Monday, July 06, 2015

Supercharged Tuberculosis, Made in India

A patient with extensively drug-resistant TB flew from Mumbai to Chicago, and the deadly disease could become an infamous export due to problems in India's public health system
By Jason Overdorf
Scientific American (July 2015)

MUMBAI, India—On a drizzly Monday afternoon here a few weeks ago, patients crowded around a door in a hallway in P. D. Hinduja Hospital—a private, nonprofit facility that caters to around 350,000 people per year. There is a loud, steady roar of voices, and patients and nurses have to shoulder past one another to get through the door, which leads to the office of lung specialist Zarir Udwadia. The walls are clean and white, and the air carries the tangy smell of disinfectant.

Against one of those white walls a grizzled old man with a breathing tube in his nose lies moaning on a stretcher. Nearby, clutching a sheaf of prescriptions, the father of a sick college student tries to catch the attention of one of Udwadia's assisting physicians. Several families have traveled thousands of kilometers to be here. Many of these patients, like 19-year-old Nisha, an engineering student from the central state of Madhya Pradesh, have tuberculosis (TB). Nisha, who asked that her real name be withheld, has been treated for lung problems for more than a year, only to learn that inaccurate diagnoses and prescription errors have supercharged the disease rather than curing it. “My doctors kept on changing the drugs,” says Nisha. Dressed in jeans and a floral-print blouse and black Buddy Holly–style horn-rimmed glasses, she speaks in a bright, optimistic voice, although her battle with TB has left her anorexic-thin.

By exposing Nisha's TB to various drugs without wiping it out, her doctors just made it stronger, a problem that Udwadia—the doctor who first identified extreme drug resistance in the germ—and other health experts say is becoming increasingly widespread in India. Too few diagnostic laboratories, too many poorly-trained health practitioners and thousands of infected people living in crowded, unsanitary conditions has made India home to the world's largest epidemic of drug-resistant TB. More than two million Indians every year get the highly contagious disease, and a patient dies every two minutes. Around 62,000 of these people harbor TB that is immune to at least four types of drugs, according to the World Health Organization, and as many as 15,000 may have an even more dangerous type called “extensively drug-resistant” TB that fights off almost every antibiotic in the medical arsenal.

Now, difficult-to-kill TB is no longer just India's nightmare. In June U.S. health authorities confirmed that an Indian patient carried this extreme form of the infection, called XDR-TB, across the ocean to Chicago. The patient drove from there to visit relatives as far away as Tennessee and Missouri. Health officials in several states are tracking down everyone with whom the patient—who is now quarantined and being treated at the National Institutes of Health in Maryland—had prolonged contact. The disease can be cured in only 30 percent of patients and sometimes requires surgery to remove infected parts of lungs. Although TB’s slow rate of infection makes explosive epidemics unlikely, the Chicago episode shows how easy it might be for the illness to become a worldwide export.

Yet until recently Indian public health officials remained reluctant to admit there's a problem, says Nerges Mistry, director of the Mumbai-based Foundation for Medical Research. “They were always trying to deny it [existed],” she says. (Neither the head of India's Revised National Tuberculosis Control Program (RNTCP) nor Mumbai's main tuberculosis control official—both of whom are new to their posts—responded to interview requests from Scientific American.)

Resisting a cure
Tuberculosis typically attacks the lungs, but can also develop in bones, the stomach or even the genitals. Unlike the Ebola virus, which can only be transmitted by direct contact with the bodily fluids of an infected person, TB can be transmitted via coughing, in airborne droplets from an infected person, though experts say it's harder to catch than viruses like influenza or chicken pox. (However, in 2013 Scientific American reported that some TB strains may be getting more virulent.) The typical symptoms of a TB lung infection include fever, night sweats and a chronic, hacking cough.

For an ordinary infection, the WHO-mandated treatment includes lengthy treatment with a cocktail of antibiotics: a two-month course of rifampicin, isoniazid, pyrazinamide and ethambutol followed by a four-month regimen of isoniazid and rifampicin alone. If the patient fails to complete the treatment or the TB bacilli in her system is already immune to one of those antibiotics, however, then some of the germs will survive, adapt and grow stronger. Some the hardier organisms can survive to pass on drug-resistant traits to their progeny, and those traits then spread to a wider group of descendants. That means it's crucial to kill off the entire population with the first course of treatment and hunt down and kill off any resistors.

The WHO defines drug-resistant TB as a strain of bacteria immune to one of the first-line drugs used to treat the disease. Multidrug resistant TB, or MDR-TB, does not respond to the two most powerful drugs, isoniazid and rifampicin. Finally, XDR-TB is resistant to those two drugs, plus any fluoroquinolone and at least one of the three injectable second-line drugs, capreomycin, kanamycin and amikacin.

In Nisha’s case her doctors never tested her for drug resistance, so she underwent treatment for more than a year with compounds doomed to failure. As a result, she suffered side effects from the antibiotics—which included hearing loss and joint pain so severe she couldn't get out of bed—without being cured. Worse, her infection grew stronger.

What concerns TB specialists like Udwadia is that India has been creating thousands of Nishas this way. And although it has begun to respond to the problem, the reaction is too small and too slow. A slim, fastidious man with a sharp nose and a thick shock of black hair, Udwadia doesn't look like an alarmist. He wears a conformist's pinstriped dress shirt and red tie as he puts Nisha through a brief examination. But Mistry and other health experts from nongovernmental organizations say his original identification of alarmingly resistant disease strains, and his continued pressure on the medical community to do something about it, are among the biggest reasons that India's culture of denial is beginning to show some cracks.

The country’s resistance problems have arisen, paradoxically, because India has made great strides against the nonresistant form of the disease. Beginning in the 1990s India adopted a WHO-developed program called “Directly Observed Treatment, Short Course,” or DOTS. It is designed to ensure poorly educated patients in the developing world properly complete the six-month-long, first-line TB treatment. Through a huge network of volunteer “DOT providers” the RNTCP has managed to dispense the free treatment to corners of the country where the nearest hospital lies hundreds of kilometers away. It boosted the detection rate for new cases above 70 percent in 2010 and it is targeting 90 percent this year. And it has achieved a treatment success rate of 88 percent for the patients it identifies, according to RNTCP documents.

