Sorry, wrong number!

The perils of counting money — and HIV and blood pressure and cholesterol

money in the hand

I give you a bundle of currency notes, let’s say 100, and ask you to count them. You count 99. I re-count and get 100 again, so I ask you to re-count. You still get 99.

Who’s count was correct?

It’s a familiar but hidden dilemma faced in all counting situations, and not necessarily only those involving human beings. For instance, when a pathology laboratory does your bloodwork, they use sophisticated counting machines to enumerate the number of white blood cells, oesinophils, neutrophils, red blood cells, disease antigens, and so on.

How sure are you of the numbers? Would a second pathology laboratory have produced identical counts from the same blood sample? Even if it did, would a third machine have? What if 10 machines were deployed and only one gave a divergent answer — what are the chances that nine were wrong and the odd-one-out was actually right?

Remember Galileo? He was the odd one out when he asserted that the earth went around the sun, and was persecuted and reviled for his belief. The majority was believed to be right because, well, how could so many people possibly be wrong?

In real life, unfortunately, we tend to side with the majority too. It takes more than some silly philosophical uncertainty to stop us.

Let’s say I’m counting a bundle of 100 notes, and get 99. Since I’m expecting 100, I’d assume this was an error and recount. If that gave me a 100, I’d probably not count again because after all, that was what I had been expecting. But if I got 99 again, then a third count would become necessary. If that yielded a 100, I’d probably count a fourth time, since I’d gotten 99 twice already. I might even count thrice to see if I got 100 more times than I got 99.

The best of many counts is the usual principle we follow.

But what if life and death were involved in getting the count right?

Counting HIV

If you were being tested for HIV, you have a choice of tests, but the rapid test typically does not look for HIV but for antibodies produced by your body to fight HIV. The assumption is that if your body has antibodies, it must have HIV.

However, there are two cases in which this assumption is not valid and the test could yield false results. in one case a false negative and in the other a false positive.

Here’s the first. It takes an HIV-infected person some time to produce enough HIV antibodies for them to be detected by a rapid test. This period could range from a few weeks to as long as three months. What if a person took an HIV test during this window period? He would test negative while a second test a few weeks later would have shown him positive.

Which of the tests should he go by? What if the positive was false and the negative was actually right? In such a situation, many doctors would advise a third test, if only because the psychological, physical and economic implications of being positive are so devastating. If the third test came out negative, then usually that would be taken as definitive. If it was positive, however, the patient might demand a more sophisticated test, such as a Polymerase chain reaction (PCR) test, to be even more certain.

But even a PCR can be fallible — no? When can we be 100% certain? The answer is, I am afraid, never. We always end up going with the best guess, no matter how sophisticated the instrument.

The other instance where a person can have HIV antibodies without having HIV infection is a child born to an HIV positive mother. Nature, in its bounty, makes sure that a newborn child inherits all her mother’s antibodies, and has natural protection against a slew of diseases until its own body becomes adept at producing its own antibodies, a process which takes about 10 months.

I know a couple who had chosen a gorgeous sunny baby for adoption, but were dismayed to learn that he was HIV positive. The prospective mother, who knew nothing about AIDS, educated herself, and when she realized that motherhood would essentially entail being a caregiver to a sick infant who would die soon, she surrendered the child with the deepest regret.

But she was wrong. The HIV test had merely detected the mother’s HIV antibodies in the baby’s blood. Ten months later they had disappeared completely, because the child was uninfected. He is today a healthy teenager in college in Delhi.

Money to be made

Miscounts can be lucrative. Let’s take blood pressure, which is routinely measured as a key vital sign when you go to a hospital. In general, a higher number (called systole) of 120 and a lower number (diastole) of 80 or less is considered ‘normal’. Let’s say your blood pressure hovers near 140/90 now and then. The doctor could declare that you are a borderline hypertensive, and pretty soon prescribe a range of medications (with their own side effects) for ‘normalizing’ your blood pressure. Depending on which medication she prescribes, your kidneys, sex life or sugar tolerance, among others, could be impaired.

However. even two blood pressure readings taken within minutes of each other will not yield the same numbers.

So — just as with counting money — we must ask how many times a person should his or her blood pressure before letting the doctor conclude they need hypertension medication? Blood pressure varies through the day, generally being a little higher during noon and afternoon, and declining towards evening. Within this period, though, stress, excitement, a near miss with a fast driving car, a rough session from your boss, any and all of these could drive your blood pressure up.

In a well-known phenomenon called ‘white coat hypertension’ it has been shown that even the presence of a doctor in a white coat grimly measuring your blood pressure is enough to drive your blood pressure up a little. Measuring blood pressure itself drives blood pressure up.

My doctor made we wear something called a Holter vest, which  monitored my blood pressure at fixed intervals as I went about my day. But my skeptical mind asks: would a different Holter vest from a different doctor have given different results?

My simple rule of thumb with any test or measurement that has implications for your health or your wallet is — measure thrice, at different establishments. The family doctor could be wrong. Worse, he could be in the pay of big pharma, no matter how much like Santa Claus he looks.

Enough for a heartache

Cholesterol measurements are another notorious area where the wrong numbers are bad for you but profitable for the doctor and some corporation in another country. Your ideal low-density cholesterol (LDL or bad cholesterol) is supposed to be between 100 and 129, while your high density cholesterol (HDL or the good cholesterol) is supposed be between 40 and 49 for men.

These numbers, from the USA, are, however, arbitrary. The United Kingdom, for instance, judges LDL over 100 as high, and considers a range of 40 to 60 normal for HDL. Risk calculations, apparently, depend on the ministry of health.

