Today I am loving India again. Dwarko-ji took us to a plantation about ten miles outside of Bodh Gaya where, having been given 70 acres of land twenty-five years ago, he built a "school for life." Here, the village children he takes are not poor "townies," but rural, almost tribal foragers. The parents have no concept of upward mobility, and do not even see a reason to send their children to the school as boarders, the way the people in Bodh Gaya do.

However, these rural forest dwellers spend the day in the forests looking for food, and they have begun to see the school, especially the kindergarten, as a safe place to drop the kids for the day. So there are 90 "boarders" and many other "day students."

This farm, which is large enough to be self-sustaining, uses biomass (cow dung) for cooking gas, exists without electricity, and doesn't even have bathrooms. The plowing is done by a man walking behind a team of oxen with a wooden plow. I'd never seen this outside a book; it is an innovation from the Middle Ages.

On the farm, the children learn how to work the generator that drives the well, how to irrigate and farm, and how to take products to market. This is part of Ghandi's program of "village development," whereby you help the village by educating the children. India is full of this concept, on every level. On the higher levels, it's why Bangalore exists: generations of Indian parents have educated their children to a better life. On the poorest level, in rural Bihar, it's teaching the children to graduate from hunter-gatherers to farmers.

But the children also become literate in this school -- at least the boarders do. Like all Indian children, they sit patiently waiting for the teacher, with their little chalk boards in their hands. They are wearing uniforms. Literacy, uniforms, farming -- these are great steps forward for these children.

So the farm is self-sustaining, while the ashram school, in the town of Bodh Gaya, is not, because it is only two acres. This is why Dwarko-ji wants to start the cow project, to produce medicines (both Ayurvedic and allopathic) from cow urine.
So yesterday I bought him the first cow of twenty he thought he would need.

We went to the cattle market. I found it hilarious: the cows are wearing fancy decorative headpieces and leashes as they are paraded around for sale. They are brought from all over the region to this market. It's like the cow prom. The Indian cows are different from the others, because they have big humps behind their necks. I think they are all ugly, but Dwarko wants one of these because they give better urine for medicine (supposedly). Just in case you think all this is crazy, I remind you that cow urine is a well-known antiseptic and antibiotic ingredient. Made into pills, it's not recognizable :-)

There are also Jersey cows, and Dutch cows at the market, some of which are much more expensive than the cow we choose. There are also lots of calves. The calves remind me of puppies.

The ashram people are not stupid; they pick a cow they think we will buy, put a deposit down, and come back the next day to milk the cow three times before consummating the purchase. We have our eyes on a gray cow; if they buy her, she will be named Francine. We hope she will urinate often, just like the original Francine.

Half way through the cattle market, I come to my senses and go back to the air conditioned car, realizing how unsanitary the conditions are, between the dust, the flies, and the animals. When I get back to the hotel, I take a shower (or rather I let the water run out of the wall in my bathroom into the plastic bucket, and then take the small plastic bucket, fill it, and pour it over my body. I use the Ayurvedic, non-foaming soap. I emerge new, and ready for dinner.

Bihar is the poorest state in India. I am here following in the Buddha's footsteps, although I think I am more aptly following in the footsteps of Buddhist monks who come here from the major Buddhist countries of the world --Sri Lanka, Thailand, Korea, Japan, Taiwan. India is not really Buddhist; it's Hindu.

But the Buddhist shrines happen to be here, and yesterday we visited Rajghir, where the Japanese Buddhists have built a Peace Pagoda on top of the mountain where Buddha lectured, and Nalanda -- the excavated remains of a university that is 2500 years old.

Walking through the campus of Nalanda, which the British excavated in the early 20th century,any visitor gets a jolt. The western world didn't invent anything. Nalanda had lecture halls, science rooms, libraries, dormitories, and most of the accoutrements of the modern university. All this was built in the 5th century BC, and at the height of Nalanda's influence, Chinese scholars came here and took the books and teachings of Buddha back to China with them. Guess who destroyed Nalanda? The Msulims. And a few earthquakes, which caused it to be buried under mounds of dirt.

