Monday, Dec 5th: The Chennai Surprise

Getting an auto rickshaw to the railway station after 9 PM is always a challenge in Bangalore. Fortunately, as we were searching for one, a BMTC (Bangalore Metropolitan Transport Corporation) bus headed that way stopped for us even though we were in between bus stops. Somehow I wasnt really surprised that he stopped again between bus stops for another 3 (or was it 5) minutes to draw cash from an ATM !! But it was a pleasant surprise to see one of the passengers call up the BMTC complaint line and immediately lodge a complaint that more than 50 people in the bus were kept waiting for the driver to draw cash in an ATM. The incident highlighted the problems of modern banking in India - not enough ATMs ... but I guess thats true even in the US, there never is an ATM nearby when one wants it real bad !

We arrived in Chennai at 5 AM, and discovered that prepaid auto isnt really prepaid here, the prepaid window writes down the cost of the ride to the destination, but the cash is given to the driver - leaving open the chances for the autowalla to make some quick money. Waking up Dhanunjay and a few others who were sleeping in the office we were ready for a long wait before the AID Chennai folks came in at 10.

Initially, the plan had been for Sudha, Madhulika, Kamayani (formerly with AID Milwaukee), Chandrika (formerly with AID Austin), and myself to join the Chennai team on a survey on health indicators amongst some communities in Vembakkam near Chennai. But the recent spate of rain and cyclones in Chennai had once again thrust the Chennai team towards relief work, and that was going to be the main agenda of the day.

As the 'stock taking and planning for the day' meeting started, Sudha and I were on opposite sides of the circle ensuring that everyone was entertained by our dozing! The situation in the affected areas was pretty grim. Reports of efforts undertaken over the previous day and an assessment of requirements and plans for the day were discussed. The limited amount of food and material collected (and bought) was distributed to the various areas on the basis of this discussion. Different members of the group were being assigned to teams headed to different places, and an inexplicable feeling within kept me in the background, and not volunteering to join any. Sudha joined a group headed for Saidapet. After the teams started to disperse, my late attempt to join the team going to get more bread was botched by my weight – I was too heavy for the only two wheeler around !

I hung around the AID Chennai office, shadowing Balaji around. After a few hours, it was decided that after lunch I would join the team going to Kallukuttai, a slum near Velachery, located in a low lying area that has been flooded every time there has been heavy rains. Given my Tamil skills, I was only too glad when I was asked to be the photographer. I was accompanying Vanaja, Mangai and another volunteer, and the 45 minute ride to Kallukuttai was another round of dozing off! Once we reached Kallukuttai, sleep was far from my mind. The area was still under water.

As we entered the water logged road leading to the slum, a catamaran was leaving with supplies of bread and rice. We were asked to wait for another one that was coming back. It was a non - surfaced catamaran that we climbed into - the shaped logs of wood were held in place by cross beams, but didnt have a surface that would keep the water out. So by the time all of us had climbed in, the water had risen to our seat level ! The only relief was to know that the water was the run off from a nearby lake and didn't have any contributions from the city sewage system ... well, that doesn't by any means imply that the water was clean ! I was clicking away on the digital camera that Balaji had given me – the scene I was witnessing was something we see in TV reports and news flashes. The only difference here was that this scene had persisted ... and repeated itself every time Chennai is hit by above 10 mm (?) of rain during a single day.

The three or so sacks of rice brought in the catamaran carrying supplies was bought by a few community members from the marooned areas for setting up a community kitchen there. The mandate of the group I had accompanied was mainly to distribute the bread. But there were way too many recipients than the group of people distributing food could control. A few attempts were made to get the food supplies across the waiting crowd to a marooned high ground before starting distribution. As the restlessness and the entropy within the crowd increased, the team decided to distribute part of the bread here and carry the rest across. Before the catamaran with supplies was brought close to the crowd for distribution, a few sacks were filled with bread and carted away to be kept aside as a reserve. The distribution started quite peacefully – a human conveyor chain was formed to get loaves of bread that were handed out, rather than getting the catamaran close to the crowd. But the situation slowly deteriorated out of control – there were too many people seeking food and too few with an appreciation of the need for order and distribution. As about half of the loaves of bread were distributed, the agitation grew and the local volunteers distributing the material steered the catamaran further away. We were advised to get back to the road and not hang around, and after a little deliberation, we climbed into the other catamaran and headed back ...

One of the area coordinators started discussing how things went and what needed to be done. An earlier discussion on the need for sarees and bedsheets was re-iterated and it was a bit of a surprise that I was now being asked to talk to Balaji and try and convince him on the need for these ... I was actually thinking how futile such an effort would be, given that the entire community was living in at least knee deep water ! The need of the community might have been better clothing and warmer beds, but it would be a hard sell for anyone to project this as the need of the hour ...

We returned to the office by evening, tired field groups were trickling back into the office. I had a quick bath and had changed out of the soggy clothes before Sudha turned up. As planned we headed out for a quick bite before heading over to Chandra's house for the night.

A trickle in the flood

December 5th, 2005 (contd.)

Once all the day's plans were made, Balaji began assigning us 'outsiders' to different teams. Other than Chandrika, none of us speak Tamil. In her case, she had accompanied some volunteers to Koturpuram the previous day where they had found many more people than they could possibly help. Chandrika had taken photographs but beyond that, could not do much. With a tiny bit of worry about what exactly I was getting into, I accompanied Gnanaprakasam, Sumati and Suresh to Saidapet. Sumati and I took about 150 packets of buns with us in an auto while Gnanam and Suresh were on a motorcycle.

In Saidapet, almost an hour of confusion followed. We waited at one gate without a mobile while the guys waited at another gate. We went through a teacher's training college where a temporary camp was set up, but could not find anyone from the group there. Finally, we met up with Suresh and Gnanam and went into a community near the relief camp. Here, people had moved back into their homes a day after the waters had receded. Recovery activities within each house were in full force – mats and household items were being laid out to dry, kerosene stoves and other appliances were being repaired and clothes were being washed. Almost all of the women were hard at work.

We met a few local people whom Gnanam had met earlier – from here on, I could only understand part of the discussion because of my limited knowledge of Tamil. But the upshot seemed to be that a few members of the community would take up the job of distributing buns and that one packet would be provided per household. A number of us had turned up, and there was no work for us at the present. Most of us chose to follow the people who were distributing the buns. It was interesting to see the reaction of families who were receiving the buns. Some were completely disinterested, mechanically receiving them. Others, with children, asked for more than one packet. One lady, on hearing the one packet-per-household rule, returned the packet and an argument ensued. Children eagerly came to the distributors and in some cases, the packets were opened and individual buns were handed out.

One of the group members went to get lunch and we sat down to eat on the street itself – later in the afternoon, a medical camp would be set up and we would have to help out with that. Meanwhile, I had been noticing a young woman washing her clothes a few yards away from where we sat. She ignored her toddler daughter who was making a fuss nearby (and who was eventually taken up by a neighbor) and methodically scrubbed and rinsed clothes, undergarments, bedsheets and more. She was representative of the women in this neighborhood – everywhere they were hard at work. I felt that our buns were of little use here. What would have really helped this woman was a full meal so that she would not have to cook or go hungry. And that was beyond our capacity...

After lunch, we moved to a parallel street where two tables had been lined up for the medical camp. Now started another long waiting period. The doctors were supposed to arrive at 2:30 pm, but that time passed without them in sight. Luckily for me, Smitha joined the group and talked to me about her work in Sulagiri and the activities in AID Bangalore. Finally, at 4:30 pm the doctors arrived. After a short discussion, it was decided that two doctors would stay here and one doctor would be escorted to Koturpuram to run a medical camp there. I chose to join them.

In Koturpuram, a government camp had been set up in a school – as before, this area was covered with drying clothes. Ravishankar met us at the entrance and escorted us to an area in the center of the school. Here, a table and chair was set up for the doctor and a couple of benches for dispensing medicines. The group got to work, opening boxes and setting out medicines while people lined up. As the doctor examined, Grace dressed wounds and some of the others handed out medicines based on the doctor's prescription. At first, just a few people were in line, but as word spread of the doctor's arrival, more began trickling in. A few had flood and water-related problems such as diarrhea, but there were other day-to-day problems. A few boys came in with play-related injuries.

Another doctor was being expected and finally arrived at about 6 pm. All this while, I hadn't been able to help in any way – expected, but frustrating. So when some full-timers left, I joined them. It seems that quite a few AID Tamilnadu full-timers live in Arakkonam, at least 2 hours away by bus and train. Thankfully, I did not have to travel all that far... after returning to the AID Chennai office, Dwiji and I headed to Chandra's house nearby for dosas and a good night's sleep.

