Diabetes in India Part 1

Diabetes is prevalent in USA.  We have good healthcare systems even for the under served thru Medicaid.  NCD, non communicable disease, have surpassed infectious disease as the number one killer in India.  It is wonderful that diseases which can be prevented by administering vaccines have decreased with the help of WHO, CDC AND NGOs.

India is a country with great disparities.the caste system is still strong and obvious everywhere I have visited, besides Ladakh and Kerala. The number of malnourished are much greater than the urban overweight. Almost 42 per cent of the children in the country numbering over 61 million (India's population is 1.2 billion) are malnourished and stunted according to the Hunger and Malnutrition Report released by Prime Minister Singh in New Delhi on Jan 2012, The report published stated that one in three malnourished children in the world is an Indian.  Malnutrition is NOT just the underfed but all people with improper diets.  I am here to work with diabetes, don't you think there are many other more pertinent healthcare tasks?  

The prevalence of malnutrition varies across states, with Madhya Pradesh-central india recording the highest rate (55 per cent) and Kerala among the lowest (27 per cent).

Malnutrition in children is not affected by food intake alone; it is also influenced by access to health services, quality of care for the child and pregnant mother as well as good hygiene practices. Girls are more at risk of malnutrition than boys because of their lower social status. Statistics found on UNICEF website.

Articles in the newspaper frequently discuss the corruption In high levels of government. There are multitude of issues that need to be addressed to solve healthcare and economic problems in India.

I live in a middle class area even so I see less fortunate, builders, rickshaw drivers, garbage collectors and sorters everywhere.  The haves and have nots. Maybe when walking NYC streets homeless can be seen but they are not everywhere allowing me to forget that its an issue.  The builders here, often transients from rural communities, come to the cities for work.  I am told that there is a strong hierarchy in the building unit.  The true laborers that carry the bricks, sand, stone are the lowest in the group, the brick layers are above and then a person overseeing.  A days work could easily be 12 hours/day everyday of the week.  And for pay, the laborers might get paid $5-7 USD/day.  Vishwa asked if I would like an interview with the builders.  I am embarrassed to ask for one but have so many questions.  They do have water for drinking, bathing and washing clothes.  They cook, sleep and exisit in their building lots.  The entire families are at the site, women and men work side by side hauling heavy loads of sand, bricks, concrete up one, two, three or even four stories.  Only a couple of times have I seen any large equipment to assist the manual laborers.  Not only do they build but they also dig, maybe a full story down - by hand!  I cannot answer if building homes in middle class areas are helping the economy as reports in the newspaper suggests that the economy is doing poorly similar to other parts of the world.

Mumbai Day 2

Evening with Swati was a bit too long, not because of Swati but the party. Ten people or so in a small room. Interesting observation: often men and men will walk arm in arm. Sometimes women but mostly men. While sitting on the couch Swati had her arm around me no problem we are friends. After chatting with the woman next to me she naturally just rested her hand on my leg. Seemed a bit strange but I felt accepted. Listened to pop Indian music, good. All was enjoyable until they started doing shots of whiskey then one of the guys started imitating a famous Bollywood star (not that I knew this) talking Hindi. This went on for what seemed like eternity. The remainder of the night everyone spoke Hindi, that was it for me. No more fun. After 5 minutes I had enough, another 30 minutes passed and I got up to leave.    Did eat some good Indian food. There was drink and Hookah, not sure what it is, not marijuana, smelt like a flavored pipe and people didn't inhale.

At first when I came to hotel I didn't like it, felt it was under par but after being here for two days my only complaint was that wifi was poor and water cost 180 rupees in hotel and on the streets it's 15 rupees.

Today went to Borivali (Sanjay Gandhi) National Park to go on Safari and visit caves. Was OK. I have to remember I am in India and there are so many other more enjoyable places to be in the world. Nice to spend with Swati.

Picnic

Old stairs leading to caves

The next stop was to join the safari. This is a national park that has lions and tigers and deer, oh my. Yes Iknow it's bears but there weren't any. The cost of the safari is only 1USD, so why not. Waited in line to board the bus. We entered a gated area and drove around. We spotted a male lion lounging. What surprised me was how course his mane appeared. For some reason I thought it would be smooth. Yes we saw tigers but they were caged- YUK!