If I were a cynic, which I am, I would guess that neither doctors nor big pharma would be particularly interested in you or anyone else testing your cholesterol several times at different laboratories, since they might disprove the need for medication. Neither would they be in favor of you taking a test after a week on a lovely salads and juices only diet, since that would reduce your cholesterol readings. Cholesterol, like the blood pressure, changes through the day and with your food intake.

The bottom line is that these readouts, taken too few times and from too few machines, and with little cross-validation, could put you in line for a lifetime of statins, supposedly to help avert a heart attack by keeping you cholesterol down. Statins have been shown to do little for cholesterol, and come with a list of side effects you do not want in your old age.

So — back to my original question: how often should you count your cholesterol?

Back to the small change

This post started with an observation about the impossible of knowing when you’d miscounted your money. Over the years, I’ve developed my own way of making sure I don’t overpay anyone because of miscounting and it’s based on human psychology. It’s a cynical little trick, but it works very well. It’s based on the assumption that if I overpay you, you might or might not draw my attention to it, depending on your honesty, but if I paid you less that I owed you, then you sure as hell wouldn’t let that slide.

So if I had to pay you, say, 1,000 dollars or rupees or Thai baht or whatever you consider money, I’d count it out first with my own hands. Maybe twice or thrice even, to be surer. Then I’d remove a single note and pocket it, reducing the amount in my hands to 999. This is what I’d give you. There are three ways this could play out now.

Scenario 1. It could turn out that my count was disastrously off, and I had given you 1001 instead of 999. You, being dishonest to the core, say nothing and walk away, richer by an unexpected dollar.

Scenario 2. Your count yields 1,000 — in which case I would ask you to recount since I’m expecting 99. If you get 999, the answer I expect, on a recount I’d give you the dollar hidden in my hand, making it a round 1,000. But if your second count also yielded 1,000 again, I’d assume I had miscounted the first time. Close shave. You get your money, and I avoided paying you an extra dollar by error.

Scenario 3. Most likely — your count detects 999 and you of course point it out at once. I, being a thorough gentleman, nod and give you the missing buck. All is well.

You can make a mistake with counting, but you can’t go wrong if you count on simple human avarice. Nobody likes to be shortchanged.

Shortlisted for the 2012 Commonwealth Book Prize!

My first novel, The Book of Answers, was today officially one of 19 novels shortlisted for the international 2012 Commonwealth Book Prize. It is a sweet moment in a novelist’s life, especially one who wrote his first novel kicking and screaming that he couldn’t.

It is also a time for some reflection.

In the 10 months since The Book of Answers was published, I have realized one abiding truth — you can never ever know if your book was good or not. While writing it, I received extreme criticism at both ends of the spectrum. Some thought the style pretentious and bombastic, the satire heavy-handed, the plot convoluted, the use of the first person too distracting. Others used words like compassionate and engaging, said they’d savored the characters, laughed a lot and so on. My agent, the unputdownable Nathan Bransford of Curtis Brown Limited, was politely ruthless and his compass always true every time. My brother, who can be piercing when he decides to be, had his own very influential views, usually at odds with everyone else’s. In between the artillery fire of so much advice, my book only improved.

However, its author, like a lover who has viewed his loved one’s face too close, had counted every pore and blemish. Beauty was in the eye of the beholders, but other beholders.

So when people talk about The Book of Answers, there is a frowning fellow inside me, who dismisses it all as merely one person’s view. At the launch of the book in Delhi, at the Habitat Centre, on July 5, 2011, the usually sharp-tongued Mani Shankar Aiyar waxed lyrical about the quality of writing and read out a certain selection — twice, the second time to point out what he considered literary gems. But that, my inner skeptic says, is merely Shri Aiyar’s point of view.

The same frowning fellow reads the reviews, frowning. Ipsita Chakravarti, of The Telegraph, found the satire feeble, and the story a disconnected collection of incidents. Arcopol Chaudhuri of uread.com thought it was a fine tribute to George Orwell’s 1984. Dharmendra D, writing for Business World, noted that “the fervent readers hopes of an engaging read are quickly dashed”. Most mainstream newspapers and magazines, such as The Times of India, Hindustan Times, Indian Express, Outlook, and India Today  did not even bother to review it.

Of my friends who had bought the book, there were three kinds — those that are still meaning to get around to reading it; those that read it and loved it; and those that have been quarter-way through the book for the last six months.  From the latter group, I begin to suspect that my novel is not an easy read. Mani Shankar Aiyar might very well have savored certain turns of phrase, but those same phrases were indigestible to others. Once again, my friends are no use at all in helping me decide if the book is a good read or not.

Of course, you are shaking your head by now and saying to me, “It isn’t what others think, it’s what you think that matters.” Alas, I am permanently crippled in that regard. I look at this book and see only the nuts and bolts and hinges of the story, not the entire gleaming body. Every time I sit down to read it as though for the first time, out comes the blue pencil after a few minutes and all I can think of is how a certain sentence or plot detail should have been done differently, or where there is an extra comma.

AND NOW THIS. The 2012 Commonwealth Book Prize, given for the best first novel and the best short story every year, from a crop of published works from 54 commonwealth countries including Canada, Australia, New Zealand, Australia, India, Pakistan and many others. A bunch of regional prizes of £2,500 each and a grand prize of £10,000. An international panel of judges from Ghana, Jamaica, the UK and Pakistan, put the shortlist together. The frowning fellow inside me points out that a different panel of judges, in 2011, had not deemed the book worth even longlisting for the Man Asia Literary Prize.

