Wednesday, June 24, 2009

The end of the road...

So I haven't posted in almost six months (I should've written about China, but I was too busy trying to survive China to write about it), and I'm starting medical school in two weeks. My Wanderjahr will officially end when I make the road trip from Minneapolis to Cleveland to begin my life at medical school. It's been absolutely mental these last 1.5 years, and great fun to know that my friends, family and even the occasional stranger has been living my adventures with me in some small part. Moreover, this blog was a great way to frame my impressions of this time, and looking back, having arrived at this point a pretty strikingly different person, I look back and think what a long, strange trip it's been.

Though my wandering is on hold for now, my blogging isn't. I cordially invite everyone to follow my every embarrassing moment over the next four years at my new medical blog:
The Questionable Admission

Hope I see you around.

Thursday, February 19, 2009

The charm of Hyderabad

So I’m the road again, and it certainly feels good. That doesn’t mean leaving Hyderabad wasn’t hard though.
The charm of Hyderabad lies in the human connection it embodies. Despite the frenetic development of the last decade, with the invasion of IT and BPO services, the city retains a lad-back vibe, and its people treasure their free time...none more so than my jihadi Muslim family, most of whom are blissfully unemployed (I’m not kidding...people with steady jobs in the family are more the exception than the norm; they’re surviving off the land holding they enjoyed as a result of their status as landed gentry in Hyderabad’s previous incarnation as an almost feudal society pre-1948). It would appear then that the apple doesn’t fall far from the tree, as I spent my last two months in Hyderabad unemployed, in typical nawabi fashion. Into this mix, add my various social networks, exquisite Hyderabadi cuisine, cheap green, and you have a recipe for complete dude-ery.
During my last few months in the city, I invariably had at least one house guest from the Center for Microfinance, Couchsurfing (the hospitality exchange website which I am so devoted to), college, or family (the median was more like two or three, and went as high as 9 people on two occasions), and as my social circle among the expat community in Hyderabad grew, my life quickly snowballed into a constant pattern of social interaction. During the day, I would spend some time on self-improvement, 10 push-ups here or there, plus the occasional cooking lesson (nothing too taxing...I swear gravity is stronger in Hyderabad), but mostly, I would simply float around the city, visiting family members, often accompanied by whoever my current house guest(s) were. Simultaneously charming and irksome, Hyderabadis are incredibly informal about social calls, and it is perfectly acceptable to simply show up on a relative’s door step with a friend and expect to be fed; I happily exercised this right, as my expanding waist line can attest to. Over lunch, I’d enjoy the color of my Banjara Hyderbilly relatives (a lame play on “Beverly Hillbillies,” excuse me, I’m an idiot who likes bad jokes...but if you’re wasting your time reading this blog, you already knew that); our conversations would cover anything from the latest anti-semitic topic (“The Jews perpetrated 9/11, I’m convinced of it!”***), family intrigue (I won’t expand on this, it’s too wrong), and perverted religious interpretations of science (“The Koran had written blueprints for atomic energy way before the idiot Germans and Americans figured it out”).
Later, as nights overtook the city, and the call to prayer would echo around the leafy boulevards of Banjara Hills, I’d inevitably call a few friends and make plans for the evening. The majority of the time, this entailed everyone gathering in the living room of my ancestral home, and listening to music, chilling out, smoking up, and getting down together. This didn’t just happen once or twice a week; we got together almost everyone night, despite the fact that almost everyone but me had a job.
By the end of my time in Hyderabad, I had implicit schedule of weekly family visits, time with my grandmother, and get-togethers with friends, and it was almost impossible to ever feel lonely in Hyderabad. It was sweet, and I will really miss it; I’d even venture to say that twenty years from now, I might look back on this time with great nostalgia, but if my delightfully unambitious life plan works out, I’ll be right back to bumming around Hyderabad in 2029 ;). You can take the Hyderabadi out of Hyderabad, but you can’t take Hyderabad out the Hyderabadi; we’re slothful, gluttonous, crude...wonderful people, in short.

***Racialist Disclaimer: I often comment on my family’s xenophobic, homophobic and racist tendences, and I just want to reassure my readers, black, asian, white, gay and particularly Jewish (or a combination of the above) that if you ever want to come to Hyderabad, you’ll be welcomed with open arms (as in those things with an elbow and fingernails, not AK-47s). Despite frequently dumping out the Hatorade, my family is waaaaay to lazy to actively harm anyone. If you can eat, drink (not alcohol though), and be merry, they’ll love you just the same.

