More on Mumbai

Yesterday's post on my first impressions of Mumbai was just that-the first impressions. Today I got a better taste of what this city is all about, and I have some more to say.

As an aside, I have to admit that in order to interest you I've had to get more creative with these posts as I'm no longer visiting care homes and hospitals and interacting with interesting people in the field. So now I'm just touring cities and talking about whatever comes to mind.

Anyway, today Sej and I were very lucky to have our very own tour guide, Kiran. Kiran is a family friend of Renu Aunty (a family friend of my parents), with whom we are staying while we're here in Mumbai. Kiran showed us the major universities of Mumbai, including St. Xavier's, Bombay University, and Jai Hind College. It was interesting to see how different they all are.

We also got to see some of the architecture typical of the city. It is distinctly different from any other city I've seen in India (and by now I feel like I've seen many). It's heavily influenced by the British. Train stations look like churches, with tall steeples and intricacies that you'd never expect from a simple public transportation building. The buildings are very very old, but surprisingly still standing despite 150 years (give or take) of wear and tear. Not all the buildings are old; there are so many high rises being built in the city, too. From apartments to corporate offices, Mumbai's skyline is rapidly growing. The mix of old and new buildings is interesting to see...more of that contrast/disparity we always talk about.

To get around, we relied on public transportation, which was an experience in itself (especially in the pouring rain!). We took the bus to the center of town, and a train to get back home (we live in a residential area of Mumbai). The bus was very convenient, and since it's Sunday, we didn't have to deal with the usual full frontal assault that is an Indian bus ride (Kiran agrees...she says that you come out of the bus half-raped, usually). The state of the trains is really bad, but it's so convenient that what it lacks in beauty, it makes up for (somewhat) in usability. However, Kiran told us that she's seen dead bodies on the train, because they are so packed during the weekdays that there isn't enough room for all the riders. They fall off the train onto the tracks. Another public health concern in a country that has more than its share.

Another interesting thing we did today was to go to Mocha, a hip coffee shop and hookah bar where teenagers and college students seem to pass their time smoking, flirting, and seeing and being seen. It was interesting to see young Indians being more "American" than me, smoking hookah, wearing lots of makeup, being totally comfortable with public displays of affection, etc. It was also a public health concern, as people were smoking indoors and we had to sit there and endure it. But that's a giant of an adversary here in India, tackling smoking in public places.

Lastly, this morning I finally went to the park to go jogging! It wasn't raining (it started pouring literally minutes after I arrived home), so I spent a good 45 minutes there. It was a Sunday morning...everyone in town that was up seemed to be there. Kids played cricket and soccer, ignoring the muddy puddles everywhere (or, more accurately, reveling in them). The elderly gathered around in the middle of the track to read the paper. Women power-walked in groups. Men strolled with their dogs...on LEASHES. It made such a difference to my impression of the city, to see everyone congregating in such a healthy way. What a huge public health blessing a decent, centrally located park is!

In the evening, we sat around munching snacks and talking about everything from life in the Gulf Coast (Kiran's family spent a lot of time there) to fashion in India and politics in the US. Life in Dubai is apparently very different from what you would expect in a Muslim country, with gay bars, excessive drinking (and driving), and ladies nights out. British immigrants apparently treat Dubai Indians like their servants, thinking they are superior simply because of their British passports. Kuwait is very shallow, with dinner conversations centered around people's income. The US media is deplorable. Mumbai real estate (in certain areas) is among the most expensive in the world. It was interesting to talk about all of these things, because in some way or another, they all affect my favorite topic: public health.

First impressions of Mumbai

So it's my first full day in Mumbai, and after driving around the city, I've had some time to form a few (public health-related) impressions.

The monsoon season hits Mumbai hard, which brings a host of issues in itself. The air is so humid and thick you can take a shower three times a day and still feel sticky. The weather is a breeding ground for water-borne diseases like malaria and yellow fever. Already, there have been reports of an unusually high number of malaria cases in the area...and that was before the monsoons even arrived this summer.

The rains bring more than infectious disease, although that in itself is disastrous to many people, particularly those living in the slums (Mumbai is home to the largest slum area in Asia, Dharavi). It also rips up the roads, creating huge craters that rickshaws and cars get stuck in, clogging the roads and endangering the lives of both drivers and pedestrians.