I hired a car for the day.  This is the best way to get around. A driver could be arranged at the hotel but when I went for my walk to "town" I passed a taxi stand.  Khan, spoke English and we negotiated a price to drive to the Natl Park and be available to us all day. This is a easy way to travel as the car waits for you.  To reach the caves one must climb about 50 stairs to approach the biggest cave with carvings and statues inside all carved from the surrounding rock.  I had not read upon the history about the dwellers which was a mistake.  The reason I went to the park was to be in nature.  Views at the top were of forest that spanned a large area. Streams and water pools were plentiful allowing people to cool off or take a shower under the waterfall.   Also there were flowers which I love.The next stop was to join the safari. This is a national park that has lions and tigers and deer, oh my. Yes Iknow it's bears but there weren't any. The cost of the safari is only 1USD, so why not. Waited in line to board the bus. We entered a gated area and drove around. We spotted a male lion lounging. What surprised me was how course his mane appeared. For some reason I thought it would be smooth. Yes we saw tigers but they were caged- YUK!

On the drive back I was surprised at all the laundry hanging from apartment balconies. Space is scarce so I guess there is not enough roof top area to dry clothes on the line, this is what I do in my apartment.

 

 

Came back to hotel, went to gym to ride bike, swim and a walk on the beach. Wifi not to good. The only place it works well is in the hallway outside my room. I chuckle.... 

Beach is nice. Remember, you need to keep an open mind. Look for the good. Couples, families, friends all enjoy. A family, dressed in every day attire (slacks, button up short sleeve top for the men and saris for women) walk towards the Arabian sea, and they continue to walk into the water until they are swimming. Interesting. Later in the evening we had a hard rainfall, people didn't run for cover (no where to go). Very few have bathing suits. 

Did some reading about Project Hope to prepare for my Pfizer meeting tomorrow. Looking forward to it.
Mumbai is much dirtier than Delhi. Garbage dumbs every few blocks, didn't really smell though. I asked someone who was two blocks away if they knew where the movie cinemas we're and they said No. Could it be that they didn't understand me, they didn't know or they didn't want to help (this I don't believe as people seem genuine).
Swati forgive me I enjoyed our time together.  Swati is happier in Mumbai than in Delhi, there is a nightlife here, she feels safe being out late and she has friends. Good for her!

 

Arriving Mumbai (Bombay) Day 1

Wow I thought Delhi was bad Mumbai is even worse!

The slums as seen in Slum Dog Millionaire are everywhere. Look at the photos and how close they are to the runway. At least 15 flights arrive every hour, it's unimaginable living that close.

The hotel I am staying is in Juhu Beach costing 150/ night equivalent to $100 in other cities I have been to. The cost is high because land is scarce and the large population. The only saving grace is the pool and it is near the beach, nice to hear sound of the surf.   

 

Went out for drinking water and it's scary out there. Called Swati, my friend who is meeting me tonight. She has a work party she invited me to. Should be interesting. My first thoughts how to get there but she offered to come to my hotel and we would go together. Sounds good!
My right shoulder is not doing that well, pain making swimming difficult but I can float. Sun out. The weather forecast was rain for my entire time so I am greatly appreciating the sun. Oh no, I didn't bring sun screen.
Talked to a foreigner here on business, he hates India. I don't hate it but find it challenging to keep positive. being in a nice hotel or my apartment removes me from the reminder of the poverty so prevalent. It would be interesting to talk to the people who have made their homes on the sidewalks. A home might be a blue rain tarp supported by pieces of wood. A family can be two, three or even four all living, cooking and surviving in this tiny area. How do they buy food? What do they think? Do they think about having a better life, a better home, food, toilet.... For the first time saw a kid shitting on the street. How does that feel? The problem is so large that I can't imagine how to fix it.
Lounging looking at the ocean, a swim in the pool - life is good. 

Nice beach

Looking at downtown Mumbai

They asked to have their picture with me

I have been in the Arabian sea!

Went for a walk on the beach-low tide. More people came out in the afternoon to play in the water, picnic on the beach, walk, cricket or just relaxing. In Crazy Mumbai this is a nice place to get away from the craziness, poverty, noise, smell and vehicles.


I am now relaxed as I spent the afternoon outside. Actually got a tiny red from lounging in the sun. That's a good thing!
Had a salad to hold me over until dinner. It was wonderful, the crispy greens were organic topped with perfectly crispy bacon (very unusual for India) and garlic croutons. They served pesto, sundried tomatoes and a lime cilantro sauce to go with the bread. Oh that was good! Italian food Yum especially when I haven't had it in a long time.  A good afternoon ending with a nice sunset.

