वापस चेन्नई में आपका स्वागत है

welcome back to chennai

arriving in chennai did NOT feel like going back to a place i had visited or lived. i felt like i was in a brand new city. i didn't recognize ANYTHING. the airport is an actual airport. it is a clean well organized affair. heading out of the airport, nothing was familiar. driving to the airport, nothing.

i shared some of what my first few days were like already. on friday, we were heading to a site visit and i asked our driver where thiruvanmiyur was (pathway, the orphanage i worked at when i was here in 1997 is in thiruvanmiyur). to my surprise, the driver said we were going thiruvanmiyur! he asked me how i knew about thiruvanmiyur and i told him. long story short, he contacted prasad and i stopped by. prasad had fallen down the stairs the day before and was headed to the doctor by the time i arrived. so i made arrangements to go by the next evening.

i hurriedly took this photo on the way out of the orphanage
if you can't see the sign says:
"given in love to the children of southern india
by members of the church of Jesus Christ of latter-day saints"

as we shuttled off to another site visit we passed a building with this "scarecrow" on it
our driver explained that it keeps bad spirits away
some people might look at the large building and covet, but this "man" will help people not covet
what do you think?

then we went to the india social welfare organization
where we met with female sex workers, male sex workers, men who have sex with men,
lesbians and transgendered people

they greeted us with innocents, cool flower lai things
(i can't remember what they are called), and tilak

here we all are
and some people who are just experts on the topics

saturday we met with a group of HIV positive women, and then we visited a "rock temple" i can't remember what it is called

the temple is actually carved out of stone,
rather than just being built by it


this is graffiti from the inside of the temple
there is a weird level of respect for things here


here are some colleagues
fiddling around with a lingam (लिङ्गं, just in case you want to study hindi)


yogi teabelly




i kinda want this bike.
i don't think i would need a car, if i had this bike



anne, laura, karina, and kristen
with diana in the back

moo


i had the crew drop me off at pathway
where i got to see prasad and chandra again!



me, chandra, and prasad
notice prasad's sling
he fractured the body of his scapula

chandra and i are dear friends. seeing her again felt like being reunited with my sister.
how funny that people with such different lives can still feel so connected.

it is crazy how little has changed at that main pathway building.
the transitory dwelling unit (my room)
is now called the sheffield room after bill sheffield,
but other than that, it looks very much the same.

and the guy who took me to the hotel is the same guy who drove me around 12 yrs ago.
he doesn't recognize me or speak english,
so the significance of this ride for us is kinda lost on him

we passed this bus on the way back to the hotel.
i couldn't help myself.

no hulu

i thought i was going to be all set for entertainment on this trip. i brought some good books, downloaded the first two seasons of mad men . . . totally addicting and awesome. and then i figured i could watch the latest office and 30 rock episodes on hulu. well no such luck.

this is a cautionary tale to all those who might try to do this. it will not work. there are some type of end user agreements made to the networks that do not allow for people outside the US to watch their shows online. you can only get what is available on i-Tunes. so now i will be forced to read, or go to bed. UgH!

things you just never think to appreciate about america. ;)

mumbai and most vulnerable populations

i have not been taking enough photos. it is tough because i am just sitting in meetings all day, so it seems kinda silly to get photos. but now there are things i wish i would have captured.

like the place where i got my ayurvedic massage and my wild goose-chase for a tailor etc. but i have what i have and i have a week left. so, i will do better.

this is the view from my hotel window in mumbai
it is weird to be living in the lap of luxury and look out over slums
i hate it actually

i am traveling with diana, the senior gender advisor in the office of global health at USAID
she had friends at the conference from all over and let me hang out with them
we decided to brave mumbai traffic one night and go to where the shopping and food was good
colaba

flat stanley on his way to colaba
(liz's neice is doing a flat stanley project and i offered to give him a tour of india.
he seems to be liking it.
he is quite adventurous!)

mumbai sky
line

bobmay police headquarters
i have memories of this place from my first visit
it is a long story that involves:
horse back riding on the arabian sea, chariots, danger, and a castration


we went to the taj hotel. the one that had been attacked in november.
it looked like nothing had happened
except for this memorial
it was pretty crazy to think of what happened in there
i remember when the attack happened i thought,
if i was in india for work, there is a good chance i would have been in one of those places
and i know how it is, you are just doing your own thing
and then suddenly people are shooting and stuff
i can't even imagine

security is much much much tighter now.
every hotel searches cars and bags and everything
it is kinda ridiculous though how we are always behind the curve
anyway . . .

the memorial

the plaque reads:

The Tree of Life is the most ancient cross cultural symbolic representation of the universe's construction. It can be seen to dwell in three worlds - a link between heaven, the earth, and the other world.

it is related to immortality and the essential dualism of the world and hence is a perfect symbol of our salutation to all the innocent and courageous guests and staff of the Taj, citizens of Mumbai, security forces and firemen who lost their lives in the tragic events of November 26, 2008.

