Trafficking Girls in India: Police Inaction
GWEN IFILL: Now to India, and a crusade to end child sex trafficking.
Special correspondent Fred de Sam Lazaro traveled there recently to take a closer look at the issue and the often unsuccessful efforts to combat the practice.
Tonight, we have the first of his two reports. They are part of our Agents for Change series.
FRED DE SAM LAZARO: There was an unusual demonstration recently in this small town near India’s border of India, Nepal, unusual because these women, most with backgrounds in prostitution, are rarely seen in public. They protested social evils, from gender bias to the caste system, India’s age-old social ladder in which they’re at the very bottom.
RUCHIRA GUPTA, Apne Aap Women Worldwide: In Bombay, in Delhi, in Calcutta, whichever red light area you go to, the girls and women are all low caste. Prostitution is passed on from mother to daughter and pimping from father to son.
FRED DE SAM LAZARO: Ruchira Gupta is a former journalist who started a group called Apne Aap, or On Our Own, which organized the rally. The group has rescued many of these women, found them new work in crafts and micro-enterprises, and put their daughters in school.
Apne Aap was also part of a protest movement that followed the fatal gang rape of a Delhi college student two years ago, a campaign that got lawmakers to act against what many called a culture of rape and misogyny.
WOMAN: I am not going to allow this incident to become another statistic.
FRED DE SAM LAZARO: The law was changed to penalize traffickers, instead of the women they traffic, recognizing the women as victims.
RUCHIRA GUPTA: And it also said beautifully that the consent of a victim to her own exploitation will still put the blame on the perpetrator who used her consent to traffic her.
FRED DE SAM LAZARO: Marchers distributed flyers to inform people of the new laws and a victory by Apne Aap in a recent court case in the regional capital, Patna.
The court ordered that citizen committees be set up in every community in this region. These committees would gather data on every child up to 18 years old in these communities and essentially keep tabs on the welfare of these children, all this to ensure that no child is trafficked.
RUCHIRA GUPTA: When I started work here eight years ago, women could not look up. They used to cover their head and they were terrified of the traffickers beating them up. And now, with the Patna high court judgment, they feel they can change the whole system and eradicate trafficking from the roots.
FRED DE SAM LAZARO: Laws are only as good as their enforcement, however, as we would see just hours after the rally.
Ruchira Gupta and a couple of Apne Aap staffers have come to this police station inside that is just inside India along the Nepal border. They have learned that there are at least two young women who have been trafficked and they’re making final arrangements with the police to conduct a raid tonight to try and rescue them.
The team met up with the police at 6:00 p.m. They hadn’t told the police beforehand where they were going, for fear the traffickers would be tipped off. But once they shared that information, they were asked to wait, because the female officers who were to accompany them had been delayed.
When the women still hadn’t arrived two hours later, the raid proceeded anyway, hours after the planned start, three women from Apne Aap and six policemen.
RUCHIRA GUPTA: This will be the front room where the customers are brought in.
FRED DE SAM LAZARO: A few minutes later, they were in the local red light area and in a three-room hovel, where they suspected one young woman was being held. It was dank, dark and deserted.
Ruchira, what’s going on?
RUCHIRA GUPTA: I think the girls have been (INAUDIBLE) when we were kept waiting at the police station for two hours.
We suspect that they sent the information to the traffickers here, because, as you can see, there’s not a man in sight, which is very unusual in the red light area. But where are the pimps? Where are the customers? Where have they all gone? It’s very, very odd.
FRED DE SAM LAZARO: Same thing a few yards away next door, a deserted home, evidence that this too was a brothel whose occupants had left in a hurry.
RUCHIRA GUPTA: And it’s almost as if something has just run from here. Look here at the beer bottles. Here is a crumpled blanket still on the bed like just now.
FRED DE SAM LAZARO: Further in the courtyard, a door was padlocked on the outside of another home used as a brothel.
The police were armed with big rifle, but they had no means to break the lock open. The task fell finally to a man said to be related to the building owner. Gupta suspected the occupants fled over the wall in the back when they heard the group arriving in the front, and she mildly admonished the policemen.
RUCHIRA GUPTA (through interpreter): Going forward, when you do such raids, you should think about circling a home like this, so that people don’t have the opportunity to run away. And you folks are not gathering any evidence. Could you please tape some of this? Let me show you.
FRED DE SAM LAZARO: An officer duly followed Gupta, but didn’t record anything.
With the lock finally broken, they found a framed picture of one of the young women they were looking for. The man who let them in initially denied knowing her, but then relented and said he knew where she was being held.
The police ordered him to produce her in one hour at the police station.
So he’s gone off to bring the girl, ostensibly.
RUCHIRA GUPTA: Yes.
FRED DE SAM LAZARO: Do you think you will see her this evening?
RUCHIRA GUPTA: We’re at the mercy of the cops, because if the cops want, we will see her. If the cops don’t want, we won’t see her.
FRED DE SAM LAZARO: Back at the police station, I asked supervisor Ajit Kumar Singh the obvious question.
The suspicion immediately is that somebody, maybe from your own police force, has tipped them off.
He was more comfortable in Hindi, less comfortable with the question. He said he didn’t have enough information, but promised to investigate. The young woman never showed up at the station, but the female police officers finally did, too late to have any effective role in the attempted rescue. There were no police vehicles available to get here from their base at another station, they complained.
RUCHIRA GUPTA: I am once again reminded why slavery still exists, because the laws are on paper and they are never implemented. And this is like — is back to ground zero, where I realize that the police, come what may, do not want to implement the laws on behalf of women and girls.
FRED DE SAM LAZARO: She says part of the job of activists is to educate an ill-informed, often ill-trained police force on the laws and then hold them accountable. In its 12 years, Apne Aap says it has helped some 20,000 young women and young girls leave or not enter the sex trade.
This is Fred de Sam Lazaro in Forbesganj, India, for the “PBS NewsHour.”
GWEN IFILL: On tomorrow night’s report, Fred goes on another rescue raid with a very different outcome.
His reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.
Trafficking in India: Breaking Traditions
GWEN IFILL: Now to the second part of special correspondent Fred de Sam Lazaro’s report on the struggles to stop sex trafficking in India.
Last night, we witnessed a failed attempt to rescue young women forced into prostitution, one in which police appeared to covering up for the traffickers.
In tonight’s report, Fred follows another rescue attempt, one with a very different outcome.
His story is part of our Agents for Change series.
FRED DE SAM LAZARO: In India’s impoverished rural state of Bihar, people struggle to live off the land. One of the few businesses that thrives is underground.
RUCHIRA GUPTA, Founder, Apne Aap Women Worldwide: This is one of the epicenters in the world for human trafficking. Little girls are trafficked into prostitution. They are put on buses and trucks and taken to the big brothels of Bombay, Delhi and Calcutta, but sometimes closer by.
FRED DE SAM LAZARO: Ruchira Gupta and the human rights group she founded, Apne Aap, or On Our Own, is working to change the tradition of lower-caste women being channeled into the sex trade.
The group sued authorities to provide schooling for girls rescued from brothels. And it runs a shelter for the women and their daughters. But, first, Apne Aap has to work with the police to free the women.
RUCHIRA GUPTA (through interpreter): So, here is the law. We have printed it out for you.
FRED DE SAM LAZARO: And that means explaining the new law the group helped get past. It punishes trackers and not those who were prostituted.
RUCHIRA GUPTA (through interpreter): We have to arrest the trafficker.
FRED DE SAM LAZARO: Sometimes, that task is not easy.
RUCHIRA GUPTA: The police is part of our society, and if the entire society believes that a girl is of less value, a low-caste girl is of even less value. So unless their mind-set changes, they don’t even try to enforce the law, because they think this is not a crime.
FRED DE SAM LAZARO: Just the previous night, we followed an Apne Aap team hoping to rescue a young woman from a brothel. The raid failed, possibly because the police tipped off the traffickers.
Ruchira, what’s going on?
RUCHIRA GUPTA: I think the girls have been prevented – we were kept waiting at the police station for two hours by local police officers, who must have informed the traffickers here that we were on our way to rescue them.
FRED DE SAM LAZARO: In this morning’s raid, the exact location was kept secret from the police until the last moment. Still, rumors of a raid had spread, and brothels cleared out.
But Fatima Katune, a Apne Aap staffer who grew up and still lives in the red light district, is a key source of intelligence. She led the search to a home where she said a girl was hidden. Not long after indignant protests from the homeowners, a frightened young woman emerged.
RUCHIRA GUPTA (through interpreter): There’s no reason to cry. Don’t be afraid. Don’t be afraid.
FRED DE SAM LAZARO: As the young woman was led to a waiting car, Fatima Katune led the team to a brothel where she had been allegedly working, hoping to gather evidence against her trafficker, apparently, the man shown here talking to police and also taunting Katune.
A loud and physical altercation ensued, before he was put into the police paddy wagon to cool down, at Gupta’s insistence.
RUCHIRA GUPTA: He was following us to try to talk the police out of it. And then he started abusing Fatima to provoke her not to go there by calling her all kinds of name, from whore to all kinds of things, provoking her so that she would hit him, and then he could hit her back. He’s trying to stop us from going to the brothel.
Here’s another room which is being used as a brothel, where the girl we rescued, this is the bed where the customers are brought and these girls are put forward for the customers. And they’re locked up in rooms like this with iron bars on the window, as you can see. Here’s a little condom lying here.
RUCHIRA GUPTA (through interpreter): Please take a picture of this. Get that book up there. It probably has names of the customers.
FRED DE SAM LAZARO: Next, another shack-like brothel. Here, they hope to rescue two teenage girls, one forced to prostitute herself, the other the daughter of this woman who owned the place.
Gupta says it’s not uncommon for women to be involved in the business of trafficking. Many were themselves trafficked when they were young.
Ruchira, what’s – what’s happening right now?
RUCHIRA GUPTA: She says those girls are in school. So, I’m saying, fine. Take us to the school. We will go and meet the girls. We will meet the – and suppose we meet the girls?
FRED DE SAM LAZARO: On what grounds?
RUCHIRA GUPTA: Saying that, I will bring, like, 4:00 to the office, which of course she won’t. But she won’t take us.
FRED DE SAM LAZARO: So, where do things stand then?
RUCHIRA GUPTA (through interpreter): No, no. Take her in. Let’s go.
FRED DE SAM LAZARO: Are they arresting her?
RUCHIRA GUPTA (through interpreter): Please turn the camera off.
FRED DE SAM LAZARO: We were asked to get out of the way because we were causing interference with the process of arresting the alleged trafficker. It appears to be happening right behind me.
The threat of going to jail seemed to cause the woman to relent. She was let out of the police vehicle just as I began talking to Gupta.
Suddenly, a new development.
RUCHIRA GUPTA: The girl is suddenly found who she said was in school. So, let’s go and see what’s going on.
FRED DE SAM LAZARO: It was the 14-year-old daughter of the brothel owner. Until recently, she had been enrolled in school and even lived in the Apne Aap shelter. But she was pulled out after seventh grade, being prepared, Gupta said, to go into the sex trade, a common tradition here passed from mother to daughter.
Negotiations resumed with the chastened brothel keeper and her son, who, in another common practice, works as a pimp.
RUCHIRA GUPTA (through interpreter): Do you want to be a pimp?
MAN (through interpreter): No, ma’am.
RUCHIRA GUPTA (through interpreter): So why are you doing this? You’re preparing a 14-year-old to prostitute herself. You have another girl in the back, Sampatia, that you have enslaved. Have you no shame? And what’s the use of you crying? Sampatia cries every day when customers come and rape her.
FRED DE SAM LAZARO: Sampatia, the girl being prostituted, wouldn’t be produced on this day, but Gupta was able to negotiate a deal for the daughter, one more year in school.
RUCHIRA GUPTA: Sumi (ph) has agreed that she can study until class eight.
