Electrification in Afghanistan

Life in Kabul is probably much more comfortable than any other parts of the country.
I say this because of the fact that electricity is widely available here in Kabul (though with frequent blackouts).

In Kabul and other major cities, 70% of the population is said to have access to electricity. Even the countless mud houses on the hill (which were originally illegal) now get grid electricity.

In Kabul, 70% of people have access to electricity - including those houses on the hills.

But if you look at Afghanistan as a whole, only 15% does. It means only 3 million live with electricity at home, while remaining 25 million depends on traditional fuels like kerosene for lighting, wood stove for cooking.

Many projects are going on within the country in order to improve the country’s power supply, including building new hydro power plants, purchasing more power from neighboring countries – Uzbekistan and Tajikistan, building transmission lines as well as distribution network in urban area.

The Afghanistan government (and international donors such as World Bank, ADB, USAID) has a target of providing access to electricity to 30-40% of the population in the next 15 years. The plan is to build a big circle of major transmission line that connects major cities in north, east, south, and west of Afghanistan. Smaller cities and towns along the transmission line will be connected to the grid, but not the ones away from the line.

Yes, after all these huge infrastructure projects, still, 60-70% of Afghans will get access to electricity. Considering the country’s power sector has never been able to serve any more than 20% of its people, this may be an ambitious goal. However, I want to urge the government and donors to take measures to address the difficulties faced by the off-grid populations. Not through random projects to give out solar home systems here and there, but 5, 10 year plan to gradually but steadily decrease the number.

Anitya Bhavana

Apparently I think too much.  (Finally realized?!)

I think too much before I speak out.

My colleagues tell me, “Don’t think. Just say it.”

I’m finally coming to know that thinking doesn’t help, or worse it may even harm the state of mind.

I came across this passage at the yoga class. 

What was in the morning is not at mid-day,What was at mid-day is not in the evening,What was in the evening is not at night,What was at night is not at mid-night,For all things are transitory.Why should I be attached to anything
when nothing is permanent and everything is changeful? 

(Anitya Bhavana)

"Anitya" means impermanence. 

What has happened has happened.

What is happening is happening anyway.

What will happen will happen.

Nothing stays unchanged. Everything comes and goes.

Why stop and think too much when everything else is constantly moving?

Give up the control, give up thinking.

Keep walking, go with the flow, and live the moment.

Differences in Learning Style

In March, a large part of my work was related to training.
For the operation of 90 ambulances, we need to train roughly 200 drivers, 200 EMTs (Emergency Medical Technicians), 50 call center executives, and 15 managers.

As I planned the curriculum, coordinated the sessions, and occasionally gave a lecture, I noticed a distinct difference in learning style.
Difference between what I see here in Amritsar, India, and the ones I grew up with in Japan.

In Japan, students are supposed to listen and take notes with their mouth shut.
In India, students listen and speak. No notebook.

It seems as the students verbally repeat what the teacher has said, they digest and memorize the contents. The more students talk, the more they remember.
At first, I was eager to explain more. I thought the more I explain, the better they understand.
Not necessarily.

For example, when I want my managers to call ambulances every morning, there are two ways of conveying information.
1) You have to call your ambulance every morning.
2) What do you have to do every morning?

Instead of me repeating “you have to do this, that, …”, it seems more effective to switch the speaker and a subject of the sentence. Let my managers speak aloud, “I have to do this, that, …”

Manager's training - We spent half of the time letting managers talk about what they had just learned.

In my case, I know I have to write it down. My colleagues will give testimony that I write down everything in my little notebook. Once I see letters, words, sentences, or diagrams, the information sticks to me. Even to remember someone’s name, it is easier for me to remember the written name.

I always thought it’s my personal inclination.
But maybe it is a result of the culture I grew up with?!
Which style do you have? Or any other style?

Get frustrated? Or move forward!!

I took this picture on March 19. 

