ots Everyday technology Carbon Silicon cing Mobile Television Internet Jugaad oftware Medicine Engineering education dian Institutes of Technology Typefaces wing machines Bicycles Food technology Merit Caste The Technological Indian Television Online streaming Outsourcing Robots Engineering education Software Jugaad Indian Institutes of Technology Food technology Sewing machines Pixels
SOUTH ASIA Harvard South Asia Institute
Cover and interior design by Marissa Giambrone
southasiainstitute.harvard.edu 1730 Cambridge Street, Fourth Floor Cambridge, Massachusetts 02138 United States of America Authors featured in this publication reserve all rights to their essays.
Technology and South Asia
Harvard South Asia Institute Cambridge, Massachusetts 2015
CONTENTS From the Director 2
Part 1: Techne Everyday Technology in South Asia David Arnold 9
Soldiers of Lead, Denizens of Pixels Vaibhav Singh 13
The Piquant Taste of Technology Vikas Khanna 17
The Evolution of Mobile Technology in Bangladesh Kamal Quadir 29
Disease Control and Mobile Technology in South Asia Caroline Buckee 33
The Art of Medicine and the Science of Technology Paul Salins 37
mHealth in Pakistan Ali Habib 43
Watching, Streaming, and Other Things to Do with TV Nalin Mehta 47
Part 2: -Logy From Technological India to Technological Indian Ross Bassett 59
Engineering for Non-Engineers Nitin Nohria 63
From Carbon to Silicon Rohan Narayana Murty 67
The Renaissance Engineer Venkatesh Narayanamurti 73
Trouble in the World’s Back Office Sudhir Chella Rajan 77
Merit and Caste in Indian Engineering Ajantha Subramanian 83
Technology for the Poor Tarun Khanna 89
Coda “The Dacca Gauzes,” by Agha Shahid Ali 92
Anil’s Ghost (excerpt), by Michael Ondaatje 93
Courtesy of vinay g
FROM THE DIRECTOR
The evolution of technology in South Asia has been a complex one and has met with resistance, but today we primarily think of technology in the region in two ways: first, that South Asians are gradually taking on leadership positions at global technological giants like Apple, Microsoft, and Google; and, second, that South Asia sits as a hotbed for the rapid proliferation of, and market for, electronic technology. The last twenty years have seen unprecedented technological developments in various sectors such as communication and information, manufacturing, transportation, defense, and space exploration. This publication, Technology & South Asia, invites the reader to think of technology within the context of its cultural, sociological, and political fields of application in South Asia. The Harvard South Asia Institute has a longstanding commitment to connect the Harvard community with professionals working in South Asia and to cultivate cross-regional collaboration. This volume introduces a wide variety of issues addressed by professionals from diverse disciplines, ranging from the scholarly to the everyday to the culinary, expanding our very understanding of the term technology. Within these pages, an anthropologist spotlights the reconstitution of caste and privilege within modern technological institutions in India. The CEO of Interactive Health Solutions, Pakistan, identifies the real challenges to mobile health initiatives in the country as the more competitive commercial ventures that draw programmers away from mHealth. A medical director and vice president of one of Indiaâ€™s most modern cancer centers refers to medicine as an â€œuncertain art,â€? emphasizing the need for technology-enabled health care that elevates human sensitivity. A Bangladeshi-American entrepreneur and artist details how the mobile handset has become one of the most democratizing 2 Technology and South Asia
tools in Bangladesh. A young scholar traces the history of typography, one of South Asian technology’s most complicated developments and historically the subject of much controversy. And a historian details how the technologies that produced modern South Asia were as simple as the bicycle, the typewriter, and the rice pounder (dhenki). In the concluding essay, I posit a simple question that has been a principal focus of mine for the past two decades: why are the poor generally underserved by technology? This publication also includes three interviews with professionals from diverse backgrounds: Venkatesh Narayanamurti, the physicist and educator credited with revitalizing the engineering and applied sciences programs at Harvard, discusses his educational foundation in India and his vision for producing renaissance engineers; Vikas Khanna, award-winning Michelin-starred chef, restaurateur, and cookbook writer, reveals food technologies South Asia has contributed to the world of flavor and cuisine; and Nitin Nohria, dean of Harvard Business School, identifies the long-term benefits of an engineering education for a non-engineer. These interviews allow us to think of technology in the context of South Asia in more expansive and unconventional ways. In the coda, we go beyond our analysis of technology in South Asia to the literary, and revisit some creative reflections on technology. The late Kashmiri poet Agha Shahid Ali recalls a technology combining human labor and love that was violently excised from the region by design; and an extract from a novel by Sri Lankan author Michael Ondaatje showcases the moment when everyday tools—paint brushes, chisels, scaffolding—are used to bring an extraordinary statue of the Buddha to life. We hope this volume not only sheds light on technological innovation, proliferation, and pedagogy, but also charts new directions for thinking about how technological progress shapes humanity. As always, we invite you to engage actively with the essays that follow in these pages. Please feel free to take notes in the blank pages provided for your thoughts. Share the digital book with your friends and colleagues. Regards,
Tarun Khanna Jorge Paulo Lemann Professor, Harvard Business School Director, Harvard South Asia Institute
Harvard South Asia Institute 3
CONTRIBUTORS David Arnold is emeritus professor of South Asian history at the University of Warwick. Ross Bassett is associate professor of history at North Carolina State University. His new book, The Technological Indian, is forthcoming from Harvard University Press. Caroline Buckee is assistant professor of epidemiology and associate director of the Center for Communicable Disease Dynamics at the Harvard T. H. Chan School of Public Health. Ali Habib is CEO of Interactive Health Solutions, a sister company to Interactive Research and Development, in Karachi. Tarun Khanna is director of the Harvard South Asia Institute and the Jorge Paulo Lemann Professor at Harvard Business School. Vikas Khanna is an award-winning Michelin-starred chef and restaurateur. Nalin Mehta is an Indian writer and social historian. He is founding co-editor of the South Asian History and Culture journal and the Routledge South Asian History and Culture book series. Rohan Narayana Murty received his PhD in computer science from Harvard University and is currently junior fellow in the Society of Fellows at Harvard. He is the founder of the Murty Classical Library of India.
4 Technology and South Asia
CONTRIBUTORS Venkatesh Narayanamurti is director of the Science, Technology and Public Policy Program at the Harvard Kennedy Schoolâ€™s Belfer Center for Science and International Affairs. He is the Benjamin Peirce Research Professor of Technology and Public Policy and a professor of physics at Harvard University. Nitin Nohria is dean of Harvard Business School and the George F. Baker Professor of Administration. Kamal Quadir is the CEO of bKash, a leading mobile financial service, and the founder CellBazaar, a mobile-based marketplace. Sudhir Chella Rajan is professor in the Department of Humanities and Social Sciences at Indian Institute of Technologyâ€“Madras. Paul Salins is medical director of the Narayana Cancer Hospital and Mazumdar-Shaw Cancer Research Center in Bangalore. Sharmila Sen is executive editor-at-large at Harvard University Press. Vaibhav Singh is a type designer and Felix scholar at the Department of Typography and Graphic Communication, University of Reading, UK. Ajantha Subramanian is professor of anthropology and South Asian studies at Harvard University.
Harvard South Asia Institute 5
6 Technology and South Asia
Techne The ancient Greek word techne first appeared in the English language in the late nineteenth century. Drawing from its origins in Greek philosophy, the word is generally defined as an art, skill, or craft; a technique, principle, or method by which something is achieved or created.
Harvard South Asia Institute 7
Courtesy of Shahnawaz Sid.
8 Technology and South Asia
Everyday Technology in South Asia David Arnold
Technologies do not need to be large—and expensive—in order to make an impact. Although scholars conventionally focus on heftier technologies, like the railroads, steamships, and telegraphs that helped transform the economy and society of colonial South Asia, many other transformative technologies were much smaller in scale, less imposing in appearance, and yet, cumulatively, far-reaching in consequence. Take the humble bicycle. Bicycles were brought to South Asia in substantial numbers in the early twentieth century: by the late 1930s, 150,000 a year were in India, and a decade later over 250,000. Millions are now in use. In colonial times bicycles were adopted by Europeans and middle-class Indians but also, increasingly, by working men to ride to work or to carry goods home and to market. Bicycles became people carriers—with passengers perched on the carrier or riding on the crossbar. Bicycles brought a new animation to cities, contributing to the confusion of traffic, their bells adding to the rich cacophony of street sounds. Bicycles helped open up the countryside, making villages barely connected by road far more accessible, and allowing children to travel further for school. But bicycles were not gender-neutral: they might be fit for girls to ride but their use by adult women met with disfavor—and still does in South Asia. Bicycles fostered small-scale entrepreneurship—cycle-hire shops sprang up in towns and villages; cycle repairmen plied their trade on sidewalks and at roadsides. Policemen took to bicycles, but so too did flag-waving, slogan-shouting protestors. Although early machines were imported (most came from Britain), India began to make its own cycle parts and accessories—saddles, bells, carriers—and, from the 1940s, started manufacturing the full bicycle at a lower cost than imported machines, helping to strengthen India’s Harvard South Asia Institute 9
economic autarky. The bicycle provided a basis for technological adaptation, like the cycle rickshaws that have become so familiar a sight on the city streets of India, Pakistan, and Bangladesh. Carts attached to bicycle frames became an invaluable mode to transport small goods, and were well suited for narrow lanes and congested streets. Even discarded bicycle parts found uses, with cycle wheels reused to make spinning wheels. Bicycles have been vernacularized—“cycle” has become an Indian word, and bicycles appear in novels, short stories, and movies as a regular, perhaps unremarkable, feature of South Asian life. If among Buddhists and Hindus the cycle’s “double chakra” suggests an inherent auspiciousness, the machine has long been a part, too, of advertising culture: painted images of bicycles in profile adorn village huts and roadside houses to promote their sale. Their foreign origins almost forgotten, some makes still bear oddly exotic names like “Hercules” and “Atlas.” Gandhi may have been censorious—who needed a bicycle when they could walk?—but for most South Asians the bicycle has been a boon. Bicycles exemplify everyday technology. Their everydayness resides in their highly visible familiarity, diverse practical uses, economic utility, social instrumentality, and cultural assimilation. But bicycles are by no means the only examples of everyday technology, either historically or contemporarily. Sewing machines first became popularized at about the same time as bicycles, and are indicative of an earlier phase of technological globalization and capitalist penetration when sales in South Asia were led by American Singers as well as by German and British makes. Sewing machines rapidly entered European households, but were also adopted as both practical and prestigious goods in many Indian homes. Among middle-class families they became dowry goods and among the first machines women were permitted to use, if only because they kept them employed within the home, away from factory and office. Sewing machines demanded new skills from the traditional tailor, the darzi, but, though manufacturers provided English or vernacular manuals with their machines or gave evening classes for novices, like many other everyday machines their use could be learned by watching and imitating. Illiteracy was no bar to technological dissemination. Tailors with sewing machines—these days, women as well as men—have become a familiar sight, even in small towns and villages. Rice mills were another basic—though not always beneficial—technology that spread rapidly, supplanting the traditional hand- or food-operated rice pounder (the dhenki) and transforming food practices much as sewing machines revolutionized the making of clothes, and bicycles everyday mobility and transportation. Like the whir of the sewing machine, the rumble of the rice mill has come to fill the air of many a city street and village lane. Women’s domestic labor—pounding and cleaning enough rice for a family’s daily needs could take hours of arduous activity—has been replaced with a trip to the nearest rice mill. It has encouraged the spread of polished white rice. Diet, like 10 Technology and South Asia
dress, has felt the impact of the machine, but not always in ways beneficial to health since rice, when polished, loses much of its vitamin value. Again, critics might protest that rice milling deprived women of remunerative work. Some (mostly men) claimed that hand-pounding rice kept women fit and made it easier for them to bear children. But, once installed in a neighborhood, the all-too-convenient machine was unlikely to be ousted. Not every kind of everyday technology was so readily domesticated or widely spread. The typewriter is a prime example of a more selective technology. Typewriters—Remingtons and Underwoods—were among the many machines imported from the United States from the 1880s onward. They began primarily as office machines, but even there they created new opportunities for women as typists and secretaries or allowed upwardly mobile communities to enter the once-exclusive ranks of the bureaucracy. By the 1930s typing schools had sprung up across South Asia, providing new work opportunities in government service, education, trade, and industry. Typewriters and typists moved out of the office and onto city streets, their services in demand outside post offices, law courts, and government buildings to type letters, affidavits, and petitions. They, too, became part of street culture and pavement enterprise. Technologically superseded, the battered old typewriter may now almost have vanished, but the keyboard skills it propagated carried over into the computer age. Everyday technologies—assimilated, exploited, reinvented—have helped develop South Asia and continue to permeate the region and grow its future.
Harvard South Asia Institute 11
Front page of the Hindi newspaper Vishwamitra, April 21, 1950: headlines in handset metal type. Left: Text set on monotype (hot metal). Extreme right: Text set on Linotype (hot metal).
