Friday, February 22, 2008

Political Violence in Mumbai

Dispute Illustrates One of the Key Issues India Faces

The cell phone rings and my Indian friend’s expression changes. I ask what happened and in a frantic voice he replies, “They are screwing foreigners! They are screwing foreigners!” The driver quickly turns down a new street because the voice on the cell phone says a riot has broken out on one of the main roads we would soon be on. After learning about what was going on, who would have thought that the “foreigners” are actually Indians themselves.

The migration “problem” is interesting for an American to view because whereas in the states it is the illegal international immigrants that garner the dubious honor of receiving the blame, in India it is proper Indians from other states or areas of the country. This causes a huge rift in the nation because after all, India is a constitutional democracy that states “India for all Indians”. However India’s deep rooted history, which includes states warring between states, empires fighting empires, and religions battling religions, has created an atmosphere that is at times state over country.

What did this experience teach me? Well for starters, the importance of internal migration is at the forefront of India’s present and future and India’s rich diversity is not accepted by all within the country. The atmosphere lends itself for unsavory politicians to take advantage of small percentages of the city’s population. For instance, Raj Thackeray, the leader of one of the Maharashtrian parties, provoked and rallied his supporters to literally beat up any North India they found in the city. The news highlights showed taxi drivers ripped out of cars, beaten by ten men, and then their cars broken.

Why is this happening? The core answer is jobs. There is a huge crunch for jobs as India’s population is over 1 billion and unemployment is a pressing issue. With the tremendous growth in the economy cities have become a center for migrants from all around seeking work. One side claims the migrants are taking jobs away from locals and that they are responsible for much of the poverty in the cities. They point to the migrants additional strain on the already overwhelmed public infrastructure and resources, such as energy and water. The migrants argue that they are doing work no locals want, or have shown interest in, and furthermore that their cheap labor keeps prices low for everyone. Lastly, their most important rallying cry, which thankfully has been reiterated in the media and by public officials, is they are Indian and have the right to be there working.

After the turmoil, Raj was arrested and let out on bail despite of the injuries sustained to north Indians, the fear that terrorized the city, and hiccup it caused in the local economy. He has a temporary restraining order against holding rallies or giving strong quotes to media. I doubt this type of punishment will stop future attempts, but one thing is surely evident, many Indians from all across the country have clearly spoken out against Raj and his intentions at causing rifts within Indian society.

Thursday, February 14, 2008

A Catch 66?

3 Different Entities Have Tough Decisions to Make

When the government run National AIDS Control Organization (NACO) implemented its new Phase III initiative it did not take into account its own country's laws. Sounds confusing right? Let me try to explain.

Well, the issue arose when NACO decided to change the targeted groups for its programs of intervention and awareness from the "high risk" population to the "core" population. This switch namely means from truckers and migrant workers to commercial sex workers and men who have sex with men. The switch seems logical - after all one sex worker can be responsible for infecting a good deal of men. Also targeting the "core" is agreed to be the best way to address the increasing prevalence rate in some of India's hardest hit states. To accomplish such feats, NACO has asked its state and district subsidiaries and reputable non-governmental organizations to choose a local commercial sex worker and homosexual man to receive proper training by NACO. These two individuals can lead the outreach work through their personal experience and connections to the different target groups. Part of this plan is to register the individuals to make sure they get the attention and help they deserve.

Now here comes the rub. While this all seems pretty logical, the grassroots people responsible to implement the Phase III initiative are walking on egg shells. According to Indian law it is illegal to be a commercial sex worker and, interesting enough, it is not illegal to be a homosexual but it is a jailable offense to engage in homosexual acts of intercourse.

So now we have three entities entangled in Joseph Heller's famous "Catch 22": the government, the NGOs, and the core group representatives. The government needs to further address the growing HIV issue and engaging the core group is the most effective approach of doing so. Including members of the core group as part of the solution will greatly increase the success rate and efficiency because they have invaluable insider knowledge. However, current laws will surely hamper the new program and any attempt by the government to alter these laws in the slightest will cause chaos with the heavy religious and conservative voices in the country.