For an author who anxiously scans the faces and words of his readers for clues of what to make of his own writing, this is what being on a shortlist feels like.

Firstly, a nice warm feeling in the stomach. In today’s self-published world with tens of thousands of books pouring out of anyone with a keyboard to type on, even a recognition as humble as this serves to set the book apart. Something to be grateful for, that the roll of the dice fell this way. Even before the shortlist was announced, two UK publishers had gotten in touch, making tentative exploratory sounds.

Second, it makes me suddenly feel that with a little more effort, perhaps the next time one might go beyond just a shortlist, even though even being on a shortlist fills me with more than I can express. Every writer needs to feel that for a while, even those who write for their own pleasure.

More than anything, though, the frowning fellow inside seems to have for just a moment stopped frowned. He knows that it is only a first book, and that writing is a long journey undertaken entirely on foot, but this seems like a wonderful place to stop and sit in the shade of a tree for a while and just enjoy the light breeze.

Why do they think I’m a terrorist, mother?

 THE NUMBERS ARE OUT. In the ten years since 9/11, the US Transportation Security Authority (TSA), responsible for haranguing innocent passengers at airports in search of possible terrorists, has spent 57 billions dollars. . Its staff has grown by 400% in that decade, each staffer earning an average $103,852 per year. Airlines estimate that the inconvenience that the TSA causes to passengers accounts for $1.1 billion loss every quarter.  So far the number of terrorists the TSA has apprehended is — zero. However, they have confiscated 1,200 guns from passengers. With an annual budget of US$ 8 billion, this equates to $6 million per gun.

__________________

THE TSA HAS ALWAYS HAD a special interest in me. In the years when I lived in Kenya, between 2000 and 2006, my airline gateway to the world outside was always Dubai, because my preferred airline was always Emirates. My journeys were usually to the west, ending in Seattle, with a port of entry into the United States at New York or Seattle. The terrorist attacks of September 11, 2001 permanently changed the travel experience of a small number of people on earth, and I was one of them. Passing through the dynamic little Arab emirate of Dubai did it, I think. Passing through an Arabian, and hence ungodly terrorist airport, I suspect I picked up Arabian molecular markers, and they picked me out of the airline queues as a person of interest as surely as if I had been colored with bio-luminous ink.

Here’s how it worked. Making me welcome in the United States then and now were the fine gentlemen of the Transportation Security Administration, conveniently shortened to TSA. These burlies, mainly black, Puerto Rican and Asian, manned the points where non-Americans entered US soil, and were responsible for checking the contents of suitcases and the people who accompanied them. There were several queues, and all and each led to the familiar beeping metal detector ‘doorway’ with its xray scanner alongside. Here laptops were taken out of their cases, cellphones disclosed and switched on, shoes doffed. If the doorway still beeped, then you were in trouble, but most people passed through this security check.

A few such as I were routinely hand-picked for additional special treatment, which included being made to stand with legs akimbo and arms outstretched in a public place while being given a extra-detailed pat down, and finally being caged in the infamous ‘passenger puffer machine’ for a minute or so while it ‘sniffed’ me for traces of drugs or explosives. The word humiliating just begins to describe it. The first time this happened, I believed the security officer who told me passengers were picked at random. But after the fourth ‘random’ test four years later, I began to suspect that some cryptic mark was probably being placed on my boarding pass at Dubai that signalled to TSA goons at New York that I needed watching as a potentially ruthless terrorist mastermind.

During my 2005 visit to Seattle, I switched from an international to a domestic carrier at New York’s John F Kennedy International Airport. TSA welcomed me warmly as they always do and led me off to the special line where I and other scum like me belonged. Meanwhile, in an entirely different room, unknown to me, my suitcase was being checked from semtex, drugs, crystal meth, ecstacy, child laborers, immigrant Chinese and pornography. It was a brand new suitcase but the locks were all wrong. Since the TSA is mandated to search everywhere, they need to be able to open your suitcases. Fine print on a document no one receives tells you that if you had the sense to use a TSA-approved lock — that is, one they know how to pick — then they’d gladly relock the suitcase after checking its contents. The TSA-approved lock is now standard on most major brands, signifying that by purchasing that suitcase you implicitly give the TSA to go through your most personal contents to clear you of possible links to terrorism and similar undesirable behavior.

I did not know these rules, so my lock was a standard issue combination lock in a color I liked, blue. I did not know that while I stood being sniffed inside New York’s brand new Passenger Puffer machine, my bag was being forced open, and its contents mangled. I discovered the damage only after reaching Seattle. My suitcase’s only lock had been  destroyed. Whoever had opened it had also not bothered to correctly release the restraining flap, and had instead ripped it from its joins. My suitcase could not only not be locked anymore, but its contents could not be neatly contained; everything came tumbling out as soon as the bag was opened. It looked like I’d have to buy a new suitcase, thanks to the TSA’s finely honed skills.

But this was America; surely the TSA would have channels for complaints and redress. I went to the TSA’s online site, and true enough, right in there was a section on claims, including how to file one. I rolled up my sleeves and described the entire episode, including unnecessary details of my humiliation at the hands of the TSA in New York while my bag was being manhandled and ripped open by TSA thugs elsewhere. Not a long letter, but not short either,  written in caustic, sarcastic sentences, sure to sting even the most uncaring security officer into action. The damage to my suitcase was described in clinical detail, including the cab fare to the nearest suitcase repair shop. I sincerely hoped they would give me a new bag really soon, preferably before I reached Nairobi, where the airport’s resident gang of luggage thieves would leave nothing behind. I clicked ‘Send’ and the mail went off.

