MAY/JUNE 2020 Rs. 20
Supporting Communities Through Entrepreneurship Solving Water Woes Designing Better Hygiene Chilling With Green Technology
Saral Designs, which promotes menstrual hygiene in under-served areas in India, modified its pad-making machines to make surgical masks during the coronavirus pandemic.
Designing
Better Hygiene
A
By DEEPANJALI KAKATI
Photographs courtesy Saral Designs
metallurgy and materials science engineer from the Indian Institute of Technology (IIT) Bombay, Suhani Mohan started her career as an investment banker. While working with Deutsche Bank’s corporate social responsibility (CSR) team, she met Anshu Gupta, founder of the nonprofit organization Goonj. She learned from Gupta how women in rural India use
newspapers, rags and other unhygienic material during menstruation, which leads to reproductive tract infections. “It had never crossed my mind that while I can spend Rs. 100 a month to manage my menstruation, how would a woman, whose entire family’s earning is less than Rs. 1,000 a month, manage hers,” says Mohan. “I felt a strong Left: Saral Designs, cofounded by Suhani Mohan (top left), provides access to high-quality and affordable menstrual hygiene products through its SWACHH range of pad-making machines (far left). Left: A pad-making machine modified to produce surgical masks during the coronavirus pandemic.
V O LU M E L X I N U M B E R 3
https://span.state.gov
Courtesy Paperman
Courtesy LetsEndorse
CONTENTS 8
29
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8
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The Spirit of Recycling
12
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Solving Water Woes
16
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Designing Better Hygiene
Yellow Rooms of Learning
19
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Conserving Crafts
22
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Breath of Life
26
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Chilling With Green Technology
29
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Endorsing Social Innovations
32
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Dealing With COVID-19
36
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39
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41
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Managing Stress During a Pandemic Breaking the Seasonal Disease Cycle Connecting Global Media Sinenkiy/iStock/Getty Images
2
Courtesy Coeo Labs
FEVERPITCHED/iStock/Getty Images
May/June 2020
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22 Editor in Chief Michael L. Cavey Editor Deepanjali Kakati Associate Editor Suparna Mukherji Hindi Editor Giriraj Agarwal Urdu Editor Syed Sulaiman Akhtar Copy Editors Akshay Kapoor, Shah Md. Tahsin Usmani
Art Director/ Production Chief Hemant Bhatnagar
Front cover: Photographs Š Getty Images. Collage by Hemant Bhatnagar.
Deputy Art Directors / Production Assistants Qasim Raza, Shah Faisal Khan
* Articles with a star may be reprinted with permission. Those without a star are copyrighted and may not be reprinted. Contact SPAN at 011-23472135 or editorspan@state.gov
Printed and published by David H. Kennedy on behalf of the Government of the United States of America and printed at Thomson Press India Ltd., 18/35 Delhi Mathura Road, Faridabad, Haryana 121007 and published at the Public Affairs Section, American Embassy, American Center, 24 K.G. Marg, New Delhi 110001. Opinions expressed in this 44-page magazine do not necessarily reflect the views or policies of the U.S. Government.
Above: Suhani Mohan (right) and Kartik Mehta (behind, right) led Saral Designs’ effort to convert its pad-making machines to produce three-ply surgical masks. Right: The start-up collaborates with government bodies and nongovernmental organizations to set up manufacturing units. It also trains staff on operating and maintaining the machines (below right), to build a lastmile women-driven network.
4 MAY/JUNE 2020
urge to do something about this, which made me quit my job in 2014 and pursue this fulltime.” A year later, she co-founded Saral Designs, a Mumbai-based start-up, which provides access to high-quality and affordable menstrual hygiene products through its SWACHH range of pad-making machines and innovative distribution model. Saral Designs has received training at the Nexus Incubator start-up hub at American Center New Delhi. In late March, as a response to the coronavirus pandemic, the start-up modified its pad-making machines to make surgical masks, to increase the availability of personal protective equipment in India. It collaborated with the Mahindra Group to produce three-ply masks at the auto group’s Kandivali factory in Mumbai. The start-up is also working with the Maharashtra State Innovation Society to help with the distribution of 100,000 sanitary pads in Mumbai’s slum areas affected by the pandemic. Excerpts from an interview with Mohan.
Photographs courtesy Saral Designs
Left: Deane De Menezes (left), founder of Red is the New Green, a menstrual hygiene project, with Suhani Mohan at a Saral Open House event.
What inspired you to change your company’s production in response to the coronavirus pandemic? A few months back, we were already thinking about adding new products in the hygiene sector. When the COVID-19 crisis came up, we started getting calls from clients who wanted to know if the sanitary pad
machines could be converted to three-ply mask machines. So, we started looking at how a regular surgical mask is manufactured. We realized that the non-woven material used in sanitary napkins is fairly similar to that of surgical masks. And, one of our machines used a very similar process. We thought we could quickly modify this machine to start making masks. Our design team, led by Saral’s co-founder and Chief Technology Officer Kartik Mehta, spent almost 14 to 18 hours every day, over two to three days, to complete the design. And then, the lockdown came into effect. We were unable to procure the components we needed to shift our machines to mask-making. I started emailing a lot of contacts. One of them was my junior from IIT Bombay, who is the executive assistant to Anand Mahindra, chairman of the Mahindra Group. I wrote to her that her company’s factories might have all these tools and would it be possible to make some of our components there. Within four hours, we got a reply from the CEO of Mahindra Vehicle
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Could you tell us why you chose to focus on the field of menstrual hygiene when you launched your start-up? We feel access to affordable sanitary napkins is a basic right of every woman. At the same time, the need for reliable and highquality napkins is increasing as more women enter the workforce. While technology is making our lives easier, we believe it should also be used to address critical challenges that affect a huge segment of the population. This motivated us to build machines that automate processes to lower the costs of production and distribution, while maintaining product quality and service.
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Photographs courtesy Saral Designs
Manufacturers Ltd., Vijay Kalra. Anand Mahindra was also involved in the email exchanges. They helped us with fabrication, and connections to suppliers and logistics. Mahindra has in-house fabrication facilities because it makes cars, and this was a fairly simple modification. We worked with its team to change the design of the rollers on our machine, from the cutout of a sanitary napkin to that of a surgical mask. Within a week of reaching out to Mahindra, we were able to start mass production at its facility. From 10,000 masks a day, we have ramped up production to 30,000 masks a day. These masks are being distributed to frontline workers through Mahindra’s corporate social responsibility wing.
cater to remote locations. There is immense potential for local production, which not only reduces distribution costs, thereby making sanitary pads affordable, but also creates local livelihood opportunities. Technology is at the heart of our solution. We have developed an indigenously designed and patented, automatic ultra-thin sanitary pad-making machine, at a decentralized scale. While decentralization reduces distribution costs, the automated production ensures economies of scale and product quality. These high-quality pads are distributed online, through various retail channels, and in partnerships with health care workers, schools and nonprofits to increase awareness and accessibility at the last mile.
Could you please elaborate on Saral Designs’ technology and how it makes and distributes its menstrual hygiene products? We aim to cater to women who do not use hygienic menstrual products by addressing the issues of awareness, access and affordability. In developing countries, due to poor infrastructure, either distribution costs make products like pads and diapers 60 percent more expensive, or the existing brands do not
Could you briefly describe the social impact Saral Designs aims to create through its technology and products? Gender inequalities, which are partly rooted in discriminatory social norms, become more pronounced during puberty and can contribute to long-term negative outcomes for adolescent girls. Approximately 48 percent women and girls in rural India use unhygienic materials like cloth, husk and newspaper to manage
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Above: Saral Designs creates awareness about menstrual hygiene through workshops. Above right: The start-up works on providing sanitary napkins to girls so that they don’t miss school during their periods.
their periods. We partner with local nongovernmental organizations (NGOs) and government bodies to set up manufacturing units and supply them raw materials. We train their staff on operating and maintaining the machines, to build a last-mile women-driven distribution network. We also co-create awareness content with a gender focus for communities. Could you provide an estimate of how many people you’ve reached so far with your menstrual hygiene products and how many you hope to reach in the near future? So far, we have sold 6.5 million low-cost pads, impacting 200,000 girls and women via more than 30 production units in India and five other developing countries. These production units are run by local NGOs and entrepreneurs in Tier II and Tier III towns, creating job opportunities in production and sales. We are working with more than 1,000 rural women, who act as our sales and outreach agents in their communities. This year, we plan to impact 51,000 girls and women with our awareness campaigns and have 45 machines running production units in different parts of India.
Is there any particular anecdote you would like to share regarding your products? One of our distributors, Jayashree Kamble, told us that women in urban slums face many challenges during periods, especially in a hilly area like hers, where accessibility to sanitary napkins is low. General stores do not stock napkins and medical stores are far away. If women need napkins at night, it is unsafe to go down to get them. This is why a door-todoor network is an essential requirement in the community. She was glad that Saral Designs is helping her solve the problem of accessibility and affordability in this urban slum. How was your experience of participating in the training at the Nexus Incubator? What were your key takeaways from the training? Nexus has been a great network. We were part of it two years ago and we still reach out to them for introductions and support. Our first machine in Bhutan was set up with another Nexus incubatee from that country, for which we are very grateful.
There is immense potential for local production, which not only reduces distribution costs, thereby making sanitary pads affordable, but also creates local livelihood opportunities.