The NGOs float in the same lake but are in a different boat. If they do not support the decisions of NACO or reject the projects as illogical, they run the risk of biting the hand that feeds them; after all, NACO provides a great deal of the funding for HIV NGOs. If they do support the measures then they run the risk of exposing their core group workers to arrest or some other potential trouble. The same is true if they are required to register the people who they are trying to help at their facilities.

Lastly, the individual core group workers that NACO demands spearhead the projects at the local level are stuck between the proverbial rock and a hard place. If they do choose to accept the position, they get a chance at a paying job, helping people who they know, and saving some from what they understand is a difficult and sometimes lonely future. However, aside from the potential of being arrested now or later, coming out and saying you are a homosexual or a commercial sex worker is not going to make anyone's life any easier anywhere, especially in India. Both face great amounts of discrimination and they also run the risk of "disgracing their families" (a one way ticket to horrible karma in Indian culture and Hindu religion). For example, I have met homosexual men who would rather say they are HIV positive than admit they are homosexual. Hopefully this shows how hard it is to take such a bold step as this job requires.

All three of these parties have a lot to think about before the Phase III initiative can be as effective, efficient, and successful as possible. NACO has forged ahead hoping that volunteers will not fear any type of repercussions. However, after talking to some of the organizations it appears that involved people, especially homosexual males, are not exactly lining up for the positions. Also another consideration that NACO may have overlooked is the education level of the commercial sex workers. For instance, one NGO is teaching their representative how to write before she goes to the training session. Decisions have certainly been made and only time will tell if they are on the right path or if phase III is already set for failure - stuck in a triple “catch 22”.

Tuesday, February 12, 2008

From a Distance

Providing Free Care in the Villages

I step off the truck and dry sandy Earth greets my shoes. Immediately a cloud of smoke from the dirt makes its way up my pant legs. We have arrived at the village center but I only see one person waiting for the free care. Where are all the people?

The person is an elderly man whose poor condition and back problems are obviously more than the staff of one doctor and two helpers can manage. The man uses a walking stick and is hunched over like a frail Quasimodo. I begin to think about how long this man must have been sitting here waiting and again my mind drifts to the question of where are all the people; after all these services are free.

I look around and only see dirt roads going in all directions. I look closer and can see the people slowly coming to the village center. From far away I can make out the beautiful saris, which are full of vibrant colors and elegant designs. Yet as they approach, the contrast of the saris and women’s physical conditions make a lasting impression. Some have light coats of dirt from the walking or skin that is very dry. Only a quick glance at the feet will bring a sense of reality back, many are bare or have such cracked skin that it is painful to look at. The first two people are a woman who is holding hands with a young child. The next two are a grandmother holding a two year old girl in her arms (See Photo). Two by two they slowly come for free treatment provided by Reliance Industry Limited. This is the village’s method of receiving primary care – a weekly visit by a RV truck. The doctor, who is stocked with only brand name drugs to insure quality, doles out medication for fungal infections, skin problems, fevers, coughs, and several other non-emergency problems. If it is serious, such as TB, they get referred to the TB/HIV Community Care Center. Also patients must present their list, which costs 2 rupees (10 cents) that shows their history of ailments and treatment. I inquire about the fee and the doctor tells me that even the most miniscule of fees has shown to make patients value and adhere to the medication.

I spend my time either sitting with the doctor or walking around the village centers trying to get a feel for the life of the village. There is a line of patients now (See Photo) and many appear to be joking around or lost in conversation. Some of my observations and questions are met with easy responses. “The men are working in the fields or in the city that’s why you don’t see any”. Others take a little longer to process. Many of the women and older children come to get “heel cream”. The bottoms of their feet and their heels are cracked, split, and extremely dry. I am told it’s due to working in the damp fields and farms and that a fungus is the culprit.