 

Less than 2 weeks to the launch, and only 4 days to the start of the training, our control and dispatch center (CDC) looked like this.  No desk, no chair, not even a ceiling!! We’ve planned, started working on it way in advance… yet, this is the reality in front of me.

On March 22, it looks slightly better, yet far from completion….

The next day is the scheduled 1^st day of training. 50 CDC executives are waiting for the training!

A few of my colleagues and I literally held our head down, held our hands up, walked around the room restlessly.

… And came up with an idea!

The solution is this…

25 people in one small room where previously only 5 of us were sitting. 3 people share one PC and one chair (bench).  Temperature was above 30 Celsius, no AC, only with fans. Someone described this looks like sardines!

Although the room was not perfect, hardware is brand new, software is also new, developed based on Ziqitza’s expertise. I guess it would not have worked in the places like U.S. or Japan where people are used to more spacious, well-prepared office space. Thanks to our patient colleagues at Ziqitza, it worked!

There is no doubt that a plan is essential in a project.

At the same time, there is no doubt (especially in a place like India) that the plan does not go as planned!

It is frustrating to see things are not moving and time is running out. But, you cannot stand still and remain frustrated. Then your frustration simply goes up. Rather, what I can do is to keep moving forward. The result may not look as elegant as planned, but as long as one takes one or even half step, the project will move forward. 

And finally.... on the due date, the place looked like this.

Things do happen, if we keep moving forward.Right?

Ambulance crew training in full scale

At 8:45am, a little bit anxious and very much curious, I reached a training center.

Today almost 200 people gathered at our temporary training center in Amritsar, Punjab, India.  Medical training has been going on for EMT (Emergency Medical Technician) since January, and finally this week drivers and call center personnel have joined for their operational training. By the end of this week, the number will go up to 450.

I have been coordinating with concerned departments, instructors and other experts to prepare for all the training programs that were scheduled to happen in the next 10 days.

In the afternoon, I stopped by at a driver’s session.  The room was hot partly due to strong sunlight from outside and partly due to the enthusiastic energy emitted from 60 drivers.

As in other states where Ziqitza operates, all ambulances in Punjab will also be equipped with GPS and mobile data terminal. This will be a major tool of communication between ambulance crew and CDC (control and dispatch center).

My colleague and I gave a series of training sessions to our field managers for operation and IT on previous days. Today, they are the teachers who would give training to drivers.  As I sat in the room and observed the session, I felt excited and confident. With the world class IT infrastructure and the power of the people, we will make this operation the best in the country... and in the developing world (as Ziqitza's mission statement claims!).

Doctor's inspection

This afternoon, our doctors conducted an inspection on our newly arrived ambulances.

All ambulances are inspected by us, and by the state government.

In addition, just before the launch date, we will have our final inspection.

Ambulance on its way

90 basic life support ambulances are on their way to people of Punjab.

I have come to Amritsar, Punjab, India, to prepare for the launch of 90 ambulances on 31 March.

Not all of the ambulances are ready yet, but some are standing in front of our office, waiting for the time to come!

They are not yellow ambulances which people in Mumbai and in the Acumen community are familiar with.
The phone number you should call will also be not 1298, but 108 as the sticker on the side of ambulance says.

It is the initiative by the Punjab State Government. Under the public private partnership, Ziqitza Health Care is undertaking the operation of emergency ambulance services for next five years. The project will start with 90 ambulances at the end of this month, then increase the number of ambulances up to 240.

For a person like me who come from the place where emergency ambulance service is already available, it  is an amazing experience to go through the process of setting up one from scratch. So many pieces of puzzle has to come together in the next few weeks!

Another episode on ambulances in Rajasthan…

In the article in the Acumen Fund Blog, Photo of the Week: Ambulances Reach the Villages, I introduced Ziqitza Health Care’s commitment in awareness-raising activities in villages in Rajasthan. I felt compelled to write about it when I learned the team's active and tireless efforts during my visit to the office in Jaipur, Rajasthan a couple of weeks ago.

During my stay there, I had an opportunity to observe a similar demonstration event in the city of Jaipur, the state capital. Well, at least I was very close to….

