Roadtrip through Delhi, Jaipur, Agra

In the past week we have seen Delhi, Jaipur, and now Agra. It's been a blur, but a lot of fun. India is so diverse and complex. There is so much about the culture to learn.

Did you know that around medieval times India had the largest GDP of any country and Agra was about 3 times larger than London? India's great ruler at the time (Akbar, a muslim) took care of the religious problem of ruling a majority Hindu population by marrying a Hindu, a Christian, and a Muslim (among others). He then tried to create his own religion with himself as a deity. Why not?

We have also done some shopping. My driver says, "Husband is the Finance Minister; wife is the Home Minister." Apparently, his wife likes to spend the money he makes driving. And, Indian women like jewelery.

Pondicherry and the beach

We went to Pondicherry on July 17 and 18. Even though it was the weekend before our final presentation, it was good for us to get out. I also wanted to visit Pondicherry before leaving Chennai. Pondicherry used to be a French colony. It is a common get-away for tourists and Chennaians who can afford to get away

I had a crepe at Le Club, which I highly recommend:


I also had steak, french fries, and chocolate mousse at Le Club. The food was excellent. In fact, I ate way too much the entire time we were there, but the prices were also great when converted back into US dollars.

We watched the sunrise on Saturday morning. I have a nice video of it, but here is a friend's picture of the sun rising, taken from the hotel room.


The day after returning from Pondicherry, the Chennai team took us out to eat at a buffet and then the beach. I decided it was about time to swim in the Bay of Bengal, because I hadn't up to that point and did not know if I would have an opportunity again. The team must have been surprised when I ran past them fully clothed!

Final Presentation

We presented our findings and recommendations last Thursday to Dr Mohan and other staff at the clinic. It was a great day and everyone was excited to hear what we'd found. Tracy also arrived in Chennai that day

Let me tell you a little about my work at the clinic. Our team is part of a partnership between Dr Mohan's Diabetes Specialities Centre (sic) and the Global Health Institute at Emory. A group of professors at Emory work with Dr Mohan on a regular basis, and the idea for this project came from that partnership.

Our task was to identify the causes and consequences of irregular patient followup at the clinic. Specifically, over 10,000 new patients were registered as having diabetes in 2005 but most have not returned to the clinic since being registered. Regular visits to the clinic are important, so why do patients not do it? We surveyed 205 patients who have not returned to find out. We also took blood samples of 80 to determine their current diabetes control.

We found that the majority of patients are simply visiting another doctor to help with their diabetes. The problem here is that instead of going to a diabetes specialist, the majority of these patients are seeking treatment from general physicians or labs. In several cases these other "doctors" simply continue to prescribe the same medications Dr Mohan's DSC did originally, even though the prescription should be adjusted. Further, a fourth of the patients who say they go to another doctor do not do so on a regular basis.

We found that patients who said they go to some kind of doctor or clinic at least yearly for their diabetes are in much better control of their diabetes than those who do not.

During the project my team worked with members from Dr Mohans DSC to conduct the survey and analyze the results. There were 4 of us from Emory: 1 business school student (me), 1 public health student, 1 sociology and economics student, and 1 bioinformatics student. On the clinic's side, we had individuals from different parts of the business: IT, reception, administration, dietetics. These individuals had never done a research study before, so not only did my team have to figure out how to conduct the study, drawing from each of our diverse backgrounds, but we also had to teach the others the methods we would be using. Our work required both teams to work across cultures, communicate, be flexible, and think creatively. We each learned a lot in the process.

Members of the team:



As part of our presentation, my team also made recommendations for how the clinic could encourage patients to followup on a regular basis. These involved some marketing schemes, simple adjustments to how the dieticians and diabetologists interact with the patients, and some adjustments to the patient process.

Working a late night on the project:


As we worked, the clinic served us lunch at the canteen every weekday. Here's a picture of a common meal:



In October, our Chennai-based team will visit Atlanta to help us present our work to GHI (Global Health Institute). We are all looking forward to it.

Today, Tracy and I are leaving to tour Delhi, Jaipur, Agra, and Mumbai (other cities in India). Wish us luck.

