Friday, February 27, 2009

The story of numbers

One of India’s greatest contributions to the world is the number system that everyone uses today. What the world knows today as Arabic numerals are really Indian numerals – including the controversial Zero. In the first millennium AD, they traveled from the Indian subcontinent westward to Baghdad, where the mathematician Musa Al Khwarizmi – who also initiated the field of algebra (al jabr) – wrote a treatise on them. At the time, Europe was using the cumbersome Roman numeral system. Watch this playful video that describes this history; watch how Indians used zeroes and ones to create stupendously large numbers.

(I should mention also that ancient Mexico also had its own sophisticated number system, and this system also included zero. Their inventions however are not always acknowledged in the history of mathematics - partly because history is not just Eurocentric, it is "Old-World centric".)

Video via Atanu. Also: An earlier post on the same topic; and the mysterious Ishango Bone of Africa.

Tuesday, February 24, 2009

My class and the US healthcare system

I am teaching a class this semester focused on the use of quantitative methods to improve the delivery of healthcare. Such things as: How can patients get faster access to medical appointments with their primary care doctors? What are the dynamics of supply and demand? How can emergency room operations be improved? Can medical practices be reorganized and if so how much improvement will it bring?

I like what I am teaching, but I don't want students to get bogged down just analyzing models and crunching numbers. I'd like them to know the big picture as well -- especially what's going on currently in the US healthcare system, how it compares to other countries. I want to bring social aspects into consideration. Some may say this borders on activism and should be avoided in a class meant for engineers. But are engineers not supposed to work for the greater good?

Anyway, in my second class, I screened this documentary -- available free online. Sick Around the World compares the health systems of developed countries -- Britain, Japan, Germany, Taiwan, Switzerland -- and reveals the glaring flaws in the US healthcare system. As to how those flaws should be fixed -- well, that's too difficult a question. Recently, an academic whose research is on improving healthcare in developing countries said to me: "You can improve and make things better in poorer countries. But the US health care system - well, I don't think that is going to change."

Three key shortcomings emerge from the documentary. In the countries listed above 1) No one with a pre-existing condition is denied insurance 2) Everyone is covered one way or another 3) Pricing mechanisms are transparent and nobody goes bankrupt because of medical bills. Are these basic things too much to ask in the United States?

And last week, I had students read and discuss this essay by Malcolm Gladwell in The New Yorker. The essay is a few years old now, but the the issues raised are still relevant. Gladwell asks the question: Why doesn't the US have universal healthcare coverage? He posits that US policy-makers fear moral hazard, the idea that people may overuse the healthcare system if they have insurance. But is moral hazard really an issue in healthcare? Would you really increase the number of times you visit the hospital if you had better insurance?

Gladwell begins the essay with an intense description of tooth decay, a seemingly peripheral condition. But as he shows, those without insurance often ignore their teeth - with no health insurance, a dentist's visit is too expensive. Their teeth rot as a result. Their social skills plummet as they become increasingly conscious of the decay.
People without health insurance have bad teeth because, if you're paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn't, of course. The loss of teeth makes eating fresh fruits and vegetables difficult, and a diet heavy in soft, processed foods exacerbates more serious health problems, like diabetes. The pain of tooth decay leads many people to use alcohol as a salve. And those struggling to get ahead in the job market quickly find that the unsightliness of bad teeth, and the self-consciousness that results, can become a major barrier. If your teeth are bad, you're not going to get a job as a receptionist, say, or a cashier. You're going to be put in the back somewhere, far from the public eye.
Bad teeth, thus, become an "outward marker of caste" -- the caste of the uninsured. Disturbing stuff. Go read the full essay.

Saturday, February 21, 2009

Conversations in cabs

I get along extremely well with cab drivers. I can hardly remember a ride without an enriching conversation. Many drivers in the major cities of the United States are immigrants; most I met were from Africa. In Washington DC there is a fifty percent chance your driver will be Ethiopian. My discussions have always been political: I ask about how things are going in this or that country; we then talk about India. Invariably, the drivers tell me about Indian acquaintances in their respective home countries – Indians settled as teachers, doctors, professionals. I also use these conversations to test my still-evolving notions about Africa.

Let me present here two vignettes. These two don’t follow the trajectory I’ve described above -- well at least not entirely -- but they are the ones that stand out in my mind.


I met Steven in 2007, in a small suburban town in Maryland. Steven was from Ghana; his demeanor was hurried and his tone aggressive. But this turned out be just an external manifestation, a habit. Steven was friendly and eager to talk. Like many other drivers I've met, he was well traveled. He had even been to India: he had visited Calcutta in the late eighties, remarkably, to participate in an international ping-pong tournament, and had been impressed. What had he found striking?