No new bag arrived, of course. I bought myself a new suitcase — this time with a TSA-approved rape-me lock — back to Kenya. But a month or so later, the wheels of TSA bureaucracy got around to my letter, and the following reply reached me, with these words —

“Thank you for you kind words of encouragement. It is through customers such as yourself that we have been able to maintain the high standards of perfection in all aspects of our service to passengers that we have been able to maintain. Your well-thought suggestions will only improve our already excellent record. The next time you visit the US, we promise to give you service at least as good as what you received this time. With more help from people like you,m we can only get better.”

The signature of the top man in TSA was sprawled across the bottom of the letter.

 

‘Kill the Indian first’

Unfettered reflections on what it means to be Indian in today’s world.
By C Y Gopinath

Criminal mastermind Kamlesh Pattni bought over the entire Kenyan government, using a fraudulent scheme to export non-existent diamonds for a premium fee

 

 

 

 

 

 

 

“WE HAVE NO DIFFICULTY WITH INDIANS, they’re just like Thais,” gushed Mr Maneechote, who was helping us to move house from one Bangkok lane to another. “They speak our language, they respect our customs, and they are kind, generous and gentle. It’s the Chinese we have trouble with.”

Sometimes you have to tell a lie if you want to hear a truth. “Me, personally,” I said, “I have some difficulty with these so-called Thai Indians. They are a discredit to their country. I find them arrogant and greedy.”

Something in Mr Maneechote’s eyes changed as it dawned on him that it might be safe to open up a little. “We have a saying in Thailand,” he said, leaning forward. “We say, If you see a snake and an Indian” — he dropped his voice — “kill the Indian first.” His smile remained courteous and pleasant.

I suppose an Indian living in India would hardly give a moment’s thought to how others see him, surrounded as he is by people who share his many failings. But for 12 years now I have been an alien Indian, living in other people’s countries as a guest with a renewable departure date, and I have developed all kinds of sensitivities. Since 2000, when I moved to take up employment and residence in Kenya, Africa, the implications of Indian-ness have been a theme in my thinking. Of my two children, one has spent no more than her first seven months in India, and the other his first three years. Their nationality, prescribed by the citizenship on their passport, is theoretical to them. Other than the over-colorful and  hyperbolic India of Bollywood, they have not a clue as to what being Indian means.

The embarrassing thing is, neither do I.

The urban India I see on my annual visits home is neither reassuring nor makes me particularly proud. I sometimes recognize familiar strains of a slower music from a more reflective older country that I grew up in, but the new one seems in too much of a hurry, too greedy, too self-centred, not at all tolerant. And the answer that slips away each time is to the question: How should I explain to my children what it means to be Indian?

If I were to look for answers in all that I have heard said about my fellow countrymen in my 12 years out of India, both from foreigners and from persons of Indian origin, then Indians —

Get rich wherever they go. And then they corrupt.

Regard any working system as a challenge.

Are incredibly racist.

Believe they have nothing to learn. They come to speak, not listen.

Are rough, unclean, undisciplined — unless there’s a penalty for that.

Let’s look at each in turn. The single most consummate criminal mastermind in Kenya was a businessmen of Indian origin, Kamlesh Pattni. During the 1990s, Pattni persuaded the government of President Daniel arap Moi to engage him in a massive money-laundering scheme in which he exported non-existent diamonds to Europe in return for guaranteed premium fees from the government. Over 600 million dollars were reportedly siphoned off by the so-called Goldenberg scheme, but an unofficial estimate is that the Kenya’s economy lost about 10% of its GDP over those years. Pattni had paid off the entire government, from its very highest levels down to the judiciary, making any investigation impossible. When Mwai Kibaki’s government came to power, the details of the Goldenberg case finally emerged into the open. Pattni cannily converted to Christianity and changed his name to Paul in a flamboyant baptism ceremony, and then demanded to know how any human court could try him when Jesus himself had forgiven him his trespasses. To no one’s surprise, Pattni was never convicted. He had gamed the system so thoroughly that it crawled under a chair and hid when it saw him.

The subversion and corruption of a working system is a nearly genetically inherited skill for us. The Indian version of If it ain’t broke, don’t fix it is probably If it ain’t broke, go ahead and break it. An Indian learns through grueling experience that every certificate, licence, no objection letter, form, approval, endorsement and visa has a price.  Every process is made deliberately tedious so that someone may invent a lucrative shortcut — consider the tatkal scheme where you pay a surcharge for slighter faster processing because glacial is the real normal. The Indian hates waiting in line like the rest of the masses when with just a little affluence or influence he can slip in through the side door.

In Kenya, knowing I worked for an American agency, several Indian traders made typically Indian overtures. A calendar and sweets would arrive at Diwali, followed by a visit and a clumsy request to throw some work his way. I tried to explain that the donor — the United States Agency for International Development — was very strict about due process and integrity, which earned me a look of frank disbelief. Surely, he seemed to be saying, I would know a way around the paperwork? “Kuch karo, yaar [Please do something],” he said, unable to believe that there could be an Indian who didn’t know how to game the system. I suddenly understood what he was saying: we are both Indians among these black strangers, who will help us if we don’t help each other?

Living in both Nairobi and then Bangkok, I grew accustomed to hearing locals of Indian origin belittling Kenyans and Thais, both people for whom I have much regard and affection. Yeh kaale log [These black people]  was the usual beginning of a sentence on its way to putting down a black Kenyan. Indians, both visiting and resident, talk of Thais as though they were giggling idiots of an inferior race. And yet the Thais manage their Bangkok a thousand times more effectively than Indians manage their Mumbai or Bangalore. In every respect — transportation, civic organization, amenities, garbage disposal, services — Thais accomplish effortlessly what, say, the Maharashtra government has proven itself utterly incapable of time and again. There is new construction everywhere, but Bangkok somehow manages to keep its dust down. There is food everywhere, but you will hardly see a fly. There are cars and buses everywhere, but you will not see impatience or hear angry cars honking. You will see people in a hurry, but no one jostling anyone.