Soldiers of Lead, Denizens of Pixels Vaibhav Singh
Toward the end of October 1934, the Indian National Congress was to hold its annual meeting in Bombay. Finding this an excellent opportunity for a trial run, the local offices of the Linotype Company, a manufacturer of typesetting machinery, sought permission from the meeting’s arrangement committee to exhibit the Devanagari Linotype machine at the venue. The machine, then just over a year old, had newly arrived from New York where it had been developed in one of the earliest attempts to compose Indian-language texts mechanically. Though the technology had existed since the late nineteenth century elsewhere, it was the cutting edge of modern machinery for Indian type and typography in the 1930s, complete with a Devanagari keyboard for text input. As it turned out, the Indian National Congress committee in keeping with its ideological position, refused to grant permission for the exhibition of the Devanagari machine at its venue on the grounds that it was a “foreign invention.” However, with “an admirable carelessness for logic,” the committee permitted its manager to have the machine installed outside of the venue for the printing of English and Hindi material officially required for the meeting. As exemplified in this ambivalent response, the question of technology—even when “foreign”—was a negotiable concern within the rhetoric of nationalism, but also had interest in its utilitarian benefits. In an anticlimactic turn of events, however, after all the arrangements had been made, the sole Devanagari keyboard operator in the employ of the company—sent from Calcutta to Bombay for this purpose—could not, owing to his slow typing speed, compose the texts on the machine within the available time. Thus, the work was ultimately completed by about fifty compositors at a local press using the age-old method of hand-setting: putting little pieces of metal together manually and collectively. Harvard South Asia Institute 13
The history of Indian script typography is replete with anecdotes such as this, rich and multilayered in subtext: from confrontations between the conventional and the novel to the swadeshi and the foreign. Most remarkably, these stories demonstrate how discussions about practical use and adaptation of new technologies are often missing from South Asian discourse about its technological past and future. Engagement with technology has been and continues to be all too readily situated within a framework of mythologized futurism, where the newest is automatically considered the best and most significant. This notion of progress not only denies the fertile interaction and long-term coexistence of multiple technologies, but also posits an essentialist view of technology devoid of alternatives and contextual relevance. The creative and collaborative processes used to adapt and acculturate technology to diverse environments and wider use are largely unacknowledged and underappreciated. Technological developments in India have consistently challenged long-accepted notions, especially in the field of type making and typography, as it highlights the absurdity of evaluating the march of technology outside of the context of its use. In the early years of hand-set type, the famed South Asian “resistance to print” was really rejection to a technology seen as limited in meaningful engagement with production. The dominant paradigm of technological progress that has tended to overshadow parallel technologies and histories is particularly untenable in the world of Indian typography, where textual practices and technologies of different eras have continued to function side by side. This has not been so because the latest technological developments take longer to reach the more remote outposts of progress, but for the simple reason that new technologies in their culturally unadapted form have often failed to offer contextually relevant improvements over existing practices. The small number of technological triumphs in type making and typography are certainly less instructive than the numerous, vastly more interesting failures. From the beginning, printing with metal type—a technology initially devised for alphabetic systems where a comparatively small number of letters line up neatly next to one another—did not prove to be an adequate solution for representing the numerous scripts of India in printed form. The syllabic writing systems of the subcontinent demanded a more flexible technology, able to handle the requirements of a large set and different formation of characters. Interestingly, the concurrent and technically more successful practice of lithography did not find great support—especially in state-owned printing establishments—perhaps because it ascribed the local artisan a critical mediating role in the process, in contrast to the rote and replaceable industrial worker, which typography could accommodate. The broad anti-technology stance of the early twentieth-century nationalist movement does not come as a surprise in this light as the power structure within which technology had long operated could easily be equated with state control, foreign domination, and oppression. 14 Technology and South Asia
Subsequent developments in mechanical typesetting in the twentieth century magnified the constraints on how printed text could be rendered: this time by restricting the number of characters that could be used for text composition. Writing practices and the technologies that serve them are in various forms interactive, evolving systems, mutually affecting their own direction and usage. Left with a keyboard that afforded only a limited number of keys (usually ninety or so) to compose text in scripts otherwise requiring several hundred to a thousand metal pieces for various characters, many writing systems were “simplified” to enable technological adaptations. Typewriters for Indian scripts carried these transformations further and brought such technological limitations to the everyday, the personal. Now, digital technologies facilitate the typographic rendering of many writing systems with fewer technical handicaps than ever before. However, this is accompanied by another universalizing, and increasingly technocratic, discourse that determines what form type and typography in various scripts can take. Once again, new technologies advance dominant typographies as the blueprint for all typographic cultures, including those identified as “less-advanced.” The question to be asked is this: Does today’s technology conflate equality with homogeneity? From handmade marks to inked pieces of metal to strings of code, it is not difficult to see how textual communication often revolves around the development of specific tools and technologies. All these technologies have, one way or another, served to facilitate or expand their possibilities—whether by supporting new forms of expression or enabling greater access to written matter—but they have also imparted their own peculiarities and limitations to the shaping of various writing systems and their present-day typographic incarnations. Setting technology within the context of its use—culturally, socioeconomically, politically—and pushing past its innovation-oriented mythology, is essential to confront and change how technology governs, empowers, and restricts the diversity of typographic practices.
Harvard South Asia Institute 15
16 Technology and South Asia
Photo courtesy of Vikas Khanna
The Piquant Taste of Technology Vikas Khanna
The Indian subcontinent has contributed to some of the most important food technologies that have changed global palates, ecologies, and economies. Refining sugar from cane, for example, was first recorded in history on the subcontinent. When Alexander the Great’s military campaign reached the edges of the Mauryan Empire, the Hellenistic world was yet unaccustomed to refined sugar—a commodity that would change the world economy in the modern period and help usher in an era of globalization and massive movements (forced and voluntary) of labor. Vikas Khanna’s Michelin-starred restaurant Junoon is the talk of New York. He has cooked for heads of states, hosted MasterChef India, and is the author of many acclaimed cookbooks. In this conversation between Chef Khanna and Sharmila Sen, we learn about humble food technologies of South Asia—found in small towns and villages—that continue to inspire a world-class chef. What is one of your favorite food-related technologies from South Asia? Flattening of rice—rice is first soaked and then flattened with a special mortar and pestle—in Maharashtra. I recently spent some time exploring this age-old technology for flattening rice in India. Is there a particular food technology that you think Indian chefs should use or learn about more from other cuisines and cultures? Indian food itself is very rich in flavors but it can be a challenge to plate it. To stimulate their own creative plating, Indian chefs could benefit from observing the plating techniques of other ethnic cuisines. Is there a particular food technology specific to South Asia that you think is in danger of being lost and should be revived? While traveling you learn that the roots of Indian cuisine are in small Harvard South Asia Institute 17
towns where the masalas (spices and spice mixes) are ground by hand. Doing so results in an amazing texture and the intermingling with other flavors that were previously ground using the same tools—this texture and flavor is unmatched when the grinding is done in a coffee grinder or spice grinder. Please share a couple of your favorite recipes that use a traditional Indian food technology or technique. The traditional Indian technique of infusion—where hot oils are infused with flavors from whole spices and ingredients—is key to many of my recipes. Here I am sharing with you some recipes from my new book Indian Harvest.
Baby Asparagus with Star Anise and Sour Cream
The luscious and velvety sour cream lends a wonderful contrast of textures to the crispy asparagus and onions. You can also use hung yogurt instead of sour cream for similar results. Thick or thin asparagus is a preference. Thin asparagus has a tender, crisp center, and a bold earthiness. They cook quickly. They don’t need to be peeled, unlike the thick variety. SERVES 4 8 ounces thin baby asparagus 2 tablespoons vegetable oil 3 to 4 whole star anise 1 cup sour cream Salt to taste 1 tablespoon butter Freshly ground black pepper to taste 1 medium red onion, thinly sliced In a medium pot of boiling water, add asparagus and cook for 2 to 3 minutes. Drain and keep warm. In a medium saucepan, heat the oil on medium heat and gently add the star anise. Cook, stirring until very fragrant, about 2 to 3 minutes. Add the sour cream, salt, butter, and pepper and cook gently until mixture is warm. Add the asparagus and onions and serve immediately.
18 Technology and South Asia
Cold Vegetable Soup with Yogurt and Cilantro
A refreshingly cool soup that tastes best when tomatoes are ripe and full of natural sweetness, with jalapeño adding a hint of spiciness. Substituting Greek yogurt for regular yogurt adds velvety creaminess and a lovely tangy flavor. This soup could be made up to two days in advance and makes a great beverage for serving at summer parties. SERVES 4 TO 6 1 medium yellow pepper 1 small red onion 2 tablespoons vegetable oil 3 cloves garlic, coarsely chopped 2 pounds ripe tomatoes, seeded and coarsely chopped 1 jalapeño chili, seeded Salt to taste 1⁄4 cup plain low-fat yogurt 1⁄3 cup sour cream 4 teaspoons fresh cilantro Coarsely chop the yellow pepper and onion. In a heavy-bottom skillet, heat the oil on medium heat. Add the garlic, yellow peppers, red onion, tomatoes, jalapeño, and salt. Cook, stirring occasionally, until the mixture becomes dry and very aromatic, about 4 to 5 minutes. Remove from the heat and let cool at room temperature. Transfer the mixture to a blender or food processor with knife blade attached. Add the yogurt and process until smooth. Pour the puree into a bowl, cover, and refrigerate until well chilled, at least 6 hours or overnight. In a small bowl, combine the sour cream and salt. Cover and refrigerate. To serve, top soup with sour cream and garnish with the cilantro.
Harvard South Asia Institute 19
Crumbled Cheese with Peaches and Pecans
Peaches bring out a subtle sweetness of the crumbled cheese, while the bitterness of the arugula complements the sweet and sour tamarind dressing. I like to lightly toast the pecans before adding them to the salad since that intensifies the flavor of the nuts and makes them the perfect crunchy topping for salads. SERVES 4 1 quart whole milk 4 tablespoons lemon juice 3 peaches, pitted and sliced 1 small bunch arugula, trimmed 1â „4 cup pecans, lightly toasted Salt to taste 2 tablespoons tamarind paste 1 tablespoon sugar 1 teaspoon cumin seeds, roasted 1 lime, cut into thin wedges Bring the milk to a boil, then turn off the heat to bring the temperature down to about 175Â°F. Add 1 tablespoon of lemon juice at a time, stirring after every addition until the milk separates. Allow the curds to cool, and then strain the mixture through a cheese cloth. Rinse the curds with fresh water and squeeze to remove the moisture. Transfer the curds to a large mixing bowl. Add the peaches, arugula, pecans, salt, tamarind, sugar, and cumin seeds and gently toss to evenly coat the ingredients. Serve chilled or at room temperature, garnished with the lime wedges.
20 Technology and South Asia
Lotus Root Silky Kofta
A symbol of beauty and purity since ancient times, most parts of the lotus flower are edible—the flowers, seeds, leaves, and the rhizome. The lotus root has a beautiful lacelike design with tiny holes. It is valued in the culinary world for its mild flavor and crunchy texture. Even in this kofta, lotus root adds a rich meaty texture and taste, added in a creamy sauce flavored with cardamom, cinnamon, and fennel. SERVES 4 1 pound tender lotus root, washed and peeled 1⁄4 cup gram flour Salt to taste 2 green chilies such as serrano or Thai, finely chopped 1⁄2 teaspoon grated fresh ginger, chopped 2 tablespoons finely chopped fresh cilantro leaves Vegetable oil for frying, plus 2 tablespoons 1 tablespoon chili powder 2 red onions, finely sliced 2 cardamom pods, lightly crushed One 1-inch cinnamon stick 1 teaspoon fennel seeds 1 cup heavy cream Cut a 3-inch piece of lotus root into roundels, about 1⁄8-inch thick, and finely grate the remaining lotus root. In a mixing bowl, combine the gram flour, grated lotus root, salt, chilies, ginger, and 1 tablespoon cilantro, and knead to a smooth mixture. Add a little water if required. Make 10 to 12 small round balls. Heat the oil to 350°F and deep-fry the balls in batches until golden. Remove them with a slotted spoon and drain the excess oil onto a paper towel. In the same oil, fry the lotus root roundels until golden brown. Remove with a slotted spoon and drain the excess oil onto the paper towel. Reserve for garnish. Heat 2 tablespoons oil over medium heat. Remove from heat and add chili powder. Reserve for garnish. In a medium pot, boil the onions, cardamom, cinnamon, and fennel seeds with 3 cups of water on high heat until the water reduces to half and the mixture becomes thick. Remove from the heat and let it cool at room temperature. Transfer to a blender and process to a smooth paste. Now shift the mixture to a saucepan and bring to a boil on medium heat. Add the cream, season with salt, and gently simmer. Transfer the sauce to a serving dish and arrange the lotus balls over it. Drizzle with chili oil and serve garnished with lotus root chips and cilantro. Harvard South Asia Institute 21
Roasted Eggplant and Basil Pilaf
Tossing the smoky, caramelized eggplant into a rice pilaf is an interesting way to bring variation to a regular vegetable pilaf. Balsamic vinegar adds a deep tanginess, which complements the natural flavors of the eggplant. The roasting can be done in advance for convenience. Basil is added right toward the end of the cooking to retain maximum flavor and aroma. SERVES 4 1 large eggplant, cut into 1-inch cubes 2 tablespoons olive oil 1 tablespoon balsamic vinegar 1⁄2 teaspoon dried oregano 1⁄2 teaspoon red chili flakes Salt to taste Freshly ground black pepper to taste 1 cup basmati or any long grain rice, washed and drained 1⁄3 cup fresh basil leaves Preheat oven to 300°F. In a mixing bowl, combine the eggplant with 1 tablespoon of the olive oil, balsamic vinegar, oregano, chili flakes, salt, and pepper. Toss well and spread out on a baking tray lined with foil. Roast in the preheated oven for 10 to 12 minutes. When done, remove from the oven and set aside. Meanwhile, combine rice with 3 cups of water and salt in a saucepan and boil over medium-high heat until the rice is tender but retains a bite, about 15 minutes. Drain the rice when done. Heat the remaining olive oil in a large frying pan, add the roasted eggplant and boiled rice, and toss well. Add the basil, toss well, and serve hot.
22 Technology and South Asia
Jala Bread with Carom Seeds
This recipe is inspired by the popular Malaysian street snack—Roti Jala. Carom seeds add a sharp, pungent flavor to these crispy lacy breads. Adding buttermilk to the dough helps make them more light and fluffy. How fine and thin these crepes turn out depends upon the smoothness of the batter which should be as lump-free as possible. SERVES 6 1 cup all-purpose flour 1 teaspoon carom seeds, finely crushed Salt to taste 1 teaspoon sugar 1⁄2 teaspoon turmeric 1⁄2 teaspoon chili powder About 1 cup buttermilk 3 tablespoons vegetable oil In a large mixing bowl, combine the flour, carom seeds, salt, sugar, turmeric, and chili powder, and mix well. Add the buttermilk, a little at a time, stirring constantly until smooth, resembling the consistency of pancake batter. Fill a squeeze bottle with the batter. Heat oil in a frying pan over medium-high heat. Drizzle the batter onto the hot pan, making a lacy pattern. Cook until golden brown, about 2 to 3 minutes on each side. Once the bread is cooked, slide it out of the pan onto a serving dish. Repeat the process with the remaining batter.
Harvard South Asia Institute 23
Creamy Black-Eyed Beans with Roasted Garlic
Any variety of canned white beans can be used for this recipe. However, I like using blackeyed beans, for their delicate flavor and creamy texture. Seasoning with the rich flavor of garlic infuses the beans with its mellow, sweet, caramelized flavor and aroma. SERVES 4 TO 6 2 tablespoons coconut or vegetable oil 1 teaspoon mustard seeds 1 teaspoon cumin seeds 5 cloves garlic, sliced 3 shallots, thinly sliced 2 cans (15.5 ounces) black-eyed peas, rinsed, drained, and patted dry Salt to taste 4 tablespoons chopped fresh cilantro 1 small red pepper, coarsely sliced 1â „2 cup heavy cream Freshly ground black pepper to taste 3 to 4 chives, finely chopped Heat the oil in a large saucepan over medium heat. Add the mustard seeds and cumin and cook until they begin to crackle, about 1 minute. Be careful, as they could spatter hot oil. Add the garlic, shallots, and 1 tablespoon of water, if required, to prevent the spices from burning. Cook until fragrant, about 2 minutes. Add the black-eyed peas, 1â „2 cup of water, salt, cilantro, and red pepper and bring to a boil. Add the cream and black pepper and continue to cook for the desired consistency. Serve hot, garnished with chives.
24 Technology and South Asia
Star Fruit and Ginger Pickle
The firm texture and tangy flavor of tropical star fruit makes it perfect for pickles. Usually vegetables are sun-dried while making pickles. However, here they are cooked on the stove top to speed up the preparation. It is additionally flavored with spicy ginger and aromaticc asafetida and the earthy flavors of sesame oil. MAKES ABOUT 1 CUP 1 teaspoon fenugreek seeds 2 tablespoons sesame seed oil 1â „2 teaspoon asafetida 2 teaspoons mustard seeds 1â „2 teaspoon ground turmeric 4 teaspoons chili powder One 5-inch fresh ginger, peeled and sliced 4 to 6 star fruits, sliced Salt to taste 3 tablespoons sugar Dry roast the fenugreek seeds on medium-low heat in a small pan until darker in color. Cool and grind to a powder. Heat oil in a medium pan over medium heat and add the asafetida and mustard seeds. When the mustard crackles, add the remaining ingredients and cook for a few minutes, stirring until flavors are well blended. Serve hot or at room temperature.
