So I'm in India. But I mean I am REALLY in India. I landed in Delhi two days ago (maybe three), after flying to Hong Kong and Singapore, watching four movies, reading a book, eating seventeen meals, taking a shower in the Singapore Airport spa (yes, spa), buying a new Motorola cameraphone in the Hong Kong Airport, and entrusting my wellbeing to my friend Sri.

Delhi is, as everyone says, heat and dust. Everyone lives in the street; as a consequence, you don't move very quickly. But you wouldn't anyway because of the intense heat and humidity. I took a long walk through the market area around our hotel (the Metro Heights in a section of Delhi called Karol Bagh), looking at the people selling merchandise to each other. Chai is the beverage, potato cakes of various kinds are the menu, and intimacy is the word of the day. There is no personal space in Delhi. After they delivered my bags to my hotel room, the two "bellmen" left, came back, and walked right in again uninvited an unannounced. They weren't waiting for a tip, because I had already done that. I think they just wanted to see a blonde woman up close.

The hotel is old, although it's being renovated, and you have to be an electrician to figure out how to charge a cell phone. Every outlet in the hotel presented a different configuration of holes, defeating even my Sharper Image "universal" converter. I had to borrow a converter from the front desk.


What's being renovated about the hotel is its public space, not the amenities in the rooms. And the same goes for every building in Delhi. The public buildings are beautiful, because the labor to maintain them is a dollar per man per day, and the government is the largest employer. However, all those dollar-a-day men go home to places that are little more than cardboard boxes.

It's a mystery why everyone stays there, when so much of the rest of India is so beautiful. Last night we took a train north to Pathankot, near the Pakistan border. Pathankot used to be the railhead for trade from Afghanistan, and it is little more than a market. But there is so much rural land around it, that half of Delhi could probably live there in peace and splendor. The problem is that the opportunity used to be in the cities, and everyone from the rural areas went there. It was like being the last person to buy in on a hot stock -- millions of people got left holding the worthless piece of paper that is opportunity in Delhi.

Remember, Delhi isn't Hyderabad or Bangalore. The outsourcing revolution is invisible there, and it certainly hasn't hit Pathankot.

On the train, we spoke to an Indian army careerman who told us he had been stationed at the Pakistani border, and that the most difficult aspect of his life there was trying to decide who is the enemy. He said everyone looks alike, and he has to avoid making a mistake and must also be responsible for the fifteen hundred men heis managing.

Right after that conversation we visited an ashram, and from there we set off on the best part of the trip so far: the drive to the headquarters of the Dalai Lama, Dharamsala. It's a mountain town not unlike a ski resort, although the amenities, once again, leave something to be desired. The toilets are holes in the ground, there's no toilet paper, and little electricity.

And yet, there's cellular. Even at the ashram people had cell phones. Not only that, they could sell me the special SIM card I needed to identify myself on the local cellular network and put it into the phone for me. I was also able to find, although this was back in Delhi, a flash memory card for my camera. In India, I find, when you want something, you express your intention to your host, who goes and obtains it for you and then sells it to you.


India is definitely a land of contrasts. It�s all here somewhere, but only if you know someone who knows someone. And now I have found I am two degrees of separation from the Dalai Lama. Who knew?

FAT FARM

For the past few months, I have been working with Byron Davies, a researcher in medical informatics at Arizona School of Health Sciences, under a grant from St.Luke�s Health Initiatives to hold focus groups for diabetes patients, their providers, insurers, and allied health professionals on how technology can help people manage their diabetes more effectively. We went in with a pretty clear idea that technology can help (Byron�s background is artificial intelligence, mine is IT); we just didn�t know where.

Like most researchers, we opened a larger can of worms than we expected. The last of the three groups, held yesterday on the Gila River Reservation, was daunting, and left me feeling that technology is a very small piece of a very large puzzle: why don�t people take personal responsibility for their health? We can blame it on fast food restaurants, or � in the case of the Gila River Indians � government supplied surplus foods, but ultimately we have to blame it on ourselves.

In the native American community, this puzzle has more pieces than in the community at large, but the finished picture is still the same. The dominant image we took away with us was the beauty of the desert interrupted by the Reservation�s large new Dialysis Center with a huge Coke machine out front. But that�s not very different from Home Depot with the same machine out front, or Costco with its hot dog vendors, or Jack-in-the-Box � it�s just slightly more ironic.

As in the other groups we held, patients stressed that compliance has to be simple; the more medications a person is on, the more difficult it is to get them to comply. And they must be really motivated, for which direct one-on-one interaction is very important. One woman said that she denied her diabetes until her daughter told her �I want you to be around for your grandchildren,� and then a light went off in her head and she took control.