A bird's eye view on a foggy morning

Sunday Dec 4^th:

Our morning in Timbaktu started early. Much to the surprise of Shailesh, who had volunteered to be our guide for the early morning hike, Anitha and I woke up on the sound of the alarm and as we were stepping out, a sleepy Sudha surprised us at the door saying she would join us if we waited for a few minutes !! We hiked up to the saddle point to the north west of Timbaktu and Sudha decided to stay on there, while Shailesh, Anitha and I went ahead to climb up the tall peak further north of the saddle. Though the trek up to the peak was good fun, once there, it wasn't much fun. The fog was still quite thick and we couldn't see much of the view that we had heard comments about from the folks at the collective. Just as Sudha was about to give up on us and turn back we reached the saddle point and all of us headed back, all primed for a much needed breakfast !

After a relaxed breakfast and a hurried bath we headed out to meet with Dinesh, Subba, and Babloo in the remaining couple of hours at the collective. Sudha was able to join in a conversation between Uzramma and Subba in the mess hall while I sought out Babloo to talk to him about our ideas for the next few years. It was a short conversation, he felt that the conversation would be better held in a wider group, especially so because he himself didn't have to make the switch from a mainstream job to that of the collective. We joined the group in the mess hall and the next hour was spent discussing perspectives and approaches that one comes with when stepping into the alternative or developmental arena. More on this in a later post ...

We headed back to the collector's hut to pack up our bags and headed to the Chintavanam office with Dinesh. Overlooking a demo plot, the Chintavanam office is located just a kilometer out of C.K. Palli village and is a spacious and airy building constructed with the purpose of serving as the main office of the collective. We sat there to chat with Dinesh about the organic farming efforts the collective has undertaken. The collective works with farmers from the neighbouring villages moving them towards organic agriculture. Produce from organic farmer's of neighboring villages are collected and marketed by the collective, and Ashis is responsible for these marketing efforts.

We headed back to the collective had a quick lunch and started back for Bangalore. Madhu also came along – the three of us would be leaving for Chennai by the night train. We reached home base after 4 and a half hours, with the last 60 kms requiring 2 hours!

An education at Timbaktu

Saturday, December 3rd:

We woke up early Saturday morning to head to the Timbaktu collective 165 km away. Travelling with Dwiji and me were his parents and sister Anitha. The collective is in Anantapur dt., AP very close to Chennekothapalli. We had heard of this group through various circles and incidentally Ashis, Madhulika's (formerly from AID Austin) husband is working there. Madhu herself is spending some time there after her return from the US and was to join us on our way back. We met up with her in Chennekothapalli and headed to Timbaktu, off the main road (National Highway-7).

One of the major efforts of the collective has been the preservation and regeneration of the local scrub forest. When they first bought the land, about 32 acres of it, it was completely bare. Now, 15 years later, it is covered with trees, shrubs and grasses. They have also protected surrounding areas from forest fires. Overgrazing is not allowed on Timbaktu land and the need to control grazing has been accepted by local communities managing their forests in the area. Of course, not everyone is happy with this – the next day, we overheard an altercation between a goatherd and a member of the collective over goats straying into areas they shouldn't be going into.

We were shown to our accomodations and found that the house we were staying in was built by a Collector who supported Timbaktu and had recently passed away. The neighboring house was built by Uzramma of Dastkar fame, who was also visiting this weekend with her son. Dastkar is a weavers' collective based in Andhra Pradesh which has done amazing work in regenerating incomes for weavers, introducing (or re-introducing) handloom textiles and natural dyeing techniques throughout the country and sensitizing the government and institutions about the problems faced by the weaving communities. Thousands of weavers have been mobilized and now have a powerful voice.

Back to Timbaktu... we headed out to lunch in the collective's kitchen and then decided to visit their demo plot. The collective has started working on agricultural issues a few years ago. Prior to that, they were procuring traditional grains such as ragi, sama and korra and using them to make biscuits, laddoos and other products. These grains were traditionally grown in an organic manner and continue to be grown thus. As time passed, the value of promoting organic techniques for other crops and approaches such as mixed cropping led the collective to begin agricultural interventions. This part of Anantapur dt. is dominated by groundnut production. But though this crop is planted along with pulses (toor), its continuous cultivation has led to lower yields and quality. Like in the cotton growing belt, there have been suicides here and depression, migration etc.

Further, with its commitment to organic products, the collective was finding it harder and harder to procure enough grain for its products. So, gradually, discussions were organized with local farmers and information about sustainable agriculture shared. The demo plot, 'Itavanam' is a valuable tool in this intervention.

The plot was about a kilometer and a half away, so the 'younger lot' walked there with Shailesh, a volunteer at the collective involved in gardening. Shailesh also talked about his involvement in putting out forest fires – the land around Timbuktu is reserve forest, but no Forest Department officials are present in the area. So, when forest fires erupt, the collective members rush out to put it out by beating the fires with palm leaves. Shailesh's job has been to cart up water for the thirsty fire-beaters – a sweat-inducing one in itself! Temperatures in the summer can go up to 45°C and they have to be particularly vigilant at such times.

'Itavanam' is flanked on one side by neem trees and by a variety of fruit trees on the other. Different pulses have been sown alternatively with ragi, castor and varied beans. Groundnuts have also been planted in some rows. The approach of the agricultural group has been to work on pest management first and then on reducing fertilizer inputs. Neem is invaluable in the former and we also noticed some insect traps throughout the plot. As Madhu explained (she has been doing a survey in one village about this) the biggest attraction of organic farming has been the reduced cost of inputs. The yield has not necessarily improved, but as long as it remains the same, farmers will be receptive to the approach.

Dwiji's mother grew up in a village (in Kolar dt.) and used a lot of these plants in her childhood. So she talked a lot about how different types of leaves are edible and in what stage, how certain pea or bean pods could be used etc. We sampled all kinds of grains, fruits and groundnuts – after all, how can a farm trip be complete without grazing?!

Timbaktu operates a number of schools – one in Timbaktu itself (a residential school) and day schools in Chennekothapalli and 3 other villages. We had to decide which school to visit and picked the residential one. We reached the school just as it was closing and the children rushed to meet us. A lot of attention was focussed on Dwiji and his hair, with one kid making up a story about how he is Dhoni's annayya! (for those uninterested in cricket, Dhoni is one of the new stars on the team and sports long, gold-highlighted hair) We talked briefly with one of the teachers and were told that this was the kids' gardening time. They all tend to gardens which supply most of the school's vegetable needs. Also, these kids are all from agricultural families, so this is a useful life skill for them. They get used to mixed planting and organic farming, so get 'trained young'. The kids were extremely enthusiastic, especially dragging Dwiji's mother to see yet another plant or tree. They had beans, tomatoes, sitaphal, brinjal, papaya... the list goes on. With the onset of heavy rain, we finally were able to say our goodbyes!

The school in Chennekothapalli, Prakruti Badi was first started to serve dropouts. As they began getting good results with these 'problem children', more people showed interest in sending their children to these school. Thus, gradually, day schools were expanded to other villages. The residential school was started with the idea to serve disadvantaged children – those with a single parent, extremely poor background, disinterested parents etc. When parents come to the school seeking admission for their children, they are asked to leave their names in a register. Some children are recommended by the cooperatives, villagers etc. Teachers go and investigate the child's background to see if they are suitable candidates for the residential school. Initially the education was offered free of charge, but it was found that this did not encourage parent involvement in their child's welfare. So a nominal fee was instituted. Since the school is fully funded, this goes into an individual savings account for the child. All this was explained to us by Kalyani, one of the teachers in Prakruti Badi, over tasty gongura tea prepared by her. Kalyani is the originator of many of the recipes for Timbaktu products. She is married to Dinesh, who is in charge of the agricultural program. Dinesh was to return the next day from Hyderabad, where a fair was being organized by CSA (Center for Sustainable Agriculture).

After dinner, we went to drop off Madhu in Chennekothapalli. Ashis was working late into the night with the cooperative to pack biscuits and other products for the fair in Hyderabad – he was heading there on Sunday night. The collective had recently participated in an organic fair in Bangalore. This year, they had produced 10 tonnes of products and Ashis was confident they could sell those pretty quickly. To reach the next level of marketing and sales, in his opinion, they would need organic certification. Most such certification is very expensive, working out to atleast Rs. 1000/acre. For a farmer who makes about Rs. 1500 profit/acre, this would only make sense if (s)he can make atleast double that profit. Again, Ashis thinks it can be achieved, but the links need to be established. That is the focus of his work with the collective.

We went to sleep with plans to go trekking the next day.

Biomass and critical mass

Tuesday, November 29th, 2005:

On this day, we visited the Magadi area, about 40 km north of Bangalore – in some villages here, Prasanna (AID Saathi + Full-timer with AID Bangalore) and others are involved in an agriculture intervention. Prasanna had sent out documents a couple of days ago and I was pleased to find a report about their trip last year to Mr. Renake's project in Solapur. Mr. Renake has been producing vegetables in arid Solapur (and neighboring areas) and it seems he has demonstrated the best yields in such conditions.

