Indiana University
  IU School of Journalism
Indiana University School of Journalism alumnus Andrew Prinsen, BAJ '07, is reporting from India as part of his Ross Hazeltine Traveling Scholarship, a $7,000 grant to report on global issues outside North America.

The grit

Andrew Prinsen | Sept. 4, 2007
The boy pulls himself along the train’s aisle on his hands, his good leg propelling him as his limp one drags behind, his bare feet sliding silently along the vinyl floor. He uses a small broom, stiff, bristly reeds lashed together, to poke under the seats, fetching a surprising amount of dirt and trash. Old ticket stubs and empty betel nut wrappers, plastered with a thin film of grease and dirt, are pulled from the locomotive’s crevices and added to the growing pile that is pushed along in front of his thin frame. And then I wonder if his leg really is limp or if his gesture, the humbling act of lowering himself to the floor, is simply a way of lowering his own status in the society of the train’s compartment, putting people more at ease and more willing to pay him a rupee since he is doing the job "his people were meant to do."

I lean my head back against my part of the bench seat right next to the bars in the window. You always hear trains approaching from the other direction about 10 seconds before they’re on you, their moaning whistles sounding so far away at first and then deafening as the column of air they have been pushing meets your face like a hot, ending slap. The force of both trains moving towards each other uncomfortably pops your ears and leaves you with a ringing like someone unloaded a 12 gauge right next to your head.

We depart the train in the early morning at a small, mostly lifeless station. I make my way over to the restroom which is "pay to use" as are most public facilities. The woman sitting outside collecting money holds out her hand before I enter and I fish a crumpled five rupee bill out of my pocket. She gives me back three rupee coins and I stand with my hand still out, waiting for one more. She looks down at my hand, then back up at my face before holding up one bony finger in question form. I nod my head, realizing she’s asking the American equivalent of "you’re going number one, then?" It’s odd for me, as I’m not much accustomed to explaining the plans for my restroom visits to old women, but this is normal here and she presses the remaining rupee into my palm, satisfied that I will not be using two rupees worth of toilet services.

And that’s the funny thing about India. I’ve heard before that it is a place of contradictions, and I’m finding that in some respects to be very true. It’s a place where marriages are arranged and if someone has an attraction or, heaven forbid, a boyfriend or girlfriend, it’s something you simply don’t speak of. There are no billboards or advertisements showing women wearing anything less than the standard sari. But it’s also a place where other basics of human nature that are more repressed in the West are laid brutally out in the open. It’s perfectly normal, for example, to be walking to dinner in the center of town and pass a few men on the way taking a leak on a wall.

The other night, I was sitting in a restaurant and there happened to be a scale sitting next to my table, the kind you might be used to seeing in dirty Chevron station bathrooms back home. But this one was right there in the middle of the place, between my table and another where a family of four was happily chomping on their dosa and curry. And then suddenly a woman in her late 20s had hopped onto the machine and plunked a coin into the slot before yelling the results to her husband across the room. I couldn’t imagine something like this happening at home and still don’t really know what to think about it.

Any time we’re in a larger city there will be people sprawled out on any free piece of concrete, filthy and exhausted beyond belief, at least they must be to sleep as soundly as they do with their limbs hanging out onto the blacktop, just inches from traffic. For me it all just seems so vivid or gritty, textured, real. And it’s not that we don’t have humanity like this where I come from. We do, but it gets hidden somehow. In India that humanity is accentuated. Here, the humanity is in your face.
This is an image made of the view from our hotel’s small balcony in Nagpur.
Two things in one here: an example of India’s sketchy bootleg electric wiring, and
also, if you look closely, you can see a man sleeping in a doorway
down below. Apparently the spot was available.