Thursday, January 8, 2009


I saw Mischa Barton. In Hyderabad. Outside a nightclub. She was stoned out of her mind. Just when I thought my year in Hyderabad couldn't get any weirder, it grew epically weirder. I f-cking saw Mischa Barton strung out on drugs (she sat on the floor for ten minutes) in Hyderabad, outside the Taj Krishna. God damn, I've seen it all now.

P.S. She was hot, but not as hot as the movies. Still pretty hot though. And in Hyderabad, which makes her that much hotter.

Wednesday, January 7, 2009

Anjuna to Ashura: Part I

What is about to follow, should, by the time I am finished, amount to a massive post tracking my progress from Hyderabad on December 28th, to Anjuna Beach, Goa, for the New Year, to Mumbai, and then back to Hyderabad, where the Shi'ite event of Ashura is upon us. In tracing this journey, I hope to offer some insights on these specific destinations, and also, dovetail on my post about the "Strangeness of India," by rendering specific examples. Enjoy ;)

Anjuna Beach, Goa (December 28th - January 2nd)

Some of you might know about my involvement in Couchsurfing (CS); for those who don't, in summary, CS is a travel social networking site, on which you have a profile, much like facebook. The twist is that you can also indicate whether you're open to meeting other travelers for coffee/beer, and even hosting them in your own home. Since travelers can search for you by your city/country, they might request to stay on your couch/bed/floor for a few nights as they pass through your local digs.

Sound unsafe? Sure, it can be, if you forget all the good advice your mother's gave you. Basically, don't be stupid. Always check someone's profile when they request to meet you or search your couch. CS offers useful indicators of social capital, such as permanent references that others can leave on your profile. In turn, you can check the profiles of the people leaving the references, and their own references, so pretty soon, you can quickly gauge a person's basic tendency to serial killer-ness.

My own experience of CS has been nothing short of sparkling. I've been hosted by people twice, once by a 58 year old ex-lawyer in San Diego, and the other time by a 43 year old in North Carolina (however, most CSers tend to be 18-35); in turn I've hosted a couple people in Hyderabad, and have gone to countless meet-ups, where you don't host anyone, but get to meet all the CSers who are your area. Invariably, I find CSers to be of above-average intelligence, outgoing, interesting, interested, and generally, very free thinkers. In short, they're brilliant people.

My trip to Goa essentially started with CS. Kishore, a local Hyderabadi friend of mine (who incidentally, I first met through CS, though we had many mutual friends), and I both hosted Cies, a lovely guy from Holland. The three of us ended up forming a trio, as Cies stayed in Hyderabad for a month, having found a short-term job through our contacts! (CS even gets you jobs ;). When the New Year was approaching, we started thinking it might be fun to make a trip to Goa together. The trip literally fell together 24 hours before anyone left, and so it came to pass that we all headed to Goa for New Years. Cies and Kishore headed to Goa on a Friday, and I followed the Tuesday after. We opted to head to Anjuna Beach to celebrate the New Year, as Anjuna is the epi-center of Goan Hippiedom.

My own trip started with me almost missing my bus, as I went to the wrong pick-up point, and had to be driven across town on a scooter by the travel agency's manager (he wasn't too pleased with me).  12 sleepless hours later (the bus was horrible, and every part of my seat, I was to learn, was thoroughly broken), I found myself in Mappusa, a small town close to North Goa's beaches.  From Mappusa, I made my way to Anjuna, and joined Cies and Kishore.  We enjoyed a leisurely, open air breakfast wrapped in liquid sunlight and equally liquid Goan trance (a genre of electronic music unique to Goa).  And the morning became only more techno-color, as my friend Cies rolled several large spliffs, and passed them around the table, not only amongst our own small trio, but sharing them with an accompanying set of rich Delhi-ites as well.  It was a perfect morning....

From there, Kishore and I headed to get me a scooter (they already had one), and a separate room, as Pawan, an old college friend of mine, would be joining us later that afternoon (by pure serendipity actually; Pawan joined in the trip 24 hours after we ourselves chose to go).  The scooter we ended up renting would ultimately turn out to be the bane of my existence, and I might have guessed from simply looking at it; it was a rusty piece of sh-t that made me wonder if my tetanus shots were up to date.  I was skeptical, but the rental guy assured me it was reliable.  Sure enough, within 2o minutes of giving "Bike Shambu," 3 days of rental money, the scooter broke down.  Thankfully, "Bike Shambu," or more appropriately, BS, was close at hand, and I was (slowly) on my way again.  