In other ways, however, India’s performance has been less than stellar. Although public health spending has risen steadily since 2000 the federal share is still less than $5 per person, a perilously low level.** As a result, the country has fewer than one doctor per 1,000 people and an even more dramatic shortage of laboratories that can test for TB resistance. DOTS cannot substitute for testing infrastructure. As recently as 2008, less than one percent of high-risk patients were tested to see if they were susceptible to various anti-TB drugs. And private sector doctors screened for TB with blood tests that were notorious for false positives.* These errors simply meant that frontline antibiotics were overused, and overuse is the classic recipe for developing resistance.Number of multidrug-resistant TB cases estimated among known TB patients, 2013. Source: WHO

In December 2011 Udwadia decided that he had seen enough. The laboratory at Hinduja—one of the few Indian labs equipped to perform drug-susceptibility testing—identified a fourth patient infected with TB that was impervious to all 12 of the first-line, second-line and last-resort drugs that the hospital had at its disposal. He dashed off a two-page note to the medical journal Clinical Infectious Diseases, declaring an outbreak of what he called “totally drug-resistant TB.”

Italian scientists had made the same claim in 2006, and the bacteria’s capacity to develop drug-resistant strains was already well known. In a country that thought it was getting its TB problems under control, however, Udwadia’s article was as important as pulling the fire alarm when you see the building in flames.

The doctor, like the antibiotics he was trying to use, encountered resistance. WHO questioned the term “totally drug-resistant,” saying absolute imperviousness had not been demonstrated. The agency also hinted that Udwadia's laboratory results might be flawed. India's health ministry added doubts about the lab, noting that Hinduja Hospital had not received accreditation from the government to conduct drug-sensitivity tests for second-line drugs.

The dispute caught the attention of the press and the public. The Times of India and other newspapers launched lengthy discussions on the extent of drug resistance. Bollywood star Amir Khan devoted an hour-long episode of his wildly popular, Oprah-style talk show to Udwadia and TB. And other Indian medical experts came out to support him, accusing the health ministry of attacking the messenger. Citations of hisClinical Infectious Diseases article by other researchers skyrocketed.

The public outcry forced the government into action. It dramatically boosted the budget for the national tuberculosis control program and increased hospital and outreach staff fourfold. Authorities stopped using older, error-prone blood tests, and began a transition to molecular testing with new GeneXpert machines that identify genetic markers of resistant strains. Though still in short supply, the machines drastically reduced false positives and allowed doctors detect resistance to first-line drugs within two hours, rather than weeks. Where they've been implemented, the machines produce a fivefold increase in detection of rifampicin resistance, for instance, according to the largest Indian study to date. Cases that the machine flags as drug-resistant are referred to the district TB officer, and a committee of specialists decides on a treatment regime. “I don't think the push would have been sustainable if not for Zarir [Udwadia]'s reports in the newspapers,” Mistry says. “It forced people to come to terms with what was really happening in the city.”

An expanding problem

But machines alone will not solve the problem. Mumbai now boasts 18 GeneXpert machines. There are only 120 nationwide, though—not enough to test all patients suspected to have MDR-TB, as recommended by WHO. And even in Mumbai, government hospitals only conduct GeneXpert tests on patients that have failed to respond to the first two months of DOTS treatment, due to the high cost of the cartridges the machine uses.

Udwadia and other physicians voice a bigger concern. The GeneXpert test can only confirm resistance to rifampicin, they note. Because India doesn't have enough laboratories to conduct further drug-susceptibility tests, any patient flagged by the machines is immediately put on the national TB program recommended regimen for MDR-TB. This one-size-fits-all treatment does have an advantage; it makes it “easier for lower category people to supervise patients and easier for the patient to take the medicines regularly,” says Rajeshree Jadhav, chief medical officer at Mumbai's government-run Pandit Madan Mohan Malviya Hospital.

Yet the off-the-shelf regimen does not account for further, stronger drug resistance that has already spread in Mumbai. According to a yet unpublished study conducted by Udwadia and his colleagues at Hinduja, it would now only cure a third of the drug-resistant patients in the city. The rest would receive three or more useless drugs and thus become even more resistant. “In Mumbai it is absolutely critical to follow up GeneXpert with full drug-susceptibility testing,” says Madhukar Pai, an epidemiologist at McGill University in Montreal and a leading TB researcher. “Otherwise, patients might get inadequate treatment.

Nor does the country have a good sense of how big the resistance problem really is. Because of the small number of diagnostic laboratories there's no way of knowing how the proportion of XDR-TB patients here compares with central Asian and eastern European countries like Lithuania—where nearly a quarter of MDR-TB patients actually have XDR-TB. But the sheer numbers of new TB infections every year, together with the tardy government response, suggest the problem may soon be larger here. A nationwide drug-resistance survey should provide more data in 2016, according to Pai. But the evidence that is available suggests XDR-TB will be “a sizeable fraction of all MDR” in cities like Mumbai—although it will remain low in rural areas.

If there are indeed many people with resistant germs, it heightens the chances of those pathogens leaving the country for the rest of the world. Nearly a million Indians traveled to the U.S. in 2014, compared with less than three million from all of central Asia. More and more middle-class Indians are being diagnosed with TB, and although the patient who carried XDR-TB to the U.S. was immediately placed in isolation, India has no provisions for quarantines or travel restrictions.

The risk of an epidemic outbreak from a single traveler is low, since TB is transmitted from person to person through prolonged, close contact. Moreover, the US has both the resources and tuberculosis control programs to react swiftly, according to Neil Schluger, chief of pulmonary medicine at Columbia University Medical Center and a specialist in TB. However, the worldwide migration of drug resistant strains does worry him a good deal. "It is like Ebola in slow motion. Potentially it is a huge public health problem,” says Schluger, but it is likely to creep along rather than explode.

A difficult future
In India, the troubling situation is not without hope Udwadia has found that some XDR-TB strains can be treated with a cocktail of drugs including the broad-spectrum antibiotic meropenem–clavulanate and the antileprosy medications linezolid and clofazamine. Johnson & Johnson's bedaquiline, the first novel TB treatment to be released in some 40 years, can also be effective. But the chances of survival using bedaquiline are less than 50–50, depending on the severity of drug-resistance and how early treatment begins. The treatment is grueling because the drug itself is highly toxic. It has not yet been approved for use in India, so Udwadia has to lodge individual requests to treat each patient on what is called “compassionate basis.”

