You light up my eyes!

KOUNTEYA SINHA TIMES NEWS NETWORK , TOI Crest 21 November 2009, 05:15am IST

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Born with beautiful large twinkling eyes, Padma Devi's newborn son soon became a favourite in her small village in southern Karnataka.

The baby was born underweight and weighed just about 1.6 kg, but the joy of his birth drove concerns about his weight out of his mother's mind. However, two months later, Padma noticed something strange - his lightbrown pupil had become white and he stopped responding to movement.

A subsequent visit to a primary health centre gave Padma a devastating shock - the child was declared irreversibly blind. He was suffering from Retinopathy of Prematurity (ROP) - the leading cause of preventable childhood blindness in India.

ROP is a condition that affects up to 47 per cent of the babies born below 2,000 grams in India. Of these, nearly 20 per cent go blind if not treated on time. Interestingly, none of these children are born with ROP. Premature babies actually go on to develop it between one to three months after birth. Strangely, even as vitamin A deficiency and corneal problems have received adequate consideration and funding from the government, retinal malfunctions that account for 22 per cent of the childhood blindness cases in India have failed to draw requisite attention from the relevant authorities.

With the Union health ministry yet to realise the seriousness of this problem, the fight against ROP is now being led by two unlikely heroes in Karnataka - Dr Anand Vinekar, a paediatric retinal surgeon armed with a laser machine and a camera the size of a 165-litre fridge on the backseat of his Qualis, and Krishna, a 25-year-old technician who has barely cleared middle school.

For the past two years, Dr Vinekar, head of Narayana Nethralaya Postgraduate Institute of Ophthalmology's department of paediatric retina, and Krishna - a lab technician trained to identify various stages of ROP with nearly 100 per cent accuracy by just looking at images - have been traversing the most backward roads of Karnataka for 13 hours a day, stopping at villages, screening newborns for ROP and surgically treating those who need it on the spot with the laser machine.

However, what's creating waves internationally is their latest project - a Tele-ROP model. This is how it works. Trained technicians visit remote villages, capture retinal images with a special portable digital wide-field camera (capable of seeing 130° of the retina with one single shot). These are then sent via email to a special server. Retinal experts sitting miles away view the images and give their diagnosis within minutes. The technician then informs the mother about ROP and gets the child treated by a Narayana Nethralaya ophthalmic surgeon.

"India has less than 300 retinal surgeons,"says Dr Vinekar. "That's why we are training common people to become technicians - those who can just look at images and detect stage one to stage five ROP, negating the requirement for a doctor. It is easy to take a retinal image, so we are training technicians to analyse the images and diagnose. Due to the massive number of babies that need to be screened, and the limited number of trained physicians, there is no other way. At present, babies born in rural areas are either never screened or screened too late for ROP, which can be prevented by timely diagnosis and appropriate treatment. That's why we are now creating self-sufficient districts - training ophthalmologists from peripheral healthcare centres to treat ROP besides having two technicians per district. Besides Karnataka , a similar project is underway in West Bengal." Till now, they have screened over 1,700 infants around a 350-km radius of the Nethralaya. Over 155 kids from neonatal centres in 18 hospitals in south Karnataka's seven districts have been treated.

The ministry has finally taken note of their efforts and through a publicprivate partnership decided to incorporate the model in India's National Rural Health Mission. Six more districts in Karnataka are now being added for the out-reach programme, which will ultimately be taken across the country. "A number of Southeast Asian and African countries are facing similar problems with ROP and have a shortage of trained ophthalmologists," Dr Vinekar says. "India has proved that a technician-driven model works. What's worse about ROP is that the retina does not look abnormal from outside till it reaches stage five when the eye looks white in the centre. The blindness is irreversible then. Till now, we have taken 100,000 images. To ensure that data is not lost via transit on the net, we have developed a specialised server where experts log in, see images and give their diagnosis. The software is now also being incorporated in an iPhone so that live images can be transferred via SMS. This will enable the iPhone to allow experts sitting anywhere to access images taken in any part of the country."

Blind spot

India is home to one fourth of the world's blind children, making it the world's blind children's capital Retinopathy of Prematurity (ROP) affects up to 47% of the babies born below 2,000 grams in India India has 24 million live births annually, of which 8.4% babies are born below 2,000 grams Of these 15-20 % will go blind if not treated in time Blindness sets in when the child is 4-6 weeks old and becomes complete before the tenth week ROP mainly affects premature infants born before 31 weeks of gestation (a full-term pregnancy has a gestation of 38-42 weeks) The smaller a baby is at birth, the more likely it is to develop ROP ROP was first diagnosed in 1942 ROP is classified in five stages, ranging from mild (stage I) to severe (stage V) Babies can be treated between stages II and III ROP occurs when abnormal blood vessels grow and spread throughout the retina. These vessels are fragile and can leak, scarring the retina and causing retinal detachment - the main cause of blindness

This man saves lives, one click at a time

Original Article : Link ,

October 20, 2009 15:10 IST , Rediff.com , Abhishek Mande

For over ten years now, Khushroo Poacha has stood by the sole belief that to do good work you don't need money. Poacha runs www.indianblooddonors.com (IBD), a site that lets blood donors and patients in need of blood connect with each other almost instantaneously. He also does not accept cash donations.

The site has been live for almost ten years and with over 50,000 donors in its database, IBD is perhaps a classic example of what the Internet is truly capable of. But more importantly, it is a reflection of a single human being's desire to make a difference to this world.

It all started in the mid-'90s when Khushroo Poacha, an employee with the Indian Railways in Nagpur saw a doctor being beaten up because he couldn't save a patient's life. No one in the mob seemed to understand that it was the lack of blood that caused the death.

"A few years later, I witnessed the death of a welder because he couldn't get blood. The two incidents really shook me up," Poacha says, "And that was when I expressed to my wife my desire of doing something."

Poacha, however, had no clue about how he could make a difference until one day, sitting in a cyber cafe with a 56 kbps connection, the idea came to him.

"I did not know head or toe of the Internet, let alone about domain names, but I knew this would be the tool that would make a difference," he says, explaining the dotcom extension to the site.

Over the next few months, Poacha liquidated practically all his savings, purchased a domain name and started up indianblooddonors.com.

"During the time, there were no companies booking or hosting web domains in India. I was paying USD 300 every three months to keep the site live and running. Meanwhile, I had spent almost Rs 40,000 in developing the site and had gone practically bankrupt," he says.

Poacha says he even went to a local newspaper to place an ad. "I needed visibility and that was the only way I thought I could reach out to the people. The day the ad appeared, I was expecting a flood of registrations," he recollects. "No one registered."

The silver lining to the dark cloud came when someone from the outskirts of his hometown Nagpur contacted him, expressing interest. "It was a saving grace," Poacha says.

