Blood Relative

Having recently written a glowing review of The Menstrual Man, here's another tale of an Indian man passionate about making a difference in his country.  Vinay Shetty, or Vinay Uncle as he's known to the children he's helped, has championed the cause of children with thalassemia for 15 years as leader of the Think Foundation.

Thalassemia is an inherited genetic disease which affects the blood's ability to make haemoglobin and is usually found in the Mediterranean, West Asia and North Africa.  Without treatment, children have a low life expectancy, and even those being treated have a stunted growth, looking years younger than their real age.  Those with the disease must receive regular weekly blood transfusions, leading to an iron overload in their system, which in turn must be treated with expensive iron chelation medicine.

In Mumbai, there is no shortage of blood for those transfusions.  Shetty, who attended the film and took questions in the Q&A was asked to name the greatest accomplishment of his foundation so far, and he pointed to that availability of blood.  The next big challenge is the cost of the chelation medication, even though there is a generic version of the drug manufactured in India, and that is the focus of the foundation's fund-raising.  Nevertheless, children born with thalassemia in Mumbai have a life expectancy about 15 years longer than in the rest of India.

Shetty has been working hard to get government help, and since the completion of the movie, the Indian government did announce funding for chelation therapy for those below a certain income level.  That still leaves a band of people too poor to afford chelation but not poor enough to make the cut-off, but "it's a start" says Shetty.  It seemed to me that focussing on getting government support for genetic screening would be important; such screening is not as emotionally appealing as helping specific children with medication and is harder to get donors to step up to funding.

Shetty also works hard at education and outreach.  Tradition still reigns strongly in many Indian households, and we see one mother who believes that praying to the goddess will offer her daughter better protection than chelation therapy.  Shetty works to get her on treatment and back in school.

Thalassemia Major is caused when a child inherits the thalassemia recessive gene from each of its parents.  Shetty is also pushing for testing of siblings before marriage to see if they are carriers of the recessive gene to provide genetic counselling.

I looked up thalassemia after watching this movie.   The disease is most common in  the Mediterranean, West Asia and North Africa.  Genetic counselling, early screening and detection, and subsequent treatment mean it's not a problem in the west, but it's still a much bigger issue in less developed countries like India.  The prevalence of such a genetic disease raises the question of why natural selection has not led to its disappearance.  The reason, not mentioned in the movie, is that carrying the thalassemia recessive gene (known there as having thalassemia minor) confers a degree of protection against malaria, which means that gene is being selected for.  This is rather similar to sickle-cell anemia, which also seems to confer some resistance to malaria, and one article I read said these two diseases are related.  This was all very interesting information, but did not appear in the film.  I'm sure the film was stronger because of the resistance of the temptation to include that information, which would have been a distraction from the film's focus on Shetty's efforts.

The director of this film is award-winning Canadian filmmaker Nimisha Mukerji, niece of Vinay Shetty.  So the film really was about her 'Vinay uncle'!

Great film.

Dabbawallas

In Mumbai, about 5,000 dabbawallas deliver 200,000 lunches a day to city workers.  The system started in the 19th century and perseveres today, although apparently the number of lunches has started to decline.

A dabbawalla picks up freshly made hot lunches from homes in the suburbs in mid-morning.  Our guide pointed out that you better have the lunch ready when they arrive - even if it's a bit before their scheduled time - because if it's not ready they go without it!  One dabbawalla collects many lunches and takes them on special dabbawalla trays, loaded onto bicycles, pushcarts or carried on their head, and takes them to the train, where they are placed in a special car on the train.  When they arrive at the Churchgate station in central Mumbai, they are picked up by more dabbawallas and sorted for delivery to their final destination at 12:30.  Empty tiffin boxes are returned home in the afternoon.  The tiffin boxes pass through several hands and travel on bicycles, handcarts, trains or on heads to reach their destinations and undergo several sorting processes along the way.

The amazing thing is that this is a totally manual process, and is based on a proprietary (some say secret) coding scheme that is used by the dabbawallas, many of whom are illiterate.  You can see the coding painted on the traditional tin tiffin box below; magic markers are used on the cloth bags and thermoses which are more the modern fashion.  I got a picture of a partially sorted tray of tiffins.

Does the central sorting station make you think of FedEx's hub in Memphis?  It certainly did for me.

And it's not quite fair to say the entire process is manual.  Dabbawallas are now accepting orders through SMS.  It is also SMS which is also killing the old habit of slipping messages into the tiffin box - why do that when you can fire off a text message?

Being a dabbawalla is a traditional job mainly held by people from the Pune area of India. The organization has very little management superstructure and is held in a charitable trust.  Dabbawallas have to make an investment of two bicycles, a wooden crate for the tiffins, white cotton kurta pajamas, and the trademark white Gandhi cap.  All the profits are distributed at the end of every month and come to about $40-$80.  It costs less than $4 for the customer to have this amazing delivery service for a month!

What is astonishing about this system is its incredible accuracy and timeliness.  Forbes magazine awarded the system Six Sigma certification in 2001, based on its 99.999999% accuracy rate which implies less than 1 error in 16 million.

Having read about this system, I was fascinated to see it, and expected to observe high intensity and even frenzy at the sorting stations.  However, we watched the tiffin boxes being sorted on the sidewalk outside Churchgate Station and the scene was totally calm, even leisurely, although very organized.  We'd been told the dabbawallas weren't fond of people getting in their way and taking lots of photos (understandable), so I have limited good pictures of the whole exercise.  Here's a picture of some of the trays ready to go; it's a heavy load for one person to carry or push.  Some bikers head off with tiffins hanging from every part of their body and the bike!

For those who think that a successful organization absolutely requires rigid top-down management, the Nutan Mumbai Tiffin Box Suppliers Charity Trust of Mumbai is a great counterexample.