We stand united in grief at their passing away and will forever be inspired by their bravery and sacrifice.

(then in small print)
this is not a permanent memorial and will be moved to its final resting place in due course.

Before i leave the topic of the terriorist attacks, i'd like to point out that the bodies of the dead terrorist are still in the morgue. the indian muslim community is denying that they are actually muslim and will not give them burial. tom friedman wrote a compelling piece in the NYTs this week about it. he makes such a fantastic point about how not honoring, or owning this behaviour the muslim community can regain its stature in the world as a loving and Good promoting faith. Please check it out!

the gateway to india

outside the taj and near the gateway
elimara, sarah, kathy, teabelly, and diana

shopping for glasses

we ate at cafe leopold
it wasn't really our intent to do a terrorist attack pilgrimage, but it happened like that
it is kinda weird because the places they attacked are the places that a westerner just happens to migrate too.

cafe leopold has been attracting travelers for 150+years.

this is the only mention of the attacks at the restaurant
we had a fabulous dinner and we all felt better after eating!

we decided to go to the train station:

victoria terminus
it was so crazy to go back to these places.
12 years ago
i had eaten my first breakfast in india at cafe leopold
and walked over to victoria terminus with my backpack to make my way to madras (chennai)
i got totally bamboozled there. they sold me a ticket to hyderabad and that was all so i got kicked off the train in hyderabad.
it is a long story
anyway, it was cool to be back
see how much it has changed, and feel how much i had changed

because we are all about gender, we had to hop on the ladies only train
obviously the guy getting on the train didn't notice that he was in the wrong car.

can you see me?

i had to use the potty

these are the toilet-wallahs.
they take 5 rupees from you to let you go to the bathroom
they took 10 rupees from me
but they were good sports about flat stanley

she is chewing lots of paan

these cops were a bit worried about my camera
sometimes they don't want you to take photos in the train station
i showed them what i was taking photos of and they cracked up
then i asked if i could get a photo of them
as you can see, they were quite enthusiastic

we then left the next day for chennai
i am finally getting over the jet lag -- kinda

here is a talli i ordered
ridiculously good!

then we had meetings yesterday (most vulnerable populations workshop)
and in the afternoon we had a site visit to a place that provides
health care and social support to male sex workers and transgendered sex workers
in chennai

they danced for us

performed a skit that trains people to use condoms all the time
and explained to us the challenges they face.

many of the male sex workers are married
i talked to one who was about to get married. i asked him if his fiance knew that he had sex with men.
nope
how will marriage change your life
"i will give up sex with men"
"is that realistic?"
"well i will not do it as much"
yikes. he has no intention of telling her
and my guess is she will never know, but he will continue to supplement his income through male sex work.

that makes her quite vulnerable to disease without her knowing. it is a tricky population to target. anyway.
i am glad that they have a place where they can learn to live safer lives, feel loved, and hopefully get out of the business.

the USG visitors with the clients.

last night i was supposed to go to dinner with some friends but got feeling so crummy i just went to sleep
i slept hard for 9 hours, and i think i might try sleeping again.

the reason i am in inda

many people have asked what i am doing in India. so i thought i might explain. i am on a three phased trip. i will explain each phase as it goes along. so, right now i am in mumbai. i am at a nice airport in a disappointing part of town. i am at least an hour from the cool, hip, energized part of mumbai. a colleague who lives here described our location as pittsburgh. i am in india’s pittsburgh. the hotel is nice (lalit intercontinental). for some reason i have a suite. so my hotel room is about the size of dianna’s apartment. but has 1 more bathroom. it is ridiculous. especially because there are slums outside my window.

so that's where i am, but why am i here? i am here for my work on the gender technical working group with PEPFAR. i am attending the International Conference on Gender-based Violence and Sexual and Reproductive Health. it is super duper interesting. though i admit i have stepped out during the 1:30 minute presentation of an award. the honorifics are a bit overdone.

obviously, violence creates health risks. homocide, femicide (the killing of women because they are women), broken bones, internal injuries, suicide, etc. but there is much much more to the story.

some interesting things i have learned so far.