This particular intervention in Magadi is being supported and planned by Dr. Datye. The team working on this includes Prasanna, his sister Prafulla, Vatsala - an (early) retired IISc professor, Ravi and Mr. Ramamurthy. The goal of the intervention is to introduce sustainable approaches to growing vegetables, grains and pulses etc. while working with the local population, especially the landless poor, to generate (or regenerate!) agricultural livelihoods. One way in which this could be achieved, according to Dr. Datye, is to work with Panchayats and develop food-for-work programs initially when the land has not reached its full productive capacity. Further, once these techniques have been well understood by the villagers, the Panchayats or Zilla Parishads (district level administration) could allot government 'wastelands' to the landless so that they can develop it further. According to Mr. Renake, 10 guntas of land would provide work and partially meet the food requirements of 5 women and their families. According to this group, that is too hard to implement, especially in the early stages, so they are working with 20 guntas (half an acre) for a group of 5 women.

Our first stop was Thorepalya and Mr. Ramamurthy's land, which is one of the plots being used. Mr. Ramamurthy retired from a senior position at the National Aeronautic Labs and is a philanthropist/social worker. AHe has raised funds to build a school for children in the area. The school buildings are all in the shape of a pyramid – apparently this structure concentrates the senses and aids thinking!

At Mr. Ramamurthy's house, we also met Ravi, one of the key members driving the project. Ravi hails from Motaganahalli, one of the villages in the area where land has been leased at a nominal price for the project. His presence and relationship with the villagers has meant that they have been actively involved in this process. Such is not the case in Mr. Ramamurthy's land – he calls for laborers when required and manages the planning etc. himself. However organic techniques, including the Madagascar or SRI technique for rice, are being employed on his land. He has also had a composting pit built and the humus generated has been used in an experimental plot. The soil in this area is predominantly red soil which has a low water-holding capacity. Addition of humus improves water-holding capacity as well as nutrient availability. In one plot, Mr. Ramamurthy has planted banana trees and in others vegetables. One plot is being used as a control plot in order to record differences in yield.

We next went to Maralagondala where Prasanna and Prafulla have bought land and are experimenting on it. This land was all under banana and ragi cultivation earlier. A caretaker, Govindappa, has been in charge of the farm and apparently he is not convinced enough about these methods to follow Prasanna's instructions. Subsequently, only one plot, in which Prasanna personally planted horse grams, has been worked on as planned. In a few other plots, mixed cropping techniques were initiated. Alternate rows of tur, jowar, marigold and other seeds had been planted in one but were not well tended. Inspite of that, they have grown well and are close to harvest. Prafulla and Prasanna had faced a number of personal issues, including their mother's illness, this past year and so could not devote as much time and energy as is needed in such an intervention. Further, because of Govindappa's lack of enthusiasm, it has not been easy to get local support. Prasanna has begun going to the farm regularly (atleast once a week) in the past few months and has also met the women in a local savings group. Hopefully, over this coming year, he can build stronger links with the community.

The last farm we visited was in Motaganahalli, Ravi's village. This was the best example of the project, also of Renake's methods. Rectangular plots had been prepared in a raised-bed style (here humus and soil is heaped on top of the ground without digging and seeds/saplings are planted directly on it – it is less labor intensive) and planted with radish. Circular heaps have bottle gourd in them and in other plots ragi is being cultivated. Vatsala and Ravi had planned to measure the height of ragi in a control plot, but it had already been harvested! Apparently, out of fear that the next day may be rainy (a reasonable one considering how wet this year has been), the women working on this land had harvested the crop the previous day. The travails of data collection!

In Renake's approach, 1.2 tonnes of biomass is required per gunta, especially in the initial stages. Since the team started work late this year, they were not able to collect as much as required, so have set up one plot with less biomass. Next year, they plan to put more land under cultivation and work with other organizations in the area. They will continue to record and analyze their results in order to come up with a feasible approach for this area.

The social aspects will also have to be concentrated on – more local people will have to be convinced about or develop an interest in the project. Prasanna has had some interactions with youth groups and women's savings groups. As he puts it, the social, economical and political conditions in this area have to be looked at to achieve some measure of success in this intervention.

Sound bytes from Magadi

Its almost been a week since we landed in Bangalore. The city has changed, but I found it more interesting that the people have changed so much more. Kannada has been on the wane for sometime now, but the ease with which auto drivers and bus conductors, vegetable and fruit stall vendors and many others start to speak in English took me by surprise. Or maybe the pony tail I sport these days is giving them the impression that I am not from these parts ...

On Tuesday, Sudha and I accompanied Prasanna, Vatsala and Prafulla to a project undertaken by the AID Bangalore chapter. While Sudha is compiling a detailed note about the visit I am have taken up the simpler task of cataloging and uploading the images and audio from our trip :-)

There are three audio files describing the two different manures that they use - green manure and vermicompost. The lead voice being that of Ravi from Motaganahalli, a village activist, mobilizer, and the local resource person for the project. Prasanna and Vatsala also chip in in the green manure snippet.

Murphy had to be vindicated - by the time we reached the most picturesque part of the project the sun had set and we had to make do with so so snaps using the small flash from a digital camera. The couple of shots of Prasanna and the one with Werner, were taken in Prasanna's house, when we visited him on Saturday.

The entire collection can be found here ...

Class wars

Living up to tradition, the night before leaving town was a non stop work-a-thon. The good thing is that I was able to (atlast) complete some book - keeping that has been pending since June !! The first journey of our tour began with an ominous sign - as we checked in our baggage and got our boarding passes at the MSP airport, we werent assigned seats for the Amsterdam to Mumbai flight - we would have to checkin (again) once we reached Schipol. As our flight approached Amsterdam, I realized that we would have just about an hour and a half in Schipol !! The ticket we originally bought for our international travel was for a Northwest Airlines flight from MSP to B'lore, via Amsterdam. NWA aborted its plans for starting flights in this segment and we were stuck at the raw end of the deal in early Nov. - either a full refund or fly in thru mumbai and out thru delhi. The decision was a no brainer, and ofcourse, this sets the context for our seatless check in. As we approached the transit desk in Schipol, the computer network went down. After a few minutes wait, we were asked to go directly to the gates and were told that the staff there should be able to assign seats as well.

One of the cool things I married into is access to the knowledge base of a seasoned traveller. In Schipol, on the level above the one in which the gates are (follow signs to Lounge 40 - 41 invitation only), there is a rest room which has a shower in it! Its just before the invitation only lounge, and yups it is free !! After a quick shower, we realized that we had less than 20 minutes left, and rushed to the gate. The chocolates I had promised my sister would have to wait for another time.

The network wasnt yet up and we were asked to wait till all the other passengers had boarded the flight. After holding off till 5 minutes after the scheduled departure time, the lady at the desk called us over and informed us that we were upgraded to First class and had seats 4J and 1 H !!! I think it was while we were checking in in MSP, in reply to Sudha's pondering on whether we would get a seat at all in the Amsterdam - Mumbai flight, I had reasoned that maybe we will be given an upgrade to first class. Well, for a change what I said had come true !

NWA cancelling flights to B'lore after we bought the tickets had brought my distaste for a floundering airline industry up close and personal. Now, stretching out on a first class seat, after a heavy meal, I am glad that the storm brewed the way it did ! We hadnt heeded to the advise of a more cautious travel agent, the Amsterdam - Bangalore flight had been cancelled just at the right time, we got our tickets for the Amsterdam Mumbai flight just at the nick of time, the network going down in Schipol, two vacant seats in the business class, quite a few factors that brought about the perfect storm ... Well, actually the other face of the storm will only be seen when my sister realizes that we did not get even a single bar of chocolate ! I hope the first class travel accessories can be the compromise goodies :-)

Even as we were settling in the lap of luxury, one thing kept striking me again and again, there's so much space here ! After a few moments of surprise at discovering the various luxuries of first class travel, invariably the contrast of the luxuries of the first class area with the cramped spaces in the economy class hit me. On our Mumbai to Bangalore flight, it was a pleasant confirmation to realize that I felt more at home in the economy class travel.

The last India trip?

Sudha and I are about to start on another trip to India. Given that we are planning to move back once I am done with my PhD, this might very well end up being our last India trip.

Its going to be a 5 week essay, with the longest stay being the week in Bangalore soon after we land on Nov 25th. As expected we are travelling on a packed itinerary. But thinking about all the places we wont be able to go and people we wont be able to meet makes me sad :( ... but then the fact that we wont be in my home town for more than 11 days aggregate also makes me sad. With all the folks we wish to meet up with in B'lore, I would be really glad if we can call on atleast the first circle of family and friends.