After 2 hours the doctor (See Photo) has seen a total of 63 patients, mostly women and children, from two villages. Two by two the villagers walk back from where they came. As they get farther and farther, once again, all I can make out is the beauty of their saris. Yet, this time I know there is much more behind the colors and designs.

Saturday, February 9, 2008

25 Orphans get a Day of Relief

Reliance Ladies Club Biweekly Matches Families with In-Need HIV/AIDS Children

The concept is simple - those who have, help those who don't. It is not a way to solve India's development problems and it is not a long term solution for children struggling with HIV, but it is a way to supply a child in need with a month worth of nutritional food and a chance to play for an hour.

Reliance women's club, which consists of approximately 50 wives of officer level employees, have paired their members with 25 HIV positive children who are either orphaned or coming from a single guardian family. I use the word guardian because many of the children have lost their parents and are cared for by their grandmothers or relatives. The in-need families are coordinated by the GSNP+ (Official State HIV Self Help Group) and the transporation is arranged by Reliance SUVS.

Physical scars, like decayed teeth or blotchy skin, are not the only toll on display for a first time visitor. As the children and the guardians pile out of the truck, it is obvious that most of the children are battling more than HIV. Some have tattered clothes and others are barefoot, but when you dig a little deeper the emotional scars begin to surface. You notice that some are very shy and others have a look of depression in their eyes and demeanor.

Whether I was ready or not I am paired with a toddler and a young lady. The littly girl was at most four years old and her chubby cheeks and Pooh Bear sweater reminded me of my kid sister. The girl stares with no hint of emotion at the young lady. Her parents have both passed from AIDS and her aunt, a girl no older than 22, has taken her in. The doctor shows me the scar on her belly from when they had to remove her gall bladder due to a serious infection. I resort to childish antics in an attempt to break the ice and overcome the inherent language barrier, but I do not find success until I pull out my camera. I place the camera in her hands and together we take a photo of her aunt. At last, she smiles! She moves onto my lap and we take a few more pictures; always making sure to stop after each one to discover what magical screen will show. She still has not said a word but her shy smile says she is enjoying her time. If that were not enough of assurance, she offers me her chocolate bar from her gift basket as a sign of friendship. I break off a chunk and place it in her mouth. If I have learned one thing in my travels it is that all children like chocolate.

Fast forward past 40 minutes of playing with all the children and as everyone gets ready to leave my new friend runs up to me, gently grabs my hand, and in a tiny voice says her first words to me - "Ow Joe". Her little feet quickly return to her aunt and as quick as she left she returns with the translation - "Bye Bye". I begin to smile and, when one of the coordinators tells me that all the children have now learned to say "Bye-Bye", it turns into a laugh.

Thursday, February 7, 2008

A Plan for Success

A Comprehensive Approach and Unified Effort Illustrates How a Program Can Flourish

Over the last week I have been dabbling in different areas of the Reliance Industry Limited's Hazira HIV/TB Center that has received so much international praise from the United Nations and Business Magazines. I use the word dabbling because it is nearly impossible to cover all that they do in a matter of six days. HIV organizations usually excel in either prevention or treatment because both require a great deal of attention, dedication, and manpower. The Hazira program is one of the special ones that has managed to do both, and do them very well.

In regards to treatment, they take a holistic approach and understand their community’s needs. Poverty is a major issue and the majority of the clients deal with the everyday struggles that it entails. A very poor living condition is only one of the obstacles faced in daily life. Understanding this the Center provides HIV, TB, and opportunistic infection treatment – all at either 50% cost or free of charge. Widows, children under 15, and anyone who is deemed temporarily unable to physically work do not pay for any services, lab work, or drugs provided. The system set up with the government has the center paying for all second line drugs and opportunistic infections treatment (namely TB) while the government provides all the first line medications and prophylactics.  Furthermore, Reliance has given a truck to the Center to do two pick-ups from a central hospital in the city. This truck comes packed with at least ten people for both trips. Without it treatment would not be an option for some because the 20-minute travel to the Center would simply be too much to afford.