The spread of knowledge so long ago is awe-inspiring, because of the lengths of the journies. Even now, a trip of 80 km roundtrip with a few shrine visits takes a day over Indian roads.

The towns in Bihar are strung out along the main roads, markets facing the street, homes and farms in the interior. Although Bodh Gaya is a tourist mecca, the nearby farming villages grow all kinds of vegetables that make up the largely vegetarian diet. Every town has numerous stores in which you can buy a phone card or a SIM chip for your mobile, and my phone worked continuously even in the most rural areas. Not data, just voice. For data, it's still one line per town, and every modem connects to it. During the day, it's impossible to get on the Internet from Bodh Gaya, although I've already optimized the hotel's machine by saving the dial in password and downloading Firefox so I don't have to struggle with Internet Explorer's fat load.

Yesterday for the first time I found I was not in love with India. The beggars are so obnoxious and omnipresent that they make the Chinese look like laggards. They paw and beat you, showing their missing teeth and their physical deformities, which they wave like badges of pride. They actually defeat their own causes with their aggressive behavior. I am told that the government has homes for these people, and they do have beds to sleep in at night, but they prefer to beg at the shrines during the day. I think the begging is the biggest deterrent to building a tourism industry in India.

That's in Bihar, where I am. In Bangalore there are no beggars; because of the presence of worldwide commerce, the government has carted them all away. I don't know whether that's better or worse, but I know we faced the same issues in downtown Phoenix on a much smaller scale, and it led to the magnificent homeless campus that opened last month.

Another issue I have with India on this trip is the use of English. The British have been gone long enough that the Indians, although they learn English, speak Hindi or another local language for their everyday life. So although they can often form English words and speak the language, they don't really understand what you say to them. Repeatedly they cheerfully answer the wrong question, telling me the date when I ask the name of the town. In Bihar, there is no real technology presence, and the people are helpful without being effective.

Nevertheless, I still see how eduation is valued even in Bihar; it's exactly the reverse of the States. At home, the houses are opulent and the schools are falling down. In Bihar, the homes may be boxes, but the schools are clean and painted. And in every market town, there is the equivalent of the Princeton Review -- a business that prepares students to take the exams for the IIT and the medical schools. There are Zoology centres, math centers, and physics centers in the middle of nowhere, coaching these kids for a better life.

It stuns me that Dwarko Sundrani, son of a wealthy merchant in India, chose to come here fifty years ago and dedicate his life to helping this village. What an amazing commitment. On the other hand, both the Hindu and Buddhist religions speak of dedicating one's life to something besides the self, so it's not as strange as it would be for a westerner. As Sri's brother said to me yesterday: "The cow gives milk, but she doesn't drink it; the river runs for everyone; the tree bears fruit only for others."

I never thought of it that way!

This morning Sri and our guide, who has been taking people to Buddhist sites in India for forty years, went to the Mahabodhi Temple, the most important Buddhist shrine in the world. It was built in the 3rd century BC, and had to be excavated and reconstructed in the 1880's. The shrine is called a stupa, in which all the little Buddhas add up to the big Buddha.

We had to take our shoes off at the entrance to the inner ring of the temple, which is mostly outside. There are seven places around the monument where Buddha spent time after receiving enlightenment sitting under the Bodhi tree. A tree still exists in the original spot, containing the DNA of the original tree.

At sunrise, the temple is almost indescribably beautiful. Monks from all over the world are softly walking around; many of the Tibetan Buddhists are doing their prostrations, as are elderly women.

This temple is a place where Buddhists from all over the world come; they seem to have a lot in common. Buddhism is a religion of ahimsa, or non-violence, and everyone in town is meditating for peace on earth.