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Aid India

Andrew Prinsen | Aug. 30, 2007
I just wanted to make a quick post to mention something I hope you’ll be interested in. As most of you probably know, I just graduated from college and am, in fact, here in India on a grant provided by donors to the Indiana University School of Journalism. My friend Tim is here with me, providing encouragement and keeping me company almost as much as he keeps me laughing. The grant has provided enough money so that Tim can stay for two months and I will stay for four (if we continue to be wise about our expenses). As you’ve also likely gathered, the goal here is to travel around and write about this place, specifically about some forgotten people in India like leprosy patients.

But I’ll be the first to admit that it’s really hard to come to a place like this, a "developing country" like India (which is just a nicer way of saying there are a whole lot of really poor people), and not want to try to do something more to help. Don’t get me wrong here, I believe in journalism and in the power it has to change people’s minds and hearts for the better simply by telling them the truth of what’s happening. But I also believe in helping people directly, redistributing some of the wealth that we in "The West" have been so fortunate to have received.

So we started a little project, less than a half drop of water into a deep lake, really, but something we think is really neat, none the less. We’re calling it "Aid India." It’s a way for people back home like yourselves to get involved, to directly give to people we meet here who are in need. We’re effectively cutting out the middle man, putting opportunities up online that you can see and decide to (or not to) give towards. It’s been such an exciting thing for us, being able to get people we know (and people we’ve only met through their generosity) involved in what’s going on here in India. We understand we’re not shaking the world here, but we also know that drops cause ripples, and ripples can turn into waves.
So check it out at that link and take some time to realize that you can easily be the direct benefactor in making someone’s life a little bit better. As always, thanks for reading. And thank you so much more for caring.


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The new kind of treatment

Andrew Prinsen | Aug. 28, 2007
Of course sandals are still the footwear of choice. It may be advanced science and pioneering research in its field, but it’s still India.

"Change your footwear please," says Hema, a sweet 20-something woman in a sari who presides over the research lab while she finishes up her Ph.D.

I look down at the shoe rack and see a few pairs of smallish-looking, white women’s flip flops. I look back at Hema’s unwavering smile before I realize she’s serious and kick off my size 13s. I wedge my foot into the flip flop and feel like one of Cinderella’s evil step sisters with the entirety of my heel still hanging off the shoe’s back as we continue into the lab. We step into the only air-conditioned area in the facility and it’s extra cold since the organism m. leprae, the bacteria that causes leprosy, needs a cooler environment to grow, which also explains why it chooses to locate itself in the skin of a person’s body.
The facility is called Karigiri and was founded in 1955 as a research branch of the Christian Medical College (CMC) hospital, its bigger, better-financed sister in the heart of Vellore. Karigiri’s founders wanted it to be placed right next to CMC but the town would have none of it, knowing that they were planning to treat "the lepers." So instead the government gave them 250 acres of worthless scrubland 20 km outside of town, four km from the nearest existing road. The name "Karigiri" in Tamil means "elephant mountain," named after the foothill that lies beside the entrance road, a foothill that everyone but me can see looks just like an elephant.

The facility at Kairgiri has pioneered several important accomplishments for leprosy and its treatment. They came up with its multi-drug therapy (MDT) treatment, a cocktail of three drugs (rifampicin, clofazimine and dapsone) that were finally able to completely kill the bacteria within a person, rendering them cured, with a surprisingly high success rate. They were also the first to learn they could grow the bacteria on the footpads of mice, an essential discovery towards being able to test different strains since m. leprae will not grow in a petri dish and the only other animal susceptible to it, the armadillo, doesn’t live in India.
Karigiri also invented micro-cellular rubber (MCR), which they use to make shoes for leprosy patients. You see, patients often do not have any sensitivity in their feet due to severe nerve damage and can begin to walk in awkward ways because of it, putting so much pressure on only one part of their foot that it becomes damaged and ulcerated. The special rubber ensures that the weight is distributed evenly across the entire sole and lowers the chance of damage.