Madras String Quartet - "Jai Ho"

On the Sunday before last we visited a rehearsal for a local string quartet, the Madras String Quartet. The rehearsal was in the lead players house, and Shruthi, one of my teammates, setup our visit. She will be learning to play Karnatic violin this fall, which is a style of music from India, and she was excited to see a professional group of Karnatik musicians. Karnatik music is a South-Indian style of music.

This quartet was excellent. They played some Beethoven for us, and a Karnatik song. We got to talking to the players, who said they typically play mostly film music professionally. In fact, they played one of the songs in Slumdog Millionaire – “Jai Ho”. We were impressed by that.

We took pictures with the group, and they were very kind toward us, offering us coffee and snacks, which we took gratefully.

auto rickshaw lesson for the uninitiated

In Chennai I have been getting around using a form of transportation known as an autorickshaw. It is a small, three-wheeled vehicle and has no doors or windows, except for a windshield. I have never seen a female driver.



Here is a short video of a ride in an autorickshaw.

There are a plethora of autorickshaws on the road, so it is easy to hail one, and this has been the preferred method of transportation for our team. I have a few tips for those uninitiated:

• Negotiate the price up front. I hear this suggestion often, even though I don’t see the logic. You won’t pay the driver until you are at your destination, so, really, the driver is vulnerable. Usually, the drivers won’t negotiate the price upfront unless you do. You probably want to avoid the headache of a driver convinced the price should be way higher than is normal once he has already delivered his service.
• If you don’t know how much the trip should cost, ask a local or compare two rickshaws. I have also found that walking away will sometimes cause the driver to offer a lower rate (several times, the driver drove beside and yelled at me from the road, continuing to negotiate). I much prefer to make the first bid at the price. Its important to act like you know what you’re talking about.
• Know your landmarks. I would not be surprised if most of these drivers haven’t seen a map, and they do not navigate by road names, which would be my preference. Usually, I will name a landmark, and when we arrive, I can navigate from there (hopefully).
• The interesting thing about Chennai is that drivers collaborate. If you try to negotiate with two at a time, they will decide amongst themselves who gets the ride before negotiating with you. Also, if one knows you negotiated with another, he will first ask the other driver what you’d negotiated with him and give you the same fare. I am actually impressed by their collaboration. Good for them.
• If you need change, make sure the driver gives you the change before handing over your bill. If you give him your large bill first, you can probably assume he will, coincidentally, not have change to give you.

Night at 10 Downing

A few weeks ago, we visited a club here in Chennai known as 10 Downing Street. It was interesting to see the locals in a different environment. We went to the club on “lady’s night”, so the girls had free admission and free drinks. I paid a $10 cover charge, but then received a $10 discount on anything I ordered. So, I ordered some kebab, won tons and a juice. The DJ was good but only played electronic/techno music. It was loud, and he only started to play music I could dance to around 10:30. By that time we were ready to leave. We had fun, nonetheless.

While we were there, a photographer wanted to take pictures of us. I saw him talking to some of the girls with us first, and I assumed there was some sort of catch: Maybe he would try to sell pictures back to us later. He had told the girls that he was from an Indian newspaper, and our pictures were about to appear in the next day’s paper. We didn’t believe his story, but we checked the papers for a while just in case. We had given up when Shruthi called us from her grandparents’ house. There were pictures of us in the paper! We checked online and found more. Joan and Katy were in the paper with a caption that read “Joan and Katy show their megawatt smiles.” Here is the link: Rocking ladies night at 10 Downing Street (Times of India).

Sights, Sounds, Smells, Tastes, and Stuff

I will be using a different style in this post. I've modeled it after Dave Letterman's top ten list segment. I have tried to compile the most common things that you would see, hear, smell, or buy if you were to travel to Chennai that would be different than the US. It is not a comprehensive list, but it will give you an idea of the experience.

Sights:

7) Squat toilets: a different way of doing business.


6) Hindu shrines: They pop up on street corners, next to offices, and installed in various nooks throughout the city.


5) Near misses: Traffic is crazy. I wouldn’t say that the rule here is to drive on the left side of the road (nominally, it is). The rule here is to fit in wherever you can. Cars, motorcycles, bicycles, cows and pedestrians share the road.


4) Public urination: Drive around long enough, and you’ll see it.