The hope, the daughter will become stronger, more educated, and she will be able to negotiate with her mother and we will, together, make her go on and stay on in school for another two years. It’s year by year that we negotiate for a child.
And even a year of not being raped, a year of not being beaten is great. It’s better than a year of being raped and beaten.
FRED DE SAM LAZARO: For the young woman brought back to school and to live in the Apne Aap shelter, it was hard to see much beyond her immediate fears and turmoil, torn and confused by family loyalty and tradition. Counseling for her is just one of the tasks that lay ahead for the Apne Aap staff.
They will do the same for the girl rescued earlier this busy day. Her testimony will be key to building the case against her alleged trafficker. In its 12 years, the anti-trafficking group Apne Aap had managed to successfully prosecute 66 traffickers, but, more critically, Gupta says, the first four alumni of its shelter now hold tickets out of generational prostitution and poverty. They have gone on to enroll in college.
This is Fred de Sam Lazaro in Bihar, India, for the PBS NewsHour.
GWEN IFILL: Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.
Modi’s Development Model
Narendra Modi invokes the father of modern India, who preached non-violence and simple living. But Modi’s vision seems in many ways more like modern China.
So this is sort of Shanghai-inspired?
RAMAKANT JHA: That’s right.
FRED DE SAM LAZARO: This is the scale model of an all new city being built in Gujarat from scratch. It was championed by Modi when he headed the state government here.
So this is what we’ll come back to in about a decade?
RAMAKANT JHA: Yes.
FRED DE SAM LAZARO: Ramakant Jha who heads a agency set up to develop it says in a decade 500,000 people will work in the new city. He says it will keep in the country some $50 billion that now goes elsewhere because India lacks such facilities.
RAMAKANT JHA: All this Indian business are being performed in other countries: Singapore, Dubai, London.
FRED DE SAM LAZARO: The multinational finance and insurance firms will come to Gujarat, he predicts, as many manufacturers have in recent years.
The Japanese company Hitachi is one. Hitachi’s Vinay Chauhan says it’s tedious to do business in India with myriad permits and corruption. But not so in Gujarat, he says, where Modi cut red tape and improved the infrastructure.
VINAY CHAUHAN: One of the most important is power. We have uninterrupted power. These governments talk but don’t do. In Gujarat nobody talks, it is just done.
FRED DE SAM LAZARO: Under Modi’s leadership, Gujarat made land available for factories and redevelopment. One showcased project is Riverfront Park in Gujarat’s largest city, Ahmedabad. Luxury high rise homes are soon to follow.
But not everyone is pleased with Modi’s approach. Critics say it favors big business at the expense of the poor, including thousands who once lived in this gentrified area.
The families living in this decrepit industrial location say they lived for years along the riverfront when all of a sudden they were abruptly displaced and moved here, given tiny plots of land and nothing more to restart their lives.
FRED DE SAM LAZARO: We are just day laborers, said this man. The city – at least an hour’s bus ride away – is where the work is, they said. But bus fare now takes half of their meager earnings; around three dollars a day.
MAN: We’re right by a garbage dump and when it rains this place floods and the water brings it all in.
WOMAN: The water is bad, we have to walk really far to latrines. We have a lot of difficulties. We’re forced to live like animals.
SHABNAM HASHMI: Modi is a very good show man. He knows how to project things. But that is about all.
FRED DE SAM LAZARO: Shabnam Hashmi founded a human rights group that advocates for marginalized communities. Hashmi says Gujarat is near the bottom among India’s states in education and health care. And poverty actually grew during Modi’s 13 years at the helm, she says.
SHABNAM HASHMI: The Gujarat model helped middle classes, and Gujarat model cared a damn about the poor, about the marginalized sections, and it is going to be the same all over India.
FRED DE SAM LAZARO: Other politicians may be criticized for favoring the wealthy over the poor. But in Modi’s case, there’s also a sectarian dimension. He’s long been dogged by accusations he did little to stop programs against Gujarat’s impoverished Muslim minority back in 2002 – allegations that led the U.S. and U.K. to ban him from entering those countries.
Inquiries later cleared Modi but he’s still hurt by long ties to Hindu nationalist groups – some with violent pasts – who want India officially declared a Hindu nation.
Modi’s election has emboldened the extremists, says Hashmi, who belongs to India’s 14 percent Muslim minority.
SHABNAM HASHMI: In the last six months, there have been more than 600 communal riots in this country.
FRED DE SAM LAZARO: Communal riots.
SHABNAM HASHMI: Communal riots. 600.
FRED DE SAM LAZARO: This is between what, Hindus and Muslims?
SHABNAM HASHMI: Yes. And I don’t know how long somebody like me should feel safe sitting in this home, frankly.
FRED DE SAM LAZARO: What does that mean?
SHABNAM HASHMI: That means that I have a Muslim name.
FRED DE SAM LAZARO: Supporters of the new prime minister say such fears are exaggerated. They say Modi has spoken out against extremist rhetoric and activity.
M.J. AKBAR, RULING PARTY SPOKESMAN: He said it in the House of Parliament, this is unacceptable. This can’t go on. We want development for all.
FRED DE SAM LAZARO: M.J. Akbar, a columnist and author and himself Muslim, is a spokesman for Modi’s Bharatiya Janata party.
M.J. AKBAR, RULING PARTY SPOKESMAN: He has said repeatedly, “I said, I want to see Muslims in India with the Quran in one hand, their holy book, but with the computer in the other hand.”
Now that is true empowerment. Jobs are true empowerment.
FRED DE SAM LAZARO: As for the Gujarat model, Akbar says, Modi inherited the challenges that underlie its poverty. He says the verdict on his tenure come from his election three times in the state.
M.J. AKBAR, RULING PARTY SPOKESMAN: We are a democracy. People will vote only if their lives have improved. It’s quite simple.
FRED DE SAM LAZARO: I asked people displaced from the riverside who they voted for in the election.
No one, they said. We lost our election cards when they took our homes away, and we don’t have proper addresses, which are required to get new ones.
WOMAN: How much have we been pleading? How long have we been writing them? No one has listened to us yet.
WOMAN: We’ve been promised help for a long time. Whoever gives it to us, Narendra Modi or anyone else, we’d be very thankful.
FRED DE SAM LAZARO: As in Gujarat, the new prime minister’s challenge will be to offer hope to some 400 million people who live below India’s poverty line, that his pro-business policies are their best path out of poverty.
India’s Slum Dwellers
FRED DE SAM LAZARO, correspondent: Few cities anywhere display a wider gap between haves and have-nots than Mumbai, or Bombay. Real estate is costlier here than in Manhattan. Yet two-thirds of this city of 16 million people live in slums-crammed spaces that are technically illegal and by most measures unfit or unsafe for human habitation.
It’s here that Jockin Arputham is a towering figure, even though he’s barely five feet tall. His efforts have helped nearly 40,000 families get out of dangerous and unsanitary improvised shelters to complexes like this one, which is now providing new homes for squatters who are living under electric towers. Those are due to be rebuilt and expanded.
(to Jockin Arputham): So you have 600 families here?
Jockin Arputham, Founder, Slum Dwellers International
JOCKIN ARPUTHAM (Founder, Slum Dwellers International): Yes.
DE SAM LAZARO: How much of a dent does that make? Are there are many more families who still need to be rehabilitated?
ARPUTHAM: There are about 3,000 families to be rehabilitated in this kind of scheme.
DE SAM LAZARO: And this is just people who are squatting in electric towers?
DE SAM LAZARO: The apartments may not look like much-one 225 square feet room but made of brick and mortar instead of plywood or tarp. They have running water and something the majority of Bombay’s residents don’t-a private toilet.
Of all the indignities suffered by slum dwellers, Arputham says, none is more humiliating than not having a toilet, private or public.
Man bathing in public
ARPUTHAM: It is the dignity! If you don’t have a toilet, what does that mean?
DE SAM LAZARO: You don’t have dignity.
DE SAM LAZARO: Arputham has spent much of his adult life trying to gain recognition for slum dwellers as citizens in legitimate communities. He says they’ve long been unfairly stereotyped as lazy and criminal.
ARPUTHAM: Everybody, every house has one person meaningfully earning.
DE SAM LAZARO: Meaningfully employed?
ARPUTHAM: Meaningfully employed.
DE SAM LAZARO: And they come from all over the country?
ARPUTHAM: All over, all over the country.
DE SAM LAZARO: Arputham came to this city 50 years ago from south India. He had almost no formal education but a facility for languages, picking up Hindi dominant in north India, the local Marathi, and functional English. He used these talents to organize neighbors into a group that’s now global called Slum Dwellers International, taking advantage of their numbers, he says, to get the attention of an often indifferent government bureaucracy.
ARPUTHAM: I create a critical mass. This is my critical mass!
DE SAM LAZARO: They’ve used guerilla tactics-nonviolent, he insists-to push for their rights or basic amenities like water hook-ups. If the city ignores or takes too long to respond to their requests, Arputham takes the task on himself.
ARPUTHAM: I will break into the water tap giving the connection.
DE SAM LAZARO: You’re going to tap into the pipes?
ARPUTHAM: I’ve done it a thousand times. When the police come, I put children in the front, then women.
DE SAM LAZARO: Today, he says, there’s no trouble getting the electric utility to fund relocation for squatters who’ve lived under their towers or getting campaigning politicians to support the group’s push for upgraded housing and especially public toilets.
ARPUTHAM: This is for little more than around 600 families.
DE SAM LAZARO: Six hundred families who don’t have a toilet now.
When he began building community-run public toilets like this one 25 years ago, the funds mostly came from foreign aid agencies, he says.
ARPUTHAM: Now slowly it has become the city’s responsibility. The city government, municipal corporation totally pays for the capital investment of this construction.
DE SAM LAZARO: So far they’ve completed or have contracts to build toilets serving some 600,000 people. Once built, they are run by the community supported by user fees, about two US cents per day for a family. A family-in this case Mamta and Dalsher Bidlan-is hired to maintain the facility in exchange for a small apartment above the structure.
Mamta Bidlan cleaning around a public toilet facility for women
Mamta Bidlan says having a toilet nearby means a lot to women for whom this has long been a safety issue.
MAMTA BIDLAN (Toilet Manager): The women had to go a long distance before, and there were bad men hovering from outside that would create problems. Now it’s very easy for women to come here.
DE SAM LAZARO: Arputham credits much of the organization’s success to its mostly female volunteers. Women have the right priorities for their family, he says, and they are keenly tuned in to goings-on in the community.
ARPUTHAM: If you want a qualitative change in life, you have to take it from women. If you don’t recognize that, you are lost.
DE SAM LAZARO: What kinds of things, specifically?
ARPUTHAM: Everything starting from how to manage your money, how to earn your money, how to live. Women have all this quality, which men don’t have.
DE SAM LAZARO: For their part, the women volunteers-most of them stay-at-home spouses by tradition as much as choice-say their lives have been transformed.
MALATI AMRE (Volunteer): Women have gotten ahead now. In years past, women used to be afraid of leaving the home. We’ve been able to get them out of the home by forming an organization.
POOJA RAO: I used to be afraid of leaving the house, afraid of living in the neighborhood. Now I’m ready to do much more. He’s given us the courage. He’s taught us how to organize ourselves, how to deal with the police.
DE SAM LAZARO: The police who were once indifferent or even hostile are now much more receptive, and in fact, partners with the slum dwellers group-providing space to set up a new system of arbitration so disputes over property or domestic issues don’t escalate to require arrests or court intervention.
Arbitration Hearing: Okay, we’ve heard your story. Now we’ll invite him in and see what he has to say.
Woman: We have people from all religions in our organization-Muslims, Hindus-no problems whatsoever.
ARPUTHAM: I think part of my teaching comes from the church. I think quite a lot. In my work, I practice.
