 "Fighting the 'womb lottery': Girindre Beeharry")
Girindre Beeharry begins our breakfast by answering a question I haven't asked. "People often ask us about our motive," the soft-spoken country director of the Bill & Melinda Gates Foundation says. "We face this suspicion: 'There must be some agenda. Some pharmaceutical company must be behind it.'" This sounds a little paranoid, but given the cottage industry of conspiracy theories that abound in India, not least about philanthropy on this scale because it is so rare among the country's tycoons, I can see where he is coming from.
The Mauritian-born Beeharry then explains what drives the foundation. "You shouldn't be captive to the womb lottery. Everybody has a right to a healthy productive life," he says. "Everybody should have a chance to have a life equal to a rich kid's life in Brooklyn."
Closer to home, the Gates Foundation is doing its bit to even the stacked odds against India's poor. In March this year, India was formally certified a polio-free country. Five years ago, it was home to half of the world's polio cases. Between 2009 and 2013, the foundation contributed more than $100 million to the eradication effort. Dating back to 2003, the foundation's first effort in India was directed at reducing the rates of HIV infection. Targeting six states ranging from Maharashtra to Nagaland, the prevention programme focused on sex workers, men having sex with men and drug users, as well as five million clients of prostitutes. The prevalence of HIV infection dropped from 0.41 per cent of the adult population in 2001 to 0.27 per cent today.
By this point in our breakfast at the Hyatt Regency coffee shop in New Delhi, Beeharry, who is mild-mannered and wiry thin, has taken about two bites of his multigrain toast with marmalade while I have finished half of a fluffy, perfectly prepared masala omlette. In addition to explaining what kala-azar is and why the Gates Foundation is determined to eradicate it in India while pointing to charts at a frenetic speed, Beeharry has been waving away a couple of flies that wish to feast on my eggs while I take notes.
It makes him seem like a classical Indian dancer, but for his cream-coloured linen suit. It's an incongruous scene for a five-star hotel but we are sitting close to a door that leads to the pool, which may explain the flies. By contrast, the sandfly that spreads kala-azar, which causes the belly and the spleen to expand, "loves cowdung". "It's one of those neglected 19th century diseases that no one has heard of - unless you live in Bihar," he says.
Amid the opulence of the Hyatt, the flies provide a useful backdrop for a discussion on the sleepy complacency that surrounds Indian sanitation. Despite the periodic pronouncements by the new Modi government to clean up the country by 2019 that are woefully short on details and funding, not much is being done. Earlier this year, the Gates Foundation's "reinvent the toilet" challenge led to an exhibition of submissions from IIT-Roorkee and a host of others seeking to build water-less toilets by, for instance, converting excrement into a kind of charcoal. In a blog at the time, Bill Gates quoted the figure of $54 billion that open defecation by more than half the population and other sanitation problems cost India every year. A video by the Foundation ended by quipping, "Let's get our shit together." Crude, but whoever wrote that has a point.
In the spirit of the foundation and Bill Gates himself, Beeharry is an optimist. He points to new vaccines approved by the government in the past few weeks, one of which will help fight diarrhoea. The others are vaccines for measles, Japanese encephalitis and an injectable polio vaccine. Of the diarrhoea vaccine's introduction, he says, "We will shave off a little bit of this pie." Then, he contrasts India's relatively poor distribution of oral rehydration salts and zinc to babies suffering from diarrhoea with Bangladesh. A dose costs all of Rs 15. (Earlier this week, the UNDP's Human Development Index confirmed that Nepal and Bangladesh, with per capita incomes that are about half India's, are rapidly catching up on health indicators.)
Working in Uttar Pradesh and Bihar, the Gates Foundation is also educating mothers about what to feed infants and when. This is one of the sticky problems with malnutrition in India, where children are fed solids too soon and not enough greens, for instance, and has been highlighted by the economist Abhijit Banerjee as well. "It's surprising how little people know about feeding toddlers," says Beeharry. He has by this point eaten half a slice of toast and drunk his cappuccino. Feeling gluttonous by comparison, I ask if that is enough. I am not a young mother, he replies.