As I look forward to it, the highlight of the trip is going to be the 2005 AID India Conference in Delhi. Other than that we will be meeting with quite a few interesting groups and individuals, more about all that in future posts. Drop back over the next few weeks to see whats happening. :-)

The North serves South crew on CBS

Unfortunately, there is no video - we might have to pay for it if the reporter forgets to send the tape. But the text of the article (linked above) conveys the spirit, I think.

After the flood

Sunday, September 4th, 2005

Early Sunday morning, the team reached Mt. Vernon and picked up relief materials collected by Brenda. The only item left to complete their load was gasoline cans – and as they found out, they would have been better off buying them earlier. Stores had run out of 5 gallon and larger cans in Memphis and even further north in Arkansas. The southernmost point for getting any was Missouri. So they got off the main road and, with the help of some locals, found a Mom-and-Pop store with cans and barrels in stock. Further down the road, another hitch: they found out that the barrels were not certified to carry diesel! Dr. Stacey, who was in Jackson to escort them further south, agreed to arrange for diesel, so they loaded the cans with gasoline and headed on.

In Jackson, they met Dr. Stacey and Jeffrey Stolworth, a parish minister from Gulfport, MS. Though gas was being rationed in Jackson, they were able to fill up as an emergency vehicle through Jeffrey's intervention. They reached the Biloxi-Gulfport area late Sunday night. Nighttime curfew is being imposed all along this stretch, so they stayed indoors (and hopefully got some sleep).

By Monday morning, they unloaded half their supplies at the Main Street Missionary Baptist Church. This church was serving as a distribution point for the neighboring areas. Most houses in the Gulfport-Biloxi area have lost their roofs, though the structures are still standing. Tarps brought in are being used as makeshift roofs.

The church has asked our team to purchase nails and 2x4s etc. as well as washtubs and other vessels for use in their kitchen. It was decided to go to Jackson for that. In the meantime, Diana and I separately had been making enquiries about Camp Sister Spirit:
http://www.campsisterspirit.com/
and the condition of it and its members. Since it was more remote, it was highly likely that relief had not reached. From Pat in Georgia and James in California, I found out that the founders and members were OK, but thery had suffered water damage and almost 200 trees had been downed by the storm.

Though it was pretty late by the time the team finished their work in Biloxi, they decided to head to the Sister Spirit camp. Maybe because they were exhausted or because the directions were bad or since it was so late, they lost their way and decided to go to sleep in their trucks somewhere close to Hattiesburg.

Caravan down the Mississippi

Saturday, September 3rd, 2005

High on euphoria after Friday's successful material and monetary collection, Diana, Lynn, Aria and Dwiji set out on Saturday morning. The donated 24' truck was only about half filled and the Litahni and I, the support team back home, were to work on setting up collection points along the way in Madison, Bloomington IL and St. Louis.

The fertile belt of South-East Minnesota sparked the idea of approaching farms along the way for their excess produce – after all, this is the peak of the harvest season. Dwiji called me and I followed up with organic farms and farmers' markets in Southern Wisconsin. We hit pay dirt at Turkey Ridge Apple Orchard, about 30 miles Southeast of La Crosse, WI. The orchard had kept aside three bushels of apples (totalling 3000 lbs) with the idea of sending them to the hurricane-affected areas, but hadn't been able to arrange transportation. Our group was in the right place at the right time - whoopee! They found out the Turkey Ridge, in league with other farm groups in Wisconsin, was planning to set up a soup kitchen in Mississippi. Yet another grassroots effort we might be able to partner with...

Further east, I reached Heck's farm market and store outside Arena, WI. They offered corn and melons and got the truck close to its weight limit. Simultaneously, Litahni made contact with Brenda in Mt. Vernon IL (north of St. Louis) who offered to collect materials locally and bring them to a collection point near I-57.

In the meantime, Diana was in contact with a doctor from Southern Mississippi who was only too pleased to hear about the incoming produce. She offered to meet them in Jackson, MS and escort them to a community near Biloxi. When last I talked to them on Saturday, they sounded tired yet excited. They planned to meet Brenda at a Walmart in Mt. Vernon at 2 am and she offered to wait in her car till they got there - good for her!

No more long distance

Friday, September 2nd, 2005

OK - for the next few blogs, instead of yakking about myself, I'll talk about my hubby Dwiji. This dude, also known as Dwija, Deepu and Guru does sometimes seem to be many different people at once. He has been been very effective in providing remote support during the tsunami and the recent floods in India. This time, in the aftermath of Katrina, he decided to take a different approach. Here it is in his own words:

Folks,

I am travelling down the Mississippi with supplies for hurricane survivors as part of a community organization that has come together here in Twin Cities, MN.

Over the day we have been able to collect ...

1. a huge 24' long truck
2. few thousand gallons of bottled water
and clothes, diapers, toiletries, dry food and lots of odds and ends
from the community either as donations.

Also raised about $3k in cash.

We are seeking donations in cash or kind. We still have space in the truck and will be stopping in different places on the way to hook up with groups that are collecting more relief materials. Please send an appeal / forward this mail to friends, relatives, contacts, etc. in Urbana Champaign IL, St Louis MO, Memphis TN and other places along I57 / I55. We are starting MN at 6 AM CDT on Sat. and plan to reach drop off locations near Jackson MS in 24 hours.

More info about the group can be found at
http://northservessouth.com

The latest of list of things that are needed is posted on the site.

The main point of contact will be Sudha Nagavarapu. she will be able to clarify any questions,
concerns and give you an update on how we are doing on time.

I plan to be back home by tuesday afternoon and will try to get as many audio snippets / photos as I can.

+ dwiji.

A great blog on PHA-2

Jeff Conant is at the Hesperian foundation and is active in Right to Water campaigns among many other things. The Cuenca Declaration is noted on his blog - it isn't yet on the PHM website.

Taking stock

July 22^nd:

Before setting out Friday morning, I packed my bags – Jael and I planned to set off at 1.30 pm. Today, there was just one plenary and we had been warned to arrive early to ensure seating and availability of headsets. The final day of the assembly started off with a parade of nations, with representatives from all countries invited onto the stage. Next, Qasem Choudhury, the convenor of the first Public Health Assembly spoke about the assembly in Bangladesh in 2000.

Then Ravi Narayan tok the stage. He spoke of the strengths and challenges that face PHM. An independent audit a year ago had yielded praise - 'PHM is a celebration of diversity.' and a 'young and growing movement'. The charter had been translated into over 50 languages and has benefited from the involvement of communities across the world. It has presence at local, national and international for a through networking and coalition buiding. A world health report – 'Global Health Watch' had been prepared and released. The weaknesses of the movement are that linkages to communities are not yet good and many areas of the globe have still not been reached. And of course, the blight of almost all movements – inadequate documentation. The language barriers have also been an impediment for achieving better documentation.

Of course, there is no dearth of opportunities: more links needed to be established with wider social movements and campaigns. Enthusiasm had to be generated among young health activists and the socially excluded – indigenous peoples, the disabled or differently abled and other groups. Ravi challenged the audience to have 50 % attendees under the age of thirty and/or from marginalized communities at the center of the next assembly. Oh geez, I'm old :(

Some of the question/challenges posed to the audience: is PHM too event- and publication-oriented? Has it done a good job in emphasizing social and political determinants of health? Does PHM make a difference in people's lives? Is it 'for the people' or 'by the people', i.e. is there true grassroots representation? Ravi remarked that this time more campaigns and movements were present (last time it was on a more individual basis), so a lot more people have been represented. But is PHM truly inclusive? A big dilemma for the movement is the balance between supporting local struggles and coordinating global actions. Local as well as policy-level changes have to be made to make a sustainable change.

The audience was then invited to make brief comments. One person mentioned how essential reports on environmental degradation was for the Global Health Watch report (which was released on Wednesday). Others comented that future PHA's should be held in grassroots communities rather than spread out in a city and should have less presentations and more songs and dances. A Canari man (indigenous, from near Cuenca) declared that this historic experience should not only remain only in our eyes and on paper. It should be translated and acted in all the countries of the world with a fraternal hug. A delegate from Africa commented on brain drain and its challenges to health care.

Ravi responded briefly to these comments. He said people have gotten quite carried away with Powerpoint presentations and this will not happen next time around (wonder what gizmo it will be then!). He also said that the choice of venue (which hasn't been very popular for conference purposes – the town is gorgeous though) had been made by the Ecuadorian delegation and reflects that PHM is everywhere – in villages, cities and grassroots communities and now in universities as well.

Next were testimonies from invited delegates. Anita Ghai represented the disabled or 'differently abled' people. She reminded us that we were all only temporarily abled. The group demanded more accessability everywhere – they have had a hard time this week, with being carried around to having to crawl up stairs in some dire cases. 'Nothing for us without us', she declared. Delegates from Australia and Haiti mentioned how important the empathy and friendship created during this week were. In typical poetic style, the Haitian woman declared that 'heaven had descended on all of us'.