 

Mumbai

I’m going to Mumbai for work (and pleasure)

Senior VP of PH, Stuart Myers visited India earlier this month to attend (one of the many) a meeting with Pfizer India to see if there could be collaboration. Pfizer India is based in Mumbai.  One of the possible topics discussed was an awareness campaign for the 13 valent Pneumococcal vaccine in India.  It was approved here earlier in the year.

My Pfizer job in USA is in the 13 V pneumococcal clinical assay group.  After the visit of Pfizer India colleagues I sent an email requesting a  follow up meeting with them and try to facilitate the PH Pfizer collaboration.  If my fellowship ends and my only success is to start negotiations I would feel I accomplished something that would benefit Pfizer and Project Hope- Bonus.

Dr. P suggested that I fly out Monday morning and return in the evening.  No way!  Swati, a woman  I met early on during my stay moved to Mumbai.  I contacted her; she immediately  replied and we  have plans to get together this weekend.   Wow- the arrangements were made within 12 hours and I am leaving in three days.  This shows me that things can happen quickly in India.

 

Wish me luck with Pfizer!

You Can't Always Get What You Want

When I accepted the fellowship I had great expectations that I would contribute to improving health. It's been four months and I haven't made any impact to health care in India. My understanding of the health care system came from my visits to Doctors and pharmacies. Today my only accomplishment is to improve the organizations skills of PHI. This is NOT what I had hoped to do but have taken the challenge to be a goal. Travelling 8000 miles, leaving during my favorite season, spring with the beauty of the flowers and fresh green color and arriving in a HOT city with lots of people, garbage, and noise has not made me very happy. Repeatedly I need to remind myself I am here for work and not pleasure. Makes me appreciate my job at home (almost).

My friend Sue is coming to visit and is planning on travelling around India and I want to join her! As the travel planner I am I have completed her itinerary, even though she only told me of some of the places she wants to visit, a trek to Nanda Devi valley, visit the Dali Lama in Dharamsala and visit me. A native Indian co worker from Pfizer, Khushroo, told me I must visit Nandi Devi valley but I haven't the vacation time to do it because to experience the locality requires hiking. Not just a day hike but a two to three trek into the valley. I could accompany her if only I could take vacation.



Ready for the mountains

My dilemma is that I really do not feel I am really contributing to PH so why not go? It's because the GHF program states we are not supposed to travel during this time. Big sigh! Rules are made to be broken, right???? I need to ask my PH manager first. How to convince him that this is a valuable experience that would add to my GHF fellowship. I could suggest I would talk to the people in the remote location and evaluate their ability to receive health care, could take an inventory of some to evaluate their diabetes and HBP conditions, what else? But I don't even have the clothes for the trek. I could borrow from my friends... Or I just put it out of my mind. Don't think I can do this as I want to go. I know things don't always go my way, a perfect example is this fellowship, but I have to make the best of it and that would include this trek.

But if you try sometime, you just might find you get what you need. Am I "getting what I need"?

 

Positive Attitude

Having a positive attitude helps! When I go out I try to find sights that are interesting and unusual. Not every time can I accomplish this task but I try.  What’s new – pigs and cows in the neighbourhood, people walking in the parks for exercise (usually overweight people), the moon (it was clear the other night!), and rain.  The monsoon season has begun causing flooding making it a challenge to get to work as the drainage system is poor or non-existent, brings out the mosquitoes which are much smaller than at home but bite just the same and puddles (drivers do not care if they get you wet!). 

This was a busy social week for me. JC, the other Pfizer GHF at Project Hope has come to the end of his fellowship.  The office will be much quieter without him. I’ll miss him and his positive attitude.  His project allowed him the independence to complete his project through his determination to help others and hard work without the full support of the office.  JC is in sales for Pfizer, our personalities are very different but we had the bond of the new experiences as a GHF.  The office had two going away celebrations and last night I met my friend Pryia at Costa coffee for a mint lemonade and a hot fudge Sunday (Yum).  Today I am going to experience the metro system to Delhi center with Pryia.  The metro system is the best way to get around during the rainy season.

My greatest highlight is the travel plans of my Aussie friend, Sue, who will be visiting next month.  Something to look forward to!!!!!  I met Sue in Nepal during my Everest expedition in 2004.  We were both hiking solo and hit it off.  She has visited me and Eric a few years back and it will be great to see her again along with having companionship. The only bummer is that I can’t take vacation time to travel with her. The fellowship doesn’t allow any vacation (I have already stretched the rules on that!).  Just booked Taj Mahal hotel in September so Sue and I will visit during the full moon.  I say that the only beauty I have seen in India is the Taj and I hope that the moonlight exhibit will make the experience even more magnificent.  To share with a friend will be extra special.