Meanwhile, the dotcom bubble had burst and Poacha was being told what a fool he had been. And then there were household expenses to be taken care of too.

"There were many occasions when unpaid phone bills would be lying in the house and there would be no money to pay them off," Poacha recollects, adding that "things always have a way of sorting themselves out. And mysteriously during such times, a cheque would make its way into the mailbox."

Poacha admits that his wife was quite apprehensive about his endeavour. "But she believed in me," he says, "And that has made all the difference."

Visibility, however, was still an issue. No publication was willing to write about him. No major hospital or blood bank was interested in taking his calls.

And then the 2001 Gujarat Earthquake happened. As visuals of the devastation flashed before his eyes on television, Poacha realised yet again he had to do something.

Only this time he knew just what.

"I called up (television channel) Zee News and requested them to flash the site's name on the ticker and they agreed."

Five minutes later, the ticker was live. Ten minutes later, the site crashed.

"I spoke to the people who were hosting the site (by now website hosting had started off in India) and explained to them the situation. They immediately put me on a fresh server and over the next three days or so I received some 3,500 odd registrations," Poacha recollects.

Realising the difference he had made, the 42-year-old started working on getting visibility again.

Over the next few months, Poacha had contacted every major magazine and sure enough, a few responded. "Outlook (magazine) wrote about me, then (British newspaper) The Guardian followed suit and then came the BBC," he says.

Along the way, IBD had also gone mobile. All you had to do was type out a message and send it to a short code and you'd have a list of blood donors in your inbox.

As luck would have it, the service became far too popular for Poacha's pocket. "By then I had stopped taking cash donations and had to discontinue it," he says.

Interestingly, IBD is not yet registered as an NGO. "We function as individuals. We don't take donations and only accept bumper stickers (of IBD) and postage stamps to send out those stickers and create awareness," he says, "I was asked to deliver a lecture at IIM during a social entrepreneurship seminar and was asked what my sustenance model was. I replied I didn't have one. And I have been doing this for the last ten years."

Today, the database of IBD is growing at the rate of 10-15 users every day and the requests have grown from 25 to 40 per day.

Poacha says he eats, drinks and breathes IBD. "The zeal I had ten years ago has not diminished and the site continuously sees innovation." The latest, Poacha tells us, is the option of being an exclusive donor to one patient.

"During my journey, I realised there were some patients who required blood every month. So if you want, we can put you onto them so you can continue making a sustained difference to one person's life."

IBD is currently on an auto pilot mode and Poacha continues to keep his day job. He says, "Initially I would take the calls and personally connect the donor with the patient's relative. But I know only three languages and I'd get calls from all over India," he laughs.

Poacha recounts an incident that never left him: "A man from Chandigarh called me and told me he was desperately seeking A-ive blood for his 2-year-old. About five minutes after the call, he got the (difficult to find) blood group he needed. Soon after the surgery he called me up crying, thanking me for saving his child's life. For me, it was just another day at work. But his whole world was at stake that day. I can never forget that call."

Last year Poacha was invited to the Asian Social Entrepreneurs Summit 2008 in South Korea where venture capitalists argued that it wasn't possible to sustain an endeavour without money. He says, "I pointed out that Mother Teresa had no revenue model when she started the Missionaries of Charity. If you want to do good work, you simply do it."

For someone who has sustained his enterprise for a decade with just a few bumper stickers and postage stamps, Khushroo Poacha knows best.

Young India is following her heart, are you?

September 29, 2009 15:45 IST
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The all new world class sea link, the surge of 3G ready mobile phones, India's say in world matters -- we are fortunate to be born in a blooming nation in the 21st century. Sure enough, this is changing the mood of Indian youth. They are game for exploring different and unusual fields and are continually moving farther from the security of 9 to 9 jobs -- they are tending more and more towards something they are passionate about, something that stems from their very heart.

Does all this strike a chord in your heart? Sounds like your story? Then welcome, to India's new-youth bandwagon, which is driving growth like never before. These are the youth, who want to work, but on their terms and do just what their heart says. YOU could be a part of this brigade.

India is following her heart

Over the past few years, many enthusiastic souls have been quietly and voluntarily involving themselves with causes like educating children and adults in the underdeveloped sections of cities, environmental drives including no pollution drives, plant more trees campaigns, no honking campaigns, liberation and education of child labourers, development of small villages and much more.

Janhvi Somaiya is passionate about the work she does, "I have been visiting a village called Saphale on the outskirts of Mumbai , for six years now. It has been an enriching experience and I am happy I can make a difference to their lives."

Meenakshi Iyer from Chennai, a member of the Satark Nagarik Sanghathan that works towards making people aware of the Right to Information Act says, "I have made it my life's mission to make citizens aware and alert of their rights."

Jishaan Roy, a final year medical student from Kolkata, believes in disseminating knowledge he has to the underprivileged people.

"I like conducting astronomy workshops for children in Pune. They feel excited about seeing the stars and planets and I feel satisfied to see them so happy with a little effort of mine."

Sunita Mahendra, an accounts manager in a private firm in Delhi helps her local NGO to maintain their finances. "The NGO I volunteer with deals with injured animals and birds. So, it becomes important to keep the finances in check for paying the doctors' bills, for medicines, for other equipment and I'm glad I can help them out with this. I feel good knowing that I too am contributing to the spirit of life."

Young India needs to choose between intent and action

With awakening taking place among the youth of India, there has been a strong urge to strike a balance between domestic, professional and social life. People today want to spend quality time with their family along with putting constructive hours into their professional lives.

However, they also wish to contribute towards building a better society, and give back to the system. What they need is an opportunity to strike a balance by utilising their skills they exercise in the professional field for the cause of building a better society.

Moreover, the time has come to convert intent to real action. Not just to think about doing, but actually doing it. Go ahead and volunteer.

India is looking for volunteers like you

Passionate Indians keen to work for the society now get a platform in the form of iVolunteer.

iVolunteer, an initiative of MITRA, a not-for-profit organisation working in the social sector in India, is now urging people to go ahead and do it -- in this case, go ahead and volunteer.

iVolunteer India Fellow Professional is an exclusive volunteering programme for 50 Most Passionate Indians to come and share their professional skills in rural development organisations for mutual benefit.

Therefore, if sharing your time as a volunteer enthuses you, if your heart feels that you can give two months of your life to something exciting and help serve a key sector of the country as well, you are in the right place.

You could visit www.ivolunteer.in/professional and find out what is in store for you and what fits you the best. We wish you the best of luck!

The sickle and the superwoman

Rohit Viswanath, Nilofer D'Souza / Forbes India

Published on Tue, Sep 15, 2009 at 12:40 in India section

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In Greek mythology, a tribe of women called the Amazons inhabited the island of Themyscira, a world without men. They lived in 1200 BC and were immortalised in Homer's Iliad as the Antianeira - 'they who fight like men'.