MAY/JUNE 2020 7
A
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Courtesy Paperman
s India’s population grows, so does the amount of trash it produces, and greater the challenge of dealing with waste. This is the problem that the Chennai-based social enterprise Paperman was created to address. “With rising urbanization and global consumption patterns, waste management is a critical sector that needs a bold vision and innovation,” says Mathew Jose, Paperman’s founder and chief executive officer. “Since 2010, Paperman has been continuously innovating to improve the waste management ecosystem in South India.” Paperman’s innovations include a mobile phone app that connects hundreds of specially trained kabadiwalas, or scrap dealers, to thousands of households, empowering them to work together to keep waste out of trash bins and landfills, and send it for recycling. Beyond such doorstep efforts, Paperman has played a key role in implementing recycling programs in over 200 schools and institutions in South India. More than 300,000 children in the region have participated in awareness campaigns that encourage more recycling and less trash. At a broader scale, Paperman
By MICHAEL GALLANT
8 MAY/JUNE 2020
IVLP alumnus Mathew Jose’s multifaceted waste management enterprise, Paperman, aims to move India toward greater sustainability.
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Below left: The Paperman app, shown here by company founder Mathew Jose, connects trained scrap dealers to thousands of households. Right and below: Paperman has kept more than one million kilograms of waste out of landfills (far right).
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Photographs courtesy Paperman
Left: Corporation trash workers play an important role in Paperman’s sustainability initiatives. Below left: A trash wholesaler employee working with Paperman.
consults with local government bodies and multinational corporations on ways to increase recycling and minimize what ends up in landfills. Jose and his team also provide a combination of solutions and software tools that help large organizations sort and recycle materials, track their sustainability efforts and fulfill their waste management requirements. Paperman has kept more than one million kilograms of waste out of landfills, and this number is expected to grow exponentially. But
the organization’s viability was never guaranteed. Jose says that he began the company as a 21-year-old, with very limited technical knowledge about waste management and recycling. While his lack of experience initially made success a challenge, “the journey really pushed me to be a better leader every day,” he says. And, approaching the problem from a fresh perspective proved to be a strength. Looking at the industry as an outsider allowed Jose “to build a more unique and cost-effective business model for waste management, compared to the model deployed by large waste management companies. This also translated into better service at a cheaper cost for our clients.” Local government bodies, a key category of clients for Paperman, are now better able to plan and execute effective waste management strategies, Jose describes. Similarly, Paperman makes it easier for multinational companies to meet their corporate requirements for sustainability. Jose recently brought fresh knowledge to his work at Paperman, through his participation in the U.S. State Department’s International Visitor Leadership Program (IVLP). Through the exchange program, he visited the United States to learn more about managing refuse and recycling in urban areas. “The experience of seeing how a city like New York handles its waste really helped me understand new technologies and management strategies that are important for the sector,” says Jose. “The program has also helped me establish new collaborations for scaling up our organization’s work.” Like other enterprises across India, the coronavirus pandemic also impacted Paperman and prompted it to initiate a number of steps. For instance, with the plastics market crashing, the organization decided to provide a weekly
The experience of seeing how a city like New York handles its waste really helped me understand new technologies and management strategies that are important for the sector. 10 MAY/JUNE 2020
“Our larger goal is to build a strong ethical and effective leadership team that will be able to truly clean up the world.” Beyond any single company, country or environment-friendly initiative, Jose says that the core value of sustainability is one that everyone around the world must live by. He urges everyone “to think about the planet when you build a new product or service, or buy a home, car or clothes. India needs bold leadership to give clean living spaces for its 1.3 billion people.”
Paperman http://www.paperman foundation.org/
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fixed price assurance, so that its partners could work without worrying about price fluctuations. In addition, the top management took salary cuts, in order to enable the organization to retain all its frontline staff. Paperman also initiated other measures like mandating hand sanitizing before entering or leaving its warehouse premises and organizing weekly meetings with its workforce on how to keep their families and neighborhoods safe from COVID-19. In the years ahead, Jose expects Paperman’s reach and capabilities to continue growing. “Over the next 5 to 10 years, we hope to build on our waste recycling capacities,” he says.
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Michael Gallant is the founder and chief executive officer of Gallant Music. He lives in New York City.
Above: Paperman’s recycling facility where discarded plastics and other materials are processed. Left: Mathew Jose (right) collaborates with hundreds of workers in India’s trash economy.
MAY/JUNE 2020 11
Solving Water By MICHAEL GALLANT
The innovative Bhungroo
irrigation system, developed
Photographs courtesy Biplab Ketan Paul
by a social enterprise cofounded by Fulbright Scholar Trupti Jain, helps farmers prosper in the face of climate change.
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Woes
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limate change is impacting people across the world, and some of the most severely affected people are the world’s poorest. Case in point, the millions of farming families in India who must find ways to cope with the increasingly volatile weather patterns, or risk losing valuable crops and vital income as a result. Around two million of them are affected by water scarcity during lean periods and excess water during the rainy season. Naireeta Services, a Gujarat-based social enterprise, has developed an innovative irrigation system, named Bhungroo, to help cope with this problem. “During my childhood in West Bengal, I saw the devastation caused by floods and, in my late 20s, I observed issues related to paucity of water and severe drought in Gujarat,” says Biplab Ketan Paul, co-founder, innovator and director of the enterprise. “These two diametrically opposite phenomena convinced me of the strength and power of Mother Nature. It was also an eye-opener for me to understand human follies and humanity’s impact on nature.” Naireeta Services’ invention was developed and refined over nearly two decades. An innovative water management and irrigation system that occupies only a small amount of physical space, Bhungroo drains and filters
excess water from farmland during the rainy season and stores it within natural reservoirs below the soil. Then, during the dry season when rain and water are scarce, farmers access the stored water to irrigate their crops. The effects can be dramatic, minimizing the damage of floods and droughts, and transforming bitter harvests into healthy ones. Paul says that over 100,000 rural poor have benefited from Bhungroo in India, Bangladesh, Africa and East Asia. Paul and Trupti Jain, co-founder and director of Naireeta Services, have also taken the extraordinary step of making Bhungroo’s technology open-source. In other words, anyone can copy, develop and implement the irrigation system, anywhere in the world, free of charge. The goal? To reach and benefit vulnerable farmers everywhere. Naireeta Services faced many challenges early on, including convincing rural farming communities that they should give the system a try. “It was really difficult for communities to comprehend that, within a space of only one square meter on their farmland, they can have a technology installation that would get rid of all excess water, making their land free from waterlogging,” says Paul. “Their sheer vulnerability and helplessness compelled them not to trust anything new or outside the box,
Top: The Bhungroo system drains and filters excess water from farmland during the rainy season, and stores it within natural reservoirs below the soil. Left: During the dry season, farmers can access the stored water to irrigate their crops.
Watching is believing. We did demonstrations and the results were overwhelming. Nobody looked back after they saw the results.
Photographs courtesy Biplab Ketan Paul
so it was a big challenge to win their confidence.” How did Naireeta Services address this challenge? “Watching is believing,” says Paul. “We did demonstrations and the results were overwhelming. Nobody looked back after they saw the results.” Jain brings extensive engineering skills to her work with Naireeta Services, as well as expertise on issues of gender and climate change. With the help of the knowledge, experience and partnerships she gained as a Fulbright Scholar in environment and governance at Michigan State University in 2012-13, Jain has focused Naireeta Services’ efforts on making Bhungroo available to poor women, empowering them to become selfsufficient and gain agency in their lives. Jain’s Fulbright experience also involved discussions on water issues with students from other countries that face similar climate-based challenges. Naireeta Services’ efforts to improve lives through Bhungroo were bolstered by a grant from the Millennium Alliance, a consortium of partners including the Government of India, the U.S. Agency for International Development (USAID) and others. The alliance provides funding, capacity building and business development support to Indian social enterprises. “They unfolded the global opportunities within the farm sector,” says Paul. “From a single district in India, we have now successfully expanded our work across 12 states of India, along with Southeast and East Asia and Africa.” With help from the Securing Water for Food program of USAID, in particular, Naireeta Services was able to further improve its management structure, save time and costs, and access higher-quality technical assistance. “All these were highly useful for quicker and more accurate decisions on all work fronts,” says Paul. In the wake of the coronavirus pandemic, Naireeta Services launched awareness Left top: Biplab Ketan Paul (left) and Trupti Jain, co-founders of Naireeta Services. Left center and left: Practical demonstrations on the benefits of the Bhungroo system helped convince farmers to install it on their farmland.