Harvard South Asia Institute 25
Persimmon-Vanilla Cobbler Cobbler is one of my favorite desserts, easy to make with so many fruit combinations. In this recipe, the tangy sweet delicate flavor of persimmons is enhanced by rich smooth vanilla and topped with buttery crispy pastry—a comforting end to a perfect meal. SERVES 4 TO 6 8 persimmons, trimmed and cut into wedges 1 teaspoon vanilla extract 1⁄2 cup brown sugar 1 1/4 cups plus 2 tablespoons all-purpose flour 6 tablespoons cold unsalted butter, cut into pieces 1 teaspoon baking powder 1 tablespoon cornstarch 1⁄4 cup thinly slivered skinless almonds Pinch of salt Heat oven to 350°F. In a bowl, toss the persimmons with the vanilla extract, 1⁄4 cup of brown sugar, and 2 tablespoons of flour. Transfer to a medium baking dish. Combine the remaining flour and 1⁄4 cup brown sugar with the butter, baking powder, cornstarch, almonds, and salt, using your fingers to form coarse crumbs. Evenly cover the persimmon layers with the mixture without pressing it. Place the baking dish on a rimmed baking sheet and bake until golden brown and bubbly, 50 to 60 minutes. Serve hot with vanilla ice cream.
26 Technology and South Asia
Mango and Mint Cooler
As the days become longer, and we enter the summer, for me the greatest joy is entering the season of green mangoes. Green mangoes are used in a variety of recipes, such as curries, pickles, and cooling drinks like these. MAKES ABOUT 4 CUPS 1 medium green mango 1 teaspoon cumin seeds, roasted 1 teaspoon black salt 3 tablespoons honey, or to taste 1 teaspoon chaat masala 3 tablespoons sugar, or to taste 1 tablespoon finely chopped mint leaves 2 lime wedges Bring 3 cups of water to a boil on high heat. Add the mango, reduce the heat to low, and simmer until the mango is tender, about 10 to 15 minutes. Remove the mango from the water and set aside to cool. Then peel and remove all the flesh, using a sharp knife and a spoon. Reserve the pulp. Place the mango pulp, cumin seeds, black salt, honey, and chaat masala powder into a blender and process until smooth. Add 3 cups of water to the mango mixture, cover, and refrigerate until chilled. Spread the sugar and mint leaves on a plate. Moisten the rim of a glass with a lime wedge. Turn the glass upside down and dip it into the mixture of sugar and mint to evenly cover the rim. Gently pour the mango drink into the glass over ice and serve.
Harvard South Asia Institute 27
28 Technology and South Asia Photo courtesy of Kamal Quadir
The Evolution of Mobile Technology in Bangladesh Kamal Quadir
Every country has competitive advantages, and Bangladesh has its fair share. While the country has fertile, flat land that yields four crops a year and keeps its citizens productive year-round, its 160 million people live in an area only as large as Wisconsin. Capitalizing on its flat land and large population, Bangladesh has boomed with mobile technology since the late 1990s. In the early days a favorable government policy also contributed to its development, and wireless service came free of charge. Mobile technology spread its roots across Bangladesh with a drive to improve the countryâ€™s socioeconomic conditions. Most significantly, mobile technology reached the indigenous, as the pervasiveness of the program allowed for bottom-up proliferation. In the first decade of the millennium, Bangladesh was one of the fastest-growing mobile-penetrated countries. By 2014 over 67 million people were using more than one hundred million mobiles; this amounted to 99% coverage across the country, far surpassing those rates of its neighboring countries. The mobile handset has become one of the most democratizing tools in human history. Efficient and cost-effective, it provides universal access and higher-level communication. Mobile technology has led to advancement in every way. It empowers people; it has had profound effects on the underprivileged, lower castes, and even the adivasi, who previously had no such tool. When such progress is multiplied by hundreds of millions, the impact of this new efficiency becomes astronomical. But the impact surpasses communication. Todayâ€™s $15 phone has more processing power than the computer NASA used in 1969 to send a man to the moon. Phones are powerful machines; each has a screen, a keyboard, a battery, and is wireless by default. A poor person with a phone, then, can communicate just as well Harvard South Asia Institute 29
as a relatively wealthy person can with a computer. Therefore, there are 100 million NASA computers in Bangladesh resting in the hands of millions of common people, and that opens up many new possibilities. Applications that go beyond providing voice connectivityâ€”services that support other human needs around market information, finance, heath care, and educationâ€”are opening new opportunities. For instance, in absence of easy access to conventional banking facilities, a mobile-based financial service connects a user-owned handset to the server of the financial service provider. While online banking is similar to ATM services, where a user accesses the bankâ€™s server through an ATM and manages cash through withdrawal or deposit services, a nationwide distribution of ATMs is difficult in such a developing country, where investment is limited and mobile phones instead allow such services at low cost. Thus, mobile phones are an effective alternative to ATMs. In effect, a mobile phone becomes a mobile wallet that provides a safe, convenient method for storing money and an easy way to make payments and transfer money. As less than 10% of Bangladeshis have encountered any formal banking facility, online banking has dramatically expanded access to formal financial services. According to Bangladesh Central Bank, more than thirty million mobile wallets have been registered by October 2015. While the most common use of mobile financial services has been to send money home to support family laboring as migrant workers, the value proposition is more far-reaching. Online banking is increasingly used as a reliable payment medium; anyone can transfer funds and pay for goods and services with just the click of a button. Instead of traveling great distances to pay a supplier, traders provide funds efficiently, parents pay off school fees, and fishermen sell fish online. The poor no longer have to hoard money under mattresses; they can store their money safely through an online account. But the challenge remains to spread awareness that they too can participate. Every mobile banking transaction generates a multiplier effect of the value. In this way common people, not just big businesses, participate in generating a massive pool of resources and participate in a nation-building effort. There is nothing new about individuals contributing to a large collective resource. What is new is that mobile technology allows the underprivileged, with $15 handsets, to partake in nation building. Though the result of network access depends on several stakeholders, the mobile network provider itself is responsible for supplying universal access; thus, the network provider has the advantage of authority over other service providers or enablers. For example, Bangladesh had an engaged Central Bank that ensured financial services were effectively under its surveillance. The Central Bank had developed effective guidelines and roles for different stakeholders: mobile users own their own handsets, mobile network operators provide connectivity for fees, and financial institutions offer 30 Technology and South Asia
compliant services. Such active engagement had provided order and control over the ways mobile payment initiatives could be directed and developed. Other mobile endeavors, like mobile moneyâ€”exchanged within the spheres of agriculture, health care, and educationâ€”will have their own challenges. But, like the other mobile initiatives that have already ignited development in the region, they will ultimately bring enormous benefit to Bangladesh.
Harvard South Asia Institute 31
32 Technology and South Asia
Courtesy of Asian Development Bank
Disease Control and Mobile Technology in South Asia Caroline Buckee
The continuing burden of infectious diseases, as well as the increasing potential for the emergence and epidemic spread of devastating new pathogens, remains an urgent threat to South Asia. Three twenty-first-century phenomena likely to accelerate in coming years underlie the immediacy of these public health crises. First, rural-to-urban migration and high birth rates have contributed to the rise of population densities within urban and peri-urban environments; they have created the â€œhuman fuelâ€? necessary for the rapid spread of communicable diseases in population centers. Second, continuing encroachment of human populations into the habitats of animals that potentially harbor zoonotic pathogens increases the chances of cross-species jumps of ecological and evolutionary events that have sparked most major global pandemics. Third, globalization has seen unprecedented human mobility on a grand regional and international scale, rendering the swift geographic expansion of disease inevitable; this is highlighted by the rapid international spread of SARS, swine flu, and Ebola in recent years. These burgeoning risks require improved surveillance systems, aggressive control programs, and efficient containment strategies, all of which can benefit from the pervasive proliferation of mobile technologies across South Asia, particularly in vulnerable populations and in physically inaccessible areas. Perhaps the most obvious applications of mobile technologies to the mitigation of infectious disease threats are specific surveillance apps that facilitate communication and data transfer between public health professionals. Many national surveillance programs in South Asia are still pencil-and-paper based systems that require the transportation of medical records from hard copy to central surveillance repository. Computer engineers have developed a plethora of mHealth approaches for the collection of epidemiological and clinical data on tablets or mobile phones by clinicians, nurses, or community health workers. These apps facilitate the rapid transfer of information to Harvard South Asia Institute 33
central databases in national control programs, at least where there is mobile or Internet connectivity. Participatory surveillance, a crowd-sourcing method of disease detection (such as Flu Near You and other apps designed to prompt users to answer questions about symptoms), is also a promising strategy for improved surveillance. These types of approaches are often hard to validate and are unreliable on an individual basis, but, when employed in densely populated areas, they can be extremely helpful to gain insight into general patterns of disease. Another area where mobile devices offer important opportunities in public health is in the direct interaction of health care providers (of all levels) in remote regions with those in more central health care systems. Community health workers and other local facilitators, such as pharmacists and shopkeepers—who are often the only interface between health systems and communities—are often isolated, lack disease-specific expertise, and are poorly incentivized financially. Mobile devices allow for the flow of information between these frontline health care service providers and central health systems, and contribute to the provision of financial support and expertise. Several specific apps have been developed to improve access and quality of care in more rural or isolated areas. However, most of these applications require public use of particular mobile apps or the active adoption of particular systems by control programs and ministries of health; these restrictions may explain the relatively small-scale nature of many current or pending mHealth approaches. By contrast, approaches that involve the passive observation of “digital exhaust,” automatically generated by the everyday use of mobile devices, are by definition scalable to national or even international levels. One of the most promising approaches to combating the challenge of growing infectious disease in South Asia is the use of mobile phone call detail records (CDRs) to understand the dynamics of human populations that drive epidemics. CDRs are collected routinely by mobile operators for billing purposes, but they also record a cell tower ID number every time a subscriber uses the phone, and they provide an approximate user location for the exact time of the call. With appropriate anonymization, information about the whereabouts and travel patterns of a large fraction of a country is available almost in real time. This provides insights into both the patterns of population density that allow epidemics to take off, and the mobility that spreads disease across countries. This valuable information can be used in combination with epidemiological information to pinpoint hotspots of disease importation, identify geographical sources of infection, and forecast epidemics. Finally, dynamic risk maps resulting from these analyses would help policy makers more effectively target resources for disease control and containment. Although these approaches are still very much in the proof-of-concept stage, they show great promise for aiding the control and containment of epidemics. South Asia faces several ongoing infectious disease threats that are uniquely impacted by ongoing societal changes. Pakistan, for example, is the global hub for polio cases and is therefore of central importance for the geographical containment and ultimate eradication of the virus. Seasonal epidemic cholera outbreaks in Bangladesh and beyond are often associated with the monsoon or cyclones that displace populations and account for a large fraction of global deaths resulting from the disease. Malaria 34 Technology and South Asia
parasites resistant to the last drug in the global arsenal against the disease have emerged in Southeast Asia and may spread throughout the region, causing a surge of morbidity and mortality which the treatment currently prevents. Resistance to all previous malaria drugs also spreads via human mobility, and since South Asia serves as a route for migration from Southeast Asia to the Middle East and Africa, where 95% of malaria deaths occur, malaria and its complications present a grave threat to migration throughout the region. Finally, as South Asian megacities continue to grow, the emergence of dengue fever in previously dengue-free regions is of increasing concern becauseâ€”unlike malaria, which is primarily transmitted by rural mosquitoesâ€”the disease is spread by species that breed in urban and peri-urban settings. If a potentially pandemic pathogen were to surface, the factors driving these infections would also trigger rapid spatial spread of a new epidemic disease. Despite the urgency of these threats, a whole range of promising new approaches to monitoring and mitigating infectious diseases is rapidly developing. The adoption of mobile technologies in South Asia has been staggering in scale and speed, reaching even the poorest and remotest communities. With scaled, integrated approaches to surveillance, and efficient pipelines for harnessing passively collected data on human behaviors (like CDRs) in ways that protect individual privacy and vulnerable groups, South Asia can, in fact, be well prepared to respond to epidemics.