Fatima from Bangladesh talked at length about Gono Shastro Kendra – about how it had created a pharmaceutical industry which employs women and supplies essential medicines. It influenced the National drug policy, the Labor movement and the status of women.

http://www.healthdevelopment.org/hphc/gonoshastha.htm

http://www.oneworldaction.org/programmes/bangladesh_partners.html

GSK were at the forefront of forming PHM and their work in Bangladesh is amazing

Lilian, a 13 year-old from Tanzania, delivered a simple message: 'We'll build a strong PHM in Africa'. Finally, a message from Director-General of WHO, Dr. Lee, was delivered to the audience via DVD. Among the various achievements he touted was a Treaty in opposition to harmful industries framed this year. He also lauded PHM's achievements.

It was time for an intermission and I stepped out to find Prasanna and Vineeta outside. After all these days, it was the first time the 3 of us were in the same place at the same time. We decided to skip the next presentation, which was the reading of the Cuenca declaration and discuss AID strategy instead. There have been a lot of misconceptions within us and this was a good opportunity to clear the air. I took the role of clarifying what AID-US is, what it can and cannot do legally and what it could strive to do operationally. The crux of the matter was the role AID-US can play in PHM-US – how much can we get involved in issues of interest in the US. We came to the conclusion that we can actively participate in decisions made in the US that directly impact India, such as the protest against the Patents Act, the anti-Dow campaign etc. The picture is less clear in the case of denial of healthcare within the US, environmental degradation etc. But plenty of AIDers have been engaged in such actions in an individual capacity and we could do that in the case of PHM-US as well. We decided to start on an educational module about PHM and Primary Health Care within chapters in the US.

Prasanna has a number of other thoughts he'd like chapters in US to internalize – thekind of projects we support and the expectations we have from them. I think he hopes that he can promote this through the Health issue. So the right to Health is not just a mobilizing but also an educational tool!

We left the venue to go to lunch and hopefully to meet Sarah and Tawnia there. But it was getting late for me, so I left to meet Jael and head out for the next part of my trip.

A link to photos

The causes of the causes of illnesses

Thursday, July 21st:

On Wednesday evening, I had thought of attending a meeting of the Indian delegation. That didn't happen, but I did talk to Janet Gottschalk of the North American delegation. Janet works part-time at George Washington University and is a visiting professor at Texas A&M University, Laredo. She works on border issues and is also the co-chair for the Religious Working committee at the WHO. She is interested in working on Trade and Health and proposed we connect up with the group working at APHA. A group called C-PATH is also working on these issues and she recommended that we connect with Ellen from that group. We also talked a bit about the education for Public Policy and Public Health in the US. Her suggestion was that I stick to online courses and self-study!

On Thursday, I decided to diligently attend every session I could, inspite of tiredness and muscle aches (in my usual fashion, I had taken a few tumbles in Cajas – but this time, blame the mud!) Plenary A was on the revitalization of the spirit of 'Health for all' and Alma Ata. The Alma Ata declaration was signed in 1978 by most of the countries in the world and promises to provide comprehensive Health Care for all by 2000. This amazing document has almost been forgotten in the mainstream for many reasons: the fall of the Soviet Union and decline of socialism, the rise of neoliberalism, the change in economies, expanding globalization etc. Details can be found at:

The testimonies covered local initiatives in Health Care and mobilization. A speaker from the Phillipines talked about the problems with militarization that her group of community health workers faces, in spite of which they have made strides. An aboriginal activist from Australia talked about the start of their movement in 1972 and the energy they got from attending Alma Ata. The Aboriginal community has been very marginalized, receiving less money for health care and facing the government's 'divide and rule' policy. A recent development has been 'personal responsibility' statements, wherein both communities and providers pledge to meet certain standards.

A short film from Guarjilla, El Salvadore was screened which talked about the resettlement of refugees who had fled to the Honduras during their civil war. Health workers had been selected from the community. They, along with an external group, worked to improve health indicators by constant monitoring through household surveys, the combination of education, treatment and rehabilitation and community radio. While malnutrition rates are 33% nationwide, they are only 12% in Guarjilla.

The next presenter, from Mozambique, talked about a comprehensive health care approach his NGO is implementing, which includes education, sanitation, small enterprises and credit programs. The primary health needs are met by training activists in rural sector and traditional birth attendants. Working groups aimed at finding problems and solving them are set up in all communities. Home visits, prenatal care, immunization and sexual and reproductive health are all part of the program. The difficulties include poor access to information, low sustainability of committees, lack of infrastructure and a poor economy.

Two community health workers from Haiti talked about the work their group Zanmi Lasante does with HIV/AIDS education and treatment. Next, a speaker from Venezuela talked about her country's 'Barrio Adentro' program. The mayor of Caracas had visited Cuba and requested its President for help in improving the medical facilities. Instead of 50 doctors, Fidel Castro sent 100. The program was expanded to the entire country by Hugo Chavez. An official mission has been formed and an agreement signed with Cuba. Health services are now completely free. She said 'Please get the word out that Hugo Chavez is not a terrorist'.

The final testimony was from a street child in Canar province (of which Cuenca is a part). In poetry and spoken word, he eloquently described the plight of street children. 'I don't have a face or a name. I look for you, but cannot find you... I am as important as the birds you feed... I have infections, but the nurses don't treat me... It's not my fault that I was born... My life is a bad dream. Why have you forgotten me?'

Next was the turn of the panelists. First was David Sanders from South Africa. He talked about the progress in Global Health – improved life expectancy and control of diseases – and the widening gap in health outcomes between and within countries. Since the 1980's, there had been mixed success in health due to a split in the health care movement. Some chose to do selected interventions, with some success like with the UNICEF's GOBI (Growth monitoring, Oral Rehydration Therapy, Breastfeeding & Immunization) program. But such programs leave out crucial gaps that can only be addressed using a Comprehensive health approach.

In the 1990's, there were reversals in health indicators due to globalization, health sector 'reform' and HIV/AIDS. Health care packages were now being drawn up with a basic set of deliverables and essential services. The cost-effectiveness of selective interventions was analyzed by the World Bank, with some very strange results. One example is the conclusion that case management of diarrhea and promotion of hand washing is more effective than providing safe water! David showed a cartoon of a man saying 'I'm hungry' and a fat executive eating a scrumptious meal replying 'Stop talking politics'!

An example from the Eastern Cape in South Africa was presented. This was a problem faced in tertiary centers - children were dying of malnutrition at rates of 28% - 46% across the hospitals in the region and this was unacceptable. A little analysis showed that children were dying due to delay in feeding which was the result of staffing and supply shortages. A 3 hour feeding cycle was established, but generated mixed results due to low morale and the underlying staff shortage. But in places that undertook leadership and capacity building, the results were very good. Mothers were educated about nutrition and 76% remembered the instructions. But 71% could not implement them due to poverty. All these households were eligible for but not receiving welfare. An advocacy campaign was launched through the press and the screening of a documentary on TV. Within 36 hours, the health minister arrived in the area and set up a task force for processing Child Support Grants. Thus, 'intersectoral action is required to institute real change'.

During and after the break, we were entertained by the exhilerating of a performance Cuban musician. After this foot-stomping routine, it was time for Michael Marmot to take the stage. Michael Marmot heads the Commission for Social Determinants at the WHO. PHM has achieved enough prominence to be recognized by the 'establishment' – it has a representative to the Commission for Social Determinants and a number of representatives from the WHO were present at the assembly. This has made it an eclectic mix - as Michael put it, this is the first time he has attended a conference with reports from the field and scientific discussions and performances all on the same stage. 'We have all come together on a basic idea – that health is a human right, not an economic activity', he said. We need to look at the causes of the causes of illness, which means that we have to address the distribution of diseases, government responsibility for health and social measures, poverty and inequality, environmental degradation and many other factors. The Commission for Social Determinants was launched in Santiago, Chile during March, 2005 to address this social imperative.

Michael Marmot also presented statistics demonstrating inequities in health. The probability that a 15-year old man will live to 60 is 8.3% in Sweden, 46.9% in Russia and 90% in Lesotho. In Russia, cardiovascular disease and violence have led to a sharp decline in health indicators. He also talked about the burden of non-communicable diseases and injury and the dependance of infant mortality on race and the mother's education.

There are 2 types of success for reducing mortality – the one most promoted is growth-mediated, such as in Hong Kong. But the other type, with support as in Cuba, Costa Rica and Sri Lanka has been equally successful. The commission will look into this and other issues through knowledge networks set up to collect information on specific issues. It plans to come out with a report in its 4-year term. In conclusion, 'what good does it do to treat people and send them back to the conditions that led to the disease in the first place?'