Another thing the hospital and its satellite campus, the Paul Brand Integrated Health Center, has changed about the treatment of leprosy is the segregation that was previously implicit. The facilities treat not just leprosy cases, but everything from toothaches to arthritis to diabetes. This has worked towards helping push the stigma out the door because Karigiri provides health care for so much less than the CMC or government-run facilities that the lower and middle class people, those without the benefit of a more advanced education and therefore with more reason to be afraid of leprosy, are consistently coming to receive treatment alongside those with leprosy. The downside of the integration, though (which has now been mandated by the national government) is that field teams are no longer sent out to look for leprosy cases and treat them in their own homes. This leads to later detection times and, therefore, more advanced nerve damage.

Up the stairs on one end of the Paul Brand Center, they are dealing with a whole other aspect of pain the disease inflicts. There is the psychology and psychiatry department, a place where patients go to be helped in dealing with the emotionally damaging aspect of their condition.

"The stigma of leprosy is still deep rooted," says Augustine Valsa, a friendly, frizzy-haired lady who remembers my name and reminds me of psychologists the world over.

The first step towards helping a patient, she says, is working on their own self-esteem, convincing them that this disease is not something they deserve or are being punished with by any god, but rather that it is just like any other bacterial infection. Interestingly enough, the words "bacteria" and "germ" don’t even translate well into Tamil. The closest word there is and thus the way that most people come to understand it, is "insect." Many of them recall insect bites they have had and believe that this must have been the cause of their condition.

"Most of the patients go first to a local healer who uses herbs on them. And herbs do have their place in medicine and can be somewhat effective, but not effective enough to battle leprosy," Valsa says. "They often don’t come to us until they already have severe nerve damage."

This nerve damage is something that the doctors at Karigiri are also, in certain cases, able to help. Dr. Ebenezer Mannam, who spends much of his days hearing complaints of aches and pains from old, overworked women, spends his Thursdays doing surgical tendon transfers. This is a $500 procedure (this includes the cost of the three week inpatient physical therapy recovery process) that turns the useless, clawed hands caused by nerve damage into again useful, almost normally functioning parts. A procedure like this can really turn a patient’s life around, says Mannam, making them again able care for themselves and, if they can find a caring enough soul, find employment.

A man shows his bandaged fingers after undergoing
tendon replacement surgery at Karigiri Hospital.

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The difference

Andrew Prinsen | Aug. 24, 2007

The following are descriptions of three different places. They are all places I was able to visit where people who have had leprosy are living. I believe that you will find, as I have, that there are some startling differences … despite what most would see as their all-important similarity.

. . .

They don’t actually open the gate. A chain stays wrapped through some openings in the metal near the top with a padlock passed through two of its rungs, leaving enough slack for the sections to be pulled wide enough apart to squeeze in and out through. Kasinath arrives and we help him pull his bicycle through the opening, banging and scratching the already-chipped blue paint off the gate. Today I barely recognized him as he rode up, dapper with his hair slicked to the side, wearing a light burgundy button-up shirt. He’s been to pay the electric bill, he tells us, a short trip to the edge of town, but worth dressing up for none the less. It helps to appear more professional when you’re representing the place he does.

Michella sits on her rope bed as we pass with her feet flat on the cement floor of her porch where the bed sits. She’s always there, on that bed. Her long, thin hair is interwoven with strings of grey but her eyes speak her age much more loudly. They’re sad, tired. She musters a namaste, lifting her hands to her head in respect as I pass, but the warm greeting makes me feel somehow guilty and patronized, knowing this front of energy is only for my benefit.

We begin to work, ripping out the weeds and grass in front of a small house where guests used to stay so that it can now be used for extra planting. Lallan and Ramdular are there helping us as we sweat despite Ramdular’s bad back and aching knees. Over my shoulder I hear some of the local boys climb onto the stone wall 20 feet away. It doesn’t take knowing the Hindi they’re speaking to know that they’re jeering the old men, for mocking transcends language. Their low, exaggeratedly-crazed voices describe what they must feel about these men that have shown us nothing but warmth and decency. Do they really feel this way? Children, those who we say are pure and blameless? What have we taught them and why have we taught them to hate?

