Thursday, April 29, 2010

India health: spit and polish

At India's most renowned hospital spitting is ubiquitous and, potentially, dangerous.
By Jason Overdorf - GlobalPost
April 29, 2010

NEW DELHI, India — New Delhi's All India Institute of Medical Sciences (AIIMS) is, arguably, India's best hospital.

But even though patients travel for hours – even days – to seek treatment here, they don't show the same respect inside its hallowed walls. A new survey shows that a whopping 90 percent of them spit inside the hospital buildings, raising the risks of dangerous hospital-acquired infections like tuberculosis, pneumonia, and swine flu.

Most hospital acquired infections are spread by indiscriminate spitting, concludes the survey, which was conducted by the Department of Neurosciences at AIIMS. The study found that attendants were even spitting in the corridors outside the ICU and isolation wards.

In other words, if you weren't sick when you got here, you might be when you leave.

“When we looked at the reason for spitting, about 80 percent said it was a habit, and about 16 percent said it was because they chew betel nut and tobacco,” said Dr. Manjari Tripathi.

Near the entrance to the outpatient department, as security guards move along the pavement, rousting patients camped here to await treatment, the challenge of keeping the premises clean becomes clear. Here and there patients and their families have set up impromptu picnics. In one corner, a man with a catheter restlessly shifts his bag of milky urine out of the sun next to a huge, blue signboard that is surely unintelligible to him. IMPORTANT NOTICE, it reads:


Most of these people camped on the pavement are villagers. Uneducated and living hand to mouth, they've traveled for eight hours or more to get here, and after the guards kick them out they'll find a place on the median or beneath an overpass to spend the night until the hospital reopens in the morning.

“Of course the people are spitting here and there,” says 60-year-old Khajan, a villager who has traveled for five hours on local buses, only to face a long day of waiting for a doctor. “What difference does it make?”

That kind of apathy from patients who have bigger problems is only one of the challenges AIIMS faces.

While private institutes like Apollo and Escorts have earned the lion's share of headlines for attracting medical tourists from Britain, the United States and other developed countries, a typical 700-bed private hospital in Delhi treats only around 200,000 people a year, at fees that start around $25 a day for inpatients — nearly half the monthly salary of a lower middle class worker. Government-run AIIMS, with around 2,000 beds, treats 3.5 million people a year, charging only about $1 a day for in-patients and providing emergency care for free.

Even with government funding of around $100 million a year, budgets are strained. The student doctors who make up the bulk of the medical staff here earn only about $300 a month. The orderlies and cleaning crew are routinely asked to put in unpaid overtime to keep the place running. And the constant flow of nearly 10,000 people per day make the outdated building materials — which include rough concrete, cracked tile floors and windows that don't seal – almost impossible to keep clean.

“See, we are in India,” says one hospital employee, who asked not to be named. “We are Indians. We have our local standards. This is a public hospital, so the public will do what the public will do. We have to deal with it.”

To be fair to its beleaguered sanitation staff, though the ramshackle premises would come as a shock to a visitor from America or Europe, AIIMS deserves some credit for cleanliness. Inside the outpatient department, the floors show signs of recent mopping, and most corners are free of the blood red spit stains — the hallmark of the popularity of the betel nut-based stimulant known as paan — that are ubiquitous in most government buildings. One can only occasionally detect the faint scent of disinfectant. But that's leaps and bounds ahead of other Delhi institutions, like Lok Nayak Hospital, where the mysterious stink of seeping sewage is pervasive.

According to the hospital staff member who spoke to GlobalPost, lack of manpower is a bigger challenge than spitting. Showing us a contract for outsourcing the cleaning of toilets to a private firm for around $80,000, the worker laments the denial of a routine request for increasing the cleaning staff by a measly six people.

“We (the cleaning staff) have no authority, and no channel for promotions,” the employee says. “If a VIP is coming, we're called for duty in the middle of the night, with no pay for overtime. They want everything done right. But they don't do anything for us.”

And it's the poor people waiting to be shown off the premises for the night by the hospital guards who have to bear the brunt.

“Sure, people spit,” says 32-year-old Bhagwan, who has been making a seven-hour journey to bring his anemic wife here for treatment for the past three years. “People even take a crap if they have to. It's only because of that they lock us out at night.”

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Wednesday, April 21, 2010

bedroom renegade

Shobhaa De’s sex-filled novels and socialite lifestyle enthrall and infuriate Indians in equal measure. Her critics call her books trashy and newspaper columns inane, but supporters say she has done much to get a conservative nation talking about sex and feminism.