I HAVE MADE A LIST OF THINGS Thais do better than we —

They keep nooks and crannies clean. The Indian is a 95 percenter, leaving the last few details of any job undone. The Thai is a 100 percenter, staying with the details until every last one has been dealt with. Proof: the layers of grime on the hard-to-reach upper surfaces of the tubes leading into the subway at Victoria Terminus. Proof: the edges where paving stones touch the kerb in our cities, never aligned, completed by careless contractors in a hurry to submit their invoices. Our cities are testimonies to the fact that we don’t give a damn in daily life, and it’s the first impression incredible India offers to visitors stepping off planes. My daughter calls it the India smell, the peculiar odour of Phenol and musty carpets that greets you in Mumbai airport as you step off your plane.

They respect each other in daily life. Beyond a shadow of doubt, Indians have stopped doing that. The urban Indian lives daily life in a state of barely suppressed road rage, and the violent honking of horns on every road is only one manifestation of that. Interruptions of any kind ignite instant anger; nothing is tolerated that could come between today’s Indian and the success and wealth that awaits him. Thais, on the other hand, never forsake courtesy, even in dire crises. Last October, with their cities submerged twenty feet deep in floodwaters, all their belongings drowned or swept away and no food even for infants, no Thai, however bereft or hungry, made a display of impatience or greed when boats with survival rations rowed up. It is the same spirit the world noticed in Japan after last year’s quake, a quality of grace and thoughtfulness in crises that seems to have deserted the Indian temperament, whether they live out of India or in it.

They do not view other people’s mishaps as money-making opportunities. A friend of mine visiting Thailand last month lost her husband to a massive heart attack at 2 am in a hotel in Bangkok. She was paralyzed with grief, and I found myself dealing on her behalf with the Thai government, bureaucracy, police, hospitals, airlines, and embalmers, trying to get clearances, autopsies, certificates, and so on. In the space of 12 hours, I dealt with a morgue for an autopsy; a police station to file a report; the District office to get a death certificate; an embalmer; and an airline to get clearance to ship the body.  Amazingly, every document my friend needed was in her hands within 12 hours. No bribes were sought; every system worked as advertised; all human beings were courteous, efficient, and friendly, even though hardly any spoke English.

I do not believe Thailand is a virtuous paradise with no corruption in daily life; policemen pocket payoffs from motorists just like in India. But I have yet to see an individual in power squeeze money out of someone else’s misfortune or grief. I remember the story of Murtuza, a boy hanging out of a train who was knocked off by a trackside telephone pole and then cut in two by the train’s wheels a few hundred yards from Sion station, Mumbai. I covered the story for Mid-day in 1996, and remember one grisly detail — Murtuza’s severed legs could not be found at Sion hospital. The morgue attendant claimed they might have been ‘misplaced’ or could perhaps be found in the garbage dump. His parents had to bribe the attendant a few hundred rupees to get their son’s limbs back.

In my more ruthlessly introspective moments, I wonder if I am an automatic racist just by being Indian. For example, I found Kenyans in general less competent in work, unable to follow management systems, and hopeless at reports, while Americans I worked with seemed more engaged with development, more dynamic, more eager to see change. How much of my assessment was linked to skin color and race? Little, I now believe. By the time I left Nairobi for Bangkok, I had begun seeing Kenyans and Americans differently, both flawed and both promising, both merely human.

ARE INDIANS PROMISING? What is the promise? More and more I suspect, they are the wise ones who forgot their wisdom and became strutting bullies. Take the case of the South Asian Association for Regional Cooperation, better known as SAARC. As the behemoth in the sub-continent, India is a natural power centre and could easily play big brother and mentor to its smaller neighbours such as Nepal, Bangladesh and Srilanka. The fact that it chooses instead to be a bully, railroading meetings, and neutralizing important discussions by simply absenting itself has made it an uphill task to get SAARC off the ground. Officials in the United Nations, aware that without India’s nod nothing can move in the region, bash their heads against the wall from the sheer frustration of trying to engage with the high-handed Indian bureaucracy. I once facilitated a South Asian meeting on gender-based violence, where the Indian delegation yawned with barely concealed disinterest as Pakistan, Srilanka, Nepal and other countries humbly spoke of their efforts and creativity in working with violent men. Then the Indians held forth on their own amazing achievements.

Which brings me back to my son and my burning question: how do I explain to him what being Indian means? We are waiting at the spotless platform of Bangkok’s skytrain, when with a sudden increase in ambient noise, a troupe of a dozen or so Indian salesmen, freshly freed from a sales conference, pour up the escalator. They’re young, full of hormones, ready for blood, and masters of all they surveyed. Three Thai girls waiting with us discreetly moved further away; after a decent interval, so did we.

The train arrived, packed wall to wall with human bodies. No one waiting on the platform even considered trying to get in — except the ratpack of Indians. Entering Churchgate Mode, they began darting up and down the platform, shouting to each other as they spied opening and footholds. As we watched, 12 of my countrymen disappeared like a biology lab trick into a train that could not possibly have held more. The few Thais on the platform waiting patiently for the next train said nothing.

And in that damning silence, my son and I wondered who we really were.