On the reservation, so near the sprawling Phoenix metropolis and made �wealthy� by the casino money, home visits are key: many people have transportation issues that prevent them from getting to the clinic, some still don�t have phones or want to use them, and older people are hesitant to use new technology, intimidated by computers or even allopathic medicine itself.

One woman, who learned she was diabetic three years ago, went through a year of denial even though she works at the health clinic. She said the hardest thing for her was to integrate modern medicine with traditional beliefs, and that many people on the reservation believed they could control their diabetes by drinking greasewood tea. She drank the tea occasionally herself, and thought it worked.

The participants in the group thought as many as 60% of the 18,000 adults on the reservation were diabetic � even young ones. Many of them don�t do anything about it, even though they are told their glucose is high. On the reservation, glucose levels of over 250 are common, and the health professionals often see people with glucose levels of 600 who are still walking around. Apparently, their bodies adapt to the high values so they can function, and they don�t realize permanent damage is occurring. As one participant put it, �people don�t realize that they�ll be hooked up to a machine in ten years, and by then they are resigned to it. We have a wonderful education center out here, but people don�t take advantage of it.�

So, after all, the issue isn�t what technology to use �it�s why don�t people stop self-destructive behavior? On the reservation, education may be part of the problem (some native Americans still think that because everyone around them has diabetes, the disease is contagious), but lack of motivation seems to be the biggest obstacle. Younger people don�t want to be monitored and have adults tell them what to eat; older people think diabetes is inevitable and they might was well just wait for it.

So remote monitoring won�t be a panacea for those who don�t have easy access to health care, unless they have first made the decision to control their diabetes. For those who do choose to control their diabetes-- a self-selected group, similar to those in the population at large who diet and exercise-- technology becomes really useful as a tool.

And also ontrary to what we originally supposed, the more �out there� and futuristic a technology was, the more people seemed to think they would like it. High on the list were ways to monitor blood sugar through a breathalyzer or through the skin; higher still was the implantable artificial pancreas.

So my takeaway from all this is the same as it always is: in life, you play ball with the people who show up. When someone �shows up� for their diabetes, even on the Gila River Reservation, they will go for the technological fix.

HOV LANES IN THE SKY

I fly a lot. Of course I no longer enjoy it, because I have to disrobe and take my shoes off to go through security, arrive at the airport two hours early and wait around or stand in an eternal line, and sit squished up against the obese person next to me in an uncomfortable airline seat. All the elegance once associated with air travel evaporated when Southwest Airlines was founded, and all the convenience disappeared on 9/11. Now you don�t even get to criticize airline food anymore; it has also vanished. Pack a lunch if you�re going to Hong Kong. I am going to India on March 19; I wonder how many legs of the trip will be food-free.

But people are innovative, and they will always find solutions to problems. About five years ago, two friends of mine from the early days of the Arizona Software Association, Vern Raburn and Dottie Hall, cashed it in and decided to follow their bliss by developing �personal� jets that could be bought relatively inexpensively. We thought they were crazy, but since they were early Microsoft employees, they had earned the right to their little experiment.
It turns out they weren�t crazy at all, but merely ahead of their times. Their company, Eclipse Aviation, is creating a luxurious six-place, twin-turbofan aircraft that costs less than most used turboprops. It is more economical to own and operate than most of today�s single engine pistons and all multi-engine pistons and turboprops. For those who don�t want to pilot themselves, aircraft charter and air taxi services with professional pilots, will be competitive with a full-fare airline ticket. You can probably even design your own menu. And you will not have to go through security.
Here�s the technical stuff: The Eclipse 500 cruises at a brisk 375 kts and has a generous 1,280 nautical mile range with 4 occupants, NBAA IFR reserve (1,395 nm with 45-minute IFR reserve). A 41,000-foot ceiling avoids most severe weather and the 67-knot stall speed makes safe landings easier. Excellent performance at high altitudes and hot temperatures builds in an extra margin of safety.
The last time I saw Dottie speak, she said there was a two-year waiting list for these jets, and they hadn�t even come off the assembly line yet.

Why is this important to you and me, even though we may never own an Eclipse Aviation product?

Because the airlines have also figured out that small can be beautiful. The only profitable airlines are the small, regional ones. The old wide body planes are vanishing, to be replaced by smaller commuter jets that fly at the same altitudes. Two of these smaller planes replace one big jet.

While this is good for the airlines, and not bad for us either (they board and disembark quickly and are usually cheaper to buy a ticket on), it creates a problem for air traffic control. Never mind personal jets that can fly at 41,000 feet, these regional jets now fly at the same altitudes the old wide bodies occupied.