We stayed at the temple for two hours, and then went to the eye camp that Swarko-ji's ashram has sponsored for twenty-three years. Dwarko-ji showed us how they have set up a system to do 1000 operations a day with no infections, serving 21,000 people this year. The people from neighboring villages come to the eye camp, where they receive a preliminary screening that tells whether they need surgery, whether this particular surgery (Yag laser cataract surgery and the insertion of interocular lenses) will work for them, and whether they have any other health conditions that might affect the surgery. The next day, they wait in line to be operated on. They are given a local anaesthetic, and they lie on massage tables, with each doctor going back and forth between two tables at once. An army of volunteers, masked and with hair covered, supports the doctors -- carrying equipment, sterilizing instruments, washing towels, etc.

After the surgery, the villagers stay at the eye camp in the tents for three more days while the dressings are changed and they are examined on a daily basis. On the fifth day, they are discharged with medications, glasses, new clothes, and instructions. During the five days, they are also fed three meals a day of healthy food.

This is all funded by a man who follows Dwarko-ji, and who is a diamond cutter by trade. He lives in Gujarat, buys diamonds in Belgium, cuts them in India, and sells them on 43rd Street in New York. His charitable trust funds the eye camp every year: 20 million rupees. And that's just for the food and the hard costs; everyone else is a volunteer. This fellow, who has never married and has, like Dwarko, dedicated his life to service, believes this is his true work.

Dwarko thinks his own life's work has been to reclaim two acres of land for the children. Although he is 84, he seems to have endless energy for organizing projects. He reclaimed the two acres of desert land into a farm for the children so they can learn the principles and technologies of farming, and he is now growing a new tree, Jatropha, that he says produces a fruit suitable to make bio-diesel. He plans to contribute his bio-diesel to the state. He already reclaims cow dung and makes it into cooking gas for his kitchens, and he is planning to buy more cows because he has been told that cow urine can be made into medicines, both for humans and for animals (it is used in antiseptics) and he wants to put his children into the pharmaceutical business. In his words, "it is a clean business with very little work."

He is moving the children along with the times.
But lest you think India is all made of Dwarko-ji figures and Tibetan monks doing prostrations, Sri was pickpocketed on the way home from the ATM machine this morning -- by a group of women, two of whom had babies with them.

It is an all day flight from Shanghai, which seems now to me like San Francisco, and Gaya, India, where Buddha received his enlightenment. I can see why enlightenment might happen here. It's a remote, dusty village where cows have the right of way on the road.

Everyone on the second flight, from Bangkok to Gaya, is a pilgrim but me. We arrive at the airport, and I can tell I am in India. We get off the plane on the tarmac and are met by a rickety bus. We are told to board the bus, and I do, but then I find that the bus rise to the terminal is only about fifty yards.
When we get to the terminal, we are asked to identify our bags outside. But once we identify them, we still can't claim them; we have to go inside and wait until they are put on a conveyor belt and come to us. It's a process they learned somewhere, and even if it's inconvenient and makes no sense, they follow it.

We then stand on a long line to go through Immigration; the monks go first.

At the hotel, the electricity goes on and off randomly, plunging everyone into darkness. In a moment, a generator will come on. Better save your files here!

At the ashram, Dwarko-ji sits in the gathering darkness anyway. He talks about the eye camp, where twenty doctors from Gujarat have done 16,000 cataract operations already this month on children blind from birth. He is proud that there has not yet been one infection, although the surgeries are done in tents by the side of the main road. I will see the eye camp later this morning; the doctors still have 5000 more surgeries to do. There are a million people in this province alone who are blind, mostly from poor nutrition. This is the poorest province in India, and Dwarko-ji chose to come here fifty years ago because of its poverty.

His education program here is, as he says, revolutionary. He teaches village kids in a dormitory setting. They are all children whose parents can't afford to feed them, much less educate them, and he prepares them for life. He teaches such subjects as hygiene, gardening, and parenting; math and English are taught in the context of the other subjects.

