Book Review: Silver Lining - Overcoming Adversity to Build NephroPlus, By Kamal Shah

Take any start-up and the chances are you will find an incident or trigger which caused the entrepreneur to found the start-up, with the noble intention of solving a problem or pain point. Nephroplus, a dialysis service provider, founded by Kamal Shah and Vikram Vuppala, to provide patient-centric dialysis treatment in India, also has a “story” behind it. However, this story is a far-cry from the usual start-up story. In 1997, Kamal Shah, one of the co-founders of Nephroplus, was hit by kidney failure at the age of twenty-one when he was on the verge of departing for the US for his master's degree. After the US Consulate in Chennai approved his student visa, Kamal took his extended family in Chennai for lunch at a restaurant called Dasa on Mount Road, which apparently served the best dosas in Chennai, before returning to Hyderabad. In Hyderabad, a mild fever, which Shah initially put down to the various vaccinations he took before his impending departure to the US, deteriorated into a full-blown emergency. After a kidney biopsy at Hyderabad’s Medwin Hospital, Shah was diagnosed with an atypical hemolytic uremic syndrome (AHUS). Shah started kidney dialysis and further complications ensued. A second doctor at Kamineni Hospitals diagnosed the problem as Acute Tubular Necrosis (ATN). Shah kept hoping that a cure was around the corner and that he would depart for the US pretty soon. He was so wrong.

Shah’s first dialysis session was a nightmare. On his way out of the dialysis centre after his first, Shah met a lady who was having her ninety-fourth one! Ultimately, it was decided that Shah needed a kidney transplant. Shah’s mother generously volunteered to donate a kidney, but the renal transplant was unsuccessful. Shah’s trauma continued.

Soon Shah got used to the frequent dialyses and learned to live with his condition. He later moved to peritoneal dialysis (PD), whereby dialysis happens without an external machine. PD made Shah’s life easier. He even took up a job at Suma Computers and learnt Visual Basic. With PD, it became possible to take holidays. He later moved to a software firm started by Obul Kambham (who had moved back to Hyderabad from the US) that focused on the Apple Platform . In December 2004, Shah and a few colleagues took a holiday at a resort in Mahabalipuram, experienced the Tsunami and lived to tell the story!

Shah mentions the names of many good doctors and technicians who helped him to slowly improve his lifestyle. Jayaram, the lead technician at KIMS is one of them. Thanks to Jayaram’s support, Shah was able to switch to home haemodialysis. His energy levels improved, and he could work for eight to ten hours a day. He started to go for a swim every day. Then, in 2007, inspired by his work colleague Akbar Pasha, Shah started a blog. Initially, his blog was on various topics that caught his fancy, including his journey with his kidney disease. However, his posts about his dialysis experience touched a chord with patients and those involved in nephrology. Shah got questions about various aspects of his disease, which he answered. His readership climbed up steadily. One day in 2009, Vikram Vuppala who had worked for Mckinsey in the US, came across Shah’s blog when he googled for ‘dialysis in India’. The rest is history.

After Shah and Vuppula founded NephroPlus, it slowly grew to become Asia's leading dialysis networks with 320+ centres across 4 countries, including India, Nepal, the Philippines and Uzbekistan. How did Shah and Vuppula achieve overwhelming success with Nephroplus? In addition to implementing many innovations which cut down the risk of infection, they started to treat dialysis patients as guests and also followed a 'guest care comes first' policy. They received VC funding. I am not going to give more on this away, other than to say that towards the end of the book, we see Nephroplus acquire a competing business run by US giant DaVita.

Shah writes in simple, but beautiful English which makes the reader glide over the story, even when it details so much hardship. Shah’s matter-of-fact approach to his ailment is reflected throughout and it is very likely that such calm, unruffled demeanour is one of the reasons for Nephroplus’s success. Silver Lining- Overcoming Adversity to Build NephroPlus is a very unique memoir by an entrepreneur which will not fail to strike a chord in any reader, especially in a reader who appreciates courage amidst adversity, despair and hopelessness. Also, Shah’s tome details so many problems which India’s healthcare industry in general and dialysis patients in particular face and will be a boon to anyone who wants to address these issues.

Go on, get hold of this book and read it. Highly recommended. 

An Interview with Sarah Khan

Dear Readers, I would like to introduce to you to my friend and former classmate Sarah Khan. Sarah is a lawyer by training and has focused on public international law for her entire career. Her focus has been international humanitarian law, human rights law and refugee law and their applicability primarily in zones of conflict and natural disasters. Her work expertise is known as “protection” - i.e., the protection of rights of refugees and displaced populations and other civilian population.

