[Tessa] Week 1

 My name is Tessa Adzemovic and I am a junior studying Biochemistry and French. I arrived in Delhi late Tuesday night. I will be working for the Hope Project, an NGO in the Nizamuddin area of Delhi. It is divided into three parts: a health clinic, a school, and a microfinance program. Everyone has been extremely caring thus far and I feel so lucky to have the opportunity to be here!

A professor at the school of music at the University of Michigan sent me an e-mail with this advice regarding India about two weeks before my departure:

“You should be prepared to be utterly shocked.  I don't care what you've seen on this side of the world, if you grew up in E. Detroit or Harlem or Watts or Compton.  This shit is DEEP.  The abuse, neglect, poverty, corruption-that-causes-it.  It's just heart-wrenching.  Bless you for doing what you're doing.”

So far I have found this to be accurate. What I have seen in the last few days has been unbelievable. From a man covered with tennis-sized boils on the street to child slave labor, I am already shocked.

That being said, I am enjoying acclimating very much. I have already taken to wearing kurtis and eating with my hands. Everyone has been so generous with their time, energy, and laughter when it comes to supporting me.

Namasde from 110 degrees,

Tessa  

Rabia, Pre-Departure

After two and a half months of waiting, whining, calling Travisa Outsourcing, and wondering if every Indian person I saw in the supermarket had something against people of Pakistani Origin- my visa finally arrived in the mail! The funny part: the FedEx parcel sat on our counter for almost 7 hours before my mom opened it and started cheering in my face with excitement. I had avoided opening it because I figured, why do I need the disappointment of opening up a parcel (which cost over $30 to ship overnight) that will only bear my unstamped passport. But hey, I'll take it- maybe this happened for a reason.

So from that moment until now, my life has been a constant stress of "is this too heavy to pack in my suitcase?" and "maybe tickets will be cheaper on Wednesday, it IS the middle of the week.." But either way, I can still finally see the reality of my trip falling into place. All the paperwork, pricelining, and packing aside-- I'm ready, anxious, nervous, scared, and excited to finally meet my roommates in Delhi, the interns at my NGO- Maitri India, and Sonal Singh- the CEO of Maitri who has worked with me endlessly to plan this trip.

I read somewhere that "Jai Ho" means "may victory be yours-" and after two months of waiting for my visa, I finally feel like it is.

[Brad] Week 1

I am still in the first week of my time in India, and I must say, it is crazy here!  I have been fortunate to have a great contact, Bipin, at Armman, my NGO, who has helped me get used to life here.  My journey started when Bipin picked me up at the airport, which took way longer than it needed too because my suitcase took a long time to leave the airplane.  Thankfully, a room (with AC!) was waiting for me.  After a night of not sleeping, I was picked up at 10 am for breakfast and my first trip to the office.  Because I started on a Friday, I only had the chance to meet my co-workers and run some errands (like converting my US money and buying a ticket for a bus tour of the city on Saturday.  Unfortunately, the exchange rate is less for lower denomination bills, a lesson learned for next time!

Saturday was spent on an all day tour of Mumbai via bus.  We stopped at many attractions (some of them more tourist-y than I prefer).  I was amazed at the incredible size of this city.  I am far from the downtown area, so I cannot fully grasp just how big it is.  Also, the disparity here is simply incredible.  I saw a Rolls-Royce dealership and an incredible shopping mall despite being in a city with squatters.

As today is Sunday and Armman is closed, I am catching up with emails and hope to visit the nearby Catholic church in a few hours.  Looking forward to work tomorrow!

[Carrie] Week 4: Settling In

After 4 weeks in India, it feels like I finally have the hang of things- I've settled into an apartment, have a morning work-out routine, and have been able to have regular meetings about interesting topics related to BOP. It has been fascinating!