In the late afternoon, the marketing team set up a demonstration site in the central area of the city where many government offices are located. There was a large open space covered with beautiful green lawn. Another group of people was setting up chairs and stages for their event in the evening.

Jaipur, Rajasthan

A new Rajasthan's 108 logo says "free service" in local language.

The location was perfect. A big banner was posted high, made visible to cars passing by. A stack of pamphlets were in our hands. We were all prepared except one thing …. an ambulance!!

We had to wait for an ambulance to come back from the nearby hospital.

In Rajasthan, ambulances are allotted so that each one would take five calls a day on average. (At this point, it is not always the case partly because the awareness is not high enough in some areas, and partly because the number of ambulances is less than the ultimate target for covering the whole state. )
 

Fortunately there seem to be enough awareness in Jaipur. There one ambulance takes up to 10 to 15 calls a day, way beyond the average!!

After 15 minutes or so, the ambulance finally came to the spot. The driver parked an ambulance and opened up the back door. I started chatting with the driver and the EMT (emergency medical technician).

But it did not last long.

Sure enough, after 5 minutes, a driver received a call from the Control Room.
Again, they were off to pick up a patient.

Such was the day with ambulance in the city….

Not until I saw the difference...

Yes, I was sure 1298’s ambulance contributes to the life of people greatly when I first heard about their business.

Yes, I was impressed with the facility of the 1298 ambulance when I saw its ALS (Advanced Life Support) ambulance.

Yes, my heart was beating so fast and hard with the sense of mission when I sat on the front seat and ran through Mumbai’s busy streets.

But not until last week in Trivandrum did I truly realize the difference this company has brought to the society…

I spent a whole week in Trivandrum, Kerala, where Ziqitza Health Care Ltd. runs the public-private-partnership (PPP) model of emergency ambulance service. (The service there is known as “Dial 108” while the company’s private model is known as “Dial 1298”.)  Under the project name KEMP (Kerala Emergency Medical Service Project), the 108 ambulance service now operates 25 ambulances in the district of Trivandrum. The service is completely free to users. 

My mission there was to investigate every detail of operations in all the departments from control room to ambulance to finance. I will do the same for other 108 operations in Bihar and Rajasthan later this month and then work with department heads to improve and standardize the processes so that the company will be well fit for further scaling.

One day, I visited the largest hospital in Trivandrum, Medical College Hospital. I was waiting for our 108 ambulance by the emergency section of the hospital. It started raining. The place was getting crowded. But our ambulance has not come yet.

Other ambulances came, though. They are as big as ours, same white body with red and blue signs. Some are run by a private organization, others by hospital itself. I looked inside. I could not believe what I saw.

“It must not be an ambulance.”

That was the first thought.

Inside was literally empty. Nothing other than a metal frame (where a carrying board is placed – not even a stretcher!), bench, and a small sink! Where are medical equipments? Where are cabinets for storing medicine, mask, glove, gauze and bandage?

From what I know in Japan, I took it for granted to have an emergency medical technician, medical equipment, some medicines and tools on ambulance. Otherwise how can I call it an ambulance?? But that moment I once again realized such service was not readily available here.

How do you feel if only an empty ambulance is available when your mother is at emergency?

How do you feel if the fully equipped ambulance comes instead?

Other ambulance

108 ambulance

 

Meet my new neighborhood

OK, I expected Mumbai to be noisy...but not quite to the extent that I'm experiencing now.

View from my apartment

Santacruz is my home for next nine month. As I sit in my apartment on the fifth floor, with nice breeze coming in, I look down rikshaws constantly coming and going on the street, and I look up airplanes flying high into the sky from the airport nearby.

Well, let's add the sound effects here. 

It means I am sandwitched by roaring aircrafts and honking rikshaws continuously from 6 am to 3 am, if not 24 hours. To make best use of the environment, every morning before I leave for work, I decided to do voice training. However loud I become, I'm pretty sure I will not disturb any neighbors because I hardly hear hearing my own voice!

