Social Ventures start because of the passion of a few individuals. It is important to stoke this early on. At this point, it is KEY to find someone who 'gets' the culture
• There IS a transition point where you have to grow out of your comfort zone, and become 'professional'. It is where the ideas and passion are no longer enough for the founders, the community you serve, or the donors who serve you, and they demand hard results. You will need people to execute the right things, the right way, and thus the skillset becomes important.

I think it is possible to misjudge this transition point too early. Organizational culture, and not financial viability, may be critical to surviving beyond the nascent stage, and stories of many NGOs would support this notion at least anecdotally. Understanding what stage you're in, and sticking to your priorities, is very difficult for any startup organization, especially when there is a talent shortage.

From early missteps (and subsequent right steps) we figured out what worked for us: the founders need to have a clear understanding of which stage they are in, what their priority is, what they want their organization's values to be, and orient prospective/new employees VERY clearly about these values. In a startup environment this seems so redundant, because everybody "knows" the values anyways, but the exercises can sometime stir up a hornet's nest. It is fruitful to be able to commit to something in writing, as well as define the limits/relative importance of these values by defining the extent to which we will demonstrate/practice/cultivate the values. For example: Does simple living come at the expense of efficient delivery? In what way? To what extent?

Of course, throughout this continuously transformative phase, the tough question may sometime not be what, but who: who are the founders, and thus, who defines the values of this organization.

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