DE SAM LAZARO: Arputham was raised Roman Catholic-a small minority in a land of many faiths and, often, religious tension. However, Slum Dwellers International, a group that now has chapters in 34 countries, says the common cause slum dwellers face easily dwarfs any divisions of ethnicity or faith.
For Religion & Ethics NewsWeekly, this is Fred de Sam Lazaro in Mumbai, India.
Low Cost Prosthetic Limbs
Fred de Sam Lazaro reports, as part of our series on Breakthroughs.
FRED DE SAM LAZARO: Jaipur is one of India’s top tourist destinations, but not far from its architectural landmarks is a far more modest one that draws a whole different kind of visitor. They come – literally – on hands and knees to an organization commonly known as Jaipur Foot.
DEVENDRA RAJ MEHTA: Now every year we are fitting anything between 23 to 25,000 limbs.
FRED DE SAM LAZARO: D.R. Mehta began offering artificial limbs and other services to physically disabled people nearly 40 years ago.
About 150 patients arrive each day from across India, desperate people like Zareena, a widow who said she is reduced to panhandling to support her two children.
DEVENDRA RAJ MEHTA: Bombay? She has come near – a place near Bombay. It’s about 100 kilometers. She has come to get a hand-pedaled tricycle.
ZAREENA, India (through interpreter): You are the answer to my prayers.
FRED DE SAM LAZARO: She’s one of at least 5.5 million people in India with so-called locomotor disabilities – caused in her case by childhood polio. Others suffer congenital conditions. But, by far, the most frequent customers are amputees, trauma victims, mainly from road accidents.
The Jaipur Foot organization was started with the help of government grants and is now funded mostly by foundations and individual donors. Its cost structure, for a lower limb, say, are minuscule by Western standards.
DEVENDRA RAJ MEHTA: Now it’s $50.
FRED DE SAM LAZARO: Here’s a comparison.
In the United States, a prosthesis like this would typically range in price from $8,000 to $12,000. It would be made of metal, aluminum, possibly carbon fiber, whereas, in Jaipur, the key ingredient is a PVC piping more commonly used to irrigate farms. And this is the key to a $50 artificial leg.
Despite the overall success with artificial limbs, one challenge that has required a lot more innovation is the knee.
DR. POOJA MUKUL, Orthopedic specialist: So much so that it’s better to lose both the limbs below the knee than to lose one leg above the knee. And the knee has been the weakest link in prosthetic componentry in the developing world. We’ve had very simple knee joints which are single axis, which are more like door hinges, and we’ve been using them largely because of the simplicity, low cost and also non-availability of any other options.
FRED DE SAM LAZARO: Dr Pooja Mukul, an orthopedic specialist, is leading the effort to develop better options, partnering with MIT and Stanford University, with software typically used in the movies. They have conducted so-called gait analysis.
DR. POOJA MUKUL: So this is the first prototype or version one of the polycentric knee that we developed in collaboration with Stanford.
FRED DE SAM LAZARO: Trials over the past five years with hundreds of patients in India and several other developing nations helped refine the new Jaipur knee, removing, for example, a clicking sound from version one.
DR. POOJA MUKUL: Our patients don’t want to hear clicks. And they don’t want to be labeled as disabled. They don’t want a sound preceding their entry into an area. So then we got a bumper put in here, and now it’s a silent knee.
And, also, the geometry – you see, this is very, very squarish, and doesn’t match the human geometry in any way. This one like – more like a knee.
FRED DE SAM LAZARO: It’s built to be especially sturdy and simple and especially for conditions in the developing world, where the typical amputee has a very different profile than in the West.
DR. POOJA MUKUL: A typical amputee in India or the developing world would be post-traumatic, and age would be 20 to 30, in fact even younger, because if you’re looking at land mines, then a lot of young children were stepping on land mines and losing their limbs.
So it’s a very young population who have no other medical condition pulling them down, except the fact that they unfortunately met with an accident. And they have their whole productive lives ahead of them, unlike in the West who’ve lost it because of diabetes or vascular insufficiency, they have cardiac issues, pulmonary issues, they’re mostly sedentary.
So the demands that our patients put on prosthesis are very, very challenging.
FRED DE SAM LAZARO: The new Jaipur knee will be ready for mass production later this year. Once the molds are made, the cost and manufacturing should come down to about $20 a piece, based on the simple low-cost approach for al prostheses here.
They are cut and trimmed by hand. About a third of the workers here have Jaipur limbs themselves. Mehta says restoring people’s mobility makes a huge difference in lives, which he asked these amputees to show us by sprinting.
This is Fred de Sam Lazaro in Jaipur, India, for the PBS NewsHour.
GWEN IFILL: A version of this story aired on the PBS program “Religion & Ethics Newsweekly.”
Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.
Nicaragua’s Controversial Mega Canal Project
JUDY WOODRUFF: Next to Nicaragua and a massive project to connect the hemispheres with another canal that’s stirring up controversy.
Special correspondent Fred de Sam Lazaro reports.
FRED DE SAM LAZARO: They came by the busload. They piled into cattle trucks. They came by horse and mule from miles around for a rally that likely tripled the population of the dusty little town of Los Chiles.
At stake was Nicaragua’s sovereignty, they chanted, sold to the Chinese. The object of their protest is a shipping canal to be built by a Chinese company. As described in this video dubbed from Chinese into Spanish for Nicaraguans, it would stretch 170 miles across the country to connect its Pacific coast to the Caribbean and thus the Atlantic.
It’s not a new idea. The Americans once considered it. This map from 1870 shows a proposed route for a shipping shortcut between the Earth’s hemispheres. In the end, the U.S. Congress opted to build in Panama.
Nicaragua’s waterway will dwarf the Panama Canal, three times as long and twice as deep. Cost estimates range from $50 billion to $100 billion.
BILL WILD, HKND Group: It is by far the largest earth-moving project ever attempted in the world.
FRED DE SAM LAZARO: The project’s chief engineer is Bill Wild, an Australian veteran of many big builds, but nothing approaching this one.
BILL WILD: There will be two large port facilities, one at either end of the project, hydroelectric schemes, and a number of other parts of the project. So, overall, it’s an incredibly exciting and large and challenging engineering project.
FRED DE SAM LAZARO: Protesters have a very different view. They fear the canal will confiscate land and livelihoods here. A new law gives the project eminent domain over land and waterways anywhere in Nicaragua.
Yader Sequeira farms this small plot of land with his grandfather.
YADER SEQUEIRA, Farmer (through interpreter): This is the place I was born, where I was raised. And I hope, with God’s help, we won’t have to leave, because we don’t have anywhere else to go.
FRED DE SAM LAZARO: Protesters like Danilo Lorio say they have been harassed, or worse, at other rallies.
DANILO LORIO (through translator): We have been censored, threatened, not only our human rights and political rights violated. Also, many of us have been jailed and have legal hassles.
FRED DE SAM LAZARO: Human rights groups have also alleged violence and intimidation. And environmental groups have sounded the alarm. They say the canal would imperil wetlands, wildlife and, critically, Lake Nicaragua, the region’s largest source of freshwater.
Victor Campos is with the Humboldt Center.
VICTOR CAMPOS, Humboldt Center (through translator): The sedimentation that is going to result from it is going to change the chemistry of the water, which will have a major impact. You will have 500 million cubic meters of material extracted.
MAN (through translator): We cannot stay in the minority. We have to become a majority to fight Daniel Ortega every day with nonviolent means.
FRED DE SAM LAZARO: Although protests and opposition have grown in recent months, surveys still show a majority of Nicaraguans support the canal, which has been championed by the country’s president, Daniel Ortega. He sees it as this country’s ticket out of poverty.
Nicaragua’s six million people are about the poorest in the hemisphere. Only Haitians are worse off. And Telemaco Talavera, who heads the canal project for the government, says that will soon change, with tens of thousands of construction and permanent jobs.
TELEMACO TALAVERA, Nicaragua Canal Commission (through translator): It’s going to generate direct and indirect employment and it’s going to double the gross national product. It’s also going to attract other kinds of foreign investments in agro industries, animal husbandry and artisanal products, all contributing to an integral concept of national development.
FRED DE SAM LAZARO: As for environmental issues, he insists the canal will actually slow global warming by allowing more efficient shipping. And locally, he says, remove poverty, and you remove much of the real threat, deforestation by poor people, mostly for cooking fuel.
TELEMACO TALAVERA (through translator): So the net environmental impact of this project will be an improvement.
FRED DE SAM LAZARO: Have you ever had to manage the water balance of a body of freshwater that large?
BILL WILD: Industry manages those sorts of things all the time. I have no doubt that you can manage the loss of water and quantify the loss of water through a lock system.
FRED DE SAM LAZARO: And the salinity?
BILL WILD: The salinity, there are a number of methodologies for managing salinity.
FRED DE SAM LAZARO: Proven?
BILL WILD: Proven, yes.
FRED DE SAM LAZARO: As for people being displaced, he says, the company will go beyond just relocating them to new land and homes.
BILL WILD: We are committed to providing equivalent or better livelihood for everyone we displace, and that’s an absolute commitment.
ANDREAS SEQUEIRA, Farmer (through translator): I don’t believe much of that, don’t believe it.
FRED DE SAM LAZARO: Farmer Andreas Sequeira says he was displaced during the civil war in the ’80s. The land he was given back was a fraction of what he had, he says.
ANDREAS SEQUEIRA (through translator): They confiscated our land before, and, later, they said they would give us our land back. But they never did.
FRED DE SAM LAZARO: Critics allege the deal, a no-bid contract, was rammed through a rubber-stamp parliament and courts by President Ortega, the one-time communist rebel, now firmly allied with big business, they allege.
And critics note that foreign investors keep much of the profits for several decades, and the developers aren’t liable for environmental damages or even if the canal is never built, which some say is likely.
Professor Maria Lopez Vigil calls the whole thing a ploy to create real estate speculation.
MARIA LOPEZ VIGIL, Central American University (through translator): There has not been one study on feasibility in terms of environment, financing, actual profits. They are going to expropriate thousands of properties from campesinos under the banner of tourism.
BILL WILD: Chairman Wang has put together a very strong team. I mean, we have McKinsey doing the feasibility, the technical feasibility studies. And ERM is doing the environmental assessment, the ESHA.
FRED DE SAM LAZARO: Bill Wild insists these studies by reputable global consultants have shown the canal is feasible, though his company has yet to fully disclose the details of its environmental reports.
And despite a groundbreaking ceremony shown last December on Nicaraguan TV, in which Chairman Wang Jing appeared alongside the president’s son, Wang has not revealed where he will get the private capital needed to build the canal. He has said it will be built by 2019.
There may or may not be a deficit in funding, but few argue there is one of trust.
I’m Fred de Sam Lazaro for the PBS NewsHour in Los Chiles, Nicaragua.
JUDY WOODRUFF: Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.
‘A curse from God’ — the stigma of mental illness in Pakistan
GWEN IFILL: Next to Pakistan.
We look at one effort to tackle a widespread public health problem that gets scant attention. It’s part of our Agents for Change series.
Special correspondent Fred de Sam Lazaro reports from Karachi.
FRED DE SAM LAZARO: For decades, Pakistan has been in a state of post-traumatic stress, from the Afghan war, ethnic tension, religious violence, terrorism.
The economy, hindered by corruption, does little to reduce the poverty that drives so much of the turmoil. It’s enough to drive anyone crazy.
And psychiatrist Saadia Quraishy, with the Pakistan-based Aman Foundation, says that’s exactly what it does to a lot of people.
DR. SAADIA QURAISHY, Psychiatrist: About 40 percent of the population suffers from common mental disorders.
FRED DE SAM LAZARO: Four-zero?
SAADIA QURAISHY: Yes. And some informal reports suggest even higher.
FRED DE SAM LAZARO: Fifty-seven-year-old shopkeeper Anwar Kaskeli presents a classic case
ANWR KASKELI, Pakistan (through translator): I wrote in the newspapers for years about why are the basic necessities of life not being provided to people here, like water, roads, schools, especially education?