Despite the sound effects, I do love my neighborhood. 

The streets are filled with vegetable and fruits vendors. I buy tomato from this person, garlic from next, potato from next, and cauliflower and cabbage from yet next person. There's a buffalo milk shop nearby, too. The same man is always standing in front of a huge barrel of milk. Every other day, I stop by and ask him to give me a smallest scoop of milk. He silently nods, pours fresh milk into a tiny plastic bag, ties it very tightly, and hands it over to me with a smile.

Home-cooked food
from my neighbor

I don't know if it happens all over Mumbai, or all over India, but at least in my neighborhood, people are very open, frank, honest, and helpful. It does not matter if they speak English or not. In my building, families leave their doors open. So whenever I pass by, they say hi or wave hand and smile. In a shop, a lady customer, not a shop keeper, recommends me different brands of soaps to try. In a milk shop, another old lady customer told me to get curd, not milk, and make lassi at home. (I actually followed her advice and it was really good!)

In a big city, at least in Tokyo where I am from, people tend to be indifferent to one another. Some people try to take advantage of foreigners, or even those from the countryside in the same country. Those were the experiences I had in the past, which made me a little defensive this time, too. To my pleasant surprise, Mumbai has overthrown my presumption so far. I am curious how this metropolitan city can also keep local flavors. 

And my everyday adventure continues…

Be The Last One To Define You

Today, my first ever guest post came on line at Rising Pyramid!

It is a reflection of one of the training sessions I had in New York.

Please take a look!!
http://risingpyramid.org/2010/11/22/be-the-last-one-to-define-you/

Dear Mumbai .... and farewell to New York

On the last day of our NY training, ten of us - Acumen Fellows class of 2011 - read a letter to our respective placement city at the Acumen's annual Investors Gathering. (In my case, the letter starts with "Dear Mumbai ...")

For weeks, we worked on writing a letter - wrote one, read, scrap, wrote again... I'm sure each of us had at least 10 versions of the letter. We read our letter to each other, and shared feelings and feedback over and over again. These are the letters coming from the deepest place of our hearts.

On the stage, as I was listening for the last time to everyone else, I could not help but feel honored to be part of the group. What incredible individuals my fellow Fellows are!!



We spent everyday together for last 8 weeks, sharing deepest feelings which I myself have forgotten that I had. We come from very different places and experiences, yet we share so much passion, feelings, fears, and love.

Now, alone in Mumbai, I miss my 9 siblings (!?) and at the same time feel empowered as I think we are all in the process of exploring a new place and new work.

With all the gratitude to the Acumen community, friends, and Fellows!

Everyday Barriers - being poor in New York

In Monday morning, I was sent to the street of Manhattan with 5 dollars and a 2-ride-worth Metro card.  In the evening, I came back with 5 dollars intact, a bunch of bananas, one sweater, and two shirts.  My stomach was warmly filled with tasty food. 

Don’t take me wrong. I am not saying it’s easy to be poor.  It was the power of human connection that enriched me.

Well, what does it mean? 

I describe my day as a mixture of two different experiences – one with the government, the other with the community.

For the former, I visited some of the public facilities in New York City, a day shelter, a public hospital and the administration office. No success at all. I could not get anything that would make me survive for a day.  At a day shelter, I was told at the entrance that I could not enter, and given a list of places where free and/or discounted services (clothing, toiletries, hair, etc.) are available to the poor. I tried to go to the nearest shop on the list, only to find it does not exist in a given address.  The city administration office was no better. White wall, grey floor, high counter coldly separating me from a receptionist, a crowded waiting area, and an electronic guidance machine no one was even paying attention. The receptionist did not waste time with me at all. In 5 seconds, I was told to leave with a stack of application documents for food stamps, which I have no idea how long it takes to fill out… I was powerless, unwelcomed, and thrown away.