Whereas regular DOTS patients undergo a short course of chemotherapy, MDR- and XDR-TB patients may be subjected to it for as long as two years. Radical lung surgery is sometimes also required. And other second-line medications frequently cause nausea, joint pain, hearing failure and depression so severe that suicide is not uncommon.

In Udwadia’s office a stocky, lower-middle-class woman who asked to be called Vanita (not her real name) says she was diagnosed with XDR-TB some four years after she was first treated with DOTS. For months she has been striving to eat better so that she is strong enough to withstand bedaquiline. She is too shy to express her relief when one of Udwadia's assistants tells her that she's finally met the health criteria. But her eyes shine with grateful tears above the green cloth mask covering her mouth and nose. And her doctor, who pushed the concept of total resistance, insists that particular adjective does not determine fate. “‘Total’ never means ‘totally doomed,’” Udwadia says.

Thursday, July 02, 2015

Inside India's Zodiac Murders

By Jason Overdorf
Newsweek (July 2015)

Kurapati Nagaraju is one of India’s wealthiest astrologers. He’s also very lucky. Several months ago, two gunmen on motorcycles skidded to a halt near his house, pumped three bullets into his gut and fled. Rushed to the hospital, Nagaraju survived—only to be jailed on murder charges.

Three of Nagaraju’s relatives—also wealthy astrologers—were much less fortunate. Last year, they were bumping down the highway outside of town when a Toyota minivan swung in behind them. Then it accelerated, roaring past the astrologers' Chevy and forcing it off the road. Three contract killers jumped out and sprayed the Chevy with bullets, killing everyone but the driver.

The victims should have seen it coming—and not because they were astrologers. A few months earlier, Nagaraju and his Gandham clan allegedly arranged the brutal murder of Durga Rao, the charismatic scion of the rival Buthams, and Durga’s relatives vowed revenge, according to a local police report. In separate reports, the police say Butham family members are suspects in the attempt on Nagaraju’s life and the murder of his relatives. Nagaraju has yet to face trial and says his enemies have framed him, according to a local prosecutor.

It’s suddenly dangerous to be a prosperous prognosticator in this country. In recent years, as astrologers and gurus have emerged as fixers and go-betweens for India's often-corrupt politicians, violence has grown increasingly common in that line of work. In 2012, hitmen dressed as police officers gunned down an astrologer who advised powerful politicians in the north Indian state of Uttar Pradesh. His murder, police say, was the result of disputes with rival kingmakers over local elections and construction contracts.

In the neighboring state of Haryana, a guru—who critics say operated with impunity for years because politicians relied on him to deliver votes from his devotees—faces charges of rape, murder and fraud, among other things. (He says his enemies fabricated the charges.) And last year, another Haryana guru barricaded himself in a compound with as many as 15,000 followers to avoid being arrested on a charge of conspiracy to commit murder, in connection with a clash between his group and another sect. He, too, is said to have long enjoyed the support of local politicians.

Residents say the Buthams and Gandhams also have enough clout to call in small favors from state-level politicians. And the bloodshed between the two families in the village of Pinakadimi, the police say, seems to be the result of that battle for money and influence. As one local police source, who asked for anonymity because he wasn’t authorized to speak to the press, put it, “Durga and his rival Nagaraju were vying for control of the local political machine.”

The Untouchable Astrologers

In a sign of the astrologers' new wealth, many villagers have multistory homes rather than the simple huts common in Indian villages. The garish pink houses of the Buthams and the gaudy blue homes of the Gandhams have satellite dishes and are decorated with expensive enamel tiles. Both families have set up lucrative fortune-telling businesses in Mumbai, New Delhi and other major Indian cities, and make frequent trips to meet clients in Australia, Japan and Singapore, among other places. Their customers, according to local journalists, include international businessman Lakshmi Mittal, as well as top local politicians and film stars.At first glance, Pinakadimi looks like a typical South Indian hamlet. Not far from the ditch where assassins threw Durga’s body, a handful of water buffalo amble across the village’s main street, a narrow dirt road. Piles of harvested corn dry in the sun in the adjacent field. But Pinakadimi is not a typical town; it’s known as “the village of the astrologers,” as many of its 500-odd families earn their living through astrology and fortune-telling, catering to clients across the country and even overseas. Not long after I arrive, a slim man with a neat mustache accosts me and offers an impromptu reading. “You will be rich,” he says. “You will have two wives and five children.” (He's zero for three so far, but I'm only 44.)

The rise of the two families represents a remarkable leap across caste barriers, experts say. For centuries, astrology was the domain of high-caste Brahmins. Traced to the ancient Hindu texts known as the Vedas, it was a priestly discipline, used for matchmaking and to identify auspicious days for weddings. So-called “remedial astrology”—which involves the sales of gems, charms and rituals as remedies to counter bad planetary alignments—is a more lucrative offshoot (astrologers sell both trinkets and advice). Such services were not available to the lowest castes, however, because the Brahmin priests considered them untouchable. So the Jangalu caste, which the Buthams and Gandhams belong to, had a vast audience for their predictions, rituals and remedies.

As long as that audience remained poor, the itinerant fortune-tellers couldn’t make much of a living. But since the 1990s, the lower castes have become a potent social and political force. The erstwhile untouchables and menial laboring castes together make up more than half of India’s population and have given rise to regional parties that have displaced both the Indian National Congress Party and the Hindu nationalist Bharatiya Janata Party—the country’s dominant political groups—in half a dozen states. This shift shrugged off centuries of prejudice, but it has created a Boss Tweed-style patronage system, as lower-caste leaders distributed contracts and government jobs to garner support.

Gandham clans is rooted in a fight for the spoils, police say. Already rivals in the astrology business and real estate speculation, the two families had also become embroiled in a long-running dispute, the result of a Romeo-and-Juliet-style romance gone wrong. In defiance of the traditional arranged marriages, Nagaraju’s niece ran away with Durga's nephew in 2006. After heated negotiations, the families reluctantly agreed to let the young couple marry. But there was no happily ever after.

Not long after the wedding, the relationship fell apart, and the marriage’s demise deepened the enmity between the two families and ended any hopes they might share political power. Both families donated heavily to rival campaigns for the local state assembly, and before the killings began last year, they backed competing candidates to head the local village council, a key conduit for government-funded projects. “The Gandhams were jealous of [Durga] because of his popularity,” says his widow, Tirupathamma. “He was always generous to the people of the village, and people of all communities came to him for help and advice.”