• 10 years ago the international center for research on women announced that 1 in 3 women in the world had been a victim of gender based violence. they now admit that they were really just guessing. and now that number is known to be quite conservative. in fact, in some populations it is now known that 70-80% of women are victims of intimate partner violence.
• one researcher asked participants to remember the women in their lives. then asked if any of them had been victims of intimate partner (IPV) or gender-based violence (GBV). then just stated: “if it is so prevalent, why is so little being done to stop it?”
• unintended pregnancy rates are higher in women who have been victims of IPV at an adjusted odd ratio (AOR) of 1.7. which means almost twice as likely
• and victims of IPV are MORE than twice as likely to have an abortion (2.1 AOR)
• if IPV was completely eliminated there would be a 15% reduction in unintended pregnancy and a 17% reduction of pregnancy loss
• men who perpetrate violence are twice as likely to be HIV infected. men who engage in HIV risk behaviours are more abusive.
• abused women have a 7 fold greater risk of contracting HIV
• IPV during pregnancy is as common or more so than many conditions that are commonly screened during pre-natal care. this violence is associated with a variety of obstetrical risks including: late entry into pre-natal care; increased smoking and substance abuse; history of STIs; vaginal and cervical infections; kidney infections; miscarriages/abortions; premature labor; fetal distress; bleeding in pregnancy; in adequate weight gain; and low birth weight
• IPV increases risk of infant mortality 3 fold
• abused women have increased physical symptoms of illness. severity of abuse correlates to severity of illness. experience of abuse could have occurred many years previous, but still affects physical health. treatment of PTSD is vital to increased health of women.
• there is a synergistic effect of maternal depression, IPV and child mortality. this includes mental, emotional, and physical abuse
• in a small study in hong kong, pregnant women were screened for IPV. they created a control group who was simply provided information on how to get help. the test group received 30 minutes of counseling. within 4 weeks the health of the expectant mother improved 4 fold. the mothers indicated that just having someone listen to them and not make fun of them made them feel better. violence against women can be reduced by proper screening and intervention in health care settings, and is very inexpensive.
• the stress of violence seems to increase the production of cortisol in pregnant women which can then lead to babies born with hormonal issues.

sometimes it is frustrating, because we know a lot about improving health. we know that screening for mental/emotional health issues in primary care settings can help improve health. using a simple screening tool taking the “mental health vital signs” can help alert primary care providers to other concerns. when the tool indicates that there is need for mental health intervention, a brief therapy session with an on-site social worker helps to reduce the severity of physical symptoms; amount of time out of work; reduces patient visits and length of time with the physician; and improved health outcomes. obviously, this type of screening can also help reduce violence against women by creating a haven for intervention and empowerment.

acting on this knowledge could reduce health-care costs AND increase health and safety. but we don’t do it.

additionally, i believe that many of the male perpetrators of this violence are themselves in need of mental health intervention. depression is expressed differently in men than in women. the current DSM definition seems quite feminine: it is all internal. women tend to internalize while men tend to externalize. men become more violent and participate in high risk behavours. women become more withdrawn, sullen, etc (the stuff you think about when you think depressed).

though men don’t access health care much, it does seem like having them screened for mental health issues will also help protect women from violence, because they would then be able to access help for their own emotional stress.

this is not well thought out, and mostly just a bunch of thoughts from a few days of lectures, but i hope to turn this into something that i can propose as part of our health care reform conversations domestically.

returning to india

i am not sure how to explain some of this . . . i wrote this the first full day i was here.

it is 5:30am and i have slept for 2.5 hours. i am not sure what to do. i am hoping that writing will help me relax again and sleep.

the call to prayer is being sung. it is strange to be here. it feels like a real return to something. india had a transcending power on me in 1997. i had been alone for months. months of solidarity in one of the most densely populated places in the world. forced to face the paradoxes of humanity. all of the opposites: beauty and ugly; delicious and sickening; aromatic and revolting; peaceful and horrifying. plus something about this place is just spiritual. it begs for you to introspect. i couldn't, and still can't, help it.

india has a smell that, i guess, doesn't change. it hit me even as i walked off the plane. the smell reminded me of the zenned out pilgrim i had been 12 years ago when i left, just before the chariot incident (a story for another day). i could feel my body slow down. i had my flip-flops on so that helped me feel like a pilgrim. but everything is different. i can't really tell yet if the place is really different, or if i am the one who is different, or if i am in a different realm of travel so it just looks different.

getting off the plane all those years ago, the airport looked like a washed out, pissed over greyhound station. there were lots of beggars IN the airport. people in rags without teeth. men just standing around holding automatic weapons but doing nothing. women in torn saris cleaning bathrooms, sleeping in bathrooms on cardboard IN THE BATHROOM, etc. there were just a handful of westerners and everyone else seemed to want to touch me. i was most definitely a foreigner.