Harvard South Asia Institute 35
Courtesy of Harsha K R
36 Technology and South Asia
The Art of Medicine and the Science of Technology Paul Salins
Health care has always needed technology to reduce the cognitive burden of delivering care, overcoming uncertainties inherent in an experience-based decision process, and bringing the medical profession closer to coping with the tremendous emerging knowledge in medicine. The marriage between technology and health care is expected to simplify, accelerate, and render critical health care processes more predictable, in turn reducing dependence on expertise and experience. Therefore, it could be argued that the limit to which the human body can be perceived as a machine, and the practice of medicine largely a technical process, would be the extent to which health care of the future would improve outcomes and become available to all. Cardiac surgery was once rightly regarded the most challenging of surgical procedures, but today, given advancements in technology and our improved understanding of anatomy as well as biological and technological processes, it can be performed in a production-line process, providing consistent outcomes and significant cost reduction. Production lines in eye surgery have similarly brought sight to millions. Yet, most of medicine still remains what Sherwin Nuland has termed â€œan uncertain artâ€? in a landscape of ever-changing facts unseating the old. This uncertainty calls for considerable judgment on the part of providers in determining management choices. Yet, an ever-expanding universe of medical facts, evidence-based medicine, randomized control trials, clinical prediction rules, and treatment algorithms can easily corrupt the value of this art and demote perception of medical practice to the level of a technical exercise capable of mechanistic certainty. As the demands on the medical profession have become overwhelming, as in Harvard South Asia Institute 37
South Asia, such a mechanistic trend has grown increasingly attractive. This trend is dangerous because judgment lies at the heart of good clinical management as the engine of causality determining outcomes. The judgment of a great clinician can rightfully confront the available evidence—just as the thought process of a great pianist defies the limitations of the pianoforte, and the illumination captured in a great work of art transcends the scope of human vision. Such extraordinary work is possible because the mix of cognition and intuition that makes up the fabric of human thought generates “predictive reasoning” that anticipates and preempts elements of any action; it creates the canvas for successfully attempting exceptional causality, whether it is a work of art or a critical clinical decision. At the same time, a tacit infrastructure of ideas provides the template on which routine actions can be automated with great economy of cerebral effort, thus making space for the grand schemes of the mind, space to indulge in the exceptional. For this reason, the real challenge of introducing technology into South Asian health care is not only in innovation of new tools, affordable technology, or intelligent repurposing of medical technology, but more importantly the creation of an enlightened culture of technology-enabled health care that elevates human sensitivity. The second most important task that technology has in South Asia is for it to create a bridge between the culturally attuned indigenous systems of medicine and the scientific, culturally agnostic, Western schools of medicine. While in the era of evidence-based medicine and strident medical activism this seems an impossibility, it is nevertheless a necessity in South Asia for three reasons: 1. In developing economies such as India and other countries of South Asia, the dominant private health care education and delivery enterprises adapt to the needs of the rapidly expanding middle class and the rich. They appropriate most of the available resources, including expert talent, and end up depriving the vast majority of the rural poor. While 70% of South Asians live in rural areas, 80% of medical infrastructure is urban.¹ Consequently, the vast majority has little access to most medical resources. Furthermore, the rural centers that exist are crippled by absenteeism and unfilled posts. According to the Indian National Rural Health Mission 2014 report, as many as 73% of specialist posts are unfilled at the community level.² In India, the professional health care pool of AYUSH (Ayurveda, yoga and naturopathy, Unani, Siddha, and homeopathy) doctors nearly matches that of allopathic doctors in total numbers as well as in basic medical curricular training and length of training; they have far higher penetration into rural areas, and yet have little direct stake in health care. This gap can be filled by technology-empowered AYUSH doctors trained and equipped with tools to provide wide-ranging diagnostic support, and IT-enabled two-way access to specialist advice, which can be escalated when necessary to facilitate hospital care. But, regardless of whether 38 Technology and South Asia
AYUSH or allopathic medicine is employed, standardizing essential clinical data acquisition and documentation, as well as auto-prioritizing according to the level of clinical intervention necessary, would be enormously beneficial. It would transform health care by improving efficiency at the primary care level, increasing the reach of specialty care, and applying hospital systems to rural health networks. 2. Poor health in rural South Asia is directly related to socioeconomic disadvantage. Mackenbach et al. have shown that more than traditional medical interventions, policies related to social, economic, preventive, and behavioral interventions might well have a greater impact on reducing disparities, even if as an unintended by-product. Therefore, a purely disease- or medicine-centric strategy is unproductive. Technology can be the bridge between drivers of socioeconomic status impacting health and health care. Rural-based AYUSH doctors are well placed to be managers, as they use technology to educate and supervise rural community-based micro-entrepreneurship units such as growing herbs and organic specialty crops. We have effectively used this approach to make rural health care attractive and economically self-sustainable. 3. Smartphones will be available soon, even to the poorest citizens. Indeed, more Africans today have access to smartphones than to electricity.Âł Their access to data will permit more people to take care of simple health needs without consulting professionals; the role of skilled labor is being redefined. Their processing power, cameras, and ports already serve as a platform to design new medical tools (from pulse oximeters to disease diagnostics) that decrease the demand for legacy technologies. The need is a hierarchy of mobile-based capabilities tailored for each strata of the community, engineered to fit a seamless architecture of health care enterprise connecting individuals, homes, community health workers, doctors, specialists, and hospitals. The natural evolution of such an approach would be to move toward a highly efficient predictive modeling-based health care, where the susceptibility of every individual to disease becomes the basis for designing interventions and personalized medicine. The continuum data from the smartphone would make it possible, for example, to track behavioral or verbal cues in order to anticipate and intercept mental disorders, or modify lifestyle to delay the onset of diabetes and provide big data for modeling and planning governmental as well as market strategy. These trends will culminate in the establishment of two distinct tiers of technology-enabled care. This system, termed â€œunified health care,â€? will deploy a lower-level community tier and a higher-level hospital tier. The community tier will focus on interceptive medicine that maintains routine health and identifies diseases in individuals and populations at very early stages, and will move gradually toward predictive modeling. This will be the domain mainly of rural AYUSH providers, seamlessly linked to the more intense tier of care. The higher tier will focus on interventional medicine, such as operations and inpatient admissions, and will make the hospital its epicenter. Harvard South Asia Institute 39
A hierarchy for technology engagement should be created. The first category would include all health care processes that can be replaced by technology without any risk; the second to comprise all health care processes where trained nonmedical personnel can be enabled by technology; the third where technology can expand a nonspecialistâ€™s scope of medical practice; and the fourth where technology safely amplifies the expertise of a doctor to improve outcomes and expand outreach. Yet even the smallest integration of diverse cognitive input into the least complicated of decision processes involves numerous dimensions of information processing. Only enlightened technology ventures that play a key role in redesigning the landscape of medicine can pull health care out of its economic quagmire. To date, health care innovation has failed to move us substantially closer to inclusive care. At fault is that small iterative improvements in technologies correspond to outsized increases in cost. In the cost-benefit setting of health care, such developments move our systems to exclusivity instead of affordability. By contrast, South Asia will be uniquely positioned to develop health IT. Because its need is so great, South Asia is more apt to risk and novelty. South Asia also lacks the tight patient data legislation that hamstrings Western technologists. Rarely can we say that processes work faster in South Asia than elsewhere, but these factors position the region as the worldâ€™s sandbox for health IT. This transformation of care today results from organic pressures, not any central planning. The technologies discussed exist or are already in development. This does not, however, eliminate the need for effective policy. For our innovations to have the most impact, we must remain disciplined entrepreneurs. Inventions that limit patient options or information flow (e.g., by using proprietary systems) are easier to monetize in the short-term, but are a disservice in aggregate since they only introduce more discontinuities into a deeply fractured system. Isaac Asimov posited rules for robotics that he hoped would keep mankind from being seduced by their myopic desires of violence. For us to pursue enlightened innovation, we need a similar framework in medical technology. As such, we posit the following three rules for medical technology: 1. Medical technology must never harm patients, or, by restricting patient options, reduce patient health or quality of life. 2. Medical technology must not introduce new frictions into patient care, except where the absence of such discordances would conflict with the First Law. 3. Innovators may monetize their technologies as long as such monetization does not conflict with the First or Second Laws. As with Asimovâ€™s rules, this comes with an implied zeroth law. Medicine is a service to humanity. As such, our zeroth law holds that medical technology must never hurt, but only help, humanity. South Asia is writing a new framework for medicine. In that creative process, let us hope that our innovators 40 Technology and South Asia
remember that the pay-off is much larger than any one company’s IPO or exit; the true pay-off is preserving and fostering the generational dividend. In entering the age of technology, South Asia has started to reform and continues to progress its medical practices, in order to grow along with rapid technological change. While it struggles to keep up, it still sits as the hotbed for health IT development. The challenge, however, will be to remember that widespread health benefits far outweigh any short-term financial shortcuts.
1. “Healthcare: Reaching Out to the Masses,” KPMG, 2010. https://www.kpmg.de/docs/ Healthcare_in_India.pdf. 2. http://www.iimahd.ernet.in/assets/snippets/workingpaperpdf/18440375092015–07–04.pdf. 3. http://a16z.com/2014/10/28/mobile-is-eating-the-world/.
Harvard South Asia Institute 41
Courtesy of Guilhem Vellut
42 Technology and South Asia
mHealth in Pakistan Ali Habib
The rapid uptake of mobile phone technology in Pakistan over the last several years has created opportunities to use mobile health (or mHealth) solutions to help solve some of the most pressing health problems the country faces. These include surveillance of diseases like TB, pneumonia, and dengue; as well as monitoring medication usage, childrenâ€™s vaccination history, and maternal and child health. Further, mHealth technologies have developed early-warning systems for diseases, and have tracked civil registration and vital statistics. Mobile health solutions allow health workers to collect clean, validated data in the field and store that data in a central server generating electronic data that is easy to analyze and report. The electronic data is of course superior to outdated paper records, which are more error-prone; take longer to transport and analyze; and are more expensive and difficult to store, search through, and report on. Where mobile data connectivity is unavailable or unreliable, data can be stored offline on mobile devices and submitted when connectivity is available. Alternatively, short message service (SMS), which is nearly ubiquitous in the country, can be used as a medium of data transmission where Internet access is unavailable. Groups like Interactive Research and Development (IRD) in Pakistan have created a range of mobile TB surveillance and screening applications that are used by health workers to verbally screen people for TBâ€”hundreds of thousands have been examined in Karachi over the past five years. Those found to potentially be suffering from the disease are given a diagnosis and care, often free of cost. All medical records of these individuals, from screening all the way through diagnosis and end of treatment, are entered Harvard South Asia Institute 43
into mobile phone–based applications and stored in a medical record system. Similarly, the Punjab IT Board (PITB) has created a mobile phone–based application for dengue surveillance and the GPS mapping of dengue hotspots and mosquito-breeding grounds. Electronic vaccine registries have been developed separately by IRD and the Punjab Information Technology Board (PITB) to electronically store children’s vaccination histories through mobile technology. The IRD and PITB are working to expand these systems throughout the country to help improve immunization coverage and save children from preventable diseases like measles and polio. In the mother and child health space, the Open Smart Register Platform (OpenSRP) is also developing and implementing a mobile platform in Pakistan as part of a multi-country impact assessment led by the WHO. OpenSRP uses a novel approach to mobile data collection; it employs a register-based user interface that mimics the paper registers frontline health workers are accustomed to. The platform, while currently used for mother and child health, is not domain-specific, and has the potential to be adapted for other health issues as well. Mobile solutions have also been used in Pakistan to spread awareness; train health care workers; and communicate with patients to encourage health-seeking behavior, schedule appointments, and inform them about test result completion. A Gates Foundation–funded mental health program allows IRD field teams to screen patients for anxiety and depression using a cell phone–based screening tool. Those identified as suffering from mental disorders are linked to counseling and sent messages over SMS to check on their statuses. Additionally, IRD has worked with health communication specialists and animators to create a video demonstrating how patients should cough up an acceptable sample of sputum that can be tested for TB. This video has been loaded onto tablet devices and placed at TB diagnostic and treatment centers for patients to view before they provide samples. Since a bad sample can result in a wasted test (advanced rapid tests can cost US$18 or more), the video saves expense and improves chances of better diagnosis. The video has been translated into languages such as Bangla, Bahasa, Zulu, and others, and is used in several countries. Hospitals in Pakistan are also using mobile technology to provide better care. For example, doctors responding to emergencies can receive basic information, including images of ECGs or other test results, on their cell phones, allowing them to be better prepared upon arriving at the emergency room. Several groups in the country—for example, the Aman Foundation—have also employed mobile technology to set up telemedicine initiatives where patients can call in, receive advice over the phone, and be directed to specialists. Despite the successful mHealth initiatives I have described, however, few have yet to reach significant scale in Pakistan. Some of this can be attributed to the lack of players in the field and too few programmers willing to work 44 Technology and South Asia
in the ICT4D (Information and Communication Technologies for Development) space, opting instead for commercial ventures. This preference indicates that the right incentives need to be in place for commercial actors to take on mobile health. An encouraging development on this front in Pakistan is the rise of tech start-ups encouraged by an increasingly supportive environment of investors, incubators, and mentors. A recently held civic hackathon in Karachi featured a number of aspiring tech entrepreneurs with novel mHealth solutions, including mobile apps to help find blood banks and to encourage the gamification of health-seeking behavior, like taking pills daily. The advent of 3G and 4G connectivity in Pakistan has also incentivized mobile network operators (MNOs) to begin development of mHealth applications and portals that have additional offerings for health and fitness. With the right kind of partnership, these technologies could provide the platforms for smaller non-profit or start-up initiatives to reach scale by using the MNOsâ€™ existing infrastructure.
Harvard South Asia Institute 45
Courtesy of Philippe Put
46 Technology and South Asia
Watching, Streaming, and Other Things to Do with TV Nalin Mehta
About a Qtiyapa In early 2014, when India’s over four hundred TV news channels were enmeshed in a bitter fight for ratings to cover the most significant election of their lifetimes—with then-challenger Narendra Modi of the Bharatiya Janata Party (BJP) taking on the Congress-led United Progressive Alliance government in a presidential-style campaign—many experimented with political satire. Aaj Tak, India’s leading Hindi news network, for instance, changed its prime-time programming to create a daily special election–focused comedy show hosted by Bollywood actor Shekhar Suman.1 Yet, the production that came to symbolize political satire in that election did not come from any one of the mainstream TV channels. It came from a web start-up called The Viral Fever (TVF) and its Qtiyapa series of spoofs had already become a new buzzword for “cool” on college campuses. The word qtiyapa itself is a derivative pun on a popular Hindi cussword that very roughly denotes idiocy. Some of the early Qtiyapa successes came from nonpolitical themes, such as spoofs on film songs or TV shows, before its makers turned their gaze toward the election fever gripping the country. “Bollywood-Aam Aadmi Party,” a Qtiyapa TVF Video, spoofing India’s most highly watched news anchor Arnab Goswami and Aam Aadmi party leader Arvind Kejriwal, leader of another successful political start-up in Delhi, debuted on YouTube in February 2014 and quickly went viral, garnering over five million views.2 A year later during another epochal election, this time for the province of Delhi, TVF managed an encore with another political satire video, Barely Speaking with Arnub. Released the day before the Delhi assembly results were Harvard South Asia Institute 47
