Saturday 22 March 2014

Post #21: Derek and Meagan's sojourn to India

DEREK AND MEAGHAN MADE IT TO INDIA -- SOMETHING WE DIDN'T THINK WOULD BE POSSIBLE. WHOOPEE!  

Before catching their breath in Delhi, they were off for a day trip to Agra
The Taj in all its splendor
HAPPY HOLI
Derek and Meaghan's arrival coincided with Holi, the very popular India festival of colors. Festivities start the night before with bonfires representing Shiva's incineration of the she-devil Holika.

Holika is about to go up in flames. Lots of neighbors contributed something to this display-- fuel, food offerings, flowers, colored string, candles, prayers, etc. 
The participants in this fun, joy filled festival shower each other with bright colors using dry or wet paints and water balloons. Holi is accompanied by significant libations laced with bhang (cannabis) and can be rowdy. We certainly got tagged a few times. A little unsettling.

The Holi holiday is a celebration of the arrival of spring as well as freedom from Holika. Holi is also known as  the festival of love, commemorating Lord Krishna's dalliance with multitudes of cowgirls. Colors and laughter everywhere.





Pretty wild.
















Holi cow, too!
...and the Gods are often covered with colors on Holi. 
UDAIPUR
Wanting to squeeze as much as we could into D & M's short sojourn to India, we went for an overnight to Udaipur
4 flights up at a rooftop lunch stop
 Meaghan with her great eye outdid herself capturing everything and its details - 420 pictures in 2 days and Derek learned patience.
Palace detail
Our hotel on the lake.
The hotel looks out over the city and the palace
Dinner at our rooftop restaurant
DELHI
We did have some down time back in Delhi to visit a couple of the key sites, do some shopping, and eat Indian [of course!].
Jantar Mantar built in 1725, the site of huge astronomical instruments charting
the heavenly bodies (with Derek playing King of the castle)
Kotla, our local market place, the night before Holi
A portrayal of Gandhi and his wife in the museum at the site where he was killed
We had some discussion about the newspaper's matrimonial classified section (see below).  In India, arranged marriages remain very common and are coordinated primarily by the son's parents with perhaps more input from the potential brides and grooms than in the past. Can you imagine your Mom and Dad running a personals ad to try to introduce you to your potential future spouse? Thankfully, Derek and Meaghan found each other on their own, and we are so thrilled they did. They are really perfect for each other.


A whirlwind trip. We are thrilled. Both of our boys have now made it to India. We didn't think Derek and Meaghan would make it so soon after their time off for the wedding and honeymoon, but they pulled it off!   It means a lot to us to have them all here, and to share a bit of our India experience.






Post #20: the Hauz Khas scene



We spent part of this weekend in Hauz Khas, a funky South Delhi enclave a short 
auto rick-shaw ride from our apartment in Defence Colony. 
Hauz means Water Tank (or lake) in Urdu and Khas means Royal. It is royal.  



Mosque, madras and tombs of the Khilji dynasty 

A beautiful look into 13th Century Delhi



 
The village near the ruins is a little artsy community by Delhi standards. 

We not only found a great South Indian thali restaurant, but also lots of 
galleries, including one with a painting that we bought.

The painting is a chaotic Delhi street scene, complete with our favorite vehicle: 

an auto-rickshaw. It will hang in Annapolis in May!









 

Post #19: Hinduism and Indian culture


One of the most remarkable aspects of living abroad is trying to come to terms with cultural, religious, and individual differences. And what differences! While India represents a myriad of separate religions, societies, and cultures, Hinduism is dominant and is at the core of Indian cultural values. No wonder the Moslems and a few others sometimes feel left out. 

To know India even a little requires focusing on culture and religion.

A Fulbright psychologist from Wittenberg University provided us with a very nice way to try to gain insights on how Americans and Indians relate to "self" and to "others" and how all this connects to Judeo-Christian vs. Hindu tradition: 


American Tendency: The self is an independent entity, bounded by one’s body and defined by stable traits. Indian Tendency: The self is a fluid entity that moves in and out of one’s being, transcending time and space. This is core to religious beliefs in India.