Her work has involved implementing these various international laws, by supporting the development of: government legislation; policies for governments, international organizations (including UN country teams- that is all UN entities in one country), and civil society; training programs for various entities including, armed forces and national security actors; establishing monitoring systems to track the situation of people in zones of crisis including, access to humanitarian assistance and services such as, education, health and legal aid; and advocacy on crisis situations. In the last few years, Sarah has worked in management, heading offices and has had less to do with law. Her day-to-day work has been managing  governmental relations, budgets and staff and overseeing programs on health, education, livelihoods, legal aid etc., for populations in crisis areas.

Sarah has worked with various NGOs and at the Red Cross prior to working for the United Nations High Commissioner for Refugees (UNHCR) as a Senior Protection Officer and then Head of Office. Her work has taken her to various places in Asia, Africa, Europe and North America. She notes, a happy accident gave her over 12 years of incredibly rewarding work with UNHCR. She has worked in some of the significant crisis’ of recent times, including, Afghanistan, Libya, Myanmar, Somalia, Sudan and Syria.  She has worked with UNHCR both in a country (colloquially called “the field) and at its headquarters -- however, her real love has been working in “the field”.

Sarah has very kindly agreed to tell us a bit about her experiences at UNHCR and give some career advice to budding public international law students who may wish to work for the UN or an International NGO  or a think tank which focuses on situations of humanitarian crisis.

Winnowed: Sarah, thank you so much for agreeing to spare a few moments and talk to Winnowed’s readers.

Sarah: It’s my pleasure and thank you for asking. I’m always happy to help law students who are interested in global affairs and  who see themselves as future public international lawyers.

Winnowed: Tell me, if a law graduate wants to work for the UNHCR, is doing a masters’ degree in public international law from a Western university still the best route into that domain? Also, are there other public international law opportunities for students other than the UN?

Sarah: There are many positions in UNHCR and other UN entities that are not just for people with a master’s degree and it was never ever the only way. However, a masters’ degree may make it possible to be recruited directly to a higher position in the UNHCR or other entities within the UN. The best way to understand what is required is by looking at the job descriptions of various positions that interest you and talking to people who work there is key.

There are different paths to join any UN entity. People have started in the UN as national officers in the country that they are from and then moved to overseas positions. So please do consider working in New Delhi UN offices as a start. Others have joined the UN Volunteer Program, which enables you to work for different UN entities either in your own country or overseas. After 5 years of service (please check if the number of years required has changed) as a UN volunteer, one can get a regular staff contract (UN civil service). The UN volunteer program is paid. There are others who have had a Junior Professional Program post with a UN agency (these are not always open to Indian nationals and are very few since they are funded by a select group of wealthy countries). I joined UNHCR as a consultant, as many do and then you apply for regular position. There are also roster positions in a lot of UN entities – where you get selected and then when a position is opened your name is selected from the roster for the position.  There is a common system for the UN secretariate for UN peace keeping, political affairs, legal affairs etc. and then the UN specialized agencies like UNHCR and UNICEF  have their own systems. You need to study each entity to understand what the methods are since new things keep getting added over the years in terms of employment schemes. I apologize that it is not simple!

After NLSIU, I opted to go to the Fletcher School of Law and Diplomacy at Tufts University in Boston for a master’s in law and diplomacy (International relations with law). Graduate school broadened my sense of the world and the career possibilities. I am thankful for that. I will list here what I did -- in case any of these entities interests the reader since they are all in human rights and related areas and beyond just the UN.

The opportunities included a paid internship at Calvert Investments (an American social responsibility firm), where I worked on developing human rights indicators. I chose that over an unpaid internship at the UN office for Legal Affairs at the UN Secretariate in New York. I believe now there are a number of UN paid internships available with different UN entities, which students reading this should check out. Note UN internships are competitive and limited but not impossible to get. Fletcher also nominated and funded me to intern with the US Institute for Peace (think tank), who put me on a project for the Pearson Peacekeeping Center in Canada. Some years later, Pearson recruited me to do trainings for NATO forces deploying to Afghanistan and  senior military officers in UN peace-keeping missions around the world --  as I had previously interned with them.