I've written about sanitation problems before, but multiply those at least twofold for a city like Mumbai, because of the rainy season. City planning is very poor, and the rains create terrible sanitation issues. Aside from the standing water everywhere, there is so much trash all over the streets. Scraps of food, rotting carcasses, plastic waste...these are all the types of things you'll encounter while walking (in your sandals!) on the road. It is deeply, deeply unsanitary.

Then there's the beaches. People visit the water in Mumbai for both religious and recreational purposes. There is the festival of Ganpati, where figures of the elephant god are made out of plaster of paris and then dunked into the water. There's Juhu Beach, which is famous for its beachside fun and its chaats (spicy snacks). Today, we had tea by the beach and until we walked closer to the waves, we didn't realize that the sand was chock full of all kinds of TRASH. How can beach goers bathe safely among so much trash? In Los Angeles, studies are done to estimate the social and economic costs of dirty beaches. It is SO much worse here in Mumbai.

Something must be done to improve the cities of India. Proper drainage must be installed; the rains will continue here from July until September. People are unable to go to work; many trains are not functioning and people are wary to step out of their houses after the flooding and loss of lives two years ago. The government has made no improvements to thwart another similar disaster. So much productivity is lost, meanwhile, in a country that cannot afford to lose productivity!

What can be done about the trash? What can be done to instill in Indian citizens a sense of civic duty? What can be done to inspire the government to make city planning a priority? To fix the roads so that huge craters don't punctuate the streets?

HAPPY BIRTHDAY NEENER!!!

Today is my sister Neener's birthday (you might know her as Reshma but inexplicably she's become Neener to me). Reshma means a thread of silk in Hindi. My sister is beautiful inside and out-if you know her you can vouch for that-but she's anything but soft and delicate, if you ask me. In my world, that's a high compliment.

Life is not about being soft and delicate...at least not most of the time (although it depends which path you take in life). I have no brothers, so my sister and I grew up not really knowing what it means to be a girl. We grew up thinking we were the same as boys. Of course, that's not exactly true. But my sister's fight and passion in life have always inspired me. Those qualities are especially useful here in India, where among one billion people, you have to be loud sometimes to get your voice heard (whether what you want is a cup of chai, or funding from an NGO for second-line ARVs).

My sister has lofty goals on the global business front, but the funny thing is that they are only lofty if you don't know her. If you do, you realize that her determination to harness market forces to solve global health problems is just about par for the course. She's already on her way there, with a prestigious internship at Gilead, a corporation known for its poverty-fighting activities in developing countries. She's also co-leading a team of fellow Stanford MBA students on an exchange program at the internationally renowned Indian Institute of Management in Bangalore.

With such an impressive resume building up, you'd think my sis would be getting a big head about it. That couldn't be further from the truth (she doesn't need fancy accolades for that! just kidding!!!) The truth is, she picked Stanford because of its commitment to fighting poverty with business acumen, and joined Gilead for similar reasons. God has blessed her with immense talent (plus, more importantly, she's the funniest person I know), so I really lucked out to get her for my big sis. Happy birthday Neener! You're good for the future of global public health.

One of my favorite Neener-inspired ideas: "The closest way to a public health solution is through business." Remember me when you're famous! And when you shop.

It's not easy being green

In California, it's hip to talk about clean fuel and recycling. Driving a Prius is "in". People who litter can expect dirty looks along with steep fines. We're all about the environment.

Given that I've lived my whole life in such a setting, I did not expect to come to India and feel like this country is a step ahead of the US in terms of converting to eco-friendly fuel. Almost all buses, and many other vehicles, sport the CNG logo, indicating that they run on certified natural gas. As I mentioned on my entry a couple weeks ago on Sawai Madhopur (tiger land), many village homes get their fule from biodigesters and similar methods-much more environmentally sound than what we have in the US. Remember how the Prakratik Society urges villagers to plant trees to offset wood-burning? Do we have that kind of accountability? What's the deal?