FRED DE SAM LAZARO: Between those worries and a growing inability to make ends meet, he says he simply withdrew.
ANWAR KASKELI (through translator): For 10 years, I couldn’t sit for more than 10 minutes. My mood was just down. My joints would hurt. That made the depression worse. This went on for 10 years.
FRED DE SAM LAZARO: Throughout South Asia, mental illness goes unreported, undiagnosed, and untreated. It’s socially taboo, often viewed as a curse from God, not an illness.
Patients have often been restrained in chains and subjected to other humiliation, says Dr. Quraishy.
DR. SAADIA QURAISHY: It’s very difficult to express mental health symptoms to — not only to the clinicians or professionals, but even to yourself and to the families. There’s such a stigma related to that. But it’s much more acceptable to say you have a headache or a stomach ache or a backache, for which you can be taken out to get help.
FRED DE SAM LAZARO: Not that much help is available. Very few Pakistani doctors are trained to diagnose psychiatric disorders, whether acute ones like schizophrenia or common ones like depression.
This is a country of 200 million people. For all of them, there are perhaps 500 practicing psychiatrists. In all likelihood, there are more psychiatrists of Pakistani origin working in the United States and great Britain than there are in all of Pakistan.
CHRIS UNDERHILL, Founder, BasicNeeds: Generally, in the developing world, in the poor world, you’re talking about 1.5 million people per psychiatrist.
FRED DE SAM LAZARO: What is it here in Britain or in the United States?
CHRIS UNDERHILL: Oh, it’s about one per 10,000.
FRED DE SAM LAZARO: Chris Underhill is the founder of a British-based aid group called BasicNeeds, which tries to deliver mental health care despite the challenges. Partnering with local nonprofits, it began running clinics here two years ago, no fancy couches here, just a temporary one-room, one-doc psychiatric ward.
DR. SALIM AHMED, Psychiatrist (through translator): Do you get angry a lot?
FRED DE SAM LAZARO: On this recent morning, Dr. Salim Ahmed swiftly dispatched patients, most in follow-up visits. Their prescriptions were refilled a few feet away. Some patients were sent to counseling behind the curtain in the corner.
DR. SALIM AHMED: The team, the community-based workers, they are making sure that they are taking their medications on a regular basis. If suppose they have some problems like some side effects of the drugs, those community-based workers, they communicate with us.
FRED DE SAM LAZARO: The team he works with is mainly drawn from the local community.
With role playing and skits, ordinary citizens are trained as outreach workers to follow up on patients, to look for symptoms or side effects and to refer patients back when clinics are held.
Families dealing with mental illness are brought together. They get training in skills, like sewing, which may earn some income and reduce stress. In Pakistan, the program has already served 12,000 people. The holistic approach, generic drugs and community-based care, has a longer track record in other countries, Underhill says, and it’s inexpensive, about $20 to $30 per person for year.
CHRIS UNDERHILL: Not just the medication and all of that, but also the rest of our model, which includes an element of encouraging and training people back into livelihood.
FRED DE SAM LAZARO: Along with antidepressant meds, Anwar Kaskeli received a micro-loan from the BasicNeeds program to reopen his tiny store.
ANWAR KASKELI (through translator): All I want is enough for three meals a day. I don’t want any riches, anything.
FRED DE SAM LAZARO: Business isn’t great, and his recovery is still precarious. It might be a metaphor for mental health care in poor countries. It’s been a challenge to scale up, because it just doesn’t seem as pressing to governments as other issues, says Underhill, even though it exacts a huge toll.
CHRIS UNDERHILL: Literally, last year, $2.5 trillion came out of the global economy because of mental ill health. Now, bringing that down to the level of policy-makers in one country, Pakistan, isn’t easy.
FRED DE SAM LAZARO: He has a similar challenge with many Western donors, on whom BasicNeeds relies heavily for support.
CHRIS UNDERHILL: If you take one of the big cities in the United States, and you think about the number of people who have mental illness on the streets, I talk to them about the developing world, and they say, but it’s right on our streets.
FRED DE SAM LAZARO: Despite the presence of mentally ill people on U.S. streets, Underhill says the harsh reality is that about three-fourths of the 450 million people with mental illness worldwide are in developing countries, and three-fourths of them are untreated.
In Pakistan’s Sindh Province, I’m Fred de Sam Lazaro for the “PBS NewsHour.”
JUDY WOODRUFF: Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.
FRED DE SAM LAZARO, correspondent: There was a time when this ballad could only be performed clandestinely in Nicaragua and even neighboring countries. It was part of a Mass banned by Church leaders and frowned on by government authorities. In this traditional Catholic region, embroiled in one of the cold war’s last proxy battles, it’s not hard to see how it could be provocative. Christ is addressed as “comrade,” for example.
CARLOS MEJIA (Composer-Performer): All the words, the expressions used were used in everyday life. This Mass was so popular because it was transparent.
DE SAM LAZARO: Carlos Mejia wrote this Mass in 1975, dedicated to campesinas or peasant farmers. He still performs selections from it in his family’s restaurant in Nicaragua’s capital, Managua.
MEJIA: This Campesina Mass was a departure from the traditional Mass, where you would be seated in the church and the faithful, they look up to God, and they pray, “God have pity on us.” And we started having people say, “God show solidarity with us.” There was no longer that distance. This was a new concept.
DE SAM LAZARO: Mejia was part of a movement across Latin America that became known as liberation theology. Its proponents pledged to work for the poor against what they saw as an oppressive ruling class. It was inspired by the Second Vatican Council, the historic gathering called in 1962 by Pope John XXIII to bring the Church closer to the faithful.
Among Vatican II’s most symbolic changes: priests who historically faced the altar began facing the congregation. And the liturgy, celebrated for centuries in Latin, was simplified. It’s now conducted in the local language.
REV. MIGUEL D’ESCOTO BROCKMANN: Pope John XXIII felt that things were stagnated in the Church—that we needed fresh air. He said we must open up the windows and let fresh air come into our Church to revitalize it.
DE SAM LAZARO: Father Miguel D’Escoto Brockmann, a priest from the Maryknoll Order, brought his belief in liberation theology to the context of Nicaragua’s politics and its civil war. He joined the leftist Sandinista government that overthrew the right-wing dictatorship in 1979. He became Nicaragua’s foreign minister.
D’ESCOTO: The message of Jesus was 100 percent political. That’s why he’s not only anti-imperialist, he’s revolutionary.
DE SAM LAZARO: Representing a Soviet-backed government fighting a civil war against the U.S.-backed Contra rebels, Brockmann was a strident critic of what he called U.S. imperialism. But his work ran afoul of a directive from John Paul II that clergy not hold political office. In 1985, Brockmann was suspended from the priesthood for defying the order. He remains unapologetic.
D’ESCOTO: I have to obey, but God first. That’s what you call the primacy of conscience. And Vatican II clearly establishes the primacy of conscience again. But John Paul II had a pre-Vatican II mentality. It’s not his fault. He was Polish, and Poland was the Catholic country where the ideas of Vatican II least penetrated, and besides that, he was extremely anti-Communist.
DE SAM LAZARO: Is it not true that communism and the ideals of socialism were very perverted in countries like Poland especially, and that that might have really affected his thinking?
Miguel D’Escoto Brockmann
D’ESCOTO: Correct, that’s true.
DE SAM LAZARO: Brockmann, who is 83 now, appealed his suspension to Pope Francis, saying he wanted to say Mass once more before he dies. The petition was approved by a Vatican that he says is being transformed.
D’ESCOTO: The Church is more attuned to Jesus. That’s the only thing that matters.
DE SAM LAZARO: Under Francis, you mean?
D’ESCOTO: Under Francis, yes.
DE SAM LAZARO: Another signal Brockmann and others point to is the pope’s decision to open the way to beatify Oscar Romero, the archbishop in neighboring El Salvador, who was assassinated in 1980 while saying Mass. Romero was a critic of the growing social and economic disparities and political repression in the region. Many analysts think his beatification was delayed under Francis’s predecessors because of Romero’s perceived sympathy for the liberation theologians. But the archbishop of Managua, who was appointed by Pope Francis, doesn’t view these developments as an endorsement of the liberation theology dissidents.
ARCHBISHOP LEOPOLDO BRENES: It has to do with the pope being a Latin American. He’s well aware of the path of the Church across this region, and he knows the problems of Latin America.
DE SAM LAZARO: Archbishop Brenes rejects the allegations by liberation theology exponents that the Church has historically sided with the moneyed and powerful interests at the expense of the poor.
BRENES: That is a falsehood. The Church in Latin America and Nicaragua has always been serving and on the side of the poor. That’s why it is strong. Liberation theology never actually gained much momentum here because people here are very faithful and allied with the Church.
DE SAM LAZARO: Theology professor Michele Naglis has a different explanation.
PROFESSOR MICHELE NAGLIS: The search for God is a very personal pursuit.
DE SAM LAZARO: She says liberation theology was not a movement to explore individual and personal spirituality but rather a collective pursuit, mixing a political and religious agenda. It was a product of its time, she says.
NAGLIS: Liberation theology had a basis in Marxism, which was very necessary and relevant at the time. But in socio-political terms, there were a lot of factors that were ignored or excluded, such as the environment or gender issues, for example.
DE SAM LAZARO: There may be disagreement on whether or not the new pope has affirmed their long-ago efforts. But the aging proponents of liberation theology say their ideals are far more closely aligned with the pope today—for the first time in a generation.
For Religion & Ethics NewsWeekly, this is Fred de Sam Lazaro in Managua, Nicaragua.
Why tech entrepreneurs are setting up shop in Pakistan
Editor’s Note. In the following broadcast segment, we incorrectly stated that Karachi is the capital of Pakistan. Islamabad is the country’s capital.
JUDY WOODRUFF: Tonight, we begin a series of reports from Pakistan, a nation that’s been gripped for years by political instability, sectarian violence, natural disasters, and poverty.
The country is also home to one of the world’s largest populations of young people.
Special correspondent Fred de Sam Lazaro met with some innovators in the capital, Karachi, who are hoping that generation will fuel Pakistan’s rise to becoming a high-tech powerhouse.
The story is part of our Agents for Change series.
FRED DE SAM LAZARO: It’s one of Asia’s fastest growing tech start-up companies. This team of Web site developers is on a project for Coca-Cola.
UMAIR AZIZ, Tech Entrepreneur: So, this is going to go up in 27, 28 different markets.
FRED DE SAM LAZARO: Umair Aziz, the founder, can name-drop other blue-chip American clients.
UMAIR AZIZ: Sears. We have worked with Amazon in the past. We have worked with Microsoft. We worked with Intel.
FRED DE SAM LAZARO: One secret to his success — actually, it’s pretty much a secret, period — is where this company, called Creative Chaos, is located, Karachi, the teeming and indeed chaotic commercial capital of Pakistan, a country beset by terrorist violence and political instability, a city that ranks as one of the world’s most violent.
UMAIR AZIZ: We don’t want to be out of the race by advertising that we’re based in Pakistan. There’s a very negative stigma associated with the country.
FRED DE SAM LAZARO: So, prospective customers see nothing on Creative Chaos’ Web site about its location. Technically, it’s headquartered in San Francisco. They soon learn that almost all workers are in Pakistan. Once hired, Aziz says, his company has never been removed from a job.
UMAIR AZIZ: People in the U.S. really don’t know that there’s a world outside of Talibans, and there’s a world outside of, you know, everything that they hear on CNN and BBC all the time.
FRED DE SAM LAZARO: It’s in that world that Aziz carved out a profitable niche. Back in 2000, he was fresh out of college in Ohio and working for a Boston tech firm when he decided to return to his native Karachi.
UMAIR AZIZ: I knew there were hundreds and thousands of people like me who could join, you know, my organization. It was a risk, but I was betting on the talent. I was betting on people just like me.