I was at Fletcher when 9/11 took place, and like a lot of young people working on global affairs then (scholar Michael Igantieff has written a great essay on this!) - I wanted to go to Afghanistan. My professor at the Kennedy School at Harvard University found me funding to go work for a tiny civil society organization in Kandahar, which was working on out-reach to women to increase their political participation in Afghanistan’s first “Loya Jirga” deliberations after the fall of the Taliban (note: Fletcher School, Harvard and MIT students can cross-register for classes with each other). In the same year, I got funding from Fletcher to intern for an American NGO, Mercy Corps in Tajikistan (I was tasked to write a report suggesting ways human rights could be incorporated into conflict resolution programs they were running there). As a result, I suspended my graduate degree for a year and half, which, luckily, Fletcher allowed me to do. These  were amazing opportunities for me as young person and I seized them when offered – so keep a look out to see what all is out there and it might be not what you have planned or foreseen. It did help my CV stand out in my initial job applications and led me to my first paid international job with Oxfam GB in Afghanistan, and it counted that I had worked in the country as an intern.

Winnowed: If I am in the fourth year of my five-year law degree in India, what should I do to create a career in the field of public international law?

Sarah: I cannot speak to the entire field but at least vis-à-vis the UN humanitarian and political actors, I would advise students to identify what interests them. The UN is vast with different entities dealing with different aspects of public international law. I would identify what interests you in the area of public international law and then check out the entities which deal with it and then apply for an internship there. Internships give you an idea of the place but also make you become a known entity for future job applications.  For example, if you are interested in human rights, do an internship with a human rights NGO or even UN offices like UN Women or UN Development Program which have representation in New Delhi. If you can afford an internship overseas as some Indian law students have done, then please do so. From NLSIU I know some who interned with International Criminal Tribunal for the former Yugoslavia (ICTY) in the Hague and subsequently got jobs there. Many from ICTY now work for the International Criminal Court.

Of course, you can write and publish on a topic that interests you and that too is a plus.  Academia is another great route to work for the UN as an expert further down the line in your career, if you so wish.

The key is to take opportunities on offer. Do also try to ask for opportunities and show an interest in your topic. While at NLSIU it was clear to my professors that I was interested in public international law, and I did get very good grades in that subject as opposed to say contract law. So right after I graduated from NLSIU, I got offered my first job with the International Committee of the Red Cross (ICRC) in Delhi by my former international law professor at NLSIU who became their regional advisor for South Asia. I still remain in touch with him and am thankful that he gave me my first big break. Working for the Red Cross for a year did wonders for my CV and helped me get into a master's program of my choice. A Red Cross contact became my reference for my job with Oxfam later in time since the Red Cross has a certain gravitas for other actors in the international law/humanitarian field. Both UNHCR and ICRC have a lot of lawyers working for them.

Winnowed: You’ve learnt French, haven’t you? How useful do you it think it’s to learn a foreign language when working in the field of public international law? 

Sarah: I just can’t emphasize sufficiently how important it is to learn an international language, in addition to English. Of course, it is much easier to learn an additional language when you are young. Most South Asians are bilingual, if not trilingual. However, that doesn’t mean one is not able to pick up an international language as an adult. In this area of work many learn foreign languages as adults since it increases your geographic work opportunities. Those who work in the foreign services of large governments learn new languages prior to each diplomatic posting. You need to be open to the possibility and have a willingness to put in the time and effort.

I have studied French for some years and have also studied Dari a little (similar to Persian and Urdu) while in Afghanistan. I tried Arabic and Russian while in the Middle East and Central Asia but found both very difficult for my limited linguistic skills.  

So having second language other than English, is a distinct advantage to have in the UN or with an international NGO. So, it’s worth learning one of the 6 UN languages, apart from English, while at law school. For crisis areas, French, Spanish and Arabic and now Russian are languages of focus. 

Winnowed: Currently, what are you up to?

Sarah: I resigned from UNHCR in 2021 to try and have a ‘normal’ life rooted in one place and decided to go back to school. For the last two years, I’ve been in a research LLM program at Osgoode Hall Law School (as law continues to be the parlance of global affairs) and as a Graduate Research Scholar at York University’s Dahdaleh Institute for Global Health Research in Toronto. My research centers on NATO’s landmark Policy on protection of civilians and the harm of displacement in law and policy of the international community. I am grateful for the funding I have from York to think, research and write about the eight significant post 9/11 wars - where over 38 million people have been displaced. I have engaged with these wars for most of my career over the last decade or so.

Winnowed: Sarah, this is very helpful. Thank you very much.

Sarah: You are welcome! Thank you.

Sarah Khan tweets at @Khan2005Sarah

Cover photo © with PBS from Part 2 of the documentary series “When Disaster Strikes”, which is a good series to watch for students, to understand the mechanics of aid work.