Next to speak was Dr. Espinoza from El Salvador. He talked about how the fight for Primary Health Care (PHC) can be used as an instrument for mobilization and development. He stated that we should be talking about the revitalization, not the resurrection, of Alma Ata, because it is still alive! The concept of PHC was born in communities, systemized in Alma Ata and still alive in communities. Alma Ata was a commitment. Cuba did it. Others have tried, but successes have been reversed in Nicaragua and elsewhere. Yet the struggle continues. He noted the success of the Guarjilla program, the 'silos' in North San Salvador and the healthy municipalities program in Nicaragua. Capacity has to be built at the local level, with activists then going beyond local spheres to mobilize people and influence government policy. Finally, Dr. Espinoza singled out IPHU, the International Public Health University, for praise.

Next was a presentation by the head of PAHO (Pan American Health Organization), the regional organization of WHO for the Americas. The presentation was lacklustre, talking about various resolutions and proposals and repeating a lot of textbook stuff. I later learnt that the PAHO head is a very strong supporter of the PHM model – good for her. Finally, in a short and simple presentation, Thelma Narayan talked about CHC's work in Karnataka. They have used theater for mobilization and have taken on the issues of gender and environmental justice. She talked about a situation (without) specifics where a local community campaigned successfully against mercury contamination by a factory in their vicinity. The Karnataka Task force set up in 1999 and Citizen's charters drawn up at PHC's also came up for honorable mention.

I had talked to Thelma a few days earlier about specific issues AID should get involved in. Our talk had been wide-ranging, with mention of the seeds issue (the new Seeds Bill that seeks to restrict barter and storing of seeds by farmers), health of slum populations and the resettlement of tsunami survivors. Incidentally, CEHAT has a project in Mumbai and Delhi which monitors health indicators of resettled slum residents, and CHC does some work with these populations in Bangalore. I hope I can follow up on this issue (volunteers welcome!) because it connects up the slum demolition issue. Resettlement is not the panacea many of us seem to think it is – conventional wisdom seems to be that slum residents are being moved to better accomodations and therefore should be better off. But this is often not the case. Anyway, more later...

Back to the plenary – it wound down after some audience comments. I was sitting next to Prasanna who was off to a meeting of the Global Right-to-Health campaign. This was being headed by Abhay Shukla and the objective was for participants to take up the responsibility of or to coordinate the developing of campaigns in their regions. This would involve contacting other groups – health-based groups, unions, human rights groups etc. As Abhay put it, the strength of the PHM – its lack of organizational structure and flexibility in operation – is also its weaknesses. At any rate, the PHM charter is such that any group can choose to adopt it and thus becomes a part of the network. He suggested a 6-month deadline for mobilizing and participating in conferences or fora in each region. Examples were the African Social Forum in Harare in October and the American Public Health Association in New Orleans in November. In Latin America, the InterAmerican forum and Alames had been invited to the PHA-2 to get an idea of how PHM functions – hopefully, now they would choose to use the Right to Health campaign as another tool for mobilization.

At 2.30 pm, I left the meeting to go to an afternoon session (no point calling these workshops). I finally figured out which bus to catch – this took me on a roundabout route and I might have been better off walking. But hey, I got to see more of Cuenca... The session I attended was on Seeds, a future under threat. Since there were only 3 English speakers, the translators chose to speak to us in a huddle rather than use the equipment. But it was a struggle – the translators deserve kudos for their hard work. Most of the speakers raced through their presentation and the translators have frantically tried to catch up. Things can't be this hard at the UN and other international meeting, what with diplomats reading carefully from documents, right?!

The presentations were average at best, with a lot of generalities about the field and statistics about the seed and pharma companies – nothing one cannot collect after a couple of hours on the web. The last 2 presentations may have been good, but I was way too tired and left. I had to plan my travel with Jael to Isla de la Plata, referred to in most guidebooks as the “poor man's Galapagos”. Or, as in our case, the poor woman's. The tickets to Galapagos alone cost ~$400. But for this island, we'd just have to take a series of buses to Puerto Lopez and then go on a 2-hour boat trip to the island.

After a rest at the hotel, the next stop was the meeting of the North American delegation. We talked about the Right to Health campaign. The Tennessee and Pennsylvania groups are doing some great mobilization and it was proposed that we build on them. Obviously, though, there is a lot of mobilization around the issue of health throughout the US and we'll have to connect with local groups. The truth commissions being planned in Tennessee could be organized elsewhere. It seems that one such commission has been organized during the Boston Social Forum (in which PHM-US had participated). These are similar to the Jan sunvaais in India. Everyone agreed that we should present information about PHM work in our local communities and there was an idea of coming up with an adaptive powerpoint presentation for this purpose. The social determinants work would involve feeding information to the knowledge networks and also the representative from the US to this commission (hope is faint that she will heed this information). Other groups provided updates – the militarization group had met with the European group and there was a proposal afloat to invite Dr. Salaam Ismael to the US and talk to communities. There was a suggestion that returning veterans who have been denied health care also speak at these events. Both on one stage? I don't know – it feels like the message will be diluted. But hey, maybe it would be a double whammy. And maybe more people will attend than the usual lot who turns up for these events. And maybe Dr. Ismael will get a visa... A national network of health workers is supporting 10,000 GI's who are refusing to go to war – it was suggested that we work with them.

The women's issues group has already been strong and they have had a great track. Nadia Van der Linde of Netherlands had arranged small group discussions in their session earlier in the day to come up with recommendations. Already some of them have been working on the global gag rule that prevents clinics who receive US aid from even mentioning abortion. More info can be found at www.globalgagrule.org
This was one of the issues it was suggested they work on.

Where trade and health was concerned, Janet and I gave our brief report. We were told that Ellen of C-Path would love to facilitate any contributions on our part. It was also suggested that debt relief should be a part of this sub-group. September 23rd, the day before a meeting of the WTO, had been suggested as a day to mobilize. Incidentally, Janet wore a white band to mark her participation in the Edinburgh protests. Finally, the meeting ended with the familiar headache of logistics and returning tickets to be sorted out.

Laura, Sonia and I headed out to dinner – some in the delegation had gone to the Cuban performance. Maybe I should have gone too, but at that moment, all I could think about was sleep, sweet sleep.

In the woods

Wednesday, July 20^th:

Back in the hotel on Tuesday night, we had received a note from Tim Sexton, a student from U of Iowa, saying he wanted to join us on our trip. Unfortunately, we couldn't connect with him. On the bright side, Patty was able to join us as there was place in the van.

For those who are reading this blog to learn about the PHA-2 – sorry, folks! I'll get back on track tomorrow. However, since we learnt about the biodiversity of Ecuador and the healing properties of plants in the mountains, this could be considered a field trip! Read on...

The ride to Cajas took about an hour. We passed through a small town right outside Cuenca. Here, Santiago (our guide) said, every family has a member in the United States. It's the case with most of Cuenca too – a picturesque and teeming town, it's also a rich one. In the usual 'pulling a tale out of a hat' approach, Santiago mentioned that Gayacuil had the highest population in Ecuador, next Quito, then New York! That is, there are more Ecuadorians in New York than in Cuenca!

Our drive to the park took about an hour. Along the way were a few villages and that scourge of the countryside – Eucalyptus. Yes, Eucalyptus does have medicinal properties, its oil is fragrant and good for the skin and its wood is useful. But the trees don't allow any other vegetation to flourish. Further, it depletes the water table with its deep roots. But hey, it's a money maker...

We entered the park and started our first trek – to a height of 4100 meters. The trek was sharply uphill in places and a light rain made it worse. Luckily, I was dressed for the weather, down to my waterproof pants. We reached the heights to encounter clouds in every direction. Santiago suggested we wait and mentioned that we were on a continental divide, that is, water west of us would flow to the Pacific and to the east would flow to the Atlantic thousands of miles away. As he promised, the clouds started drifting away and some of the hundreds of lakes in the park became visible. We returned to the van and drove to the start of the second trek. This would be a 2-hour trek through the mountains and also in a 'wet mountain forest'. Santiago stopped every few minutes to show us a plant or tell us a legend about a certain lake. One lake is considered to 'eat the people' as it has a lot of algae that entangle swimmers. A type of tulip is a hermaphrodite and never opens. Another plant, related to the pineapple, can be eaten in emergencies. A number of medicinal plants and flowers were shown to us.

The wet mountain forest had trees with barks that peeled like paper – I forget their scientific name. After the wilderness in Minnesota, this forest was a welcome change. Here and elsewhere in the mountains, even rocks are covered with vegetation. Mosses, lichens, small plants, daisies at ground level (evolutionary response to the winds) abound. In the mountain forest, we had to watch our heads. Tracks were hard to make out – I wasn't much in favor of a guided tour but now was glad we took it instead of losing our way.