While he labors, others who come to Gaya visit the Buddhist temples and shrines. There is a monastery here representing every form of Buddhism: Tibetan, Japanese, Thai, etc. Today I will see them, too.

I think of my life in the United States and how difficult it is to communicate to my friends and family what I see on these trips I take. In some ways, it's the same world -- one with children to be raised, cell phones to be used, and computers. But the climate of uncertainty is so much greater here. Not even a question of will your child get into college. More a question of whether you can feed him till he grows up.

Shala Yoga Shanghai

The yoga studio in Shanghai is in an old remodeled building that is part of the French Concession , and the Taiwanese owner, Cecillia, has spared no expense. The building is three stories high, with four different classrooms, and dark wood flooring throughout. It has many private toilets and showers, rare for a building in China. The last toilet I visited was a row of stalls with a canal running through it. You peed in the canal, and every so often the entire row was flushed and the water ran downhill. Not quite as clever as the Toto toilet in Chantal's house down the lane from the studio, where the powder room toilet refills itself from a faucet on top of the tank, at which you also wash your hands.

Our instructor, Meg, has just moved to Shanghai from Beijing, and is Australian. Her voice is very soft, and I think of Ian barking out the cues over a rap song in Arizona.

Here in China, we are given mats and towels, water bottles and fruit, tea and juice before and after class. We don't pick up our mats and towels; someone does it for us, and wipes the floor between classes as well.

I lay on the floor during savasana thinking once again that I am blessed. It is a beautiful sunny day in Shanghai, China, and I am here. It is a Communist country, but I don't suffer from the lack of regard for human rights. I simply visit, take the best, and am free to leave. Namaste.

After yoga, we visit the wonton soup restaurant. It has three rows of picnic tables at which about thirty people can eat lunch simultaneously. Nothing is served but variations of won ton soup, which are delicious. Then we grab one of the ubiquitous taxis and head off to the fabric mart, where we pick up the jackets we ordered hand tailored yesterday. We stop then at the antique market, where booth after booth displays both authentic and faux pieces of Chinese tradition -- Buddhas and jewel boxes, jade and ivory, vases and novelties. Unlike in India, where tourism has made it necessary for all the stores to take Visa and offer shipping to the US, in China there's no such luxury, and although I find a Tibetan chest that I'd love to have, I can't figure out how to pay for it or ship it home.

technorati tags: yoga, shanghai, shala yoga shanghai

China Business

Everything is made in China. The other day we went to a home improvement center, where manufacturers reps show all the different brands of paint, kitchens, bathroom fixtures, hardaware, and flooring. My friend Ed Salatka and his brother own a company that sources these products and packs them into containers to ship to the US for people who are building homes or remodeling. It's amazing how much money you can save sourcing these products in China, even if they have Italian, German, or Japanese brand names. We saw Toto toilets, Kohler fixtures, Grohe faucets -- everything they have in Home Depot, and everything you seen in the upscale design magazines, too. I have decided to give myself a Eurokitchen and a new bathroom in my California house. I'm impressed by China...

We have also been to the Bund, where Tom Cruise is hanging out while shooting Mission Impossible 3 in Shanghai. And we went to a fabric mart, where everything from linen to cashmere is sold, and you can have a designer dress handmade (knocked off) in under twenty-four hours. I can remember doing this in Hong Kong twenty years ago, but the scale of it in Shanghai, especially in this one market, is amazing.

It appears that there's a themed mart for everything. On another day, we went to the electronics mart, where I saw floors and floors of cell phones, and binoculars, once again assembled in China.

Shanghai in 2010: The Urban Planning Museum

The Museum of Urban Planning

Shanghai actually has an urban planning museum. In it, visitors can see a floor-size scale model of what Shanghai will look like in 2020, accompanied by virtual tours, videos, and propaganda about the "meilleur ville, meilleur vie" (better city, better life) to which they can look forward in the future.. Residents come to this museum to see if their houses will still be standing in 2020, or will have been torn down as part of some municipal redevelopment plan.

