Return of the Coconut

Bollywood on Ice

noreply@blogger.com (Rohan Radhakrishna) — Wed, 24 Feb 2010 09:15:00 +0000

2010 Olympic silver medalists, figure skaters Meryl Davis & Charlie White, performed to Indian folksongs at the national figure skating championships gala. They are the winners of this event for the second year in a row. They have been partners on the ice since paired up in 1997 making them the longest running ice dance partnership in the US. They are both currently students at University of Michigan. In the spirit of the Olympics and cross-cultural everything, enjoy.

Link to video is here.

Shit Luck & Slum Health: Dropping Your Phone into Sewage Slush

noreply@blogger.com (Rohan Radhakrishna) — Sat, 12 Dec 2009 08:19:00 +0000

DISCLAIMER: FECULENT TEXT AND PHOTOS BELOW

VIEW AT YOUR OWN RISK

What would you do if you dropped your cell phone in raw human sewage in the middle of a slum?

This was my dilemma last week in Bhopal. I was rushing to the airport, navigating my way on foot through a slum in Old Town, dodging potholes with my roll-a-luggage, when I bumped my cell phone off my hip clip and it flew into the gulley of raw human sewage, right where I had seen boys pooing the day before. The image of one lad was fresh in my mind. He must have been 3 years old. While maintaining his squat nicely throughout the download, he waved at me with one hand and screamed "Hello, Hello, Vat Yer Name, Vat Yer Name, Hello, Hello?" The image vanished as I realized the task before me.

Option A: Don't even think about going for it. Head to airport.
Option B: Look dejected and deeply troubled until a good Samaritan comes and gets it out for you. Offer them a cash reward.
Option C: Start screaming "Oh No, Hurry Hurry - Aye-oooooo, Julthee, Julthee" As people gather, wave a 100 rupee note and see who goes for it.
Option D: Delve in with your hands and pick it out.

I pondered for ten long seconds.
Mind you this wasn't your average plastic Nokia Indian cell phone, it was my Palm Treo PDA-Personal Digital Assistant. Basically, my secretary was drowning before my eyes and I had to take action. Given my rush to catch a plane and the thought of all the necessary information I had stored in that phone (all my Indian contacts, my calendar, my medical drug encyclopedia and clinical software programs), I chose Option D and fished out the phone. It was submerged in brown tarry goop. A lady in a nearby shack brought me a bucket of water to wash my hands and gently rinse off the phone. I dropped the phone into a spare plastic bag and rushed off to find an auto rickshaw. After airport security clearance, I dashed to the bathroom and used Dettol soap to scrub my hands and my phone. The smell wouldn't go away. While trying to use the phone, I discerned that clots of gunk had gotten stuck in the ports on the bottom of the phone. The phone was optically sensing the micro-poo-pieces lodged in the ports and thought it was the cable connecting to my laptop so the phone was stuck in "Synchronizing with Computer, Please Wait....." mode.

On the plane, I asked the air hostess for a plastic tea stirrer that, to my luck, looked more like an olive spear. I broke it into pieces and used it as a tool to dissect out the poo pieces. After 15 minutes of using my cadaveric trained surgical precision, with full sterile procedure taking care not to fling pieces on my neighbor or get my hands dirty, I had managed to dislodge all the major pieces. "Synchronizing with Computer" had disappeared. Victory! Unfortunately, I had more hurdles ahead. I quickly learned that none of the buttons on the phone worked. I reached home and scrubbed the phone more. The following day, I took it to a phone repair center for a thorough inside clean-job. 250 rupees and 24 hours later, I had my phone back in order with 80% of the buttons working and only 10% of the stench still present.

In a perfect world all kids would poo like this boy from the classic Japanese children's book Everybody Poops.

"washes his hands" "with soap and water" the cartoon forgot to add

Unfortunately, the situation in slums is quite different. Due to the rush to catch my flight and my acute traumatic reaction, I was unable to photodocument my experience. But with a little imagination, you can put the following 3 pictures together (obtained from Google Images) and recreate the exact scene.

I gained great compassion for those who don't have toilets and especially for those slum-dwellers who may occasionally drop something into the sewage gully. This is more than a few little boys. 32% of humans currently live in slums. The UN predicts that before 2030, two billion more people will be crammed into urban spaces. Slum health is a serious issue that I will write more about in future postings. If you'd like a nice overview you can read this article titled Slum Health: From Understanding to Action, co-authored by one of my professors Dr. Lee Riley.

But for now, in honor of going into sewage to get what you really want in life, I present my favorite movie vignette of all time, from the award-winning Slumdog Millionaire. Although I got my cell phone back and was able to rehabilitate it, I didn't get an Amitabh Bachan autograph like this brave soul.

B'eauPal Stunt- The World's Finest Water Aged 25 Years

noreply@blogger.com (Rohan Radhakrishna) — Sun, 06 Dec 2009 20:57:00 +0000

25 years of finely aged water, with toxins leached from the world's most notorious chemical disaster, served fresh to Londonites and delivered to the doorstep of Dow Chemicals.

The Yes Men, International Campaign for Justice in Bhopal, and the Bhopal Medical Appeal bring you none other than B'eauPal.

Watch this video of the B'eauPal stunt in London.