Now you may be asking what the holistic thing is all about. Well, for starters they provide pre and post test counseling to infected persons and families and no one is placed on treatment until they have gone two rounds of counseling that stresses the importance of medication adherence. Taking your medications on time and never skipping doses is the best possible way to limit the chances of developing resistance and having to move to the next class of drugs, which are much more costly and stressful on the body. In addition, they have a yoga class set up that is specifically designed for HIV positive people. They play light music throughout the sick wards and try their best to provide a family atmosphere. For orphaned children they have set up a family partnering system that sees Reliance families helping the children with costs of education, food, and odds and ends.  Lastly, a garden is in the process of being created for HIV positive people to grow vegetables and the majority of staff employed is HIV positive.

The Center’s partnership with a local NGO and the Gujarati State Network of People + has taken prevention literally to the streets. While the NGO officials do talks and counseling with sex workers and migrant labor shanty towns, the Network follows up each new case with one on one meetings and support groups; therefore providing the safety network that is invaluable for individuals faced with the stark reality of being HIV + in a developing country. The Center does its share of prevention work as well. All of Reliance’s nearly 10,000 Hazira site workers must go through an HIV and TB learning session to get their worksite IDs validated and they also do annual check ups. Truck drivers are welcomed to the gates of the Hazira site with an HIV pamphlet and a three pack of condoms and lastly one Thursday a month the head staff go to three factories and get the CEO to sign legal documents that state HIV workers rights and prevention campaigns to workers.

Like I said in the beginning it is difficult to immerse yourself in all that the Center does, but it does not go unnoticed or unwritten. The results over three complete years are concrete. Over 1800 HIV positive people registered at the clinic. Over 2200 STDs treated. Over 500 people on Highly Active HIV medication (HAART). Over 250 people on TB treatment. More over they have begun to change the culture of HIV and the stigma surrounding the disease through all the prevention work. In summary, the most important thing to take from this post is the accomplishments that can be achieved and realized when different entities come together with a common goal and each one contributing with their own strengths. 

Tuesday, February 5, 2008

Corporate Social Responsibility

The Concept that is Developing a Country

What if I told you one of India's largest and most important corporations is behind one of its biggest HIV success stories? You would think there is a catch, but with the good publicity comes great work that is transforming an entire city.

The story starts with a notion that is simple in sound and proven effective in action. The concept is what experts coin "Corporate Social Responsibility" (CSR) and, for whatever reasons it is initiated, it plays opposite to corporate capitalism, something Americans are unfortunately all too familiar with. In this model the corporate world goes past philanthropy and donating to charities, and instead bases its practices and focus on human rights. It sounds idyllic and the jury is still out on the successes and pitfalls of such work, but some examples illustrate the type of vision that can foster positive change.

The secret to this recipe is mixing the right amount of ingredients and letting the flavors of each spice blend and not overwhelm the pallet. One part corporation for the business smarts of management and efficieny, one part government to utilize the experts in the various ministries, increased resources, and its ability to coordinate with different sectors, and lastly, non-governmental organizations to run the grassroot initiatives and provide added man power. After all this you have what is know as "public-private partnerships" that are responsible for much of India's development in the social sectors, such as health, education, and even infrastructure.

Coming from a corporate capitalist society I was quick to ask questions and fact find when I met with an official from the Bombay Chamber of Commerce. There has to be a catch or esle why would these large corporations committ such amazing amount of capital. Well, good publicity and favorable public relations can certainly account for some of the good will, but the top corporations that have embraced the idea really take it to the next level. The official explained a key concept ingrained in Indian society - repayment of debt (and no I do not mean the bank). A further explanation was given by the Chief Medical Officer at one of the coporations. He said one of the most important concepts for Indians is karma and reincarnation; therefore repayment of debts, especially to your parents and teachers, is a vital component of life. This is achieved by taking care of your parents in their old age and putting what the teacher taught you into practice and good use.