Women in Badiya, a tiny hamlet in the Himalayan foothills, may have never heard of the Amazons or the Iliad, but, they run their villages not much unlike the ancient Greeks - with minimal patriarchal interference.

Rural India is undergoing a gradual change in its social landscape. As more men leave for cities in search of the 'great urban dream', women are being thrust into the role of family head, becoming the sole caretaker for everything from farms to parents. According to the Draft National Policy for Women in Agriculture (April, 2008), prepared by the National Commission for Women (NCW), "An estimated 20 per cent of rural households are de facto female headed due to widowhood, desertion, or male out-migration."

Secretary, Ministry of Rural Development, Rita Sharma, says, "We are aware of the phenomenon. Nearly 13 per cent of rural households are headed by wo-men today."

The figures may vary, but it is still considered significant as in the 1970s only about five per cent of rural households were headed by women, according to a Delhi-based labour economist. It's not as if women were never involved in agriculture. According to NCW's draft policy, women constitute 40 per cent of the agricultural workforce. But it was the men who took decisions about which crops to grow, how much bank loan to take and whether it was worth pledging the farm to a moneylender.

Now, the women are getting to make some of the decisions. Yet, even as they step into their husbands' shoes, they have had to face several challenges. The biggest constraint remains less access to land, credit and technical assistance. In addition, they have to battle tradition, and deal with organisations and equipment geared to service men.

Filling the Vacuum

The man-to-woman ratio in Badiya village, in Tehri district of Uttarakhand state, has witnessed a gradual decline over the years and is now approximately 30:70. Joining the army seems to be a favourite option for the men.

Vinita is one such farmer who now heads the household while her husband is away. Her family owns about 400 square metres of farm land. Like before, she gets up at sun rise, tends to the livestock, works on the land, and also looks after her three young children and aged mother-in-law. But the difference is that she's the boss now. She sells the surplus and uses the money for household expenses.

But Vinita is an exception here rather than the norm. Most women in a similar position take over production of food crops for home consumption rather than for the market.

The women of Badiya still don't have a say in property rights. That means they can't negotiate with banks or micro-finance organisations. In any case their holdings are so fragmented and the scale of their farming so small that they don't pledge the land.

The vacuum created by the men leaving the villages has forced the women to come together. In Badiya, the women have formed a self help group to address common problems.

They pooled in their meagre funds to buy fertilisers and other inputs. As this co-operation helped increase farm productivity, though marginally, the women began to sell whatever little surplus they grew each season. Over a period of time, they had enough to pool in Rs 320 each to set up a shop of their own which became the first one to make daily provisions available to the hamlet.

A similar pooling of resources is helping women in villages around the town of Doddaballapur in Karnataka. Under the Government's Stree Shakthi programme, self help groups of women pool in funds, from which money is lent to those in need.

These self help groups are also successfully challenging the patriarchal land ownership. In some cases, men have added their wives' names as co-owners of their land. Where such joint ownership doesn't materialise, help comes in the form of a pool-in fund run by the self-help groups. However, in the total number of title deeds, women account for just 10 to 20 per cent of ownership, according to State Vice-President of the Karnataka Rajya Raitha Sangha (a farmer's movement), N Venkata Reddy.

Senior Fellow, Indian Council for Research on International Economic Relations, Dr Surabhi Mittal, says, "Policy must be conducive to the changes that are happening. Once married, the women should have a joint title to the land, so that they become eligible for credit, Kisan Credit Cards and other government schemes for small and marginal farmers." Joint ownership will enable them to access various entitlements essential for commercially viable small scale farming, including horticulture and animal husbandry.

Outside Help

Being responsible for the farming doesn't come easy to women. Duties like ploughing and harvesting that were taken for granted as part of a man's chore have become an issue. Also, the additional responsibility often adds to their drudgery. "The women of rural Uttarakhand work an average of 14-18 hours a day. Women who want their children to go to school take on the work children traditionally did such as caring for cattle and poultry," says Manager Uttaranchal Gramya Vikas Samiti, Pawan Kumar.

In Uttarakhand, NGOs working to improve rural livelihood realised that the women needed help. Kumar says, "We realised that the women's lives were tough given the sheer amount of their workload. Our main goal was drudgery reduction."

They helped introduce high-yielding varieties of seeds and also improved agriculture tools. The women have now begun growing cash crops like mustard and groundnuts that fetches them a higher margin in the market.

Sharma says the Government is keeping a close tab on the trend. "Even under our own employment schemes like the National Rural Employment Guarantee Act, almost 50 per cent are women, going up to 80 per cent in states like Tamil Nadu," she says. According to her, Government agencies are working on various initiatives to help women farmers. Earlier agricultural extension agents were largely men. Now more women have been encouraged to join the profession. The men have been trained to be sensitive to the women farmers. The Central Institute of Agricultural Engineering, for example, is developing lightweight equipment, including ploughs, keeping in mind the needs of women farmers.

For Vinita's family, earlier, the paddy harvest was just enough for the family of six for three months. Now with the improved seeds and soil fertility, the yield has increased five-fold.

The concept of banking was introduced to the village. "Bank itself was a foreign word, unheard of in our remote hamlet of Badiya. Today, having seen the advantages of banking each and every woman has come forth and proudly states that they all visit the bank at least once in two weeks," says leader of a self help group, Prameela.

Breaking Social Barriers

With men gone, some social barriers are breaking down too. Vinita, an upper caste woman-farmer, would never have joined hands with Ranjana Devi from a lower caste, while her husband was around. But today all village women come together at meetings where they discuss and solve problems over a cup of tea. This cup of tea hasn't been an easy brew.

They have had to battle old prejudices. During weekly meetings held at members' homes, tea is served in metal and plastic glasses depending on what caste one belongs to. "Elders still don't allow us to mingle at par, hence these practices, but we have overcome all our mind blocks personally," says Prameela.

Missing meetings is out of question. It is, after all, a matter of survival. The initial feeling of incompetence and lack of confidence was overcome within a few meetings.

Challenging the Old Order

The new role assumed by women has changed the perception of their family members towards them. La­kshmi, a woman farmer from Badiya says, "Earlier my husband would speak and I would listen. Today, all major househ­old decisions are taken through mutual discussion. Even my in-laws respect me because I have become a major breadwinner."

Consultancy group Pragmatix carried out a survey in five Uttarakhand districts. It found a 93 per cent rise in the number of women influencing household decis­ions in the last three years. But some old attitudes die hard. While men are receptive to the changing status of women, they still view domestic duties as part of the woman's responsibility.