The Chinese government's plan for Shanghai is very specific and focussed. The city will remain a center for trade, but it will be re-forested, its pollution will be gone, and its citizens will live in planned communities. No more of the haphazard growth that comes as a result of commerce. Nine new towns are planned, as well as a huge industrial and R park designed to catapult Shanghai into the forefront of technology. Waste water treatment plants are being built, "clean" nuclear power is replacing coal, and industrial zones are being consolidated from 200 to 78. The industrial zones of the future will be pollution-free pleasant places to work.

I've never seen so much organized economic development hype. In America, none of this centralized planning could take place, because we would be having town meetings where NIMBYs would be packing the halls to prevent change and activists would be insisting that things be brought to a vote. In a communist society, they don't have to worry about any of that, and as a result Shanghai was essentially re-invented over the past twenty years.

China's new industrial planning is even more frightening because it takes place in a context of intellectual property theft and human rights violations. And because it seems to be succeeding so quickly.

Not to mention the fact that the government thinks nothing of building a museum to showcase its own master plan. This plan guides real estate development, industrial policy, and every other aspect of Shanghai life. The museum creates the perception of change, and convinces the people change is coming. Because of the scale model on floors 3 and 4 of the museum, residents and visitors alike are convinced the future will be as it is visualized.

It was a very eerie feeling coming out of that museum. None of the random results of a democracy are seen in China; everything happens as it should. I remember when, in the 1950s, the Soviet government had plans like these. Five year plans. Ten year plans. In the Soviet Union, the plans never happened as advertised. And perhaps that's why the Cold War ended the way it did -- not with a bang, but with a whimper.

But what if the plans of the Chinese government succeed?

technorati tags: China, Shanghai, Cold War, urban planning

The International terminal at SFO is not very busy on a Sunday afternoon, which is surprising to me. I guess Shanghai, my destination, is not the number one place Americans go for Thanksgiving. My flight's only half full, which is also surprising after all the publicity I've been reading about China, and hardly any of the passengers are American.

We land four movies, three meals, and thirteen hours later. The Chinese government has a sign at the airport: "Implementing seriously the government policy on preventing fraud in re-entry and development"...or something like that. Puts you on notice right away that China's first industry isn't tourism.

The English on many of the signs that are supposed to be helpful is tortured. "Your transaction has been rejected for ambiguous reasons," the ATM machine told me; "Police advice is not to follow profiteers off the market site," says the sign at the entrance of the "knockoff market" where I shop for Christmas gifts (major brands) that cost more to ship back to the US than I paid for them. I guess the policy on piracy of luxury brands is not one the government is "seriously implementing."

Shanghai is a first-world city in a third world country. 15 million people live here, mostly in 40-story apartments, where the average rent for an expat working for an American corporation is $8000/month. Why? Because the corporations whose American operations are now subsidized by their Chinese markets (Intel, Dell, Carlson) will pay those rents just to have "feet on the street" in Shanghai. There are over 100,000 expats in this town. Many of them live here because they have servant, drivers, and luxuries they could not afford if they worked in the US.

Over lunch in a classic Chinese restaurant (lazy Susan in the middle of the table, family style dishes of food we only partially recognize), my host tells us a story of his friend whose business was just ruined by a Chinese manufacturer who thought her order was too small to bother with in time for Christmas delivery. Apparently, stories about the vagaries of Chinese manufacturing are quite common; many foreign businesses are at the mercy of their Chinese producers. China's in the driver's seat when it comes to manufacturing.