I don't know if I would say that things are progressing as I expected. The ways that people tackle BOP design and marketing is extremely unique to each market segment and fascinating in so many more aspects than I had really thought about before. There is so much that goes into every aspect that it seems at times that I would need a lifetime to understand everything. I wouldn't say that my project plans have changed since I've got here but my knowledge has definitely grown tremendously. One aspect that I've been thinking about recently and though I had a firm grasp on but really didn't was means of funding and money complications. . Some of the most interesting things I've been discussing recently is ability to pay, how to sell a product or service. It seems like in BOP so much focuses on money and that funding is such a huge driver in so many areas.  As a total there is a lot of money, because of the huge number of people, but tapping it is very difficult.

One interesting case study is with energy. It turns out that in rural villages that the main source of electricity is kerosene lamps- this is a huge expense and when the total money spent is added up, it is more than regular electricity would cost, more than solar, and just as a total, a significant investment for the village person. The huge advantage that is has is that the user can pay whenever they can- or not when they don't have the money. The regular payments of electricity are something they can't afford to do (even though they are cheaper- although extending the grid to the smaller villages is a cost that at least at this point electric companies won't do because the profit is not there). That same issue of regular payments is why a lot of companies have trouble operating in rural villages. One organization decided to tackle that problem by basing their business model for solar energy to mimic that of kerosene's. They a few payment options they are working with
1. pay as you go (utility bills) where the company owns the hardware (solar panels etc)
2. pay slowly off the cost of the initial set-up with irregular small payments until you eventually own the solar powered unit (and pay a regular maintenance fee throughout).
3. A combination of the two that works like a utility system but will allow the villager to eventually own the unit.

Embrace is also so driven by cost. They also want to sell to a village mother but don't seem to have a system completely worked out yet for their incubator that is heated with boiling water.They have been planning on a single-use product that they are selling for individual babies, but have had to recently think about buy-backs of different components, possibilities of renting (which actually turns out not to be wanted by the doctors), for a cost how long the device has to be operational for. It's been fascinating and the medical aspect adds a very interesting twist. I won't say more now- it's too much to write but ask me if you are interested or wait for my research paper!

Another interesting topic is micro-loans, and here is a perspective I had never considered before: With micro-loans I've always felt a little unsure about the ethics of the huge interest prices; however if you think about a lot of it, as a friend put it, the profit margin for the coconut seller on the side of the road is probably huge; however it is the scale that he is lacking in order to make enough money to be able to make investments. If you can increase his capacity to sell more coconuts, it is often easy for him to pay back even those high interest rates do to the steep increase in his income.

Anyways- a few examples of many. 

The classes I've taken - especially cross disciplinary classes in organizational studies and the business school, as well as the support and resources U of M have afforded me have given me a fantastic foundation and ability to talk intelligently on all these topics, but the longer I am here the more I realize I have to learn. I know that by the end of the summer I'll have built a strong structure of knowledge over that foundation. I can't wait to see what the next week will bring!

[Marisa] Pre-Departure

Hey there! My name is Marisa Perera and I traveling to Chennai, India in a little under two weeks. My trip to India is only possible due to anonymous funds provided to me by the Center for South Asian Studies (CSAS) at the University of Michigan.

So, who am I? Well, here is a little information about me. I will be entering my senior year at the University of Michigan and completing my double concentration in Spanish and Psychology, and obtaining my B.A. by May 2013. Though I am of Sri Lankan descent, I have been fully raised as an American. However, my past three years as a student at the University of Michigan has opened my eyes to the diversity that fills not only my campus, but our world. After taking classes like cultural anthropology and Asian religions, I found myself subconsciously gravitating towards South Asian culture, yearning to learn more about the culture. In addition to learning about South Asian cultures, my other passion is clinical psychology. I will be attending a Master's program in psychology at the University of Michigan and plan to obtain my Ph.D in clinical psychology shortly thereafter. I am particularly interested in researching clinical issues in Asian populations. Thanks to UM's CSAS, I have been given the opportunity to tie my passions together and research mental health in India.