declared—giving sixty-seven of seventy Delhi assembly seats to Arvind Kejriwal’s Aam Aadmi Party—and featuring a fake Mr. Kejriwal coming face-toface with the real Mr. Kejriwal in a TV interview, it garnered over 3.5 million views on YouTube.3 These web-only viral successes revealed early warning signals for mainstream Indian television that the ground beneath its feet was shifting. Even two years ago, these would have been dismissed as flash-in-the-pan initiatives, burning briefly with brilliance but without the scale needed to damage the behemoth of mainstream media. Yet, 2014 was a game changer of sorts. It was the year Google reported that two of the top five non-music videos watched on YouTube in India were web-exclusives—one from TVF, another from All India Backchod (AIB), another comedy act.4 Much of this online video content was being produced by people who chose to bypass traditional media channels because of their institutional rigidity. TVF, for example, was co-founded by an IIT–Kharagpur graduate, Arunabh Kumar, whose ideas for a television show were famously rejected by MTV before he struck out on his own. He says the rejections from mainstream media made him realize that they had a “pigeon-hold” idea about “what would work” and they weren’t willing to let go of the formula.5 It led to the creation of TVF, which by February 2015 had become the first YouTube online network to attract one million subscribers on the basis of original content within the shortest period of time.6 Between June 2014 and June 2015, it had raised revenue of $628,000 (Rs. 4 crore) and Arunabh was already making claims that “we want TVF to be India’s answer to Disney.”7 For those who had long wondered about why India doesn’t have its own version of, say, House of Cards by mid-2015, TVF launched two very successful web series. The first was Permanent Roommates, which debuted in October 2014. Five episodes, one season, and nine million views later, the show about a girl-next-door in a complication-filled relationship with a non-resident Indian who lands up in the country to marry her, was already being touted as the second most-watched web series (after Video Game High School) on YouTube. Its second such attempt was another successful five-part series called Pitchers, launched in June 2015, which some have called an Indian version of HBO’s Silicon Valley.8 TV, Mobiles, and Digital Futures in India TVF is only one example. But what does its rise, and of platforms like it, mean for a traditional Indian Rs. 475 billion ($7.22 billion)9 television industry? With 168 million TV sets in 2014, India is the second largest TV market in the world. It has been growing roughly at 15% annually over the past decade and current industry estimates project such high rates to continue over the next five years too—largely because television penetration in India is still 48 Technology and South Asia
only restricted to about 61% of Indian households.10 How are the Internet and mobiles changing Indian television, and how are companies reacting to this most cultural of products, which has ramifications on identity formation, nationhood, and the self ? This is not a particularly new question in Western media markets where big media companies have long been struggling to cope with the rise of new technologies. Global media executives like Andy Kaplan of Sony Pictures have argued that the greatest threat television companies face right now is “irrelevance.”11 Yet, the importance of this question in India is different, as Internet penetration in the world’s largest democracy remains abysmally low. The world may be getting flat but only for about 20% of Indians—the 250 million or so connected online.12 No other major country has fewer people connected online. It would be unfair to compare India with developed countries—where Internet connectivity is typically over 70%—but even Brazil manages Internet access for nearly half its population.13 The vast majority of Indians are still waiting to be logged on to the digital future. This is why traditional newspapers and television continue to grow in India unlike any other major country, save China. Internet connections are expanding fast, no doubt, but the upending of the old order that we have seen in media industries elsewhere is still relatively some distance away in India. Yet, Indian TV, learning from lessons elsewhere, is fundamentally changing. By 2015, every major Indian TV company was working hard to change its DNA to be ready for the coming online surge. The game changer is mobiles. Between 2000 and 2010, mobile phones grew faster in India than in any other country in the world, chalking up staggering annual growth figures of almost 2,000%.14 In 2001, there were only 37 million phone connections in India (one for every 28 Indians); and by 2011, over 900 million (one practically for every citizen, and most of them mobiles).15 By any standards, this is nothing short of a revolution and the easy availability of mobiles has changed everything from politics and social relations to caste structures.16 Mobiles take on many social meanings, but in India they offer millions an easy way of getting onto the Internet. This is where the battle for the future of television in India is currently being fought: in the interstices of the marriage between mobiles and the Internet. There are many more mobiles in India than television sets, or toilets for that matter. Recent studies have shown that mobile phones are now the second-most viewed screen in India. Things are changing so much that in early 2013 India overtook Japan as the third largest buyer of smartphones in the world. Smartphone use in India is growing at 163% annually, four times the global average17 and more than half of all Internet access in India now goes through mobile phones.18 Tellingly, much of this traffic comes from outside the top eight metros, where erratic electricity means that a lot of people are increasingly more dependent on mobiles.19 Harvard South Asia Institute 49
The sheer multiplicity of screens in Indian lives means that the basic social matrix on which the dominance of television was based is now changing. Smita Jha, who heads the Indian entertainment and media practice at PricewaterhouseCoopers, says, “Gone are the days when a television channel could command dedicated viewers or users as the presence of multiple devices, television channels among other reasons has led to fragmentation. While television is known as the ‘sit-back’ medium, mobile devices are known as the ‘sit-forward’ medium.”20 People move from one device to the other and watch multiple screens. Their viewing habits are changing. Part of the problem for big TV companies until recently was that while they knew they had to do something, they weren’t sure what. Embracing mobiles meant unlearning everything they had done so far and adopting a completely new way of doing things. “I fear that we are trying to force-fit an older analogue model of doing things into a new world where this just does not work,” mused Uday Shankar, CEO of India’s biggest TV company, Star India.21 The New Digital Play in Indian TV In 2001, Star TV was taken in by the heady promise of an Internet future and wasted $50 million in buying indya.com in an investment that went down the drain. Since that disaster, though, Indian media managers have become much more savvy about using the Internet. They have figured out that it may not be enough to directly generate big money, but it is certainly enough to generate lots of noise. The sorts of people who are on Twitter and Facebook are also the sorts of people who advertisers like. The more they comment and tweet on shows, the more intimate TV programming gets. What is interesting is how the big channels are adapting. Since 2014, India has seen a series of new launches in the mobile entertainment space by traditional big media companies. Even as Netflix is scheduled to enter India in 2016, companies like Star, Sony, Balaji Telefilms, and Eros have launched digital streaming apps like Hotstar, Sony LIV, and Eros Now, respectively. Their experience so far has been instructive. Sony LIV, the platform from Multi Screen Media (MSM), claims to have seen a 30% increase in viewership, downloads, and unique views month by month. Shows such as season 3 of Hannibal, Sankatmochan Mahabali Hanuman, and Suryaputra Karn premiered first on Sony LIV before going live on television. Hat-trick, a fantasy league game which was launched on the platform, also had a huge response.22 Sony LIV followed the success of Sony’s official YouTube channel, which by 2015 had 4.5 million subscribers and boasted over two million video views.23 Since 2013, the network adopted a strategy of uploading every episode of every serial within two hours of telecast and each such upload garnered 25,000 views on average. The channels have realized that the more buzz 50 Technology and South Asia
they create online, the more they can send traffic to the television. Eventually, the online traffic may count for much more than conventional ratings. Sony’s three-stage progression with new media is typical. It started with simple Short Message Service (SMS) messages for Indian Idol auditions and voting. It then progressed to promoting its YouTube channel and in the third phase shifted attention to its Sony LIV app. Few companies have managed to make significant money from the relatively small Indian digital market. But the digital pie is growing and everybody is getting ready for when it will be large enough to pay economic dividends. In 2012, for instance, Sony’s official YouTube channel did earn revenues online from sponsors of its TV shows but this was still small change. This is why Nitesh Kriplani, who heads its online operations, says, “Currently, our goal is not one of maximum monetisation. In fact, we believe the platform must be primarily used for reaching out to our viewers. Perhaps a year from now, we may look at subscription-based content following a premium model where 80 per cent of the content is free while the rest is paid for.”24 Star’s strategy is similar: a live digital streaming app, combined with mixing online exclusivity and the personal touch and feel of Facebook and Twitter. Star’s Hotstar app gained a lot of traction from cricket during the 2015 cricket World Cup and the domestic Indian Premier League (IPL) that followed. It generated over 200 million views during the 2015 IPL, a threefold jump over the 61 million views in the last season.25 The Hotstar strategy of digital premieres is particularly interesting. The network decided to premier avant-garde Bollywood producer Anurag Kashyap’s 2015 film Bombay Velvet on its app even before it was put on television. It is now said to be planning digital premieres for films such as Phantom, Prem Ratan Dhan Payo, Bajrangi Bhaijaan, and Dhrishyam. As one media report noted, chat segments with the cast of Bombay Velvet got Hotstar nearly two million video views in two weeks.26 This was a logical extension of what Star has been doing with its soap operas already. When it got the filmmaker Sanjay Leela Bhansali to make his debut on television by directing its marquee soap opera Saraswatichandra, it premiered the show’s launch exclusively on the web. Similarly, for several of its other big ticket programs like Nach Baliye and MasterChef India, it runs special add-ons exclusively for digital viewers. Live interactive chats with participants, behindthe-scenes clips, rehearsal footage, bloopers, and interviews are meant to draw in the faithful and keep them hooked with the promise of something regular TV watchers don’t get. It is a strategy that has helped drive YouTube views of Star’s official channel to over 2.5 million. “We have even made special edits of the episode acts just for digital,” says a senior manager. “For example, Chaavat Boys, which is a group of engineering students from a Mumbai college, have already become a rage online, and all their dance acts have gone viral. In fact, people have been uploading videos of their own version of Chaavatgiri.” Harvard South Asia Institute 51
Star’s Satyamev Jayate with Bollywood actor Aamir Khan is a case in point. It was the first major talk show in India to have as much of an online presence as television presence. There is a reason why it became the most-searched query on Google immediately after its first episode, why it became the most talked-about show for a while on social media worldwide, and why its official Facebook page has 1.69 million likes.27 It top-trended on Twitter on each Sunday that it was aired in India and four episodes—on female feticide, child sex abuse, marriage or marketplace, people with disabilities—trended globally. By the time it finished, Satyamev Jayate had garnered over a billion digital impressions from 165 countries and over 5,400 cities.28 Its strong web presence, with every episode being uploaded soon after its launch, was a trigger, and so was Aamir Khan’s celebrity, but most of the conversation it engendered thereafter was on the issues it touched upon. Similarly, Eros Now, the digital app of film distribution company Eros, has over 26.5 million registered users worldwide. It also offers films, television content, music videos and audio tracks, and premieres of films before they arrive on television. Eros Now is also planning web-only soap operas.29 The Next Indian Netflix or Hulu India is essentially on the cusp of the digital shift that in the US led to the creation of platforms like Hulu and Netflix. The first tipping point in the Indian mobile phone revolution came in March 2003 when tariffs fell below Rs. 3 per minute for the first time. That was when mobiles suddenly became affordable for millions of Indians. A similar tipping point for smartphones may be just around the corner. It could come when cheap $50 smartphones become commercially viable. Or when the new 4G networks are rolled out. That would be the moment that would change the entire media landscape. India can do “instantaneous shifts that are not possible elsewhere because there you have to rip out existing infrastructure to use new technologies,” says Walt Disney’s Andy Bird. Just like it did with satellite TV twenty years ago and mobiles ten years ago, the technological landscape can switch very fast to into the mobile Internet age, defining “new futures unencumbered.” Everyone is preparing for the big mobile wave. The problem is nobody knows how to make it pay. At a recent industry meeting in Mumbai, Manish Agrawal, the CEO of Reliance Entertainment Digital, a company that focuses on gaming, wryly noted how investors get excited every time he travels abroad when he tells them that he heads a company which boasts of more digital subscribers than any other in Indian gaming. The excitement quickly dissipates, he says, when he quietly adds that this means only about 20,000 subscribers. “I am constantly torn by the dilemma of whether I focus on generating bigger numbers by giving away my product for free, or whether I stay patient and keep waiting for paying subscribers.”30 This is the single biggest problem for every 52 Technology and South Asia
digital-focused company in India. All of them agree that consumers must pay for content, but few are ready to pay yet. The music industry, for example, has grown fast online but makes little money online in India. Less than 7% of its content generates any money for its makers. It is the kind of figure that scares content providers and TV companies. Neeraj Roy, CEO of Hungama, which distributes online content, finds a parallel with television. “We can’t make the same mistake we made 20 years ago with cable,” he insists.31 That was when channels chose to sacrifice revenues in favor of faster growth by providing free content. It made them dependent on fickle advertisers and forced them into the slow-death embrace of TV ratings. A similar dynamic is unfolding again with the Internet, which is roughly at the stage where Indian television was around the early 2000s before it exploded. India’s 254.4 million Internet users in 2013 seemed miniscule by global standards but growth can be fast. China grew from around 70 million Internet users in the mid-2000s to about 600 million in just about five to six years. In less than a decade it went from negligible Internet penetration into a USD 350 billion digital economy. India’s five- to six-billion-rupee Internet economy was hardly anything by comparison, but most industry watchers think that getting to 500–600 million users is a shift that can happen very fast. The writing is on the wall. Those who don’t see it, says the filmmaker Mahesh Bhatt, are “like tadpoles swimming in a pool, unable to see the sun when it comes out.” The trick for media companies is how best to be ready for it, when the critical size is reached. And to figure out how to make it pay.
Harvard South Asia Institute 53
1. Aaj Tak’s Election Ooh La La ran daily at 9:30 p.m. from April 1, 2014, Mondays to Saturdays. http://www.indiantelevision.com/television/tv-channels/news-broadcasting/electionooh-la-la%E2%80%99-on-aaj-tak-with-shekhar-suman-140401 (accessed September 1, 2015). 2. https://www.youtube.com/watch?v=enyC07HPv18 (accessed September 1, 2015). 3. https://www.youtube.com/watch?v=A9nCPQ2_FlQ (accessed September 1, 2015). 4. Ridhi Mukherjee “1 Million and Counting for AIB & TVF, but YouTube Dependency Is a Cause for Concern,” http://www.medianama.com/2015/03/223–1-million-and-countingfor-aib-tvf-but-youtube-dependency-is-a-cause-for-concern/, March 17, 2015 (accessed September 1, 2015). 5. Vishnupriya Bhandaram, “A Curious Case of Q-tiyapa,” The Hindu, June 20, 2013, http:// www.thehindu.com/features/metroplus/a-curious-case-of-qtiyapa/article4833730.ece (accessed September 1, 2015). Also see Seta Kaushal, “How MTV’s Rejection Created Q-tiyapa,” The Hindustan Times, December 24, 2013, http://www.hindustantimes.com/ television/how-mtv-s-rejection-created-q-tiyapa/article1–1165973.aspx. 6. AFAQ Bureau, “TVF Hits One Million Subscribers,” March 16, 2015, http://www.afaqs.com/ news/story/43590_TVF-hits-one-million-subscribers (accessed September 1, 2015). 7. Yatti Soni, “We Want TVF to Be India’s Answer to Disney,” http://inc42.com/buzz/tvfindias-answer-to-disney-arunabh-kumar/, June 9, 2015 (accessed September 1, 2015). 8. Suprateek Chatterjee, “The Viral Fever’s New Web Series Is about India’s Frenzied Start-Up Scene,” http://www.huffingtonpost.in/2015/06/05/arunabh-kumar-tvf_n_7511834. html, June 5, 2015 (accessed September 1, 2015); Suprateek Chatterjee, “Pitchers’ Season 1 Review: Present Imperfect, Future Promising,” http://www.huffingtonpost. in/2015/09/01/pitchers-season-review_n_8068852.html, September 1, 2015 (accessed September 10, 2015). 9. http://www.indiantelevision.com/specials/event-coverage/ficci-frames/tv-industry-to-touchrs-975-billion-in-2019-ficci-kpmg-report-150325 (accessed September 10, 2015). 10. http://www.indiantelevision.com/specials/event-coverage/ficci-frames/tv-industry-totouch-rs-975-billion-in-2019-ficci-kpmg-report-150325 (accessed September 10, 2015). 11. Andy Kaplan, President, International Networks, Sony Pictures. Guest of honor speech at CII Big Picture Summit, October 29, 2012. 12. PTI, “India Has Lowest Internet Penetration Growth in Apac: Report,” http://timesofindia. indiatimes.com/tech/tech-news/India-has-lowest-internet-penetration-growth-in-ApacReport/articleshow/36108762.cms, June 5, 2014 (accessed September 1, 2015). Another study by the Boston Consulting Group predicts that the number of Internet users in India is expected to nearly triple from 125 million in 2011 to 330 million by 2016. It argued that 40% of some 90 million urban Internet users in 2013 already said that online activities influence what they buy. Arvind Subramaniam, Nimisha Jain, Shweta Bajpai, and Shruti Patodia (Boston Consulting Group), From Buzz to Bucks: Capitalizing on India’s “Digitally Influenced” Consumers (April 2013) http://startupcatalyst.in/wp-content/uploads/2013/05/ From_Buzz_to_Bucks_Apr_2013_tcm80–132875.pdf. 13. World Bank and ITU Data. Quoted in Rasmus Nielsen, Ten Years That Shook the Media World, Reuters Institute of Journalism (October 2012), p. 31.
54 Technology and South Asia
14. India’s telecom market grew at an annual average of 1,902% between 2000 and 2010. Only Indonesia with 535% and Russia with 653.1% came close. By comparison, annual average growth in this period was 82.5% in China, 71.2% in Argentina, 70% in Brazil, 49.9% in Mexico, and 45.8% in South Africa. “Mobile Marvels,” The Economist special report on telecoms in emerging markets (September 24, 2009). 15. See Robin Jeffrey and Assa Doron, The Great Indian Phone Book (Cambridge, MA: Harvard University Press, 2013), p. 28. 16. See Robin Jeffrey and Assa Doron, The Great Indian Phone Book (Cambridge MA: Harvard University Press, 2013). 17. The global average is 39%. Data and quote from “India Pips Japan to Become 3rd Largest Smartphone Market,” The Hindu Business Line, June 28, 2013. http://www. thehindubusinessline.com/info-tech/india-pips-japan-to-become-3rd-largest-smartphonemarket/article4859603.ece. 18. TechTree, “Internet Access in India: Mobiles Overtake Desktops,” September 4, 2012, http://www.techtree.com/content/news/1810/internet-access-india-mobiles-overtakedesktops.html. 19. Study by ViziSense, quoted in Meenakshi Verma Ambwani, “The Digital Challenge for Indian Media,” The Hindu Business Line, February 10, 2012. 20. Quoted in Meenakshi Verma Ambwani, “The Digital Challenge for Indian Media,” The Hindu Business Line, February 10, 2012. 21. Panel discussion on “Engaging a Billion Consumers in the Media and Entertainment Industry,” FICCI Frames 2013, March 12, 2013. Mumbai. 22. Anushree Chandran, “The Digital Wheel of Fortune,” The Financial Express, September 1, 2015. 23. https://www.youtube.com/user/setindia/about. 24. All details on Sony from Zeba Warsi, “How Sony Is Driving Its Online Ambitions,” May 20, 2013. http://www.indiantelevision.com/special/y2k13/sony_special.php. 25. http://www.livemint.com/Consumer/Hk3d4d6KIQ6YgpnxGjxn1I/Hotstar-notches-up-61million-views-in-IPL8.html. 26. Anushree Chandran, “The Digital Wheel of Fortune,” The Financial Express, September 1, 2015. 27. Details on Star from Disha Shah, “Star Plus Believes Digital Is the Way Forward,” June 5, 2013, www.indiantelevision.com/special/y2k13/Star_Plus_special.php. 28. Data from Star. Also see “Satyamev Jayate among Top Ten TV shows in Social Media Worldwide,” http://www.worldscreen.com/articles/display/2012–6-15-the-wit-socialmedia. 29. Anushree Chandran, “The Digital Wheel of Fortune,” The Financial Express, September 1, 2015. 30. Conversation in Delhi, October 29, 2012. 31. In panel discussion on “Digital Consumption on the Rise: Developing a Robust Paid Ecosystem,” FICCI-Frames, March 13, 2013, Mumbai.
