the extraordinary women of rural india

i went on a field visit to a cluster of 6 or 7 villages in a rural district a couple of weeks ago. i had to carry out a survey grameen koota's clients about their utilisation of healthcare services, their health awareness, and their receptiveness towards volunteering community health workers as well as participating in a micro health insurance programme. additionally, i wanted to go to a real center meeting to observe the application and disbursement of loans or, in other words, observe the very core processes of microfinance. this day-long field visit not only left a lasting impression on me, it also evoked a whole gamut of feelings that i have not been able to express in words (which is why i have been delaying writing about this). at the end of the day, the only thing i was sure of was that i would be back in part of the world as a physician offering my services to as many of these wonderful yet unfortunate people as i could and improving their lives in every way possible.

i went to a bunch of villages near the town of mandya, about 120kms out of bangalore. these villages were only about 15-20km outside of mandya but they were so frightfully backward and lost to civilisation. it made me shudder at the thought of what villages that are far more remote are like. they didn't have paved roads; their homes could hardly be called homes; they have to rely on a very unreliable water tank or well for water; and they only get power for 5 hours a day! not only that, they have no idea of knowing when the 5-hour block will begin, and so if they are out working in the fields or mills, they will probably have missed their only chance to cook, listen to the radio, or watch their black-and-white televisions. most houses were small but looked spacious only because their residents were too poor to furnish them with anything. many houses had leaks in their roofs or big holes (see pic) which must wreak havoc when the monsoons arrive. most of the households had farm animals as their only assets- for some, the milk from these animals was their only livelihood and so their own lives were inextricably linked with those of their cows or goats. i have an image of a house that will stay with me forever. we met with someone in a house which comprised of just one room that was approximately 10feet by 20feet. of this, the woman had designated more than half the space for her lone cow! when asked why, she told me that her only source of income was milk from this one cow and the cow's death would hasten her own so she had to offer it the greatest care and comfort she could. it was so heart-wrenching to hear this, and to see her live in a room permeated by the putrid odor of cow and cow dung, and to see her sleep on the floor right next to her cow. to sum up her abysmal situation, while she slept on the rock hard floor, her cow was at least rolling comfortably in bales of hay. the room in question is in the picture- the cows area is everything behind the ledge till the door, while the woman sleeps where the women in the picture are sitting. i cannot imagine how they live like this.

despite their miserable environs, the women of rural india are quite extraordinary. they are not at all conservative, backward, or mindful of Purdah like i thought they would be. an elderly woman told my colleague not to marry young because her husband would ruin her life, and to never have an arranged marriage. i was quite stunned by this! they were all also very strong-willed and vocal- not one woman i spoke to shied away from responding, and i was frightfully impressed with their responses. not only that, i was astounded at their desire to learn- every single one of the 200 women i spoke to had a burning desire to learn about good health and nutrition. they wanted to be able to take care of themselves and their families, and they wanted their children to succeed in life. some of the groups i spoke to even volunteered women from amongst their midst to be community health workers for their villages! in every village center, at least 1 or 2 women had a bachelor's degree or were in pursuit of one. how wonderful is that? they were respectful and courteous, and very forward-thinking. when i explained a health insurance scheme to them, they were very receptive towards the idea (i thought they would be cautious and unyielding) and they asked very thoughtful and probing questions about the scheme that admittedly had me even going back to the drawing board to reconsider certain things. they offered elaborate opinions on government insurance schemes in which they were enrolled in, and they even made a great number of suggestions as to how we could make things work.

microfinance has truly given these women a voice. they are no longer suppressed by their husband and in-laws. they have a say in family matters and i could say that their role has even evolved to the extent that they are the leaders of their households. since microfinance is only extended to women, they make the final decision as to how the loans they receive will be used. kendra managers (loan officers) ensure that these women have a channel to voice any abuse by their husbands. with the money they have borrowed, the women have started their own businesses and generated a vital source of self-made money. unlike a husband who will gamble or drink away money, you can be assured that the money a woman makes will be used for the good of the household and for the education of the children. this was the core concept of microfinance when prof yunus started it some 30 years ago, and it is still valid. i cannot forget the hope visible on the faces of the women i met. at each village i went to, every single woman came up to me and told me that they had faith that i would do something for them, that i would offer them and their families a chance to lead healthier, better lives. these personal requests for help, i cannot forget nor ignore. i only have 2 weeks left but i am confident that, by the time i leave, i will have put in place a model concrete enough in theory. i have faith that grameen koota is committed enough to respond to the needs of their clients and will put this model in practise. how i wish i could have been around for that, to see the joy and satisfaction on the faces of those very women i set out trying to help. 