I will be volunteering at the Banyan in Chennai, India. The Banyan is a non-governmental organization that offers various types of mental health services to people with mental illness in Chennai. Their services include care for those individuals with mental illness as well as their families. Additionally, the Banyan has numerous programs to promote awareness and understanding of mental health within India.
Specifically, I will be working with the Banyan Academy of Leadership in Mental Health (BALM), an initiative of the Banyan that began in 2007. This academy has the purpose of researching, educating, and advocating mental health issues. I will be working closely with a team of BALM professionals to create and implement indicators of mental health status in Chennai. The BALM has asked me to begin creating ideas of potential indicators before arriving in Chennai. So far, I plan to visit the psychology/psychiatrist departments of nearby hospitals to gauge patients' knowledge of mental health, as well as to consider the opinions of mental health doctors and professionals involved in the mental health system in Chennai. Additionally, I plan to conduct an analysis of the Banyan's current programs offered to mentally ill individuals and their families, to assess for success rates. All in all, I plan to examine mental health in Chennai, for both individuals receiving care as well as individuals involved in the system.

India, I'm ready for you!

[Eric R] Week 5

Apologies for the late post! I was traveling from Bangalore to Delhi (Yesvantpur Junction to Hazrat Nizamuddin) this past weekend (Friday-Sunday), and have been recuperating from the journey ever since… This post will be all about my journey, because that is all I can focus on at this moment.

To say the journey was easy is an understatement. India has a very well-developed train reservation scheme, where a series of waitlisted and “reserved against cancellation” (RAC) tickets are granted before you receive a confirmed ticket. As the departure date draws nearer, you usually move farther and farther up the queue. I purchased my train ticket a month before departure and received a WL-28 ticket, which I was told was a near guarantee of a confirmed seat, in the 2^nd AC class (which is quite comfortable!).

I arrived at the train station at 8p for my 10p train, and was WL-6, but the seating chart still hadn’t been prepared. This was good news. In addition to the “General Quota” of tickets (which I had purchased), the railways have many other quotas, including “Ladies,” “Tatkal” ( “at once/immediate”), “Defense,” “Handicapped,” “Parliament House,” and still others. The result is that usually when charts are prepared, all of the empty seats from those quotas are filled by people on the General Quota waitlist. So being WL-6 with the charts not prepared was a good sign. I waited just over an hour, and saw a ticket teller (TT) posting seating charts on the sides of train cars. I rushed to the ticket counter to check if I had gotten lucky. She scribbled on my ticket and passed it back to me with a forlorn look on her face and a curt “no ticket.” WL-5. I had only moved up one place, and because I was still on the waitlist, I couldn’t board the train.

With not many other options, I joined the line at the unreserved ticket counter, and purchased an unreserved second class ticket for just over a tenth of the price of 2^nd AC. Below are the comments from www.seat61.com, the reputed global train-travel information website.

The efficient reservation system means that you can safely forget any pictures you've seen of overcrowded Indian trains with people on the roof or hanging on the side.  These these photos show suburban [local] trains, or basic unreserved 2nd Class on long distance ones [my new ticket choice].  On fast long-distance trains in AC1, AC2, AC3, or AC Chair Class, all passengers have an assigned seat or sleeping berth so there's no overcrowding … On the other hand, Sleeper Class [of which I was jealous] gets much grubbier than the AC classes and unreserved passengers can sometimes enter the coaches making it crowded [ha].  2nd class unreserved can be [read: is] incredibly crowded.  Toilets in sleeper class or basic non-AC 2nd Class seats can leave a lot to be desired...

I could not put it any better. I sat on the floor near the two Indian-style bathrooms, on top of my backpack with my knees tucked against my chest, for the majority of the 36-hour journey. Not only did I need to lean out of the way every time somebody came to use the toilets, but whenever the door opened I got a nice waft of the smell. Around me where other kids about my age, and we each took turns stretching out on top of each other to “sleep” in 1-hour shifts. I think I maybe dozed off once. The car was designed to seat about 80 people; there were easily 200. Towards the end of the trip (after Gwalior), a fair number of people disembarked and I managed to snag a bit of bench space for the last 5 hours of the trip. Again, I didn’t catch any sleep, but it was a blessing to stretch out my legs when I wanted.