After lunch we walk down to the Bund, where the old and new Shanghai are separated by the river. Never again will I think the San Antonio River Walk is worth talking about. Even the Left and Right Banks of the Seine pale before the dramatic differences between the Pudong side of the Huang Po River and the old Shanghai side. Built by colonial companies in the 19th and early 20th century, the older buildings have incredible mosaics, tile work, and marble inside, and house merchants like Cartier and Georgio Armani. Many of them were taken over by the Cultural Revolution and recently renovated to reflect China's new economic goals. On the other side of the river rises an army of skyscrapers built within the last twenty years.

Between the banks runs the river with its traffic jam of barges, reminding me how Shanghai grew in the first place -- as a center for international trade.

Even though I've been in many third world countries, the air quality in Shanghai seems about the worse I've experienced. It's a combination of thermal inversion, cars, and particulates. Everyone coughs, despite the efforts they make to get out every morning before work to the many public parks, where they practice Tai Chi and Qi Gong.

I like it here. It's a happening place, like Hong Kong, although you never forget the influence of the government, whose uniformed representatives seem to be everywhere.

I know many of us are familiar with the stories of China's growth, and feel we know all about it because of people like Thomas Friedman. But just as many of us are also still stuck in our former perceptions of China as a country where unpaved streets and outdoor markets barely support peasants who raise chickens or grow rice for a living.

But honestly, until you see it you can't understand how threatening China is to the arrogance of the United States. China is the largest cell phone market in the world, it's going to be the largest Internet market in the world, and it opens new universities every day. There are just so many PEOPLE in China. And if you want to know how sheer numbers influence economics, think of what the Baby Boomers have done to America.

Shanghai

At the knockoff market there is something called the "morning price." It's the lower price you can bargain for if you are the first customer of the day. The bargaining is like a game in these markets, and only an American tourist would pay what is asked by the merchant. It's dynamic pricing at its best.

I shop for Christmas gifts and send them back to the US via China Post, an efficient but no inexpensive service. In fact, sending the package back by air so it will arrive before Christmas costs just as much as the gifts themselves.

We eat lunch at a classic Chinese restaurant -- large tables, a lazy Susan, and many things we don't recognize on the tables around us. Duck, duck skin, hot and sour soup, shrimp with a vegetable we can't identify, and the fattiest pork ribs I've ever seen.

After lunch we visit the Bund, which is the riverfront area of Shanghai. On one side of the river are the colonial buildings and the high end shops. On the other side is Pudong -- a section of Shanghai developed entirely over the past twenty years. Between them are the barges that remind me of how Shanghai came to be so large in the first place: international business.

Greetings from Shanghai

Shanghai is definitely a first world city in a third world country. Coming from the airport, which is new and well-organized, into downtown, which is crowded and polluted, all you see is skyscrapers, and my friend Lindsey lives in one of them -- a fairly new three-building complex with the washer in the kitchen, and the "dryer" out on the balcony. Her daughter goes to an international school, and she tells me there are over 100,000 expatriates in a city of 15 million.

Lindsey is part of a new, global generation. Her husband owns a business in Shanghai, and she moved here from Bali, where she lived last year. She is taking Chinese language lessons, and her daughter speaks English, Chinese, and some words of Balinese. She has a wireless network in her home -- although the Internet is censored here. In fact, she tells me, when CNN talks about Taiwan, the screen goes black.

This morning, walking along the big shopping street to the "knock-off" market, we pass bicycles, taxis, busses, cars, and motorbikes. We get to the market, and are literally accosted by people with Louis Vuitton catalogues, and pictures of Rolex watches, although no Vuitton or Prada appears openly in the market. Because of the crackdown on pirated intellectual property, vendors don't present their merchandise openly, but it's still there for sale if you just stand there and look western.

As a blonde, I was overrun with people trying to sell me things. You can bargain endlessly, but you have to have the stomach for it.

technorati tags: shanghai, china

Flock, Web 2.0

Do you ever feel the need to try a new browser? Probably very few people do, since most people don't think about what a browser does, or should do. Most of the world still uses Internet Explorer, or AOL when it wants to access the Internet, except for the security freaks who have migrated to Firefox because it's supposed to be safer. I migrated about a year ago, mostly because Firefox is faster than IE, which takes forever to load. Because I'm on a Mac, I don't think much about security.

