ByeBye human race unless you can help us find medical word's top 10 World Record Jobs Creators 9 8 7 ...Ironically knowledge of the curriculum of entrepreneurial revolution - as the net generation's opportunity to collaborate in human sustainability peaked in 1984 - unless you can help World Record Jobs Creators retrieve it now - thanks chris macrae wash dc text 240 316 8157 EconomistDiary.com ERworld.tv amychina.net Anyone seriously transparent about affordable global health and sustainability needs to develop segments of health services and then decide whether an integrated service is still to have place boundaries. THE BLOCKCHAIN WARS. New media is always a battle between the forces for evil who linkin fast and those who needed to open space for a deeper social order (which takes time). Understanding blockchain mapping will also be absolutely essential: it may be how sustainability's last call is won by little sisters or lost to big brothers. these are the most exciting times to be alive.. 4 markets human sustainability depends on health & . linkedin UNwomens - question collab blog editors: chris.macrae@yahoo.co.uk washington DC

china; Qatar bangladesh and asean ghana france india

usa CHINA UNICORNS

good news china's robot teachers assistants will soon be better at diagnosis than 99% of docs. china



online library of norman macrae...world record jobs creators: sir fazle abed .. jim kim.JKU. larry brilliant.. gerge soros..paul farmer .leana wen .BillionGirlsBoys network
health.nutrition.edu.green.job


Tuesday, December 10, 2019

the most brilliant health service anywhere?

thanks to dr vin india with a little bit of fan support from larry brilliant
aravind 10 times more productive https://www.youtube.com/watch?v=Jr70IrWM-n8

and about 1% of cost of ending unnecessary blindness in UK

https://www.youtube.com/watch?v=Jr70IrWM-n8
if we could provide eyecare the way mcdonalds provides hamburgers we could end unnecessary blindness

a fast surgeon at aravind can do a surgery in 3,5 minutes because of the system design