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Fulbright Scholar Program
Photographs courtesy Biplab Ketan Paul
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Naireeta Services
Above: Biplab Ketan Paul (center) explains the right strategy for surface-level rainwater catchment in red soil areas during a hands-on field training program in Andhra Pradesh. Right: A Bhungroo evaluation visit by a team from the U.S. Agency for International Development (USAID).
sessions across India through its state teams. Over 31,000 members from eight states received information in local languages on how to stay safe from the virus. Additionally, Bhungroo women members and the organization’s women climate leaders augmented the capacities of over 210 women self-help group members to conduct peer monitoring and support. They helped monitor more than 18,700 rural people in the Patan district of Gujarat and provided training on how to report cases with critical symptoms to appropriate authorities. The social enterprise has also distributed personal protective equipment to about 410 families and facilitated its partners to undertake sourcing and distribution of relief packages in areas with a high rate of migration and with a large number of vulnerable people. As the Bhungroo technology spreads, Jain and Paul expect to see their efforts touch millions more poor, rural families around the world, guaranteeing food security and safe adaptation to climate change. They also
recognize that addressing issues of global warming and poverty requires the participation of all generations. As a jury member and mentor for the Incubation Center of Indian Institute of Technology Kanpur, Paul deals with many young innovators. He describes the successful ones as those who identify the pain point of clients and find solutions that fix the most acute problems. “If these criteria are honored, then a social enterprise is guaranteed to succeed,” he says. “Everything else will follow.” Michael Gallant is the founder and chief executive officer of Gallant Music. He lives in New York City. To share articles go to https://span.state.gov MAY/JUNE 2020 15
Yellow Roo By PAROMITA PAIN
Y
Photographs courtesy Kshama Hastak
oung children from economically weaker sections become vulnerable to being recruited as child labor when they are unable to access educational opportunities. According to UNICEF, “There are close to six million outof-school children in India. Out of 100 students, 29 percent of girls and boys drop out of school before completing the full cycle of elementary education and, often, they are the most marginalized children.” Kshama Hastak decided to make a difference. Her efforts
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resulted in the formation of Sarthak Foundation in Lucknow. Started in 2013 with six children, it now serves about 1,000 children in seven centers and a rural primary school. Dedicated to bringing education to the doorstep of the poor and traditionally marginalized, the seeds for Sarthak Foundation were laid when Hastak used to teach at Amity University, Lucknow. On her way to work, she used to “see these children from nearby slums and would often give them something to eat,”
ms of Learning
AIRSWEEE participant Kshama Hastak’s Sarthak Foundation provides free-of-cost education to children from economically disadvantaged sections of society. she says. “One day, all I could offer was sweetened fennel.” However, the children relished the treat and watching the joy on their faces made Hastak rue the fact that they could not attend school because their families were too poor. She started visiting these children to teach them. Hastak thought she would work with them as long as she stayed in Lucknow. “But they shared their plans for the future with me,” she says, “and I realized that they were depending on me to fulfill their dreams.” MAY/JUNE 2020 17
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Above: Kshama Hastak (right) is the founder of Sarthak Foundation, which provides free-of-cost school lessons as well as life skills to children at its Yellow Rooms.
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Within the next four months, Hastak created the Sarthak Foundation project. “Initially, my students from Amity University helped set up classes and reach out to children,” she says. Hastak quit her job in 2016 and has been working full-time with the foundation. It works through “Yellow Rooms” located in different areas where children are taught, free of cost, school lessons and life skills. Classes run for five to six hours daily. “When we started, we would teach in the basic rooms available in the slums,” says Hastak. “The children told us that their favorite color was yellow.” So, each room was painted bright yellow, and equipped with computers and television sets. The program starts with a seven-day orientation, after which the children are divided into three sections based on their learning levels. Those who have had access to no learning are called Tenderfeet, the second group is called Learners and the third are the Advancers. “Our students are mainly beggars, ragpickers or those who work menial jobs in shops,” says Hastak. The program lays great emphasis on gender equality and ethics with initiatives like Bachon Ki Panchayat (children’s government), which are predominantly led by girls. “We ensure that girls, too, have access to education because they bear the brunt of poverty,” says Hastak. When Sarthak Foundation educators reach out to people, they inform them that they cannot start classes without the girls. This strategy helps ensure that families send their daughters too to these classes. An essential element of the foundation’s program is school inclusion, through which these children are admitted to private and government schools, where they have maintained an almost negligible dropout rate. Sarthak Foundation sponsors their high school education and plans to enroll them in skillbuilding courses after graduation, with the aim of making them educated as well as employable. The organization has a record of 95 percent enrollment into formal schools
within two years of setting up a Yellow Room. They have increased regular school attendance of children from 20 percent to an average of 80 percent. Sarthak Foundation has also established Gurukul, a low-fee primary school in Sonari village in Uttar Pradesh, catering to children in the area. The aim is to ensure that these children do not have to move out of their villages to search for education and employment. When the government’s coronavirus prevention measures came into effect, Sarthak Foundation started organizing sessions on life skills for children from economically disadvantaged and rural families through digital platforms like YouTube and WhatsApp. It also collaborated with community kitchens and local government officials in Lucknow to regularly provide food items to almost 300 families. In 2018, Hastak participated in the All-India Roadshow on Women’s Economic Empowerment through Entrepreneurship (AIRSWEEE), a Public Affairs New Delhi grants program implemented by the U.S.-based nonprofit organization The Indus Entrepreneurs (TiE Inc.) and its India chapters. She says that Project AIRSWEEE helped her enhance her leadership skills. “I created a special module of what I had learned, for our teachers and volunteers,” she continues. “Project AIRSWEEE has been a tremendous support for me in a lot of ways.” She adds that while there’s been tangible benefits like improved financial management, marketing plans and donor engagement, the project has also had a lot of intangible benefits. “I’ve been connected to wonderful people and the association has continued after the workshop. A lot of them have got involved with my foundation and they have been helping me, connecting me to new people,” says Hastak. “I’ve also learned lessons on leadership, team management, ethics and integrity.” Paromita Pain is an assistant professor of Global Media Studies at the University of Nevada, Reno.
Conserving Crafts
Photographs courtesy Parul Bajoria
By RANJITA BISWAS
AIRSWEEE 2.0 participant Parul Bajoria’s social enterprise Miharu connects rural artisans and urban customers to
preserve ancient arts and crafts of India. To share articles go to https://span.state.gov MAY/JUNE 2020 19
D
okra, also known as dhokra, is an ancient art of metal craft famous in various parts of India, including West Bengal. Artisans from the state’s districts like Bankura and Birbhum create figurines of gods, birds and animals and ethnic jewelry from bronze- and copperbased alloys using lost-wax casting. The procedure involves making a wax mold, casting it with mud and putting it in the furnace to replace the wax with metal. The laborious process of creating the items and the time consumed—a single piece can take up to a month—led to a decline in the art form and impoverishment of the artisans. However, in recent years, artists, designers and entrepreneurs have given a boost to this age-old tribal art by creating pieces to cater to
Photographs courtesy Parul Bajoria
Right and below: Miharu’s contemporary designs aim to revive and preserve the art form of dokra.
20 MAY/JUNE 2020
modern tastes. One such designerentrepreneur is Parul Bajoria, who sells her dokra jewelry and artifacts under the brand name Miharu, through various online portals and major offline retail chains. Launched in 2013, Miharu has become popular with urban customers for its innovative designs and product quality, certified under the Craftmark label. Its contemporary designs aim to revive and preserve the art form by product development and accessing different markets. “My goal is to help revive dying crafts, generate jobs for artisans and maintain a sustainable venture,” says Bajoria. A diploma holder in fashion designing, Bajoria grew up in Siliguri in North Bengal and moved to Bankura after she got married. She tried different enterprises, but it was in dokra that she found her métier. Bajoria observed and interacted with local artisans and the idea of the social development enterprise was born. “In rural India, it’s difficult for housewives to work, especially if they need to meet people and travel,” she says. “The Internet, however, is bringing the world into our homes.” Bajoria works with artisans of Bikna
Photographs courtesy Parul Bajoria
Right and below right: Parul Bajoria’s social enterprise works with local artisans to promote crafts as well as provide them sustainable livelihoods.
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village in West Bengal, who are known for their jali work. “They are clean and precise with small components,” says Bajoria. “I find it’s the best area for contemporary designs, particularly for smaller products. Artisans in other parts of India make bigger dokra products, which are heavier. But the intricacy of work, with clarity, is best in Bikna.” Bajoria works with artisans in other parts of West Bengal, too, for traditional figurines and larger products as well as with artisans in the Dumka district of Jharkhand for jewelry pieces like beads and pendants. In the wake of the coronavirus pandemic, Miharu had to stop its e-commerce operations. However, it continued to place orders with all its regular artisans and supported them by providing essential food and hygiene items. Bajoria is also venturing into the world of décor products with Baluchari weaving. The Baluchari silk saree of West Bengal is famous for its intricate weaves on the pallu, depicting mythological stories from the “Ramayana,” “Mahabharata” and tales about Lord Krishna. Once upon a time, only women from aristocratic families were allowed to wear these sarees. Bajoria has adapted the style to create home décor products and dupattas to complement salwar-suit ensembles. “I’ve always wanted to help rural artisans, who struggled to sell their creations and were often swindled by middle men,” she says. “These artisans weren’t adapting to modern trends and I thought that working with them would be a perfect way to help and also promote our textile heritage. In this way, more artisans could make a living.” Bajoria was a participant of the All-India Roadshow on Women’s Economic
Empowerment through Entrepreneurship (AIRSWEEE 2.0), a Public Affairs New Delhi grants program implemented by the U.S.based nonprofit organization The Indus Entrepreneurs (TiE Inc.) and its India chapters. The project aims to educate and inspire women in Tier II and Tier III Indian cities to consider entrepreneurship as a viable and rewarding career option. “AIRSWEEE 2.0 impacted every aspect of my journey as an entrepreneur,” says Bajoria. “It gave me a reason to take forward the venture as an example for others. It provided exposure to business through friends in the same milieu and the opportunity to explore marketing through digital media.” She adds that the project workshop addressed all her queries and problems associated with entrepreneurship. “My takeaway from the experience is that hard work, with the right product, right placement and right links, is sure to succeed.” Ranjita Biswas is a Kolkata-based journalist. She also translates fiction and writes short stories.