Jason Overdorf
Monocle (April 2010, Vol. 4, Issue 33)

To hear Indians tell it, author Shobhaa De has built an empire on smut. Billed as “the Jackie Collins of India” since an editor at Time magazine’s India bureau coined the phrase decades ago, De is renowned for writing her strong heroines into sex scenes that would make Madonna blush. But even a dip into de’s novels makes it clear her books are only the means to an end; the author’s masterwork has been her construction of her public self – and the performance of her life.

A columnist for four different newspapers, a near-constant blogger and the author of 16 books, De has managed to hold India’s attention for nearly 40 years through a mix of poise, savvy and ruthlessness – and a prodigious knack for self reinvention. “The performance comes easily and effortlessly,” she says. “The performance also gives me a sense of separation from the self. It’s a performance and I know it’s a performance, so it doesn’t matter. It doesn’t touch me.”

Born Shobha Rajadhyaksha, the daughter of a bureaucrat, De parlayed her remarkable beauty into a career as a model, then as an editor at a film magazine, and finally, somehow – a marriage, divorce- and-remarriage later – emerged as what the Indian press describes as a socialite. “By that they mean, you’re glamorous, and you’re seen at some of the best evenings and soirees in India, and internationally, and it sets you apart from the ordinary hack,” says De.

The author of Socialite Evenings, Starry Nights, Sultry Days, and so on, De describes herself as a compulsive writer, for whom writing is “almost like a physical need”, and her free-flowing, often contradictory, seemingly unedited prose reflects this quality. She probably writes too much. Her blog, columns and books range from the cuttingly savage to the self-congratulatory and banal. But she has an unerring understanding of her audience’s fantasies, anxieties and prejudices, and her self-created celebrity makes her most inane, throwaway remarks important because Shobhaa De has said them.

Her romance novels are perennial best-sellers – so much so that then-editor of Penguin India David Davidar once reprimanded staff sniggering over one of her manuscripts, “Don’t laugh; her books pay your salaries.” And her provocative columns not only attract a legion of loyal readers, they often make headlines of their own – as when debutante Bollywood actress Sonam Kapoor responded to a characteristic De savaging by calling her “a 60-something porn writer”. Suffice
to say, De didn’t dissolve into tears. “I love spats,” De says. “I’m sure I have [made enemies], but that’s not my concern. If they think of me as an enemy, then that’s their problem, not mine.”

Relaxed on the sofa in her opulent apartment overlooking the Malabar Hill neighbourhood, De is dressed casually, eschewing the glam saris she trots out for photo shoots and public appearances. With flowing black hair, high cheekbones and a powerful nose, she is indeed a beautiful woman – by appearance, closer to 45 than 62. To the rest of India, she says, she represents “a woman who has lived life on her own terms, and done so fearlessly”. In person, she’s charismatic enough to pull it off without sounding like an ass. but it is obvious why her critics have focused on the faults that have prevented her from gaining literary respect,
rather than the strengths that have brought her commercial success.

Sex is part of the formula, no doubt. Written 10 years before Bollywood depicted its first on-screen kiss, one of her lesser novels begins, “Prem liked to make love in public places,” and the scene that follows delivers the goods. But the sex in De’s novels is neither exciting nor unusual enough to warrant much attention – even in reputedly conservative India – and Bollywood actresses such as Zeenat Aman and Rekha have lived more provocative lives. De’s shock value came because she performed her public persona as the author of the fantasy, rather than its object, and she overturned the bedroom hierarchy by writing and acting out all India’s fears about female sexuality. “She has not only lived an unconventional life,” says literature professor Rukmini Bhaya Nair. “She has talked about it and written about it.”

“I think what people found extremely shocking was not even the [sex] scene itself,” De recalls. “But the idea that a woman could walk out of a marriage because she is bored with the man, not because he is a wife-beater or an alcoholic or insane or impotent or any of the usual reasons that could be condoned for leaving a marriage. When I wrote Surviving Men, a lot of men refused to bring that book home for their wives, or forbade them from reading it, because they felt I was putting ideas into their heads.”

De’s supporters find something subversive in her life, perhaps even more than in her books. “She is the other in every woman,” says Prem K Srivastava, a literature professor at Delhi University. “No woman can ever dare to do what she does. She can only dream and fantasise about writing what Shobhaa De writes.”

In recent years, De’s drive to reinvent herself has been relentless. She’s written a sort of self-help book, a Thomas Friedman-esque paean to the new India, and a work of fiction for young adults. But she has a new novel in the works, and she’s not ready to shed her reputation as a sex symbol yet. “I’m going to go back to it with a vengeance,” she says.