American Tendency: Self-descriptions emphasize personal attributes, and bad behavior is explained in terms of personal attributes. Indian Tendency: Self-descriptions emphasize relational attributes, and bad behavior is explained in terms of situational demands. This is not easy for Americans to fully comprehend or to accept its significance.

American Tendency: Resolves moral dilemmas in favor of individual justice. Indian Tendency: Resolves moral dilemmas in favor of interpersonal obligations. This ties to corruption and all kinds of behaviors that we as Americans frown on.

- American Tendency: Feels morally obligated to help strangers only in a crisis. Indian Tendency: Feels morally obligated to help others in a wide range of situations. We see this almost every day. Indians have given extremely generously of their time as we struggle to learn about health and pension reforms.

American Tendency: Resists accommodating to social expectations, feeling that it impinges on personal freedom. Indian Tendency: Experiences accommodation to others’ expectations as freely chosen and personally satisfying.  This plays out, for example, in the high success rates of arranged marriages.

The relationship of all of the above to religion? Pretty clear. 
First, from the Judeo-Christian tradition:

“Then God blessed them, and God said to them, “Be fruitful and multiply; fill the earth and subdue it; have dominion over the fish of the sea, over the birds of the air, and over every living thing that moves on the earth.”  …from Genesis

Second, from the Indian-Hindu tradition:


“The one who loves all intensely begins perceiving in all living beings a part of himself. He becomes a lover of all, a part and parcel of the Universal Joy. He flows with the stream of happiness, and is enriched by each soul.”  ...from Yajur Veda
“The source of creation is an infinity, a wholeness. As the source is infinite, the creation is also infinite. You cannot divide life into Divine and non-Divine. The Divinity never gets exhausted. Destruction and creation are not two different events. One is emergence and the other is merging back. So let there be peace through the realization that the whole life is Divine.”  ...from Shavasya Upanishad

Even after all of our reading and talking, we are still total novices on Hinduism. What is clear to us is that Hindus have a deeply personal connection to their faith and their gods. There are literally millions of gods and these personal gods can take many forms: statues, trees, rocks, mountains, etc. These objects become gods as individuals believe in them thus everything is interconnected and very personal.

In the late afternoon in the apartment below ours in Defence Colony, candles are lit, and the sandalwood incense burns at the family altar, permeating our apartment.  We can look directly down at the altar from our apartment and we often we see our landlady Shammi worshipping to her god.  

A woman worshipping her tree god ouside of a Hindu temple

This a close-up from the picture above. Hindus often add eyes to inaminate objects of worship to deepen the personal connection to their god, Notice the Holi colors all over the icon.

We have often visited one particular local Hindu temple. We've gone here alone, and we've taken all of our India visitors to the temple. Situated just four metro stops away, it is quite a place, with many, many places of worship, a health clinic, a food preparation and donation center for the hungry, and administrative areas. 

We are invariably engaged by members of the community during our visits to help us feel embraced by their world. Once a man with a big smile and passable English latched on to us as we entered the temple. He guided us through the many Hindu rituals including offering gifts of flowers and corn,  receiving blessings such as water.sprinkled on our heads,  and connecting with the individual gods through touch.  Yes, the taking of pictures was fine. He spoke excitedly about all the gods, but made a point of pointing out his personal god. Sadly there was much that was said that was unintelligible as his eagerness to share this temple he had visited since his childhood bubbled over. 


Before leaving  the temple our guide ushered us into  a room with 12 foot long cushions on the floor where we sat. He insisted we meet the very intelligent and caring head of the complex. Clearly he  hoped that we would support on a greater level than we already had this place that was doing such good work. As we left and thanked him, he gave us his cell number and told us to call him any time. He said it was his duty to help visitors.  Truly amazing hospitality and not at all atypical. We experience similar acts all the time.

Within the temple worshippers shove and elbow to get ahead or get closer to the altar to provide offerings to the gods. What a contrast to the Ba’hai temple 1/3 mile away.  We approached the Ba’hai temple with its acres of grounds. We waited as instructed and were admitted to the temple after a briefing on Bahai beliefs and instructions regarding maintaining silence and not taking pictures. It was a very meditative experience at Ba'hai, but none of the personal chaos and connection that we see in the Hindu temples. 