With all the hurdles and the extra work, what is driving the women to take up a bigger responsibility in the villages? Hope for a better life for their children. Back in Badiya, Vinita says she is much more confident today that her 15-year-old daughter will get good education. After all, Vinita is not only making money of her own but also getting to decide how it will be spent.

Doc who charges only Rs 2

A Ganesh Nadar, Rediff News
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Dr Ravindra Koelhe, MD, lives and runs a clinic in Melghat, Maharashtra. His fee is Rs 2 for the first consultation and Rs 1 for the second.

Not only is he a doctor and social worker, Dr Koelhe has also taken the government to court for having failed in its duty to protect the Korku tribals of the region.

After completing his MBBS, he worked in Melghat for a year-and-a-half only to realise that he needed more expertise to handle the problems of the tribals. So he went back to medical college for an MD in preventive and social medicine.

"I have now been here for 24 years. In those days there were two public health centres and no roads. Once a week, I used to walk 40 kms from Dharni to Bairagarh to reach my clinic. I used to see at least one tiger every month. Since the last three years I haven't seen a single one," he says remembering his early days as a young doctor.

After completing his MBBS from Nagpur University, he decided to work in rural India. An ardent follower of Mahatma Gandhi and Vinoba Bhave, he was also influenced by Ruskin Bond who wrote, 'If you want to serve mankind, go and work among the poorest and most neglected.'

He toured the rural areas of Gujarat, Maharashtra and Madhya Pradesh and decided that Gadricholi in Maharashtra was the most backward amongst his travels and decided to work there. His mother discouraged him since it was a Naxalite affected area. She told him that Melghat was equally backward and that he should work here instead.

Dr Koelhe has been in Melghat since then. It has been 24 years now.

Melghat means the place where mountains meet. It lies on the Maharashtra-Madhya Pradesh border and is easily one of the most beautiful places in the country, its greenery only broken by the brightly coloured clothes of the Korku tribals who have made these mountains their home.

But the region's beauty is overshadowed by its hostile terrain. Its infrastructure is deplorable. The roads are pathetic, the only way one can access its remote villages is in rugged four-wheel jeep.

Melghat's problems are far too many. There is no power for miles, new power lines are discouraged because this a designated tiger reserve. Though the tiger is rarely spotted here, the so-called presence of the tiger has contributed to the total neglect of this region.

The poor tribals live off the land. They cultivate their small patch of fields on the incline of the mountains. There is no irrigation system and no wells because there is no power to pump the water.

In this wilderness, Dr Koelhe has stayed on to alleviate the misery of the tribals.

He feels Melghat is a socio-economic problem, which needs to be dealt with holistically. "We as doctors can look after them when they fall sick, but there are other shortcomings that have to be addressed like education, skill enhancement and assured economic activity through out the year."

"When I came here the infant mortality rate was close to 200 per 1,000 babies. Now it is 60. In Kerala it is 8 and in rural India 9. We have to bring it down to the national level. That is why I have filed a public interest litigation in the Mumbai high court."

Discussing the case, he says, "We have filed our affidavits. Now the government has to reply. They don't file a reply for months together. Who can do anything? We want to sit down and discuss the problem and solution, but they don't want to sit with us. We cannot force them."

Stressing on the need that it was important to improve the health of the tribals he feels the attitude of doctors assigned to the government's public health centres has to change.

"They have to learn to serve. They should not make the tribals feel they are doing them a favour."

Highlighting the problems of the area, he says farming depends on the rain and tribals are jobless with no avenues of income for eight months in a year.

To add to that, there is no availability of food in Melghat from March to October. Milk is scarce and irrigation facilities are absent. Before 1978, tribals used to hunt and eat small animals like the rabbit to sustain themselves but after the region was declared as a tiger reserve, hunting became illegal.

Since there are no veterinarians, the cattle owned by the tribals often die without the right medication. There are 20 artificial insemination centres but are all shut for want of vets.

The Melghat area shot into the national limelight last year because of infant deaths due to malnutrition, but Dr Koelhe said it was wrong to label them as 'malnutrition deaths.' "It is more like starvation," he had said when I met him last year while reporting the infant deaths.

"There is no availability of food here from March to October. The mother is therefore malnourished, and thus we have neo-natal deaths," he explained.

Milk is in short supply because the milk co-op closed down due to the competition between the Jersey and Indian cow. "The Jersey doesn't get enough nutrition here and the Indian cow does not give milk here. The reason being, the cow does not get enough nutrition. Where does it have the energy to give milk?" he said.

The tribals are unable to rear poultry for their livelihood because the chicks often die within the first two days. "There is a vaccination that has to be given in the first 36 hours after birth, but how do we give it? Since the tribals are a scattered population, it is not possible."

The National Rural Employment Guarantee Scheme, the government's programme to provide rural employment for 100 days, was started here, but was then halted. Bhandu Sane, the founder of the non governmental organisation Khoj, told rediff.com that the NREGA was not functioning in the Dharni and Chikaldhara talukas. Moreover, workers who had worked under the NREGA had not been paid wages totalling Rs 3 million in the Chikaldhara taluka. Wages were also pending in Dharni.

Dharni has been declared a drought hit area. Many areas in Chikaldhara also face drought.

"What we need is awareness. There are 400 schemes to look after the tribals from the womb to the grave, but the tribals don't even know what these schemes are. And those who know are not interested in implementing them," says Dr Koelhe resignedly.

The tribals have to be provided with safe drinking water and need well stocked ration shops in every village. "The agricultural board is closed. It has to start again. Irrigation facilities to store water are needed and tribals have to be taught the use of fertilizers and pesticides."

"The best thing the government has done here is to open more than 300 schools. In those days there were no teachers. The even better thing that the government did was to introduce Korku text books in 1985. Now primary education is in the Korku language. This has gone a long way in making the tribals literate and given them confidence to attend school."

Instead of discussing what the government should do for the tribals, Dr Koelhe firmly believes that the tribals should be taught to be independent and demand what is theirs.

"I run training classes here for batches of tribal youth. We tell them about their rights and the schemes available for them. We teach them to demand what is their right and tell then never to bribe," he declareS proudly.

He also advises them to grow vegetables which are necessary for their nutrition.

"We are not here to duplicate the government's work, but to supplement it. I tell all my patients to go to the public health centre, and come to me only if they are not satisfied there. Even then after seeing them I always send them back to the PHC. I also call the PHC to explain the problem so that they can solve it."

The doctors at the PHC respect him and follow his advice. The cooperation of the medical faculty in this area makes life easier for the tribals who feel assured with Dr Koelhe around.

Dr Ravindra Koelhe can be contacted on his Bairagarh landline: 07226-202002, Dharni landline: 07226-202829 and mobile: 094231 46181.