FRED DE SAM LAZARO: His is one of a handful of thriving Pakistani start-ups, designing Web sites, databases and applications for global clients. The tech sector is seeing a healthy 35 percent annual growth and Aziz expects his firm to grow fivefold by 2020.
In raw numbers, though, that talent pool could be a lot larger, says Jehan Ara, herself a tech entrepreneur.
JEHAN ARA, President, The Nest: The country is about 200 million people, and 70 percent of them below the age of 30. So it’s a very young population. So, the potential is amazing. How to channel that potential is something that we are all sort of thinking about.
FRED DE SAM LAZARO: Ara is leading an effort to scout that talent, trying to create what the technology business calls an ecosystem to foster creativity and new business.
This is The Nest. It’s one of a handful of so-called incubators that have been built in Pakistan. Here, 13 teams of techies chosen from more than a hundred applicants are working on what a panel of judges decided were promising business ideas.
JEHAN ARA: We are looking for young people who’ve developed a minimum viable product themselves while at home or at university and we know that they are committed to doing this. And then, once they get here, then we can help them further.
FRED DE SAM LAZARO: For Pakistan, this is a rare work environment, and not just because it’s offered for free to these would-be tech titans. They have reliable power, broadband and hardware many could not afford on their own, plus a connection to global resources from donors to the facility, including Google and Samsung.
The U.S. government also financially supports The Nest. They practice their pitches in speed dating sessions, a classic Silicon Valley approach to lure investors. And they subject each other to sometimes withering critiques. This argument was about the Web site of a start-up by 23-year-old Shoaib Iqbaugh. It’s a kind of local Angie’s List that provides certified workers vetted not just by background checks, critical in this crime-ridden city.
RUMAISA MUGHAL, Tech Entrepreneur: But it’s so cluttered.
FRED DE SAM LAZARO: What would you like to see in it, specifically?
RUMAISA MUGHAL: Less clutter and, as we talked about, their brand personality. If their best brand is so mess up, their — probably the organization is also messed up, right?
MAN: I think that she is right in many ways, but I would disagree, with due respect, on many points.
FRED DE SAM LAZARO: Rumaisa Mughal has her own start-up, a design business called Artboard. Her presence in this mix is also significant.
RUMAISA MUGHAL: I.T. and the new economy are certainly opening doors for a woman. However, the progress, sadly, is slow, but definitely more women are coming in this field.
FRED DE SAM LAZARO: While The Nest has attracted some investment from abroad, Ara says Pakistan’s own business community has been slower to provide the venture capital that’s fueled so much of the information tech business globally.
JEHAN ARA: It’s only when the local investors get really interested that the industry is going to take off, the start-up culture is going to take off.
FRED DE SAM LAZARO: One big worry is Pakistan’s precarious security situation, which she fears could drive many entrepreneurs to take off, but for jobs abroad.
In fact, we had interviewed Sabeen Mahmud for this story. She was social activist and one-time tech entrepreneur who ran a performance space for the arts and sometimes controversial political debates. Days later, she was assassinated by gunmen who have yet to be identified.
For the PBS NewsHour, this is Fred de Sam Lazaro in Karachi, Pakistan.
JUDY WOODRUFF: You can see Fred’s next story from Pakistan later this week. Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.
Experimental Karachi school teaches students to aim high
WOODRUFF: Now to one woman’s efforts to find answers in one of the world’s most distressed school systems.
Special correspondent Fred de Sam Lazaro reports from Karachi, Pakistan, part of his series Agents for Change.
FRED DE SAM LAZARO: Eleven-year-old Aqsa has high ambitions.
GIRL: First, I want to be a public speaker, and then president of Pakistan to change.
FRED DE SAM LAZARO: To change things?
How do you harness the energy and the enthusiasm of young children?
If you became president of Pakistan, what would you like to do?
GIRL: First, I will clean the litter, because the biggest problem is litter.
FRED DE SAM LAZARO: In Lyari, one of Karachi’s toughest neighborhoods, Aqsa is part of an experiment started six years ago called the Kiran School. The children here are encouraged to think big, to use their imaginations. But the gritty reality just outside of a city often racked by terrorism and violence looms large.
GIRL: There are many people who are like, they are heartless, so they kill people.
FRED DE SAM LAZARO: What kind of terrorism do you see in Lyari?
GIRL: They killed one man at night. It was late, 2:00. They came and they killed and went.
FRED DE SAM LAZARO: Eleven-year-old Hammad also has witnessed killing first hand. He wants to be a robotics scientist when he grows up.
BOY: Robots, like, do everything. And they will stop terrorism, not kill them, but they will stop terrorism and just give to the police.
SABINA KHATRI, Founder, Kiran School: He said that, why can’t we have robots in Lyari as policemen?
FRED DE SAM LAZARO: Sabina Khatri is the school founder.
SABINA KHATRI: Nobody can kill the robots. The bad people will be defeated.
FRED DE SAM LAZARO: A mother of grown children, Khatri lived in Europe for many years before returning to Karachi. She started the Kiran School six years ago, based on the Montessori learning model, admitting just 20 students each year, the goal, prepare them to attend top private English-language schools, alongside children from Karachi’s tiny upper class.
She’s raised scholarships and donations in a foundation for her social enterprise. The children have thrived, Khatri says, even become Harvard material.
SABINA KHATRI: And this is one of the principals who told me that this kid can make it to Harvard.
FRED DE SAM LAZARO: Problem is, the vast majority of children in Lyari and Pakistan will go nowhere. Just 2 percent of the government’s budget goes to education, and much of that is squandered. Public schools are in decrepit condition. Fifty percent lack electricity; 40 percent have no toilets. Many are stripped of furniture. And it gets worse.
It’s not uncommon in this country for there to be public schools that exist only on paper. The money’s been allocated, but no building’s been built, no students enrolled. The only thing that is up and running is the payroll for so-called teachers. They are, in fact, mostly beneficiaries of political favors.
Khatri says the government is starting to face facts, and it’s invited outsiders to take over failing schools. A few months ago, Khatri adopted this Lyari middle school. Her first task was to hire new teachers and tell most of the old ones, tenured, so they could not be fired, to just stay away.
SABINA KHATRI: They come and make — create troubles in the school.
FRED DE SAM LAZARO: So, you would just as soon have them be…
SABINA KHATRI: Yes. I just tell them that, if you’re creating trouble here, it’s better that you don’t come.
FRED DE SAM LAZARO: Her next step, rearrange classes to cluster students by ability, not grade level.
SABINA KHATRI: Although they do say that they are in the eighth grade or ninth grade, they can’t even — they don’t even know how to write their name in Urdu, let alone in English.
FRED DE SAM LAZARO: The students here have been put in an intense remedial curriculum.
There’s strong emphasis on inquiry and critical thinking, instead of the more common rote learning. The school also teaches Islamic values that Khatri says are too often neglected, like tolerance. It’s a challenge in a conservative and in many ways isolated society.
SABINA KHATRI: The biggest criticism and concern was that maybe we were very modern, that they feel that we teach our children music and dance and we are making them broad-minded.
FRED DE SAM LAZARO: And she’s poised to take a controversial step.
SABINA KHATRI: We have actually taken permission for a co-education school. So, we want to admit girls now, because we already have 250 boys in school.
FRED DE SAM LAZARO: Regular meetings with parents and the community are also part of the job. When one woman at a recent open house worried the school was teaching liberal values, Khatri asked an 11-year-old from the Kiran School to respond.
SABINA KHATRI: She actually said that, you know, we believe in God. The way we have learned about God is, God is love. But that is not the way other children are taught. It’s always taught that God will punish you. God loves you.
They were quiet.
FRED DE SAM LAZARO: And accepting?
SABINA KHATRI: It was a wonderful — yes, I think so, because, then, after that, the same lady, she said, I want an admission form.
FRED DE SAM LAZARO: One parent was assuaged, but Khatri says intolerance remains a threat. So, community service projects are another way to win the neighborhood over. But in a country racked by instability, there is no guarantee.
SABINA KHATRI: Anything can happen to me any time, especially in the situation I am, and especially the kind of things that have been happening in our country, because social workers have been targeted lately, in the past two or three years. Anyone who’s trying to help out people, they just kill them.
FRED DE SAM LAZARO: Still, Khatri, who was recently joined by a prominent business leader, plans to persist with what she calls a promising prototype to fix a broken school system.
She and many others say it’s where intolerance and most of Pakistan’s social and economic problems have their root.
I’m Fred de Sam Lazaro for the PBS NewsHour in Karachi, Pakistan.
JUDY WOODRUFF: Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.
Philippines rolls out reproductive health law amid opposition
Special correspondent Fred de Sam Lazaro reports from Manila.
A version of this story aired on PBS’ “Religion & Ethics Newsweekly.”
FRED DE SAM LAZARO: It’s known as the baby factory. But unlike most factories, the people who run Manila’s biggest public hospital wish this one were less productive.
The staff here at the maternity ward say this is a fairly typical, if not slightly quieter than usual day. Still, there are 165 new mothers squeezed into 127 beds. About 70 babies are delivered every day. Their mothers are treated free of charge. They couldn’t afford much anyway, with household incomes of $5 a day, often less.
Most, like Irene Ocampo, who’s 19, will tell you their pregnancy was unplanned.
IRENE OCAMPO, New mother (through interpreter): I didn’t know anything about family planning before becoming pregnant. That’s why I had my baby. I would have preferred to start having children at 20-plus, maybe 25.
FRED DE SAM LAZARO: The hospital recently added a new service that could help her better control when or even whether to have more children.
IRENE OCAMPO (through interpreter): I want to have three to five years between them.
FRED DE SAM LAZARO: The Philippines has begun implementing a law contested for years in congress and court. It requires public health facilities to offer free contraceptive services. These have long been legally available in private clinics, which poor patients like these women could never afford.
DR. SYLVIA DELA PAZ, Obstetrician: We want all pregnancies should be wanted and should end in a healthy baby and mother.
FRED DE SAM LAZARO: Obstetrician Sylvia De La Paz has worked in these wards for 22 years. In that time, she says, most patients have seen their living conditions go from poor to poorer.
DR. SYLVIA DELA PAZ: Before, there used to be street children. Now you see street families. They sleep in the streets. They have no homes.
FRED DE SAM LAZARO: Most disturbing, she says, has been a spike in teen pregnancies: up 50 percent in the country in the last decade, more than double in this hospital.
Why do you think that is?
DR. SYLVIA DE LA PAZ: I think it’s also exposure to early sexual encounters. The age is now, I think, 12 to 14, where, before, it used to 16 to 18. It’s slid down now.
ANGEL (through interpreter): I had no idea that young people like me could have family planning.
FRED DE SAM LAZARO: Angel came to this clinic run by a nonprofit group to be fitted with a contraceptive implant. Like most teenagers who come here, she only learned of this service after becoming pregnant at 14.
ANGEL (through interpreter): I wanted to finish my studies to become a teacher. Becoming pregnant broke my dreams.
FRED DE SAM LAZARO: Some proponents of the new reproductive health law say an entire nation’s dream has been broken by its failure to control population growth.
For instance, the Philippines and neighboring Thailand once has similar poverty levels, but Thailand cut its population growth rate substantially in recent decades, the result, Thais are far better off economically, says Dr. Esparanza Cabral, a former Philippine health minister and one of the architects of the new law.
DR. ESPERANZA CABRAL, Former Health Minister, Philippines: We know that there is a big correlation between number of children and poverty incidents. So the less number of children you have, the lesser are your chances that your family is poor. So that is one aspect. And we can see this not just a family basis, but on a countrywide basis.
FRED DE SAM LAZARO: Father Joel Jason is a spokesman for the Catholic Archdiocese of Manila. He argues people are an economic asset. He says they have been poorly served by their government.
REV. JOEL JASON, Roman Catholic Archdiocese of Manila: Give people job opportunities, give children education, and then you bring them out of poverty. Just giving them condoms and contraceptives will not automatically draw them out of poverty.