Ahead of us was another group so Santiago took us on another path. This took a lot longer than expected – a bonus was another wet forest. But we were dog tired when we reached the restaurant almost 4 hours later. The lunch was excellent – for the rest, a fried cod and for me, a salad with heart of palms, broccoli etc. The food has been almost universally good here – lots of fruits like naranjilla, mora etc. that are unique here and plenty of vegetables to satisfy the herbivores. After the meal, we went to see a cloud forest. This was at 2.30 pm and the clouds were gone by then. We also didn't see any birds – too many tourists, I guess. We did ask Santiago about the indigenous people – whether they lived in the park and were evicted. Santiago said yes, they were 'destroying' the environment. The biggest failure of environmental movements that look at local communities as the problem...

But overall, it was great to experience the combination of the tropics and the altitude and the amazing biodiversity of Ecuador.

The cost of war

July 19th:

After breakfast, I went to an Internet center to check e-mail and send out blogs. It took longer than planned and I entered the Plenary late. This was on militarization. Outside, I met Nadia and exchanged notes on Monday. She said that her track had decided to shorten presentations and try to facilitate small group discussions so that the afternoon workshops would not turn into mini plenaries. The translation headphones had run out, so she had come out of the session to make phone calls. I went in to find out that the talk was in English – whew!

I also came in for what might be considered the highlight of the session – a presentation by Dr. Salaam Ismael of the Doctors from Iraq society. Dr. Ismael spoke from his heart. No, from his gut. I have been reading quite a bit on the war in Iraq – the casualties, the human rights violations, the devastation. But none of this was enough preparation for listening to a firsthand account of the horrors of Fallujah. Dr. Ismael talked about multiple ways in which health has been impacted – the new weapons of war (cluster bombs, depleted uranium), structural failures (power failures, lack of water), shortage of supplies (medicines, oxygen, anasthesia) and the brain drain of medical professionals. With photos and personal anecdotes, he thrust the situation into our midst. He had to cut short his talk due to time constraints – a crying shame. The crowd gave him a standing ovation.

The next presentation was the Medact report on Iraq by Judith Cook - a summary of statistics, a few of which had been covered by Dr. Ismael, and a list of recommendations. A valiant effort it was, but felt like the lull after a storm. Next was Dr. Bert de Belder from Belgium with an analysis of US military strategy and some actions Belgian doctors have taken. A little more lively. A statistic he quoted from http://costofwar.com was that so far $178.741 billion has been spent on the war. This money could provide 59 years of basic immunizations for all children in the world. An action his group had undertaken was to present a bill of medical expenses for an Iraqi child to the US government. This child had been injured during a US military operation. Reuters had picked up this story and thus it got circulated widely.

Again I had to leave early – we were singing near the food tent at 1 pm. At lunch, Pervez sat at my table and talked about the film he wanted to make and the struggle in obtaining funding for it. Pervez is an ex-psychiatrist who now makes films and performs. He comes from a family of activists – more pedigree. At our table was Patty of IPAS, a group that works on providing safe abortions based in North Carolina (!) and Brahm from the people's grocery in California.

The performance started late, as usual. This time, PHA attendees were present. A positive response here too.

Post-performance, some chitchat and then confusion in finding the venue led to me reaching the Nutrition and Health session late. The room was completely inadequate for the crowd. The smell of sweat permeated the atmosphere and there was barely enough space to stand. Narendra Gupta from Rajasthan was presenting when I arrived. He talked about the Right to Food, Information and Employment campaigns that were launched through mobilization, pressuring of government officials and other approaches. The questions he was asked were about the white revolution, on conditions of Dalits and the use of traditional medicines compared to Western medicine.

Next were two speakers from Columbia. The first speaker talked about a nutrition program launched by her group in a remote rural area of Columbia. This area is at a high altitude and experiences very high humidity. It seems the people in this area were eating a diet heavy in carbs but low in vitamins and minerals. The group went in with ideas about growing quinua, a highly nutritious cereal, and vegetables. To interest the villagers, they conducted cooking classes with recipes including quinua and vegetables. They helped the community set up vegetable gardens and rear hamsters for consumption. After 2 years, there has been marked improvement in nutrition in the area. The second presenter, an agriculture student, presented a proposal for a similar project in Sumapaz, a rural area of Columbia. He also talked about quinua. Incidentally, he talked later about the problems with monoculture, including the increased use of pesticides. But he didn't elaborate on strategies to combat that.

I had a number of questions: one, is quinua a non-native plant to the area, or was it just forgotten by these communities? (I'm guessing they migrated from lower altitudes) If non-native, are there native plants that could provide the same kind of nutrition? What are the pitfalls of introducing a non-native crop? Were they trying any kind of mixed cropping? If so, what?

A number of people raised their hands, however, and asked extremely valid questions. One was about land ownership. The answer was that this is a land reserve, so all land belongs to the government. Which means that the people can be forcibly evicted if the government wishes it. The next question was: how can any work in the area be done without allegiance either to government forces or the guerrilas? The answer was diplomatic, on the lines of 'We are doctors, we can be neutral'. After that, a number of audience members began asking about Plan Columbia – how one could even conceptualize a program for the Right to Food without the Right to Life. A number of people began speaking, there was shouting and I figured my questions could keep – it was past 5 pm and it didn't look like anything else would happen.

I handed my earphones back, thanked the translator (they truly have a thankless job and are exhausted – simultaneous translation is no joke with extremely passionate, rapid fire speakers). Claudia and Jael, a Jewish native of Calcutta currently working for the Ford Foundation, met me outside. They were in the Gender session. We wanted to play hookey the next day and visit either Cajas National Park or Ingapirca, a place with Inca ruins. We went back to the hotel and in search of a travel agent – IXA tours, the official travel company for the Assembly was swamped anyway. We booked a tour to Cajas for the next day.

Next, we headed to the North American delegation meeting. This time, the room was much fuller and we had some involved discussion. Not as much as I would have liked, but I have to agree that longer discussions should be carried out with smaller working groups. Working groups were asked for their reports and sadly had little to talk about. A group was set up to frame a press release – no shortage of volunteers for that! Tawnia was to coordinate a group to work on social determinants for health – I volunteered for that. Sonia and I talked about doing some work on the issue of Trade and Health. Then was time for logistics – Sarah Shannon has been worked hard on this. Some of us had to pay for our tickets even though we had paid Hesparian, others had to run around for hotels. The logistics for this event have been bad. It didn't need to be this way – so many things were done in a hurry in the last month inspite of a year of planning. Anyway, the delegation decided to meet again on Thursday.

A group of us went out to dinner and we convinced Patty to join us on our trip the next day. Lots of food and laughter later, the day came to a close.

Just another manic Monday

July 18th:

Some carry-overs from yesterday – I had met folks from the Media Team and made some suggestions to them. In true voluntary group tradition, I was asked to do the work! One of the tasks included writing profiles of children attending the conference. I met and talked to 2 children from the African delegation (profile will be posted when complete). I also talked to their delegation head, Mwajuma Masaiganah – more about her later.

Anyway, Monday dawned gloomily and we walked over to the University for Plenary A dressed for the weather. The sound system was being unloaded as we entered the building at 7.55 am – so much for starting on time! Deepa (a member of the singing troupe) and I were to leave early so we sat close to the exit. It worked for another reason, because as soon as the auditorium began to fill up, an announcement was made that we had to go out and collect headphones for translation. A group of students collected ID's and even passports in return for headsets. Finally, around 8.40 am, the plenary rumbled to a start.

First, it was the testimonies. A group from Argentina screened a film about the takeover of a factory by workers. This brought out yet another problem – the film didn't run! Too many programs running on the laptop or as one panelist tried to explain it, 'problems with the RAM of the laptop'. Well, the audio was being provided in realtime, so it continued. A doctor from Columbia talked about the struggled to keep the government hospital where he works running in the wake of militarization. The hospital employees had not been paid for months and were now living in the hospital itself. When money stopped coming from the government, the hospital tried to reinvent itself as a cultural center with health facilities and mobilize the community to keep it alive. It hasn't succeeded and is set to close. Next another film which actually ran without hitches – one from Brazil for the 'right to sport'. I had been in discussions the previous day where this 'testimony' had been discussed, criticized and derided for being 'unrealistic', 'promoting something that already occupies so many minds' and so on. The film was OK, interspersing child laborers with elite athletes training in expensive facilities to show the contrast and ending with images of children playing in their school and on the streets as they should.