3) White symbols in driveways. Traditionally, every morning the area in front of the house is swept clean and washed with water, and a symbol is drawn on the ground with rice flour. The symbol has to be symmetric, and as far as I can tell can be any shape. Basically, it serves as a good luck charm, and it is made with ground rice as a gift to the animals.



2) A clutter of advertising: small shops are peppered with various advertisements. Walls are covered with “bills”, which is what posters are called here.


1) Trash: the streets are littered with it. Everywhere is dusty, and most buildings, sidewalks and roads are crumbling.



Sounds

4) “Call back to confirm”: This is probably a “No.” When we’re scheduling interviews with patients it may take us three tries before we get the hint.

3) “No problem”: Sometimes, it means “Yes, though I really want to say No.” Other times, “Stop bothering me.” It usually means “OK”.

2) Cell phone ring: At our apartment, someone’s cell phone (outside) is constantly going off, and I seem to be able to hear everything outside with crystal clarity. I have grown somewhat used to it. Also, when you call someone, expect to hear their favorite song, instead of ringing. I have heard this in the US, but it is really common here.

1) Horns: Everyone is honking. When passing someone you should honk three times: once when you are approaching from behind, once when you’re beside them in the hope they won’t swerve unexpectedly into you, and again when you’re passing them (for good measure). I want to get an air horn, so when I am running in the morning I can honk back, just for fun.

Smells

It is amazing how walking around Chennai, you will literally walk through many different zones of smells. At times, a waft of some smell or another may just catch you off-guard and will disappear as quickly as it appeared. It may be good; it may be not so good.

5) Fire

4) Delicious food, herbs or drinks

3) Sewage / manure: animals still roam the streets, and the rivers are the worst places in terms of smell.

2) Diesel exhaust

1) Garbage

Taste

5) Spicy

4) Rice: A LOT of it, and it comes with various sauces and minced vegetables. Even the cafeteria at the diabetes clinic serves more rice per meal than I am able to eat. They have tried to change that, but after a revolt by the patients, they reinstated rice with “reduced” quantities. The food here is typically vegetarian.

3) Spicy

2) Naan: mmmmm. It’s a flat bread, and I love it.

1) Spicy: you would think such a hot country would not be known for food that would make you sweat in Alaska (let alone coffee and hot tea).

Stuff

5) Men and women wear wraps. For women it is called a “saree”. For men a “kirta” and “dhoti”. The men’s skirt-like bottom can be worn long or short, depending on how it is wrapped and a person can change it throughout the day, if he is starting to feel hot.


4) Stores have limited refrigeration, so as many products as can be stored on the open-air shelves will be. For example, milk is in boxes (instead of plastic jugs) and on the shelf, as are eggs, vegetables, juices, etc. There isn’t much meat on sale, so that reduces the need for refrigeration still further. Some drinks are stored cold for convenience, though (eg some of the bottled water is stored in the fridge and some is left out).

3) Voicemail – doesn’t exist

2) Yoghurt is called “dahi” here, and it is all plain. You won’t get the flavored or sweetened varieties common in the US.

1) Banana flavored Corn Flakes – great idea! When can I get it in America?



As you can see, India holds intense sensations for all of your five senses. I was told as much before traveling here, and I have not been disappointed.

Shadowing a patient for a day

On Saturday I met a patient who, though he is from India originally, lives 10 months of the year in Toronto, where he works. His wife lives in Singapore. His sons are studying in Australia. They took her to the clinic where I work to check her diabetes. Healthcare costs in India are quite inexpensive, which is why they came here.

It was interesting to talk to this patient about his perception of various countries, including the US. He likes Singapore the best.

I asked him if he was mistreated at all in India, because he is Muslim. He said, “No”, and told me that the only thing that matters is your work ethic. Do your job and be reliable. He holds down 2 full time jobs, which has helped him be successful and provide for his family. He supervises cleaning staff at the Westin hotel.

I asked him about India, and he said Indians need to learn to care. In Singapore, you can get in trouble for littering on the bus. Most Indians don’t mind littering. I have noticed that too. Taking care of your area doesn’t seem to be a cultural norm, at least in this area. I think I see a culture that is changing, though. During my run I sometimes see people sweeping in front of their houses in a vain attempt at achieving some sort of cleanliness.

250 patients went through the clinic today, and any one of the doctors might see 30 or more patients in a day. Those are huge numbers by any standards.