After getting a room for myself and Pawan, I joined the guys and we headed to some random beach (Calangute, I think?), where we ogled the natural beauty of the place, and smoked ourselves into an even more elevated stupor.  Only with night approaching did we make our way back to Cies and Kishore's place (which had a lovely garden seating area adjacent to their room, and hence formed the "adda" or central hangout of the trip).  Upon getting back, I was privileged to be part of a miraculous college reunion, and saw not only Pawan, but Madhav, Manoj, Auyon, and Vivek (all of them South Asian students who atteneded Macalester with me); I actually hadn't known that all of these guys were coming, so it was an unexpected treat.

That night, we headed out to Curlies, a beach side club, to partake in a mini-rave that heralds back to the giant beach parties of the 1990's.  The scooter ride was half the fun; by this point, our automatic gear scooter had become trapped between 3rd and 4th gear.  So if we started from a standstill, we started in third gear...which meant we didn't start....which in turn meant we had to start the bike Flinstone style (you know, running your feet along the ground below your vehicle)....EVERY time we stopped.  Add to this the fact that we were all blazed beyond recognition, it made for a buzzy, frenetic ride that set the pace for our whole trip.  After winding our way through meandering, moonlit village roads, we parked our faithfully unreliable scooter amid a veritable thicket of two-wheelers, and followed a shady, shady path to what was a shanti-shanti party.  As soon I stepped foot in Curlies, the vibe was hippy, trippy good fun.  The party population ranged from three foot dreadlocks and Neanderthalesque dress to Bombay elite lounge suits, and designer hair-cuts....but it didn't matter, everyone was on E, acid, coke, weed, whatever, and everyone was there to have a good time.  Loping through the crowd, which resembled a seabed garden of undulating kelp (the only way I can describe the way people dance to the expansive rhythms of Goa trance), we staked out our corner of the dance floor, and so remained, till the wee hours.  Stumbling home hours later, we spent 20 minutes searching for our bike (which incidentally resembled almost exactly the other ~500 bikes parked in the dark), and made our loopy way home, to sweet, sweet sleep. 

The next morning, rising sluggishly, we eventually made our way to Morjim beach.  I had stayed their on my last trip to Goa, and I wanted my friends to experience the panoramic vistas, the Russian mobsters, and the leggy beauties that stalked the beach.  After run-starting my bike, Cies, Pawan and I were off (sans Kishore, who would end up sleeping the entire day, and even part of New Year's eve...loser).  Apart from Cies' bike running out of gas within spitting distance of the beach, we made it their ok, immensely enjoying the liberation of the thirty minute ride to Morjim (we took in backwaters, oceanside, farmland, and townships on the journey).  

We spent the day at Morjim, lazing about a uber-hippy beach hangout like fat Cheshire felines. We occasionally summoned the reserves to go for a leisurely swim or walk, but it was mostly a stony, still day.

In the evening we met up with my college buddies again, and headed back to Curlies, to enjoy more of the same.  Exhausted from the previous night, I made it to 2:30 AM, at which point, I blissfully passed out on a beach chair, where I slept largely undisturbed (a few druggies took liberties with hair, ears and nose, but no penetration mind you) till 6:30 AM.  I was awoken by a relatively sober Pawan, who had been separated from me during the evening, and had only just sobered up enough to find me.  Re-energized, we hit the dance floor again (which was still just as packed as 8 hours earlier), and enjoyed the fading hours of the celebration.  I should take a moment to note that I have seen only once or twice before such a gathering of stunningly attractive hippy women.  Mind you, these are not rail-thin, Victoria Secret catalogue wanna-be's, but shanti-shanti, wheat-grass infused, fair-trade, organic women, from every ethnicity, Indian, Asian, White, Black, Mixed, etc.  The only thing they unanimously shared were their earthy good-looks (and the smelled good too!).  I could go on for pages, but I'll stop now.  In closing, it was a welcome relief after months in Hyderabad (which has beautiful women, but they're all locked up at home in cages, lest they accidentally speak to a boy before they get married).  