FRED DE SAM LAZARO: The church has long been a huge influence in this predominantly Catholic nation, its moral teachings imprinted not just in liturgy, but also in law.
The Philippine constitution, updated in 1987, says that the state shall equally protect the mother and the unborn from conception, and that’s the basis of opposition to the reproductive health law. Opponents argue that just about all methods of artificial contraception can lead to abortion.
Despite church opposition, the court upheld most of the new law, directing the country’s food and drug administration to approve non-abortion-causing contraceptives. But the fight hasn’t ended. Some opponents plans to go back to court. They argue the methods now approved, like injectables or implants, pills and IUDs, make the uterus hostile to implantation, that is, they prevent an embryo, which is legally protected, from attaching to the womb.
Maria Noche is an attorney with the group Alliance for the Family.
MARIA CONCEPCION NOCHE, Alliance for the Family: All the contraceptives that have been registered right now, per our studies, are all abortifacient.
FRED DE SAM LAZARO: That is, using them can lead to abortion.
Father Jason draws a distinction between contraception and family planning, for which the church has no problem, he says.
REV. JOEL JASON: You will not find any single document, present or in the past, that the church says women should have as many children as they can possibly bear.
FRED DE SAM LAZARO: In fact, Pope Francis drew worldwide attention after recently visiting the Philippines when he said Catholics need not breed like rabbits.
But the pontiff reiterated that the only acceptable birth control method is natural family planning, or NFP, where couples abstain from sex on days when the woman is fertile. Jason says artificial methods are a symbol of a moral decay.
REV. JOEL JASON: Why did we invent contraceptives? Not because NFP doesn’t work, but because we do not want to say no. And that is why we are actually slowly losing our sense of what sexuality really is all about.
FRED DE SAM LAZARO: Back in the maternity ward, Blessy Padua, a laundry assistant who did go to high school, says she and her husband did try what she calls the calendar method, without success.
BLESSY PADUA, Founder, BasicNeeds (through interpreter): I am Catholic, and I am aware the Church does not approve of family planning, that God said go and multiply. But at the same time, I already have a lot of kids. I had to stop getting pregnant.
FRED DE SAM LAZARO: After delivering her seventh child, 34-year-old Padua opted to be sterilized.
Obstetrician De La Paz says, for many women here, especially those younger and unmarried, natural family planning is not a good choice or a choice at all.
DR. SYLVIA DELA PAZ: Yes, a lot of them have challenges with their partners, who have issues with alcoholism, no job, or inadequate income, so…
FRED DE SAM LAZARO: How many of them are married, would you guess?
DR. SYLVIA DE LA PAZ: The majority not.
FRED DE SAM LAZARO: One year since implementation of the new law began, she says most urban women now have access to family planning services. About a third of Philippine women still lack such access, most in rural areas of this sprawling archipelago.
For the PBS NewsHour, this is Fred de Sam Lazaro in the Philippines.
GWEN IFILL: Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University in Minnesota.
The Dalai Lama at 80
Transcript not available.
King of Hearts: Affordable Heart Surgery in India
DR. DEVI PRASAD SHETTY (Founder, Narayana Health): Hole in the heart. It is one of those standard procedures.
FRED DE SAM LAZARO, correspondent: It’s probably more “standard” for Devi Prasad Shetty than just about anyone else. The 62-year-old surgeon says he stopped counting after his 15,000th open-heart operation.
DR. SHETTY: I do now about one or two surgeries a day, and we work six days a week. My colleagues—some of them do four surgeries, five surgeries a day.
DE SAM LAZARO: Anywhere from 25 to 35 open-heart operations are performed in the theaters here every day, many on babies, making this by far the largest cardiac care facility in the world. This 1000-bed hospital in Bangalore is part of a fast-growing for-profit hospital chain called Narayana Health. Its error rate is similar to or lower than most American hospitals, at a tiny fraction of the cost. Take this complicated valve replacement operation that took more than six hours.
DR. SHETTY: This patient would have paid us about $2500 to about $3000, but in the US an operation of this nature would cost, I guess, anything from $70,000 to $100,000.
DE SAM LAZARO: Dr. Shetty founded Narayana Health 15 years ago. Like similar enterprises in India, it does serve wealthy patients and some medical tourists. But he says the mission is to bring the latest advances in cardiac surgery to the lower middle class and the poor.
DR. SHETTY: If a solution is not affordable, it is not a solution. It’s pointless if we talk about huge developments in cardiac surgery or a brain operation or complex cancer surgery if [the] common man cannot afford it.
(examining infant): Here’s a chocolate for you…
I see 70 [to] 100 patients a day. A typical patient of mine is a little kid on a mother’s lap.
(to infant’s mother): He has a leakage in the valve of his heart. He needs an operation.
DE SAM LAZARO: The surgery carries risks, Shetty told the child’s family.
Mother of infant: Sir, he is my only child, that’s all I want to say.
DR. SHETTY: I will do everything possible. God will make it alright. Don’t worry.
DE SAM LAZARO: It’s a scene repeated several times a day, Shetty says, and the tears, the anguish are not always about whether the surgery will be successful.
DR. SHETTY: I tell the mother that the baby requires a heart operation, and she has only one question: how much it is going to cost? And I tell her that it is going to cost 80,000 rupees, which she doesn’t have, and that is the price tag on the kid’s life. She comes up with 80,000 rupees, she can have the baby. If she does not have 80,000 rupees, she going to lose the kid.
DE SAM LAZARO: That’s about $1300, a lot of money in India, where hundreds of millions earn less than two dollars a day. A few patients are helped by a charitable trust set up by Narayana Health. Most have somehow scrounged together the resources. In India, Shetty says 80 percent of all medical bills are paid out of pocket.
DR. SHETTY: They virtually sell everything that they have and come for treatment. Half the country’s population borrow money or sell assets to pay the medical bills.
DE SAM LAZARO: The parents of five-month-old Manoj borrowed about three times their monthly income as rural farm laborers just to figure out why the child wasn’t thriving.
HEMAKSHI SIVAPURA (Mother of Baby Manoj): He was not taking his milk properly, he had fevers and cough, so we took him to see the doctor. They told us he needed surgery.
DE SAM LAZARO: That meant a day-long train journey to this hospital. But once there, another Narayana benefit kicked in: an insurance policy developed with farmers associations and state governments in South India. The plan covers only major medical costs like surgery, but the premium of just 10 cents a month makes it widely affordable.
DR. ASHUTOSH RAGHUVANSHI (CEO, Narayana Health): It’s amazing that such a small amount of money could provide that care. The number of people who are covered under this scheme is about 10 million now, and it has performed close to about 100,000 operations of various kinds.
DE SAM LAZARO: We were assured three-year-old Chitrashri was in no physical pain, just anxious as nurses removed her stitches from a successful heart operation—a huge relief medically and financially for her parents, who struggle to get by selling milk from their two cows. The insurance coverage for their extended family and so many others has been a significant revenue source for Narayana Health.
DR. RAGHUVANSHI: About 25 percent.
DE SAM LAZARO: Really?
DR. RAGHUVANSHI: Yes.
DE SAM LAZARO: So it’s significant?
DR. RAGHUVANSHI: It is significant.
DE SAM LAZARO: It is just one business strategy Narayana has used to find revenue. It also has a Walmart-like approach to cost saving, squeezing vendors for everything from surgical gowns to supplies to devices.
DR. SHETTY: We have 32 hospitals across India. Twelve percent of the heart surgery done in India is done by us. When we implant one of the largest number of heart valves in the world, obviously you pay for it less than others. And also, more than the cost, our results get better.
DE SAM LAZARO: He says the sheer volume of surgery not only improves productivity and lowers cost, it also makes the surgeons better at their art. They’re paid well by Indian standards, but probably far less than they could earn elsewhere, especially in the West.
DR. SHETTY: We can address the need of the doctors, but we cannot address the greed of the doctors. And I’m pleased to say that our attrition rate among doctors is virtually zero percent. They love working here.
DE SAM LAZARO: What qualities are you looking for specifically to work in a place like this?
DR. SHETTY: The most important quality is the passion. The second most important quality is compassion.
DE SAM LAZARO: Shetty grew up in a middle-class Hindu family and developed an early passion for medicine watching doctors treat his parents, who both suffered ill health. After medical school, he trained in London and returned to work in India, at first in Calcutta. There, by chance, he got to treat the city’s most famous citizen, Mother Teresa.
DR. SHETTY: I was truly, truly touched by her thoughts and deeds—like a simple statement from her which says that hands which serve are more sacred than the lips that pray.
DE SAM LAZARO: Shetty says he serves with his hands. And he prays.
DR. SHETTY: I am very, very spiritual but I am not religious. I believe in the existence of God, and before I start an operation I pray to God, and after the surgery I again pray to him for taking me through the operation.
DE SAM LAZARO: Prayer…Mother Teresa…Walmart? Shetty sees no contradiction. In order to be charitable at any scale, he says, you can’t be a charity.
DR. SHETTY: Charity is not scalable. It doesn’t matter who you are. You may be the richest person living on this planet, but if you want to offer free surgery, free treatment to everyone, you will go broke within a month. But good business principles, standard business policies are scalable.
DE SAM LAZARO: Narayana Health has branched out beyond cardiac surgery into cancer and kidney care, and Shetty says it will become the world’s largest hospital system in a few years.
SIVAPURA: It was very difficult at first when we came to see him, but the doctors told us that things are going to be alright.
DE SAM LAZARO: Baby Manoj is but one case, Shetty says, that proves health care—even sophisticated surgery—can be made accessible to the poorest people in the farthest corner of the world.
For Religion & Ethics NewsWeekly, this is Fred de Sam Lazaro in Bengaluru, India.
The Dalai Lama’s Doctor
But, first, the Dalai Lama was supposed to arrive in the U.S. yesterday. He didn’t, because doctors at the Mayo Clinic advised him to rest.
But advice flows both ways in the relationship between the Buddhist leader and his personal physician.
Special correspondent Fred de Sam Lazaro reports on how the Dalai Lama inspired a California native to move halfway across the world and bring compassion back into a medical care system dominated by technology.
The report is part of Fred’s ongoing series Agents for Change.
Fred De Sam Lazaro:
Sixty-eight-year-old California native Barry Kerzin began his career as a professor of family medicine at the University of Washington. He never dreamed it would lead to a pro bono house calls thousands of miles away in Tibetan.
Dr. Barry Kerzin,
Buddhist Scholar: I keep pinching myself, Fred. I don’t know.
Fred De Sam Lazaro:
He first arrived here after hearing that the Dalai Lama had wanted a Western physician to train traditional Tibetan doctors in modern research methods.
Dr. Barry Kerzin,
Buddhist Scholar: We did a research study. And we used that pedagogically to train the local Tibetan medicine doctors how to do the research.
And then I got more involved with Buddhism. I had already been very interested. I got more involved with meditation and study. And I ended up extending my stay. And that’s happened again and again and here I am 27 years.
Fred De Sam Lazaro:
He came to India from a life punctuated by pain and loss, at 11, a near fatal brain abscess that required extensive surgery and left a permanent lump on his skull. His mother died young, and a few years later so did his wife, only in her mid-30s, both from cancer.
Buddhism became a sanctuary under the tutelage of the Dalai Lama, who told him to stay connected to the world.
Dr. Barry Kerzin:
He always encouraged me to keep my credentials and to continue practicing medicine. Don’t just do the wisdom. Also do the love and the compassion. In fact, do them 50/50. Those were his words.
Fred De Sam Lazaro:
Scholarship in Buddhism led to his ordination as a monk, while meditation has been a path to inner peace and happiness. And that’s translated into empathy, he said.
Dr. Barry Kerzin:
It’s slowly moved me along to be more compassionate, to be less selfish.
