Archive for March, 2005

Born into Brothels

Go and see Born into Brothels, Zana Briski and Ross Kauffman’s award-winning documentary about Briski’s interactions with the children of prostitutes in Sonagachi, a red light district in northern Kolkata. Briski lived off-and-on in the brothels in Sonagachi starting in 1997, and befriended many of the children there. A photographer, she began teaching some of the children how to use a camera, and in 2002, founded Kids with Cameras, a nonprofit organization to help educate these children and to empower other marginalized children around the world by teaching the art of photography.Born into Brothels is a beautifully made film. Briski captures life in Kolkata as it is lived by the people in Sonagachi, through the cameras of the children. The children fly kites, sing and dance to film songs, and perform daily chores; they are loved, neglected and abused. A significant part of the film chronicles Briski’s efforts to enroll some of the children in boarding schools so that they can escape the inevitable slide into prostitution or pimping.

One of the most fascinating threads in the film was seeing the different expressions of creativity in one of the children, Avijit. “There is nothing called hope in my future.” He is a talented painter and photographer. His paintings have won him drawers full of awards in school, and he was invited to participate in the World Press Photo Foundation’s Children’s jury in 2002 in Amsterdam. Watching him frame a photograph, stage a shot, or describe another photograph gives rare insight into the creative process of a natural artist.

Several other photographers have done similar work with children in different parts of the world. Among them, former war photographer Nancy McGirr, who set up Fotokids to work with children in Guatemala and Honduras, Lana Wong, who founded Shootback, to work with adolescents in Mathare, the largest slum in Kenya, just outside of Nairobi, and Wendy Ewald, Literacy through Photography, who has worked with underprivileged children around the world.

On the Road to Recovery

Mark woke up this morning and felt like himself again.  Good enough to walk for an hour.  Good enough to reduce his pain medication from 2 pills every 6 hours to 1.  He still experiences pain, had a bout of rashes (he claims I gave him fleas), and still needs to sleep a lot, but all in all, he’s turned the corner to recovery.

The Aftermath

The day after Mark’s surgery, which had gone so well, was spent trying to deal with his pain management, which had not. Around noon, an epidural specialist came and replaced the epidural, and took Mark off some of the other narcotics he had been given. In the meantime, from early morning until late afternoon, Betsy, Kaki, Kaki’s husband Tib, Mark’s father Marvin and I took turns urging and shaking Mark awake to breathe. We all got to be experts at playing that video game – watching the monitor to see the bell curves of his respiration, telling Mark to “breathe” before the yellow warning beep goes off when his respiration level falls below “8”; you lose when the red light flashes on with more insistent beeps, and the word “***APNEA***” appears in the top right hand corner of the monitor.

Later that evening, while Mark was asleep (and finally breathing on his own), his hepatologist motioned for me to come outside. “Did you hear what the pathologists found?” “No.” “They found a worm!”

A worm; a tiny parasite. And an egg! Something picked up from a “developing” country. This mysterious mass was the body doing what it had to do to protect itself from a foreign body. (Our friend Duran Randolph put it best – Mark’s body created a pearl.) In this “first” world country, we’ve had so little experience with the results of infectious diseases that the doctors (radiologists, hepatologists, surgeons) had no idea what this lesion could be. When Mark first discussed the results of all the images that were taken of the lesion, the doctors said that there was a 60% chance that it was benign. Two months later, after more imaging, the percentage was increased to 90% benign. But they still did not know. Better to take it out than live with the uncertainty.

Three days later, the epidural was taken out, and Mark had another setback, of his own doing. He decided to try and sleep off the pain after the epidural had been removed without taking any additional medication. (Why did we all listen to him?) For two and a half hours, he did not use his self-administered morphine. After realizing his mistake, he couldn’t bear to wait the 15 minutes between doses, and kept pressing the button continuously (beep beep beep) until the medication was released (beeeep). Yaniv, who was visiting during part of that time, played time-keeper, and discovered that it was actually 15 minutes and 15 seconds before the drug could be released. Too long…

Mark stayed in his room in the Transitional ICU for three days, two more days than is generally allowed, then was transfered to the best room in the hospital for his last day and a half. Room 565. Large (could house an Indian family of 7), with views of the Bay, and a window in the bathroom (could house an Indian family of 3). It helps to have a sister who is the favorite resident.

He is home now (walked out of the hospital at 1pm on the 21st because he got tired of waiting for the Transport person with the wheelchair), and is pretty much in constant pain. He stopped taking the Tylenol with codeine that had been prescribed for “breakthrough” pain two days ago, and is just taking a non-narcotic drug for baseline pain management. After taking so many drugs to counteract the effects (fluid retention, headaches, nausea, constipation) of other drugs, it must be a relief to be done with most of them.

He is eating solid (normal) foods, walking, climbing steps… he just can’t lift anything heavier than a cup.

Thanks to all of you who visited, brought food, books and gag gifts, called, emailed, sent cards, and pampered me. We love you.