Learn more about the stunt here:

On the Ground for 25th Anniversary of World's Worst Chemical Disaster

noreply@blogger.com (Rohan Radhakrishna) — Sat, 05 Dec 2009 11:27:00 +0000

Adil is one of a thousand stories of struggle and survivorship in Bhopal. You can read Adil's story here

Last week I had the fortune of attending the marches of the 25th anniversary of the world's worst industrial disaster in Bhopal, India. Over 2 days, I marched with over a thousand survivors and their families.

To see their conviction, courage, and empowerment 25 years later was humbling.

To see their suffering, anger, and deep-seated sense of injustice was tragic.

Today I got permission from the government to tour the abandoned Union Carbide factory, the ill-fated American-owned pesticide plant which exploded on "that night." Sadly I witnessed a lack of corporate and governmental responsibility for the neighbors. Little environmental clean-up has taken place.

Walls between the contaminated area and the nearby slums had fallen down as children played cricket 50 meters from the infamous tanks which leaked tons of methyl isocyanate shown in the below photo. One kid was collecting firewood next to the tanks. Goats and pigs were feeding inside the contaminated area. While I filmed and photographed near the tanks, I felt light-headed and nauseated. Later, something landed in my eye which burned like acid and I had to wash it with water for several minutes.

You can learn more about the ongoing tragedy through this brief video titled Hush, Baby.

What do they want? Justice
When do they want it?

If you find yourself concerned, compelled, and would like to help take action go to Amnesty International's website to contact either Indian Prime Minister Manmohan Singh or Dow Chemicals who now owns Union Carbide. You can also get involved with the International Coalition for Justice in Bhopal.

Rather than use my words to paraphrase what happened and what's happening, you can read these excerpts from the Bhopal Medical Appeal.

Remembers Aziza Sultan, a survivor: "At about 12.30 am I woke to the sound of my baby coughing badly. In the half light I saw that the room was filled with a white cloud. I heard a lot of people shouting. They were shouting 'run, run'. Then I started coughing with each breath seeming as if I was breathing in fire. My eyes were burning.

Another survivor, Champa Devi Shukla, remembers that "It felt like somebody had filled our bodies up with red chillies, our eyes tears coming out, noses were watering, we had froth in our mouths. The coughing was so bad that people were writhing in pain. Some people just got up and ran in whatever they were wearing or even if they were wearing nothing at all. Somebody was running this way and somebody was running that way, some people were just running in their underclothes. People were only concerned as to how they would save their lives so they just ran.

"Those who fell were not picked up by anybody, they just kept falling, and were trampled on by other people. People climbed and scrambled over each other to save their lives – even cows were running and trying to save their lives and crushing people as they ran." In those apocalyptic moments no one knew what was happening. People simply started dying in the most hideous ways. Some vomited uncontrollably, went into convulsions and fell dead. Others choked to death, drowning in their own body fluids. Many died in the stampedes through narrow gullies where street lamps burned a dim brown through clouds of gas. The force of the human torrent wrenched children's hands from their parents' grasp. Families were whirled apart," reported the Bhopal Medical Appeal in 1994.

"The poison cloud was so dense and searing that people were reduced to near blindness. As they gasped for breath its effects grew ever more suffocating. The gases burned the tissues of their eyes and lungs and attacked their nervous systems. People lost control of their bodies. Urine and feces ran down their legs. Women lost their unborn children as they ran, their wombs spontaneously opening in bloody abortion." According to Rashida Bi, a survivor who lost five gas-exposed family members to cancers, those who escaped with their lives “ are the unlucky ones; the lucky ones are those who died on that night.”

On the night of Dec. 2nd and 3rd, 1984, a Union Carbide plant in Bhopal, India, began leaking 27 tons of the deadly gas methyl isocyanate. None of the six safety systems designed to contain such a leak were operational, allowing the gas to spread throughout the city of Bhopal.[1] Half a million people were exposed to the gas and 20,000 have died to date as a result of their exposure. More than 120,000 people still suffer from ailments caused by the accident and the subsequent pollution at the plant site. These ailments include blindness, extreme difficulty in breathing, and gynecological disorders. The site has never been properly cleaned up and it continues to poison the residents of Bhopal. In 1999, local groundwater and wellwater testing near the site of the accident revealed mercury at levels between 20,000 and 6 million times those expected. Cancer and brain-damage- and birth-defect-causing chemicals were found in the water;
trichloroethene, a chemical that has been shown to impair fetal development, was found at levels 50 times higher than EPA safety limits.[2]Testing published in a 2002 report revealed poisons such as 1,3,5 trichlorobenzene, dichloromethane, chloroform, lead and mercury in the breast milk of nursing women.[3] In 2001, Michigan-based chemical corporation Dow Chemical purchased Union Carbide, thereby acquiring its assets and liabilities. However Dow Chemical has steadfastly refused to clean up the site, provide safe drinking water, compensate the victims, or disclose the composition of the gas leak, information that doctors could use to properly treat the victims.

The agony of Bhopal
On 3rd December 1984, poison gas leaked from a Union Carbide factory, killing thousands. How many thousands, no one knows. Carbide says 3,800. Municipal workers who picked up bodies with their own hands, loading them onto trucks for burial in mass graves or to be burned on mass pyres, reckon they shifted at least 15,000 bodies. Survivors, basing their estimates on the number of shrouds sold in the city, conservatively claim about 8,000 died in the first week. Such body counts become meaningless when you know that the dying has never stopped.