So no one is flying at 20,000 feet anymore, where the old turboprops did. This will create quite a traffic problem in the sky at peak travel season. The people in the know already have figured out that one problem (the inconvenience of flying) may have been replaced by another (the decreased safety of flying) as the airlanes become more and more crowded.

Are you old enough to remember �Fly the friendly skies of United?� Well, the skies aren�t going to be so friendly now that each large United plane has been replaced by two smaller TEDs. Pilots have had a quiet confraternity since the inception of the aviation industry, but that might soon be replaced by a form of road rage as everyone struggles to make all these new planes reach their destinations on time. I suspect that for the passengers, things will get worse before they get better, and we can expect big delays as the entire airline industry undergoes a paradigm shift away from the railroad paradigm �herd everyone into the same car and make them all travel at the same time for economies of scale �and arrives at the single occupant automobile paradigm (make it convenient for the individual at the expense of natural resources, other people, the environment, and safety).

Everything you always wanted to know about prison...
For those of you who have been following the travails of my bipolar former foster son, LJ, and his experiences in the prison system, here�s an update that demonstrates everything that is wrong-headed and downright stupid about that system. Every time he and I think we have it figured out and we�re making some headway on preparing him for a life when he is released, some more s___ hits the planning fan and we�re back to ground zero. It�s as if we are trying to make lemonade and the lemons are juiceless.

After being moved around five times in the last 25 months, Jerry was at Sam Lewis Prison in Buckeye, Arizona. We had arranged for him to start working at Hickman�s Egg Ranch in the near future, and for him to register for two college classes.

You probably remember that the longest hostage crisis in history took place recently at Sam Lewis Buckeye Prison. Although LJ was on a minimum security �yard�, and wasn�t near it, it stopped us from being able to visit him for a month. His sister and I try to visit as often as we can, because most of the prisoners in minimum security have large and attentive families who try to do the same, and LJ�s birth family is pretty scattered. Visiting him in prison, while always a bummer, is a way to keep him connected to the outside world and planning for a different future.

But as soon as the hostages were released, they started moving prisoners around � I guess because Lewis Prison is overcrowded. They moved LJ to Globe�sixty miles away and in the middle of nowhere.

Before they moved him, they took all his books away from him (I had sent about twenty-five, and he had read them all) and most of his clothing (I had sent money for extra shoes and jackets). After confiscating these possessions, they told him he had two weeks either to get someone to pick them up and take them home for him, or to mail them home himself. After that, they�ll be donated to the prison library and the clothes will be given to someone else.

Well, the last $200 I sent him through Western Union appears on my credit card, but never arrived on his books. The money we allocated for his college classes is on �hold� for education and can�t be used by him for postage. So he doesn�t have money to mail the package to us; we will have to drive to Globe next weekend. But we don�t know the visiting hours yet, and neither does he.

At Globe prison, the glamor jobs at Hickman�s Egg Ranch for $.50 an hour don�t exist. He has been told he is eligible for a $.10 an hour job, however, of which they will take 25% for restitution. It�s like a bad joke.

It gets worse. When they took all his possessions, they took his razors. But the rules require him to be clean-shaven to enter the chow hall. He has no more money for new razors, and I don�t know how to send him any yet. So the guards are issuing tickets to him for not being clean-shaven.

Prison is like that; it�s a series of Catch-22s, and if you are a prisoner your biggest challenge is to contain your frustration so you won�t get yourself in trouble and get your stay extended.

Coincidentally, I�m in the middle of a New Yorker article on the The Brand, a very violent Aryan gang that operates within prisons. Apparently, convicts are running drug rings from solitary confinement, and ordering hits on the order of the Mafia. These people are in for violents crimes, they have long sentences, and they have made an adjustment. These gangs run the prisons, and consume the time and energy of the guards, who then don�t have much impetus to rehabilitate the others.

It�s really uplifting for me to read these articles and know that little Jerry, who was incarcerated when he was only nineteen (and then only because he was a non-violent drug addict who stole to �support� himself), is meeting these fine upstanding people in the slammer.

Little Jerry wouldn�t be in prison at all if he hadn�t begun to self-medicate when my husband died. When my husband was alive, because he was a physician, he treated LJ himself. But when he died�the second time LJ lost a father figure-- it was too much for LJ and he began looking around for something to numb the pain. If someone had prescribed lithium for him instead of offering him crack, we wouldn�t now be planning our weekend trips to Globe. But in the foster care system, like the prison system, no one cares about the future; the system is too busy keeping the lid on situations in the present. For that, our entire society pays.