Before arrival in India, Ken felt somewhat negative and Caroline felt confused about Hinduism. No longer.  

The serenity and simplicity of India's Ba'hai Temple...

...the Hindu temple is anything but serene and simple.


Lots of offerings to these Hindu gods.

The Christian Mother Mary gets absorbed into the Hindu tidal wave in India.

Sunday 16 March 2014

Post #18: Indian health: take one


We will certainly have more to say on India's health system before our return in May, but we wanted to start writing down some impressions as we pass the half way point of our India sojourn. We have spent a lot of time on India's health issues, and it has been great for the two of us to work on it together and compare notes. We have met with lots of Delhi experts, and in Kerala and in Tamil Nadu we've visited health facilities, public and private agencies and insurance providers.  We are in and out of the Public Health Foundation of India. We've also met with academics and international development folks focused on health. And we have read a ton of stuff.

Bottom line? Health care delivery is certainly getting better over time and health outcomes are  improving.  But very slowly. India's health and nutrition indicators compare unfavorably to those of comparable countries. For example: 28% of Indian births are low birth rate, compared to 13% in sub-Saharan Africa and 8% in Latin America.

Health care is another area where neoliberal thinking has permeated government action. For years, India has called for increasing public support for health overall, but public health as a share of GDP has hovered at 1% for the past couple decades, all during the period of massive economic growth. This is dramatically lower than most comparable nations. Many nations, including China and most of Latin America, spend 3-4% of GDP on public health.

Actually, India's overall spending on health is not all that dramatically lower than many countries, but what is different is where the money comes from.  Well over two thirds of India's health expenses is financed directly out of the pocket of its citizens. No wonder health care is the #1 reason for financial calamities for Indian families -- a health event is a real financial catastrophe. Think twice before you get treatment! If you like "consumer-driven" health care, then India is a great experimental site.    

India does finance a large public primary care system, but it has been starved for cash for decades. Underfunded and deteriorating public facilities, often very poorly run, lack the necessary health care personnel, medications, and supplies. In the rural areas it is difficult, even with incentives, to attract and retain doctors. There is a shortage of nursing personnel. And when health personnel don't show up for work (a regular occurrence), the population goes without care and there are no consequences for the "non-providers".

A rural public health center in Tamil Nadu -- a fairly deteriorated place. While it is available to all residents, only the poor use the public facilities. 


The Center's labor and delivery wing.  A couple of women were resting in the labor room at the time.

The public is voting with their feet, shifting over to private facilities, even though all the studies show that many of the private facilities provide a lower level of care than the public facilities. Some private facilities for the poor do seem to be doing great work (below):

One of 7 Health Centers run by a non-profit in Tamil Nadu - a model that they hope to grow to include 500+ clinics.

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Everyone seemed wonderful. The woman on the left is a health extension worker who registers families in the cachement area, collects health info, draws blood for tests and provides education to those who come to the clinic for care. The second person on the left is the ayurvedic doc who was provided with 3 months of training in allopathic (Western) medicine by the non-profit and follows a protocol which recognizes both practices. The woman in the middle was with us all day; she got her PhD from the University of Florida and then returned home to Tamil Nadu to try to improve the health care system here.  The woman on the right is the office support person who helps individuals with their records, etc. In India AYUSH trained doctors are plentiful because their training is far shorter and less expensive than allopathic training.  The clinic here is trying to use this lower level, nursing model (using the AYUSH docs) to provide basic care.  They are hoping that they can provide health care in areas where MD's are mostly unavailable.


 A cost sheet of the tests that are provided in the clinics. So figuring on 60 rupees (Rs) to $1.00 means that 80 cents buys a malaria test -- incredibly cheap by US standards and much cheaper than most high class private facilities in India.

Below is the other end of the private health care system:
The top 10% of the population has access to great health facilities, as Ken can attest.