What he calls "simple interventions that can prevent child mortality" are also crucial to getting the discussion on family planning going again. "India has lived for a long time in the shadow of [forced sterilisation during] the Emergency," he says with characteristic understatement. The foundation, working with the government, is pushing for greater availability of condoms, pills and IUDs, which are used by 5.2, 3.1 and 1.7 per cent of couples nationwide, and also seeking to increase the duration between children being born.
I wonder aloud about what it is like to work with the Indian central and state governments as the Gates Foundation always does. Beeharry's response mirrors comments by Bill Gates. "We see how big the problem is and how small we are," he says with apparent sincerity. It is a measure of how large the problems of health and education in places like sub-Saharan Africa and Uttar Pradesh and Bihar are that the country head of an organisation with "unrestricted net assets" of $36 billion, according to its financial statements, puts it that way. "I am sure we frustrate [non-governmental organisations] who say, 'You are doing X, we are doing X. Give us money.' We say, 'No, we can't reach 200 million people in UP that way.'" India's government may spend only 1.3 per cent of GDP on health, compared with four per cent in Sri Lanka, but it still far outspends donors. Most healthcare in rural India is in the hands of private hospitals and quacks but 90 per cent of immunisation is done by the government, he says.
It is now 9.30 a m and my tutorial in public health is almost up. He allows 10 minutes more as I segue quickly into questions about untreatable strains of tuberculosis and his career, which included a stint at the World Bank. "What I like about the foundation is the freedom to think; I don't spend my time fundraising," Beeharry says. He also likes its obsession with data. "What I just did looking at the data, I would not have done five years ago." I ask about when his ancestors left India for Mauritius and learn that his mother's side was from Uttar Pradesh and his father's side from Bihar. An intrepid traveller, this return to his roots has made him a tireless explorer of India's monuments and ruins in the two years he has lived here.
Beeharry is now standing up and I have time for one last question as he shakes hands. Doesn't the scale of India's problems depress him? He points to the recent decision to introduce new vaccines as progress even though he concedes India's government spending on healthcare is too low. Beeharry contrasts the 3.3 million children who died under the age of five in 1990 with 1.4 million currently. "When you look at the data, it's impossible to be pessimistic," Beeharry says. He has managed to eat a slice of toast, but two remain untouched. With that, he is off at a fast trot. There is much work to be done making India's rigged "womb lottery" fairer for the poor.
The Mauritian-born Beeharry then explains what drives the foundation. "You shouldn't be captive to the womb lottery. Everybody has a right to a healthy productive life," he says. "Everybody should have a chance to have a life equal to a rich kid's life in Brooklyn."
Closer to home, the Gates Foundation is doing its bit to even the stacked odds against India's poor. In March this year, India was formally certified a polio-free country. Five years ago, it was home to half of the world's polio cases. Between 2009 and 2013, the foundation contributed more than $100 million to the eradication effort. Dating back to 2003, the foundation's first effort in India was directed at reducing the rates of HIV infection. Targeting six states ranging from Maharashtra to Nagaland, the prevention programme focused on sex workers, men having sex with men and drug users, as well as five million clients of prostitutes. The prevalence of HIV infection dropped from 0.41 per cent of the adult population in 2001 to 0.27 per cent today.
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When I look back at my notes, I find Beeharry, 46, has spent little time talking about these two successes. Instead, he speaks about maternal mortality as a result of the wound where the umbilical cord is cut being treated with cow dung and oil in India's villages, and infant mortality from diarrhoea and pneumonia. He says with feeling. "How do we attack this pie?" stabbing with his finger a grim chart that enumerates the causes of death of the 1.4 million Indian children who die annually before the age of five.
By this point in our breakfast at the Hyatt Regency coffee shop in New Delhi, Beeharry, who is mild-mannered and wiry thin, has taken about two bites of his multigrain toast with marmalade while I have finished half of a fluffy, perfectly prepared masala omlette. In addition to explaining what kala-azar is and why the Gates Foundation is determined to eradicate it in India while pointing to charts at a frenetic speed, Beeharry has been waving away a couple of flies that wish to feast on my eggs while I take notes.
It makes him seem like a classical Indian dancer, but for his cream-coloured linen suit. It's an incongruous scene for a five-star hotel but we are sitting close to a door that leads to the pool, which may explain the flies. By contrast, the sandfly that spreads kala-azar, which causes the belly and the spleen to expand, "loves cowdung". "It's one of those neglected 19th century diseases that no one has heard of - unless you live in Bihar," he says.
