Sunday, May 31, 2015

Oh Dear?

What matters? 

Oh dear. This feels very college-freshman-philosophy-class here. I guess I'm regressing.

You know I love dogs. I was raised with Rebel, and Penny and Maggie and they were part of the family. Penny was my only sibling after Lynn abandoned me for UNCW, and the family member, by far, that I missed the most when I left home for Georgetown. When I was working part-time for Perfect Sense Digital, I spent 8 hours a week working for Animal Care and Control in Brooklyn walking shelter dogs that would be euthanized in a couple days. I like most dogs more than most people.
This is a stray dog literally inside Humayun's Tomb. They are EVERYWHERE.
In Delhi there were stray dogs everywhere. It was one of the first things I noticed on the taxi ride home from the airport with Sravan at 3 AM. Everywhere on the highway. Plenty in the street in front of the Dimagi flat. I easily passed 50 of them on my 15 minute walk to work in C block Vasant Vihar. 
This is an advert for a fertility clinic posted on an electric transistor in Visant Vihar.

Vasant Vihar is a bougie ambassador neighborhood where some of the ex-pats are walking pets on a leash. There is a pet store selling dog and cat food and toys. And right there out front of the store for your disjuncture-seeking brain there are innumerable stray dogs. Cute fluffy dogs with horrible open sores and flies in the sores like a Steinbeck novel. And the pets on the leash. And the stray dogs hit by the insane traffic but not killed and dragging their wasting paralyzed hind-quarters behind them for a few more days until they starve. And 1 billion people. And fertility clinics.

I can’t really care about those stray dogs suffering. There are so many. Unlimited. I have to separate that out if I'm going to get out of bed. I wish Peter Singer were here.  It's like worrying about the suffering of pigeons. Or ants. Or the bacteria in my mouth when I brush my teeth. It’s vast an immeasurable and what is so much more important about the suffering I see than the suffering I know about but don't see? So I'll just push this suffering into the 'doesn't matter' category of suffering. That category is getting crowded. (See also: Boat Migrants, Guantanamo, Rwandan children 'outside the fence'.)

The danger of shifting the dogs, who I care so much about reflexively, into this category is that to get them over there, you rip a hole wide enough that pretty much everything could go. Seems like getting people over there might just follow naturally.

So I get up in the morning and I guess I can say I didn't create that situation, but then who did? Who exactly has to fix it? And if there's not one simple answer, and if there's not much likelihood that that a responsible governing body will fix it, then this is just the 'normal' we need to accept.

And we can take some comfort in saying we try to do our bit. So I take a pay cut and work for a social enterprise that is trying to improve health outcomes for all kinds of interventions for the underserved populations around the world. And maybe if I help this organization to achieve its mission then the gradual improvement of outcomes reduces suffering some other way… Like a suffering offset. Feels thin and hollow.

Then there's a suffering calculus. To live is to suffer. And how much do these stray dogs suffer. X amount? What does it matter if they suffer 2X or 10X? Or .01X? In the long range view the suffering will be gone. I know it hurt like hell when I tore my rotator cuff, but now that suffering seems not just distant but nonexistent. Pain in the past counts for nothing. Once I'm dead, will it matter how much pain I felt when I was alive? To who exactly? Ok so pain and suffering don't matter? Oh dear…

Friday, May 22, 2015

3 weeks in Delhi

So my first trip for my new job was to the Delhi office to meet the team there and do some onboarding. I built my own custom CommCare app and saw the technology in use in 3 different hospitals in India. I saw nurses that would typically put medical details like heart rate and blood pressure in these huge ledgers that reminded me of Harry Potter into wireless tablets instead, for better medical record keeping, and hopefully for better medical outcomes. (RCTs pending.)

Hindsight 20/20: When telling your mom you are going to a hospital in India, it might be good to provide a little context.

My welcome lunch with much of the Delhi office

Me in front of a hospital in Delhi where they are using CommCare in the maternity ward. 


Me at Humayun's Tomb

Look in the mirror for a tiny me riding in a moto rickshaw 


There was construction everywhere I went. These little guys were at every work site. Caterpillar has nothing on them.

This is me in front of a hospital in Rajasthan where CommCare is being used in the diagnosis of Diabetes, Hypertension, and Depression.