My goal is to help revive dying crafts, generate jobs for artisans and maintain a sustainable venture. MAY/JUNE 2020 21
Breath of Life By JASON CHIANG
Millennium Alliance awardee Coeo Labs offers solutions to prevent deaths due to infant
respiratory distress syndrome and ventilator-associated pneumonia in low-resource settings in India.
A Photographs courtesy Coeo Labs
s part of a clinical needs assessment program run by the Affordable Inventions in MedTech research fellowship of the Bengaluru-based medtech company InnAccel, two entrepreneurs set out to help identify crucial problems in the health care industry and build indigenous solutions. For about three months, Nitesh K. Jangir and Nachiket Deval shadowed doctors, patients and other staff inside a Bengaluru hospital to better understand what problems they face every day. Based on this experience, they formed Coeo Labs in 2014 to build innovative medtech solutions for low-resource areas.
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One of the major problems Jangir and Deval noticed was the high number of deaths due to infant respiratory distress syndrome— about 250,000 cases are reported in India every year, and 32 percent affected babies die while being transported to medical facilities. A majority of these deaths can be prevented by the application of Continuous Positive Airway Pressure (CPAP). Unfortunately, many newborns and infants do not get access to this technology during transport, nor are electricity and skilled manpower widely available at many care centers. To address this problem, Coeo Labs developed Saans, an
Below left: Coeo Labs’ Saans device helps maintain airflow in babies with respiratory distress syndrome. Above left: Nitesh Jangir, cofounder of Coeo Labs. Above: A discussion on Coeo Labs’ VAPCare device (center), which reduces chances of acquiring ventilator-associated pneumonia.
unpowered, purely mechanical, low-skill neonatal CPAP device, which helps maintain airflow in babies with respiratory distress syndrome while being transported to a medical facility. Coeo Labs also focused on ventilatorassociated pneumonia (VAP), a major nosocomial cause of mortality in intensive care units, and created the VAPCare critical care device. For its work, the Bengaluru-based company won a grant from the Millennium Alliance, a consortium of partners including the Government of India, the United States Agency for International Development
(USAID) among others. Millennium Alliance provides funding, capacity building and business development support to Indian social enterprises. Excerpts from an interview with Jangir. How did you first become interested in health care? I was born in a village in Rajasthan. The nearest specialty hospital was over 150 kilometers away from my house. I have seen people lose their lives as a result of not getting timely access to health care. This led me to think about becoming a doctor and
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Millennium Alliance
www.coeo.in
www.millennium alliance.in
Photographs courtesy Coeo Labs
Coeo Labs
Below left: Coeo Labs’ Saans device was one of the India winners at the Innovation Showcase organized by the American Society of Mechanical Engineers in Bengaluru in 2017. The showcase was a competition for hardware with a social purpose. Below: Coeo Labs works on solving unmet clinical needs in the fields of emergency and critical care.
serving people. But I also had a keen interest in physics and biology.
Coeo Labs’ focus is to understand local needs and problems, and solve them with appropriate solutions.
Could you tell us a bit about Coeo Labs? Coeo Labs is a medical device company, which solves unmet clinical needs in the fields of emergency and critical care. We have a vision of preventing preventable deaths in emergency and critical care. Coeo Labs’ focus is to understand local needs and problems, and solve them with appropriate solutions. In a country like India, more than 75 percent of medical devices are imported. Even after paying a premium price, many times, these are not the most suitable products for low-resource settings. We wanted to change this scenario and set an example of how innovating for low-resource settings can make both financial and social impact. Preventing VAP and providing breathing support at the first point-of-care for babies with respiratory problems were the top two critical problems that we wanted to try solving. Currently, we offer two solutions. The first is called Saans, a low-cost neonatal breathing support system to cater to five million newborns in low-resource settings. Our other solution is a critical care device called VAPCare, which prevents the risk of ventilator-associated pneumonia in patients on long-term ventilator care. Please tell us about Coeo Labs’ work in
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response to the coronavirus pandemic. We have upgraded our neonatal CPAP machine, Saans, by changing the amount of air delivered through the machine to help coronavirus-affected patients. This is already available in the market. Our other product, VAPCare, has been installed in some hospitals, coronavirus treatment centers and isolation wards in Andhra Pradesh. VAPcare is an intelligent secretions and oral hygiene management system. It goes inside the patient’s airway, especially those who are on ventilators, and automatically senses and removes all the infected saliva and secretions without human intervention, to make sure that the patient does not get any secondary infection. It also helps prevent caregivers from coming into contact with the infected saliva of the patients. Additionally, the automatic suctioning procedure saves caregivers’ time as they don’t have to do it manually. What are some of the unique challenges of working in the health care industry? The issue with a new concept or invention is that the market is slow to adopt a product that has never been seen before, especially if it comes from a new Indian company. We have to build a strong brand name, strong clinical data, strong collaborations and work with top physicians to prove our solutions are worldclass.
Right: The Saans device (bottom) has helped save more than 1,000 babies so far.
How did winning the Millennium Alliance grant in 2016 help you in your work? We won a Millennium Alliance grant at a very crucial stage, when we had a proof of concept and were looking for funding to develop a product. The capacity-building workshops by the Alliance partners were especially useful for us to better understand project management. The funding amount, and the validation that came along with the grant, helped us in developing the product and in customer acquisition. It has helped us conduct testing of the product in the field and helped health care workers save lives. What are the current status and future plans of Coeo Labs for its Saans device? Our product is purchased by many health care providers in India and Africa. Two clinical trials have already been done with the Saans device. The product has saved more than 1,000 babies and counting. There are 60,000 birth centers in India where Saans could be used and we are not present in even 10 percent of these centers. Our goal in the next five years is to reach 5,000 of these birthing centers and help health care workers save 100,000 more lives. We are looking for both public and private partnerships to reach this goal and achieve financial sustainability. Jason Chiang is a freelance writer based in Silver Lake, Los Angeles.
MAY/JUNE 2020 25
Chilling With Green
Technology
S By PAROMITA PAIN
University of Utah graduate Akash Agarwal’s New Leaf Dynamic Technologies offers GreenCHILL, an
off-g grid refrigeration system for
farmers in rural and remote locations in India.
tudents usually take a gap year after completing a course of study, but Akash Agarwal took a year off during his studies at the University of Utah to develop a cooling system powered by clean energy. Always interested in social entrepreneurship using green technologies, Agarwal conceptualized GreenCHILL in 2011, based on the idea of using biomass, or farm waste like rice husk, straw, paddy, waste wood, bagasse, or any crop waste, to keep agricultural products cold without depending on electricity or dieselpowered generators. He, of course, went back to the United States to complete his higher education. Today, as the co-founder of the New Delhi-based New Leaf Dynamic Technologies, which researches and markets the technology, Agarwal has successfully deployed GreenCHILL in farms across India. “I was associated with the agriculture industry even before I finished my
undergraduate degree from the University of Utah,” he says. “I have traveled extensively across India and met thousands of farmers and surveyed large, medium and small farms to understand their needs and challenges.”
Preventing loss The technology addresses a very fundamental issue—the loss of agricultural produce, often due to inadequate cold storage facilities. GreenCHILL is essentially a cooling system that can, for example, cool up to 1,000 liters of milk, thereby leading to better incomes for farmers. Thus, using this technology to maintain a cold storage, pre-cooler, ripening chamber and bulk milk cooler is a costeffective option, especially for farms that are not connected to the electricity grid or those that do not have continuous power supply. And, there are no greenhouse gas emissions either. “Our first pilot project was in Ghazipur, Delhi, where we were able to successfully chill 500 liters of milk using energy generated from cow dung,” says Agarwal. “Since then, many individual farmers have installed GreenCHILL at their farms to store milk and high-value perishable produce like apples, pomegranates, muskmelons, oranges, bananas, mangoes, pears, custard apples, lemons, potatoes, capsicums, peas, green chilis and marigold flowers.” Left: Akash Agarwal (center, left) at an agriculture workshop in Maharashtra.
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© Getty Images
Photographs courtesy Akash Agarwal
Below: Peas being sorted for storage in a chamber cooled by GreenCHILL.
Inspired to change The initial idea for GreenCHILL was sparked by dairy farmers in Saharanpur, Uttar Pradesh, whom Agarwal used to see waiting for trucks to carry milk to the nearest processing center, 40 to 50 km away, as there was no cold storage facility nearby. “I was inspired to change this supply chain logistic and prevent the losses that occur because of the unavailability of trucks,” he says. “We wanted to develop a refrigeration system right
at the village where farmers could come and preserve milk, which could be taken to the processing center later or the next day.” The Off-Grid Bulk Milk Chiller was the first product to use the GreenCHILL technology, followed by the Off-Grid Cold Storage, for other produce. In 2018, American retail corporation Walmart funded New Leaf Dynamic Technologies, under its corporate social responsibility program, to bring together 500 small and marginal farmers in Uttar Pradesh to naturally ripen mangoes and bananas, and sell them directly to Best Price stores owned by Walmart. This helped the farmers get a higher price for their produce.