More testimonies: one from Chile about increasing privatization and another from Argentina about a community struggling with high rates of cancers and gastrointestinal problems. Finally, Thelma Narayan, who was chairing the plenary, took the stage. She said that they had hope to have testimonies from other continents but couldn't get the speakers to the Assembly, so chose to have testimonies entirely from Latin America. Next a dance was presented by 2 children from Bangladesh to celebrate the passing of the torch from Bangladesh to Ecuador. The girl was confident and in control and the boy compensated with plenty of enthusiasm!
After this came the turn of the presenters starting with Abhay Shukla of CEHAT. Abhay talked about the mobilization carried out by PHM throughout India – the 'Jan sunwaais' (people's courts), trainings, reports and so on. Halfway through his speech, Deepa (of PHM Bangalore), Raman (of the government and Mitanin, Chhatisgarh) and I had to leave to join Pervez. We took a cab to Parque Calderon to find, as seems par for the course, confusion. After a few minutes of walking around, we finally figured out where we would be performing. Another group was already setting up – we had been told we'd perform first. Some more talking and negotiating with the other group led to us getting the stage. The lead singer of the other group, Diego, kindly offered to translate. As we performed, the citizenry of Cuenca gathered around - old men talking a walk in the park, mothers with children, some youth. The PHA attendees were still in their meetings, so we had a crowd that had no contextual info about us. Well, they still enjoyed it, I think, or were extremely polite!

It was time for lunch, which was being served in the Medical Facility on the other side of town. There are multiple venues for PHA-2 plenaries and sessions throughout Cuenca and none of them are within walking distance. The only time everyone is at a single venue is lunch. Even more confusing, some venues are listed differently in the English and Spanish versions of the program and others are not marked on the map. The Media center is also in the Medical Facility and I went to visit Nisha and the rest of the team there. Letchu a.k.a. Sowbhagya was talking about the huge quantities of food wasted during the meal – Cuencans believe in serving big portions. I mentioned the widespread use of bottled water in an Assembly that has taken on the Right to Water campaign. She asked me to write about it by 7 pm.

Earlier, when I was entering the building, a young woman sitting outside it had asked me a logistics question. She then wondered aloud how I had figured out all these details – she turned out to be an Ecuadorian by birth (now a US citizen). Sonia is studying health policy at Johns Hopkins and looking at issues of international health and trade. I had planned on attending the Trade and Health session where the discussion was to be on Patents. But since it was already 2.30 pm, we headed to the nearest session – that on an education and training strategy for PHM activists. After some confusion, we found the room – it was tightly packed with more people than capacity. The simultaneous translation system via earphones didn't work, so the translator had to come forward to translate. This meant that each presentation would take twice as long and presentors were asked to cut short their talks.

Lanny Smith of Doctors for Global Health went first – he talked about Liberacion Medicin, a group started in Latin America that 'promotes the conscientious use of medicine with social justice and human dignity'. The talk didn't get into as much specifics as I would have liked – I wasn't able to understand what exactly LM does. There was no round of questions after the talk. Next was David Sanders, Director of the School of Public Health at the University of the Western Cape, South Africa. He presented some health statistics for South Africa. Despite public sector spending per citizen of $140/year, the country' health statistics are poor even in areas such as immunization of children (78%). He then talked about the gaps in delivery, most of which he sees as due to poor training. His School's program for Public Health aims to fill this gap with training of doctors and nurses. It does not focus on methodologies and theoretical work as much on training of health workers from the undergrad stage onwards. Thus even dieticians and physiotherapists are exposed to the Public Health perspectives.

At this point in Dr. Sanders talk, he began getting into more detail than I thought necessary (I sound like Goldilocks here!) Finally he did yield the stage. Thelma Narayan was next but now began a royal snafu. The simultaneous translation system was back on, but there weren't enough earphones to go around. Eventually, folks realized that there were more Spanish speakers than English ones in the room. So a Spanish speaker, Florence Levy, was asked to go next. She is from Nicaragua and began speaking of a University for Public Health there. By this point, I was hot and tired. Further it didn't seem like there'd be any discussion – there were 3-4 more speakers to go. So Sonia and I left to get some coffee and chill out.

Afterwards, I went to the Media Center to write out the article on water and also complete the profile on the African children. I found Mwajuma Masaiganah, the head of the African delegation, in the travel office nearby and asked her for some background on them. We talked about other issues affecting Africa. I asked her if she ever felt that the focus on HIV/AIDS in Africa was drowning out attention to other diseases and problems. She told me that in her talk earlier in the afternoon (in the Gender issues track), she had given case studies of women suffering from Malaria. She had consciously chosen not to talk about HIV/AIDS and had given her reasons to the audience – to return focus to Malaria and other diseases that kill as much as AIDS.

I finished my writeups at 7 pm and left for the hotel. Claudia wasn't in our room. At the Presidente, I found Vineeta Gupta (of AID-US, SHAI and other groups working on HIV/AIDS) She had just contacted Tawnia. Yet another tale of woe, this time hers' of having to pay $60 for 4 hours in a hotel in Gayacuil! A journalist from the Indian Express, Rajeev, was with her – he hadn't yet received his luggage. It was on a merry trip to Caracas and then Gayacuil and...

Anyway, they weren't ready to go for dinner, so I headed out to a vegetarian retaurant for a lonely meal. The fried rice I ordered was great, and the serving as usual was enormous. I asked for a leftovers box with gestures, in the stereotypical manner of every klutzy tourist out there :) Well, at any rate, the mimes worked and I carried my next day's breakfast back to my room.

Heal the world, one delegate at a time

July 17th:

Claudia and I had been told that the US delegation would be meeting at 9.30 am in the Presidente. After a breakfast at the hotel (more explaining about 'sin carne' – no meat), we went to the Presidente. There, we found a number of people dressed in white – it seemed that white apparel was suggested for the healing ceremony at noon. The closest thing I had to white was yellow, luckily ethnic (that wins some points). Some of the members of the Indian delegation were in the lobby and the restaurant upstairs.

The US delegation, or at least those who had arrived – about 20, met in a room nearby. About 65 people have registered for the conference from US and Canada. It was then we found out that we are actually the North American delegation. Mexican delegates are part of the Central American delegation – well, it atleast works out in terms of language!

We went through a round of introductions – this was a diverse set of people with varied experiences. Some have worked on US-Mexico border issues, others are union representatives fighting for heathcare, yet others work on global campaigns and quite a few are students. One delegate from Tennessee, Lori Smith, talked about her problems with health insurance when she fell sick. She is now part of a group organizing a sit-in in Tennessee protesting cuts in healthcare.

We discussed logistics – essential for finding people in this town filled with ~1500 delegates and more tourists. Incidentally, it seems there are only 1700 beds in hotels in this town. I guess a lot more people turned out than the organizers expected! Daily meetings of 5.30 pm were planned and a bulletin board would be set up so that delegates could exchange information. Some topics of interest to this group were discussed – a global 'Right to Health' campaign, right to water, protesting militarization, food security, women's health and reproductive rights and social determinants of health. I volunteered for a few tasks – the result of a high predilection for raising my hand at every occasion :)

Next, I had to buy batteries for my camera. The first shop I enquired in asked for $7 per battery (C2 lithium). 2 blocks down, it was $4!

The healing ceremony was to be led by indigenous peoples from across the world. The goal was to 'activate the earth' and seek blessings. It was held in a highly scenic place – a quadrangle bounded by buildings on three sides and a glorious backdrop on the fourth. We walked in to chanting interspersed with haunting music. The 'convenors', dressed in traditional clothes stood in a circle, with attendees in concentric circles around them and yet more in balconies around. The part of the ceremony that I witnessed included calls to the four directions, the heavens and the earth. Speakers talked about war, oppression and the hope for a better world.

I found Navin, Prasanna and Abraham from PHM, Bangalore in the crowd. All of them were in impeccable white, Prasanna attired in traditional South Indian style. 45 minutes into the event, I felt healed enough and headed out to the secretariat. More walking, especially since I lost my way. Thankfully, streets are labeled reasonably well.

At the secretariat, I found Laura of the North American delegation. We had volunteered to find the room we were assigned (Mt. St. Helena). One hour of searching and questioning everyone we could find (in fluent Spanish, thanks to Laura) was unsuccessful. Finally, Laura was able to collar the Dean of the Medical college and he promised her any room she wanted in the new facility.

Meanwhile, I joined the meeting of the Indian delegation. Because of the organizational needs, many members of this group had been drafted by various committees. The remaining members, almost to a person, were presenting papers – a marked difference from the N American delegation. As they remarked, this is just an indication of how mobilized PHM-India is. Among the attendees from India are Meera Shiva (VHAI), Abhay Shukla (CEHAT), Amitava Guha (of Patents fame) and others. One of the delegates, Pervez, is a filmmaker and musician. He asked for volunteers for a chorus for some performances around town. One more task, definitely more pleasant, added to my list.

After the meeting, I waited for Prasanna to finish his other tasks so that we could discuss a plan of action – we had earlier discussed sharing information throughout the week with AIDers and others. No luck – not only was he busy, but he was feeling mentally drained. We decided to convene the discussion to another day.

Finally, at 8 pm, a group of 5 met in Pervez's room to practice the songs we were to perform – one from the NBA (Narmada Bachao Andolan), another a Bhojpuri song and finally a 'maajhi' (boatman) song. That and a hearty meal signalled the end of one hectic day (of many to follow, hopefully).