Pig farm on Nazi ‘Roma Camp’ Demolished

I have for long been fascinated by the Roma, nomads in Europe whose roots can be traced to the Indian subcontinent. The Roma have historically been discriminated against and marginalized in Europe. During the Nazi era, the Roma got caught in Nazi theories of racial superiority and were subjected to a genocide. Historians believe that between25% and 70% of Europe’s Roma population was murdered during the 2nd World War. Unfortunately, even after World War Two ended, the Roma continued to face discrimination and prejudice. They still do. There can be no better example of such discrimination and prejudice than the communist government of Czechoslovakia allowing a piggery to be set up on the site of a Nazi camp near Lety, about 80 kilometers south of Prague, were thousands of Roma were held, exploited, tortured and many killed. The guards who operated the Lety camp were local Czech.

This piggery  at Lety has now been demolished.

Book Review: Marriages Not Made In Heaven, by Vathi Agrawal

A South Delhi mother of three daughters of marriageable age is a special creature and Nita Chopra runs true to the stereotype. Her three daughters are as different from each other as chalk and cheese and chai, with just one thing in common - all three, Payal, Simran and Nisha, are very keen to get married, just as keen as their parents are in getting them married. Anand Chopra, the father, works for the Mittal Group of companies and the Chopras are well-off, though not filthy rich and they have the money and wherewithal to spend on the desired weddings. Vathi Agrawal definitely believes in ‘getting on with it’ since the marriages happen in quick succession, atleast for two of the daughters, and the last one doesn’t take too long either, but that’s because the story moves fast. Agrawal’s characters are real-life ones and many run true to stereotypes, though a few don’t. Nita Chopra is ambitious, but also realistic. Nisha is the prettiest of the lot and ‘it was an unacknowledged aspiration of Nita, that her youngest daughter get married to the young scion of the Mittal family, Sidaarth Mittal. After all, aren’t rich business tycoons always marrying beneath them, so long as the bride is young and good looking.’ However, for the eldest Payal, an old maid who had crossed thirty and who took after her father in looks and brains, broad of shoulders, neck and waist, she did not harbour any extravagant ambitions and is even willing to shell out a substantial dowry to get a half-decent groom.

Marriages Not Made In Heaven is definitely not a politically correct novel, though it gets its characters and their settings correct. There is nastiness and jealousy, pettiness and greed, love and longing, sacrifice and benevolence. Each character is vividly drawn. Was it Mark Twain who said that human beings show their true colours when they are dating, getting married or getting ditched? Actually, I made that one up, but after reading Marriages Not Made In Heaven, one would find it difficult not to agree.

Agarwal’s debut effort is such a romantic (or rather unromantic) thriller that I read it in one go – I think I took around five hours to read the 198-page page-turner on a warm Saturday afternoon, not needing a single cup of coffee while doing so. Agrawal writes well in simple, everyday Indian English, the sort of English which the Chopras and their neighbours, the Grovers, would speak. Agrawal’s use of ‘will’ instead of the more common ‘would’ threw me initially, but I soon started to enjoy the usage. For example: “He knew Nisha had a steady boy friend, but was naive enough to believe that if he displayed his steadfast unshakeable devotion to her, she will fall in love with him sooner or later.”

I highly recommend Marriages Not Made In Heaven. Go on, do pick up a copy and read. Actually, its fine even if you don’t read it because it is very likely to be made into a TV serial soon and you can watch it on screen.

SPOILERS AHEAD

Thanks to Nita Chopra’s quest for sons-in-law from the get-go, despite the title of the book suggesting otherwise, I ended up looking (in vain) for Jane and Elizabeth and Lydia, Mr. Bingley, Mr. Darcy and Mr. Wickham in Marriages Not Made In Heaven.  In India, with its patriarchy and dowry, dyed-in-the-MCP-wool men and steeped-in-tradition women, many marriages, unlike the marriages that take place in Austen-land, don’t have a happy ending, even if both horoscopes had been matched before the M boat set sail. Payal, a marketing executive in a technology firm, does have a few things in common with Jane, but not in the looks department. Second daughter Simran, a doctor to boot, ‘attractive and unapproachable’, the official snob of the family who has a high opinion of herself, has nothing in common with Elizabeth Bennett. As for Nisha, the youngest and the prettiest, she is as head-strong as Lydia, but not as lucky.