Those around me spoke about as much English as I do Hindi, so there were many interesting “conversations” had. There was a long debate between them regarding who I resembled more: Harry Potter, or Spiderman.  I wasn’t wearing red, and I didn’t know how to ask which Spiderman I reminded them of. I’m not sure where that idea came from, but the camps were evenly divided. Everyone was fascinated by the US $1 I had with me, and everyone wanted a picture with me on their phones.

I am certainly checking this box off my bucket list, and can say that I’ve ridden in the lowest-of-lows when it comes to measures of comfort. I am lethargic, achy, congested, and just coming down with my first serious bout of stomach-bowl sickness. Yet, I am blessed to have witnessed my GSI’s wedding last week (graduate student instructor), satisfied that I made it to Narayana Hrudayalaya for my project, and excited to be in a new city.

I look forward to posting next about the developments that will come with this new week!

-ericr

[Brad] Week 0

Hello everyone! I am Brad and I will be traveling to Mumbai on Wednesday to complete a research project with Armman India. Some struggles obtaining a visa have kept me in the states later than I expected, but now my ticket's bought and my bags are (almost) packed. I am excited to share all of my experiences to come soon, but for now I wanted to write to say hello. See you soon, in India!

[Carrie Y] Week 2-3 Learning

What an adventure so far! I'm sorry I've been a little MIA lately- I've been meaning to post every Sunday, but a small trip which led to food poisoning which led to me curled up at my apartment (or rather my friends apartment) near the bathroom with no internet. But that is getting a little ahead of myself.

The best way to describe India is that it is uncomfortable. I don't mean that in a negative way, but more in the sense that I am constantly tested and stretched and never really left to relax. I think that there are a few life lessons to keep in mind from India

• Always have a plan B. And if plan A fails, make plan C, if B fails have plan D, or in other words always be ready and analyze, adjust, and adapt and move on to another option. There always will be another route. 
• Be wait for things to happen- I've been waiting to be settled in my apartment to put certain plans into action. But as 3 weeks have gone by I've realized- that may not happen anytime soon. You shouldn't wait. You should do.
• Don't be too concerned about time- do things when the moment is right, not when you plan on them. But at the same time, keep your commitments. 

Most of these lessons stem from my living arrangements, my research, and my adventures. My living arrangement, surprising has probably been my best introduction into Indian culture. I've been living with a friend for the last three weeks- an arrangement that was only supposed to last one week but has turned into three. I've had 5 separate housing plans fall through and I am finally moving out tomorrow morning. (thus the plan A, B, C, D and at this point, E). In the process I've been disappointed by housing plans with co-workers falling through, had a realtor arrange something and then decided to start hitting on me instead of following through on the final details on housing I had 80% arranged and when I resorted to having my Indian co-workers talk to him stopped answering my phone calls.

Now I am moving in with a couple of social entrepreneurs who work on Solar powered energy for base of the pyramid- I think it will work out great and I will be able to pick their brains for my research project. In moving in, I am actually not as excited about a bed of my own as for a blank wall. I have been waiting and looking forward for these three weeks for a wall to paste post-it notes on and organize my thoughts- I've been journaling some and thinking lots, and I can't wait to map it all out.  I'll take pictures to share.

I've been living a 10-7 working life so far. I've started by immersing myself in work at Embrace and becoming part of the team. I've just started setting up lunch-meetings regularly with different parts of the Embrace team in order to fully understand every aspect of Embrace. Next Tuesday I am meeting with one woman who is the head of their base of the pyramid (BOP) education system and public health outreach and I'm working my way through the different sectors of Embrace. I was planning to start last week but a nasty case of food poisoning kept me out of commission completely for half the week and half-functioning for the other half. Just seeing how things work is giving me amazing insights into the innovation, hardships, and daily life of a working BOP social venture.

I've also been networking with local social entrepreneurs and trying to make as many connections as I can so that I can pick their brains for my research. I have many conversations and thoughts and I'm looking forward to taking it to the next level this month and visiting some of their facilities.