Joining dots in Bangladesh

A simple question about diabetes on a flight to Bangladesh leads to the story of “the largest mass poisoning in history” — arsenic in Bangladesh’s drinking water. And the role that two well-meaning donor agencies played in it.   

Have you ever had a day when disconnected things — conversations, images, thoughts — all somehow come together into something much larger and more interesting? A day of joining dots and seeing a pattern emerge? This happened to me last week, on the day I flew from Bangkok to Bangladesh. From the airport, the plan was to drive straight for five hours till we reached the district town of Bogura. On such long sojourns, I do three things mainly — talk, look, and ask questions. Usually one thing leads to another.

Dot 1: Something about sugar

The man sitting next to me on the flight to Dhaka had no rice on his plate. Not that he hadn’t eaten it; I could see he hadn’t been served rice. He muttered something but because his mouth was busy at the time, I only heard the word diabetes. Earlier I’d mistaken him for Amin Sayani, a well-know radio voice of yesteryear, and that had gotten us off to a good start.  He was a Calcutta boy, then a Delhi boy, but went to university in Karachi, though now his only son is married to a girl from Kerala. He thought Keralites were the most refined of Indians. I told him I was from Kerala, which was partly true, but not that refined, which was also partly true.

His family and friends were all over the plane, I realized, when a daughter, a grandson, a son-in-law and other kin swung by to check on him. Presently, a younger man from business class ambled up to chat with him, a friend this time, and my ears perked up when the word cropped up again — diabetes. As they exchanged woes, I reflected on the chances of meeting two men from two generations of two different Bangladesh families suffered from the same disease, and traveling on the same plane.

Dot 2: The driver’s diet

Shah Jahan became a driver with the United Nations Food and Agriculture Organisation less than a year ago. The division he is assigned to is intensely concerned with emerging infectious diseases, and Bangladesh has been endemic for avian influenza since 1983, so Shah Jahan tends to be on the road a lot, ferrying carloads of epidemiologists to distant hatcheries where birds are dying off.

Shortly after we left Dhaka city limits, we decided to stop for a bite to eat. Small town food in Bangladesh tends to be generally simply and tasty, though you need to check the hygiene standards yourself before taking a table. Generally, there will be rice or chapatis, a vegetable (bitter gourd is almost a standard), a dish featuring potatoes and raw papaya cooked together, a water thin dal made with red lentils, and either a chicken or fish curry for meat. There will be a cucumber salad, served with wedges of aromatic kaffir lime. Shah Jahan sat a different table from us, a reflection of Bangladesh’s bureaucratic awareness of social status and seniority/juniority.

On my way to washing my hands after eating, I noticed that he had skipped the rice and gone for the refined wheat flour chapatis instead. “Did you eat well?” I asked him in the car later. “I saw you didn’t eat rice.”

“I don’t eat rice, sir,” he replied. “I have diabetes.”

Shah Jahan is just a little over 40, too young to have diabetes. I asked him if he carried insulin injections around. No, sir, he replied, I take insulin tablets.

The third man with diabetes in as many hours. All from Bangladesh. Two of them too young to have diabetes. I whipped out my iPhone and went online as the car bumped along. Within moments I was looking at  some data from the Diabetic Association of Bangladesh. Professor Akhtar Hussain, diabetic researcher, wrote —

In 2010, the International Diabetes Federation (IDF) estimated that 5.7 million (6.1%) and 6.7 million (7.1%) of people living in Bangladesh is suffering from diabetes and impaired glucose tolerance (IGT) respectively. By 2030, that number of diabetic population is expected to rise to 11.1 million. This explosion in diabetes prevalence will place Bangladesh among the top seven countries in terms of the number of people living with diabetes in 2030.

Dot 3: Something in the tube well

We were passing vast plains of floodwater, a common sight in Bangladesh in the rainy season. The road, built on an embankment, rose above it all. Here and there, the topmost branches of submerged trees stuck out of the water, giving the landscape a surreal Dali-esque feel. Water reminded me of arsenic, and the number of times I’d heard about Bangladesh’s ubiquitous problem of arsenic in its drinking water. I also realized how little I knew about it. Was all water in Bangladesh contaminated? Did the arsenic find its way into the drinking water through industrial waste poorly disposed of? What did arsenic poisoning do to the body? Could arsenic be filtered out of drinking water?

I looked at the label on the bottle of mineral water in my hand — in fine print below the logo were the words Free of arsenic. For some reason, that sent a small chill through me. Well, that took care of the last question about filtering arsenic.

“The arsenic is everywhere,” said Arif, my colleague and traveling companion on this visit, “but specially near the big river.” The big river was of course the Ganges, on its way to a greater nirvana in the Bay of Bengal.

“Are we near the big river?” I asked, suddenly seeing a direct link between arsenic and myself. Our destination was the 140-acre campus of the Rural Development Academy in Bogura, Bangladesh. Would the water be safe? “They have their own arsenic filter on the campus,” Arif said reassuringly. This only alarmed me further: why would they install an arsenic filter unless the water there had arsenic?

We stopped at a roadside tea stall, with a tube well next to it. As he cranked water for tea from several hundred feet under ground, I noted that his pump did not carry anything that looked like it might be an arsenic filter. So while I pretended to drink my tea, I pulled out my trusty iPhone again and did some reading about arsenic in well water.