00:42
it's an honor to be in front of you
00:45
tonight I come to this story through two
00:50
doorways the doorway of a granddaughter
00:53
and the doorway of a storyteller doctor
00:57
Venkata swami you all see there was my
01:01
grandmother's eldest brother my grand
01:03
uncle
01:03
we called him grandfather actually we
01:06
called him doctor grandfather and that's
01:09
really what he was to us he was an elder
01:12
and a healer
01:14
those were the twin roles he played this
01:16
man never married never had any children
01:18
of his own but he left the world an
01:21
incredible legacy today six years nearly
01:24
six years after his passing I continued
01:27
to find myself unpacking the gifts that
01:29
he embedded in our lives and I I'm a one
01:35
time filmmaker and a writer in a family
01:37
of 21 I surgeons and still counting
01:42
we've got a few more in the pipeline and
01:44
I often joke I made a film called
01:46
infinite vision that follows the work of
01:48
dr. v and then worked on the book
01:49
infinite vision I say only partly in
01:53
jest to the family that these are my
01:55
apologies for not being an eye surgeon
01:57
myself and in the last decade of
02:01
chronicling this story I think I've come
02:03
to learn a pretty humbling truth and
02:06
that is that stories in a very real way
02:10
can also help people see the world a
02:14
little bit better a little bit more
02:16
clearly and the story of uh turbans and
02:19
the story of dr. v is one of those
02:21
luminous stories that definitely has
02:23
that potential where does this story
02:27
begin and before I jump into that I'd
02:30
like to bring some words of dr. v into
02:32
the room through a journal entry that he
02:35
wrote and this was back in the 1980s
02:37
before his vision had really taken root
02:39
and the manifestation of it had been
02:41
realized
02:42
Aravind was a speck on the horizon and
02:44
in his journal at that time he wrote of
02:48
his aspiration his twin aspirations and
02:51
they were one to give sight for all and
02:54
the second
02:55
was to see all as one to give sight for
03:00
all and to see all as one there's
03:03
something ultra practical in there and
03:05
then something deeply profound the deep
03:08
practicality of setting up service
03:11
delivery mechanisms to end one form of
03:13
human suffering to give sight for all
03:15
but to do that from a mindset that
03:18
recognizes our ultimate interconnection
03:20
to do that from a mindset rooted in
03:22
compassion these were his two
03:24
aspirations and that really is the arc
03:27
that this story travels from the
03:29
practical to the profound it dances
03:32
between strategy and spirit between the
03:34
gritty changing choppy realities of the
03:37
external world and that internal still
03:40
point that anchor of our values our
03:42
compass and that Universal goodness this
03:46
man was born in 1918 in a small village
03:49
in southern India the eldest of five
03:51
children walked barefoot to school wrote
03:53
his lessons in the sand by the his tenth
03:56
birthday he'd lost three cousins in
03:58
childbirth there were no doctors in the
03:59
village no medicines to be had no one
04:01
they could run to for help
04:02
and at that young age he committed
04:04
himself to that vision of becoming a
04:07
doctor and preventing such untimely
04:08
deaths he put himself through school
04:10
Medical School and then in his early 30s
04:13
when he was just about to embark on a
04:15
career in obstetrics he was struck by a
04:18
crippling form of rheumatoid arthritis
04:20
that permanently twisted and froze his
04:24
fingers out of shape he was bedridden
04:26
for two years and was told his dream of
04:28
becoming an obstetrician was a no-go
04:30
when he had recovered enough to be he
04:33
couldn't sits down walk or anything for
04:35
quite a long time and we had finally
04:36
recovered enough strength to return to
04:38
the medical field
04:40
he ended up by some sort of he calls it
04:43
sheer accident it we think of it more as
04:45
a divine accident he ended up in
04:48
ophthalmology and he trained those
04:49
fingers to cut and operate on the eye
04:51
and restore sight those fingers in his
04:55
time as a government surgeon alone he
04:57
performed over 100,000 sight restoring
05:00
surgeries then the year 1976 and he did
05:03
phenomenal things of the government
05:05
surgeon he was for all that work awarded
05:07
one of the nation's
05:07
highest honors the Padma Shree then 1976
05:10
rolled around and that was the year the
05:13
dr. V hit retirement age that's the
05:15
mandatory retirement age but he wasn't
05:17
ready to play golf
05:18
there was so much unfinished work in the
05:21
field and so he decided with his
05:23
brothers and sisters to start an 11 bed
05:25
eye clinic in Madurai a temple city of
05:28
southern India his five brothers and
05:31
sisters and their spouses they had no
05:32
money no business plan no safety net but
05:35
they did have a mission and their
05:37
mission was to end curable blindness
05:40
they had 11 beds in the world had 45
05:44
million blind people 80% of that was
05:47
curable they were a little bit
05:49
outnumbered their 11 beds with 45
05:52
million blind but fast forward a little
05:54
bit
05:55
35 odd years later they've got a network
05:59
there's only four hospitals shown there