Since the disaster, survivors have been plagued with an epidemic of cancers, menstrual disorders and what one doctor described as "monstrous births.” The gas-affected people of Bhopal continue to succumb to injuries sustained during the disaster, dying at the rate of one each day. Treatment protocols are hampered by the company's continuing refusal to share information it holds on the toxic effects of MIC. Both Union Carbide and its new owner Dow Chemical claim the data is a "trade secret," frustrating the efforts of doctors to treat gas-affected victims. The site itself has never been cleaned up, and a new generation is being poisoned by the chemicals that Union Carbide left behind.

In December 1999, Greenpeace reported that soil and water in and around the plant were contaminated by organochlorines and heavy metals. A February 2002 study found mercury, lead and organochlorines in the breast milk of women living near the plant. The children of gas-affected women are subject to a frightening array of debilitating illnesses, including retardation, gruesome birth defects, and reproductive disorders.
It wasn’t until 1989 that Union Carbide, in a partial settlement with the Indian government, agreed to pay out some $470 million in compensation. The victims weren’t consulted in the settlement discussions, and many felt cheated by their compensation -$300-$500 - or about five years’ worth of medical expenses. Today, those who were awarded compensation are hardly better off than those who weren’t.

Victims of the gas attack eke out a perilous existence; 50,000 Bhopalis can’t work due to their injuries and some can’t even muster the strength to move. The lucky survivors have relatives to look after them; many survivors have no family left. Everyone has perished.

In 1991, the local government in Bhopal charged Warren Anderson, Union Carbide’s CEO at the time of the disaster, with manslaughter. If tried in India and convicted, he faces a maximum of ten years in prison. However Mr. Anderson has never stood trial before an Indian court; he has, instead, evaded an international arrest warrant and a summons to appear before a US court. For years Mr. Anderson’s whereabouts were unknown, and it wasn’t until August of 2002 that Greenpeace found him, living a life of luxury in the Hamptons. Neither the American nor the Indian government seem interested in disturbing him with an extradition, despite the recent scandals over corporate crime. This is unfortunate: Mr. Anderson’s decisions didn’t just wipe out retirement plans, they killed people.

The Union Carbide Corporation itself was charged with culpable homicide, a criminal charge whose penalty has no upper limit. These charges have never been resolved, as Union Carbide, like its former CEO, has refused to appear before an Indian court. Union Carbide also remains liable for the environmental devastation its operations have caused. Environmental damages were never addressed in the 1989 settlement, and the contamination that Union Carbide left behind continues to spread. These liabilities became the property of the Dow Corporation, following its 2001 purchase of Union Carbide. The deal was completed much to the chagrin of a number of Dow stockholders, who filed suit in a desperate attempt to stop it. These stockholders were surely aware that a corporation assumes both the assets and the liabilities of any company it purchases, according to established corporate law. Indeed, Dow was quick to pay off an outstanding claim against Union Carbide soon after it acquired the company, setting aside $2.2 billion to pay off former Union Carbide asbestos workers in Texas. However Dow has consistently and stringently maintained that it isn’t liable for the Bhopal accident.
Thus the victims in Bhopal have been left in the lurch, told to fend for themselves as corporate executives elude justice and big corporations elude the blame. Dow’s unwillingness to fulfill its legal and moral obligations in Bhopal represents only the latest chapter in this horrifying humanitarian disaster. For twenty years, the victims of Bhopal have continued to demand justice; the only question is: will we listen? Another excellent article about the disaster can be found here, and a comprehensive interview with Sathyu about the 20-year campaign can be found here. For more information about the Bhopal accident, please visit our links page.

For Emergency Dial Auspicious 1-0-8, not 9-1-1

noreply@blogger.com (Rohan Radhakrishna) — Wed, 02 Dec 2009 08:56:00 +0000

Get your cell phones out and put 1-0-8 on Speed Dial in case you find yourself in India with an emergency. Although certain Indian states tried using 911 as the code to dial (based on Western movies and TV shows), some locales faced excessive prank calls and the number 911 was discontinued. Furthermore, the average Indian can remember 108 much easier than 911 based on its cultural significance (read on!).

Surprisingly, India has never had a coordinated Emergency Response service until a public-private partnership sprung up in 2005. The Emergency Management and Research Institute (EMRI) has handled emergencies in an increasing number of Indian cities and is now present in 10 of India's 28 states. It is a toll-free 24-7 service for health, fire, and police related emergencies. Testimonies vary from hour long waits to prompt service. Some people still prefer to take their loved ones directly to an Emergency Room, or they have the number for an ambulance based at the closest hospital to where they live. However, most people panic and don’t have such prepared plans, thus 108 is providing a niche service to many in unanticipated need.

In Tamil Nadu, the Southeastern Indian state where I’m based, Mrs. G. Saraswathi got up close and personal with this new service when she delivered twins in the ambulance at the hands of paramedics. So far 15 deliveries have taken place inside the ambulances in Tamil Nadu. Since the service was introduced, 1,709 calls have been attended to reports a Special Correspondent from The Hindu on November 5th.

Why 108?

It's a favorite astrological number in Hinduism, Buddhism, Jainism, and Sikhism that has many meanings.