Dot 4: From arsenic to diabetes

The first thing I learned was that Bangladesh was only one among a slew of countries that had unsafe levels of arsenic in their well-water, others including the United States, Thailand and Taiwan. A 2007 study found that over 137 million people in more than 70 countries are probably affected by arsenic poisoning of drinking water. Approximately 20 incidents of groundwater arsenic contamination have been reported from all over the world. Of these, four major incidents were in Asia, including locations in Thailand, Taiwan, and Mainland China. South American countries like Argentina and Chile have also been affected. There are also many locations in the United States where the groundwater contains arsenic concentrations in excess of the Environmental Protection Agency standard of 10 parts per billion adopted in 2001. According to a recent film funded by the US Superfund, In Small Doses, millions of private wells have unknown arsenic levels, and in some areas of the US, over 20% of wells may contain levels that are not safe.

“Bangladesh had to change the limit otherwise they would have had to report that the entire country was at risk from arsenic poisoning,” said Arif cynically. The acceptable level as defined by WHO for maximum concentrations of arsenic in safe drinking water is 0.01 mg/L. The Bangladesh government set its limit at 0.05 mg/L. According to a British Geological Survey study in 1998 on shallow tube-wells in 61 of the 64 districts in Bangladesh, 46 percent of the samples were above 0.01 mg/L and 27 percent were above 0.050 mg/L. When combined with the estimated 1999 population, it was estimated that the number of people exposed to arsenic concentrations above 0.05 mg/L is 28-35 million and the number of those exposed to more than 0.01 mg/L is 46-57 million (BGS, 2000).

Bangladesh’s population is 142 million, according to preliminary reports from the latest census. This means nearly one-third of its population is exposed to unsafe levels of arsenic.

All riveting stuff, but I wanted to know what exactly happens to a person poisoned by arsenic. Easy — my iPhone reappeared in my hand, and a few taps later, I was looking at how I would be feeling if I’d been living in a village by the Ganges in Bangladesh —

Symptoms of arsenic poisoning begin with headaches, confusion, severe diarrhea, and drowsiness. As the poisoning develops, convulsions and changes in fingernail pigmentation called leukonychia may occur. When the poisoning becomes acute, symptoms may include diarrhea, vomiting, blood in the urine, cramping muscles, hair loss, stomach pain, and more convulsions. The organs of the body that are usually affected by arsenic poisoning are the lungs, skin, kidneys, and liver. The final result of arsenic poisoning is coma to death.

Arsenic is related to heart disease (hypertension related cardiovascular), cancer, stroke (cerebrovascular diseases), chronic lower respiratory diseases, and diabetes.

Dot 5: A case on unintended harm

There is very little evidence in Bangladesh to link arsenic poisoning with the increase in diabetes. Certainly, a major disease like diabetes can be linked to much more obvious causes such as poor diet, lack of exercises, genetic predispositions, and stress. Arsenic could be an exacerbating factor, no more. Or could it be more? In 2010, the British medical journal Lancet published a study led by Dr. Habibul Ahsan of the University of Chicago, which found that as many as 77 million people—half the population of crowded Bangladesh—may have been exposed to toxic levels of arsenic. Ashan and his colleagues followed nearly 12,000 Bangladeshis over the course of 10 years and found that more than 20% of deaths were caused by arsenic.

This had been predicted as early as 2000 by Dr Allan H Smith, professor of epidemiology at the University of California at Berkeley, USA, whose study forecast a major increase in the cases of diseases caused by arsenic ranging from skin lesions to cancers of the bladder, kidney, lung and skin, neurological effects, cardiovascular and pulmonary disease, and diabetes. The diseases, he warned, may develop slowly over many years. WHO called it “the largest mass poisoning in history”. The most detailed exposition I have read of the tragedy is here.

Based on these numbers, the three diabetes patients I had met today could easily be victims of a slowly blooming pandemic of arsenic poisoning. But by now my interest in arsenic was deep and urgent. Clearly there had been a time when Bangladesh’s drinking water did not contain arsenic  — so what brought it about?

I had the shocking answer before we reached Bogura. In the 1970s, nearly a quarter of a million Bangladeshi children were dying every year of a different disease — diarrhea — because of sewage-contaminated water from village ponds. Unicef, with the Bangladesh Department of Public Health and Engineering, proposed that water that was pumped out from deep ground through tubewells would be clean and safe to drink and not cause diarrhea. The World Bank pitched in with millions of dollars — and a massive tubewell construction project was launched in Bangladesh. Today over 3 million deep water tubewells pump up water to 97 percent of the population.

Unicef was telling its story  as recently as 1997, in a brochure of picture-postcard images of plump peasant women pumping well water: “During the 26 years since independence, the coverage record of the Bangladesh rural drinking water programme has been outstanding,” it said. “In spite of rapid population growth, 2.5 million public and private handpump tubewells have been installed, bringing safe drinking water to 97 per cent of the population.”

But alas, the story was false. Although the infant mortality in Bangladesh had halved by 1996, a different problem that affected anyone who drank water, had reared its head, first showing up as skin lesions and a burning sensation in the chest. Those who crossed the border into India for diagnosis and treatment were told that the symptoms corresponded to arsenic poisoning. The Bangladesh government, alerted, apparently stood in denial of the issue for some years rather than disrupt the well-funded tubewell programme.

The governments change, and each now is funded anew to address the problems created by previous governments and previous well-meaning donors. Everyone prospers, including the contractors hired to do the electrical and mechanical work. Everyone is better off, of course.

Except the 142 million people for whom all this is being done.

Is this book in the Top Ten?

I got news two days ago that my first novel, the 348-page long The Book of Answers was spotted in the Asian Age newspaper’s India Top Ten Bestselling Books list.