“Well, you guys have your own cars, and you have your own transportation systems. I could tell you were well on your way to becoming a superpower.”

I wasn’t surprised with the superpower part – that was a common refrain in the Western media as well. I was surprised because Steven’s conclusions were based on an India glimpsed before the country’s economic liberalization. The cars he was referring to were hulky Ambassadors, and the transportation system, Calcutta’s trams. Many Indians lament the period before the economic reforms of the 90s, when growth in India was sluggish and stifled by bureaucracy.

Steven, in contrast, had been impressed by the achievements of the Indian state. Admittedly, he could not have learned much from one short visit. But perhaps Steven looked at it that way because African states, with a few exceptions, provide little for their people. I told him I thought Ghana was doing well. He did not think so. “There are no jobs,” he said unhappily, with something approaching rage. “What do you do when you have no work?” He wasn’t convinced that other parts of Africa were doing well either. “People say South Africa is doing well. But it’s just the white people, a small minority. For the blacks, it’s the same story.”

Steven wasn't the only one with such cynicism. The same sentiments constantly resurfaced in almost all my conversations. There was frustration and helplessness over the divisive, ethnic nature of politics in Africa. What I’ve heard from Africans only provides anecdotal evidence that supports a well-known fact: that Africa’s nations – whose borders were decided rather arbitrarily in European capitals in the 19th century and not on any templates from African history – are not nations fully yet.


In Atlanta earlier this week, I rode with a driver whose accent suggested he might be African-American. But I was mistaken. Paul was from Jamaica. And since the Caribbean is full of people of Indian origin, it wasn’t surprising that Paul had several close Indian acquaintances; his own half-brothers were half-Indian. To top it off, Paul, like me, loved cricket. As we headed towards Midtown Atlanta, we were bogged down by the morning traffic. But I didn't mind at all: we had plenty to talk about.

I called Paul again in the evening for a ride back to my hotel, but he was busy, and instead sent someone else. This time, it was a middle-aged man, Olivier Kone, from Côte d'Ivoire. It felt like a relay: one interesting cabbie was passing me to another. I had never met anyone from Côte d'Ivoire before. But I did remember VS Naipaul’s long travel essay about the country, The Crocodiles of Yamoussoukro. Yamoussoukro is the capital of Côte d'Ivoire – rather it was made into a political center by the country’s first leader, Félix Houphouët-Boigny. In the 1960s and 70s the country was booming: exports in cocoa and coffee fed the economy. Naipaul, writing at the time of the boom, had presciently stated it would all collapse. He saw an excessive reliance on French expertise. The country unraveled in the 1990s after the death of Houphouët-Boigny; I am not fully cognizant of the reasons, but ethnicity – Africa’s bane – played a role here as well.

I discussed all this with Olivier. As we approached my hotel, he asked what I had seen in Atlanta. I told him I’d been too busy. I'd been considering the Coca Cola Center -- which many recommended -- but I was much more interested in the Martin Luther King Center on Auburn Avenue in downtown Atlanta. Atlanta had been King’s home and is where he is buried. The Ebenezer Baptist church, where King and his father had pastored, is also in the neighborhood.

“What’s there to see in the Coca Cola center man? They charge you $25 to see a beverage! Go see King’s place. It's free; and it’s a special place. In fact call me tomorrow morning; I’ll take you there and drive you back to the airport. I won’t charge you for the time you spend watching the exhibits.”

We agreed on a time and set out together the next morning. The Atlanta skyline was ahead of us as we took the interstate. When we got to the center, Olivier took off the Taxi sign from the roof of the cab and accompanied me -- he wasn't a cabbie for this visit. The King Center comprised of about three buildings, all with drab exteriors. That was disappointing: I expected the place to be grander; it was, after all, commemorating one of America's greatest leaders. The emptiness on Auburn Avenue that morning only added to the seeming insignificance of the place. The interior was better and consisted mostly of black and white pictures from the 1950s and 60s and sound clips of King’s rousing speeches.

Olivier was keen to show me the large, dark-brown statue of a walking Gandhi – a gift from India – outside one of the buildings. He led me also to a room dedicated to Gandhi; there were pictures of King visiting India in 1959 -- one picture showed him shaking hands with Lal Bahadur Shastri. King was born in 1929, sixty years after Gandhi. Gandhi’s non-violent struggle against the British had inspired King; but King’s achievement, in my opinion, surmounts Gandhi’s. The legacy of slavery and segregation is far more humiliating than of colonialism. It is also harder to fight against: the struggle is as much in the mind of the oppressed as against the policies of the oppressors.