indian success story

today i met an indian success story. when you think of an indian success story, you usually think of the lone son of a poor lower-class family slogging at school between handling 3 jobs to take care of his ailing parents and hungry siblings. he manages to excel in his 12th class examinations and is offered a place at the various IITs and IIMs , and so his life immediately takes a giant leap into the burgeoning middle class. 


that, however, is not the story of vikash kumar. vikash kumar was terrible at school, he never even used to go to his classes. he had no lofty ambition of entering the IITs and the IIMs of India. hell, vikash kumar did not even know a word of english till 5 years ago but he is now the executive director of the world's premier microfinance magazine- Microfinance Focus. we sat down and had lunch together today, and as he was narrating his life-story to me i could not help but gape in awe.


vikash told me he was born in a remote village in Jharkhand- his village is 16 hours away from Calcutta and the journey involves a bullock cart, a boat, a bus, train, and many many kilometres of walking. just to put things in perspective, i can leave washington dc the same time that he leaves his hamlet and we will both arrive in Calcutta at the same time. additionally, you should know that Jharkhand is one of the most backward states in India- it is one of the poorest and most illiterate, and it also has the some of the highest mortality rates in the nation (and invariably, in the world). anyway, vikash grew up in a piddly village in Jharkhand and was educated in a government school up till his 12th grade. now, government schools in rural districts are frightfully bad. the teachers are incompetent, the facilities are non-existent, and parents themselves do not value education as much as they do child labour. vikash never used to care about studies because of the typical villager's small-world mentality that education would be pointless for his likely future career in farming or taking over the family kirana store. he said that he would never go to class, instead whiling away his time goofing around in the fields with his friends. after his poor showing in his 12th grade board exams, his family admonished him for being a wastrel and told him he would be a complete good-for-nothing. 


vikash finally decided to make something of his life, so he decided to head to the nearest big town in his district. his family was against this, they thought he would be of better use working in the fields rather than roaming around  cities trying to make a living. finally, he managed to convince them on the condition that he return in a year if he did not make a name for himself. he wanted to get a MBA but this was not possible without a solid command of English. vikash's education in his village was in the hindi medium and so he had not a clue about the english language. the first thing he did when he got to Bhagalpur was find a premier english coaching academy and he enrolled himself at great expense to himself and his family. he studied english intensively for just 6 months before writing his GMATs. he had only learnt english for 6 months up to this point! how much can you possibly learn in 6 months?! i am pretty sure that i would have only gotten a little past the alphabet. vikash did exceptionally well in his GMATs and got accepted into a number of prestigious indian business schools but coming from a poor family, he could not afford them. he finally enrolled himself in a MBA programme in Rural Management in the Entrepreneurs' Development Institute where he found that he was unable to compete with the other students and was only an average student.


however, it was here that vikash's brainchild was spawned. he recognised that microfinance was a growing field and he decided that he would take it upon himself to annal its progress and offer a database of information for his colleagues in the field. his first newsletter was written and distributed in MS Word; i'll put it up here when he sends it to me but when i read it, i remember it being poorly worded and grammatically awful. i had no idea why anyone would want to read it. but this guy had tremendous courage and determination- he would work on his newsletter late into the night after coming home from his day job (which was a low-paying position at Grameen Koota).


it must have been immensely challenging and disheartening, and his road must have been littered with so many obstacles the way but look at where he is now! he is the go-to person for any microfinance news/information/research. he has an excellent website with tons of information, he has even managed to interview Muhd Yunus and Princess Maxima of the Netherlands, and most importantly, he has turnover of a couple of hundred lakhs (Rs 100,000). can you imagine someone who has just learnt english as the editor-in-chief and executive director of a leading editorial? his english may not be the best but he is still learning the language avidly. he is lively and jovial, and in his eyes, you can see hardship but you can also see hope. he is the sort of person who makes you realise that if you put your mind to it, anything can be done! america always brands itself as the land of dreams but vikash kumar is living proof that any place in this world may be the land of dreams if the dreamer has the courage, drive, and determination to pluck his dream out of the sky and land it in reality.