After sleeping a few hours through the afternoon, and seeing Pawan off, we were at it again, this time, heading for the Hilltop Rave, a landmark of the Goa social scene that had been toned down because of terrorism threats (normally, Hilltop starts on New Year's eve, and continues for 72 hours straight, no stopping).  Despite the abbreviation of the event (it was only 12 hours), it was still a winner, with an even hippier vibe the curlies (there was a group of people dressed like cavemen and women next to us, doing a tribal-ish circle dance the whole was absolutely mental.  Moreover, the undulating kelp bed of of trance-heads at Hilltop constantly focus on the DJ, who was enveloped in a giant, glowing DJ booth, flanked by a gauntlet of trippy blacklight poster; all in all, it made for a delightfully zombie-ish atmosphere.  We ended up sharing a chillum with a sadu (Hindu holy man) on the dance floor, and remained at the rave till it ended at 10 PM (it had been going since 10 AM).

Thinking the night had just begun, we rambled out to hop on our scooters, and head for the next party.....except my scooter wasn't there.  Where was it?  Maybe somebody moved we combed the surroundings.  No luck.  Someone towed it?  Nope, the party organizers said no one had been towing that night.  What could've happened to it?  "Well" say the party organizers, searching the ground at their feet, and shrugging as they continue "it was probably stolen, it happens all the time."  Sounds plausible, but wait...there are over 1000 bikes parked outside...why would the thief choose what was undoubtedly (I'm not exaggerating), the most useless piece of shit, pathetic excuse for working transportation in the lot.  Regardless, I'm certain justice was delivered before the crime was even completed, as the criminal realized the sheer folly of his choice as he tried to make a speedy getaway (the bike had a top speed of 40k, going downhill; uphill, you were lucky if it went at all, and it was all uphill to get out of Hilltop's parking lot).  

However, we chose to test conventional means of justice as well, and ambled over to the cops, who promptly interrogated us about our own purposes in Goa, rather than the bikes.  Clearly, that was a poor option.  What to do?  We needed to clear our minds, and think this through.  So we went back, settled down to figure out a plan, and ended up smoking ourselves silly.  It ended up being the antidote.  We woke in the morning, decided to simply skip town without consulting Bike Shambu, and wire him some compensation later, and sure enough, that's what we did.  

Anjuna Hippie Culture

Goa is India's smallest state, located south of Mumbai.  A coastal state, Goa features a distinct local culture, having been under Portuguese rule for several hundred years prior to 1947.  It's a beautiful beach destination, with a balmy tropical climate, and a tourist industry that makes it one of India's richest states.  

However, Goa's tourist status was first established the way many third world destinations have gotten their start in the last 5o years, through backpackers.  The flower power generation, motivated by a desire to leave behind the quotidian routines of life in Western capitalist nations, left home in search of social, cultural and religious revelations, embarking on extended travel, lasting not months, but years.  Given the length of their journeys, they opted for shoestring travel options, traveling from Europe to India by primitive land and sea transport networks.  Given the political situation of East Asia at the time, many travelers finished their trip with a last hedonistic hurrah in Goa, India, before heading home, and so began the hippie scene in Goa, India.

In summary, the hippies sought to construct an underground anti-culture, that usurped the strictures of Western consumerism and productivity obsessed society.  In the end, they imported a hodge-podge of values to India, which were rather unsuccessfully merged with local Indian culture (they quite simply had no idea what India was about, hopelessly mysticizing the place).  The were left with a muddled vision of pseudo-utopian hedonism, about which entire books have been authored; at the core of this were raves (huge underground parties consisting of thousands of people), drugs (everything from hash, to LSD, heroin, etc.), and sex (a lot of it). 

And the latter is largely what survives of Goa's hippie heyday.  Most of the original hippies have ODed, gone home, etc.  What's left is concentrated in North Goa, at Anjuna beach.  The scene is now dominated by young European backpackers, Israeli's fresh out of the army (easily distinguished by their bronzed complexions and devil may care attitudes), and most curiously, a new generation of highly liberated young Indians.  All of these groups have wordlessly co-opted Goa's hippie traditions for their own means, and I have to say, I quite like to result.  At its most essential, Goa is about pure hedonism.  You go there to have a fun time, unfettered by considerations of time, money or responsibility.  And given the laidback atmosphere, low cost of living, and easygoing attitude of the police to all dirty doings, you can get that.  I think few of the people who go to Goa these days fully endorse the escapism it once represented.  I for one, don't think doing drugs on the beach all day exactly amounts to bucking capitalist society.  