Discouraged to seek any support from public service, I then turned to community.  I found a soup kitchen in a church in Harlem, to fill my stomach.  First, I felt odd as it was obvious most of them there knew one another and I was totally a stranger.  I was nervous if I would be questioned anything or if I would get food at all!  I anxiously waited in line. My turn came. A big smile, and warm food was in my hand! Wow! Soon after, as I was sitting on the sidewalk and eating warm tomato squash stew, a man stood in front of me and started talking. 

He (Let me keep him anonymous), 52, migrated to U.S. over 25 years ago, started his life in NY by sleeping on the floor of the movie theater, later worked in barbers and restaurants, now lives happily with his family in a 3-bedroom apartment in Harlem. He looked much younger than his age, spoke with confidence as well as humility. He says he cannot read or write, but he is proud and grateful to be who he is.

As I continued my way, a lady at another church stopped me and asked to take some second hand cloths. I was not sure if I should take any since I was just pretending to be poor for a day (though I needed some winter clothing for the rest of the training in NY). Despite my hesitation, she insisted to take some because it is for the “community”. Community? I was a random person who (probably looked helpless but) happened to stop by. It was obvious I don’t live in the area. Still, she and others there instantly received me as part of their community.  So there I was with a sweater and two shirts in my hands. I left the area with a strong sense of connectedness and desire to take turns to give back to the community.

This is how I was enriched by the power of human connection in New York.  It was also a day when I realized the distance and the wall that silently but firmly exist between me and public services. I was very much tempted to avoid the government and to stay close to family, friends, and community. It’s probably a best way to find me food and shelter, isn’t it?

Maybe… but, what if I don’t have a family or a community to count on?

We, at Acumen Fund, aspire to bring basic public services to the poor by utilizing capital and business. We emphasize local entrepreneurship to be close to people, and collaboration with the government to bring scale to our impact. 

Now, I have a new question in my repository of questions which I need to take with me to the field: “How can we achieve scale while not sacrificing (or rather empowering) the human connection of the community?”

Swimming in the “Good Society” River

Draw your image of culture.

This is how our "Good Society" retreat started last week.

In a sunny, cool morning, I was sitting in a living room with other Fellows, surrounded by gorgeous autumn colors in the midst of the woods in upstate New York. Not a slightest sign of men and women other than our team...

I was totally relaxed till the question came up. I'm not an artist. How can I express such a philosophical question with drawing?! I didn't have many ideas but one. So I started.

First, I drew myself in a circle in the center. Then, from top I drew many lines converging to the circle in the center, just like a family tree. Lastly, I did the same, this time lines are stemming from the circle, diverging toward the bottom, a mirror image of the family tree in the top half.

Culture for me is like many streams running from the past to the future, some of which converge, others diverge. I am, just like anyone else is, an intersection of a unique set of streams.

The “Good Society” retreat is, according to many Fellow alumni, the highlight of 7-week training in New York (and I cannot agree more). In an isolated house, we do nothing but immerse ourselves into the words of great leaders. What does a “good society” look like for Plato?  Or for Hobbes, Rousseau, Tocqueville?  Why did they think this way or that way?  We also talked about the great leaders of our time, Martin Luther King Jr., Nelson Mandela, Aung San Sui Kyi, Lee Kwan Yew, Vaclav Havel, and many others.  

From ancient Greece till present, so many great leaders and individuals have worked very hard to create “Good Society” on the earth. Some shares views, others have conflicting opinions. But all for the single purpose of creating a “Good Society”.

Then my poor drawing of culture came back.

Aha, now at this table of the isolated house in upstate New York intersect the rivers of the “Good Society”, also enriched by each one of us at the table!

Of course a question remains.

What is a “Good Society” which I want to create?

I don’t have a clear answer yet. I have to keep asking this question throughout this year’s fellowship and probably in many years to come.

Nevertheless, I ended the week feeling empowered. I know I am not alone, nor our generation, in this endeavor. We will be always supported by those great predecessors. And so many comrades swimming the rivers of “Good Society” all over the world, which may be invisible but certainly connected. We do what each of us can do, and will help one another if someone get drowned!