Localizing technology Much of the research to develop the products came from published journal papers on large-
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Photographs courtesy Akash Agarwal
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New Leaf Dynamic Technologies www.newleafdynamic .com/
United StatesIndia Science & Technology Endowment Fund https://bit.ly/2LISCXX
The University of Utah https://www.utah.edu/
The technology addresses a very fundamental issue— the loss of agricultural produce, often due to inadequate cold storage facilities.
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volume refrigeration systems and green technology. The New Leaf plant in Noida assembles the products and parts are ordered from other local companies to save on high manufacturing and labor costs. Each machine needs some amount of customization. Prices range from Rs. 12 lakh to Rs. 14 lakh, depending on the storage capacity. New Leaf has partnerships with banks which can provide financial resources to farmers. During the coronavirus pandemic, the company’s service and support staff across the country continued to support its customers who needed GreenCHILL more than ever. “We are using this as an opportunity to redesign GreenCHILL,” says Agarwal, “so that when we come out of this crisis we have a vastly improved system.” Agarwal and his father, with whom he cofounded the company, faced many challenges in the development and deployment of GreenCHILL. “It is hard to convince farmers to use a product they have not seen before,” he says. “We financed our earliest ventures ourselves, and our machines costed nearly double of what they cost now.” Agarwal says that his management studies at the University of Utah, where personal selling was his
Above: The GreenCHILL cooling system can be used to maintain a cold storage, a pre-cooler or a ripening chamber.
favorite topic, taught him how to convince customers to buy products they had neither seen nor heard of before. Today, GreenCHILL is being used in New Delhi, Gujarat, Maharashtra, Madhya Pradesh, Uttar Pradesh, Punjab and Rajasthan. Each unit can be used to preserve 1,000 liters of milk and 20 metric tons of other high-value perishable produce like fruits, vegetables, flowers and fish before they are ready to ship to market or processing facilities. Recently, New Leaf Dynamic Technologies received funding from the United States-India Science & Technology Endowment Fund (USISTEF). The U.S. State Department and India’s Department of Science and Technology established the fund in 2009 to support joint applied research and development. The fund also supports commercialization of technology developed through partnerships between U.S. and Indian researchers and entrepreneurs. Its activities are administered by the Indo-U.S. Science and Technology Forum. The funding from USISTEF “is in line with the memorandum of understanding we have with Georgia Tech [Georgia Institute of Technology], which is a pioneer in the field of absorption refrigeration systems,” says Agarwal. “This partnership will help us develop the next generation of GreenCHILL products, bring down costs of manufacturing and bring the technology to the masses.” Paromita Pain is an assistant professor of Global Media Studies at the University of Nevada, Reno.
Endorsing
Social
Innovations
N
By JASON CHIANG
ot every innovator is an entrepreneur. Likewise, not every entrepreneur is an innovator. It was this epiphany that inspired the creation of LetsEndorse, a marketplace for connecting social innovators with grassroots organizations, corporations, government bodies and individuals. The connections help take the most effective and befitting social innovations and solutions to the lastmile communities who need them. Since 2015, the Bengaluru-based company has functioned as a network to
Nexus Incubatortrained LetsEndorse offers a
collaborative ecosystem to social
Top right: Monika Shukla (left) and Varun Kashyap, co-founders of LetsEndorse. Above right, above far right, right and far right: LetsEndorse is working in more than 100 districts across five states, with support from the Small Industries Development Bank of India, to boost self-employment.
Photographs courtesy LetsEndorse
innovators and connects them with other stakeholders to benefit communities.
bring together social innovations from across the world for discovery by those who need them. It offers technology platforms and tools to enable operational and financial efficiencies as well as transparency in the process of bringing about social change. LetsEndorse was part of the third cohort at the Nexus Incubator start-up hub at American Center New Delhi. Excerpts from an interview with LetsEndorse’s co-founder Monika Shukla about the company’s platform and its mission.
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Photographs courtesy LetsEndorse
Could you please tell us about LetsEndorse and its work? LetsEndorse is a market network of practicable social innovations from over 40 countries. Our network includes more than 2,000 grassroots-level community-based organizations and several enablers like funders, volunteers and pro bono workers. We modeled LetsEndorse as a solutions exchange platform, with the ideology of taking beneficial and innovative solutions to the last mile. It brings together communities, represented by nongovernmental organizations; social innovators; and individual and institutional funders. It enables discovery, blueprinting, viability checking, fundraising and complete lifecycle tracking of the process of solution deployment. We have fueled over 350 solution-centric interventions in the last four-and-a-half years. How did the idea for LetsEndorse come together? LetsEndorse believes that resolving the problems of access and affordability of solutions can remove the biggest barriers, while empowering people to meet their needs. I met Varun Kashyap, the company’s co-founder, in 2012 during a master’s course. We worked with various social organizations in different capacities, only to realize how many promising solutions to social issues are not coming off the shelf and are not benefiting people in need. To bridge the funds gap, if a community cannot pay for procuring an innovation, the marketplace should include funders like philanthropists, family offices, corporations through their corporate social responsibility 30 MAY/JUNE 2020
Above: Volunteers from Intel Corporation create a life-sized snakes and ladders board at a government primary school in Karnataka, as part of Project Rangmaidan. Left: Children with school bags that unfold into detachable desks, distributed as part of Project Jigyasa. Left: LetsEndorse presents its technologyenabled data platform to the Maharashtra Ministry of Education.
verticals and local governments, who fuel such solution-centric interventions. Please tell us about the COVID-19 response efforts by LetsEndorse. We built and launched a technology platform, called Aapoorti, with the Maharashtra State Innovation Society to identify real-time material gaps in hospitals and garner collective support to bridge those gaps. Considering the inadequately equipped public health infrastructure in most states, there is a need to ensure transparent movement of medical supplies, right from fundraising and ordering to inventory allocation and dispatch. Aapoorti is our solution for this issue. Additionally, over the last few months, we have been working toward boosting selfreliance, through self-employment, among
Right: A menstrual hygiene workshop for adolescent girls. Far right: An electronic sanitary napkin incinerator, installed at a government school, helps dispose waste material in a safe and ecofriendly manner.
What were some of your biggest takeaways from training with the Nexus Incubator? Some of the noteworthy aspects of the Nexus program that clearly stood out and
What do you see as being the most important challenges for social entrepreneurs to address in the near future? How can the “impact ecosystem” achieve the most good? Addressing the basic needs of communities, in terms of providing access to potable water, good housing, nutrition and clean air; ensuring maximum productivity from agriculture; social and economic parity; and disaster proofing are some of the biggest challenges which still need innovation. The “impact ecosystem” can achieve the maximum when the efforts are synchronized, when promising solutions get enough resources to scale up and when the “impact capital” gets channelized toward solving problems effectively. Do you have any advice for those interested in getting more involved in social entrepreneurship? Solving people’s problems would take years. In order to have the patience and the sustained drive to keep at it, we advise entrepreneurs to work on a problem which speaks to them the most. If they build value for people, they would end up building value for themselves. A few things we wish we could tell ourselves in our early days are that research and instincts are equally important. Think about scale and sustainability. Be resilient and build your tribe of people, who are as driven and passionate to solve the problem as you are.
LetsEndorse www.letsendorse.com
Nexus Incubator https://startupnexus.in
Our network includes more than 2,000 grassroots-level communitybased organizations and several enablers like funders, volunteers and pro bono workers.
Jason Chiang is a freelance writer based in Silver Lake, Los Angeles. Photographs courtesy LetsEndorse
Having worked globally with different types of industries, what similarities do you notice between the most impactful organizations? Some of the similarities are a holistic understanding of the problem, which comes from thorough research; effective validation of perceived problems; staying very lean; community-centered solution testing; having a sustainability plan and a vision to convert their beneficiaries into potential customers; and not being dependent on grants forever. Missionorientedness and staying true to being an impact-first organization are some of the other common themes of these organizations.
continue to guide us are: First, the “get out of the building” exercise, which is essentially about testing and validating your ideas and solutions with real people. Second, pitching perfectly, which is the ability to introduce the work you do to different audiences, and do that articulately. This also involved gauging the interests of the audience or listener, what could be the potential synergies, and focusing on those aspects.
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India’s economically vulnerable population. We have worked extensively with the Small Industries Development Bank of India in 108 districts spread across Uttar Pradesh, Bihar, Jharkhand, Odisha and Telangana, to help create 10,000 micro, small and medium enterprises. In post-COVID India, livelihoods for a large number of reverse migrants, who moved back to their villages and small towns from cities, will remain uncertain and job creation will slow down. Through Project Udyamita, we aim to fuel a rapid growth of nano and microentrepreneurship across India. As part of the overall mission, we will identify, nurture and equip hundreds of young aspirants to become self-employed through robust business models. We are working with state administrations, civil society organizations and corporate partners with the goal of making 100,000 people become self-reliant in the next 24 months. Besides these, we have worked closely with several grassroots nongovernmental organizations to design effective communication strategies for them and to recruit virtual volunteers to support key functions of their work.
MAY/JUNE 2020 31
Fulbright-Nehru Fellow Dr. Ashish Goel shares how underlying conditions, like diabetes and hypertension, might put people at greater risk during outbreaks like coronavirus, and what people can do to protect themselves.