The police paint a less flattering portrait. Just before the local polls, Durga apparently ditched the candidate he'd been supporting in the race for village council chief and threw his money and support behind another man, said the local police officer. Police say the maneuver may also have been part of the motive for the attack.

‘He Was Covered in Blood’

Today, Tirupathamma is living under police protection. A solidly built woman with a broad face and long hair, she wears a bright-green sari printed with purple flowers and a dozen red and gold bangles on both wrists when I meet her on the porch of a massive bungalow. Standing between two armed police officers, she produces a smartphone and swipes through a series of professional-looking photos of her husband—a strikingly handsome man with the wavy, swept-back hair of a South Indian film star. Wearing black aviators and a tight-fitting shirt, he strides boldly toward the camera in one of the pics. In another, embossed with the Michael Jackson's name, he poses like the singer.

Tirupathamma's voice cracks and her eyelids flutter as she describes the night her husband was killed. (The police say at least four attackers stabbed him 16 times.) After his usual dinner of an apple and two chapatis, a type of unleavened bread, Durga went for a walk. Tirupathamma was washing the dishes when she heard people shouting outside. She stepped onto her balcony to see what was going on. “Durga has been attacked,” one of the villagers shouted. Durga's brother went out to find him, Tirupathamma says. When he came back, he was covered in blood. “He told me that Durga had been murdered, and he collapsed on the ground.”

Nagaraju’s first hearing is slated for August, at which time he’ll apply for bail. The trial itself may drag on for decades, due to the Indian court system’s glacial pace. For Tirupathamma, the resolution can’t come soon enough. As she speaks, a tear rolls down her cheek. “I vowed that I will not begin mourning until all my husband's killers have been eliminated.”

Thursday, April 16, 2015

Documenting India's Villages Before They Vanish

The country's greatest chronicler of rural life embarks on a mission to digitize, well, everything.

By Jason Overdorf
The Atlantic (April 2015)

NEW DELHI—When Palagummi Sainath was starting out as a young reporter in the 1980s, his news agency sent him into India’s heartland to collect the usual sob stories from farmers devastated by drought. Farmer after farmer explained to him that the disaster was not an accident of weather, but a man-made crisis caused by bad government policies. But when Sainath got back to Mumbai and read through the stories that he’d filed, he found that none of them captured what was happening on the ground. Relying on his training, he’d afforded undue weight to the narrative put forward by Indian officials. “That’s when I realized that conventional journalism is about the service of power,” he says today.

The epiphany shaped his career.

Frustrated by urban Indians’ headlong sprint to forget their rural roots following the liberalization of the country’s economy in 1991, Sainath applied for a journalism fellowship to travel through 10 rural districts in various Indian states and report on how the end of socialist-style planning, and the residue of its mistakes, was affecting India’s farms and villages. The senior journalists on the selection panel begged him to reconsider. The task was too big, and the budget too small, they warned. “‘You’ll be bankrupt after three districts,’ they told me. I was bankrupt after two,” Sainath recalled when I spoke with him by telephone last week from Princeton, where he is teaching this semester. Nevertheless, he kept going, selling cameras to stay afloat. “In the end, I did 19 districts. I covered more than 100,000 kilometers, much of it on foot.”

The result was a series of newspaper articles, later collected in book form under the title Everybody Loves a Good Drought (the title refers to a quote from a villager describing the way local bureaucrats and contractors line their pockets with government-relief packages). The reporting captured the complexity of rural poverty in India as a function of state policy and centuries-old social relationships—not in dry statistics but through engaging characters whom urban readers could recognize. When I searched out a copy a decade or so ago, it reminded me of James Agee’s Dust Bowl classic Let Us Now Praise Famous Men. But Sainath’s style is less high-flown and his tone less earnest. He’s more like a world-weary cousin of New York Times columnist Nicholas Kristof, as illustrated by a lengthy flight of fancy about all the brilliant progress India could make in eliminating its housing shortage if it redefined a sleeping bag as a house.

Now Sainath is at it again, leading an encyclopedic, volunteer-driven effort to digitize the faces, songs, arts, occupations, and struggles of India’s rapidly changing farms and villages. Called the People’s Archive of Rural India, or PARI, the project—in its ambition, at least—dwarfs Alan Lomax’s campaign to collect American blues and folk songs and James Murray’s crowdsourced Oxford English Dictionary. The website went live in December, featuring photographs, audio recordings, videos, and texts that document the celebrations and tribulations that make up “the everyday life of everyday people,” as Sainath puts it.

Among the goals: collect photographs of the faces of one man, one woman, and one child in every district of India; record speakers of all 780 Indian languages; chronicle the story of India’s agrarian crisis; and gather in full text all official (and unofficial but credible) reports relating to rural India, so researchers will not have to scour badly designed government websites to access vital studies. Sainath wants the archive to be as much a weapon as a resource. It will document not only music and festivals but also the rural India that remains “ugly, obnoxious, and dehumanizing, and deserves to die—like untouchability and atrocities against women.”The project won't shy away from the rural India that remains “ugly, obnoxious, and dehumanizing, and deserves to die.”

A suave, erudite man with a disheveled mop of silver curls, Sainath is not the son of the soil I imagined when I first read Everybody Loves a Good Drought. He hails from neither the grain belt of Punjab nor the cotton belt of Maharashtra, but from Tamil Nadu in India’s deep south. Though he sometimes dresses like ajholawallah—a mildly disparaging term applied to India’s leftist activists—he speaks in the plummy, British-inflected accent that marks the Indian elite of his generation. He lives in the metropolis of Mumbai, though he claims to have spent an average of 270 days a year in Indian villages beginning in 1993. Since his first drought, he’s been fascinated by the resilience of India’s farmers and forest-dwellers.

“My generation has lost its connection to rural India,” Sainath, who’s 57, told me. “The generation that’s coming after us doesn’t even know that a connection existed. My grandmother’s generation knew that water came from rains, and they put out vessels to catch the rain. My generation grew up thinking that water came from a tap. Today’s generation thinks that water comes out of plastic bottles.”