Tuesday, April 20, 2010

India: radioactive in Delhi

A mysterious radiation leak exposes the dangers of recycling.

By Jason Overdorf - GlobalPost
April 20, 2010

NEW DELHI, India — In the post-apocalyptic West Delhi junk market of Mayapuri, Ram Kumar sits with a group of laborers like himself in the scant shade provided by a ramshackle shed.

Due to a mysterious radiation leak that has sent seven neighborhood residents to the hospital with radiation poisoning over the past week, business is slow, and there's no work for these loaders. But Kumar says he has no choice but to wait.

“You can't see it (radiation), you can't feel it, you can only imagine how contaminated the air is here,” said Kumar. “Everyone thinks of leaving, but where would we go?”

Recycling is big business in India, which imports as much as 3 million tons of scrap metal each year. But this week's radiation poisonings have shifted focus, temporarily, to the flip side of the fortune: Along with the towering heaps of steel and copper comes a mountain of hazardous waste — asbestos, lead, mercury and, it turns out, potentially deadly radioactive materials.

“Under metal scrap, almost everything comes in — be it radioactive material, be it ammunition, be it e-waste, hazardous waste, toxic waste,” said Kushal Yadav, head of the toxins unit at New Delhi's Centre for Science and Environment, a non-government think tank. “We don't really know what's coming in. It's only when such incidents happen that we come to know.”

On April 7, shop owner Deepak Jain and four others were hospitalized with radiation sickness after they were exposed to what initial press reports described as a bright, shining metal object. Subsequent investigations by the country's atomic energy regulators identified the radioactive material as Cobalt 60 — a metal used in the sterilization of medical equipment and for radiotherapy.

Before long, the team of scientists discovered 11 different sources of radiation in Mayapuri's scrap heaps, and an anonymous source at one of the investigating bodies told India's Mail Today newspaper that the Cobalt 60 was believed to be part of a larger, yet undiscovered consignment of metal.

This is not the first such incident, and will by no means be the last. Last year, high levels of radioactive metal were found in a shipment of stainless steel elevator buttons which were exported to Germany. And not long ago, a railway worker was seriously irradiated when he pocketed a shining object he discovered on the job.

Radiation poisonings are just the tip of the iceberg. Exposure to other forms of hazardous medical, electronic and industrial waste is so commonplace that no one keeps statistics about the associated health problems.

“In this incident around 10 people have been affected, but this is only a case where you have seen acute exposure,” said Yadav. “In terms of chronic exposure, which is happening over long periods of time, there are hundreds of thousands of workers exposed to tiny amounts of toxins every day, and it's affecting their health. This is never documented anywhere.”

According to a recent study by the Indian Institute of Management, Lucknow, only half of the 400,000 kilograms of hospital waste that India generates each day is treated before its disposal. Toxic Links, an NGO, estimates that as much as 50,000 tons of electronic waste is illegally imported each month, bringing with it lead, mercury, cadmium, beryllium and other hazardous materials, while Indian industry generates 6 million or 7 million tons of hazardous waste per year. On Indian shores, poor laborers — even children — climb its mountains in rubber sandals and tear it to pieces with their bare hands. And they do it for next to nothing.

Kumar and the other loaders in Mayapuri earn between $2 and $5 a day heaving clapped out drive shafts, truck tires, axles, steel pipe and all manner of scrap onto trucks and wagons. It's brutally hard work in one of the hottest Aprils on record — the mercury already nearing 110 degrees Fahrenheit. Even in the lee of the dilapidated warehouse, a hairdryer wind sandblasts the ragged workers with grit. The air smells of ozone and sweat and scorched metal. The danger is as bald-faced as the filth.

“Getting hurt is part of the job,” said Kumar.

Shop number DII-32, where the first pin made of radioactive Cobalt 60 was discovered, is now shuttered, a stack of Delhi Police barricades forgotten against the wall. But the scrap dealers on either side are still watching their workers sift and sort wire and pipe. Nobody seems unduly worried about being irradiated. The national Atomic Energy Regulatory Board has given the all-clear signal after repeated sweeps of the area. And, if anything, the shop owners are defensive about the safety of their trade.

“It's perfectly safe,” one dealer said. “Why should I be worried? I'm sitting in my shop. I don't have the hobby of going around with my notebook.”

With not a spot of grease on him, he's probably never in his life touched a piece of the scrap he sells.

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Sunday, April 11, 2010

india: the good capitalist

Fabindia's William Bissell plans to reinvent India's companies.

By Jason Overdorf - GlobalPost
April 11, 2010

NEW DELHI, India — India's rural cooperatives helped save millions from starvation. But with little incentive to grow and invest, small farmers and cottage craftsmen stayed small. Fabindia's William Bissell offers a new solution.