Dealing
T
By SUPARNA MUKHERJI
he coronavirus pandemic is one of the biggest global health crises of our time. Countries across the world are trying to slow the spread of the virus through measures like testing and treating patients, carrying out contact tracing, restricting travel, quarantining citizens and canceling large events and gatherings. Certain groups of people, however, are considered particularly vulnerable. These include individuals with underlying health conditions like hypertension, diabetes and cardiovascular diseases. This has, thus, become a key focus area in the health sector. Dr. Ashish Goel, clinical associate professor at University College of Medical Sciences and Guru Teg Bahadur (GTB) Hospital, New Delhi, is among those at the forefront of India’s fight against COVID19. Dr. Goel attended the Johns Hopkins Bloomberg School of Public Health in Maryland as a Fulbright-Nehru Fellow in 2017 to pursue a master’s degree in public health. Excerpts from an interview.
LUSIA599/iStock/Getty Images
Could you tell us briefly about your academic and professional background? I completed my master’s degree in medicine from the first rural medical college in India at Sevagram, Maharashtra, in 2003 and pursued a senior residency program at the All India Institute of Medical Sciences in New Delhi. I joined as a teaching faculty at the University
32 MAY/JUNE 2020
Courtesy Dr. Ashish Goel
COVID-19
College of Medical Sciences and affiliated GTB Hospital in 2009. I further completed a master’s in public health from the Johns Hopkins Bloomberg School of Public Health, under a Fulbright-Nehru Fellowship in 2017. Over the years, I have worked in several medical schools and trained in geriatric and emergency medicine, ethics, epidemiology and biostatistics. What are some of the underlying health conditions that put people more at risk of the coronavirus? It has been found that older individuals with comorbid illnesses, such as diabetes, hypertension, cardiovascular disease, chronic obstructive airway disease (COPD), malignancy and chronic kidney disease, are at a greater risk of developing serious illness, requiring hospitalization, after exposure to the COVID-19 virus infection (Emami et al., 2020). In what ways does the virus affect these groups of people? Without going into too much technical detail, I would briefly say that the novel coronavirus affects the renin-angiotensinaldosterone axis and depends on angiotensin-converting enzyme (ACE) receptors to gain entry into human cells. The precise mechanism is still under exploration
and analysis. The verdict on the use of antihypertension drugs is still under consideration and there is no evidence to guide the use of ACE-inhibitor drugs or angiotensin receptor blocker drugs (Cheng et al., 2020; Danser et al., 2020; Meng et al., 2020). The COVID-19 infection also affects the glucose metabolism. Strict control of blood sugars is an important consideration during management in previously diabetic patients (Zhou et al., 2020a). What are some of the precautions that people with underlying health conditions can take to minimize the risk? Social, rather physical, distancing and good hygiene, in addition to handwashing, are very important to reduce an individual’s risk of exposure. In addition, the role of wearing a mask at all times when interacting with people cannot be over-emphasized. While the role of N95 masks has been emphasized in different forms of media, it has been seen that using any kind of mask will be protective, as compared to not using masks (Zhou et al., 2020b). It is also important to stay indoors as much as possible and to move out as briefly as possible, only when it is essential, to contain the disease spread and prevent the health care system from collapsing.
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With
Left: Dr. Ashish Goel, (right), with colleagues at the Guru Teg Bahadur Hospital in New Delhi.
Courtesy Pixabay Chinnapong/iStock/Getty Images
Top: Older individuals with comorbid illnesses like hypertension are at a greater risk of developing serious illness, requiring hospitalization, after exposure to the coronavirus infection.
There are reports that claim certain medications like ACE inhibitors, commonly taken by diabetes and hypertension patients, might increase susceptibility to coronavirus. How true are these claims? The final verdict on the use of ACE inhibitors and angiotensin receptor blockers (ARBs) is not out yet. While the role of ACE receptors has been studied in the pathogenesis of COVID-19 viral infection at the cellular level, arguments on both sides have been put forward (Danser et al., 2020; Liu et al., 2020; Meng et al., 2020; Sparks et al., 2020; Talreja et al., 2020). At present, there is no evidence favoring discontinuation of ACE inhibitors or ARB among patients with hypertension. The protective effects of these drugs outweigh the potential speculated harm. In fact, I am continuing with Olmesartan, an ARB, for myself. How soon can we hope to find a cure or vaccine for the coronavirus? Vaccine development is a slow process and needs to be executed with meticulous planning. There has been considerable focus on the possible development of a vaccine in recent times. Social media is rife with reports of a new vaccine every day. But, it would be impractical to expect a vaccine to help us fight the current first wave of the epidemic (Amanat and Krammer, 2020). To understand the practical timeframe, let me draw a comparison to the H1N1 epidemic in 2009. During the epidemic, vaccine production was immediately geared to produce a monovalent pandemic vaccine, instead of making the usual trivalent seasonal influenza vaccine. Although this was a minor change of strategy to target the new strain, the new vaccine became ready for use only after a period of six months.
Above: A healthy nutritious balanced diet is important to strengthen our immune systems.
References Amanat, F. and Krammer, F. (2020). SARS-CoV-2 Vaccines: Status Report. Immunity.
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Cheng, H., Wang, Y. and Wang, G. Q. (2020). Organprotective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19. J Med Virol.
Danser, A. H. J., Epstein, M. and Batlle, D. (2020). ReninAngiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. Hypertension, Hypertensionaha12015 082.
Emami, A., Javanmardi, F., Pirbonyeh, N. and Akbari, A. (2020). Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis. Arch Acad Emerg Med, 8, e35.
Jawhara, S. (2020). Could Intravenous Immunoglobulin Collected from Recovered Coronavirus Patients Protect against COVID-19 and Strengthen the Immune System of New Patients? Int J Mol Sci, 21.
Kim, S. W. and Su, K. P. (2020). Using psychoneuroimmunity against COVID-19. Brain Behav Immun.
Lechien, J. R., et al. (2020). Olfactory and gustatory dysfunctions as a clinical presentation of mildto-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol.
Liu, Y., et al. (2020). Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci, 63, 364-374.
What measures do you think can help us strengthen our immune systems? The novel coronavirus appears to affect lymphocytes in the body, as evidenced from recent data (Qin et al., 2020). Among the different approaches that are being explored to challenge the virus, the role of immunomodulatory therapy with harvested antibodies from recovering patients as well as established chemotherapy is under the lens (Jawhara, 2020; Russell et al., 2020). There have been reports emphasizing the role of Vitamin D (McCartney and Byrne, 2020) and several mechanisms have been proposed in alternative and traditional medicine approaches. But there is no evidence that either of these will make a definitive impact on the human body’s response against the virus. Anosmia, or the loss of olfaction/smell sensation, and ageusia, or the loss of taste sensation, have been reported in association of COVID-19 infection (Lechien et al., 2020). Intuitively, this may, in turn, reduce appetite and affect diet even in mild cases. The only advice that may be valid is that one should take a healthy nutritious balanced diet, sleep adequately, reduce stress, exercise regularly and maintain a daily schedule. While social (read physical) distancing is important to reduce infection, social contact and uninterrupted communication (read camaraderie) are essential to maintain mental balance (Kim and Su, 2020).
McCartney, D. M. and Byrne, D. G. (2020). Optimisation of Vitamin D Status for Enhanced Immuno-protection Against Covid-19. Ir Med J, 113, 58.
Meng, J., et al. (2020). Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Emerg Microbes Infect, 9, 757-760.
Qin, C., et al. (2020). Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis.
Could you please tell us about the cooperation between the United States and India to help prevent the further spread of COVID-19? There is the highest degree of cooperation and mutual collaborative work being done at the highest administrative levels in both countries. Indeed, it is heartening to see the camaraderie between President Donald Trump and Prime Minister Narendra Modi in this difficult time. In my opinion, the one thing that we urgently need is transparent sharing of realtime data. There are several researchers and experts who can interrogate a dataset and explore its diverse aspects in different ways. If there were a universally accessible realtime database of clinical and demographic details on outcome of patients, freely available on the cloud, maintained by participant countries, it would be the most valuable resource we could create. Several independent experts, trained in epidemiology and biostatistics around the world, who are not directly involved in the pandemic response, could then analyze this data to understand how the pandemic is behaving in different countries. This may not only provide guidance to countries lagging on the epidemic curve, but will also open the door to several thousands of brilliant minds around the world. While this may be easy in health care systems already maintaining electronic medical records, it becomes difficult for clinical epidemiologists like myself to understand what is happening at the local level, despite my training and expertise to do so. A timely international collaborative undertaking, led by the United States in this direction, could provide the necessary impetus to preserve the existing world order.
Russell, B., et al. (2020). Associations between immune-suppressive and stimulating drugs and novel COVID-19-a systematic review of current evidence. Ecancermedicalscience, 14, 1022.
Sparks, M. A., et al. (2020). Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19. Clin J Am Soc Nephrol.
Talreja, H., et al. (2020). A consensus statement on the use of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in relation to COVID-19 (coronavirus disease 2019). N Z Med J, 133, 85-87.
Fulbright-Nehru Fellowships http://www.usief.org.in/ Fulbright-NehruFellowships.aspx
Johns Hopkins Bloomberg School of Public Health
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Notwithstanding the progress in vaccine development over the last decade, the safety, efficacy and sustained antibody response of a new vaccine for COVID-19, an entirely new virus that has just emerged in humans, first needs to be established in animal models before it can be made available for use in human subjects.
https://www.jhsph.edu
The role of wearing a mask at all times when interacting with people cannot be overemphasized.