The deal is, environmentally, India might actually have an advantage over the US and countries like it. It's easier to go from having no buses at all (in some areas of India) to CNG buses. It's way more efficient to install biodigesters in villages that had not previous power source, rather than tear up old infrastructure and install new, incompatible systems.

So in the developed countries, or at least in most parts of them, our modern way of thinking-green is cool-still needs to be translated into action. Fewer SUVs. More public transportation. Cleaner burning fuel and more hybrid vehicles. More planting of trees and smaller carbon footprints for each transnational corporation, factory, family, and individual.

It's a tall order. Buses crammed with 100+ people may fly here in India, but people in the US don't want to deal with public transportation if they can afford not to (and most can). It's tough to go backwards, socioeconomically, once you've had the luxury of your own personal vehicle (and a sports utility one at that), your own power source, your own unlimited resources so long as you can foot the bill.

Not that India doesn't have its own hands full, environment wise. Pollution here is horrible. The rising middle class is suddenly able to afford cars, which is reflected in increased smog, toxic air (and rampant respiratory diseases), and unfailingly clogged, chaotic roads. But all I'm saying is that India is taking practical steps forward. Maybe it's not enough, maybe it's just a drop in the ocean, but it's a tangible effort.

Developed countries may be able to get away with doing nothing. They have lower population sizes, the ability to afford carbon credits, if they are ever implemented, and the ability to pay for skyrocketing fuel prices. It's even been said that global warming won't hit the richer countries so hard as the poor ones. Even if countries start to convert to biofuel, poor countries will face disadvantages because precious land (thousands and thousands of hectares in one state of India alone, as specified by Indian Oil) will be converted from food crop use to fuel crop use. Creative solutions, like using only crops that can be used for both food and fuel (ie corn, sugar cane) may need to be implemented. Even more complex is the fact that crop prices have already started to rise in response to the growing demand for biofuel raw materials. This will have negative consequences in countries dealing with suffering subsistence farmers and rising national food insecurity.

Sahastradhara and School-Based HIV/AIDS Education in Uttaranchal

From Ajay's travel blog...pretty similar to my own, except my pictures have about 3x more people!

Yesterday was another interesting day in Dehradun. Waking up for our last full day here, we thought we'd make a lazy day out of an internet cafe session, coffee shop relaxing, and other in-town pursuits.

Of course, that's not what happened. We did do all of the above, but we also made an impromptu trek to Sahastradhara, a cool sulfur spring embedded in the mountains. We had no idea what to expect, really, but in my mind I pictured a series of clear, deserted pools emitting a faint scent of boiled eggs.

Sahastradhara is neither clear nor deserted (come on, this is India), and the smells are of sweaty people, not sulfur. The pools themselves are undeniably beautiful (though probably not their natural color anymore), situated among mountain ranges and punctuated by big boulders. They ARE arranged in series, like a waterfall. But like Mussoorie, Sahastradhara has become a crazy tourist attraction full of food stalls and souvenir shops, trash, and PEOPLE.

The best part of our trip was the ride up the mountain. We took a bus, which, if you've never been in one, is quite an experience in Idnai. I got to know a LOT of people in that bus, if you know what I mean. You get stepped on, sat on, rubbed up against...ahhh, there's nothing like it. The views, as always, were gorgeous. Nature never disappoints; we humans are what deface things.

To treat ourselvse for finishing the last tourist attraction in Dehradun, Sej and I went to the haven that is McDonald's and got well-deserved junk food. It felt like imminent rain, so it was hot and humid as we walked the long walk back from the bus depot to our section of Rajpur Road (where we're staying). As soon as we got back, it started pouring. It's still coming down strong today. Monsoon season!

Now for the public health related part. Dehradun is located in Uttaranchal, and happens to be home to one of the two most prestigious prep schools in India. However, the fledgling state of Uttaranchal has just definitively banned school-based HIV/AIDS education because of traditionalist thinkers who fear talking about HIV in schools will encourage earlier sexual behavior among children.

Ironically, this is the same state that's pushing for IT and e-literacy for all in the next few years. What do you think children do on the internet? Not everyone looks up gossip and sports. I can tell you from my time spent in cyber cafes (where cookies are unfortunately not always cleared after use) that sex education is definitely taking place on the internet.