Before you rush out with the old autograph book, let me draw you attention to the fact that it is only The Asian Age. Heaven knows how they figure out which ten books are doing the best, but I’d wager they call a friendly accountant at a nearby Crossword or Oxford Book Shop. I’m leery of Top Ten anythings and so should you be. Besides, the book had been launched in India just about a week earlier, on July 5, at Delhi India Habitat Centre.

Which brings me directly to Mani Shankar Aiyar.

I have heard of Mani Shankar Aiyar only that he has the sharpest tongue and most unvarnished views of any politicians in India. Or perhaps ex-politician, seeing where his views have gotten him. I didn’t know, for instance, that he spoke flawless French. That though nudging 70, he jetted around like a young free radical. I certainly didn’t expect that he would say yes to launching my first novel, The Book of Answers, in New Delhi on July 5 this year, at the Casuarina Hall at the India Habitat Centre.

Mani Saar, as people at HarperCollins seem to call him, admitted frankly to me that though he had been carrying the book around with him for a couple of days, he had not found the time to read. However, he had opened the book at random, the correct word is browsing, or perhaps grazing, and his eyes had fallen on an early chapter calledThe Matter with Rose. In this chapter, Rose and Patros meet with the morose doctor of venereal diseases in Kamathipura, Dr Dimtimkar. What had caught Mani Saar’s eyes, it seems, was my description of Mumbai’s red light district.

“I was totally struck by the quality of his writing,” said Mani Shankar. “I can’t believe that it was somebody who was a journalist, and therefore presumably a bad writer, who was capable of producing prose of this kind.” He then proceeded to read slowly and with apparent relish two paragraphs from the random chapter that had taken his fancy, pausing to savor choice phrases. When he was done reading it, he read it all over again a second time, this time pulling out phrases and expressions that he clearly though masterly — skeptical alleysdaytime children of evening mothers, the clinic’s lurid curtain that the ceiling fan blew up every few minutes like Marilyn Monroe’s skirt.

Read it for yourself here —  The matter with Rose.

To watch Mani Shankar reading from my book, go here What Mani Shankar Aiyar really thinks of The Book of Answers

Mani Shankar was smartly by one of Delhi’s most beloved voices, Sunit Tandon, who dramatically read out the excerpt where Patros and Rose learn that they owe the governments pots and pots of money as arrears in the Happiness Tax, payable by all who have sex. Read it for yourself here — Ministry of Regrets.

Launch events in Mumbai, Kolkata and Bangalore are coming up in November. Watch this space.

Book of Answers launch on July 5

July 1, 2011, Bangkok: At 6.30 pm on July 5, 2011, at the Casuarina hall in New Delhi’s Habitat Centre, the Book of Answers will be officially released to the general public in a publishing ritual that usually lasts about two hours. Mr Mani Shankar Iyer, popular and plain-spoken diplomat, journalist, and political and social worker, will be the chief guest. Sunit Tandon, actor, will read out his favorite excerpt from the book in his sonorous perfect voice. I’ll probably mumble a few words. And there — it’ll be out in the open. Six years of work now smartly bounded in a 345-page colume, printed in Minion Pro 11 point type, published by HarperCollins India.

This is not a bad time to trot out the milestones in the writing of The Book of Answers.

Dec 2004 — The copyright to my first book, Travels with the Fish, reverts to me after the mandatory five years. A letter from India notifies me of this.

Jan 2005 — I have a narrow escape. My Left Anterior Descending artery is found to be 80% blocked. I undergo a procedure in Bangalore, where the block is removed and stent installed there.

Feb 2005 — I spam some 700 US literary agents with a sample chapter of Travels with the Fish and an offer I don’t see how they can refuse. A done deal: already published by HarperCollins, already on the best-seller lists in India. What’s to refuse? But no takers. A few write short and polite refusals. One thinks I have potential as a writer.

Feb 2005 — Nathan Bransford, a literary agent with Curtis Brown, gets in touch, rather enthusiastically. He likes my travel chapter but wonders if I have any fiction work in progress. Always good to launch internationally with fiction, he says. Here’s the thing — I’ve never written to Nathan before. He was not on the list of 700 I spammed. He got my sample chapter as a forward from one of the spamees.

Mar 2005 — After struggling with Nathan a bit, protesting that I am not a fiction person, don’t have a novel in me etcetera, I agree to try. I have had a recurring story line in my head, a single sentence, no more, about a man who inherits a book with answers to all the world’s problems. I give myself till May 30, my birthday, to bang out one chapter.

Apr 2005 — I somehow finish a chapter ahead of schedule. Nathan loves it, my brother Ramu finds it interesting and I don’t feel it’s all that bad. I undertake to write the novel.

May 2005 — I meet Nathan Bransford in New York, there, at the same pub where Jack Kerouac used to imbibe. I sign a contract with Curtis Brown Limited, America’s oldest literary agency.

Mar 2008 — Three years later, the book is done. It’s 150,000 words long and written in the first person. Along the way, it’s been entirely re-written in the third person, and then again back to the first person twice. It has undergone eight version edits, two entire restructurings, ruthless editing to tame the narrative, and bottom-up revisualization. Nathan has read it every step of the way and commented whenever asked.

April 2008 — HarperCollins India is interested in publishing the book. I sign up with them, but a clause abjures them from publishing before the book is released in the US.

Mar 2010 — After several rounds of submissions in the USA, and a long list of what Nathan calls “rave rejections” — letters that are more than usually complimentary but end with declining the offer — Nathan comes reluctantly to the conclusion that the recession-hit US publishing market is too risk-averse to take up a book like The Book of Answers.

Early 2010 — HarperCollins India is given the go ahead to release the first edition of The Book of Answers.

And the rest, as they say, is tomorrow’s news.

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