The buildings here were once majestic, lined in the front by romanesque columns and white marble. The concrete and marble are crumbling now, though, and even the statue at the front, a bust of the colony’s founder, has stains creeping down from his finely-sculpted hair. Fourteen people here now, in this place built for over 100. It’s a good thing, I suppose, for less people means less segregation, less exclusion. It’s quiet as we leave, though I suppose it’s always quiet. I wonder if it’s like this everywhere, or if there are perhaps places less forgotten?

. . .

We’re now on a bridge, crossing over a branch of the Ganges River, people everywhere contributing to what I’ve come to know as the sound of India, and intrusive and constant noise, air horns on every truck that have been supercharged in order to fit into the country’s driver safety policy of "honk first, check your mirrors never." The driver suddenly dodges off the road onto a dirt path more jarring than the three-wheeled vehicle likes to handle. It’s not more than 15 seconds and I’m looking down a row of tightly-packed dwellings, single rooms, really. The central walkway is dirt and smoke floats throughout the dirty gathering as some begin to heat charcoal to cook the night’s meal. The blare of televisions can be heard through open windows, a sound that seems somehow out of place when I consider the primitiveness of my surroundings.

"There was a festival today," my guide says, "so they spent a long time there, for their jobs." I absentmindedly stare in the direction of two wooden carts sitting near a stone ledge. The smiling man sitting near them takes this as an opportunity to demonstrate and hops in, hollering at his friend to push him along. He stretches out his deformed hands, first to the right and then to the left in further demonstration, pandering to an unseen crowd.

The old man has been feeling sick today and was lying under a blanket when we arrived with just his feet poking out from the bottom. But now he sits up to tell me about this place that he founded in 1972 when so many of them needed a place to live. He tells me about their current situation, that the government will give each patient no more than 150 rupees ($3.75 USD) a month, clearly not enough to live on these days. And of course they cannot find "real jobs," no one would dream of hiring people with their sickness, their impurity. And so what choice do they have but to go out every day and put themselves in a place where they can be seen and, hopefully, pitied?

There is another option, my guide later tells me. Any of these people would be accepted at the aging colony just eight kilometers up the road in Sarnath. There they would get food, clothing and a place to live. What they would not get, however, is "cash money," as he puts it, to spend as they please. There would be no television sets or betelnut (the local tobacco product) because the committee sees these items as superfluous, as luxuries. And luxury is not something the committee has made itself in the habit of providing.

And so the question stands for each as such. Live simply, while provided for, in a world somewhat forgotten, or keep oneself in the center of it all and eke out a daily living with the palms of your outstretched hands? Is this all? Are these where the choices stop? Or could there be something more?

. . .

The knock at our door comes early. It always seems to come early. I pull on my unwashed pants and fumble with my belt as I make my way towards the door. I swing it open to see Maddaum there, a goofy smile on his face as he tells the blinking, shirtless foreigner. "Breakfast, ten minutes." He turns on his heel and walks away, a slight limp as he favors his left leg, holding his withered left arm up against his side. At breakfast we eat in silence despite the fact that a five man crew is working around us, dodging in and out of the kitchen. One man finishes dishing me out some curry with eggs and then turns to leave before I remember to ask for a bottle of water. "Excuse me, sir," I say to the man who is not yet five feet from me. He doesn’t turn to respond and I realize that I have again forgotten that the man who has served my breakfast, the whole kitchen crew, in fact, is deaf.

We have come to Anandwan upon learning of its amazing programs and treatment of leprosy patients and the disabled. They are not only provided with a home, food and clothing, but also with jobs that they work for "pocket money," which they are free to do with whatever they please. The place houses a textile center, greeting card production facility and even an area where they shred down old plastic bottles into a fine enough consistency that they use it to stuff mattresses which they then sell to hotels. Another program was started a while back that brings kids off the street, giving them the opportunity to live at Anandwan for a year where they work and learn a trade like metalworking so that when they return to their cities they have a skill that they can market.