So far, Sainath has recruited more than 1,000 volunteers for the archive project, ranging from 30-year veterans of the journalism business to software engineers who’ve nary written a word. They’ve documented some fascinating characters. One of them is a 73-year-old librarian who manages a trove of 170 classics, mostly translations of Russian masters, in a tiny forest village frequented by wild elephants. Another is a young folk dancer who overcame poverty and untouchability—the outlawed but still lingering practice of treating certain castes as “polluted” sub-humans—to win a spot at the country’s top institute for the classical Bharatanatyam form, which, after India’s independence in 1947, has become as much the domain of the elite as ballet is in the United States. Still another is a tribal bard, captured in spontaneous composition-performance of a song protesting the acquisition of his tribe’s ancestral lands by the South Korean steel giant POSCO.

But there are hundreds of thousands of miles yet to travel. Rural India is home to some 800 million people who speak hundreds of languages. Sainath reckons that he’s already spent between $30,000 and $40,000 on the nonprofit project since late 2012, drawing on journalism awards and prizes, along with his own money. But he says he’ll need around $240,000 over the next two years to fund sojourns in rural India by 70-odd “chroniclers.” Though he attracts 150 volunteers a week to do everything from writing articles to helping with back-end work, the quality of some of the content is spotty. And as with many other new-media ventures, it’s unclear whether sufficient thought has gone into the question of what the archive will be—a historical resource or an outlet for subaltern journalism—or how it will survive.

India is currently undergoing what Sainath calls “an extremely painful transformation.” The country’s 2011 census reflected one of the largest mass migrations in history—one that has swelled over the past decade. For the first time, the census recorded more population growth in cities than villages. But despite rapid economic growth in India, the shift bears more resemblance to the Joads leaving the Dust Bowl for California than the Great Migration of southern blacks to Chicago and Detroit. Indians are not so much leaving the countryside to seek better-paying jobs in the city, as they are fleeing increasing poverty resulting from the stagnation of agricultural growth, the rising cost of inputs like water and fertilizer, and a shortage of land. India’s landless agricultural laborers nowoutnumber landed farmers, and the average plot size of those who do own land is shrinking. Roughly three-quarters of India’s land-owning farmers now till less than two and a half acres of land, according to the latest report by India’s National Sample Survey Organization. They can hope to earn around $84 a month with that sized plot, but it costs them $96 a month to raise their crops, forcing small-scale farmers to take on other jobs to make ends meet. A lack of crop insurance, poor access to low-cost loans, and unpredictable rains—plus cultural pressure to shell out fat dowries and lavish weddings for their daughters—leave many farmers crippled by debt.A woman picks tendu leaves for use in beedi cigarettes.
Some give up altogether. As many as 300,000 farmers have committed suicide over the past two decades. While statistics such as this, along with the causes behind them, are hotly contested, Sainath argues that the suicide rate among Indian farmers is 47-percent higher than the national average—and believes that the actual number of farmer suicides may be higher than reported. Countless indigenous tribal people, too, have lost their lands and cultures to dams, mines, and tiger reserves.

Prime Minister Narendra Modi sees this transformation as inevitable. Expressing scorn for programs like his predecessors’ rural-employment guarantee, which helped the poor survive but kept them on the farm, he has promised to create 300 million jobs in “industrial corridors” through schemes like “Make in India,” which reduces or removes caps on foreign investment in various business sectors. But critics like farm-policy analyst Devinder Sharma say desperation is pushing people out of the countryside far faster than industry can create jobs for them in cities and towns. Among the hot-button issues in India at the moment is an executive order by Modi that allows the government to force farmers to sell their land for infrastructure projects without seeking their consent.

“We have not created 300 million jobs over the past 67 years since independence,” Sharma told me, noting that only 8 percent of Indians work in the formal sector of the economy. “How can you create that number in five years?” he asked, referring to the Indian government’s term limit.

Technology, including the Internet-based sort at the heart of Sainath’s archive project, has both been blamed for causing India’s agrarian crisis and held up as a magical solution to farmers’ woes.

For example, hybrid wheat and rice sparked the Green Revolution that saved India from starvation in the 1960s—that is, until pesticides and chemical fertilizers depleted the soil and boosted cancer rates, according to activists like Vandana Shiva, a prominent advocate of organic farming. Banks and finance companies often grant farmers easy access to loans to buy tractors, whether or not the farmers own enough land to make a tractor pay for itself—to the point where Punjab villagers routinely take out a loan to buy an $8,000 tractor, only to flip it and buy a new car for their daughter’s dowry, according to Sharma. “One of the biggest reasons for farmer suicides is that we have loaded the farmer with unwanted technologies,” he said.

Meanwhile, the Indian Tobacco Company and various nonprofits have promoted Internet kiosks as a way to free farmers from rapacious middlemen by giving them direct access to market information. Companies like Reuters and Nokiahave proposed mobile updates with weather reports and expert crop advice to increase farm output. Top banks and mobile-service providers have teamed up to offer financial services through rural Indians’ mobile phones in a bid to get hundreds of millions of people out of the moneylender system and into the banking system. And, in the latest silicon dream, Modi has proposed 100 technology-enabled “smart cities” to bring rural Indians out of the countryside altogether.

But none of these innovations has struck at the root of the problem, which is that farmers who increasingly till plots smaller than a football field cannot hope to earn a living wage. Still, Aditya Dev Sood at the Center for Knowledge Societies told me that mobile- and Internet-based technologies have increased rural incomes and had more radical sociological effects. Interconnectivity with the outside world is eroding the “closed social networks” of the village that have fostered the ghettoization of Muslims and untouchables. “I’m willing to hazard that within my lifetime we’re going to see that change utterly,” he said.“My generation has lost its connection to rural India. The generation coming after us doesn’t even know that a connection existed.”

Sainath—whose archive project lies somewhere between these dystopian and utopian visions—is not so sure. One moment he’s enthusiastically relating an anecdote about a taxi driver in the city of Raipur who hailed from a Punjab village and found Sainath’s project so interesting that he posted about it on Facebook using his mobile phone. The next he’s expressing reservations about the growing monopolization of the web, which in India has recently taken the form of companies like Facebook and Flipkart (an Indian competitor to Amazon) teaming up with mobile companies to offer free Internet access—a move that some see as a threat to net neutrality.