06:00
but it's actually a network of seven
06:02
tertiary care facilities and for T
06:04
smaller vision centers they are the
06:06
world largest and most productive eye
06:08
care facility what does that mean it
06:10
means in that time since inception
06:12
they've performed they've seen over 32
06:14
million patients and performed over 4
06:17
million surgeries the vast majority of
06:19
that either completely free of charge or
06:21
it ultra subsidized rates the numbers
06:25
are relative and are magical and they're
06:26
fun to look at one of my favorite slides
06:28
is the next one and it shows you how
06:30
many eye surgeries the average surgeon
06:33
at Otterbein does per year with a kind
06:35
of global comparison next to it the
06:37
average eye surgeon at Otterbein does
06:40
2,000 a surgeries a year the national
06:43
average in India is around 400 the
06:46
United States isn't on that graph but in
06:48
this country it's about 200 surgeries a
06:50
year in incredible productivity but this
06:54
isn't just a story about number about
06:56
volume sometimes when you when people
06:59
hear the story they think amazing this
07:01
kind of work being done on a charity
07:03
basis in the developing world really
07:05
inspiring but how relevant is it to us
07:07
sitting here in this auditorium today
07:08
the next slide is a comparison that kind
07:11
of teeth speaks to that point
07:14
health care we all know is not exactly
07:15
in its golden era in in the way
07:18
and the next slide is a comparison of uh
07:20
turbines productivity against the
07:22
national health system of the United
07:24
Kingdom which is their main provider of
07:26
health and eye care and they do around
07:29
half a million surgeries eye surgeries a
07:31
year our turbines does around 300,000 so
07:35
you've got a single organization in the
07:37
developing world doing close to 60% of
07:39
the volume of the united kingdom in eye
07:42
care and then you look at the cost
07:45
comparisons how much does it cost the
07:47
United Kingdom to provide that care cost
07:50
them 1.6 billion pounds it costs Aravind
07:54
less than 1% of that so you've got a
07:58
high-volume low-cost system and then the
08:01
first thing that creeps into people's
08:03
heads here as well that means quality
08:05
must be taking a hit somewhere they've
08:08
done fairly recent studies that compare
08:10
complication rates at Aravind with the
08:13
Royal College of autumn ology again in
08:15
the United Kingdom they studied the
08:16
complication rates across 20 different
08:18
types of complications our turbines
08:21
quality outcomes were found to match and
08:24
in many cases exceed that of its western
08:27
counterpart you've got a high-volume
08:30
high-quality low-cost system that's the
08:33
tripart mantra for healthcare providers
08:36
anywhere that's the sweet spot we all
08:39
want to be in and when you look at what
08:42
makes this possible how do these people
08:44
do this when you pop open the hood and
08:47
look underneath you find an upside down
08:51
business model this is an organization
08:53
that turns completely on its head
08:56
conventional wisdom for what it means to
08:59
run a successful business and it does
09:01
this and triumph there are three things
09:04
before I talk about the different
09:05
aspects of that model there are three
09:07
commitments that dr. V and his team
09:10
brought to the organization very early
09:12
on they were part of the founding DNA of
09:15
the organization and there were three
09:18
commitments that were all linked to
09:21
compassion the first commitment we will
09:24
not turn anyone away based on financial
09:27
need the second commitment we will not
09:29
compromise on
09:30
quality and the third was really
09:32
interesting we will be we must be
09:36
self-reliant
09:36
so what those three commitments meant
09:39
was that whatever other VIN did over its
09:40
35 years and beyond
09:42
it had to do it with compassion with
09:45
excellence and with its own resources
09:49
service for all so that first thing that
09:52
it did it ripped the price tag off of a
09:54
site restoring surgery and this it did
09:56
it did this in a country where there are
09:58
12 million blind people the majority of
10:00
whom live on less than $2 a day so when
10:03
you have another constraint of being
10:05
self-reliant that seems like a really
10:06
bizarre move and then the next thing
10:09
they did was even crazier they said
10:11
we're gonna let the patient decide
10:12
whether or not they pay and they did
10:16
that because they wanted to design for
10:17
dignity dr. V would say repeatedly to
10:20
his team were not here just to restore
10:22
sight we have to affirm people's dignity
10:25
and if you're blind in rural India very
10:28
quickly that means you've lost not just
10:29
your sight you've lost your livelihood
10:31
very soon after your place in your
10:33
family your place in society and in the
10:35
community in giving people choice dr. V
10:40
and his team were affirming their
10:42
dignity in this system a barefoot farmer
10:44
can come in and decide to access paid
10:47
services where a man who would become
10:50
the future president of India this is a
10:52
true story can come in and choose to
10:55
access free services so and in this
10:58
thing was a really interesting part is