“The” Day and Night

March 16, 2005

5:30am. Mark drove his sister’s car (which he had borrowed the night before) to pick up his mom and the two of them went to his sister Betsy’s place.

6:00am. Mark and Betsy (who is a resident at California Pacific Medical Center (CPMC)) walked to CPMC to check in for his surgery.

7:30am. Mark is taken to the operating theatre, and Betsy is asked to leave.

9:00am. Sonesh Surana babysits me while Mark is in surgery, and we have breakfast at The Grove, on Fillmore Street, close to the hospital.

11:00am. Betsy calls to say that the surgery is done, and that Dr. Robert Osorio is coming down to the waiting area to talk to us. Sonesh and I race over, and get there as Dr. Osorio is telling Mark’s mom, Kaki, and Betsy that the surgery went very well, there was very little loss of blood (they did not need to use any of the blood that Mark had banked over the last two weeks) and that the mass in Mark’s liver was a benign granuloma, probably caused by a previous infection. Nothing further to worry about.

We all tip toe over to the Intensive Care Unit (ICU), where Mark has been taken. He is conscious and talking.

An ICU nurse asks Mark if he has any allergies (supposedly to medication). He replies: “Violence.” She then asks him to rate the level of his pain, on a scale of 1 to 10, with 10 being the greatest pain he has ever had. He says “2”.

2:00pm. Mark is doing so well that they decide to move him from ICU to Transitional ICU, which is where they put patients that do not need constant monitoring, but is a little more comfortable and not as noisy. Mark is in Room 335, a private room with a door you can close.

A young anesthesiologist (not the one who was in the operating room) comes in to test Mark’s epidural. It is not working properly. (It was knocked out of place by some radiologists who inserted X-ray plates behind Mark’s back twice, because they forgot to expose the film the first time.) In fact, it is not blocking the pain on his right side, where the incision through muscle took place, but is numbing the left side (would that they could move his liver to that side). The young anesthesiologist is to consult the original anesthesiologist to see if he can adjust the epidural.

2:30pm. We all leave to let Mark get some sleep. Sometime while we are ALL gone, the young anesthesiologist comes back, fails to get the epidural working, and leaves Mark in a position that strains his stomach muscles. Mark tries to get the attention of a nurse for about 10 minutes before someone comes to make him more comfortable.

5:00pm. Mark is now getting three different kinds of narcotics, including morphine, to try and ease his pain.

8:30pm. Betsy decides that it would make more sense for her to stay overnight with Mark, because if something happened, she would be better able to deal with it.

10:00pm. I leave to go home.

Sometime during the night, Mark’s respitory function is reduced by the narcotics to such an extent that he loses his sympathetic breathing response. Betsy has to tell Mark to breath about every 10 seconds. Betsy saves Mark from being intubated and hooked up to an artificial lung. Neither of them get any sleep.

“The End of Poverty”

At breakfast this morning, I reached over for an open magazine left at the table by one of our guests, Elektra Gorski, visiting from Tokyo, where she is finishing her Rotary Peace Fellowship this summer. The (Time) magazine was open to an “exclusive book excerpt” of The End of Poverty by Jeffrey D. Sachs. The picture that covered two thirds of the double page showed Bihari (Bihar is one of the poorest states in India) women carrying away the contents of latrines in metal buckets on their heads.

For those of you who don’t know, Jeffrey Sachs is an economist who made his name turning around developing economies, starting with Bolivia in the mid ’80s, while a tenured professor at Harvard. His success in helping the Solidarity-led Polish government create a market economy propelled him to stardom in the post-Soviet era, then later to infamy when his program for Boris Yeltsin’s Russia failed to have the anticipated impact. He is now with Columbia University’s Earth Institute and is the director of the United Nation’s Millenium Project, whose Millenium Development Goals are, among other things, to reduce extreme poverty and hunger by half by 2015.

“This is a story about ending poverty in our time. It is not a forecast. I am not predicting what will happen, only explaining what can happen. Currently, more than 8 million people around the world die each year because they are too poor to stay alive…”

“Yet our generation, in the U.S. and abroad, can choose to end extreme poverty by the year 2025. To do it, we need to adopt a new method, which I call “clinical economics,” to underscore the similarities between good development economics and good clinical medicine… Development economics needs an overhaul in order to be much more like modern medicine, a profession of rigor, insight and practicality.”

I started to read the excerpt. It begins with a description of the conditions in a small village, Nthandire, in Malawi, and ends with a list of nine steps that we can take to reach the Millenium Development Goals.

… “Nearly half the 6 billion people in the world are poor.”… Sachs goes on to define the three levels of poverty classified by the World Bank: extreme (or absolute) poverty, moderate poverty and relative poverty. The World Bank estimates that there are 1.1 billion people living in extreme poverty who cannot meet their basic requirements for survival.

In July 2004, Sachs and his colleagues spent some time in a group of eight Kenyan villages known as the Sauri sublocation in the Siaya district of Nyanza province. The Earth Institute has received a grant from the Lenfest Foundation to “put some novel ideas to work in the Sauri.”