Towers of Silence

Indian Parsis (or Parsees) are members of the Zoroastrian religion and descendents of the original Parsis in Iran.  The number of Parsis in India has been dwindling, and may number as few as 50,000, mostly concentrated near Mumbai, with forecasts that the number will fall further to about 23,000 by 2020.

Zoroastrians believe that a dead body is contaminated and must neither be buried (where it would pollute the earth) or cremated (where it would pollute fire).  In order to avoid this pollution, dead bodies are placed near the top of an open circular tower, exposed to sun and to birds of prey.  After about a year, the bones are collected in an ossuary pit at the bottom of the tower, and the final deterioration of the bones is assisted by applications of lime.  Eventually rain water washes the remains through various filters out to sea.

The name Tower of Silence was given to these towers by a British translator in the 19th Century. I had heard of Towers of Silence from two separate sources: an article four years ago in The Economist, and in A Son of the Circus set in Mumbai and reviewed in a previous post.

We visited the "Hanging Gardens" at the top of Malabar Hill in Mumbai, an upscale residential area in Mumbai.  The Gardens are a lovely urban oasis in a busy city, with a pleasant view over the smog-covered city below.  They sit immediately adjacent to the Mumbai Tower of Silence.  The park is built on top of an enclosed reservoir; it's said the reservoir was originally enclosed to avoid contamination from the Tower of Silence.

There is a major problem these days with the towers: the vultures on whom they depend are being devastated by diclofenac, a drug used to treat cattle (as described in detail in this article from The Economist).  Vultures not only help with human bodies in Towers of Silence; they are a key part of the Indian ecosystem in getting rid of the carcases of cattle and buffalo.  Since Indians don't eat much beef and revere sacred cows and since there are about 200M cattle and buffalo in India used exclusively for milk, Indian farmers have depended on vultures to dispose of their carcases.  These cows have been the carriers of diclofenac to the vultures.

Both vultures and Parsis are dwindling in numbers.  Sadly, it's a question of who will outlast whom.  The good news for the vultures is that diclofenac is now banned (though farmers are allowed to use up their old stocks), and there are conservationists breeding vultures in captivity.  Meanwhile, Parsis are experimenting with other techniques such as installing solar relectors to speed up the action of the sun.

Divali in Mumbai

If you look up Divali on Wikipedia, it is described as a festival of lights honouring good over evil, celebrated by both Hindus and Jains.  There are five days to the festival, each with separate significance.

But in Mumbai, everyone we asked described Divali as the festival to honour Lakshmi, the goddess of prosperity.  This festival has been highly commercialized because it is considered an auspicious time for important purchases and proper observances will set you up for a prosperous upcoming year.  Hence we saw huge billboards and newspaper ads encouraging people to get out there and shop: cars, furniture, home renovations, but most of all gold, both as a jewelry and an investment.

Divali is called the Festival of Lights but it seemed to me it could equally be called the Festival of Flowers.  Buildings and cars were festooned with flowers, mostly marigolds, and rangolis were painstakingly shaped with flower petals on floors everywhere.   Markets were full of clay saucers, to be filled with tiny candles floating in oil, and placed decoratively inside or outside buildings, or within rangolis.  We saw a rangoli etched out with glittery powder and sprinkled with candles on the pavement in front of one shop, which was very pretty as it sparkled in the night.

We had spoken to some hotel staff about Divali and when we arrived back from breakfast, we were greeted with wide conspiratorial smiles.  When we opened the door to our room, we were surprised and delighted to see that our room had been decorated for us, with a rangoli, and an elephant (representing Ganesh, the elephant of good fortune) decorated with flower petals.

Divali lasts for five days and Mumbai is reputed to celebrate most vigorously, especially with fireworks and firecrackers.  We were at Marine Drive to enjoy the first night of Divali.  Marine Drive is a boulevard that borders the bay in Mumbai, with wide sidewalks for strolling and a cement wall for sitting to appreciate the view.  It gracefully curves around the bay and is dubbed 'The Queen's Necklace' at night. 

On Divali along Marine Drive there were clusters of people were setting off things every few feet - six-foot high sizzlers on the ground, noisy crackers that startled you with loud bangs, beautiful fireworks shot into the sky.  The cacophony was continuous and the air was filled with smoke.  You had to keep your wits about you, as you might be standing looking at one display, to find another being lit right behind you, or perhaps a dud firework that had been shot high in the air coming to land near you.  I found this short video on YouTube which captures the randomness of the firecrackers and fireworks very well.

It was such a contrast to Canada, where everything is so controlled, with planned fireworks by municipal authorities, let off by certified fireworks people, and with the crowds a specified safe distance from the point of lighting.  Here very young children would dash up to the fireworks with sparklers to light them up.  It was up to the crowd to be alert and stay clear of the explosions on all sides.  It was similar to the Duresha celebrations where giant effigies 90 feet tall were burned, and people were standing very close.  The effigies were supported by guy wires to force them to fall in place, but any surprises would have been quite devastating to the crowd.  It was great to be part of something so different. 

One lovely custom of Divali is that on the third day, brothers are supposed to visit their sisters.  The sister ties a rakhi, a colourful thread, around the wrist of the brother, signifying the strong bond between brother and sister.  The brother brings a gift to the sister.  One of our guides said that he had given his sister a card.  That seemed a bit modest compared to what we'd heard about.  It turned out to be a credit card!  His sister is studying in university and he had offered to help her, but she had declined preferring instead to earn her own money as a tutor, he said proudly.  I think he is quite confident his credit card won't be abused.  In a society of multi-generation families, where the wife lives with her husband' family, this custom to strengthen the bond between brothers and sisters is quite heartwarming.