Harvard South Asia Institute 55
56 Technology and South Asia
-Logy The suffix -logy in the English language originates from ancient Greek via French or medieval Latin. It denotes a type of discourse or a subject of study. The Greek word to which it is linked etymologically, logia (plural of logion), carried the meaning of divine sayings or oracles in antiquity.
Harvard South Asia Institute 57
58 Technology and South Asia The Rogers Building, circa 1901
From Technological India to Technological Indian Ross Bassett
In October 1949, during his first visit to the United States, Indian Prime Minister Jawaharlal Nehru stopped at the Massachusetts Institute of Technology (MIT), where he was met by MIT President James Killian and a crowd that included eighty to ninety Indian students. The Washington part of Nehru’s visit had been marked by tension between America’s cold warriors and the nonaligned Nehru. In Cambridge, Nehru found a more receptive audience, where he discussed a subject everyone there agreed upon: the role of technology in society. Nehru asserted that the history of a nation “must be looked at from a technological viewpoint.” He went on to claim that India’s technological lag had led to its colonization. As he considered India’s future, he said: “It is most important not only that our country advance along known technological lines, but that our technicians should show initiative and add to the existing fund of knowledge.” He expressed his happiness that so many Indians were studying engineering and stated that “India has too many lawyers and too few engineers.” He urged the students to “work hard to make India once again a first-class nation.” To an elite few in India, MIT was not new in 1949. The first Indian had gone to MIT in 1882, and in 1884 both of nationalist leader Bal Tilak’s newspapers, the Kesari and the Mahratta, suggested that MIT had something to offer India. In 1893, at the prodding of Cambridge economist Alfred Marshall, Devchand Parekh, a young student from Gujarat, visited MIT, inspiring a dream of sending Indians to study there with the hope that they This essay is based on Ross Bassett’s forthcoming book The Technological Indian (Cambridge, MA: Harvard University Press, 2016).
Harvard South Asia Institute 59
would return, start industries in India, and help ignite a homegrown economy. Finally, in 1944, British Nobel Laureate A. V. Hill advocated, “There ought to be founded in India a few Colleges of Technology on a really great scale, like the MIT at Cambridge, Mass.” That “Indian MIT” was in the process of being realized during Nehru’s visit, through the establishment of the first Indian Institute of Technology, at Kharagpur. The high point of Nehru’s vision of state-controlled technological development came in the decade and a half following his visit to MIT. Nehru called modern hydropower dams India’s new temples. India built such dams, but also research laboratories, steel mills, and atomic energy research facilities. Although they were a minute fraction of India’s engineering workforce, Indians trained at MIT played a disproportionately large role in these new ventures. And during this time India set up five Indian Institutes of Technology, designed to train engineers to the highest global standards. In 1961, the United States and India reached an agreement on a plan for the Indian Institute of Technology at Kanpur, where MIT and a group of eight other universities would provide faculty and support to establish an American model of engineering education in India. Nehru’s was not the only vision for how MIT might be used to develop technology in India. Leaders of prominent Indian business families, such as Birla, Kirloskar, Godrej, and Chauhan, sent heirs to MIT to prepare them to run the family business competitively and operate at the cutting edge. G. D. Birla won MIT’s support to provide assistance to the Birla Institute of Technology and Science, a privately run technological institute that would offer an alternative to the state-run IITs. The House of Tata recruited three Indians who had been exposed to computing during their years of study at MIT to start a computer venture, which would later morph into India’s first global IT company—Tata Consultancy Services. In the years immediately following Nehru’s death in 1964, the dream of a technological India became increasingly illusory. The Indian bureaucracy came to be a formidable opponent of the Indian engineer, and India’s research laboratories failed to produce the expected breakthroughs. Most tellingly young Indian engineers became captivated by a different, more personal dream. As American engineering educators came to Kanpur, they brought with them an engineering system that was designed for the American economy and the American technological system. That system would spread from Kanpur and be adopted at all the IITs. Thus, the IITs became part of a system of education that had its apex not in India, but in the United States. As students completed their undergraduate education at the Indian Institutes of Technology, the beneficiaries of heavy subsidies from the Government of India, they were increasing drawn to that apex, where their tuition and other expenses were often funded by the lavish grants the US government gave to American universities to support Cold War military-related research. While discriminatory 60 Technology and South Asia
US immigration policies had required Indian students to return home after their studies, in 1965 US immigration reforms removed those restrictions and allowed Indians to permanently migrate to the United States. From then on more and more Indian students in the United States made the decision to stay and take permanent positions. In the United States, their technical virtuosity was recognized and they took jobs in corporate research labs and as university professors. By the 1980s, they were starting companies in Silicon Valley. Their rise through the American technological hierarchy has continued apace. Although popular rhetoric asserted that “all” IIT grads migrated to the United States, the phenomenon was never so universal, with a study of IIT– Bombay showing 30% of its undergraduates relocating to the United States in the 1970s. But still, for a system designed to produce engineers for India, it was a remarkable engineering inefficiency, best exemplified by the fact that the top graduating student at any of the IITs almost invariably went to the United States for higher studies. In 2015 India finds itself in a different era. With a liberalized economy that now removes the barriers that previously existed and gives foreign companies easy entry into India, IIT graduates more frequently stay in India, albeit often working for American firms. A burgeoning Indian middle class, increasingly with the means to pay its own way, copes with the inadequacies of the Indian technical education system by sending their children to the United States. But in this new era, an older pattern remains: Nehru’s dream of a technological India has given way to an individual technological Indian, more closely tied to a global system of technology-based capitalism than to a nation-state. In looking at India’s technical elite, one might ask: Did India free itself from one empire, only to tie itself to another one, a technical empire?
Harvard South Asia Institute 61
Courtesy of Sidbij
62 Technology and South Asia
Engineering for Non-Engineers Nitin Nohria
The dean of Harvard Business School and the George F. Baker Professor of Administration, Nitin Nohria represents the best of a generation of Indians who attended Indian Institutes of Technology (IITs) but did not pursue a career in technology. Instead, they went on to become successful professionals who made important contributions to other fields. Nitin Nohria received his B. Tech in chemical engineering from IIT–Bombay and his PhD in management from the MIT Sloan School of Management. In this conversation with Sharmila Sen, he discusses his IIT education and the long-term benefits of an engineering education for a non-engineer. Tell us about what made you choose to enroll in an IIT. Did you imagine pursuing a career in technology? Was it a “choice” or a predetermined path? When I was growing up in India, the two most “sensible” paths that a young person could pursue were to become a doctor or an engineer. Each provided the assurance of a comfortable life. My father was the perfect example. He had become an engineer and was the first in his family to be able to leave his village and do well for himself. I joined IIT–Bombay, because my father’s experience suggested that it was the most sensible path for me. Incidentally, my sister chose the other practical path of becoming a doctor. Broadly speaking, what was your IIT education like and do you think students who are currently enrolled in various IITs have a similar educational experience? My IIT experience—from entrance through graduation—was primarily shaped by how well I could perform on a continuous stream of demanding exams. We were always graded on a curve, all results were transparent, and how Harvard South Asia Institute 63
well or poorly you were doing was common knowledge. It was an educational experience that drove you to perform well within a highly structured and prescribed curriculum. Looking back, how did an undergraduate education in a technological institute in India shape your critical thinking, your social self, your approach to solving problems in your current professional environment? I think my performance on the GMAT exam was one of the reasons I was able to attend graduate school at MIT. For that alone I will always be grateful to IIT. Beyond that, my IIT education trained me to think through difficult problems; to have a broad understanding of science and technology; to be realistic about my strengths and weaknesses; and to feel prepared to survive in competitive environments. What can a liberal arts educational institution learn from a technical institute and vice versa? Should students who may not pursue a “technical” career consider an IIT, or are they better served by a different higher education model? This assumes a certain degree of “free choice” in how one consumes education in India, and you are welcome to correct that assumption if you wish. I think institutions like IIT could benefit from a liberal arts overlay— perhaps a year of the four-year curriculum could be devoted to cultivating a broader worldview; exploring interests outside your specialization; exercising your mind in a wider range of ways of thinking, reasoning, and problem solving. Equally, I think some liberal arts programs, in completely celebrating free choice, risk graduating students who may have no exposure to math, science, and technology. They too might benefit from a modest core requirement that requires a basic understanding of these areas, especially in a world in which technology is so pervasive and important. When you look back on your IIT education and how it prepared you for later challenges in your professional life, is the content or the form— what they taught or how they taught—of an IIT education more salient? I benefited most from the “what” rather than the “how,” though the discipline of test taking was an aspect of the “how” that was very formative.
64 Technology and South Asia
Harvard South Asia Institute 65
66 Technology and South Asia
Courtesy of BMW Werk Leipzig
Courtesy of Harvard College Observatory
From Carbon to Silicon Rohan Narayana Murty
Amazon, Airbnb, and Uber operate in spaces where companies run on traditional business models. Yet, these new-age companies have differentiated themselves from traditional companies by employing novel software systems, illustrating a truth that lies at the heart of every industry: every company, at its core, has increasingly become a technology company—one that is fundamentally reshaped by software. For example a bank of today is a software company that lends money. Software lies at the very core of transformation in every industry. Software creation is a creative endeavor requiring imagination, patience, and careful thought. Hence, until about the late 1970s, several computer scientists believed that to successfully build a large software system, the entire team of software writers must be geographically co-located and in constant communication with each other in order to coordinate effectively on software development. The early 1980s shattered this artisanal view of software creation. The development of the global delivery model, one of modern India’s great inventions in the technology world, changed the way software was built. It distributed the art of writing software across large teams of people around the globe, running relays to build complex software systems. Teams across the US, Europe, India, and Japan transcended geographies and time zones to create a twenty-four-hour working day. This required fundamental innovations in software engineering as software creation had to become less of an art form and more of a process. Its goals and steps needed to be clearly defined and broken down into smaller tasks, which could then be allocated to teams across the globe. This evolution was an example of industrializing software creation, and it has been India’s contribution to the software world, as well as its technological history, for the better part of the last thirty years. It also explains the birth and Harvard South Asia Institute 67
sustenance of the Indian software industry and has changed how global corporations operate. Once built, all software systems must be maintained and upgraded constantly, as they not only evolve with new paradigms in computing, but also inevitably suffer from flaws and bugs. This virtue has afforded the Indian software industry a significant revenue opportunity: Indian software companies not only build bespoke software systems for global corporations, but also maintain, test, patch, and upgrade them. With the advent of networks and the Internet, software systems grew in complexity, spanning multiple machines across multiple geographies. Consequently, the Indian software industry found a gold mine in large contracts for managing these complex systems and networks. Essentially, these revenue-earning streams were all by-products of building software systems for clients. Thus, the last ten years have witnessed a large number of people hired to perform these fairly deterministic tasks—work that follows a set of preexisting rules to be followed faithfully in order to produce a desired outcome. It is in this area that the Indian software industry has not yet done enough to move to the next phase in the evolution of software systems. Hence, what started off as creative innovation, and a lucrative business of software production, has evolved into a more lucrative business of managing human effort at scale. And this is where the Indian software industry has an opportunity to innovate further and change its future. To put matters in perspective, let us consider the history of manufacturing. A hundred years ago, a typical car-company assembly line consisted of scores of people building cars. The early carmakers were artisans and each car was handmade, the proportions slightly different from unit to unit, even in the same models. As demand for cars increased, carmakers had to innovate to mass produce cars, reduce costs, and introduce variety. Eventually, a series of innovations in manufacturing—including to mechanization, the assembly line, division of labor, distribution of tasks, and quality and cost control—gradually improved the productivity of the assembly lines. Today, the artisanal (read human) effort in car manufacturing still remains in designing cars, laying out the plants, choosing the materials, and so on. However, the act of producing a car has been industrialized: the same assembly line has been totally transformed, with physical robots replacing repetitive human tasks. Is there any limit to what human effort can industrialize? Consider one of mankind’s oldest activities—looking up at the sky and contemplating our place in the universe. This human pastime is a romantic trope and the inspiration for everything from religion to poetry to science. Professor Shrinivas Kulkarni, the John D. and Catherine T. MacArthur Professor of Astronomy and Planetary Science at the California Institute of Technology, leads the Palomar Transient Factory (PTF) project. Kulkarni’s team has built software to completely automate the very act of discovering through a telescope. The large telescopes at Mt. Palomar in California constantly scan the sky, look for patterns, and use an 68 Technology and South Asia
array of sophisticated machine learning and digital signal processing algorithms to crunch the observational data in real time, in order to ascertain whether a new discovery has been made. As a result, the cycle time for a single astronomical discovery has been reduced from a two-year time frame in the early 1980s to a mere few hours in the present day. This story should astonish us. Apart from the lamentable obviation of astronomers observing the night sky from telescopes in exotic locations, this transformation is a prime example of how sophisticated software has replaced complex human activity. Or, consider a lesson in the history of computing itself. Over four hundred years ago, the term computer was a job title, not a machine. Computers were often humans hired to perform calculations on data using pencil and paper. In the nineteenth century, Charles Babbage, often referred to as the father of computing, even applied for such a job. In 1913, Harvard astronomer Charles Pickering hired a group of “computers”—mostly housewives—who were taught to execute fairly deterministic steps to process observational data. These women, collectively called the “Harvard Computers,” played a crucial role in the development of modern astronomy. Pickering’s use of human effort to crunch astronomical data had tremendous ramifications on how science and engineering transpired. Subsequently, during World War II, the US government hired large numbers of women computers to crunch navigational, ballistic, and radar data. Back then, computers were entirely carbon-based life forms (read humans). Now, compare that picture with what we see today in the Indian software industry. Despite several advances in computing, we still have scores of people working on deterministic tasks, by-products of software construction, that technology could potentially perform faster and better on its own. Clearly, the work done by human computers of the past is highly deterministic and hence appears very primitive to us today. But twenty years from now, will the work we do today in the Indian software industry appear any less primitive? In many ways, the elimination of redundant mental work is the history of computing itself. In 1821, even Babbage grew frustrated with such mental labor (read human computers) and wondered instead if he could “compute with steam.” The software services industry of today does not appear to have learned from the history of computing, manufacturing, or science. In Babbage’s day, steam was the motive power of commerce. For us, in the twenty-first century, it is silicon. Technology will inevitably obviate the need for the carbon-based labor of today and push us into the Silicon Age, when software will replace large classes of human tasks. While history holds up a mirror, the current reality presents an opportunity to change the future. I do not prognosticate that all creative human endeavors will be dead or that software creation can be performed entirely by software itself. Well, at least not yet. But, there are several deterministic tasks for which the software industry still relies on volumes of human capital. People still believe these tasks require Harvard South Asia Institute 69
human effort, when, in reality, technology will do just fine. While we often confuse “complex” human tasks with those that involve several steps, this is of no consequence to a machine. A first-order litmus test for whether software can eventually perform a human task is this: Does the task require a person to solve a problem that he or she has not frequently seen before? If the answer is no, then the task is almost always deterministic and can be performed by software and replace human effort. An important corollary is that if the first-order test is false and yet people are very productive in performing some tasks, then those tasks are even more amenable to being replaced with software. High human productivity by itself is no defense against automation. Perhaps, the very reason why people are efficient at these tasks today is because they have broken them down into a series of finite and deterministic steps. Excepting professions and activities requiring creative ideation and human interaction, many tasks in our lives fall into the realm of nearly deterministic. The superfluity of human work derives from a fundamental problem: most businesses consume and reshape themselves with technology because they are concerned about productivity. And that is why replacing human effort with software is the logical next step in the evolution of the Indian software industry. The global delivery model has become synonymous with the age of the carbon (human) footprint, where a large number of well-trained people performed tasks at lower costs. The next step is to take this model to its logical conclusion: redirect these tasks from people to machines and dramatically improve speed, accuracy, transparency, and cost. This evolution will require more than empty hype about artificial intelligence, cognitive machines, neuroscience, etc. (These are, after all, bleeding-edge areas of research about which we do not yet understand enough, let alone apply to business contexts.) Instead, it will require an organization whose raison d’être is the elimination of deterministic human effort in the enterprise. How might such technological organization be different from what we see today? It would require the following: • A much deeper use of new computer science ideas, including machine learning, distributed systems, programming languages, software engineering, and statistics. • A new industrialized process that defines and measures human productivity in the development and maintenance of software. • The seamless integration of intelligent software into a human workforce, since not all work may be immediately replaceable with software. • A reexamination of the business models and pricing strategies of our current software service companies.