*The prayer beads that Indians use (japamalas) have 108 beads.

*Ancient Vedic scholars correctly predicted that:

-The distance between the Earth and Moon is 108 times the diameter of the Moon

-The distance between the Earth and Sun is 108 times the diameter of the Sun

-The diameter of the Sun is 108 times the diameter of the Earth

*Ayurveda, Indian traditional healing system, believes there are 108 pressure points.

*Lord Shiva's cosmic dance, Nataraja, is done in 108 poses

*Lord Krishna flirted with 108 gopis: cow-herd-girls

*Most Hindu deities have 108 names that are ceremoniously recited

*Many Buddhist temples have 108 steps

*In mathematics 108 is a semiperfect number and a tetranacci number

*Hundreds of other 108 significances can be viewed here:

108 for 1.1 Billion

1.1 billion people become a challenge for scalability of such emergency services. In addition, crowds and Indian traffic create extra hurdles for 108. This photo I took shows a 108 ambulance trying to penetrate a huge crowd of pilgrims taking up the road.

At this pilgrimage I attended ~500,000 people came to walk a holy circuit and the one lane road was packed like sardines for over 24 hours straight. The pilgrimage was a challenging 14km around a mountain, which must be undertaken barefoot, in a sea of people, which I equate to a 5-hour moving mosh pit. Children, the elderly, and the disabled do the circuit as well for many believe that completing the pradakshina (circumambulation) will bestow you with good health and success. I saw one man with a shortened leg hobbling along in makeshift crutches and suddenly my toes (which I stubbed 3 times amongst the crowd) didn't hurt as much. Throughout the night I saw several 108 ambulances battling the crowds trying to get through and I wondered how 108 is faring in other parts of India.

Sexual Slavery's Biggest Challenge-Civil Society Silence

noreply@blogger.com (Rohan Radhakrishna) — Mon, 30 Nov 2009 18:51:00 +0000

Image from Prajwala
Can you break your culture of silence? Can you offer compassion to survivors of sexual slavery? Will you hire them, let your children study with them, treat them as equal human beings?

TED reports "Each year, some two million women and children, many younger than 10 years old, are bought and sold around the globe. Impassioned by the silence surrounding the sex-trafficking epidemic, Sunitha Krishnan co-founded Prajwala, or "eternal flame," a group in Hyderabad that rescues women from brothels and educates their children to prevent second-generation prostitution. Prajwala runs 17 schools throughout Hyderabad for 5,000 children and has rescued more than 2,500 women from prostitution, 1,500 of whom Krishnan personally liberated.

Krishnan has sparked India's anti-trafficking movement by coordinating government, corporations, and NGOs. She forged NGO-corporate partnerships with companies like Amul India, Taj Group of Hotels and Heritage Hospitals to find jobs for rehabilitated women. In collaboration with UN agencies and other NGOs, she established printing and furniture shops that have rehabilitated some 300 survivors. Krishnan works closely with the government to define anti-trafficking policy, and her recommendations for rehabilitating sex victims have been passed into state legislation."

In this courageous talk, she tells three powerful stories, as well as her own, and calls for a more humane approach to helping these young survivors rebuild their lives. See her harrowing TED India talk below.

Dance to Change the World

noreply@blogger.com (Rohan Radhakrishna) — Wed, 25 Nov 2009 19:43:00 +0000

How did a dance get Nehru to investigate dowry deaths?

How can a dance convince villagers to make their own clean water when governments fail?

To find the answers to these two questions, you'll have to watch the dance video posted below by Mallika Sarabhai, a dancer/actor/politician, who tells a transformative story through dance and argues that the arts may be the most powerful way to effect change, whether political, social or personal. As her website states: "When asked what I like to be introduced as - dancer, choreographer, publisher, activist, writer, actor – I tend to say that I am a communicator. And that all the others are the different languages in which I communicate. There are many things that concern me, and that I think concern many many people around the world. The web is a great place to [communicate] as you know."

Watch her in full effect at her TED India talk below:

His Dataset Will Change Your Mindset

noreply@blogger.com (Rohan Radhakrishna) — Wed, 25 Nov 2009 15:28:00 +0000

Hans Rosling, global health expert and data visionary, has dozens of eye-opening talks available at Gap Minder. Watch them and let his dataset change your mindset.

His most recent presentation in Nov. 2009 at TED India talks about Asia's Rise. Watch the video here:

In the summer of 2009 he spoke at the US State Department showing the overall global trends in health and income over the last 200 years, the development of the HIV/AIDS-epidemic, and how China is catching up on the richest countries.
Enjoy this video below.

TED writes that "Even the most worldly and well-traveled among us will have their perspectives shifted by Hans Rosling. A professor of global health at Sweden's Karolinska Institute, his current work focuses on dispelling common myths about the so-called developing world, which (he points out) is no longer worlds away from the west. In fact, most of the third world is on the same trajectory toward health and prosperity, and many countries are moving twice as fast as the west did.

What sets Rosling apart isn't just his apt observations of broad social and economic trends, but the stunning way he presents them. Guaranteed: You've never seen data presented like this. By any logic, a presentation that tracks global health and poverty trends should be, in a word: boring. But in Rosling's hands, data sings. Trends come to life. And the big picture — usually hazy at best — snaps into sharp focus.