The UN has declared that school-based sex education actually deters early sexual behavior among youth; why, then, is India (and the world) having such a hard time with it?

As usual we are, foremost, victims of ourselves.

Historiography and Public Health

There are only a few voices in history, and they are the rich ones.

As a comparative literature major in college, I am most intrigued by the concept of history as works of literary fiction. I specialized in Latin American literature, and found that throughout various important literary time periods, colonial history-a history of occidental subjugation and exploitation-is deeply embedded in literary works (both colonial and postcolonial/postmodern). As a result, Latin American fiction is anything but. It’s a politically charged, militant vehicle to say what, in the real world, cannot be said. Meanwhile, history books written by conquerors sing their one-sided tune, painting a picture on the surface of things while destroying native culture and truth on the side. This is not history. This is historiography-the crafting of stories.

So what does this mean for India? There is a point. India is another country that not so long ago was under imperialist rule. After gaining its independence in 1952, the fledgling democracy suffered a lot of civil strife and poverty. Freedom has its costs, whether the emancipated party is Black slaves in America, Latin American countries under USSR/US occupation, or Indians ruled by the British. In Bharat’s case, Muslim-Hindu tension heightened, Pakistan was born, and population-and its partner in crime, poverty-exploded. Public health, as usual, suffered dearly.

Muslim-Hindu tensions are still high. The most ornate Hindu temples in Delhi (such as Akshardham) are high on the supposed Islamic terrorist list (according to Sej, my Hindu culture informant). It’s still considered controversial for Hindus and Muslims to marry-better a Hindu marry a Christian or a Sikh than a Muslim! I feel the tension myself when Hindus talk about the introduction of Islam to India-it is always portrayed as a shameless invasion by Moghuls who forcefully converted their subjects to the austere religion.

However, I just read an article in the Times of India that argues that the Moghul invasion theory is a myth, not a fact. The scholastically accepted version of history is now that Arab traders brought Islam into the country-not by force, but peacefully.

So, my faithful readers (hi Mom, Dad, Neener and Grandma) that I’m Muslim. But I’m not trying to defend my religion at all-it makes no difference to my identity or my faith how Islam came to influence my mother country. I AM, however, interested in this bit of history from a public health perspective. It’s not just Muslim-Hindu conflict that affects Indian public health, but tribalism and religious/ethnic clashes in general. Sometimes, individual pride, mistrust, and hatred of the Other run so deep that castes and tribes don’t even stop to think that their inability to unite under common causes (education, health, electricity, sanitation, city planning) results in much more damage to their communities than anything else.

Of course, from a social-ecological perspective, these individualists are not to blame; it’s not their fault. There are always deeply embedded root causes that explain surface tension. India’s immature democracy has the gargantuan task now of building political parties capable of appealing to hundreds of scheduled tribes (as well as the growing, modern middle class). I think the answer lies in human development-not just empty campaign promises during election months, but real follow through in areas of public health. That’s a cause no ethnic group should reject, if communication is effectively executed by the public sector (if only…).

Mussoorie Day Trip - A Hill Station in the Himalayas

Sej is featured in several of my photos. She has all of my pictures and I have all of hers. We've become very efficient at alternately running in front of a scene to have our pictures taken by each other!






Kempty Falls...ok, it's not Niagara, but it's a natural waterfall! I ain't complaining.



Today we went to Mussoorie, the main attraction of Dehradun. The Himalayas are breathtaking, although the little town was way too populated to take in the beauty of the mountains themselves. But still, it was amazing. When you stand in a mountain range like this one, you start to feel how small you are, and how you're just a part of something bigger and very, very amazing. Praise God.

Another interesting thing about Mussoorie is how much British influence is reflected in the architecture. As Sej pointed out, a lot of the buildings (and the windows, specifically) are not Indian. There are a lot of old structures, too--the library is dated to 1843. This was a British settlement. It makes me angry when I think about how imperialists claimed this beautiful mountain area as their own, making ugly pink buildings and bringing plastic and other types of garbage here. It's the Himalayas!!! It's a town among the clouds. And now it's way too touristy. In my opinion (and I probably am in the minority here), the ride up to and down from Mussoorie is much more calm and engaging than the town itself.