The manager who does funerals for abandoned bodies

Shobha Warrier in Chennai, Rediff News
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A lazy Sunday morning, when the majority of people relax with a cup of hot coffee and a newspaper, S Sreedhar is at the mortuary at the general hospital in Chennai. The hospital authorities hand over 17 bodies wrapped in a white cloth to him. No, they are not his relatives. In fact, all those 17 people are strangers to him -- unclaimed bodies with no one to give them a last farewell.

Sreedhar takes all these unknown bodies to the cemetery, and gives them a decent burial after showering them with rice, flowers and milk with a prayer on his lips. They are buried because the names or religion of the dead are unknown. If the deceased are Hindu and from an old age home, he gives them a proper cremation according to Hindu rites.

Back home, Sreedhar, associate vice-president, IndiaInfoline, does not feel bad that his weekly holiday starts in a burial ground. On the contrary, he feels calm and blissful, having bidden farewell with dignity to some unknown souls.

Sreedhar started this service of cremating the unknown 24 years ago in 1985 after he happened to read the book Daivathin Kural (God's voice) by Chandrasekharendra Saraswati, the Paramacharya or senior shankaracharya of the Kanchi Mutt.

"In the book, he says that a dead man should be given a decent farewell irrespective of the cast or religion the person belongs to. When the atma (soul)) leaves the body, it should be given a proper farewell. This is the belief of all Hindus."

The observation made Sreedhar think of all those unknown and unclaimed bodies in the hospitals and the abandoned old people in old age homes. And when he expressed his desire to cremate the abandoned bodies to the Paramacharya, he blessed Sreedhar and asked him to go ahead.

Soon after, when he went to an old age home called Vishranthi, he found that Savithri Vaithi, who ran the home, was not there. She had gone to cremate a person who had died that day.

Ever since she started Vishranthi, Savithri Vaithi has been performing the last rites of all the inmates who die there. He told her he would like to take over her job.

Within a few days, he was there at Vishranthi to collect the body of an elderly woman. She had a son and a daughter, but the man who lit her pyre was Sreedhar, a stranger.

That night, he couldn't sleep. The image of the old woman came to haunt him, and he could only think of the futility of all relationships.

"I couldn't eat or sleep that night. At that time, we had the conventional type of cremation where firewood was used, not the electric crematorium. So I lit her pyre and cremated the body of a total stranger."

Then, there was this old man on his death bed in a government hospital, yearning to see his only daughter. He had refused to see her when she married a man of her choice. Sreedhar went to see the daughter to let her know that her father was in the last days of his life and longed to see her.

But she refused to forgive her father or visit him. He told the old man that his daughter was not at home and that he had left a message for her to come and see him immediately.

For more details log on to www.dharmaa.org

Email: sreedhar.1955@rediffmail.com

Phone: 98407 44400

He gave up a 5-star job to feed the mentally ill

A Ganesh Nadar in Madurai
Rediff.com, Article Link

'I don't feed beggars. They can look after themselves. The mentally ill won't ask anyone for food or money,' says N Krishnan who has been feeding them thrice a day for the past seven years.

For more information on N Krishnan's trust, log on to: http://www.akshayatrust.org/

Do you know Extraordinary Indians like N Krishnan? Please send us their name, contact information and a description of their work at extraordinarylives@rediffmail.com

N Krishnan feeds 400 mentally ill people on the streets of Madurai three times a day, every day, all 365 days of the year.

The 28 year old has been doing this for seven years via a charity called the Akshaya Trust.

A look into the kitchen reveals a spotlessly clean room. Sparkling vessels stacked neatly, groceries and provisions all lined up in rows -- rice, dal, vegetables, spices -- all of the best quality. One would think this was the kitchen of a five star hotel.

Maybe Krishnan achieves that effect because he was once a chef at a five star hotel in Bengaluru.

"Today's lunch is curd rice, with home made pickle, please taste it," he says, serving me on a plate made of dried leaves.

The food is excellent.

"I change the menu for different days of the week. They will get bored if I serve the same food every day," he says with an enthusiastic and infectious smile.

Krishnan cooks breakfast, lunch and dinner with the help of two cooks. He takes it himself to his wards on the street each day.

"I don't feed beggars. They can look after themselves. The mentally ill won't ask anyone for food or money. They don't move around much too. I find them in the same place every day."

That morning he put the food in a large vessel, the pickle in a smaller one and loaded it into a Maruti van donated by a Madurai philanthropist.

Ten minutes later we stopped near a man lying on the ground by a high wall. Krishnan put the food next to him. The man refused to even look at it, but grabbed the water bottle and drank eagerly. "He will eat the food later, looks like he was very thirsty," said Krishnan.

At the next stop, he laid the dry leaf-plate and served the food. He then scooped some food and started feeding the mentally ill man himself. After two morsels, the man started eating on his own.

We then crossed a crowded traffic signal and stopped the vehicle. On seeing Krishnan, four individuals moved slowly towards the Maruti van. They stood out in the crowd with their dirty, tattered clothes and unshaven beards.

They knew this Maruti van meant food. But they did not hurry, knowing that Krishnan would wait for them.

Krishnan served them under a tree and carried water for them. "They are not aware enough to get their own water," he explained.

And thus we went around the city till the Akshaya patra was empty. Of course, it would be full again for dinner later in the day.

As we returned, a startling fact hit me. Not a single mentally challenged person had thanked Krishnan. They did not even smile or acknowledge him. Still Krishnan carried on in a world where most of us get offended if someone doesn't say thank you, sometimes even for doing our jobs.

The food costs Rs 12,000 a day, but that doesn't worry him. "I have donors for 22 days. The remaining days, I manage myself. I am sure I will get donors for that too, people who can afford it are generally generous, particularly when they know that their hard earned money is actually going to the poor. That is why I maintain my accounts correctly and scrupulously."

He then pulled out a bill from the cabinet and showed it to me. It was a bill for groceries he had bought seven years ago. "This bill has sentimental value. It is the first one after I started Akshaya."

The economic slowdown has resulted in a drop in the number of donors. Earlier, they sustained meals for 25 days.

Software giant Infosys and TVS were so impressed with his work that they donated three acres of land to him in Madurai. Krishnan hopes to build a home for his wards there. He has built the basement for a woman's block which will house 80 inmates, but work has currently halted due to a lack of funds.

This, however, is not the sum of his good deeds. Krishnan also performs the funerals of unclaimed bodies in Madurai. He collects the body, bathes it and gives it a decent burial or cremation as the need may be.

He gets calls, both from the municipal corporation and general hospital for the funerals.

He recalls with a little prompting how one day he saw a mentally ill man eating his excreta. He rushed to the nearest restaurant and bought the man five idlis. The man ate voraciously, and then smiled at him. The smile made Krishnan want to do it again and again.