However, I do relish the egalitarian festival atmosphere, in which you can rub shoulders with backpackers, local Goans, rich Indian society, package tourists, etc. etc.  Never have I felt less self-conscious on the dance floor than at the raves around Anjuna beach.  Distinguished by striking visual themes (think blacklight posters of alien, mushroom, Hindu gods, and the like), massive beach parties (ranging from 1,000 - 10,0oo), partying that is literally 24 hours (I'm not kidding, around New Years, there is always a 1,000+ person party going on somewhere), and party-goers who are striking non-judgemental, you can let your hair down in Goa as you can in few places.  

Most people would compare Goa to Ko Pha Ngan, where I was earlier this year.  KPN has effectively usurped Goa, as the Full Moon Parties that now make KPN famous were actually a Goan innovation that were shut down in the 1990's (since which Goa's hippie culture has been gradually fading as its replaced by mass, luxury tourism).  However, rich as it sounds, KPN lacks a certain refinement which Goa enjoys.  While KPN is literally pure hedonism (never in my life have I see such excess, in all respects), Goa marries hedonism with a counter-culture sensibility that is free-thinking, intelligent, and very, very rare among party destinations (Ibitza, KPN, and Rio, are again, purely hedonistic in comparison).  In this sense, it has shades of Dharamsala, Rishikesh, and the like.  

Intriguingly, the rich, young Indians who frequent Goa around New Years seem to be embracing this free-thinking, egalitarian hedonism.  Descending like pilgrims from Bangalore, Mumbai, Delhi, Hyderbad, Pune, Chennai, and India's other big cities, these kids often represent the social elite of their respective cities.  However, as soon as they hit Goa, they exchange their designer outfits for hippie uniforms, and mix freely with everyone on the scene, from penniless backpackers to eager local Goans.  Promisingly, some of them seem to be importing some of this egalitarian ethos back to the underground cultures in their home city, creating party scenes that aren't just the playground of the rich, but of young Indians from the middle class as well.  I really hope that the next twenty years sees the emergence of counter-culture's in India that throw off the prim Victoria social strictures that currently dominate youth culture in India (which I can write another post about entirely; the conservatism of even young people has been one of the most trying aspects of my year in India).  I'm hoping for something like Jack Kerouac's "On the Road" beat generation. 

Sunday, December 28, 2008

My life in Microfinance

So I never really posted anything about microfinance, and honestly, I probably never will. In all honesty, it's interesting to read about in the NY times or similar, but to spend six months invested in nothing but can be a dreadful bore, what with all the talk of interest rates, variable repayment schedules on so-on. Nor is it it the silver bullet against poverty. In brief, it is an approach with incredible promise in extending the package of services we can offer the world's poor in pursuit of sustainable development, but we understand ridiculously little of how it works (the jury is even out on interest rates, too high, too low, do the poor even understand the notion of an interest rate, etc.), and we'll need to wait at least ten years (I think), until studies coming down the research pipeline, from institutes such as the one I used to work at (Center for Microfinance/Poverty Action Lab).

As part of my cop-out, I'm pasting in an article that my colleagues and I recently wrote for an economics quarterly. It neatly summarizes the project I worked on. Cheers ;)

Health insurance for India’s poor: All for one, one for Five Dollars

How should a society organize limited resources to finance healthcare for its citizens? A tough question, with many potential answers. An even tougher question might be how a poor society, with 600 million people living on under $2 a day, should finance its healthcare.

The Indian government has opted for a publicly funded health system, but limited by resources, and further burdened by its own corruption and bureaucracy, it has struggled to meet its population’s needs. While vertical programs have achieved some degree of success in combating diseases such as polio and tuberculosis, community health programs meant to address broader issues are less successful. Patients with other illnesses (e.g. hypertension) find government clinics and hospitals overworked, and under-resourced. To help fill this void, non-governmental organizations have stepped forward with their own solutions, but coverage is hardly universal, and often relies on capricious donor funding that only accounts for 2.3% of health expenditure in India1.

When government public health systems and NGO services are inadequate or unreachable, poor households often turn to fee-levying and generally unregulated private providers. These private providers typically offer decent care (though a substantial number of medical quacks operate in this space), at premium prices. Ultimately, households are the major financing source, accounting for 72% of total health expenditure, and moreover, since a very small percentage of households have health insurance, 98% of household healthcare spending is out-of-pocket2. This burden is particularly felt by low-income households, which are vulnerable to illnesses and their corresponding economic shocks.