Peasants and small landholders have historically resisted being documented in archives, Sainath notes, since they recognize that being measured and recorded may be the first step to being dispossessed. Recently, for instance, slum dwellersprevented the Delhi Urban Shelter Improvement Board from conducting a survey of 33 out of 622 slum clusters slated for “resettlement” in low-income housing. And governments have often found reasons to censor or restrict access to the archives they control. Today’s India is no different, Sainath says.

Sainath’s project accepts no government funding or corporate sponsorship. And unlike a magazine or TV station, it grants primary credit for all its material to the people who are depicted in the archive rather than the writers or filmmakers who document them, in addition to training and encouraging “subjects” to take pictures and make films themselves. In other words, control over information related to rural people is taken out of the hands of governments and corporations.

“Ours is a people’s archive,” Sainath said. “It can’t lead to dispossession. Nobody can take it down or make it their own.” Yet the archive’s very reason for existence is the rapid dispossession of the people it seeks to celebrate and defend. And even if nobody can take down the site, the archivists may struggle to avoid sinking into oblivion amid the cacophony of the Internet, which itself operates at the whim of governments and corporations.

Sainath is optimistic about what the archive could become. “We want that parents will show this to their kids. We want schools to use it in their courses,” he said. But he also concedes the challenge ahead. “The site is gigantic,” he noted, “and we are few.”

Tuesday, April 14, 2015

How Do Brazilian Coffee Prices Threaten Indian Tigers?

There are more tigers in India than people thought, but the perverse impact of the global marketplace means they’re more endangered than ever.
By Jason Overdorf
The Daily Beast (April 2015)

NEW DELHI — When South Indian wildlife researcher M.D. Madhusudan detected a spike in illegal cattle grazing in the tiger reserves near the coffee plantations of Karnataka state some years ago, he traced the problem to a surprising source: a prolonged drought, not in India, but in Brazil.

With world coffee prices soaring, plantation owners boosted production, and neighboring subsistence farmers left their fields fallow to focus on a far more lucrative product: cow dung. Thanks to globalization, the organic fertilizer for coffee plants now sold at auction like brown gold. The result was tens of thousands more cattle trampling through nominally protected forest, which locals viewed as free pasture, and stripping it bare.

“This was a contingency in the global market that opened up an opportunity for locals here. But the change was so large that the knock-on consequences were pretty serious,” said Madhusudan, who is a wildlife biologist and co-founder of the Mysore-based Nature Conservation Foundation.

With consecutive droughts cutting Brazil's coffee exports by half in the mid-1990s, profits for Indian coffee growers soared by more than nine times, Madhusudan wrote in an academic paper published in Conservation Biology. (PDF)

New demand for organic fertilizer allowed subsistence farmers living near Bandipur National Park—who'd once used cow dung as fertilizer for their own crops—to sell it to coffee growers for as much as $100 a truckload, which is about 100 times the amount typically earned by a rural day-laborer. Recognizing a windfall when they saw one, they raised more cows, increasing their herds as much as 17 times faster than the national average, and drove them into the reserve to graze—making a third of it unfit for the tiger's natural prey.

Although coffee prices have dropped, the dung-sellers have moved on to supply farmers of organic ginger instead of scaling back, Madhusudan says. And his findings are more relevant than ever.

This January, the most thorough census of India's tiger population ever conducted showed that there are some 2,226 tigers living in the country's shrinking forests. That's a full third more than researchers had previously believed, and accounts for nearly three-quarters of the 3,200-odd wild tigers still surviving around the world. But it made headlines for the wrong reasons.

The world's newspapers almost universally reported the new number as a 30 percent increase in India's tigers over the past four years. But according to Alan Rabinowitz, CEO of Panthera, a global wild cat conservation organization, “Saying that there's been a 30 percent increase in tigers is flat out wrong.”

Not only did the latest count rely on new methods— camera traps instead of the distinctive footprints, called pugmarks—but also for the first time the census covered large swaths of forest outside the country's 47 protected reserves. Some of the new numbers represented tigers found living in these previously unmonitored areas.

Reserves are already full, and locals hardly needed a census to tell them of big cats prowling outside their borders—thanks to a dramatic increase in attacks on livestock and people.

That the results show there are more tigers in India than was previously thought “is great news,” says Rabinowitz, “and the Indian government along with other NGO’s should be applauded for their efforts.” But, he adds, “Misstating these numbers as only increases resulting from better enforcement and protection efforts is a gross disservice to future tiger conservation.”

Which brings us back to the problem of coffee and dung and cattle grazing, which is really the problem of the perverse ways the global marketplace can affect delicate ecosystems like the tiger habitat and undermine the best-laid plans to protect them.

For decades, Indian conservationists thought they need only stop the commercial exploitation of forest resources by mining and timber companies. They believed that so-called subsistence use by the 147 million poor people who depend on the forests for survival was, or could be made, sustainable. Meanwhile, the leaders of Project Tiger, the government agency responsible for protecting the big cat, focused on carving out reserves and slowly pushing villages out of them.

But the improved tiger count shows those reserves are already full, and locals hardly needed a census to tell them of big cats prowling outside their borders—thanks to a dramatic increase in attacks on livestock and people.

At the same time, as the government endeavors to free up more and more territory for the mining of coal, bauxite and iron ore, Madhusudan's research indicates that the lines between subsistence and commercial use of the forest are growing increasingly blurred.

That means conservation must go beyond drawing borders, resettling residents, blocking highways and barring industries. Instead, planners must focus on creating economic opportunities for villagers outside the parks, while conservationists need to shed their obsession with inviolate forests and seek compromises that allow developments that do not sever the green corridors connecting protected zones.

Neither task is impossible.

In South America, Rabinowitz and Panthera have succeeded in getting governments from Mexico to Argentina to cooperate in the maintenance of a breeding corridor for jaguars by emphasizing that it doesn't mean freezing economic development—getting to the negotiating table and winning important concessions on projects such as Costa Rica's Reventaz√≥n hydroelectric project.

And with small scale projects near Bandipur, Madhusudan has demonstrated that straightforward measures like helping farmers acquire and install a solar-powered fence to stop wild animals from eating their crops encouraged them to invest in irrigation and replace their dung cattle with milk cows deemed too valuable to turn loose in the forest.

“You may be able to create completely protected areas. But you will never be able to rid them of neighbors,” Madhusudan said.

The trick is to make those neighbors into good ones.