Zhou, F., et al. (2020a). Clinical course and risk factors for mortality of adult inpatients with COVID19 in Wuhan, China: a retrospective cohort study. Lancet, 395, 1054-1062.
Zhou, Z. G., Yue, D. S., Mu, C. L. and Zhang, L. (2020b). Mask is the possible key for selfisolation in COVID-19 pandemic. J Med Virol.
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Managing Stress During How to cope with anxiety and panic during public health crises like the coronavirus
pandemic.
P
GDArts/iStock/Getty Images
ublic health crises can take a huge mental toll on people as these create fear, worry and uncertainty. For many, these crises can take away the very things that give life joy, meaning and purpose. These situations are especially tough for those struggling with anxiety, depression and other mental health conditions. SPAN spoke to Nivida Chandra on how people can ease some of this anxiety and gain a better sense of being in control during a public health crisis. Chandra is a Fulbright-Nehru doctoral scholar (201718) and has a master’s degree in psychology from Delhi University. She is currently a research scholar at the Indian Institute of Technology Delhi and is the founder-editor of TheShrinkingCouch.com, which hosts informational and experiential articles for those affected by mental health concerns. Excerpts from the interview.
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In what ways do public health crises take a mental toll on people? Public health crises can create mass panic and fear, which have a tendency to gain a momentum of their own. People fear for the health and lives of loved ones and their own, as they grapple with the uncertainty of what’s next and the sudden disruption of life as they knew it. External pressures like threatened job security add to this syndrome. Suddenly, nothing seems to be in our control. In situations like the coronavirus pandemic, where we are required to stay home for extended periods of time, there are additional feelings of dismay. Even if we expect ourselves to feel relaxed at home, have a lot of time on our hands, and achieve our bucket-list items, there is an inexplicable lack of motivation to actually execute these tasks. Somehow, we feel exhausted instead of feeling
a Pandemic energized. People who are used to having full schedules with predictable and organized tasks may suddenly find themselves with “nothing to do.” As a result, some people feel lonely, anxious, panicked, hopeless and isolated. Others may feel a sense of illness in their mind and body. We may experience an increase or decrease in appetite and sleep, making us feel physically weak and disoriented. Issues that one might have been avoiding have a tendency to emerge. For instance, we may be forced to face personal issues such as our purpose in life, or relationship issues like re-evaluating marriages. There is also an increase in incidences of domestic violence and other forms of abusive relationships. Those already coping with depression or anxiety may be more susceptible to feeling hopeless or listless in the face of a public health crisis. How can people control their sense of panic and anxiety at such times? Some of the popular and effective ways being widely shared are eating healthy; exercising daily, even if indoors; meditating or doing yoga; and keeping in touch with friends and family. Creating a daily routine that incorporates these is a good practice. I would like everyone to remember that feelings of fear, panic, listlessness or any of the related psychological states is absolutely normal. In fact, it is detrimental to your health to rationalize it as weak or unnecessary. When feeling any form of distress, take a moment to accept it. Try simple exercises like taking a few deep and calming breaths. If this feels inadequate, consider asking yourself what’s bothering you. If you can verbalize the fear, you can talk to yourself about it. If these don’t work, call a friend or loved one and ask them to help you talk it through. If nothing seems to work, you could involve yourself in any task that can help you disengage from that emotion for that moment, though I would encourage you to return to it later and understand it, so that it does not keep coming back and overwhelming you. Days may seem to blur together, so maintaining a routine helps retain a semblance of normalcy. There can be tremendous pressure to “make the most of this time” at home. Avoid falling for this! Examine what you can reasonably do in a day. Tasks involving work from home, cleaning, cooking, other odd chores take both time and
By DEEPANJALI KAKATI
mindspace, and can even be frustrating to adjust to. Do not discount their effect on your day. While you may be at home, these are not times of rejuvenation any more than they were before these circumstances set in. This, of course, should not stop you from taking time for self-care. But, just be careful to not hold soaring expectations of yourself to come out a brand new person on the other side of this pandemic. Not accomplishing these unrealistic goals will then become another source of disappointment and frustration. It is also important to take a moment to examine what is meaningful for you right now. It must include setting a routine and continuing to pay attention to projects and tasks that you were in the middle of before we had to stay at home. Pick activities or tasks that make you feel fulfilled with your day. For those who have to self-isolate or go into quarantine, what can they do to deal with feelings of loneliness and being disconnected? Self-isolating is a physical activity and should not be equated to emotionally distancing oneself. Reach out to old acquaintances, join online communities, play online games. Most importantly, talk to people both about the difficulties of self-isolating as well as the ways in which you are coping. All the tips mentioned in the previous question also apply. When feeling lonely or disconnected, remind yourself of the ways in which you cope— whether it is through breathing exercises, calling a friend or loved one, taking one’s prescription medication, writing about it, or engaging in some activity. If the feelings persist and feel out of control, please reach out to a mental health professional. Working from home sometimes creates stressful situations due to the blurring of boundaries between work and home. What steps can people take to deal with these situations? The first and most important step is to temper one’s expectations about having clear boundaries at home. They will be blurred. If with family, talk to them about your need for a separate work time, and what might help you be efficient in that time. Try and set some rules like no distractions during work hours, and break your day up into chunks of hours and allot work, family, self , home, etc. labels to it. Expect a restlessness in implementing this, but allow yourself to adapt as you learn. You might also have to adjust to working alone.
Far left: FulbrightNehru doctoral scholar Nivida Chandra.
Be careful to not hold soaring expectations of yourself to come out a brand new person on the other side of this pandemic.
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Many of us are used to going to work and seeing it as a place of meeting friends or working hands-on with a team. It may also feel like you have a lot more time to accomplish tasks in the work-from-home option, but this is not the case. A lot of commitments may arise, including cooking and cleaning, which take substantial amounts of physical and mental energy. Remember to account for these when you plan your work day. What can parents do to create a safe environment for children, where they can convey the urgency of the situation without scaring them? First, there are many children of all ages who are not panicked or fearful, even when they have been asked to stay home. They may just be wondering about what’s happening and why their routines have changed, where their friends are and when they’ll get to go back to school. In such cases, parents should be careful not to introduce or transfer their own panic to their children. With children who need interventions, ask them what they understand about the circumstances and tailor your response to them. If they are afraid, ask them to trust you, remind them of their safety in the world, and ask them to talk openly about this fear. Most
importantly, do not minimize or banish your children’s fears or think that they are not capable of dealing with them. Trust in them as they trust in you, and invite them to engage with their fears in the safety of your presence. For those struggling with anxiety, depression and other conditions, these situations are especially challenging. In what ways can families and caregivers help ease the impact? Times such as these have the unique effect of exaggerating pre-existing conditions. Caregivers and loved ones are experts at knowing these signs and symptoms. They should be prepared for, though not assume, heightened symptoms; be in constant touch with a psychiatrist or clinical psychologist; and definitely find resources of support for themselves, too. They must carve out some time for themselves when they do not have to engage with their loved ones’ mental illness. If possible, talk to the person with mental illness and help them to take additional precautions to keep symptoms at bay. These times may be frustrating and angering for those involved. The role of compassion cannot be emphasized enough, both toward others and oneself.
Steps to Control Anxiety
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stablishing a routine to create a sense of normalcy and predictability during a public health crisis can help people feel calmer and more in control. Here are some suggestions from Dr. Kathy HoganBruen (right) on things to include in a routine. Dr. HoganBruen is a clinical professor of psychology at The George Washington University and adjunct psychology professor at The Chicago School of Professional Psychology (D.C. campus). • Exercise. It can reduce anxiety; improve mood; improve sleep, which can reduce anxiety and improve problem-solving abilities during crises; and improve health. • Prioritize setting the same bedtime and wakeup time, along with a dark room, no screens 30 to 60 minutes before bed, no caffeine after 2 p.m. and limited alcohol. • Eat healthy. • Spend time in sunlight, which has positive 38 MAY/JUNE 2020
effects on mental health. • Connect with others through social hours for texting or video calling. • Take up meaningful and/or challenging work, if possible. • Do something to help others. For example, make masks to donate, call to check on elderly relatives. • Start a new hobby or pick back up an old one. • Take in a moderate amount of news from trusted and reliable sources. Get enough information to know what to do, but not too much to be emotionally overwhelmed, or to take you away from healthier activities. • Get grounded, meditate, practice thinking and being in the “here and now” rather than excessively worrying about the future. —D.K.
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CDC resources on stress and coping
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Breaking the Seasonal Disease Cycle
M By GIRIRAJ AGARWAL
Fulbright-Nehru Senior Research Scholar Dr. Rajib Dasgupta discusses ways to deal with seasonal disease cycles and the role of U.S.-India collaborations in the public health sector.
ost of us are aware of the seasonal cycle of influenza outbreaks. Scientists claim that all infectious diseases have a seasonal element, and seasonality occurs not just in acute infectious diseases like flu, but also in chronic infectious diseases like Hepatitis B which, depending on geography, flare up with greater regularity at certain times of the year. To know more about this, SPAN spoke to Dr. Rajib Dasgupta, a professor at the Centre of Social Medicine and Community Health at Jawaharlal Nehru University’s (JNU) School of Social Sciences, New Delhi. He holds an MBBS degree from NRS Medical College, Kolkata, and a Ph.D. in community health from JNU, and has worked with the epidemiology and public health divisions of the Municipal Corporation of Delhi. Dr. Dasgupta was also a Fulbright-Nehru Senior Research Scholar at Johns Hopkins Bloomberg School of Public Health, Maryland, where he worked on developing a social determinants framework for understanding child health programs, including those on nutrition and polio eradication. Excerpts from an interview.