Rosling's presentations are grounded in solid statistics (often drawn from United Nations data), illustrated by the visualization software he developed. The animations transform development statistics into moving bubbles and flowing curves that make global trends clear, intuitive and even playful. During his legendary presentations, Rosling takes this one step farther, narrating the animations with a sportscaster's flair.

Rosling developed the breakthrough software behind his visualizations through his nonprofit Gapminder, founded with his son and daughter-in-law. The free software — which can be loaded with any data — was purchased by Google in March 2007."

Ideas Worth Spreading at TED India

noreply@blogger.com (Rohan Radhakrishna) — Tue, 24 Nov 2009 14:52:00 +0000

"We believe passionately in the power of ideas to change attitudes, lives and ultimately, the world. So we're building here a clearinghouse that offers free knowledge and inspiration from the world's most inspired thinkers, and also a community of curious souls to engage with ideas and each other."

TED (Technology Entertainment Design) hosted their first-ever gathering in India at the Infosys campus in Mysore on November 4-7th, 2009. It offered a fast-paced, highly curated three-day stage program featuring the famous 18-minute TED talks. These talks will open your eyes and drop your jaw in mind-expanding ways. Below I highlight some of my favorite TED India talks. You can access most of the TED India talks here.

*Pranav Mistry, MIT grad student prodigy and inventor of the SixthSense technology, shows his wearable device that enables new interactions between the real world and the world of data. Watch him showcase this technology in the talk below.

If you want to see another video about applications of Sixthsense Technology see this video.

*Ryan Lobo, Indian filmmaker and photographer, speaks about "compassionate storytelling" sharing photographs that tell stories of unusual human lives. In this talk, he reframes controversial subjects with empathy, so that we see the pain of a Liberian war criminal, the quiet strength of Indian UN women peacekeepers stationed in Liberia, and the perseverance of Delhi's underappreciated firefighters. See more of his photography at his blog. Watch the video of his moving TED talk below.

*Hans Rosling, global health expert and data visionary, talks about Asia's Rise with a mind boggling data presentation. Watch the video here:

"I like my Women like my Laptops-Light and Slim"

noreply@blogger.com (Rohan Radhakrishna) — Sun, 08 Nov 2009 09:12:00 +0000

White Skin and Size Zero Sells in India

How often do you find an Indian with lighter skin tone than a Japanese? When it comes to product marketing and the Indian media, more often than is statistically likely.

Image from Getty Images.

Bollywood Actress Kareena Kapoor (right) and Managing Director of Sony India Masaru Tamagawa (left) pose with Sony's lightest weight and ultra slim VAIO X notebook after the launch in New Delhi on November 3, 2009. This notebook is a half-inch thin and 655 grams and is being marketed as a size Zero.

“I am proud to be India’s size Zero.” News4u-Entertainment Desk reports Kareena saying “I only lend my name to a brand that is suitable to my personality type. Vaio X is slim, stylish and sexy, something that I easily relate with.”

“I think in India, size zero means being slim. Every girl wants to be really slim and I think I am quite slim. India’s size zero is associated with me and I am proud of that,” said Kareena who has often denied being the size zero according to international standards. The 27-year-old actress hit headlines when she lost eight kilograms to acquire a bikini body for the 2007 film ‘Tashan’. Though the film flopped at the box office, Kareena’s thin figure became the talk of the country, sparking a size zero trend in India.

If Indian men aren’t already telling their friends the following, such media is only likely to encourage it: “I like my women like my laptops-light and slim.”

I’ve always been frustrated seeing Billboards in developing countries where the women are absurdly thinner and whiter than the actual local population. This soft cultural hegemony infiltrates the minds of the young and old redefining beauty and in some instances leading to pathologically low self-esteem and eating disorders. When I scan the Indian newspaper matrimonial sections (not for myself, for cultural research purposes I swear!), I frequently find “fair-skinned” as mandatory inclusion criteria.

If we conducted a study were we used a photospectrometer or some melanin detection device to quantify the lightness of a person’s skin, we would see that the stars who grace the magazine covers and Bollywood films are several standard deviations away from the average Indian. India’s largest cultural export, Bollywood films, is a gross misrepresentation of the average Indian, but perhaps the same can be said of many industries. Tobacco companies have long used "light and slim" in association with women to market cigarettes. For some reason, living in Tamil Nadu where people are dark skinned, and seeing “India” exported through film, advertising, and beauty pageants I struggle with how this country “sells” its beauty and skin color. Having lived in Latin America, I am used to people being typecasted into “blanca” “morena” or “negra” based on minute differences in skin tone. However, the exported image of India seems more out of touch with the reality of India.

"100 million limbs are at risk of amputation!"

noreply@blogger.com (Rohan Radhakrishna) — Sat, 07 Nov 2009 11:13:00 +0000

Diabetes in India: A Sandal Scandal

"India will have 50 million diabetics by 2010. Close to 20% of all diabetics have some form of amputation and surveys indicate that 60% of these amputations are because of wrong or no footwear" said Mr. Vijay Viswanathan, Managing Director of the MV Hospital for Diabetes. Although he was referring to unpublished data which was likely somewhat exaggerated, India is becoming the diabetes capital of the world.

During the first week of November when Diastep was launched, a new Indian sandal for low-risk diabetics to prevent foot ulcers and ultimately amputations, I happened to spend a morning at a rural diabetic foot clinic with a physical therapist.