Monday, January 12, 2015

Robots, not immigrants, could take half of German jobs

As right-wing protesters march against immigration, industry looks to machines, hoping robots will add at least as many jobs as they take away.
By Jason Overdorf

GlobalPost (January 2015)

BERLIN, Germany — Right-wing protesters marching against immigration and the so-called Islamization of Germany may soon face a new foe: the rise of the machines.

With low unemployment and a shrinking workforce, the economic engine of Europe continues to endeavor to reinvent itself as a nation of immigrants, even as the demise of the welfare state and fear of multiculturalism have brought tens of thousands of protesters to the streets.

But recent reports suggest that robots, not immigrants, may pose the greatest threat to German workers — though the European Union has placed a $4 billion bet that robots will create rather than eliminate jobs.

The new wave of automation will hit white-collar workers hardest, according to Jeremy Bowles, a researcher at the Brussels-based Bruegel Institute.

“What's fundamentally different is that [these advances] have the ability to affect a broader set of workers,” Bowles said, comparing the next generation of computerization to the first wave of robots that hit assembly line jobs in the 1980s.

The impact of these innovations will vary across Europe, Bowles argues. But in Germany, as in the US, robots may soon take as many as half the existing jobs, according to the Bruegel Institute's analysis of the labor market.

These white-collar robots will be more software than hardware, eliminating service industry jobs in the way ATMs and automated telephone systems have already done. But — as the hostile reaction from German unions to other disruptive business models (think Amazon and Uber) has shown — bytes can be more revolutionary than bolts.

Why, then, is the European Union investing $4 billion to speed the development of robotics?

Automation was the bogeyman of the 1980s, but the automobile industry's experience with it then proved that robots can not only increase productivity but also create jobs, says Uwe Haass, secretary general of the European Robotics Association (euRobotics AISBL).

“Robotics is seen as a pivotal technology, which is not only going into robotics per se but into so many other branches and technologies. It will create new jobs because [it will make] new businesses possible,” Haass said.

The introduction of robots to perform deepwater inspections of oil drilling facilities, for example, has created a profitable new business sector following disastrous oil spills in the North Sea and Gulf of Mexico.

The Autonomous Inspection Vehicle (AIV) Subsea 7.
(Heriot-Watt University/Courtesy)

A new generation of robot tools that operate like a worker's assistant, rather than their replacement, can help ensure that Germany's small, family-owned manufacturing businesses can stave off low-cost competitors from Asia.

Some robots in industries like agriculture, such as a self-driven picking machine, take over jobs that would otherwise go to migrant workers. But others make possible the tasks eliminated by high labor costs. In “precision farming,” for example, a robot nurse tends to individual plants, injecting water, pesticide or fertilizer in the precise amounts required — rather than spraying the entire field.

“All this is mesmerizing,” Haass said. “When I talk with people in agricultural industries, they are flabbergasted by these ideas.”

The EU suggests that robotics will have the net impact of creating 240,000 jobs across Europe, while a study by the International Federation of Robotics found recently that the 1 million industrial robots currently in operation were directly responsible for the creation of 3 million jobs.

To take advantage of those new opportunities, workers will need new skills, says Haass — and that will create major new challenges.

“How can we steer education in schools and universities to improve the qualification of people? How can we improve qualification of industrial workers who have been doing repetitve jobs?” he said.

“That's the crucial point.”

Over the longer term, these new developments could also mitigate immigration by unskilled workers, says economic researcher Bowles, because machines will become cheaper than workers more quickly in rich countries than in poor ones. But the rise of the machines is likely to inspire a lot of white-collar hand wringing before that happens.

“Historically, technology has created as many jobs as it has destroyed,” Bowles said. “[But] this exact topic has created panics for decades and decades.”

Wednesday, December 31, 2014

In Berlin, the party isn’t over — it's just no longer free

The German capital’s legendary club scene has gone for-profit.
By Jason Overdorf
GlobalPost (December 2014)

BERLIN, Germany — On the eve of a new year, Europe's capital of slouching, grungy cool has found itself in the midst of an identity crisis.

This debt-plagued city has clawed its way to international respectability partly thanks to a tourism boom. But longtime residents who gave the German capital its cachet as “poor but sexy” — as dubbed by former Mayor Klaus Wowereit, who stepped down this month — worry newcomers are killing the vibe.

That includes the legendary club scene.

Something definitive has already been lost, says Jan Jasper Kosok, the founder of an influential German pop culture blog called Knicken, or Kink.

“The era of the ultra-cool, big and central club is basically over,” he says, going on to name several shuttered or transformed venues. “There’s no such thing as the Deep, the old, old Cookies or 103 anymore. Big clubs are either commercial or overcrowded with tourists.”

The club scene emerged after the fall of the Berlin Wall and the reunification of Germany, when the euphoria of newfound freedom in the ex-communist parts of the city found expression in some of the thousands of square feet of empty space created by the closure of former East German businesses.

Although techno was the musical genre of choice, the aesthetic was industrial because of the available concrete venues. The club Tresor, for one, was housed in a department store vault. And because there was no such thing as closing time in Berlin, unlike most other cities, the party never had to stop.

“All these kids from East and West went to Berlin to see what’s going on, and then there were no authorities for a while to chase after illegal clubs,” Tresor founder Dimitri Hegemann recently told The New York Times.

Now some complain that there are just too many of those kids.

Hardly a month goes by without a newspaper article bemoaning the onset of higher rents, the end of grungy authenticity or the demise of a cherished nightspot.

Earlier this month, artists painted over iconic building-sized murals by the Italian artist Blu in the hip neighborhood of Kreuzberg, in the former east, rather than participate in the city's transformation into “an amusement park for those who can afford the rising rents,” Lutz Henke, one of the artists/vandals wrote in the Guardian.

Last summer, Friedrichshain-Kreuzberg Mayor Monika Hermann raised eyebrows in the Berlin senate with a proposed “code of conduct” for tourists who view the party-town reputation as an invitation to smash bottles and urinate on doorsteps.

And at last year's “Berlin Music Days” festival, also called “Bermuda," panel discussionsfeatured topics such as “Techno-tourism: We don't want to become Ibiza,” a reference to the Spanish island renowned for its tourist-oriented summer club scene.

But amid all the naysaying, some believe something more than just common gentrification and immigration may be underway.

Although the frontier days of underground parties are winding down, impressarios from the golden age have figured out how to commercialize the club scene without sacrificing everything that made its reputation.