Sunset in the lovely Hauz Khas Village park in Delhi

Sravan and me in the kitchen of the Dimagi flat where he is always whipping up something gourmet.

From the roof of the Dimagi flat in Delhi you can see these amazing trees.

Here's a little something I wrote from there when I was up all night with the heat and my stomach:

Sravan is doing his best to take care of me. He really is. But if you’ve met me (and let’s face it my blog audience is pretty much just my mom, so you have) you know he’s fighting an uphill battle.

Sravan is a Dimagi engineer who lives in the flat in Delhi where I’m staying. He came to fetch me from the airport and has been doing his best to walk with me to work and back and keeps cooking food and offering it to me.

He really is amazing. This morning (Saturday) he was up early reading “Introduction to Special Relativity”. He’s this kid that just graduated from Engineering Physics from IIT Delhi from a rural village. Check out his bio. He seems to know almost everything and is figuring out the rest. He’s taught himself to be a gourmet cook watching youtube videos. He’s always offering me some kind of help or support. (Nick Hamlin, Miki Vizner, you two would both love Srav instantly like the long lost brother he is from your tribe.)

But you know I’m like a three year old who wants to do it BY MYSELF! Everything has to be by myself. (One part loathe of ever seeming dependent on any other person, one part antisocial.) So I’ve been working hard to master the route between the flat and the office and also where to buy anything I need so that I don’t need any help. Srav is always making some amazing dal and offering it to me. He is a bit perplexed by my making a meal out of ramen and biscuits. It is hard to explain. He makes me strong Indian coffee and convinces me to get a delicious chai on the street. (It was 38C/100F and we were walking to work and he said “Do you want a hot chai?” and I said “No I’m okay.” and he said, “We’ll just get some then.” And we did. And it was delicious. And it really didn’t make me any hotter. It was 10 rupees (about 16 cents).

The flat is really nice. There are ceiling fans and three big bedrooms for the full time residents and two washrooms with water heaters for the shower. (Not that you need them this time of year. It’s been over 104F/ 40C every day I’ve been here so far.) There’s a well-stocked kitchen for Sravan to cook in and a housekeeper who straightens up after us and does the laundry. We have wifi. There are some small shops and fruit stands nearby.

Shops in Delhi have pretty much anything you would need. Familiar brands of everything. (Ragu, Oreos, Pantene, Colgate.) One liter of Coke is 55 INR, (about 86 cents). Doritos are easy to find here and 200 INR a big bag (about $3.14). I haven’t seen a Snickers yet, but when I do, I’ll know how to price my own ‘basket of goods’. (Ed note: 38 rupees / 60 cents) It seems like it would be an easy place to live. Delhi is great. I’m enjoying the trip. I have some other thoughts that started while I was walking around the city, maybe darker thoughts, but they’re really not about Delhi. A future post I guess… Stay tuned.

So far my impression of the new job is that it’s filled with these nice geniuses. Everyone here is being warm and kind and is really impressive. They all speak a ton of languages and have a bunch of degrees and I keep hoping they don’t realize I don’t belong… I’ve been onboarding and learning tons of processes: their sales process, the pricing model, application customization and design. Every day they bring in some amazing catered lunch and the whole office eats rice, and roti and dals and yogurt and some other delicious items I’ve been told the name of lots of times but can’t quite retain.

On Friday I got to go on a fascinating project visit. The project is a pilot funded by Grand Challenges Canada to improve outcomes for maternal health by tracking antenatal care and labor and delivery care in a maternity ward on an app on a samsung tablet, rather than these crazy giant (ex-colonial) registers where they record everything now. We went to Jamia hospital, in the maternity ward and saw the nurses recording details in the custom app. Patient name and medical history, risk factors, maternal and fetal heart rate and all the elements of a ‘partograph’. A partograph records data like dilation, contraction frequency and severity and location of the fetus and can provide decision support. It makes a lot of sense to me that a tool like that should be in an app and not on paper. It is faster for the nurses to complete and then of course there can be reporting and data analysis afterwards. There are so many factors that influence maternal health outcomes, so this is only a tiny piece of the puzzle but it does seem like a step forward.