I don’t get angry very much anymore. I used to be highly competitive. I’m still somewhat competitive, but it’s more now personal, not at the expense of somebody else. I think it’s a combination of meditation and also, as His Holiness calls, emotional hygiene.
Fred De Sam Lazaro:
Kerzin, who now serves as a personal physician to the Dalai Lama, has taken the spiritual leader’s gospel of emotional hygiene and compassion to medical practitioners around the world.
(through interpreter): He is my messenger. Go to Japan, go to Mongolia.
Fred De Sam Lazaro:
And full circle to America.
Dr. Barry Kerzin:
It’s lovely to be at Stanford.
Fred De Sam Lazaro:
A few years ago, a prestigious lecture at a top U.S. medical school wouldn’t have been given by a man who left American medicine and many stunned colleagues for a very different world, where he doesn’t own a house, car or refrigerator.
Dr. Barry Kerzin:
I think initially they thought I went off the deep end. What are you doing living in India? Come on. You know, how can you stay healthy? Why don’t you come back? And you could have a very good life. You could have a very good academic life in medicine. You could have a very comfortable economic life. It’s ridiculous what you’re doing.
So let’s meditate, OK?
Fred De Sam Lazaro:
But on this day, they were listening, even meditating, with him. Kerzin says meditation helps one focus on the now, the present. You tune out the past and all your regrets, tune out planning and worry about the future. It’s taken years, he says, but gotten results, scientifically measured results.
Dr. Barry Kerzin:
This is in Madison, the University of Wisconsin, and they’re researching my brain.
Fred De Sam Lazaro:
Kerzin has been part of a series of studies into the impact of meditation on the brain.
Dr. Barry Kerzin:
What they found were changes in the prefrontal cortex. This area is called the executive function area, the PFC, and it helps with things like planning, reasoning, imagination, empathy, to feel as — like another person is feeling. So these areas were enhanced, both anatomically and functionally, in long-term meditators.
Fred De Sam Lazaro:
Kerzin’s host at Stanford said there’s an epidemic of dissatisfaction among American doctors today, which likely makes them more receptive to a message like Kerzin’s.
Dr. Abraham Verghese,
Stanford School of Medicine: Fifty percent of them, they say in some studies, are unhappy. And that tells you this is not an individual problem. This is a systemic problem.
Fred De Sam Lazaro:
Dr. Abraham Verghese, well-known author and professor at Stanford, says technology, for all its benefits, leaves doctors little time for the compassion that drew most of them to medicine.
Dr. Abraham Verghese:
There was a chilling paper from the “Journal of Emergency Medicine” titled “4,000 Clicks,” suggesting that an emergency medicine physician does 4,000 clicks a day and spends the great majority of their time on the computer, very little percentage of the time actually with patients, and similar studies that are coming out suggesting the same about residents and medical students and physicians in other specialties.
Fred De Sam Lazaro:
Kerzin says he wants to make compassion as integral to medical education as physiology or biochemistry, more partnerships between scientists and Buddhist scholars, a reconciliation of very different perspectives on life that he said he’s made internally.
Dr. Barry Kerzin:
I used to say I wear two hats. So, sometimes, this is the medical hat, this is the Buddhist hat. But I don’t say that any more.
Fred De Sam Lazaro:
Today, he says he wears one scientist monk hat.
For the PBS NewsHour, this is Fred de Sam Lazaro in Dharmsala, India.
Rest Stop on the Migrant’s Journey
One of the few safe harbors here is the Casa del Migrante, started by 72-year-old Pedro Pantoja, a Jesuit priest.
REV. PEDRO PANTOJA: Every migrant is a potential kidnapping victim, and the criminals extort up to $5000 in order to set them free. In the first six months of 2009, we know of about 9000 migrants who were kidnapped. In that six months, that was worth $25 million for organized crime.
DE SAM LAZARO: And now, he says, they must contend with immigration authorities in Mexico. With pressure and aid from the US government, Mexican authorities have been clamping down on Central American migration, and the number of people making it as far north as the US border has dropped significantly. But they haven’t stopped coming.
Rev. Pedro Pantoja
REV. PANTOJA: These guys are really tired. They just got here early this morning.
DE SAM LAZARO: The new arrivals eluded the Mexican migrant dragnet which deported 25,000 Central Americans in the first two months of 2015, double the number from a year earlier. Unaccompanied minors, thousands of whom were once reaching the US, are intercepted long before they could get this far north.
Why do they persist, I asked?
REV. PANTOJA: The answer is what one migrant said to me: “Yes, I fear organized crime, I fear the police, but I fear hunger more, and violence.” They are the strongest motivators.
DE SAM LAZARO: Many of the mostly male migrants say they’re fleeing conscription into the criminal gangs that now dominate urban life in Guatemala, Honduras, and El Salvador, a region with the world’s highest homicide rate.
REV. PANTOJA: They have young gang members on every street corner, and they know exactly who lives in every house, who goes in and out.
DE SAM LAZARO: This 22-year-old wanted his identity concealed to protect family back home. He escaped El Salvador only to be apprehended along with four fellow migrants by Mexican police along their train journey. They weren’t arrested but were instead stripped, forced into a nearby pond, and robbed, he told me.
Migrant from El Salvador: They took all of our money, our phones, shoes, and they threw our clothes in the water. They were laughing at us.
DE SAM LAZARO: They found refuge in a church, he said, and were eventually referred to this shelter.
REV. PANTOJA: We get the details of each person. This allows me to communicate with their families if they get kidnapped, if they die, if they end up in jail or get lost on the route.
DE SAM LAZARO: Santos was being registered on this morning.
FEMALE EMPLOYEE: From which country?
FEMALE EMPLOYEE: And a telephone number that we can reach loved ones?
DE SAM LAZARO: He’s hoping to return to Texas where he worked undocumented for years before a fateful traffic stop led to his deportation. Going to the US is far more perilous now, he says.
SANTOS: In the nineties, you could easily cross. Now they own the river. If they catch you they’ll beat you up, even kill you. The only way now is to find a good coyote.
DE SAM LAZARO: Coyotes, or traffickers, usually tied to gangs, charge about $4000, he says, though other reports put the price tag much higher-with no guarantees. Santos tried once before, in 2010, and did make it into the US, barely, but was immediately caught and sent back by the border patrol.
Why do you want to take the risk, given how dangerous this journey is?
SANTOS: Because the situation in Honduras is that for a 46-year-old, no one will give you a job in my line of work, construction. If you try to start your own business, no matter how small, the gangs who would extort any earnings.
MAVER: My life was threatened by the gangs because I couldn’t afford to pay the extortion.
DE SAM LAZARO: Thirty-six-year-old Maver also fled Honduras, leaving behind her small shop and two older children. She brought her three-year-old, Emily, on a journey that turned from tiring to terrifying. She says Emily was snatched from her by men who’d posed as good Samaritans offering to help them.
MAVER: It was about 3:30 in the morning. It was really dark. That’s when they came and took my child. They shoved me to the ground, took the child, and said I had to pay $10,000 to get her back.
DE SAM LAZARO: Sensing her anguish, the often hostile Mexican authorities were sympathetic, she said, as were many strangers.
MAVER: I’ll never forget being in church on Mother’s Day and watching all these mothers with their children and wondering, where is my child?
DE SAM LAZARO: In the end, Emily was found in the custody of child protection authorities, apparently turned over by her kidnappers, though no one will say, and the child does not remember.
MAVER: The moment I lifted her up was the happiest moment of my life, to hug her, to know she was alive. Emily told me she was very scared, kept saying, “Why did you leave me to travel by myself? Why did you leave me alone?” Now every time I hug her I tell her she’s not alone.
DE SAM LAZARO: With so much worry about crime, it’s easy to forget that the journey-walking and stowing away on freight trains-is physically tiring and dangerous. Getting your leg jammed between train cars, for instance. That happened to 50-year-old Laura, who then fell to the ground in excruciating pain.
LAURA: I thought I was going to die, and all I kept thinking was, let me die in a town so they’ll be able to identify me and take me back to my family. And then I saw a man and shouted for him, and he called the Red Cross.
DE SAM LAZARO: After three days in the hospital, she was brought here, where she’ll wait several months for her wound to heal, for a prosthesis, and then rehab. After that, she says she’ll continue her journey north.
LAURA: I know it will be more difficult, but what else can I do? I have to support a family, not just my daughter, but I have grandchildren. They don’t even have a place to live.
DE SAM LAZARO: She can stay here for as long as she needs. Unlike other shelters along the long migrant route, this one has no time limit.
REV. PANTOJA: All people who come here injured or hurt, they do not leave here until they’re completely recovered. They have to leave here as persons who are free and with dignity.
DE SAM LAZARO: Some migrants engage in crimes, he said, but the numbers are grossly exaggerated. Over the years he says the shelter has convinced a once skeptical and fearful local community to support his work-now with donations of cash and kind and moral support that helps protect it from local gangs.
REV. PANTOJA: In Genesis chapter 12, God called Abraham to be a migrant. In reality we are all migrants…
DE SAM LAZARO: But with varying fortunes. The shelter helped Maver and Emily get a humanitarian visa to legally be in Mexico. That will allow her to make a much safer bus journey to Texas. Guadalupe Arguello, who works at the shelter, says Maver has a decent chance to plead her case for asylum, based on the threat to her life.
GUADALUPE ARGUELLO: In our experience, based on the experience of other mothers with children, yes. Also, she has family in the US who will help her financially and legally.
DE SAM LAZARO: That’s not an option for Santos, who was preparing for the perilous hike to the US border. His main task: to find a trafficker with both a good track record getting people across and one willing to take most of the payment once Santos gets there.
For Religion & Ethics NewsWeekly, this is Fred de Sam Lazaro in Saltillo, Mexico.
New Clinic Model Addresses Mexico’s Diabetes Crisis
GWEN IFILL: But, first, combating a growing diabetes epidemic in Mexico.
Special correspondent Fred de Sam Lazaro reports. It’s part of his series Agents for Change.
FRED DE SAM LAZARO: The North American Free Trade Agreement brought Mexico chain restaurants, malls and big box stores with abundant shelves, and an epidemic of diabetes.
JAVIER LOZANO, Founder, Clinicas del Azucar: Regular food, but sugar free.
FRED DE SAM LAZARO: Javier Lozano, whose mother suffers from the disease, thinks he can make a difference. Three years ago, he opened a chain called Clinicas del Azucar, or the Sugar Clinics.
JAVIER LOZANO: Our dream was, imagine there’s a clinic in every corner. Just as we have franchise for hamburgers and pizza and fried chicken.
FRED DE SAM LAZARO: The clinics are a one-stop shop to see a doctor or nutritionist, get your eyes checked, or feet, then pick up a pair of shoes or snacks.
Lozano, a 33-year-old MIT graduate, hopes to have 200 outlets by 2020, but it’s a tiny fraction of the demand in a country that by then could have 20 million diabetics.
DR. SIMON BARQUERA, National Institute of Public Health: Basically, diabetes prevalence has been doubling every six to 10 years.
FRED DE SAM LAZARO: Dr. Simon Barquera of Mexico’s National Health Institute says it now affects 14 percent of Mexican adults, a population with widespread genetic predisposition to diabetes.
Adding to the risk, 72 percent are obese or overweight. Those numbers are now higher than Mexico’s northern neighbors, but with double the impact. Far fewer Mexicans have their symptoms under control.
DR. SIMON BARQUERA: For example, in Canada and the U.S., more than half of the population with diabetes has adequate control, in Mexico, only 25 percent.
FRED DE SAM LAZARO: Complicating matters, half of those affected aren’t aware they have diabetes. And those who are diagnosed can remain asymptomatic for years, and they do little to control its advance.
DR. SIMON BARQUERA: They go looking for private care and they see that it’s too expensive. Then, usually, they go back to the public care, and it’s limited. So, you know, when people have a difficult decision, we usually just defer the decision.