the airport is not the same, at least in my perception. it is now clean and well maintained. i saw no beggars. the immigration went super smoothly. not problems, no issues.

last time my backpack was the LAST piece of luggage to come out. it was two hours of waiting for luggage. this time, mine was in the middle of all the luggage (so much for priority) but the whole system was much smoother. within an hour of landing, i am quite certain everyone had their bags. also, there wasn't the crush of the line. last time, in line for immigration, people were pushing and shoving and just throwing their passports at the immigration officers. this time, people were calm, stayed in line, did what they were told. same at the luggage. last time i thought i was going to be hurled onto the rickety conveyor belt, this time no one was pushing. people were polite. so different.

the biggest, strangest difference i saw was coming out of the airport. years ago when i walked out into my first foreign country, i had no idea where i was going. it was 5:am and i needed food. i was tagging along with some other travelers who were going to the leopold cafe (later made infamous by the terrorist attacks). we walked out of the airport and there was an amazing crush of people. rickshaw-wallas, taxi-wallas, prostitutes, who knows who else was there. people were grabbing at us and pulling on us. i was totally wigged out. this guy i was tagging along with, pulled me into one of the taxis. i was scared to death. am i being kidnapped? what is happening??!!! it was one of those old white ambassador taxis. the driver pulled away and i thought we would die. the driver was a maniac. we sped through the city in the morning. people were starting to work. we passed the slums and the kid with diarrhea and the woman cleaning out the open sewer, colorful tata trucks and slum after slum after slum they didn't end. i could see nothing redeeming about the place. it seemed like the hell of the earth. it was scary, unfair and wild.

this time as i walked to get out of the hotel there was order. walking out of the airport, there wasn't a crush of people. you have to walk along a wall of windows to get the the exit. i think it is so you can see if where the person you are meeting is. there were lots of people, but they weren't pushing and pulling on people. i spotted a man holding a sign "mr. teabelly" as i passed around to the exit. outside there is a yellow barrier that keeps the travelers and the "picker-uppers" separate. no one was crossing the yellow barrier. there wasn't a rickshaw to be found. just people holding signs, and official taxis. no shouting. no touching. i walked up to the man holding the "mr. teabelly sign". and we walked on either side of the yellow barrier until we could actually meet. he took my bags, walked me to a mercedes, offered me bottled water, and drove me to the hotel.

so who knows what it is. i am a different kind of traveler. i have work to do, a real mission. i know where i am going and i have money to pay for it. then i hadn't been out of the US. in fact, i the biggest city i had been in was LA and the farthest away from gilbert i had been was austin, tx. maybe 38 (or so) countries changes you? maybe i don't see things the same. it isn't as scary, it isn't as unfamiliar, it isn't foreign anymore. can india become not foreign?

also, i have money. a few days in this country and the US government will have spent well over the $700 i survived on for 3 months (or however long i was here). maybe that is it. i have become that person i hated to see. the ex-pat that was so removed from the "real" india that they never saw it. last time i was here i road second-class non-a/c trains. now it seems that i don't even have time for trains, i will fly. and the flights seem cheap. so has that changed me? am i a different because i now travel with money and live in excess?

my hotel room has two bathrooms. it has a jacuzzi tub. 2 huge flat screen t.v. what is all this? the india i visited before is not the same one as it was when i came 12 years ago. that is certain. i am just not sure why? there are still slums. i can see them outside my window. i saw a father walking his child in the moonlight during the call to prayer through the slum of scrap wood and corrugated steel. it makes me wonder how i ended up here? an american, with an education, working for the US government, with access to the white house and health secretaries. how in the world has this happened to me and that guy down there, in the slums, how did he end up there?

i was listening to cnn while i unpacked. someone had figured out that if they took all the stimulus money and doled it out to every human being alive on the planet. everyone would get $1200. maybe that is a better solution? $1200 to that guy walking his child during prayers would probably change his whole life. what would happen? that money would FLOW into the economy. it would probably move all over. it might change the entire power structure though. india and china would get the most money because they have the most people. it would flow through all sorts of shops and up and up and up. anyway, that is a different topic.

this feels like a return. a homecoming. it also feels like it is a new place, strange, unknown. i am excited for the next couple of weeks. really excited to be over jet lagged and get some breakfast this morning. i don't expect that india will change me like it did last time, but maybe it will remind me of why i got into this business in the first place. it tugs at something in me, that is for sure. it makes me pause. it slows me down.