Challenges at the household level
Take for example Fatima Begum, standing outside her small two bedroom hut in rural Karnataka. A diminutive, but noisy woman in her forties, Fatima relates a sobering story of her family’s health. It starts three months ago with her joint pain and a visit to a local government clinic; the prescribed medication from the visit achieved no improvement, and so Fatima visited additional clinicians. Rolling her eyes and smiling, she relates how her husband, Mohammad, suddenly experienced chest pain around the same time (Mohammed grunts to confirm the veracity of this account), and fearing for his life, the family rushed to hospitalize him in a nearby city, where he spent a night under supervision. Add illnesses of one of their children to this bill of health, and you arrive at 22,000 Indian rupees (INR), about $460, spent over the last three months. This is a staggering sum for a poor household which likely earns about INR 2,000 – 5,000 a month ($20-$50). Indeed, the family was unable to finance its healthcare needs through savings, and progressively borrowed money from relatives, then money-lenders, and eventually, resorted to selling household assets to avert complete ruin.

Can microfinance institutions play a positive role?
Enter PRATHAK Microfinance3, one of the major players in the Indian microfinance industry. Out in the dusty Deccan, not far from where Fatima lives, PRATHAK is exploring the use of a health insurance scheme among poor households. Fatima is already an PRATHAK client, having previously taken out a small loan to purchase livestock. However, had she renewed her loan, she could have chosen among several new health insurance options, which range from insuring only herself to insuring herself and up to four immediate family members. An insurance package, costing about 500 Rupees, insures families up to 20,000 Rupees. Insured individuals either obtain medical care with a provider of their choice and then file for reimbursement, or go to “network” hospitals where they receive care at no cost—a “cashless” claim. Had Fatima opted for family coverage, the policy would not have paid for all of her expenses, but it certainly could have covered the most expensive item, her husband’s hospitalization, at INR 15,000.

PRATHAK is not entirely unique among microfinance institutions (MFIs) in considering the implementation of insurance products. Globally, the microfinance industry has matured considerably from its early days, when Mohammed Yunus and the Grameen bank were considered audacious. Loans and savings products are increasingly well-understood, and improved technologies are facilitating the delivery of financial services to developing country households once considered “unbankable.” A few MFI giants have even crossed the controversial threshold of profitability, which to some is the critical indicator of sustainability.

As the microfinance industry has matured globally, it looks for new products to sustain its meteoric growth, and for many insurance products represent the new frontier. For some such products are means of gaining competitive advantage, as certain regions of the world now see unprecedented levels of competition for customers amongst MFIs. Other MFIs are exploring insurance products as a means of insuring their own portfolios; if clients can be protected from income shocks related to adverse events of weather, health and other uncertainties, they are more likely to repay their loans and invest the money in income generating ventures or assets (as opposed to smoothing capital requirements during health shocks). And finally, many pursue insurance based on moral imperatives.

However, economists have long understood that healthcare, and health insurance, function uniquely as commodities, and as such, can cause market-based solutions to malfunction badly, leading to market failures. Actually, some would say this is exactly the case in America, which relies on private insurance markets to provide health coverage. Terms familiar from a Principles of Economics course ring true in this respect: asymmetric information, moral hazard and adverse selection can limit the effectiveness of private health insurance.

In this respect, MFIs possess some unique characteristics that may make them unusually well-suited to deliver health insurance, and potentially sidestep such issues. PRATHAK makes health insurance mandatory for clients taking new loans, thus averting adverse selection. (Avoiding adverse selection, though highly important from an insurer’s perspective, can make an MFI vulnerable to competition. When MFIs are competing against other lenders, they risk losing clients who do not wish for a health insurance product, or to pay a premium, with their loan.) Moreover, large MFIs often serve millions of clients, providing a critical mass to make the risk-pooling required for health insurance feasible. Finally, MFIs have already developed the distribution networks necessary to service clients taking out loans (often on a weekly basis), and this infrastructure could easily lend itself to sustaining health insurance schemes.