70 Technology and South Asia
Furthermore, while the cost of human work is inflationary, the cost of intelligent software, by virtue of Mooreâ€™s law, is deflationary. Hence, the cost to the client will have to be reduced continuously and significantly over time. For technology vendors, it entails more pressure on sales quotas. As software systems continue to cannibalize human tasks, we will need to find more meaningful tasks for the human workforce in the Indian software services industry. This has ramifications on hiring, salaries, promotion cycles, and HR practices. Therefore, the software services business model, as we know it, must be re-tooled. This leads to perhaps the most difficult cultural change of all: to stay relevant, the remaining human labor force will need to constantly adapt to and learn technologies that are not yet replaced by machinery; in turn, this will emphasize and invariably alter professional education in the field. Without this constant focus on re-education, we may end up with a labor force that is no longer in tune with the latest trends in technology. Thus far, India has pioneered how software was built and delivered. But now, there is an opportunity to create a giant new shift in the very business model that first made this industry successful. Upon us is a chance for imaginative entrepreneurs who are not shackled by the vestiges of the past to reimagine the next version of the global delivery model: the replacement of human work with software. New innovations and changes in technology and traditional business models will result, and the industry will no longer rely on an outdated carbon (human) footprint to serve global customers. The Age of Carbon is fast fading. The Age of Silicon is here.
Harvard South Asia Institute 71
Photo of Venkatesh Narayanamurti and Bob Dynes. Dynes and Narayanamurti joined Bell Labs in September 1968 and collaborated on more than 40 papers together. They were once known as the â€œBobbsey Twins.â€? Photo courtesy of Venkatesh Narayanamurti.
72 Technology and South Asia
The Renaissance Engineer Venkatesh Narayanamurti
Widely recognized for revitalizing the engineering and applied sciences programs at Harvard, Venkatesh Narayanamurti (fondly referred to as Venky) continues to advocate a liberal arts education for future generations of engineers. In this conversation with Sharmila Sen, he reminisces about his formative years at St. Stephen’s College and offers his vision for a generation of engineers who first learn about the world around them before they set out to solve its problems. Do tell us a little about your own college education in India during the late 1950s. What was it like to study physics at St. Stephen’s at that time? I only have fond memories of my five years at St. Stephen’s, where I got my BSc (Honors) and MSc in Physics. It was a special place modeled after Cambridge, and which championed liberal education. Even though I was a physics major, I was on the track team and their debating team and was elected president of the college union in my senior year. My nephew, the Indian historian Ram Guha, also studied there. Most of my physics classmates joined Indian Administrative Service (IAS), which was modeled after the British civil service. Many of the members of my cabinet in the college union, fellow Stephanians, went on to high office: Arun Shourie, Mani Shankar Aiyar, and Vinod Dikshit are among those I remember. I continue to meet others such as Shankar Menon and Kapil Sibal who also went to Stephen’s. Sadly, I am told the college in recent years has lost some of its luster. Looking back to your St. Stephen’s education, how well did it prepare you for your PhD training at Cornell, and for your professional work at Bell Labs? Are there particular classes, teachers, or even methods of learning you recall from your college days that were especially helpful in the making of an engiHarvard South Asia Institute 73
neer? With 20/20 hindsight, do you feel any regret about the undergraduate or graduate education you and your cohort received in India? The most important part of being part of St. Stephen’s was that it emphasized the broader aspects of going to college—being part of a liberal education and emphasizing extracurricular activities like debating, arts, and politics besides science. That has served me particularly well and shaped some of my thinking on education. I also had some very good physics teachers who knew how to show the broader implications of physics. In the 1950s St. Stephen’s was a preeminent college in India and the IITs were yet to be created. So I had some high-achieving students as my classmates and that always serves as a spur. Much of my graduate and postdoctoral education was in the US at Cornell. That of course had a major impact on me—a way of thinking which is unique to the US emphasis on curiosity, exploration, and problem solving. In retrospect, in India there is much greater emphasis on memory testing and on rote learning. My subsequent research experience at Bell Labs was what gave me the truly balanced view of the joys of combining science and engineering and working with exceptional colleagues involved in inventing the future. So, St. Stephen’s, along with Cornell and Bell Labs, were all critical in my early formative years. In recent years there has been a renewed focus in the United States—arguably fueled by a diffuse sense of economic insecurity—on STEM subjects in both secondary and higher education. Often American students are compared unfavorably to their peers in other Asian countries. As an educator in the field of science and engineering, you have had decades-long experience and a global perspective on STEM education. How does the American secondary school system compare to Indian or Chinese systems in this area? How does American higher education in STEM subjects compare to these same nations? It is well known that economic development is intimately tied to technology development. In Asia engineering is more often viewed as the path to personal success, than it is in the US. In India, for example, the brightest students often go to the IITs. High-achieving Asian families encourage their children into STEM fields, and they are generally extremely good in mathematics. The US culture, on the other hand, is far more entrepreneurial, and that works as a tremendous magnet to draw students from Asia (for graduate education), who often become leaders in Silicon Valley, to the US. In postgraduate education the US has some of the most leading universities because of the linking of research excellence in our higher education system. This gives us a competitive advantage. The US, as a land of immigrants, has learned how to meld different cultures more effectively than any other nation, and that is a true competitive advantage in the global landscape. 74 Technology and South Asia
Venky, how do you view the evolution of engineering education? What should such an education look like in the future? I am most familiar with the evolution of engineering education in the US and more recently globally through my deanships at the University of California–Santa Barbara and then at Harvard and in initiating (in 2008) the Global Engineering Deans Council with a few international colleagues to prepare engineers to address global societal challenges. Engineering education accreditation in the US was limited in its breadth because of its need for a strong grounding in math and physics and as it had to cover the breadth of knowledge necessary for the various disciplines of engineering (civil, mechanical, chemical, electrical, etc.). Engineering is almost the only profession with an undergraduate degree, while other professions such as medicine, law, business etc., usually professionalize at the master’s and higher levels. So a considerable rethinking has been occurring on when to introduce the essence of engineering, which involves creation of new designs and inventions to address problems of society. Engineering, in my view, is really the ultimate “liberal” art, entailing concepts not only from the sciences, but also ideas for solving societal problems; in a sense all technological systems are socio-technical systems and are human creations just like art, and yet they must function to address issues humans face. I often showed my students a commencement speech by Steve Jobs on the intersection of engineering and the liberal arts where he said, “It’s in Apple’s DNA that technology alone is not enough. It’s technology married with liberal arts, married with humanities, that yields us with the result that makes our heart sing.” At Harvard, I coined the word “renaissance engineer”—an engineer who knows not only how things work but also how the world works! This broader view of the role of technology and its connections to society needs to be an important part of how we describe engineering and engineers, and a critical component for enhancing diversity and getting away from the perception that we are just “nerds.” There is room for specialization and deep understanding, but that needs to happen after exposure to the broader landscape and the essence of engineering. Many colleges in the US are in the process of rethinking engineering education along these lines, to combat specialization at too early a stage. This movement is still weak in other parts of the world, including in India at the IITs, in my view. In fact, in countries like the former Soviet Union and China, the preponderance of training was in highly specialized engineering disciplines. This needs to change. The US National Academy of Engineering (NAE) has been advocating such broadening activities through its championing of the Grand Challenge Scholars Program with several US university partners, and, in my recent role as foreign secretary of the NAE, I organized a joint symposium with our Indian counterparts to adopt this line of thinking.
Harvard South Asia Institute 75
Courtesy of Ginny
76 Technology and South Asia
Trouble in the World’s Back Office Sudhir Chella Rajan
Within twenty miles of Chennai, along any of three dusty and bustling highways headed south or west of the city, one passes by at least a dozen college campuses speckled with a few young trees, elaborate gates, tall compound walls, and occasionally curious acronyms such as RRASE preceding the words “College of Engineering.” Little activity seems apparent outside, but the campuses are usually busy inside, with several hundred students managing brutal classroom schedules. Most are coeducational institutions, but there is also a famous women’s college in the vicinity. Tamil Nadu, the large southern Indian state in which Chennai is located, has about 580 engineering colleges, and is second only in its population of such colleges to Andhra Pradesh, its northern neighbor. Most of these colleges are self-financed or private. While many used to be quite competitive, in the past two years significant numbers of seats have remained unfilled, in part because of the very proliferation of these campuses. Throughout India, the growth of engineering colleges over the past decade has been phenomenal. Engineering enrollment in the country went from about half a million in 2006 to over 1.5 million in 2015. Responding to the increase are the now over 3,500 engineering colleges and about 2,200 polytechnic institutes providing vocational training. The city of Chennai itself has several engineering colleges, the most prominent of which are Anna University and the Indian Institute of Technology (IIT)–Madras, where I teach. IIT–Madras is one of the original five IITs inaugurated by Jawaharlal Nehru, India’s first prime minister, whose abiding vision was one of a technologically led nation. IIT alumni, as well as engineers from elsewhere in India, are famous around the world for their leadership Harvard South Asia Institute 77
roles at various levels of academia, government, and industry. In addition to the original five that are about half a century old, more than a dozen new IITs have opened in the past decade or so. IITs have developed the reputation for having severely competitive entrance procedures, resulting in a 1–2% rate of admission. These days, they also attract media attention for the eye-popping salaries that global firms like Google, Amazon, Goldman Sachs, and Deutsche Bank offer to top graduates. Most of these jobs are not connected to technology as such, but are typically in sales, software development, data analytics, or management consulting. Fewer than a third of IIT graduates tend to take up core engineering jobs; indeed, most join the institute in their late teens assuming that their careers will not be in engineering, and that the IIT degree is simply a gateway to finding better opportunities later. For most other engineering graduates, however, salaries are more modest, although their expectations for career advancement in and beyond engineering jobs are quite high. The most attractive domestic recruiters, such as Wipro, Tata Consultancy Services, and Infosys, mostly manage outsourced jobs for international banks, financial firms, and software developers. It is perhaps because the IIT entrance exam weeds out so many aspirants that engineering colleges beyond the IITs have become so significant, with several coaching institutes and consultants also popping up to help high school students organize their academic choices. Even now, some two decades after India was identified as the great “back office” to the world for major international software, finance, and accounting firms, it is still an attractive destination for consolidators, disparagingly termed “body shops.” From their standpoint, it does not seem to matter that someone was really trained to learn to build bridges or chemical factories; what they are really useful for is their knowledge of computer programming or their ability to learn Java and other tools relatively easily compared to someone with no prior technical training. Since about 2008, however, India’s preeminence in providing this cheap labor pool has been challenged by other contenders from Latin America, Eastern Europe, and elsewhere in Asia. The structure of these jobs has also changed, often requiring flexible, short-term contractual work, rather than long-term work for larger firms. At IIT–Madras, my home is the Department of Humanities and Social Sciences, the group of faculty on campus responsible for delivering over two hundred courses a year in various subjects ranging from disciplines like literature and philosophy to history and economics. We also teach a small group of non-engineering students in a five-year integrated program leading to a master’s degree in development studies or English literature. My colleagues and I perhaps present an odd view of liberal arts education to the 3,000-odd undergraduate engineering students in our institute. Most of them have never previously taken a course outside of science, technology, 78 Technology and South Asia
engineering, and mathematics (STEM) during high school or college. Though IIT students are faced with a broad selection of over fifty courses, they typically only have enough time to take just three humanities electives in separate semesters. There is always enormous enrollment in a basic economics course, which my department now offers in five separate sections. Though students are often stuck with an eclectic assortment of humanities electives by the time they graduate (e.g., “Literature and Life” in one semester, “Financial Economics” in the second, and “China in Contemporary Global Politics” in the third), alumni often tell us years later that they found the courses “inspirational” or “novel.” Occasionally, an engineering student will spend more time at our department seminars and events than at his or her own, or will seek permission to audit humanities courses and help faculty with their research. Such a student may even find a way to do a master’s or PhD abroad in the humanities or social sciences, since most universities in India are not flexible enough to allow admission to graduate students regardless of their background. Most often, however, IIT students join the great stream of jobs in consulting, finance, or civil service that the rest of their cohort are already tuned toward, or turn to some form of social entrepreneurship. No one seems to know why the rush toward engineering education has abated in recent years. Newspapers have been reporting that several colleges around the country have not been able to find enough students this year, a situation not unlike 2014, when nearly half the seats remained unfilled. This is not true of IITs, for which record numbers of high school graduates continue to fill coaching programs for writing their tough entrance exams. But, for most other colleges, some clues for the declining interest may come from the engineering profession itself. In spite of producing more than a million engineers each year, the industry claims that most graduates are unemployable because they simply lack the skills and hands-on training needed for actual civil, chemical, electrical, or mechanical engineering work. Instead, they have a knack for computers and can write programs easily. With a decline in the growth of software jobs, a glut in supply, and a general perception that those trained as engineers in India really do not have the skills or motivation to focus on technology, several hundred of the new engineering colleges that still have reputations to build may soon find themselves in trouble. IIT graduates and those from the higher-rated engineering colleges are not likely to lose very much in this downturn. But the hundreds of thousands of other students may not be so lucky. Long-time observers of engineering education point to other dire problems. The first has to do with the theory-practice divide that afflicts many types of professional education. Engineering curricula in India tend to be heavily oriented toward mathematical puzzle-solving, rather than the practical, hands-on operations needed on the shop floor. Finding appropriately trained recruits with the requisite skills seems difficult among the large pool Harvard South Asia Institute 79
of students mostly uninterested in core engineering subjects but who were instead drawn into the profession by peer pressure, parental influence, and the lure of better opportunities. Another issue may be the limited forms of innovation within domestic engineering firms. In manufacturing, the most lucrative jobs involve those that have tie-ups with international companies, but, even there, the work is contractual or licensed assembly rather than development of new products. Ironically, much of the actual innovation taking place in India is within the informal economy, captured in the street term jugaad, which simply implies making do with available materials. If self-taught technicians and product developers have to make do with off-the-street forms of engineering knowledge they have gained, then the million and a half engineers that India produces seem to be doing far less of the job they were really trained to do. For administrators in the vast majority of engineering colleges, the future may not be so dim after all. Of late, there has been talk about integrating medicine, law, and the sciences into universities. It is possible that some engineering colleges may indeed diversify to include these disciplines. Alternatively, given the way land prices have been booming in and around cities, it is possible that campuses may simply give way for housing estates and gated communities. Engineers themselves, however, may not be so lucky.