Part-time DJ Julian Braun says now there's a place for everyone.

“It became way more professional and institutionalized,” he says. “Before, you'd have to know people or be on some underground mailing list to be invited to parties. That's not so important anymore.”

Instead, clubs such as Berghain and Watergate — which both recently celebrated their 10-year anniversaries — have become institutions of a sort while remaining at the cutting edge of the techno music scene, where they still defend their own ideas of cool.

Notorious for its anything-goes gay floor, where a guest is said to have once turned up with a dildo made of frozen feces, Berghain has neither toned down for tourists nor allowed the club to become a circus show for the curious.

In addition to their strict, seemingly arbitrary door policy, bouncers put stickers on smartphone camera lenses to enforce the club's ban on selfies — and turf out anyone who dares peel them off.

And while Watergate has reputedly become such a tourist mecca that Berlin clubbers say they'd never pay for entry there, many still wait in lines that are rarely shorter than 50 yards. Impressario Steffen Hack, a Berlin squatter and radical before reunification, ensures that only the money in the till at the end of the night reminds him of Ibiza.

“Do you feel like I’m a snobby, arrogant guy who sits on his club and feels like Puff Daddy?” Hack recently told Exberliner, a Berlin newspaper for English speakers. “We are Kreuzbergers. It sounds stupid, but we feel probably like a socialist club, with all the [contradictions] that are in that sentence.”

Police raids are still virtually unknown and Saturday-night parties continue well into Monday, thanks to both the usual club drugs and tourists who turn up on Sunday afternoons, when lines are shorter and bouncers apply a more liberal door policy.

Smaller clubs such as Farbfernseher — or Color TV, located in a former television shop — and throwbacks like About:Blank, Chalet and Renate still have something of the old Berlin vibe, and the quality of the music on offer hasn't declined, the pop culture writer Kosok says.

It's just that now it's about making money.

“The good times of Berlin clubbing were kind of over, when the illegal summer parties were not taking place at the center of the city anymore,” Kosok adds.

“They charge you for that Berlin feeling now, which renders it senseless.”

Senseless, perhaps. But still sexy.

Saturday, December 27, 2014

Germany’s hipster scene meets precision engineering

A tattooed engine guru is bringing California hot rod style to Porsches.
By Jason Overdorf

GlobalPost (December 2014)

HAMBURG, Germany — Dressed in black denim, canvas sneakers and a motorcycle-gang inspired Mezgerwerk sweatshirt — the brand he created with his business partner — Matthias Hoeing looks more professional skateboarder than expert engine-builder.

As a machine tool whirs in the background inside his workshop, he raises the cuff of his sweatshirt to reveal a forearm “sleeved” by red and green tattoo ink.

“I grew up with skateboarding and rap music and punk rock and American cars,” the 40-year-old mechanics guru says. “That's the kind of stuff that influences me.”

As a veteran racecar engine builder, however, Hoeing has the technical chops to realize his drive to bring California hot-rod culture to Germany's staid community of Porsche afficionados.

With its reputation for clockwork precision, special certification programs for “authorized” mechanics and pricetags upward of $50,000, Porsche likes to present its cars as unimprovable.

Most Germans who drive and restore classic models have always approached their cars more like museum curators than motorheads. But Hoeing wants to smash that conservative image, whatever the old-school collectors or brand stewards may say.

“To them it's sacrilege,” he says. “But I don't care.”

Hoeing cut his teeth building racing engines for Hamburg-based manufacturer Thielert in 1998 before moving to southern California in 2001 to work for Porsche Motorsport, the Stuttgart-based automaker's racing team.

Then he met Magnus Walker, a British Porsche restorer who has brought the rocker hair, tattoos and wild designs of the custom car scene to California Porsche fans for the past 20 years.

“In Germany, I was building Porsche engines,” Hoeing says. “But I had no desire to get into the Porsche scene because to me it was dentists and lawyers and people who drive their preppy cars to the ice cream parlor.”

“When I met Magnus,” he adds, “it was an eye-opener.”

Since he returned to Hamburg in 2008, Hoeing's supercharged engines have been clawing out a foothold for the muscle car in Germany's Porsche world.

Although the Southern California aesthetic for body styling has yet to take off, the growing popularity of hot rodding and so-called “custom culture” suggests he may have picked the right moment.

Hot rods, tattoos, low-riders and choppers have made a dramatic leap in popularity during the past decade and a half, says 44-year-old Michael Perrech, who started organizing the “Kustom Kulture Forever” exhibition in Herten, Germany, 13 years ago.

“It was very hard in the early years because hot rods weren't very popular,” he says. “Now we're at the point that companies like [workwear maker] Dickies come to us about sponsorships.”

Hot rodding is especially big in the former East Germany, where groups like Hot Heads Eastembrace Rockabilly and American cars — perhaps a reaction to the political repression and 18-horsepower, recycled-plastic vehicles that were the specialty of the German Democratic Republic.

At least one company, Sour Krauts, has created a “motowear” brand featuring helmeted skulls, gothic script and slogans in the vein of “Trust me: I have a beard.”

But a huge gulf remains between the hot rod world of facial hair, tattoos and ducktail haircuts and big brands like Audi, BMW, Mercedes-Benz and Porsche, Perrech says.

“They don't really get hot rodding,” he says. “Everything has to be strict and on the point.”

Hoeing says he's an engine builder, not a car builder, and the high price of admission — one of his rebuilt engines runs $25,000 to $60,000 — means Porsches will never outstrip Fords in Germany's custom car scene. But with his engines providing the muscle and his image setting the tone, the gulf may be set to shrink.

Touted by Walker as the best Porsche engine builder in Europe, Hoeing had more business than he could handle before he teamed up with his business partner Torsten Hanenkamp last year. Their six-man workshop's engine business is now growing fast on the strength of bread-and-butter rebuilds that coax 380 horsepower from a standard 3.6 liter, 250-horsepower Porsche 911.

Their Mezgerwerk brand — named after Hans Mezger, sometimes called the greatest engine designer of all time — has all the right ingredients to become a cult hit like West Coast Customs, the team behind MTV's “Pimp My Ride,” and Orange County Choppers.

Hoeing says his business is already diversifying. “I get emails from people who want to buy T-shirts or sweatshirts every day.”