But now I have migrated again, just for the sport of it, and I'm thinking about browsers and how they function for perhaps the first time in my life. I'm trying out a pre-release version of Flock, a product that seems to do the opposite of the old browsers -- it cares not a whit about privacy and seeks to help me share everything. It's part of the new era called Web 2.0, the next generation of the Internet.

In this new era of broadband Internet access, the browser is almost the only interface between you and your computer, and everything you use is a "web service." What, of all the things on your computer, do you use most? Well, I use an email client, Microsoft Word, and a browser. When I travel, I often forgo the email client and use a browser to read email over Yahoo or Gmail. And now Microsoft has announced that it will put new versions of its productivity applications (Word, Excel, Powerpoint) online soon in a complete 180 degree shift from its old business model.

The times they are a changin'. Pretty soon, I will be using only a browser to access everything I need.

So here's how Flock works: instead of composing this blog entry in MS Word ( as I would have done in the past,) and then cutting and pasting it into Blogger ( as I would have done in the past) to post it to my blog, I now compose directly into Flock. Then I press a button and Flock posts it for me.

The intermediate step, using the browser to access the place where I post my blog, is gone, taken over by the browser.

Now suppose I want people to find my blog. As I write, Flock allows me to "tag" my blog in a sidebar. This means I pick some key words, like browser, Flock, and Web 2.0 that I think describe what I'm writing about, and enter those to the right of my post.

Those tags go directly to deli.cio.us, where they can be searched by people looking for blog entries on these topics. Since I have been tagging my blog in this way, using Flock and deli.cio.us, the number of new visitors to my blog has tripled. People are now finding me. Or to be more exact, they're finding the subjects they want to read about, and maybe this week I'm writing about them.

This is a cool way to organize information. However, it does assume that everyone on the Internet wants to be found, read, and shared. This is a new way of looking at privacy -- it may cease to be a desirable attribute altogether, let alone a right. We are entering an era of globalization, collaboration, networking and sharing.

And although I haven't explored it yet, Flock also allows photo collaboration and photo blogging -- stay tuned for when I discover how to do this. This is way beyond using email to exchange pictures of grandchildren: this is a way to present one half of the world to the other half.
will all be treated to endless photos of my trip to Shanghai (next week) and Bodh Gaya, India, whether you want them or not.

technorati tags: browser, Flock, Web 2.0, entrepreneurship, early adopter

Doctor No

I am sitting in the doctor's office waiting for my eyes to dilate, wildly searching the room for something to read or do. Of course there is no open wireless network for patients, and there are only half a dozen dog-eared magazines. Four of them are issues of either "Outdoor Life" or "Field and Stream." The other two are "Elle," a magazine I never read, but happened to find at the spa last week while I was getting a pedicure. So I had read the two-month-old issue at the doctor's office. Same thing with "Entertainment Weekly," the September issue about "Nip/Tuck." And the TV monitor wasn't connected to cable, and was there only to play patient education films.

Why isn't there more customer service, I always ask myself? Why don't they visualize themselves in these aptly named waiting rooms and make something interesting out of them? Why? Because doctors feel that they have it tougher than their patients do, seeing high volumes of patients with low reimbursements in an unfulfilling rat-on-a-treadmill fashion, and they are awash in self-pity (if they can't afford to retire). This is not why they went to medical school: they went to medical school to help people. But all they do is shuffle paper.

It has taken me an inordinately long time to figure out that doctors are unproductive and inefficient about the way they run their offices, and it trickles down to their patients in a kind of misery-loves-company way.