Puzzles are what keep me entertained. How will I adjust to being home with chores? The apartment has a cleaning service which I am taking full advantage of. It was a shock when I noticed that my hairbrush had been cleaned! I still have the responsibility (I have put that upon myself) to take care of “my puppies”.  I no longer think about bringing the dogs home.  Eric had a good point when I mentioned that it would be nice to have one or two as pets.  He said that we wouldn’t want to bring them in the house at 8 months old because they were not housebroken.  Good point!  Last night confirmed this as right after I fed them, Whiskey took a poop right there!  I will miss them but being home should ease the sadness of saying goodbye.

This week Eric is on vacation for two weeks in Yosemite and we haven’t been in contact. I miss speaking with him a lot.  During the week we usually talk through Facetime at least two times per week.  I do keep in touch through Facetime or Skype with my sisters, Iris, Kristin, Jacek, Marian and Tricia.   I love the ipad as it allows me to connect with home. 
So long for now!

Have I adapted to India?

Walking back from the store I was thinking that I have adjusted to life here. Knowing where I can purchase what I need and how to get around, either by car, auto rickshaw or hire a taxi allows me to feel comfortable in my surroundings. The first month or two after I arrived, I wanted to explore Delhi and see the tourist attractions. Now, not so much. Most of my time is spent at work; doing puzzles either Soduko, solitaire, playing games on the iPad. Or checking social websites. I do spend enough time with others preventing me from living in isolation. My daily routine of feeding my four street puppies allows me to fulfil my nurturing needs.

The blog allows me to keep friends up to date on some of my more adventurous activities. Almost every day I visit FB to see what others are up to. I never used FB at home to follow my friends but while in India it is a nice way to keep up with a few. This is completely unlike the Sue from the states who spends most of her time "doing things". I don't have any hobbies here. What can I do? What interests me here? I have been doing exercises in the morning and going for walks. Every day I do get out.

I have to remember I am here to work for Project Hope.

I haven't written much about work as I have been unfulfilled. Work ethics in the US are MUCH different than what I have experienced from most people here. Of course there are exceptions.

Friday, over three months into my fellowship, I was called into a meeting to discuss my Scope Of Work., SOW, 3 1/2 months since the start of my fellowship!!!! I was requested to prepare a presentation which spotlight your Fellowship work in India describing Aim, objectives, Activities, key accomplishments, learning’s, suggestions for future. I created a presentation in an upbeat manner highlighting what I have done. I included some challenges with the fellowship: a fellow should not be invited for a project that had not started, they need specific goals and to be included in group discussions, When I arrived the director mentioned they had weekly meetings, in my three months here there was NEVER a weekly meeting! There are four employees of PHI, Vishwa, HR/finance, Cheena and Ciju, project leaders and the director Dr. P. Juan and I are Pfizer GHFs. An example of the inefficiencies: the director sends and email requesting that Cheena, Ciju and I create a questionnaire that would be used for evaluating the people in the NCD project study groups. I do not feel that this is a productive way of distributing work. I thought that we would have a meeting to discuss thoughts, but the next thing was sample questionnaires from each. Last week I got so frustrated that I requested that we have weekly meetings on Monday. The office staff thought it was a good idea as there is also frustration among the others.   

During the SOW meeting, Cheena and Dr. P got together before our meeting to discuss the presentation. They then proceeded to TELL me what I have done and my accomplishments. I was stunned as we didn't discuss. You might not be surprised but I lost my cool. I laughed and proceeded to rant about the disorganization, how unproductive I have been and that they are not making use of the GHFs.

They responded.  Overall: I felt the meeting was productive as Dr. P explained that both Juan and I were "senior" and most of the people he has supervised were very junior and he was unsure what to do with us. For his benefit, maybe he thought it was best to leave us alone and allow us to do what we do best. Good thing he knows as I didn't know. Maybe this is part of my developing and "growing experience". Dr. P can be very professional and sound very knowledgeable but he also can be disruptive.

Oh well, again I hope things improve and I will try to assume role of project manager for the NCD project.

Happy Puppies:  Spritey, Whiskey and Alpha (standing).  Nimba was camera shy.