The one side just-fun adventure that I undertook was last weekend I went with some other interns I met to Hampi- an ancient religious site where we saw different temples for Ganesh and Hanuman (aka the elephant and monkey temples) among others. I think one of my favorites was we took as small circular boat made of tar and bamboo down a river, walked across a field, climbed to the top of a large mountain (something like 600 steps) to the monkey temple, to an amazing view overlooking the whole area where you could see other temples. The temple wasn't that exciting- some cement, white paint, and incense, but the view was amazing. Unfortunately, this trip also gave me food poisoning, but it was well worth it, and who knows- maybe this will make me stronger for the next time.

It has been an amazing experience so far and I am very thankful for the opportunity. For all its hardships and frustrations, I wouldn't change a thing. In summary of my life here, to be added to as my journey continues:

You know you are in India when:

• You fit 12 people in one rickshaw (a three- wheeled cross between a motorcycle and car)
• You wonder why you are in a traffic jam, and then realize everyone is just waiting for the herd of cows to finish crossing the road

[Eric R] Week 4

I seem to have really good weeks (last week in Mumbai!) followed by really bad weeks (this week in Bangalore), in terms of my project at least. Last week was extremely enlightening, and I managed to meet with many doctors at some very excellent hospitals. I learned a lot, and can tell that a bulk of my research material will come from my visits in Mumbai.

Going into this week, a great number of things changed for me. First, I moved to Bangalore, the Silicon Valley of India. I left Mumbai Tuesday afternoon, and arrived here on Wednesday late-morning by bus. The drive was spectacular, and I loved getting the opportunity to see the country a bit. I sat next to a gentleman (Shreeshan) who had studied civil engineering in Mumbai but was headed to Bangalore to interview for a spot at a college studying journalism (he got bored, he said). I enjoyed traveling with him, and the 18 hours felt more like 3 or 4.

Second, the monsoon season started! B’lore is much more elevated than Mumbai and also inland, so it’s cooler here to begin with. The result? It’s a mere 80 degrees here, completely overcast, and a nice breeze to keep the humidity at Ann Arbor summer levels. It rains for only about an hour here each day, usually in the late afternoon. In Mumbai I’m told it rains much more (up to 6-8 hours/day), but again, due to the elevation and proximity to the ocean, B’lore’s monsoon season is much less pronounced.

Third, my phone was put on hold. As a result of the 2008 terrorist attacks in Mumbai, it has become much more difficult for anyone to get a SIM card. Mine was working perfectly fine, until someone somewhere decided I needed additional verification, which includes a trip to the stall that I purchased my card at originally…in Pune. So, I’m working with OHUM to get my service restored ASAP.

This leads into my fourth change: unbeknownst to me, three of the four hospitals I wanted to meet with in Bangalore had been trying to contact me on my cell phone since Monday. They eventually all emailed me, a couple days later (the day I arrived in Bangalore), regretting to inform me that it would no longer be possible to accommodate my project. Their reasons were all because they were denied approval from their research boards. So, as far as Bangalore goes, my research has hit a wall. I’ll be visiting the remaining hospital on Monday (Manipal Hospital).

Next Thursday I’ll be attending my GSI’s wedding in Bangalore! I’m so proud of him for being the recipient of this year’s ChE Department‘s Excellence in Teaching Award, and can’t wait to be there for him! Two other ChEs, Carrie Yarina (another CSAS Fellow!) and Pete Wangwongwiroj, are also in Bangalore and are attending as well. We look forward to bonding in Bangalore!

Next Friday I’ll be taking the 35hr train trip to Delhi, the last stop for my research project! I’m looking forward to my hospital visits there – everyone I’ve talked to so far has said that Delhi is at the forefront of EMR adoption. While there I will take a weekend trip to the Taj to take that iconic picture! It will provide good closure for my trip, and I will be sad to leave this beautiful country. I can hardly believe that I passed the halfway mark, and know that the rest of my time will fly by. I plan to make the most of every moment and learn everything I can.

Until next week.

-ericr

[Eric R] Week 3

It’s time for my next post! This past week has been inspiring for me. Overall, I was very productive; I managed to make new friends, see some sights, and have many well-developed conversations with very smart people.