80 Technology and South Asia
Harvard South Asia Institute 81
Courtesy of Yoga Balaji
82 Technology and South Asia
Merit and Caste in Indian Engineering Ajantha Subramanian
In India today, the term “merit” is a ubiquitous term that generates a lot of political heat. Over the post-independence period, it has come to reference caste distinctions that have had a longer social life than others. The relationship between merit and caste is debated in a variety of arenas but none more vocally and consistently than in engineering education. Engineering education in India took off after independence as part of the state’s technologically oriented model of national development. Initially, engineering training was principally a state effort but, from the early 1990s, many private actors entered this lucrative field. Today, India has over 4,200 engineering colleges, with Andhra Pradesh and Tamil Nadu leading the growth with 960 and 934 colleges, respectively. Within the world of Indian engineering education, there is a recognized hierarchy of institutions. Those considered most “meritocratic” are the Indian Institutes of Technology, or IITs—the focus of my research. Over the post-independence period, the IITs have become the most coveted institutions of higher education in India. The Joint Entrance Exam (JEE) to gain admission to the IITs is held every April and is a hotly anticipated event. Since the exam was first held in the early 1960s, the number of candidates has grown steadily with over 1.3 million students taking the exam in 2014 and under 3% gaining admission to the now nineteen IITs. Every year, exam “toppers” become instant celebrities, with their faces and “All India Ranks” splashed over newspapers and billboards. The success of the IITs has also spawned a massive coaching industry to train students for the JEE. With key outposts in the states of Andhra Pradesh and Rajasthan, coaching centers now admit students from as early as the seventh grade who spend up to five years mastering Harvard South Asia Institute 83
a single exam. That families are willing to invest money to send children to coaching centers speaks volumes about the anticipated payoff. Over the post-independence period, the “IITian” has become exemplary of Indian merit. But what are obscured in public assessments of the IITian’s innate intelligence and competitiveness are the social advantages that have enabled admission to the IITs. The majority of IITians come from high-caste families of bureaucrats, schoolteachers, and academics, where social capital has long been held in education. While they are arguably from middle-class backgrounds, the value of their educational capital has suddenly spiked from the reorganization of late twentieth-century and early twenty-first-century capitalism around the “knowledge economy.” Now, IIT graduates join companies like Amazon, Google, Microsoft, Shell Oil, Tata Consultancy Services, or Infosys for starting salaries considerably higher than those of their parents, after a lifetime of work. Significantly, and despite the IITs’ reputation as top-tier engineering colleges, most IITians have left engineering altogether in favor of more lucrative careers in computer science, finance, and management. Now, it is the graduates of lower-tier engineering colleges with far more socially diverse student bodies that populate the industrial workplace. What we are seeing, then, is the reproduction of caste privilege through a highly stratified system of technical education and professional tracking. At the same time, IITs have been misrepresented as casteless meritocracies. Moreover, attempts at opening up these institutions to low castes through quotas, or “reservations” as they are known in India, are consistently met with fervent opposition, not in the name of caste, but in the name of preserving “merit.” This was the case both in 1973 when a 22.5% quota was implemented for Scheduled Castes and Scheduled Tribes, and in 2006 when a 27% quota was instated for Other Backward Classes. While the leveraging of meritocracy against redistributive justice is not limited to the Indian context, here, the public debate around merit is particularly shrill. In part, it is triggered by the intense competition for seats in the more desirable educational institutions. It also reflects the constitutional language of redress that has framed popular discourse around merit and caste in India. Within the constitutional assembly debates leading up to independence, caste was widely regarded as a part of Indian social organization that would and should be abolished with social progress. At the same time, there was a stated commitment to redress for those groups who were historically disadvantaged by the institution of caste. Paradoxically, the very language of redress ended up reinforcing the idea of high castes as meritorious and beyond caste status. We see this clearly within reservations policy where only the historically disadvantaged are named as castes, while the historically privileged appear simply as the “general category” of casteless, individual citizens. Within the educational domain, the correlation between the “general category” and castelessness becomes even more charged when we consider the 84 Technology and South Asia
other term for the “general category”: “merit-based” admissions. Rendering the general, the casteless, and the meritorious as equal reinforces the idea that those who fall within the general category do so not on the basis of any caste advantage, but simply by virtue of their merit. This distinction between the general/meritorious/casteless and the reserved/unmeritorious/caste-based has profoundly shaped the debate around educational equality in India. It has allowed those who fall within the general category to argue that it is the reservations system itself, and not historical caste privilege, that generates inequality and undermines the modern democratic ideal of equal citizenship. Debates surrounding caste and merit at the IITs echo such assumptions about the general and the reserved. My own ethnographic research has been focused on IIT–Madras in the southeastern state of Tamil Nadu and it is from that work that I draw most of my observations. At IIT–Madras, discerning who is truly meritorious is an ongoing preoccupation. For one, students who gain admission through the general category are assumed to be high caste. This came across clearly in a story narrated to me by a low-caste Tamil alumnus from the early 1990s. He was changing his clothes when his Tamil Brahmin roommate inquired into the whereabouts of his poonal, the sacred thread worn by male Brahmins. The alumnus narrated to me, “When I told him that I don’t wear one, he paused and then asked, ‘Doesn’t your mother get upset?’ It never struck him that I was low caste. In fact, I think he still assumes that I’m from a particularly liberal Brahmin family.” This student’s experience speaks to the explicit marking of general-category students as high caste and the associated assumption that low castes could not possibly gain admission through open competition. This common assumption about low-caste intellectual inferiority leads to the routine denigration of quota students, who are perceived as having no merit and of having taken seats away from deserving high castes. The prejudice against low-caste IITians has only increased after the implementation of the 2006 quota. The recent influx of low-caste students is seen as eroding the original character of IIT–Madras and its association with academic excellence. Moreover, there is a palpable sense that the exceptional status of the IITs that served earlier graduates so well in the marketplace is being systematically undermined by the increased presence of “the reserved.” To put it bluntly, the reserved are seen as threatening the brand value of the IITs. At IIT–Madras, contempt is not leveled only at “the reserved.” A different set of pejorative assessments is made with regard to JEE coaching. The explosion in JEE coaching has generated new anxieties about the ability of the exam to select those who are truly meritorious. In particular, low-caste and lower-middle-class students from Andhra Pradesh who started to arrive in large numbers in the 2000s, resulting from the explosion in JEE coaching in their state, are seen to have attained admission through their rote learning ability, but not by virtue of their intelligence. The distinction between the “coachHarvard South Asia Institute 85
ing factories” of Andhra Pradesh and the more exclusive coaching centers of Chennai, populated by the city’s high-caste students, reinforces the equation between being high caste and having merit. In all these ways, high-caste IITians claim to have a monopoly on merit. But such distinctions between the meritorious and the reserved do not account for the starkly unequal caste histories of education and white-collar employment that have made Indian education anything but a level playing field. It bears mentioning that, sixty-eight years after independence, most public “centers of excellence” that until recently were exempt from quotas continue to be overwhelmingly high caste in composition. This is equally the case in the most rapidly expanding spaces of private-sector employment, such as IT, with its largely high-caste managerial class. These patterns reveal the enduring salience of caste privilege as an indicator of success and the fallacy of defining merit as an innate, individual trait. So what are some takeaways from this research? First is the role of technical education in caste formation. Rather than serve as a space for universal knowledge where caste is no longer relevant, what we see in the technical sciences is the reconstitution of caste. The high-caste claim to merit is even legitimized by a leveraging of these forms of knowledge that appears to transcend culture and identity. What this suggests is that caste is both resilient within and foundational to the makeup of the most modern, apparently identity-free, institutions. Second is how we understand the relationship between meritocracy and democracy. By bracketing out historically accumulated privileges and disadvantages, the notion of meritocracy, like that of a color-blind society, has come to service the reproduction of privilege. Of course, the ideal meaning of meritocracy as a system that corrects for historical privilege has not vanished. However, the gradual divergence between its ideal meaning and its social life that so clearly comes through in ethnographic analysis should call into question the easy assumption that meritocracy is indeed a leveler of opportunity.
86 Technology and South Asia
Harvard South Asia Institute 87
Courtesy of Adam Jones
88 Technology and South Asia
Technology for the Poor Tarun Khanna
Why are the poor generally underserved by technology? Researching this question had been a principle vocation of mine for the past two decades. A common answer is that new technologies tend to be expensive to bring to fruition, not just because of the research and development that goes into their gestation, but also because they have to subsequently be adapted to and customized for the poor. Since the poor do not have the capacity to compensate entrepreneurs for the cost of resources dedicated to pull this off, their technological needs go unmet. One sees this rich-world neglect of the lower demographics most poignantly in the so-called orphan diseases category, where research on treatment of diseases that disproportionately afflict the poor remains quite scarce. Orphan diseases include some that are rare across the board and don’t discriminate based on affluence of the afflicted, but they also include diseases that primarily still afflict the poor—think malaria and tuberculosis, which are still the scourge of many, as well as sleeping sickness and Chagas disease, for example. Now, some entrepreneurs are addressing such rare and treatable diseases. For example, the Cambridge-based science team founded by Henri Termeer at Genzyme, subsequently part of the French pharmaceutical giant Sanofi-Aventis, has made a viable business out of treating rare diseases. Other organizations, like the Gates Foundation, generously support some research. But the overwhelming fact is that the poor’s diseases are systemically under-addressed, and the neglect is not limited to drugs; surgical capacity is also woefully inadequate in the developing world. This predicament prompts a number of questions. First, how do we get the technology in question to the poor, or the poor to the technology? The access Harvard South Asia Institute 89
issue is obvious at one level: of course, the technology is useless without it actually reaching the poor, but we must understand why this matter remains largely unacknowledged and mishandled. I have seen this firsthand over the years at surgeon and philanthropist Devi Shetty’s Health City in Bangalore—now quite a massive complex, though I’ve watched it evolve almost from its inception. Here, immense resources are poured into helping patients access the hospital: through health education camps and transport services, or otherwise—through satellite-based telemedicine to triage their needs, through financial subsidies allowing them to take time off work for healing and treatment, through insurance schemes reimbursing them for lost compensation, and so on. In my work, I have referred to such ambient barriers to reaching the underserved as a series of “institutional voids.” The “void” refers to mechanisms, physical or otherwise, that we take for granted in the sheltered West, but which are missing or are in various ways inaccessible to the global poor. Shetty’s team has done an excellent job at addressing such voids proactively, efficiently, and viably, partly on their own, and partly by coaxing civil society, other entrepreneurs, and even the state on occasion. A second concern is how the poor engages with technology, how they “behave,” as it were, when face-to-face with it. Now, social scientists have started to research such behaviors and proudly append their professional titles with the word “behavioral” to indicate this relatively new-fangled interest (for example, behavioral economics; behavioral finance; behavioral strategy). This verbal accoutrement complements those from the engineering side enthralled with socalled man-machine interfaces, though their concern is not particularly, or even occasionally, with the poor. While adequate consideration of the poor’s behavior toward various types of technology is crucial, that research is still in its infancy. As I gathered from Shetty’s hospitals, the starkest illustration of these behavioral factors was the realization that the poorest and most vulnerable—even when requiring urgent care such as heart surgery—simply did not believe that such state-of-the-art hospital services were or could be available to them. This psychological limitation is often a significant barrier to them being treated. The sad reality is that the poor are conditioned not to expect care, and that presents further impediments to providing technology to the poor. Another telling example of such behavioral issues is the hospital’s provision of free telemedicine diagnoses to villagers in remote communities. I often witnessed a surgeon providing verbal medical advice for a typical heart patient—in rural India, frequently an emaciated man in his forties or even late thirties, as heart disease often strikes early—and addressing his treatment instructions to the women who accompanied him (usually a wife or daughter). The reality is that the medical instructions are followed much more closely in these circumstances. However, while the patient and his family would verbally comply, that is no guarantee of adherence to treatment; nor is a family member playing the role of doctor adequate treatment in and of itself. In 90 Technology and South Asia
such an instance, determining how to transport the bewildered patient to a medical facility and see through an appropriate care program required its own experimentation and creativity. Still, sometimes the poor are better technology users, more adept and adaptable, than the better-heeled. The so-called lead sectors of mobile phone–enabled services—initially banking and remittances, but more recently health, agriculture, and the like—have mostly involved the poor, in Kenya and Bangladesh, for example. A third factor concerns society’s rules and regulations. As technologies become more widespread and their usage patterns better understood, their boundaries will also evolve. However, it is axiomatic that some social norms will delay the development and deployment of new technologies. We see this in concerns about genetic testing and genetic modification of embryos, for example, an area full of possibilities for treating all manner of diseases, a potential ethical minefield. As it affects the poor, genetic technology is all the more important. Being poor is normally correlated with being less formally educated, less adept at handling the vagaries of the world, and therefore more susceptible to exploitation by the privileged. Factoring in this vulnerability of the poor should not burden the entrepreneur; it is in fact his responsibility to consider and develop viable means of including and treating the less fortunate classes of our society.
Harvard South Asia Institute 91
CODA For a whole year he sought to accumulate the most exquisite Dacca gauzes. —Oscar Wilde, The Picture of Dorian Gray Those transparent Dacca gauzes known as woven air, running water, evening dew: a dead art now, dead over a hundred years. “No one now knows,” my grandmother says, “what it was to wear or touch that cloth.” She wore it once, an heirloom sari from her mother’s dowry, proved genuine when it was pulled, all six yards, through a ring. Years later when it tore, many handkerchiefs embroidered with gold-thread paisleys were distributed among the nieces and daughters-in-law. Those too now lost. In history we learned: the hands of weavers were amputated, the looms of Bengal silenced, and the cotton shipped raw by the British to England. History of little use to her,
92 Technology and South Asia
CODA my grandmother just says how the muslins of today seem so coarse and that only in autumn should one wake up at dawn to pray, can one feel that same texture again. One morning, she says, the air was dew-starched: she pulled it absently through her ring. —“The Dacca Gauzes,” from The Half-Inch Himalayas, by Agha Shahid Ali (1987)
He reached the head a few minutes before the precise hour for the eye ceremony. His nephew was there, waiting for him. Ananda had climbed this ladder a day earlier and so knew he would be most comfortable and efficient two rungs from the top. He used a sash to tie himself to the ladder and then his nephew passed him the chisels and brushes. Below them the drumming stopped. The boy held up the metal mirror so that it reflected the blank stare of the statue. The eyes unformed, unable to see. And until he had eyes—always the last thing painted or sculpted—he was not the Buddha. . . . The noise of his hammering stopped and there was just the wind around them, its tugs and gusts and whistles. He handed the tools to his nephew. Then he drew from a satchel the colours for the eye. He looked past the vertical line of cheek into the landscape. Pale greens, dark greens, bird movement and their nearby sounds. It was the figure of the world the statue would see forever, in rainlight and sunlight, a combustible world of weather even without the human element. —From Anil’s Ghost, by Michael Ondaatje (2000)
Harvard South Asia Institute 93
94 Technology and South Asia
Harvard South Asia Institute 95
The Harvard South Asia Institute presents its third annual publication, a collection of essays by professionals from diverse disciplines abo...
Published on Jan 14, 2016
The Harvard South Asia Institute presents its third annual publication, a collection of essays by professionals from diverse disciplines abo...