The PRATHAK Experience: Challenges in Implementation
Nonetheless, PRATHAK faces many challenges. Behavioral economics tells us that people do not allocate their incomes rationally and that the poor are particularly vulnerable to the consequences of this irrationality.4 Anecdotal evidence—witnessed by the authors themselves—suggests that PRATHAK clients do not understand their health insurance. For example, they do not understand the purpose of paying money upfront for health care, which they later may or may not need later. PRATHAK worries that the mandatory nature of the health insurance program might decrease its primary business—small group loans for enterprise development. However, other insurance products, such as life insurance, have been successful nationwide in India thanks to strong government backing. Similarly, before PRATHAK can scale up its program, increased financial literacy and a standardized method for encouraging financial literacy at the community level are needed. Another issue involves reimbursement; some of PRATHAK’ clients complain that the filing process is too long and technical.

Administering health insurance in rural India also presents PRATHAK with many operational difficulties. The geographical distance between the client and the insurer causes great delays in reimbursements: the claims must travel from the client in her village, to her loan officer, then to PRATHAK headquarters in Hyderabad and finally to the third-party insurer in Mumbai for final processing. Reimbursements must travel the same route in the other direction. As a result, reimbursement claims initially took up to 6 months. PRATHAK says they have streamlined this process to less than one month.

Another operational difficulty that PRATHAK has encountered is finding “network” hospitals. These hospitals are advantageous because they do not require the client to pay any upfront costs, and PRATHAK can assure both quality and a reasonable cost to the insurer ahead of time. However, identifying hospitals in rural areas that meet the insurer’s standards has been difficult.

The Verdict is Out
Despite these complications, MFIs like PRATHAK are well-positioned to offer health insurance to the poor. Insurance requires a large base of people, and large MFIs have that base. MFIs have already successfully developed life insurance programs, and health insurance is the next natural step in the expansion of services. Moreover, the poor, who suffer enormously from health shocks, stand to benefit hugely from a health insurance product.

An important step in confirming its feasibility will be the use of rigorous evaluation. The authors of this article are currently running a five-year evaluation of PRATHAK’ health insurance product as a joint collaboration of the Centre for Micro Finance and MIT’s Poverty Action Lab. Respectively, these institutions are committed to conducting action-based research for microfinance and development interventions. Results of rigorous trials from such organizations will help verify if health insurance through MFIs can succeed (the authors certainly think it can), and if so, help identify the major hurdles to making it a success.

Poor societies, and poor households, such as those in India, face difficult choices in parceling out their income. Health is often not a priority until it becomes a calamity, but leaving individuals to pay out-of-pocket is too risky. In India, 24% of the population falls below the poverty line due to hospitalization. Indeed, health is vital to breaking poverty traps, and in countries such as India, where the government’s role is limited by resources and corruption, private solutions can help improve poor families’ access to health coverage. Through their unique delivery channels and large base of clients, major players in microfinance are well situated to help achieve that objective. Microfinance has already chalked up considerable success with its loans; perhaps it can score further gains with health insurance.

Update on me and Mumbai

First a quick personal update:

I’ve been accepted to a couple medical schools, but haven’t decided where to go. I don’ t need to, and likely won’t, decide till May 15th, so there’s no rush.

In the interim, I’ve quit my job (’s becoming a recurring theme for me to hand in a resignation every 6 months), and for now, I have 6 weeks off to enjoy my last few days in India. I’m relishing my time off (being a bum is highly underrated), and have a list of things to do (travel, self-improvement, family visits), that bears resemblance to that of a retiree (sans grandchildren). Some highlights from the next weeks: trips to Goa/Bombay, and Calcutta/Darjeeling/Sikkim, cooking lessons in Hyderabadi cuisine, exercise to shed the excess baggage gained thanks to the latter cuisine, and time with my crazy Jihadi family.

In anticipation of my own laziness, I’ve signed up for a new job that will only last 5 months, and entails 15 hours/week of work for a comfortable paycheck and accommodation included (in my, surely irrelevant, opinion, it’s not about working hard or smart, but working less ;). An important detail about the job: it involves teaching Chinese tikes how to speak English in Suzhou, a city located one hour from Shanghai. China features a booming job market in Teaching English as a Foreign Language jobs for native speakers, and recruits the same from the US/UK/Australia. I can’t help but think they’ll feel cheated when a brown guy shows up, no matter how clearly nasally American my accent.