Krishnan has not married and wonders if anyone would want to marry a man who spends his days cooking food for others. He is firm that his life partner has to agree to this kind of life.

His parents were initially shocked, but are now very supportive of their son. They advise him about the cuisine and also about how he can streamline the process.

One wonders why he left his job in a five star hotel to bury the dead and feed the mentally ill. To this he just smiles and says, "I like doing it."

He put his life's savings for a home for prisoner's children

Rediff.com


Article Link

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Weaving the magic carpet: Forbes India

Neelima Mahajan-Bansal / Forbes India
Published on Mon, Jul 27, 2009 at 16:08 in Business section

Jaipur Rugs Website

Article Link : Read

Kanni Devi’s hands work deftly as they knot brightly coloured wool on tightly wound warp threads. “Do taar chodd ke lagaale re; lal jhai sabaj bachcha; kala chalta,” she sings.
Her husband Chottelal, who is working at the other end of the loom, chants, “haanji”, in sync. It sounds like a Rajasthani folk song but is really instructions based on the design template this carpet has. Loosely translated, it means, “Leave two strings and then put the red on the red; put it behind the green; and put it right on the black.”
Kanni and Chottelal are two of the 125 carpet weavers in Narhet, a tiny village close to Jaipur. Narhet is what local administrators term as a “landless village”. No one here owns land. Most belong to impoverished backward classes and 70 percent are into rug-making.
Carpet weaving is an industry associated with worker exploitation in the popular imagination. But over the last three years, things have changed for Kanni and Chottelal.
Chottelal, who has always lived hand-to-mouth, recently took a Rs. 1 lakh loan to build a pukka house. He put both his daughters in a private school, for a fee of Rs. 100 per child. One month ago, he filed a health insurance claim — and got Rs 1,400 — for hospital visits. He keeps his latest acquisition, a Nokia mobile phone, under his loom. “We would love to buy a TV too but because of the hill ranges around, we don’t get TV signals here,” says Chottelal. Kanni wears bright magenta lipstick now, an indulgence that was unthinkable three years ago.
Earlier the couple used to weave carpets for contractors who paid them Rs. 50-60 per day per person. Now they earn above Rs. 100 a day each. The raw material is delivered to them unlike before when they had to travel to town to get it. Chottelal now has a better sense of carpet weaving, as he has received rigorous training.
Like Kanni and Chottelal, scores of families in this village have made the crossover to a better life.
Changing the Template
The soft-spoken Nand Kishore Chaudhary, founder of Jaipur Rugs, is the person responsible for all this. Chaudhary doesn’t speak much English and has never studied in a business school. But the social enterprise model that he has created for Jaipur Rugs has changed the lives of 40,000-odd weavers in villages across 10 states in India.
Under this model, his Rs. 67.75 crore (turnover) company engages independent weavers in far-flung villages — none of whom are on his rolls.
The idea first came to him in 1990, when he realised that the government was keen to promote carpet weaving in the tribal belts of Gujarat. “The government was using co-operative societies to develop carpet weaving in Gujarat. But I felt that co-operatives couldn’t do this well so it would be a great opportunity for me,” says Chaudhary.
So he relocated to Gujarat and, for eight years, developed a weaver network there. He deputed area commanders to oversee the existing business in Rajasthan. “We had 200 looms in Rajasthan by then and wherever we had a concentration of 50 looms, we would depute an area commander to monitor them, distribute raw material and supervise quality,” says Chaudhary.
Communication was a problem in those parts of Gujarat and Chaudhary needed to be in touch with his weavers. So in 1992, he set up a wireless network there! Since then, he has travelled across India to develop a weaver network. By 2015, Jaipur Rugs aims to have 100,000 weavers on board. For that, Chaudhary has deputed two people who are constantly on fact-finding missions across the country looking for new regions where carpet weaving can be done. “We recently found that in Orissa, there are lots of Muslim women who aren’t allowed to go out of the house. They end up becoming beedi workers earning Rs. 10-15 a day,” says Chaudhary. So Jaipur Rugs started a pilot project in six regions with 500 weavers on board about 18 months ago.
But working with scattered communities of weavers makes it tough to maintain quality standards acceptable to international clients.
Another alarming fact: Each month Jaipur Rugs was incurring a loss of Rs. 5 lakh (on a turnover of Rs. 4 crore) due to defects. “That is Rs. 60 lakh wasted each year due to mistakes!” he says. “After a carpet is woven, it goes through 27 other processes and the defects were proving to be a big drain.”
To tackle that, Chaudhary put in place an army of quality supervisors who visit every loom at least twice a week. The weavers — some of whom have been working for contractors for years — are given intense training where proper processes are enforced. “Changing habits is tough. Weavers, who have worked for contractors all these years, are not used to being process-driven. Even the trainers don’t take us seriously initially,” says Chaudhary. Constant communication, he says, is key.
Chaudhary also embarked on a mission called Zero Defect that is being piloted in Narhet. It lays down the processes that the weaver must follow. Says Deepak Sharma, director, Kanvic, the consultants who have taken on the task, “We developed a booklet for the processes the quality supervisors are supposed to look at — this has a full checklist.”
During a seminar, Chaudhary picked up the idea of implementing Quality Circles, or forming volunteer groups that analyse, discuss and find solutions to larger organisational challenges. “I tried to implement this concept with the weaver community by forming self-help groups for them,” says Chaudhary. “These groups meet regularly, brainstorm and solve problems.”
The Next Level
Chaudhary also ensures that the company implements the most modern techniques to help business. Recently, the company invested Rs. 50 lakh and implemented an ERP package (enterprise resource planning package — a company-wide computer software system). Then, in 2007, it took on board a search engine optimiser to ensure that the company name would show up prominently in Web searches. Says Yogesh Chaudhary, N.K. Chaudhary’s son, who looks after the IT aspects of the business, “Our Web presence was very limited. But after doing search engine optimisation, people can now find our company easily online.” Similarly, they realised that many of the small buyers abroad — who are also the most profitable — did not understand English. So Yogesh launched Jaipur Rugs’ Web sites in other languages.
Chaudhary also realises that increasingly, buyers want to work with companies that do not have exploitative practices. Which is why, Jaipur Rugs applied for and attained Social Accountability International’s SA 8000 Workplace and Human Rights Standards.
Chaudhary believes that everyone working for the company is part of a family.
The Jaipur Rugs Foundation (JRF), a welfare foundation for weavers, fits in perfectly with this belief. Says Devendra Shukla, director, JRF, “The foundation aims to take weavers to the next level and make them stakeholders in the business.” It provides skill training, skill upgradation, computer-aided design training and entrepreneurship development.
It also gets the weavers Artisan Cards, a government initiative that allows artisans several benefits, helps them get health insurance, and forms self-help groups (SHGs) of weavers.
JRF is also trying out a new experiment where it will form SHGs of weavers, bring them together as a company or a trust, and produce carpets under the new company’s own brand. A pilot for this is on in Thanagazi in Rajasthan. The ownership of the brand will lie with the weavers and Jaipur Rugs will don the role of a mentor.
A couple of months ago, Chaudhary got a phone call. The voice at the other end said, “Mr Chaudhary, this is CK. Do you know me?” Chaudhary almost fell off his chair. The person on the line was management guru C.K. Prahalad — Chaudhary had met him at a TiE (an NGO for promoting entrepreneurship) seminar in Jaipur in January and told him about his company. Jaipur Rugs is now being documented as a case study in the fifth edition of Prahalad’s Fortune at the Bottom of the Pyramid. Chaudhary is also being invited by business schools like Wharton to talk about his business model. Teams of students and professors from INSEAD and IMD are also visiting his company. Says Chaudhary, “I love exploring. I experiment with small things. When I see the results, I get excited. And that prompts me to do bigger things.”