For the last year or so, I've been meeting with a group of people who are trying to break the cycle of inefficiency in Arizona through the better use of information technology in small physician practices-- which make up the bulk of the health care delivery system in the state. After thinking about it, we formed a not-for-profit called AHITA -- Arizona Health Information Technology Accelerator. That was about three months ago. We spent the next three months gathering information on national models, early adopters, vendors, case studies, white papers, ROI to the practice, ROI to the patient, ROI to the insurer, etc. We are knee deep in national initiatives, local committees, and partnerships. We know that in most cases, after plunging into the icy water of automation, early-adopting docs who have gone to EMRs, or EHRs, have increased their revenues, lowered their expenses, and saved themselves a wad of time.

The evidence is all there. And we don't want to make money from this. All we want to do is mak everyone's life a little easier -- ours and our doctors'. We want to help physicians navigate the myriad of funding, vendor selection, data migration, work flow changes, and psychological barriers that keep them from adopting products are not only ready, but have been ready for years. Dozens of medical software companies have gone broke trying to leap across the chasm from early adopters to the mass market.

It's the original chicken-and-egg problem, however. Because the offices are so inefficient, the doctors are crushingly busy, especially in Arizona, where there is a real shortage of doctors to service a rapidly growing (and aging) population. It's tough to get to see a doctor when you want to pay him, much less when you want to sell him something -- or even sell him ON something, like why to risk automating his health records rather than paying for the extra room of real estate necessary to house the paper records of some 4000 patients (at least).

So there I sat, entering my name, social security number, date of birth, and family history on probably the twentieth paper form attached to the twentieth clipboard of the year. And there sat the front office person, scanning my insurance card for the twentieth time.

I realize I've written about this before, but it never ceases to amaze me. You can have LASIK surgery in less time than it takes to fill out the form in the surgeon's office.

technorati tags: EHR, health care, electronic health records, medical informatics

Remember the day when you could just take your junk mail out of the mailbox and throw it straight into the trash, bypassing the waste baskets in the house? Or when you could receive a credit card bill, write a check without reading the bill, and throw the bill out? Those days are long gone--sacrificed to the spectre of identity theft.

I've had my identity stolen several times, each time by a foster child who snagged a credit card to charged small things like fast food and gas.

But I've not (yet) experienced "the big one"--the kind of identity theft where someone assumes your name, but not your frugal lifestyle, and causes you untold hassles just to prove you are really yourself.

I say "not yet," because I figure identity theft is like bird flu; it will either mutate and catch me, or not, and there's little I can do about it.

I am, however, irrationally hoarding a dose of Tamiflu, and I'm irrationally trying to prevent identity theft as well. And I can only tell you that living in fear is terribly time consuming.

First I had to buy the shredder. Then I had to figure out what to shred. This meant I had to start reading my junk mail. If anything says "preapproved," or comes with one of those fake checks, I shred it.

Sometimes I even wait for the postman, because my mail is delivered to a slot in the front of my house, but it doesn't all fit through, and it hangs out until I get it from the outside. I imagine this was a very secure way of getting mail fifty years ago, when the house was built, before all the deluge of catalogues, flyers and newspapers that now constitutes the bulk of the US Mail (bad pun).

I shred my bank statements, which now come in both paper and plastic(computer). I also shred my credit card bills -- the ones I still have to receive in the mail. I've stopped almost everything from coming in the mail, because the mail is a big source of identity theft.

This creates problems in and of itself, because if my Quickbooks fails, I have no tax records. This summer, my PC was stolen, and that's where I have all my financial records. Although they were backed up, it was a struggle restoring them. And there's no paper trail. The days of the paper trail are over.

All this takes time. It takes even more time if you try to short cut the process by overloading the shredder, which then stops in the middle. Then you have to un-jam it and begin all over again, with the half-shredded documents in your hand.

All this is a long way of saying that I am moving again: this time to a high rise condo in the Central City where they deliver the mail to a locked box in a secure room.

You may find me in the future at : 4750 North Central Avenue, Unit 9N, Phoenix, AZ 85012. But don't you dare send me anything in the mail. I will only shred it.