Marriages Not Made In Heaven is as different from Pride and Prejudice as pride is different from prejudice, or are they really? Don’t pride and prejudice have a lot in common? If Jane Austen were to write Pride and Prejudice today, wouldn’t the Bennett sisters also be career-minded? Actually, unlike her two elder sisters, Nisha isn’t very career-minded, but she is pushed into working for an investment bank and she does pretty well, effortlessly stealing credit from her colleague Ananya and sleeping with a key client. Wouldn’t Lydia have done the same?

ONE MORE SPOILER

By the way, I did find Mr. Darcy in Marriages Not Made In Heaven. Actually, Nisha’s colleague Ananya found him for me. No, I’m not going to tell you more. Please read this potboiler to find out more for yourself.

Book Review: Once Upon A Plate – The Recipes and Memories of an Unhurried Cook, by Radhika Ramachandran

Do you know how Chicken 65 originated? Radhika Ramchandran’s cookbook Once Upon A Plate tells me that in 1965, when hostilities between India and Pakistan were on, Chennai’s famous chef A. M. Buhari came up with this delicious non-vegetarian dish that could be prepared instantly and served to soldiers. The resulting dish draws its name from the year in which it was invented. Or is it called Chicken 65 because it is made by cutting chicken into 65 pieces? Or did its name come about because a 65 day old chicken was used to prepare it? Once Upon A Plate is not conclusive on this point, but it doesn’t really matter. The eye-watering photo of a plate of chicken 65 and the accompanying recipe ensure that one is focused more on preparing a plate of Chicken 65 than resolve the mystery behind its name.

A cookbook they say, is made not just of paper, but carries with it the author’s sweat, grime from her kitchen, fragrant aromas wafting from her oven, the burnt smell of experiments that went wrong and sounds of grateful lips smacking in appreciation.

In the case of Radhika Ramachandran, Once Upon A Plate – The Recipes and Memories of an Unhurried Cook also has buried in it generations of inherited kitchen wisdom and culinary dust gathered from across the world. Ramachandran, a lawyer cum cook, has poured her heart and soul into this coffee table cookbook, which has been many years in the baking. Once Upon A Plate is more than just a collection of recipes. Rather, ‘it stands conveniently at the beautiful intersection of a cookbook and a food memoir’. It lovingly describes how Ramachandran inherited a passion for cooking, how the time spent with her grandmother laid the seeds for her motivation to write Once Upon A Plate for which she spent years accumulating recipes in meticulous detail. Ramachandran’s English is simple and unadorned and her instructions straightforward.

Ramachandran has her roots in Andhra, spent her childhood in various cantonments across India, went to law school in Bengaluru, married a Bengali man who too has a military background and much later moved to Nigeria where she lives even now. Once Upon A Plate draws on the culinary traditions of all these places.

There are recipes for chutneys, pickles, dips, sauces, salads, dozens of south Indian vegetarian dishes, many chicken, fish, mutton dishes from across the world, including Iran, Pakistan and Nigeria, breads and biriyanis and other rice dishes and more than enough desserts to satisfy any sweet tooth anywhere in the world.

One of the best bits about Once Upon A Plate is that it is almost autobiographical and Ramachandran’s background is truly fascinating. Ramachandran’s maternal grandfather BDP Rao was a military doctor in the British Indian army who was awarded an MBE for his exemplary service in World War II. Her maternal grandmother Anasuya Rao hailed from a Zamindari family. All four of their children became doctors.  Ramachandran received from her ammamma lessons in mythology, cookery, proper demeanour and Sai Bhajans. Ramachandran’s mother and her two sisters, all doctors at one time, formed a close-knit group of strong opinionated women and there is little doubt that Ramachandran is cut from the same cloth.

As the daughter of two army officers and granddaughter of an army general, Ramachandran who grew up in ‘magical cantonments’ where many evenings were spent at the Officer’s Mess and Army Clubs such as the Defence Services Officers’ Institute and various Rajendra Sinji Institutes.

 Isn’t the proof of the pudding in the eating? Well, I made Bhuna Gosht using the recipe from Once Upon A Plate and it’s lip smacking good, though I ended up deviating a bit from Ramachandran's toolkit - mainly in that the mutton I used was chopped into small pieces. Here’s a photo:

Once Upon A Plate is beautiful coffee table book which can adorn any drawing room. It runs to over 550 odd pages, has hundreds of photographs of the finished dishes and a painstakingly prepared index at the end which will be very useful to any reader.

I do encourage all my readers to acquire a copy of this beautiful book which will not only be useful in cooking tasty dishes, but can be passed on lovingly to future generations.

Once upon A Plate is available on Amazon and at Notion Press.