In 150 minutes, we examined 47 patients with diabetes for cracks, callouses, corns, bunions, ulcers, tingling, burning, loss of sensation, and other risk factors for nerve damage, infection, and amputation. The only thing that slowed us down was when the electricity went off and we had to use the light from our cell phones to examine people's feet. That morning I saw the rigor of village life emblazoned on the feet of dozens of farmers, coolies, animal herders, and other rural folk. All the patients had their pre-breakfast glucose checked and they were surprisingly high across the board. My colleague commented on the "post-Diwali glucose surge" (Diwali is the Indian festival of lights where people eat copious sweets with friends and family).

That same afternoon while making a home visit to a patient with HIV/AIDS, we passed a man on the street who the hospital had distributed a tricycle to after he lost his leg from diabetes. I asked him if I could take his picture and use it to educate others about what can happen in late stages of poorly managed diabetes and he obliged. Mr Subramaniam of NK Pallayam village, featured in the photo below, stated "It started out as a blister on my foot, before I knew it I had to get a below the knee amputation. I didn't take my medicines so things got worse and I had to have an above the knee amputation." His message to other diabetics is "I suffer so you better take care of your diabetes so you don't suffer too. This happened to me because I was careless."

In an attempt to meet the needs of (and profit from) the millions of diabetics in India, Diastep was launched through a collaboration between the MV Hospital for Diabetes, its research wing the Diabetes Research Center, the Novo Nordisk Education Foundation, and the Central Leather Research Institute.

Its special design features address issues such as pressure distribution on the foot, grip, traction, comfort and durability to prevent foot ulcers and infection. “We have the best medical technology in the world but very poor access. Affordability and access are the primary concerns which have to be addressed,” said T. Ramasami, Secretary, Department of Science and Technology, IIT-Chennai. Although such important issues were discussed at the launch, they have yet to be addressed.

At a starting price of 1,350 rupees a pair ($35 USD) who can afford Diastep? None of the 57 villagers I saw that morning at the diabetic foot clinic, most of whom earn less than $2 dollars a day, could afford Diastep. Mr. Subramaniam, featured above, couldn't even afford a Diastep for his remaining left leg. He lamented to me, his inability to pay for his insulin injections which totaled less than 500 rupees per month.

Diastep should have hired a cultural anthropologist to assist in marketing and distribution because amputations and special sandals have a long history in India. I learned that earlier models of the MCR Chappals marketed for diabetics faced resistance from some local people since they were worn by people with leprosy in the past who had peripheral nerve damage and amputations. Perhaps more important than the stigma of special footwear, is the need for gradated pricing and social marketing to the lower socioeconomic classes. My colleagues who work with diabetics told me the on-the-ground reality: many elderly aren't used to wearing shoes, farmers don't like to wear them when they're wading through their fields, and most models are too costly.

Although the multidisciplinary research collaboration to create Diastep was exciting and impressive, is it simply another example of an Indian innovation that will never reach the average Indian? Time will tell if it is really a technological "feet" or a sandal scandal.

Watch a video of the launch of Diastep below set to classical music:

Nanosensors Warn of Impending Heart Attacks?

noreply@blogger.com (Rohan Radhakrishna) — Thu, 05 Nov 2009 10:55:00 +0000

India-Japan Medical Nanotech Collaboration

"India has ideas and manpower and Japan has experience," said Mr. Hiroshi Iwai of the Tokyo Institute of Technology speaking about developing real-time tomographic diagrams of the human body and the promise of medical nanotechnology.

He spoke at the November 2009 Workshop held by Electron Device Society of Institute of Electronics and Electrical Engineering (EDS IEEE) at SKP Engineering College in Thiruvannamalai, Tamil Nadu. The session on nanotechnology described how nano chips would improve computer performance to assist in real-time diagnosis and potentially facilitate automation of surgeries. The Chairman of the session described biosensors, which could potentially warn of impending heart attacks, being developed at Indian Institute of Technology IIT-Mumbai . A staff reporter at The Hindu writes that the session ended with a call for more Memorandums of Understanding and formal collaboration between the technology institutes of India and Japan.

PM safe but CM dead

noreply@blogger.com (Rohan Radhakrishna) — Wed, 04 Nov 2009 07:49:00 +0000

A common man died on November 3rd due to the traffic restrictions in place for the visit of Indian Prime Minister Manmohan Singh to the Post Graduate Institute of Medical Education and Research in Chandigarh. Security restrictions during the movement of VVIP’s are notorious for causing inconveniences to the public, but unfortunately this time the delay was fatal.

The 32-year-old now widow of the patient received a letter from Singh stating “I am writing to you to express my profound sense of sadness at the death of your husband Shri Sumit Verma yesterday. I understand that he could not get access to the Post Graduate Institute of Medical Education and Research, Chandigarh, in time because of the restrictions in place for my visit there. This is something I regret deeply. I have issued instructions, so that in future the authorities are more sensitive to the concerns of the common man, while imposing such restrictions for reasons of security.”

What changes will actually take place? In a country of 1.1 billion people is this a “collateral damage” or “necessary loss” that is to be expected? My cousin said, “This is India. If 1 person dies like this nobody pays attention. People die every day from tragic accidents. That’s life.” Being a public health practitioner, I’m befuddled by how many of these deaths can be prevented by structural changes.