Ok, update done

My blog is experiencing a bit of an identity crisis, given my relatively stationary existence since returning from my SE Asian adventure, but I recently read “Freakonomics” and one of the pleasures of the book was it’s distinct lack of theme. In that vein, I give up on trying to make this blog about anything more specific than the meanderings of my own perverse sense of curiosity. With that I give you an update on the Mumbai bombings:

I was recently in Mumbai for a lavish wedding hosted by Parsi friends of the family. It was a sumptuous affair, rife with glittering attire, sparkling small talk, and all the trappings of “Mumbai Society.” In short, it was trippy, trippy fun, given how utterly removed I am from any sort of “elite”. I felt like a millionaire playboy for a couple days, instead of a post-college bum...
However, the wedding also offered a chance to interact with some of the social elite of Mumbai, and understand how the recent attacks had played themselves out in the city’s psyche; I was particularly well-situated for this purpose, given the wedding’s location in South Bombay, where the targets of the attack were located.

In a nutshell, the mood was sober. Unlike many of the terrorist attacks in recent history, this one had hit the elite (a striking parallel to the 9/11 attacks), as the Taj Mahal Hotel and Trident occupy a central location in the social constellations of the the city rich and/or famous (one graduate of Mumbai’s elite Cathedral school told me he knew many of the victims, and that his family lunched at the Taj two or three times a week). For many, Christmas and the upcoming New Year’s celebrations will be decidedly low-key.

The attacks attracted disproportionate attention given their high profile targets (note, the attack at the Victoria Terminus, also a Mumbai landmark, but one frequented by a relatively pedestrian crowd, received considerably less press, and I’m about to committ the same sin in writing about the Taj Mahal hotel).

Incidentally, I visited the Taj Mahal Hotel the day after it re-opened, an astonishing three weeks after the attack. The management had done a spectacular job! Photos of the hotel from the attack were no less than a visual metaphor for the nature of strike, the well-appointed lobby riddled with random bullet holes, and smeared with blood. However, the lobby into which I stepped that day evidenced the attacks only by way of a temporary Tree of Life memorial, featuring the names of the dead. Apart from that, a few stores had been walled off, but very professionally, to the point where you would’ve only known had you visited the hotel earlier (I had).

My mom and I hadn’t come as terror tourists (though there were a fair share of those), but to visit the famous Gazdar Jewelry shop, where my family has frequently struck gold in finding rare and exquisite antique jewelry (shameless pun, I’m sorry); this trip was both to look for more, and to show our solidarity with the owner. The shop’s owner, an old family friend, waxed lyrical of the Tata heirs role in quickly rebuilding the hotel. He said the speech given at the re-opening speech the previous day was surprisingly moving, and Tata himself was moved to tears while thanking the hotel’s staff for their individual acts of courage, which certainly saved lives that day. Interestingly, I repeatedly heard Tata referenced in the ensuing days, by numerous Mumbaikers. It would appear that just as NYC collectively narrated its own patriot mythologies in the days following 9/11, the 26/11 attacks in Mumbai had curiously fixed Tata in the role of the fearless leader (akin to Guiliani in NYC). In a way, I think it quite appropriate. The Taj is certainly an elitist symbol, but its history can certainly be a source of national pride. In 1903’s, Jamsedji Tata had visited Watson's, then Mumbai’s most lavish hotel. He was turned away for being Indian, and vowed to build a hotel so magnificent and classic, he would neatly turn the snub on its head (note: there is considerable speculation that this story is apocryphal, and I'm inclined to believe it is, but what is history but a fable agreed upon). Regardless of his motivations, he undoubtedly built a hotel worthy of Mumbai: the Taj is undoubtedly a remarkable piece of Mumbai history, and in a sense, a symbol of Indian self-reliance (it’s also about as classy a “Fuck You” Tata could’ve offered his would be detractors). Its quick renovation following the attacks deepens it role a symbol of Indian defiance, this time, in the face of terrorism.

On that note, Indians have a remarkable threshold for chaos, and with it, terrorism. While America threw the relative equivalent of a national hissy fit in the wake of 9/11 (and not unrightly), most Indians regarded the 26/11 attacks with directed exasperation (the government screwed up royally, most feel), and an almost spiritual patience.

Finally, some Indians simply took no note at all. One of my cousins, a member of South Mumbai upwardly mobile youth (he’s an I-banking analyst, one of the increasingly rare few who still has a job), smoked himself silly with his friends on Mumbai’s finest hash. When I asked him with measured gravity (lest I upset him and his friends), about whether the attacks were directly traumatic, he replied with an irreverent grin: “Traumatic? Are you kidding? I fucking partied!....a two day vacation in the middle of the week. It was fricking sweet, I was high the whole time.”

Though not as classy as Tata’s retort, I suppose that’s as big a “Fuck You” to the terrorists as any.