Before we leave I make my way down to the accounting office to settle for our room and board costs. A distinguished gentleman with a grey moustache tells me the bill and then takes the money I hand him. As I’m walking out of the office, I glance back and see him pull out his ledger and begin to flip through it. It’s not until then that I notice his nubbed fingers, a reminder of the disease that had once stricken him, flipping through the pages expertly.

The following slideshow are images from Anandwan:

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Where mud and cell phones meet

Andrew Prinsen | Aug. 19, 2007
Water rises slowly in the Sarnath market, trickling in branched rivulets to slowly fill slices of track cut by thin rickshaw wheels. Shortly after it has begun, the rain is folded haphazardly into the dirt and manure left by slowly trudging bulls as they pull their heavy loads behind them. The mixture creates a deeply colored, foul sludge that quickly falls into place lining the creases between my toes. And yet the rickshaws continue to pounce through the mess, buried at times up to their axles in the muck. People crowd under the awnings of their store fronts while the less fortunate, like the women sitting cross-legged on the side of the road as they rotate their ears of corn over charcoal fires, simply pull their shawls a bit lower.

Yet we are happy for the rain for with it comes an end to the draught that has been hanging here with the eastern border of Uttar Pradesh. The rain brings an end to the nagging worries of barren fields come harvest time in December. I’ve only been here a week, and yet I know that it’s great that we now have the rain and the harvest and the the happiness and what not, but in the mean time half of the vendors’ marketing area is turning to sludge and my feet are still covered in bull crap.

I found this late afternoon trudge to the market to be strangely symbolic of the irony that surrounds village life here in India, that being a rejoicing in the same things that end up hurting us. Take, for example, the general store in little Sarnath where we have been staying. It’s a small storefront, just two counters really, that sells soap, toilet paper, single-use packets of laundry detergent and shampoo, and some assorted chips and biscuit cookies. Stacked next to these basic items, however, are about 12 to 15 different models of cell phones with every option from cameras to Internet capability that you would find gracing the display cases of the Verizon kiosk at your local mall. One thing I quickly realized is that most everyone owns one, too. From the slim university student practicing his English on me at the bus stop to the old and whiskered food peddler badgering me to buy things from his cart that couldn’t possibly qualify as the kind of "safe food" I am encouraged to stick with in my travel guide, you never know when that jingle will begin and someone will have to take a call.

High-tech cellular telephones in a country where the average income is still less than a dollar per day, in a place where it’s likely that its owner is still sleeping every night with nothing more than a blanket between him and the concrete floor, if he’s fortunate enough to have concrete, that is. You can hardly blame people for this, of course. Technology is attractive and I will be the first to admit that I, myself, am slightly infatuated with certain brands and advancements. Why should these people be any less excited about it? There are people in India, however, who can very much afford cell phones. In a city south of here called Bangalore, lattes flow freely as young businessmen and women gather for a post-work brew at the local Starbucks or for a treat at the downtown Baskin Robbins. It is said that being in upscale Bangalore is virtually indistinguishable from being on a Manhattan street corner. Bangalore is the technology center of India, the kind of place that houses the incomes which jack up the national average to its still-meager perch.

It seems to me that the obsession with technology like cellphones in these smaller, more modest villages is simply the runoff from more developed places like Bangalore, or perhaps a desire to ride along side the West that they know from movies and episodes of Friends. To me, it seems like these villages are like a child trying to walk around in his father’s oversized shoes. As soon as he begins to run, the shoes cause him to fall on his face. As India rejoices in these new conveniences, it seems to forget about its more basic needs, finding a way to dispose of it trash that sits in heaps on the side of the road, perhaps. Or how about establishing the kind of social infrastructure that would create a way for all its children to receive at least a basic education, the only hope if India wants to begin pecking away at its inexcusable illiteracy rate (just 61 percent, or near a half billion people not being able to read or write by age 15), the figure is even worse for women only.