Global Health Coalition Announces Policy Recommendations for Obama

noreply@blogger.com (Rohan Radhakrishna) — Sat, 31 Oct 2009 12:44:00 +0000

An impressive coalition of 25 US based global health organizations has promulgated their policy recommendations for Obama this week.

Learn more and read the Full Report

The United States, through a Global Health Initiative, should:
• Double U.S. aid for global health to approximately $16 billion per year in 2011 and challenge other donors to similarly scale up their investments;
• Establish bold U.S. targets for improved health outcomes in each of the six GHI areas and contribute our fair share to reach the healthrelated Millenium Development Goals; and
• Ensure that as we invest in programs to scale up health for all, we build on successful programs and fulfill existing commitments.

The Global Health Initiative
President Obama’s Global Health Initiative (GHI) represents an historic opportunity to achieve bold and ambitious targets in the fight against the most daunting global health challenges of our generation. Alongside related efforts to reform U.S. foreign assistance and to coordinate various initiatives that populate the global health landscape, the GHI is an important signal of the intention of the U.S. government to expand its leadership on global health. At a moment of global economic downturn, we recall the Institute of Medicine’s statement from earlier this year that global health programs “play a crucial role in the broader mission of U.S. foreign policy to reduce poverty, build stronger economies, promote peace, and enhance the U.S. image in the world today.”

Currently the GHI consists only of a limited number of known elements; fundamental aspects such as scope, targets, timelines, and specific costing data have yet to be finalized. The language of a broad and realistic vision of what the U.S. can accomplish, however, is encouraging. This report strongly supports the President’s focus on the six areas identified: HIV; tuberculosis; malaria; reproductive, maternal, newborn and child health; health systems and health workforce; and neglected tropical diseases.

TOWARD A BOLD & EFFECTIVE GLOBAL HEALTH INITIATIVE
“We cannot fix every problem. But we have a responsibility to protect the health of our people, while saving lives, reducing suffering, and supporting the health and dignity of people everywhere. America can make a significant difference in meeting these challenges, and that is why my Administration is committed to act.” –-President Barack Obama, May 5, 2009

To substantively tackle these areas, success will depend upon key decisions:
• First, funding targets must be sufficient to meet current estimates of the U.S. share of funding required to reach internationally agreed upon goals in the six priority areas of the GHI. The nation’s highest scientific body— the National Academies of Sciences, Institute of Medicine—eloquently articulated the U.S. interest in investing significantly more in global health. Initial figures for GHI—$63 billion over six years – will not be sufficient.
• Second, investing in each of these key areas could yield major synergies for people’s health—with an exponential benefit in lives saved. Yet an expanded response to certain health priorities at the expense of planned scale up in other areas would miss this opportunity. To help achieve these key elements of what the GHI can be, a coalition of civil society organizations with expertise in the six GHI priority areas has developed an analysis of the appropriate U.S. program and funding targets that should define the GHI. Our analysis also includes recommendations for policy changes necessary to facilitate the success of the GHI.

Ingredients for A Bold & Effective Initiative
The U.S. government can and should be a leader in global health on a larger scale—moving the world toward realization of the human right to health through smart, aggressive scale up of key health services that improve not only the health of people but also the economies of nations.

This requires continued expansion of what is working and scale up of other priority efforts to levels sufficient to reap the synergies possible—ensuring systems of health that can care for people long term. We cannot address maternal and child health in Southern Africa, for example, without aggressively scaling up AIDS treatment to address the largest cause of deaths of mothers and, often, their nurses and midwives as well. Simultaneously, with smart, integrated and additional programming we can ensure that their communities are stronger because these same women do not die in child birth, their children do not die of pneumonia, and everyone receives core preventative care. As the GHI announcement highlights, a cross-cutting commitment to strengthening country health systems is essential for this to happen—and this will require increased investment in the health workforce to address bottlenecks that have impeded effective health programs for decades. In order to reflect a bold, innovative new approach to global health a GHI is needed which:
1• Supports bold, people-centered, outcome-oriented services reaching toward universal access to health. A focus on a selective set of the cheapest interventions has been the hallmark of weak and ineffective responses that have undermined progress in reaching global health commitments. The GHI should not support rationing of services based on a narrow and restrictive concept of cost effectiveness.
2• Supports direct health service delivery as the core of U.S. global health programs. Major scale up in the purchase of commodities and provision of services to people should be central where it is not currently.
3• Continues promised growth of HIV/AIDS, TB, and malaria programs and uses these as a platform for expanded services. As the greatest killers of people living in impoverished nations, infectious diseases must continue to be a major priority. U.S.-supported HIV programs have been used to expand community health care coverage; these innovative models for delivering integrated community care should be expanded as best practices. This will require full funding of the Lantos-Hyde Act.
4• Sets bold U.S. targets based on global need to urgently scale-up sexual, reproductive, maternal, and child health and neglected disease response. Despite decades of promises to address these priorities, far too little progress has been made, and scandalous rates of preventable sickness, death and disability must spur the U.S. to bold action.
5• Strengthens health systems by focusing on recruiting, training, and retaining health workers. None of the U.S. priorities described here will be reached without sufficient midwives, doctors, nurses, and community health workers.