The Indian government calls for a substantial increase in public support for health care. Rahul Gandhi, the Congress Party heir apparent, calls for India moving from 1% up to 3% of GDP for health. But the political climate seems to call for more fiscal retrenchment at least in the short term.

“…it is not only a question of giving the health system more money… What is clear is that the country can ill afford to move ahead on parallel tracks – expanding financing of both the demand and supply sides without a clear notion of coordination and clear convergence.”                                      
                                ---L.C. Goyal, Secretary, India Ministry of Health


So if resources are to expand (and we do believe that they will in the years ahead), should India continue in the current direction of privatized health care and health insurance, or instead develop a strong foundation of public provision?  This is a red hot debate in policy circles, with many on the Left strongly opposed to the former, but many others in favor of private health. This is very, very hard for us to sort through.

It is very hard to envision a dramatic reversal of private insurance and delivery in India. But it is also hard to see how an unregulated private system will provide quality, affordability, access and efficiencies to the average Indian -- the rickshaw driver, the construction worker, the farmer, etc.

The Indian system has some similarities to the US system, with a reliance on a public-private system of care as well as a mix of direct public delivery and health insurance mechanisms. We all know how poorly the US manages its health systems -- and costs!! In India, this public-private system will create huge management challenges for central and state governments. The required governance and regulatory systems have not yet been built or if they have been instituted they have deteriorated over time.

There is a lot of exciting stuff going on in health but no easy answers.   More later...




There are health facilities everywhere you look in the cities. 
Some are super specialty facilities.  Some focus on medical niches. 
Here to the right is the entrance to an Arurvedic hospital that focuses on
ancient Indian treatments. 
Health is big business. In india, almost all care is paid for out of pocket.














Saturday 15 March 2014

Post #17: trip to Tamil Nadu

We just returned from a week in the southeastern state of Tamil Nadu, a relatively prosperous state with lots and lots of history. We first spent a couple nights in the coastal city of Ponducherry, the old French outpost that still does have a decayed veneer of old colonial France. The French are gone, but the old buildings (and a few French restaurants for the tourists) remain. Quite a change of pace from most Indian cities.


A little bit like New Orleans in South India

Joan of Arc statue by the shore. A strange site in South India.
Beyond this statue is a wide beach road which is only open to pedestrians - almost unheard of in India. People take advantage particularly in the early morning and in the evening to peacefully stroll along the water, meditate by the the ocean, hold hands with lovers or friends, play with their kids or pay homage to the Gandhi statue.  This one location alone would make the city memorable!





International Women's Day was celebrated with a demonstration which included this dance.



It might be an old French town, but Pondy really is Tamil through and through. Hindu temples are everywhere, including one we visited that was dedicated to Ganesh, complete with a live elephant standing out front that blesses the Hindus with gentle head rubs (in exchange for a banana as a gift to Ganesh).  
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After Pondy, we were off to Chennai, a big, bustling modern city previously called Madras. This was the locale for this year's annual four day Fulbright conference, which was a lot of fun. Tons of presentations by the Fulbrighters on the many areas that they are working on in the South East Asia region -- education, public health, the arts, literature, history, the environment, women's issues, culture. There was much more learning here for both of us than at the average conference.

Ken did a talk on pension and health reforms in India

The keynote speech given by a third time Fulbrighter was an extraordinary talk on Hinduism and the worship of natural forms such as trees and mountains. It gave us both a much deeper understanding of the intensely personal relationship that Hindus have with their gods.  Fulbrighters also provided the evening entertainment of Indian music and dance presentations.  All great!

Fulbrighters performing an improv at the conference. The guy is singing Dhrupad music from northern India and the woman is singing Carnatic music from southern India. The accompanist is studying Indian and jazz hybrid music for his Fulbright. The three somehow put it all together. Cool!   

The senior Fulbright researchers at the conference were interesting, but the 80 or so student Fulbrighters who were in attendance were the real hit of the conference for us. They were full of open-eyed insights and involvement and passion and a desire to make an impact. An inspiring group of kids who will make their marks on the world. Bravo.