Please tell us about your work as an epidemiologist and a public health specialist in India and the United States. I served in the epidemiology division of the Municipal Corporation of Delhi for a decade before joining the faculty at the Jawaharlal Nehru University, New Delhi. During my stint at the Municipal Corporation of Delhi, I was at the frontline of technical and managerial roles during outbreaks of Cholera O139, plague, dengue fever or dengue hemorrhagic fever and SARS. I spent an academic year at the Global Disease Epidemiology and Control Program at Johns Hopkins Bloomberg School of Public Health during 2010-11 as a FulbrightNehru Senior Research Scholar. Additional support from the Occasional Lecturer Program, as part of the Council for International Exchange of Scholars, accorded a wonderful opportunity to share and learn with a number of minority-serving institutions in the United States. I continue to research the social epidemiology aspects of communicable diseases across India and in the South East Asia region of the World Health Organization.
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What would be your advice to people to protect themselves and their families from coronavirus? The do’s and don’ts have been widely publicized. The challenge for Indians is to be able to practice some of the key messages, such as frequent handwashing and physical distancing, given our structural and societal constraints. The National Sample Survey (NSS) 76th round reported in 2019 that 25.3 percent rural households and 56 percent urban households washed hands with soap or detergent before a
Dr. Rajib Dasgupta (left) participates in a discussion on H5N1, or bird flu, on All India Radio.
The collaborations should include a focus on public health education that addresses the requirements of both academicians and researchers as well as public health practice down to the frontlines. 40 MAY/JUNE 2020
meal. Earlier, a 2015 report estimated that 150 million people lacked access to “at least basic” water, with a greater share in rural areas. Census 2011 reported that nearly 40 percent households of India lived in one-room houses; add to these the number of homeless people. There are no easy answers and some of the local health authorities and voluntary organizations are doing wonderful work to negotiate these challenges. What kind of cooperation do you think is possible between the United States and India during the spread of diseases and pandemics like COVID-19? India continues to have the classical double burden of both communicable and noncommunicable diseases. Disease surveillance systems have been constantly improving and we know that acute respiratory infections account for almost 70 percent of morbidity from communicable diseases. There were 38,811 cases of H1N1 during 2017 with a case fatality rate of 6 percent. Japanese encephalitis and acute encephalitis syndrome are the communicable diseases with the highest case
fatality rates–12 percent and 8 percent, respectively. The coronavirus pandemic has brought back the much-needed focus on communicable diseases. While there is a declining trend in malaria, 842,095 cases were reported in 2017. Add to those 157,996 cases of dengue and 63,679 cases of chikungunya. The challenge is obviously enormous and requires strengthening of health systems, particularly primary health care as well as specific disease control programs. U.S.-India collaborations can considerably benefit the work to address these challenges. The collaborations should include a focus on public health education that addresses the requirements of both academicians and researchers as well as public health practice down to the frontlines. Appropriate technologies in disease surveillance and epidemiologic analyses will be important inputs. The two countries have a lot to work together. A pandemic of this scale will require global cooperation. India has opened up the export of hydroxychloroquine to the United States. The United States can support India with technologysharing on related emerging fields and discoveries. What would you say about the intensity of seasonal influenza outbreaks in India? How can citizens better respond to these? There is a much wider diagnosis of seasonal influenza in India and disease reporting systems are picking up a lot of cases, though we know that these do not represent the true burden, which is obviously higher. We do not yet have an awareness program on seasonal influenzas, and COVID-19 will surely bring that into popular discourse. Though there are no national guidelines for adult vaccination, it is increasingly being discussed in policy circles. The Association of Physicians of India has come out with expert panel guidelines, for healthy adults and high-risk individuals. How can India fight dengue and other mosquito-borne diseases? Dengue fever and other mosquito-borne diseases are endemic in most parts of the country now. These no longer remain problems of big cities, but have spread to peri-urban and rural areas. These diseases need to be tackled with human resource-intensive programs, and many local health authorities lack the resources to institutionalize robust programs. On the other hand, there are several good models available around the country. There is a lot of room for cross-learning and adapting to local contexts.
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Right: Fellows of Global Media Makers and Film Independent pair up to create a short iPhone film as part of a collaborative workshop. Below: Indian writer and director Shazia Iqbal (center) works with actors at a Directing Actors Workshop led by Brad Barnes.
t’s often said that when it comes to one’s career, it’s not just about what you know but also about who you know. This may be more true in the film industry than anywhere else. Professionals in the film industry get to, for instance, learn a lot about their craft from each other and explore opportunities for collaboration. The Global Media Makers cultural exchange program fosters this very idea. It was launched in 2016 to connect professionals in the American and international film communities. Supported through a partnership between the U.S. Department of State’s Bureau of
Courtesy Film Independent
U.S. State Department’s and Film Independent’s Global Media Makers exchange program connects Indian film professionals with U.S. experts.
Connecting
Global Media
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By CANDICE YACONO
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Educational and Cultural Affairs and the nonprofit organization Film Independent, it links international filmmakers with leading U.S. professionals who provide education on filmmaking and business, besides networking opportunities and mentorship. “To have the chance to be back in a classroom mid-career is sheer joy,” says Miriam Chandy Menacherry, an Indian filmmaker and journalist, who has directed several series and films for National Geographic Channel and BBC World. “The Global Media Makers residency in Los Angeles gave us the unique opportunity to attend master classes in all aspects of filmmaking. We learned from experts whose work we admire as well as from the other 17 fellows selected from Asia and the Middle East.” The fellowship came at a time when Menacherry was trying to find creative solutions for the documentary
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feature she had been shooting on child sex trafficking for over four years. “I was able to step back from all the issues and give it a fresh creative vision with mentors who were handpicked for my film,” she says. The Los Angeles-based Film Independent has paired more than 200 mentors with 46 fellows to date, resulting in seven produced projects. This includes Amr Salama’s “Sheikh Jackson,” which was Egypt’s official submission to the Academy Awards’ best foreign language film category in 2018. María Raquel Bozzi, Film Independent’s senior director of education and international initiatives, says that U.S. State Department officials saw a need to create a space for American filmmakers to engage in professional dialogues with mid-career filmmakers from diverse regions of the world. “Even though American films reach audiences all over the
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include a documentary about human trafficking; a Rabindranath Tagore-inspired tale set in modern-day rural India; a very lyrical, more experimental documentary about issues in the jute industry; and a family drama and love story set in South India. “I am excited about these projects,” says Bozzi “because even though they all deal with current social issues of modern-day India, they are all rooted in very personal experiences, which provide a very fresh and authentic perspective.” Each year, up to 18 fellows are chosen for a mentoring program, which begins with a six-week residency in Los Angeles, in which they get hands-on experience in the latest technology used in the film industry. “This is a very immersive communal experience for our fellows,” says Bozzi. Coming from 14 different countries, they get to share a lot about their professional backgrounds and personal stories amongst themselves and with a wide array of American mentors. “We host them in the same complex, where they get an opportunity to share their day-to-day experiences, learn about each other’s countries and filmmaking industries, and compare notes on their practices,” she adds. Bozzi says the intensive program includes an overview of the American film industry and best practices, project development, workshops and hands-on training in emerging technologies like virtual reality. “In addition, they have tailored individual mentorships with leading film professionals and filmmakers working in Los Angeles,” says Bozzi. “Although it sounds all very busy, we also make sure they get enough time and opportunities to take advantage of and enjoy all the amazing cultural opportunities L.A. has to offer.” Candice Yacono is a magazine and newspaper writer based in southern California.
Above: Global Media Makers fellow Min Bahadur Bham speaks during a showcase of the fellows’ work at Film Independent’s The New Wave, a presentation of films, conversations and performances. Above left: Editor Nancy Richardson (center) teaches a master class on editing at Film Independent. Far left: Global Media Makers fellows (from left) Christo Tomy (India), Min
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world,” says Bozzi, “our film industry, meaning the way films are made in the United States, is in a way very isolated from the rest of the world. There are not many opportunities for filmmakers to engage and collaborate creatively with other filmmakers outside of the United States.” So, a program like this seemed like a step in the right direction to begin fostering such collaborations. After working with the Arab world and Turkey from 2016 to 2018, the Global Media Makers program expanded in 2019 to include India and other South Asian countries. “I am personally very excited about all the projects we have supported from India—at the moment, six of them, by two men and four women—that cover a wide array of genres, formats, stories and regional issues, made by very diverse filmmakers from Mumbai, Hyderabad and Kerala,” says Bozzi. These
We host them in the same complex, where they get an opportunity to share their day-to-day experiences, learn about each other’s countries and filmmaking industries, and compare notes on their practice.
Bahadur Bham (Nepal), Bikas Mishra (India), Triparna Banerjee (India), Shazia Iqbal (India), Rezwan Shahriar Sumit (Bangladesh) and Sanjeewa Pushpakumara (Sri Lanka) at a writing retreat for the Screenwriting Track. Left: Filmmaker Jasmine Jaisinghani (from left), and Global Media Makers fellows Miriam Chandy Menacherry and Bikas Mishra at a welcome reception.
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