The Promise of Patent Pools for Access to Medicines-Cute Educational Animation

noreply@blogger.com (Rohan Radhakrishna) — Fri, 30 Oct 2009 14:06:00 +0000

Often prices set by pharmaceutical companies are out of reach for developing countries. With a growing need for second-line treatment for millions of people living with HIV, how can access to currently expensive drugs be assured?

On 29 October, the UNAIDS Liaison Office to the European Union organized a roundtable to discuss UNITAID’s initiative to create a voluntary Patent Pool for AIDS medicines. The meeting brought together representatives of the European Commission, Médecins Sans Frontières, European AIDS Treatment Group and representatives from the pharmaceutical industry. UNITAID, an international drug purchase facility, has taken the first steps to create a voluntary patent pool for AIDS medicines for developing countries for the public good.

*Intellectual Property Rights *

A patent is a form of ownership, intellectual property, which covers creations of the mind including inventions and pharmaceuticals. It acts as an incentive for companies to invest in research and development, knowing that with a monopoly in the market place, they stand a good chance of recouping their investment and making a profit.

Patents are regulated through the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property rights (TRIPS) together with the Doha Declaration on TRIPS and Public health and other World Trade Organization key decisions.

HIV-related patents remain a controversial topic between AIDS activists and the major pharmaceutical companies; while drug prices have dropped dramatically, newer products – such as second line treatment - are still very expensive.

*Patent Pools – the solution? *

UNITAD argues that a patent pool could be one of the solutions to expand access to more appropriate and lower priced medicines in low- and middle-income countries. A patent pool is when patent rights held by different owners such as universities, pharmaceutical companies or government institutions, are brought together and made available on a non-exclusive basis.
Through this mechanism pharmaceutical producers could access a “one-stop-shop” for patents. In return producers would pay royalty to the patent holder. Such a pool could make it easier to produce new medicines that combine several pharmaceutical compounds patented by different companies into a single pill. These medicines, known as “fixed-dose combinations” are easier than multiple tablets for children and adults to take, promoting HIV treatment compliance and boosting treatment outcomes.

The patent pool could also make newer medicines more affordable and accessible in developing countries, through opening up for completion between different producers as well as producers not having to wait to the end of the patent term (usually 20years). The need for affordable HIV treatment will become more urgent as increasing numbers of people living with HIV fail their first-line therapy and need second-line treatments.

*Moving the Patent Pool agenda forward*

The purpose of the UNAIDS-hosted meeting was to present the creation of the patent pool to stakeholders. Discussions were broad-ranging and a constructive dialogue took place. Ellen ‘t Hoen who is Senior Intellectual Property and Medicines Patent Pool advisor with UNITAID gave an overview on the ongoing discussions between the pharmaceutical industries and UNITAID which include terms of license agreements.

Questions on how pharmaceuticals could effectively work with the patent pool were raised by Brendan Barnes, Director at the European Federation of Pharmaceutical Industries, indicating his members’ willingness to engage if adequate data on the functions of the patent pool is made available. Wim Vandevelde, Chair of the European Community Advisory Board of the European AIDS Treatment Group (EATG) welcomed the current scope of the patent pool including Middle Income countries and urged UNTAID to stand firm on this point in the negotiations with the patent holders. “We appreciate the cautious welcome from the pharmaceutical industry but we all know that the devil will be in the detail,” said Mr Vandevelde.

The meeting ended with a bold call from the EATG and Médecins Sans Frontières (MSF) who challenged pharmaceutical partners “to jump into the patent pool and get yourselves wet, in order to prevent millions of avoidable deaths.” “Newer, better antiretrovirals are already used by patients in the US and Europe, but aren’t available to people in developing countries... We need these newer drugs, with fewer side effects, to gradually replace older treatments,” said Michelle Childs, Director of Policy & Advocacy, MSF Campaign for Access to Essential Medicines. “By making these drugs more affordable, a patent pool will ensure the delivery of these newer drugs for people in the developing world.”

Full Story Here

South Indian Carnatic Jazz Fusion Improvisation

noreply@blogger.com (Rohan Radhakrishna) — Tue, 20 Oct 2009 16:48:00 +0000

Rarely will you see a band leader playing South Indian melodies on a Hawaiian slide guitar while the lead percussionist plays a clay pot sitting next to a visiting German guitarist battling with an Indian guitarist while the tabla and kanjira players keep the beat and the keyboardist rocks out in his corner. This is just one of the many eclectic ensembles created by Prakash Sontakke and group. Their group Confluence of Streams played in the hip Kyra Lounge on October 16th in Bangalore.

Two unique instruments featured in the performance are the the Ghatam and Kanjira. Ghatam-a Clay Pot Percussion Instrument shown in the photo below. Learn more about Ghatam here:

Kanjira-a South Indian frame drum in the tambourine family. It is made from the wood of the jackfruit tree and the skin of a monitor lizard (see photo below). During a performance the Kanjira player will sprinkle water on the skin to reduce the tension achieving a richer bass sound which is shown in the video below. Learn more about Kanjira here:

You can learn more about Carnatic musical instruments here:

While the instrumentation was superb, it was the vocal improvisation that stole the show. Enjoy this video montage of the musical performance highlighting Carnatic vocal improvisation where the musicians create a lyrical language and pass the verbal beat from person to person. This is my first mini video-reporting piece.