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We finished up our trip to Tamil Nadu with a couple days in Thanjavur to learn about rural health delivery in India. We had a sensational health care day that we describe in more detail on our health page. While in Thanjavur, we had a chance to visit Brihadeeswarar Temple -- a gigantic one thousand year old Hindu temple dedicated to Shiva and built during the Chola dynasty.  The interior of the temple seemed right out of Raiders of the Lost Ark.  Inside, many people were providing gifts to Shiva. At the very center of the temple is one gigantic Shiva lingam covered in flowers.

Caroline was not able to fully appreciate the temple because she had her second bout with Delhi belly. A tough couple of days for Caroline.

It is monumental -- over 200 feet tall -- and still used as an active Hindu temple by lots and lots of people.

Filled inside and out with statues and deities and animals and more...


...including some Brihadeeswarwar Temple walls that are quite erotic!

There is a lot of erotic art in many old Hindu temples, but the Brihadeeswarar Temple that we visited is nothing compared to the Khajuraho Temple complex in central India, which is literally covered in erotic art. Sadly for Ken, we missed this stop! The picture above is not ours --complements of google images. 


Wednesday 5 March 2014

Post #16: pension insecurity in India


A current -- and a future -- old Indian. Will either of them gain a measure of financial security?

For many generations, Indian families have provided primary support for the elderly.  Now India is changing rapidly. Will India's public policies change with the times? It looks like a steep climb ahead. A big change here would not only buck old cultural traditions but also the current economic thinking of a lot of the political elite.

For years now many international organizations, think tanks, and governments have promoted neoliberal economic development policies. A generation ago India took steps to dramatically liberalize and open up its economy -- with generally positive results. This freed the country from some of the worst features of its old, overly bureaucratic straightjacket, thereby spurring growth, job creation, and movement from the rural areas and to cities. The country still suffers from the bureaucratic "license raj". It seems to take forever to start a business much less build a highway. Nonetheless many Indians have benefited from the changes.  There is less abject poverty, higher living standards, and more growth. That's important.

So economic liberalization has had a very positive side for India. There are, however, downsides -- and we're not just talking about the air pollution! Part of the liberalization message is to minimize government activities. In India, investments in social programs -- education, health and public pensions -- are very low. Public governance systems have grown weaker and weaker over the past couple of decades, as privatization spreads.

India is a poor country, yet many other countries in similar economic circumstances are doing much more in social policy development. India's leaders have been quite timid about adoption of major public government initiatives. Unfortunately, it seems very likely that the next elections will push the country even further to the right. 

The public pension situation is a good example of the dominance of neoliberal philosophy in India. Expanding retirement savings fits nicely into neoliberal thought -- personal responsibility, small government expenditure, limited long term government exposure. India's policies fit this framework. Formal workers -- only 10% of the workforce -- generally have pension coverage, but mostly in the form of a large personal savings program. It is not a great foundation of support but better than nothing. The lmuch arger problem is the 90% of the workforce in the informal sector -- the farmers, construction workers, rickshaw drivers, small shop owners, small factory workers, etc. They mostly have nothing for old age beyond their children -- and government is doing little to prepare for the inevitable demographic and family shifts that are well underway. Thre does need to be a major increase in retirement savings, but that won't happen without major government intervention. And as of now, there's also very little talk about creating a foundation of income support for the elderly to complement retirement savings.

In the middle of the 20th century, the US was allocating well over 2% of GDP to Social Security and tax incentives for private pensions.  India currently allocates squat, and seems to be sleepwalking into the 21st Century when it comes to pensions. Not so China, Korea, Thailand, even poor Nepal. Wake up, India!

We have spent a fair amount of time in India meeting with folks and researching this issue.  Ken has given several talks on this topic, with more to come, all part of an effort to help spark a larger debate. An uphill climb...

Below is an op-ed by Ken that was published in MINT, the big business newspaper in India that is connected to the Wall Street Journal (this certainly wouldn't have made it into the WSJ!):



Many of India’s growing elderly population face serious financial challenges. It is imperative that India institute a long-term strategy to strengthen the economic security of the elderly. While steps have been taken to provide pension security for some citizens, India still has a very long ways to go to prepare for the future.