The higher ups and decision makers have all witnessed the change that has happened within the last few decades in India. The large corporations have grown almost exponentially in the last 10 years and to whom do they owe their debt? Well the answer given was India and they see their duty is to repay it by running development programs.

One of the India's biggest corporate success stories is Reliance Industries Limited (RIL), which last year accounted for 12% of India's Exports and 2.7% of India's GDP, and it is also a paradigm for the corporate social responsibility model. They run a plethora of programs meant to increase healthcare, education, local infrastructure, and the enviroment (which seeing a petro-chemical factory with a large "green" zone is quite interesting to say the least). Perhaps the most internationally celebrated one is the HIV program they run, which is cited as a "Global Best Pratice" by the United Nations Global Pact. This is the program that I will be documenting for the book and my next post will attempt to highlight why such praise has been bestowed upon them.

Saturday, February 2, 2008

Mumbai It Is

First Impressions of India

Indian cuisine and culture are things that I have grown accustomed to through family friends and reading international news. However, I knew after a few dozen pages into my travelers guide that it would be quite impossible to familiarize myself with "all that is India". The history and culture are simply too rich and deep to understand the quagmire that is India, but the realities of Mumbai offer quite a crash course. Here is what two days of Mumbai has taught me:

My first lesson was taught quite early on as I was still in the Airport. People here know how to deal with crowds. Bumping, pushing, and aggressive maneuvering are all part of the lesson plan, and if you take offense, and they notice, a sorry or excuse me always greets your American urges to bump back! This lesson continues throughout your daily activities as you are never away from loads of traffic, markets, and people. The human density that makes up Mumbai is simply remarkable - 16 million people, no less on an island of course.

The second lesson comes as a result of the first. My teacher was a sign at the hostel I am staying at which is run by Jesuits. The sign tells patrons that water is an extremely valuable resource so it must be used only when needed and that energy is only available from shared outlets outside of rooms. Water and energy are items often taken for granted in the States but here they are resourses that are often discussed in local politics. The amount of people have led to a crunch that is something I have never witnessed before. Infrastructure expenditures are where much of the money is being spent in Mumbai and it is understandable but hotly debated. Roads, bridges, subways are only some of the things being built to ease the immense amount of traffic and the endless commutes through bumper to bumper metal. However, affordable housing is a topic that must be addressed as many sources say 55% of Mumbai's population live in slums. The most famous has more than 1 million people in 1.7 square kilometers.

My third lesson is that India has got a great deal of money coming in and floating around its country in large corporations. A topic I will be writing about later is a development driven enterprise that is called "private-public partnerships" that puts together large corporations and government ministries to run service programs. The amount of growth that is being seen is quite remarkable. Immense bridges, fortune 500 companies, open markets, and bollywood, they all show that wealth is being created, but it appears to be in the hands of the few and surely not reaching the grand majority of Mumbai's population.

My fourth lesson was perhaps the best glimpse into India life. I have never seen religion play such a major role in the life of a city before. It is quite obvious who are mulsim, who are hindu, and who are catholic. Of course other religions are abundant as well. For instance, the Parsi community, which seem to be responsible for much of the philathropic works of the past and present, is always a popular topic of discussion. The impact of religion will be something that I undoubtedly will return to after experiencing more because its impact is immeasurable.

My last lesson is a vital part to understanding India. Indians are extremely friendly and honest people. Every person I have met through the foundation, churches, and families have shown me that hospitality and a friendly demeanor is something that is fundamentally at India's core, but that still does not mean a taxi driver won't try to charge you double!

The lessons will continue and the next post will share more about the organization that I have chosen to include in the project. Check back on Monday.