A slim and bookish 41-year-old, Bissell's side parting and earnest manner give him the air of a boy scholar. But he doesn't keep his ideas locked up in an ivory tower. A curious mix of devout capitalist and social reformer, Bissell first turned the village-based textile export company he inherited into a multimillion-dollar retailer. Then he turned it into a laboratory for an idea that could transform rural India.

In 2007, Bissell hived off a substantial portion of Fabindia's assets to create a new firm dedicated to investing in and promoting community-owned companies comprising the retailer's rural artisan suppliers. The scheme is based on an innovative system that makes workers into shareholders and creates its own micro stock exchange. And if Fabindia can work out the kinks, it could translate the old idea of agrarian cooperatives into fast-growing firms capable of simultaneously unleashing capitalism's unrivaled energy and reigning in its destructive appetites.

“I'm a communitarian. That's where the philosophical underpinning comes from,” said Bissell. “What's interesting to me is how to use capitalism, the way it organizes capital and information and shares and distributes wealth – because it is a fairly comprehensive ideology – to produce beneficial outcomes for society.”

Founded in 1960 by William's father, John Bissell, an American who'd worked as a consultant for the Ford Foundation, Fabindia arose as an export firm that marketed India's rich heritage of handloom fabrics to the world. The company began to shift focus to the domestic market in 1976, when it opened its first retail outlet in Delhi.

But it was after William took over in 1998 that the firm really took off. In less than a decade, the young entrepreneur built Fabindia into a 112-store, $75 million retailer with outlets in Rome, Dubai and Guangzhou, expanding the product line to include designer clothes, jewelry, home furnishings, body care products and organic foods — all without straying from the company's socially conscious roots. Giving usually staid handicrafts a slick, modern spin, it's Pottery Barn meets The Body Shop meets Pier One — the company is incredibly popular with ordinary Indians, posh socialites and Western expatriates alike.

But Bissell isn't resting on his laurels. He is reinventing the company again.

The essentials of Fabindia's new business model are simple. Bissell first created Artisans Microfinance (AMFL), an investment company, which identified and helped fund 17 community-owned firms that Fabindia calls “supplier-region companies,” or SRCs. Many of these firms had at their core non-profits and cooperatives that had been Fabindia suppliers for two generations.

But when they were restructured, their artisan-workers bought shares in the future — and a guaranteed piece of Fabindia's pie. By tapping the locals and angel investors, Fabindia got a 50-percent boost in investment. More importantly, the SRC shares have already appreciated 50 percent and more, said Prableen Sabhaney, a Fabindia spokesperson. Returns like those – and the jobs they generate – could spell an end to rural poverty and the ills of urban migration.

Hiving off management responsibilities to shareholder-owned companies promises to make Fabindia more efficient, too. Now, instead of dealing with more than 700 individual suppliers, the corporation only deals with 17 SRCs. That already means it can handle larger volumes and theoretically gives smaller artisans and suppliers a better chance to showcase their products locally and break into the retailer's supply chain.

But there have been growing pains. In some cases, instead of looking for new sources for products, the SRCs took the easiest route — resting on their laurels and relying on supplier companies that were almost as large as the community-owned units themselves.

“We had too many carrots and not enough sticks,” Bissell said. “Now we've given some of their suppliers the ability to come to us directly to make the SRCs feel that they need to sing for their supper. Because just sitting around and expecting checks to roll in is not the model that we had in mind.”

Bissell's community-owned companies represent a marked change from the rural cooperative. Currently, Fabindia still owns about half the stock of the SRCs. But within five to seven years Bissell plans to reduce that to about a fourth, as artisans, employees and outside investors pick up more stock.

Unlike in traditional cooperatives, however, where members have equal voting rights regardless of their investment or productivity, SRCs will reward the artisans who hold larger stakes in the units with a larger say in how they are run. Shareholders also reap rewards from the company's growth in direct proportion to how much — and how early — they invested. That means that, like cooperatives, the SRCs provide a vehicle for small, cash-starved rural artisans to pool their money to expand and modernize their operations. But unlike cooperatives, they give the savviest and most successful of the bunch a very strong motive to invest.

“The person who uses the cooperative most benefits the most as well — not the person who started the cooperative and took the risk. So that basically means that nobody individually will take the risk,” said Vineet Rai, the founder of Aavishkaar. Unlike cooperatives, which also prohibit outside investors, the shareholder system of Fabindia's community-owned companies encourages entrepreneurial investment by promising a larger payoff to the early movers when the firm grows.

And that could mean rapid growth for rural India, too.

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