I ended my time in Pune with a round of laundry. Although Malik offered to take care of it himself in the communal washing machine behind the guesthouse, he also (politely) suggested I take my laundry to “My Dhobi,” a business that does your washing for you. I elected for that option, and had a lovely conversation with the manager who has traveled extensively in the southwest US, and has a niece in Auburn Hills, MI.

I had my first experience with the long-distance trains – I managed the four-hour trip from Pune to Mumbai (Dadar Station) by myself. I almost missed it; I literally hopped aboard the first car I saw, and we started chugging along (note to self: remember to print your ticket beforehand!). Luckily, I jumped onto the right one! At Dadar, I took a taxi to my hotel in Khar West, about a 10min ride. The taxi driver promised me a good deal, and tried to charge ₨2000 when his meter said ₨57. He pulled out a fare conversion card “given to him by the government,” that although looked plausible, I knew was a forgery based on the prices. I was astounded when a local started to back him up, and so I called Ketaki to make sure I wasn’t just being ignorant. In fact, the charge was ₨57. Fellow SiSA students… be careful!

I visited two hospitals this week, but had multiple interviews at each, over four days. At the first, Tata Memorial Hospital in Parel, I met with five physicians. Each chose to focus on slightly different aspects of EMR systems. I’m finding that a good first question to ask is, “What do you define as an EMR system,” followed by, “What is the difference between that, and an HIS system?” A high percentage of all hospitals here have a hospital information system (HIS) that might include modules such as “Admissions, Discharge, and Transfers,” “Bed Occupancy,” “Billing,” or “Patient Registration.” Many of the physicians, when asked if they use an EMR system, they say yes, but really are referring to their hospital’s HIS system. The key difference, in my opinion, is that an EMR system needs to provide support for clinicians when making important decisions regarding patient care. Such provisions could include patient allergy alerts, diagnosis information, prior medical histories, lab results, and all medical images. Of these features, none of the hospitals I’ve visited so far have implemented all of them. Most have implemented a module for viewing images (MRIs, CTs, etc.) and some have implemented a module for viewing lab results. But of course, the modules are all separate, and have unique login information for each.

The second hospital I visited was Fortis, Mulund, where I interviewed another five physicians, four of which were during their outpatient clinic periods. This provided a unique opportunity for me to understand the different settings in which an EMR system could be used. The number one challenge these physicians emphasized was patient volumes. There are simply too many patients to be seen each day to spend time wrestling with their computers while they’re at it. And frankly, I don’t blame them. If there is one thing I’ve seen most during my time here, it’s people. I’ve ridden the trains a few times in the last couple days, but always during off-hours. The trains and platforms have been crowded, but I’ve managed to always make it on and off the trains alright. Today on my trip to Fortis (about a 1.5hr journey), I left Khar at 9a, just as peak travel times were beginning. It was madness. I felt like a sheep being herded through a tunnel squished against a million other sheep. The transfer at Dadar was equally as crazy; there were easily 5,000 people on the station platforms at any given time. I loved having the opportunity to fit as a local, and even had some people ask me, "agle station kya hai?" (what is the next station?) To which I was able to proudly offer, "Bandra," "Khar Road," and "Nahur."

I’ve been told there is not a lack of doctors here, and I’m inclined to believe that after hearing so many of them graduate and continue into hospital administration, business, and pharmacy. From what doctors have told me, what India lacks is healthcare facilities. There simply aren’t enough hospitals to take care of every person with the same level of attention as in the US. When time is of the essence, and an “expensive” hospital consult is ₨500 ($9), doctors simply don’t care to put the effort into learning a new system and dealing with the training period required for an EMR system to stick. Not to mention the grossly inadequate amount of infrastructure – imagine having to run from the patient’s bedside to the single nursing station in the ward to check a patient’s chart one more time. Then there’s the slow Internet connection, the forgotten passwords, and my favorite, the software runtime errors.

At some point during all of my interviews, the physician says something along the lines of, “You know, all we need is a visionary – someone to come in and push for EMRs. Someone just needs to take our paper away!” If you’re reading this and feeling inspired, let me know, and I will put you in touch with the right people!


-ericr