“African safari guides speak of the Big Five animals to watch for on the savannah. The world should speak of the Big Five development interventions that would spell the difference between life and death for the savannah’s people. Sauri’s Big Five are:

Boosting Agriculture With fertilizers, cover crops, irrigation and improved seeds, Sauri’s farmers could triple their food yields and quickly end chronic hunger. Grain could be protected in locally made storage bins using leaves from the improved fallow species tephrosia, which has insecticide properties.

Improving Basic Health A village clinic with one doctor and nurse for the 5,000 residents would provide free antimalarial bed nets, effective antimalarial medicines and treatments for HIV/AIDS opportunistic infections.

Investing in Education Meals for all the children at the primary school could improve the health of the kids, the quality of education and the attendance at school. Expanded vocational training for the students could teach them the skills of modern farming, computer literacy, basic infrastructure maintenance and carpentry. The village is ready and eager to be empowered by increased information and technical knowledge.

Bringing Power Electricity could be made available to the villages either via a power line or an off-grid diesel generator. The electricity would power lights and perhaps a computer for the school; pumps for safe well water; power for milling grain, refrigeration and other needs. The villagers emphasized that the students would like to study after sunset but cannot do so without electric lighting.

Providing Clean Water and Sanitation With enough water points and latrines for the safety of the entire village, women and children would save countless hours of toil each day fetching water. The water could be provided through a combination of protected springs, rainwater harvesting and other basic technologies.

The irony is that the cost of these services for Sauri’s 5,000 residents would be very low. My Earth Institute colleagues and I estimated that the combined cost of these improvements, even including the cost of treatment of AIDS, would total only $70 per person per year, or around $350,000 for all of Sauri. …

With a population of some 33 million people, of whom two-thirds are in rural areas, Kenya would need annual investments on the order of $1.5 billion for its Sauris, with donors filling most of that financing gap, since the national government is already stretched beyond its means. Instead, donor support for investment in rural Kenya is perhaps $100 million, or a mere one-fifteenth of what is needed. …

My blood began to boil. Why is Sachs still talking about bringing “first” world solutions to developing economies? Fertilizers and improved seeds, vocational training to teach “modern” farming techniques, computer training in areas with no electricity, bringing electricity through power lines or diesel generator… all at a “low” cost of $70 per person per year… only $1.5 billion for the rural development of Kenya.

Where are the sustainable solutions? Green manure and other natural (and cheaper, or free) fertilizers, going off the grid with solar instead of diesel, composting toilets, foot pumps for drawing well water… the truly appropriate technologies? Why promote the dependence on fertilizers, improved seeds, and pesticides that have driven thousands of farmers in South Asia into a cycle of debt and suicide? In countries where electric power generation cannot keep up with the demands even in cities, when will power lines reach the rural areas with steady supplies of electricity to power refrigerators? What are the “novel” ideas?

“From the world as a whole, the amount of aid per African per year is really very small, just $30 per sub-Saharan African in 2002. Of that modest amount, almost $5 was actually for consultants from the donor countries, more than $3 was for emergency aid, about $4 went for servicing Africa’s debts and $5 was for debt-relief operations. The rest, about $12, went to Africa. Since the “money down the drain” argument is heard most frequently in the U.S., it’s worth looking a the same calculations for U.S. aid alone. In 2002, the U.S. gave $3 per sub-Saharan African. Taking out the parts for U.S. consultants and technical cooperation, food and other emergency aid, administrative costs and debt relief, the aid per African came to the grand total of perhaps 6 cents.”

Given this reality, a reality that neither he, nor members of congress, nor administrators of the United Nations, World Bank and International Monetary Fund have been able to change for decades, where will we find the $1.5 billion for rural Kenya, let alone the 1.1 billion of the world’s absolute poor?

Thermal and a Quarter

“Hey Mark, those are Rs. 200 seats; we have Rs. 100 tickets.”

“Smita, why don’t you announce that a little louder so the whole theatre can hear?”

Rahul, Smita, and Dinesh dozing in our front row seats at the beautiful Museum Theatre last Friday, February 25, while PC Ramakrishna of The Madras Players performed his heart out in Mercy, a solo theatre adaptaion in English of a novel by Sivasankari.

Rahul: “So, did the wife die in the end?”

Dinesh: “Yeah, I was wondering that too!”

***

“Malayalis never work in Kerala; they work really hard everywhere else, but you can’t find anyone working in Kerala.”

I smiled remembering this statement as I was listening to a National Public Radio story on All Things Considered about the Bangalore-based band Thermal and a Quarter playing in Chennai. (Three and a quarter of the band are Malayalis, from Kerala.)

Archana has publically admitted that she is wrong to think that nothing much happens in Chennai (when in fact, she actually didn’t say that… she questioned the existence of an intellectual community in Chennai… oops, am I going to get her in trouble now that my blog is being read by the who’s who of Indian bloggers thanks to Kiruba?), particularly after she mentioned that she and Smita had gone to see Susheela Raman a couple of days ago (much to Mark’s chagrin for not being invited).

Why am I still thinking about Chennai?


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