It was time for me to get to the airport. As Olivier and I walked back to the cab, it struck me that ours was a special visit. We were certainly an unusual pair: he was from Côte d'Ivoire; I was from India. We hardly knew each other and yet it did not feel that way. Olivier is black and the struggle for civil rights no doubt resonates strongly with him. I was aware business was one reason why he had suggested I call him in the morning. But there was also earnestness: Olivier genuinely wanted to show me the place, especially the Gandhi statue and exhibits. He wanted to take pictures for me and was disappointed I did not have a camera.

And to think that it was all chance. Had Paul, the Jamaican cab-driver, not sent Olivier, I would have never met him. And but for Olivier’s insistence the previous night that I visit the King Center and his offer to take me there, I would have never gone.

But then itineraries do change unexpectedly -- I am glad mine did.

Friday, February 13, 2009

Nigeriatown in China, like Chinatown in Nigeria

Perhaps globalization's most visible symbol is the ubiquity of Chinese products everywhere in the world. China in Africa is an especially big story these days. But what you might not have heard is the growing presence of African immigrants - many of them Nigerians - in Guangzhou, China. Take a look.

Thursday, February 12, 2009

Let's kindle reading passions

How? With this product that will allow both the structured reading of books and unsystematic browsing. I am sold.

Friday, February 06, 2009

Ramble on! And pictures from Mexico

I've been overwhelmed with work. The downside of being an academic in the US, especially if you are in engineering or the sciences and at a research university, is the relentless emphasis on getting grant money -- from federal sources such as the National Science Foundation, the National Institutes of Health (if you work in healthcare). And grants carry even more weight as universities struggle with budget cuts in the current economic situation.

There are positive things about the process: once you get a grant, students get funded, research happens, new discoveries are made. But boy, is the process sapping! And grant writing is strange also because the content is largely triumphant and runs roughshod over skepticism. No one will give money unless you sound completely sure. The best writing, though, comes from intense introspection: great literature is all about doubt and fallibility.

I have couple of deadlines coming in a week. Which is why this space has been idle so far this month. I expect this to be a slow month for blogging. But since this might be one of the few chances I may have to write in the coming days, let me keep typing - or rambling.

I've written only a couple of essays about my Mexico trip; I had been planning to do a whole lot more. It may still happen but here are some pictures meanwhile, with some narrative. Please make sure you click on the pictures - you'll get a much better view.

1. I took this picture during the southern approach to Mexico City. The Valley of Mexico is a high valley - Mexico City sits in it at 7000 feet. And all around are mountains, some of them volcanic. When Cortes met Montezuma in Mexico City (then called Tenochtitlan) on Nov 8th, 1519, one of them could be seen in eruption. Let's imagine, then, that the mountain you see below was the one Cortes saw.

2. This one I took before the final approach to Mexico City. The sprawl of Mexico City is partially captured here. The city and its immediate surroundings are home to about 20 million people, like Bombay.

Let's do a thought experiment. Imagine for a moment that the plane was approaching Mexico City on Nov 8, 1519, at the same moment that the Spanish conquistador Cortes had that historic meeting with the Mexica ruler, Montezuma. What would we have seen? First of all, the valley would have been filled with lakes, almost none of which exist today. Secondly, in the middle of one such lake, would be a city that would keep you spellbound. Pyramids, towers, markets, long arrow-straight causeways, neatly swept streets, stunning botanical gardens, canoes flitting in the lake like butterflies, and hundreds of thousands of people.

What a sight that would have been!

3. The Spanish destroyed the lake city, and built Mexico City on top of the Aztec capital. The lakes were drained. The debris from Aztec monuments and buildings was used in the construction of churches. Curiously enough in Mexico, the surviving great monuments are from a much older time. Like this one below, the Pyramid of the Sun (part of Teotihuacan), dated to around 500 CE (no connection to the Aztecs). It is the third largest pyramid in the world. The largest pyramid in the world is - are you ready? - also in Mexico, in Cholula, Puebla. It is not, as you might have thought, the Giza pyramid.

The little figures you see crawling atop the pyramid are people (like I said before, click for a better view). In Mexico, tourists fall upon ancient ruins as an army of ants upon tasty crumbs. Most tourists are Europeans. They are generally fascinated by the ancient cultures of Mexico. This is really an extension of the European reaction to the splendors of the Americas when they were "discovered". Most cultures place themselves at the center of the world (China, for example, is The Middle Kingdom);the Europeans were no different . They were bewildered upon encountering the civilizations of the Americas. How could it be that others had independently figured out the nuances of architecture, astronomy and mathematics? This disbelief mixes with a horrified fascination for the brutality of pre-Columbian cultures of Mexico: many of them practiced ritual sacrifices.

Yes, human sacrifice is a bad thing, and the Spanish were right in being shocked. But how many heretics did Spain burn at the stake during its inquisitions?