Dregs in NREGS

Udit Misra / Forbes India
Published on Wed, Jul 15, 2009 at 14:45, Updated on Wed, Jul 15, 2009 at 16:05 in Business section.

Article Link : Read

The Roster:
The man
Jean Dreze
The mission
To improve the operation of National Rural Employment Guarantee Scheme (NREGS).

What’s the big deal?
India’s largest social safety net.
Why we need it
To help the rural economy catch up with the cities, the main beneficiaries of economic growth in recent years.
The challenge
Lack of proper field-level records and a mechanism for handling grievances. Need to create locally relevant infrastructure.
What can he do?
As a key influence in the original design of NREGS, Dreze can give ideas to plug loopholes.
People to watch out for
Kaluram Salvi, a village sarpanch in Rajasthan, who has solved some of the problems of NREGS.
Budget highlights
Allocation raised 144 per cent to Rs 39,100.
Kaluram Salvi first came into the limelight in 2002 when he blew his fuse over 50 paise. The labour activist and budding politician was checking out a worker site at Phukiya Thad village in Vijaypura panchayat (council of villages) of Rajasthan. He saw that the officials at the site were paying the workers Rs 59.50 for a day’s work, while the minimum compulsory wage was Rs 60.
Salvi argued with them till the additional money was paid. It was perhaps the turning point in his political career.
Today, with Salvi as the sarpanch (head), Vijaypura has emerged on the national map as a shining example of worker welfare. The grassroots innovations of Salvi and his team has led to a nearly flawless implementation of India’s largest social sector programme — the National Rural Employment Guarantee Scheme (NREGS).
Salvi’s success has recently got corroborated — the government of Rajasthan now plans to take his ideas across all the NREGS sites in the state to plug leaks and make sure the benefits of the scheme reach the deserving.
For a scheduled caste man in a multi-caste community, this is a rare achievement. “I only promised to do an honest job of implementing the different government schemes. I did not offer any favours,” Salvi says recalling his election campaign three years ago.
The good news about Salvi’s experiments couldn’t have come at a better time for the Congress-led government at the Centre, which is looking for templates of efficient but caring governance.
NREGS is an attempt launched in 2006 by the Manmohan Singh government to transform the rural economy through legally guaranteed employment for up to 100 days at a minimum wage of Rs. 100 per worker. The scheme, run jointly by the Centre and the states, has reached several milestones towards its goal, but suffers from the same deficiencies of most other official projects — corruption and diversion of funds.
An audit by the Comptroller and Auditor General of India (CAG) found that crores spent on the scheme may not have reached the targetted beneficiaries.
NREGS is now ripe for version 2.0, without the leaks and the hassles of the first round. In this context, it is worth pondering how Vijaypura conquered the typical problems and made sure the scheme achieves its purpose.
One of the best judges of NREGS implementation is the development economist Jean Dreze, an Indian of Belgian origin. This luminary from the Delhi School of Economics was a key influence in the original design of NREGS. Dreze has lived and worked in India for 30 years, observing the nuances of the rural economy up close. He thinks experiences such as in Vijaypura present many answers to meet the next set of challenges for NREGS.
There is also a clamour for urban employment guarantee and the use of modern technology to prevent corruption. “Many of these things will happen in due course, but it is important to realise that a lot of ground work still needs to be done to ensure proper implementation of the existing NREGS,” says Dreze.
That’s why the Centre can learn from Vijaypura. More than half of the total 1,600 households in this panchayat have participated in the programme. More than 60 per cent completed the full quota of 100 workdays per household. What’s more, at many sites, women account for a lion’s share of the employment. “People work whole-heartedly because the scheme has given them a sense of dignity and partnership in development,” Salvi asserts.
So what did Salvi do right? Basically, he found simple solutions for complex problems.

NREGA, Andhra Pradesh

Cnn-IBN
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Forbes India: Dr Shetty and his business with a heart

Article Link : http://ibnlive.in.com/news/forbes-india-dr-shetty-and-his-business-with-a-heart/96567-7-single.html

Neelima Mahajan-Bansal / Forbes India

Published on Tue, Jul 07, 2009 at 14:25, Updated on Tue, Jul 07, 2009 at 14:54 in Business section

Twenty-day-old Samuel Idoko’s parents were worried sick. The boy’s heart condition needed urgent surgery but back home in Nigeria, there were no hospitals dealing with such cases. They didn’t even have the time to celebrate his birth as they rushed him to Bangalore. Their destination: Narayana Hrudyalaya Institute of Cardiac Sciences.

Established in 2001, this 1,000-bed hospital and its sister concern, Rabindranath Tagore Institute of Cardiac Sciences in Kolkata, together do 15 percent of all heart surgeries in India. At the rate of 30 cardiac surgeries a day, the Bangalore facility handles the highest number of heart surgeries in the world.

It’s not for nothing that patients come here in droves. It has an impossible-sounding success rate of 95 percent and charges a fraction of what other heart hospitals do. The charismatic Dr Devi Shetty, the hospital’s founder, has been relentlessly pursuing a mission: To make world-class healthcare affordable to the masses. “Hundred years after the first heart surgery was done, only 8 percent of the world’s population can afford it,” he says, quickly pointing out that this is a five-year-old statistic and today we might be worse off. “What happens to the rest?” asks Shetty.

Filling the Gap

Shetty’s hospital has managed to dissociate healthcare from affluence. The patient is told beforehand what he will pay. This is fixed irrespective of any future complications or the duration of stay.