On the way back to our guest house the rain had stopped, giving me a chance to lift my eyes and consider the landscape. The fields already seemed more alive, the shower having settled their previously dusty state and the sprouts of okra had perked back up to attention. This all pleased me somewhat more than I would have guessed, getting this taste of greenery when I had become so accustomed to bland, dry browns. And so I rode along on the rickshaw with a smile on my face, forgetting almost completely for that sweet moment about the crap stuck between my toes.

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Welcome to reality

Andrew Prinsen | Aug. 12, 2007
There is a place in the heart of Delhi where the sun sets early, casting its orange glow across walls of crumbling brick and mortar. Tim and I sat on a ledge near the steps that led up to our rooftop dwelling, a tiny, stifling room with a stiff bed and plastic bags taping up leaks in the ceiling. It wasn’t comfortable, but that didn’t matter as the effects of jet lag and dehydration are constant friends in aiding our sleep. But before we fell into our reverie, we sat there on that ledge just looking, looking at the men who had been working on the rooftop across from us hanging their clothes to dry in the monkey-frequented trees that stretched their branched fingers skyward. Everything I had thought about India was, at that moment, entirely true. I had pictured the urban sprawl and the grandiose colonial-era architecture falling apart for lack of means by which to upkeep it. It felt like a movie scene and I felt then like the main character. But when you realize that these things haven’t been put there for you and the fulfillment of your imagination, that it’s not some sort of tourist attraction but rather everyday life for the people around you, you suddenly feel very small and slightly overwhelmed.
I arrived in India about two days ago with my traveling companion, Tim. We’re on a journey to better understand this place and specifically to learn more about an often overlooked and ostracized group of people, those inflicted with an ancient disease known most commonly worldwide as leprosy. Leprosy is a disease that is most likely spread through microorganisms in the air. However, the disease is much less contagious than previously believed. In fact, around 95 percent of the world’s population hold a natural immunity to the the disease. Another common misconception, even among the educated West, is that leprosy is incurable. In fact, it is very curable using an astonishingly effective three or four antibiotic cocktail, in the worst cases a process that takes no longer than 12 months. India has been effectively treating leprosy in this way since the early 1980s, seeing the country’s 4 million cases drop to below epedemic rate (less than one case per 10,000 population) at the end of 2005. Of course, in a country of over 1.1 billion people, just under one in 10,000 can add up. The country currently has about 83,000 cases of the disease under treatment, but a figure that may surprise is that there are still about 113,000 new cases being detected every year. This is due to the fact that leprosy can have an incubation period of up to 10 years. Therefore, it’s not so much that new people are getting the disease as much as it is that people who were previously infected are finally beginning to show symptoms of the disease, which begins with reddish patches of skin that have lost sensitivity.
A couple of days ago in Delhi, I spoke with Dr. Indranath Banerjee, the World Health Organization’s (W.H.O.) National Professional Officer on leprosy and neglected tropical diseases in India. He gave me much of the disease’s history in India and the steps that the Indian government as well as the W.H.O. and foreign aid agencies have taken to correct it. He is a small, genial man who obviously holds a true affection for his work and the progress the programs have made in bringing the rates of the disease down. During the interview, I asked him what the biggest battles are that India currently faces in dealing with leprosy. He said the biggest problem is still the stigma surrounding the disease. He said that leprosy, largely due to stories found in the Indian epics, has always been seen as a sort of divine punishment or retribution for ones sins. This created an out-casting of the lepers from normal society. He said that while today the general population has become more accepting of those inflicted with the disease as more trust is being put in science (the disease is harmless to others once under treatment), there are still 60 to 70,000 people living on the fringes of society, in separate groups often known as "colonies."
Tim and I have since traveled to a town called Sarnath, which is a part of a larger city known as Varanasi. Over the next few days, we will be able to visit a couple of these colonies in order to learn more about these people and how they are living in our present age.

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