Amid the opulence of the Hyatt, the flies provide a useful backdrop for a discussion on the sleepy complacency that surrounds Indian sanitation. Despite the periodic pronouncements by the new Modi government to clean up the country by 2019 that are woefully short on details and funding, not much is being done. Earlier this year, the Gates Foundation's "reinvent the toilet" challenge led to an exhibition of submissions from IIT-Roorkee and a host of others seeking to build water-less toilets by, for instance, converting excrement into a kind of charcoal. In a blog at the time, Bill Gates quoted the figure of $54 billion that open defecation by more than half the population and other sanitation problems cost India every year. A video by the Foundation ended by quipping, "Let's get our shit together." Crude, but whoever wrote that has a point.
In the spirit of the foundation and Bill Gates himself, Beeharry is an optimist. He points to new vaccines approved by the government in the past few weeks, one of which will help fight diarrhoea. The others are vaccines for measles, Japanese encephalitis and an injectable polio vaccine. Of the diarrhoea vaccine's introduction, he says, "We will shave off a little bit of this pie." Then, he contrasts India's relatively poor distribution of oral rehydration salts and zinc to babies suffering from diarrhoea with Bangladesh. A dose costs all of Rs 15. (Earlier this week, the UNDP's Human Development Index confirmed that Nepal and Bangladesh, with per capita incomes that are about half India's, are rapidly catching up on health indicators.)
Working in Uttar Pradesh and Bihar, the Gates Foundation is also educating mothers about what to feed infants and when. This is one of the sticky problems with malnutrition in India, where children are fed solids too soon and not enough greens, for instance, and has been highlighted by the economist Abhijit Banerjee as well. "It's surprising how little people know about feeding toddlers," says Beeharry. He has by this point eaten half a slice of toast and drunk his cappuccino. Feeling gluttonous by comparison, I ask if that is enough. I am not a young mother, he replies.
What he calls "simple interventions that can prevent child mortality" are also crucial to getting the discussion on family planning going again. "India has lived for a long time in the shadow of [forced sterilisation during] the Emergency," he says with characteristic understatement. The foundation, working with the government, is pushing for greater availability of condoms, pills and IUDs, which are used by 5.2, 3.1 and 1.7 per cent of couples nationwide, and also seeking to increase the duration between children being born.
I wonder aloud about what it is like to work with the Indian central and state governments as the Gates Foundation always does. Beeharry's response mirrors comments by Bill Gates. "We see how big the problem is and how small we are," he says with apparent sincerity. It is a measure of how large the problems of health and education in places like sub-Saharan Africa and Uttar Pradesh and Bihar are that the country head of an organisation with "unrestricted net assets" of $36 billion, according to its financial statements, puts it that way. "I am sure we frustrate [non-governmental organisations] who say, 'You are doing X, we are doing X. Give us money.' We say, 'No, we can't reach 200 million people in UP that way.'" India's government may spend only 1.3 per cent of GDP on health, compared with four per cent in Sri Lanka, but it still far outspends donors. Most healthcare in rural India is in the hands of private hospitals and quacks but 90 per cent of immunisation is done by the government, he says.
It is now 9.30 a m and my tutorial in public health is almost up. He allows 10 minutes more as I segue quickly into questions about untreatable strains of tuberculosis and his career, which included a stint at the World Bank. "What I like about the foundation is the freedom to think; I don't spend my time fundraising," Beeharry says. He also likes its obsession with data. "What I just did looking at the data, I would not have done five years ago." I ask about when his ancestors left India for Mauritius and learn that his mother's side was from Uttar Pradesh and his father's side from Bihar. An intrepid traveller, this return to his roots has made him a tireless explorer of India's monuments and ruins in the two years he has lived here.
Beeharry is now standing up and I have time for one last question as he shakes hands. Doesn't the scale of India's problems depress him? He points to the recent decision to introduce new vaccines as progress even though he concedes India's government spending on healthcare is too low. Beeharry contrasts the 3.3 million children who died under the age of five in 1990 with 1.4 million currently. "When you look at the data, it's impossible to be pessimistic," Beeharry says. He has managed to eat a slice of toast, but two remain untouched. With that, he is off at a fast trot. There is much work to be done making India's rigged "womb lottery" fairer for the poor.