FRED DE SAM LAZARO: Maria De La Luz Mireles says she struggled for years with scattered, substandard care until specialists at the Sugar Clinic helped bring her symptoms under control.
MARIA DE LA LUZ MIRELES, Diabetes patient (through interpreter): I went to many clinics and never got to see a specialist. It was general doctors and they’d change my medications. This went on for 20 years.
FRED DE SAM LAZARO: That overall lack of access to care means more advanced cases: limb amputations, heart, kidney and eye disease, more people like Luis Martinez, at 64, long retired and nearly incapacitated.
LUIS MARTINEZ, Diabetes Patient (through interpreter): My kidneys have been very seriously affected, so I have to have dialysis twice a day, and four months ago, I lost the last bit of sight that I had.
FRED DE SAM LAZARO: As a young man, Martinez moved from the country to the city, part of a massive urbanization. Three out of four people now inhabit cities in this once agrarian nation, says Sugar Clinics endocrinologist Eduardo Camacho.
DR. EDUARDO CAMACHO, Clinicas del Azucar (through interpreter): Most people lived in the countryside, and so they used a lot of energy and got a lot of exercise in order to feed themselves. It was labor-intensive work. Now, with urbanization, people are using much less energy in their daily lives to get the food that that they need.
FRED DE SAM LAZARO: Then there’s the food, plentiful, affordable, but processed. Dr. Barquera says it’s an industrialized version of the healthy, traditional Mexican diet.
EDUARDO CAMACHO: What we have now, tacos, both the tortillas, bigger. They have a lot of meat. They have a lot of fat. Sometimes, the quesadillas are deep-fried.
MAN (through interpreter): People are on the go, working, so if you have got money, you go to a restaurant. If you don’t, you eat tacos on the street. And people drink soda, rather than have water.
FRED DE SAM LAZARO: Maria Sanchez Perez, who is losing her sight and lives in fear of a stroke, blames her addiction to Coca-Cola.
MARIA SANCHEZ PEREZ, Diabetes patient (through interpreter): Those big bottles that you see, those wouldn’t even last me a day.
FRED DE SAM LAZARO: She’s hardly alone. According to Coca-Cola, Mexicans are far and away the biggest consumers of the company’s products, especially the flagship Coca-Cola, which is sold in three-liter bottles in this country. On average, the company says Mexicans consume 43 gallons of Coke products per year. That works out to about 55 of these per person per year.
In 2014, after a campaign by citizen activist groups, Mexico became the first nation to enact a so-called soda tax, 10 percent on sugar-sweetened drinks, 8 percent on salty snacks. In its first year, one study showed consumption dropped by 6 percent. But the study’s methods were questioned by the food and beverage industry, led by multinationals including U.S.- based Coke and Pepsi.
The industry has fought such tax proposals, successfully in most cases, including New York and San Francisco.
LORENA CERDAN, Food and Beverage Industry Spokesperson: It’s a regressive…
FRED DE SAM LAZARO: It’s a regressive tax, is what you’re saying.
LORENA CERDAN: It’s a regressive tax, yes.
FRED DE SAM LAZARO: Lorena Cerdan is a spokesperson for Mexico’s food and beverage trade group, which argues its products are unfairly singled out.
There’s absolutely no link between soda consumption at 43 gallons per person per year and the disease burden of this country?
LORENA CERDAN (through interpreter): There is no causal relationship to link directly sugary drinks with diabetes. There is a causal relationship between a sedentary lifestyle and an overconsumption of calories.
FRED DE SAM LAZARO: She says the urbanized lifestyle and overall increase in calories from many sources are the problem.
The industry has contributed to public awareness and fitness campaigns. But its critics, like consumer advocate Alejandro Calvillo, are skeptical.
ALEJANDRO CALVILLO, Consumer advocate: They are, by this way, trying to create confusion, that you don’t have good products or bad products. Everything is on the relation of the calorie intake that you consume and the calories that you spend.
FRED DE SAM LAZARO: He says there’s also been lackluster enforcement of recent regulations, banning salty snacks and sodas in schools, for example.
CAVUTO: All right. This is the schools in the country that we have reports that are not following the regulation. We are making a list of the schools.
FRED DE SAM LAZARO: And experts say it’s not just at school, but at home that a culture shift is needed; 26-year-old Karla Almanza gets good grades from her nutritionist at the Sugar Clinics for controlling her weight and sugar levels. But she says its not been easy cutting out foods and sugary drinks she loves and imposing a diet on her mother, who is also diabetic, and two daughters and her husband, who are not.
KARLA ALMANZA, Diabetes Sufferer (through interpreter): For the children, I have always cooked like that. They’re used to it. It’s really difficult for my husband. He says: “I’m not a rabbit. Give me some more meat.”
FRED DE SAM LAZARO: It’s also hard on the budget, she says. The healthy diet, ironically, is costlier than fast food. Helping her budget, her clinic fees are fixed, payable up front for the full year, though financing is offered to help patients afford care.
Lozano says this ensures patients come back regularly, their complications not only treated, but also tracked.
JAVIER LOZANO: We have been on the — more than three years in care and we have seen more than 15,000 patients. So we have a lot of data.
FRED DE SAM LAZARO: The data helps determine what works and what doesn’t, which also in turn helps lower costs and increase access to care in an epidemic that most experts says this nation is unprepared for.
For the PBS NewsHour, this is Fred de Sam Lazaro in Monterrey, Mexico.
GWEN IFILL: Fred’s reporting is a partnership with the Under-Told Stories Project at Saint Mary’s University of Minnesota.
How an environmental group is trying to clean up China’s pollution problem
The scenes are a stark reminder of the huge environmental price China has paid for becoming the world’s factory, a problem experts say the government is now taking seriously.
One gauge of that is the free rein given to a non-government environmental group.
Fred de Sam Lazaro reports from China as a part of his ongoing series Agents for Change.
FRED DE SAM LAZARO: The inspectors came calling recently at this massive textile factory in the eastern city of Hangzhou. The plant is part of the Saintyear company, one of the icons of China’s rapid rise as a manufacturing powerhouse. It produces two billion feet of patterned and dyed fabric each year for clothing makers and retailers around the world.
This plant also produces some 60,000 tons of waste water, and a 2013 investigation found it wasn’t being adequately treated.
Manager Wang Wei said millions of dollars were invested to upgrade the system.
WANG WEI, Vice President, Saintyear (through interpreter): Today, we invited IPE in to show them our changes, our improvement in environmental protection, so their inspectors can see we are in compliance with government requirements.
FRED DE SAM LAZARO: But IPE, the inspectors, are not from the all-powerful government. The Institute of Public and Environmental Affairs, is a small non-government organization.
IPE founder Ma Jun has won international awards for his environmental activism, with no apparent objection from the government. He’s used technology and political savvy to take on China’s powerful industrial establishment, says Linda Greer of the Washington-based NRDC, the Natural Resources Defense Council, which has partnered with IPE.
LINDA GREER, Natural Resources Defense Council: I think he’s an astute observer of what are the problems and how can they best be solved in China.
FRED DE SAM LAZARO: Ma was an investigative journalist in the 1990s, when he began documenting the toll of China’s industrialization, environmental and human.
MA JUN, Founder, Institute of Public and Environmental Affairs: Like in those cancer village, a group of old ladies kneeling down in front of me, you know, holding a bottle of polluted water and hoping that they would get help, this is the voice that got drowned in this complex globalized supply chain system.
FRED DE SAM LAZARO: He says hundreds of millions of Chinese have been exposed to health hazards.
In our interview, which occurred right after he injured his lip in a bicycling accident, Ma said things are approaching a tipping point.
MA JUN: If we don’t handle that right, this will not just threaten our social stability, but it could hinder the very economic growth itself.
FRED DE SAM LAZARO: It’s not hard to get a sense of public concern, even anger.
WOMAN (through interpreter): The air is not good, and it’s getting worse and worse.
FRED DE SAM LAZARO: At the sidewalk barbershop outside the industrial city of Tianjin, people shared their feelings, though not their names.
MAN (through interpreter): You do feel the pollution when you breathe. It’s a lot more polluted than before. The water is also polluted and our food.
MAN (through interpreter): The officials are corrupt. People with money can buy favor. Corrupt officials are everywhere.
FRED DE SAM LAZARO: Ma says there’s growing political will in Beijing to tackle the crisis. Standards have been tightened and factories are now required to report their emission levels in real time.
IPE then makes this information user-friendly to the public online and now on mobile.
This is a large power plant just outside the industrial city of Tianjin, and it’s one of thousands of industrial sites across the country that are monitored. And that information is readily available to anyone who’s downloaded the IPE app onto their smartphone. As it turns out, this plant today is well within the range of allowable emissions.
As you can see, there are dozens of plants being monitored. Some of them are in the red zone. And the one that we’re standing in front of comes in at 33.
But environmental concerns often take a back seat to economic growth. Local officials who are supposed to enforce emission levels are instead rewarded for creating jobs.
LINDA GREER: There’s sort of a nobody will ever know mentality down there at the provincial and local level.
FRED DE SAM LAZARO: So IPE has taken matters to the global level, to customers, far likelier to be sensitive about their public image.
When IPE learned the Hangzhou factory was out of compliance, for example, it contacted its biggest customers, including Nike, Wal-Mart, Gap and H&M.
MA JUN: They made very clear commitment to sustainable manufacturing and sourcing. And we just want to hold them accountable for that.
WANG WEI (through interpreter): IPE convinced our brand customers not to place any order from any supplier who did not meet their environmental requirements. IPE is trusted by the public, and we can trust their data.
FRED DE SAM LAZARO: Because of its size, Wang says his company was able to afford the $30 million-plus upgrade. But he says that may not be true of all suppliers, who are often pressured by their brand customers to lower costs.
Ma Jun says the solution is to make information accessible to all parties.
MA JUN: Many stakeholders would like to join the efforts, including, including even the polluters themselves. You know, they pollute. It’s not because morally they have a problem, but more because the mechanism now is rewarding those who cut corners to save cost. So I think that we can level the playing field.
FRED DE SAM LAZARO: One way IPE does that is by publishing an annual transparency index.
MA JUN (through interpreter): Today, I would like to announce the top 100 brands and their ranking and scores.
FRED DE SAM LAZARO: The index ranks international brands on how they have dealt with suppliers that are violating pollution laws. Are they working to reduce emissions or increase recycling, for instance?
MA JUN (through interpreter): Scores have been on the rise. And the score for Apple has exceeded 70 twice.
FRED DE SAM LAZARO: Apple ranks number one, ironic, since the company initially declined to work with IPE. It relented after IPE’s investigations linked several polluting factories to the Silicon Valley giant. Today, Apple and several global brands use the group’s data as a resource.
Here’s retailer Target’s Ninh Trinh.
NINH TRINH, Target Corp.: We look at IPE to ensure that there are no irregularities. What is the progress of our suppliers that have irregularities that need to be reported?
FRED DE SAM LAZARO: Several, like Macy’s, J.C. Penney, and Victoria’s Secret, were rated at zero. The brands insist they monitor their suppliers. Macy’s and Penney told us they never heard from IPE. The group says each brand was contacted by letter. Ma says IPE will add brands on the next version of its mobile app, not just the factory names that mean little to consumers, especially in the West.
LINDA GREER: China’s pollution problem is caused by about one-third by export to America and to Western Europe. So this pollution is our pollution, and I think we have an ethical obligation to help reduce it.
FRED DE SAM LAZARO: And even as China begins cleaning up, she and Ma Jun fear the global supply chain will migrate to less expensive countries, eager, as China was a generation ago, to attract new factories, but lacking systems to safeguard the environment.
For the PBS NewsHour, this is Fred de Sam Lazaro in Tianjin, China.
GWEN IFILL: Fred’s report was funded in part by the Pulitzer Center on Crisis Reporting.
A version of this story also appeared on the PBS show “Religion & Ethics Newsweekly.”