drugs in the prison system

i have been reading jeffrey archer's prison diaries- ive already read volume 1:hell and volume 2:purgatory so i just have volume 3:heaven to read. however, i wanted to write a blog post about it before i could even finish because jeffrey archer relates some shocking tales about drug abuse in the prison system that i cannot help but think about. no doubt, he was 'banged up' in the UK but i am sure that the same problems exist in the US (although definitely not in drug-free squeaky clean singapore) and many other Western countries.


in his diary, jeffrey archer talks about the rampant use of drugs by prison inmates. most of them get into prison for drugs- be it growing, pushing, or using- and being unable to rid themselves of their addiction, they continue to abuse drugs while serving time. the way that drugs are brought into prisons are quite imaginative to say the least but i rather you read the books to find out! i was much more concerned about the manner in which previously drug-free convicts first begin abusing drugs while in prison. with so much time on their hands and absolutely nothing to do, they are sucked in to the drug culture by their cell mates. 


what is even more astonishing is that heroin (a far more dangerous drug) is the most common drug that felons abuse, far more so than cannabis. know why? all convicts are subject to a Mandatory Drug Test (MDT) randomly, and while cannabis can only be flushed out of the system after 28 days, heroin is flushed out of the system in a day by simply drinking copious amounts of water. since a positive MDT test increases your sentence by 28 days and involves a revoke of some of your prisoner privileges, inmates regard heroin as a safer option. 


the problem is, heroin is not the safer option! heroin is addictive and the heroin available in prisons is highly diluted so inmates need greater quantities of it for the same effect. once they leave prison, a lot of them go straight back into the drug peddling business because the payouts are huge compared to the measly minimum wage vocational job they will be qualified for. the heroin outside prisons is much purer than the stuff inside so when prisoners  inject themselves with the same quantity of heroin as they used to while on the inside, they die because the stuff is just too pure for their bodies to handle.


something needs to be done.

a special summer

i am working for Grameen Koota this summer. Grameen Koota is a microfinance institution (the world's 4th best in fact) based in Bangalore, India, and which offers micro credit to nearly 500,000 women and therefore, households, in the southern state of Karnataka. i had taken a class in developmental economics last fall and it got me fascinated about the concept of microfinance and how it unleashes new opportunities for the world's poorest entrepreneurs and revitalises the village economies they serve. i wanted to go to India and see for myself if this new wave of social capitalism was actually working and to see if it was lifting the rural poor out of poverty and enabling them to change their lives through profitable investments. i also thought it would be a great last use of my economics degree before i dived into my medical studies.

although i did expect to have a wonderful time, i did not for once think that i would be able to change the lives of half a million families (~2 million people!) because i was a mere intern. boy was i wrong! grameen koota started the department of New Initiatives so as to offer non-financial products to their clients thereby improving their social status as well as their economic status. within this department, i have been identified as the 'health care expert' because of the few public health classes that i have taken and the fact that i am planning to be a doctor, even though i am not even close to being one yet and can hardly find my own pulse. i have been tasked with coming up with a sustainable healthcare model for GK's clients. in other words, i am responsible for making sure that 2 million impoverished citizens receive some form of basic health care. when first notified of my role, i was flabbergasted. to be honest, i seem to be a little under-qualified; i only hold a high-school diploma! was GK really going to entrust me with this job? were they sure they knew what they were doing?

i am ecstatic that they have so much faith in my ability (either that or they want to be cheap and get an intern to do a pro's job). the past few weeks have been challenging, intellectually stimulating, and extremely insightful. the role i play involves a synergy of all my educational pursuits: economics, public health, and medicine. it is quite literally what i have always wanted to do with my life. i want to apply myself with pure dedication to the principle that healthcare has always been and should always be a basic constitutional right. healthcare is not a consumer good that should be subject to traditional market forces, leaving it beyond the reach of millions who do not have a high enough willingness- no scratch that, ability- to pay. with this passion fueling me, i set about this seemingly herculean task. in line with stephen covey's 5th habit, i have spent the first few weeks understanding the situation, and now i would like to spend the next few weeks seeking to be understood as i come up with a healthcare model that should have been put in place more than some time ago.

the past 3 weeks have been quite a journey. you can claim to know about poverty sitting on a plush couch in the great cities of America but you will only know poverty when you travel to the rural reaches of India. i have learnt so much and seen so much that sometimes it leads me to wonder- can i do so much? but the very sight of these people who are no less human than you and i but on whom fate has played a very cruel trick ignites in me a burning desire to change their lives. i have told myself that i will do the very best i can for them, no less than they deserve, and that in my 6 weeks here i will have hopefully changed their lives and touched their hearts as they have touched mine,