A heart surgery here costs Rs. 110,000, much less than what it costs elsewhere. Even so, you pay the full price only if you can afford it. Many don’t pay at all. In 2008, out of 6,088 heart surgeries at the Bangalore centre, only 1,232 were fully paid for. Yet, the hospital makes a tidy profit. The Narayana Hrudyalaya group had a turnover of close to Rs. 300 crore in 2008-09, up from Rs. 150 crore in the previous year.

Narayana Hrudayalaya is now moving to have the largest number of beds in the country, beating Apollo Hospitals which has 6,000. It is creating multi-specialty “Health Cities”. The Bangalore facility will be ramped up to 5,000 beds. In addition to the 1,000-bed heart hospital, it has new cancer, orthopedic and eye hospitals. In the next two years, it will add two more, one for women and children and another for tropical diseases. The Kolkata facility will also be expanded to 5,000 beds. The idea is to have a health city in every state of India and have a presence in every emerging economy of the world. Already work is on to set up facilities in Malaysia and Mexico. “Next year our turnover should be Rs. 600 crore and after Phase 1 of the Health Cities plan is complete in 2010, we should be closer to Rs. 1,000 crore,” says Sreenath Reddy, chief financial officer.

All this will be done without increasing the costs of the business. Before Devi Shetty, it was considered impossible to drive down costs to such levels; even now, no one has been able to replicate this. Top-flight management researchers want to understand how Shetty does it. “The mortality rate in Narayana Hrudyalaya is much lower than in New York State for similar kinds of heart disease,” says University of Michigan’s C.K. Prahalad. The hospital has been discussed extensively in his 2004 bestseller, The Fortune at the Bottom of the Pyramid. It has also become a case study at Harvard Business School. Adds Kokila P. Doshi, professor of Economics at University of San Diego’s business school, “Till now the trend was that government serves the poor. Shetty has shown that private enterprise can serve the poor profitably.”

Leveraging Scale

But how does Shetty do it? The answer lies in what he likes to call his “Wal-Mart approach to healthcare”. Wal-Mart proved that with size, the cost of inputs could be challenged. “They had the size which let them dictate terms to anyone starting from a giant like Procter & Gamble to potato growers,” he says.

Shetty relentlessly pursues Wal-Mart’s dictum of “everyday low prices”. Only that potato growers have been replaced by pharmaceutical companies and medical equipment manufacturers, who account for almost 40 percent of a hospital’s revenue outflow.

Here’s how it works: Most catheters sold in India by multinationals, for instance, are not manufactured by them. But the original equipment makers don’t sell directly to hospitals unless they get sufficient volumes. Narayana Hrudyalaya has the volumes: It handles 30 heart surgeries and at least 1,000 walk-in patients a day. It was able to convince them to supply at a low cost.

Scale helped Shetty shave off costs of medical tests too. Take blood gas analysis. At Rs. 350-400 per test, it forms the bulk of the cost for an ICU patient in India. At Narayana Hrudyalaya it costs merely Rs. 8.50 per test!

How? “Most hospitals do just 20, 30 tests in a day. We do about 2,000,” says Shetty. He used that to persuade manufacturers to merely “park” their machines in the hospital and instead make money from selling chemical reagents for the tests. It’s a win-win: Narayana Hrudyalaya saves on the cost of these machines (Rs. 12-15 lakh each) and the manufacturer does Rs 50,000 worth of business selling reagents every month.

Unlike other hospitals that make most of their money through in-patient care (procedures and operations), Narayana Hrudyalaya makes the bulk of its profits in the out-patient department (OPD) — just through registrations and investigations such as ultrasounds and X-rays.

The logic is simple. “At the OPD level, every person can afford to pay Rs 200-300. When he needs treatment that will cost Rs. 2-3 lakh, that is when he expects help,” says Reddy. “Today the revenue point for every hospital is in-patient services, which give a margin of hardly 8-10 percent while our margin in the out-patient is 80 percent,” adds Shetty. “So you try to get huge numbers of out-patients.”

But to get so many people to the OPD, you need a sound value proposition. “Patients will come to you provided your in-patient cost is affordable — if you are doing a heart operation for Rs. 60,000-70,000, or a brain operation for, say, Rs. 10,000. So you reduce your in-patient cost,” says Shetty.

Each evening, Shetty and his team of senior doctors examine a profit and loss account for the day. If they go below their average realisation benchmark of Rs, 95,000 the next day they prefer patients who can pay more. Also, Shetty searches for ways to save — he got his microbiology department to make hand-wash and disinfectants in-house, bringing down the monthly cost from Rs. 4 lakh to Rs. 50,000.

Practicing Quality

‘Specialisation’ is his mantra to ensure quality even as costs are driven down. “We train technically skilled people for a particular job,” says Shetty. So each surgeon specialises in doing only bypass surgeries or valve replacements or paediatric surgeries. That gives them phenomenal experience.

Shetty does something else to cut costs. Every ICU patient has dedicated nurses watching over him, 24 hours a day. They work eight-hour shifts, standing in front of the patient. Shetty doesn’t provide chairs: “The moment you provide a chair, the efficiency of the nurse goes down by at least 30 percent.” He encourages attrition among them: “As they grow older, they don’t contribute as much to patient care, but their salary keeps going up.”

To keep salary costs low, he hires people with basic college education and trains them for jobs like reading radiology charts.

Going forward, the biggest challenge for Shetty is how to make sure all this doesn’t remain a one man show, and get the same quality. “That means enormous commitment to training and recruitment,” says Prahalad.

Shetty is clear that the new facilities will be run by people who have perfected their skills at Narayana Hrudyalaya so that there’s no cultural mismatch. It is already running 49 training programmes and the plan is to turn it into an academic institution. “When you have an academic institution as a hospital, the succession plan is already in place,” he says.

The Wal-Mart Effect

Dr Devi Shetty’s Narayana Hrudyalaya in Bangalore uses economies of scale to keep the cost of treatment low

Rs 8.50 for a blood gas analysis

This normally costs Rs. 350-400 per test and forms the bulk of the cost for an ICU patient. Where others do 30 tests a day, Narayana Hrudyalaya does 2,000. It used these numbers to persuade manufacturers to install machines — which cost Rs. 12-15 lakh each — for free and make money instead by charging only for chemical reagents for the test.

Rs 110,000 cost of a heart surgery; 6,088 heart surgeries (in 2008), 1,232 fully paid for; Rs. 300 crore turnover (2008-09)

Unlike other hospitals, the bulk of its profits come from the out- patients ward, where the cost to the patient is low but the margins are as high as 80 percent. The number of walk-in patients remains high because they know the cost of surgery will be subsidised should they need it.

30 heart surgeries, 1,000 walk-in patients a day

Medicines and equipment account for 40 percent of revenue outflows, but original equipment makers for instance, don’t usually supply directly to hospitals. Narayana Hrudyalaya used these numbers to convince them to supply directly, at a low cost.