As a very young country and one with a long history of family support for the elderly, India has understandably focused on issues other than elderly pensions. According to NCAER’s India Human Development Survey (IHDS), about three quarters of the elderly now live with married children or other relatives.  

India is changing, however, and programs and policies must also change. India’s aging population is expected to grow at more than double the rate of the general population. In addition, more elderly Indians, particularly women, are economically vulnerable. According to the IHDS, 45% of elderly males and 75% of elderly females are currently fully dependent on others for sustenance, and the same NCAER survey shows that vulnerability is particularly high in urban areas which are experiencing rapid population growth. The economic transformation that is taking place in India calls into to question whether the family-based system of support will continue over the next century.
Many countries are making major strides in providing basic economic security in old age. China is moving closer to a universal pension system – extending basic coverage to a quarter billion people over the last few years. Bolivia and New Zealand have already instituted universal pensions, covering virtually all older citizens, and Nepal and Thailand are also taking major steps in the direction of universal social pensions for its elderly. Is it time for India to explore universal options?
India has already taken some actions. Many in the formal workforce have some pension coverage. In addition, a tiny share of informal workers is enrolled in retirement savings schemes supported by the central government (NPS-S). A small share of very poor elderly receives social pensions of 200Rs a month, rising to 500Rs a month after age 80. While most states supplement these amounts, the scope and depth of coverage is too often meager. There is still no basic system of economic security - beyond families - for the vast majority of elderly Indians.
While the analysts debate policy options, almost no major public debate is taking place on this topic. The silence from political officials is deafening, possibly because the problems seem too far away to deal with now. Real problems are emerging that need public action.
What should India do? I would propose four important steps:
First, to prepare for the upcoming demographic transition, India must find the way to greatly expand retirement savings for the informal workforce. Unless many more Indians increase retirement savings very soon, future generations of elderly will be at real financial risk.
What’s needed is a universal retirement savings account for informal workers: greater government financial incentives to encourage participation; better access to micro-pension financing models; flexible contribution schedules; and better financial information to educate Indians on the need for expanded retirement savings. India should set a target of encouraging 50-100 million informal workers to start these accounts.
Second, while instituting a more universal retirement savings system is essential, by itself it will never be more than a partial solution. Retirement savings accounts will be too small for most workers to live adequately in retirement, particularly lower income workers and today’s middle-aged workers -- who either won’t have the time or the resources to accumulate sizeable assets. India must therefore complement a stronger retirement savings approach with some form of a lifelong foundation of public support for all of the elderly.  Given the size of the India’s informal workforce, payroll tax financing used by many other countries won’t work, and small targeted programs clearly won’t meet the core financial needs of most of India’s elderly.
What’s needed is a universal (or near universal) social pension: a flat non-contributory pension for everyone over a certain age. India should build the full delivery infrastructure now, but keep monthly benefit levels very modest and start with a fairly high retirement age. It is always easier to liberalize programs over time than it is to scale them back.
Third, India should link both of these new approaches directly to the new universal ID that is now under development. In the United States, the creation of a universal Social Security number in the 1930’s was an important reform that ultimately enabled the integration of the nation’s pension, finance and taxation systems. A universal ID tied to universal pensions can be a great mechanism to help India handle its upcoming demographic transition. 
Lastly, pension security takes very long term planning – by individuals and by governments. India needs to start planning to make fiscal room for these initiatives by setting mid-century budget targets for pensions for the informal workforce. In very crude terms, by 2050, modest universal social pensions will probably necessitate spending about 1% of GDP, and universal retirement savings accounts might cost an additional 1% of GDP.  If India does not start to plan now for these eventualities, it will find itself in much deeper hole by 2050.
The 21st Century has the makings of an “Asian Century”. India’s future policy and economic decisions will be a key. Can India be an important player on the international stage and still not provide basic economic support for the elderly? The time to plan -- and then to act -- is now.
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One of the several Indian families who have come up to us in public places asking to take our picture.
We are still curiosities to many Indians, particulary those from outside the big cities.
We often follow up by asking them to join us in the picture. A nice way to share warm connections.