11:00
that free is not seen as a charitable
11:03
handout zero in this model is a
11:05
legitimate price point and it's one
11:07
among a series of other price points
11:09
it's a self-selecting user system the
11:12
rates go from zero all the way up to
11:14
market high quality is free we've
11:18
already seen that they didn't put a
11:20
price tag on good quality the doctors
11:22
rotate between the free and the paying
11:24
sections you don't have separate
11:25
specialists looking at the rich patients
11:28
and others looking at the poor quality
11:30
outcomes are monitored with equal rigor
11:32
across free and pane broaden the pie
11:37
this is one of my favorites other than I
11:38
had a marketing team but the marketing
11:41
team was exclusively focused
11:43
on the patient who couldn't pay them I
11:45
don't know much about marketing but I'm
11:47
pretty sure that's not the way it
11:48
usually works they went through
11:51
extraordinary lengths to find the person
11:53
who wasn't in their service loop who
11:55
couldn't pay them if even if they'd came
11:58
to the even if they knew about the
11:59
hospital and even if they could access
12:01
the service they wouldn't have anything
12:03
to give them and the way they did this
12:05
was by going out into the villages and
12:07
finding people who needed care and
12:10
bringing the services to them and they
12:13
did this with a mindset that really
12:15
owned the barriers they learned this
12:19
from a blind beggar what happened in the
12:21
early days they said look we've got free
12:23
service come and get it we'll give you
12:25
surgery for free and very few people
12:27
showed up and it was puzzling to them
12:29
until they talked to a beggar who was
12:32
blind and he told him look you tell me
12:33
your service is free but to get to your
12:36
hospital I need bus fare once I get
12:38
there I need accommodation I need food I
12:40
need medicine
12:41
I need return transport I'm 80 years old
12:43
I can't come alone if my son comes with
12:45
me he loses his daily wage your free
12:48
service cost me a hundred rupees when
12:51
they heard that they decided we've got
12:53
to own the barriers and so they sent
12:55
they sent out medical teams doctors and
12:57
nurses who would go and conduct what
12:59
they called I camps thousands of
13:00
patients would be screened in the
13:02
villages those who needed care were
13:04
bused back to the base hospital given
13:07
treatment accommodation food medicines
13:10
returned transport and follow-up care
13:12
all completely free of charge and this
13:15
happens not once or twice a year this
13:17
happens 40 or 50 times a week over 2,000
13:21
times a year 76th upward of 76,000
13:25
patients are brought in every year
13:27
through those I camps once you have that
13:30
kind of volume coming into the system
13:31
you need really efficient processes to
13:34
handle them and to set up those
13:36
processes they had a really interesting
13:38
model that they were emulating
13:41
McDonald's what's blindness and burgers
13:45
have in common it's a puzzling question
13:47
but when dr. V came to the United States
13:49
in the early 80s he was fascinated by
13:52
the golden arches that he saw everywhere
13:55
kind of sidestepped the public health
13:57
implications of the corporation and what
14:00
he was looking at when he saw McDonald's
14:02
was the power of standardization scale
14:05
product reliability and consistency that
14:09
kind of access and affordability and he
14:10
would say over and over again if we can
14:13
provide I care the way McDonald's
14:16
provides hamburgers the problem of
14:18
blindness would be gone and so what he
14:20
did was he tried to bring in assembly
14:22
line techniques into the hospital he
14:25
looked at the process from the moment of
14:27
a patient steps into the hospital and
14:29
registers to the point of discharge and
14:31
he divided that up into discrete sets of
14:33
tasks that were then assigned to highly
14:36
trained paraprofessionals and these
14:38
paraprofessionals were more often than
14:40
not high school women recruited from the
14:43
local villages and put through an
14:44
intensive training program a two-year
14:46
training program one that's been
14:48
accredited by the way by the same
14:49
organization that accredits nursing
14:51
training here in the states the the
14:54
whole idea of process improvement and
14:57
process flow comes into play beautifully
14:59
in the operating rooms where you have
15:01
rows of operating beds and as the
15:03
surgeon is operating on a patient on one
15:06
side a team of nurses is busy readying
15:08
the next patient on the adjacent bed the
15:11
lag time between surgeries is the time
15:13
it takes for the surgeon to swing the
15:16
microscope over to the other side the
15:19
fastest surgeon at uh turbine can do a
15:22
cataract surgery in 3.5 minutes not just
15:26
because he's a phenomenal surgeon but
15:27
because of the phenomenal systems that
15:30
surround him or her self-reliance is the
15:36
thing that really catches the business
15:38
world I Harvard did a case study on uh
15:40
turbine in the early 90s it's a
15:41
mandatory case every single MBA student
15:43
that goes through Harvard has to do the
15:45
out of in case the idea that something
15:48
that operates in this way that has zero
15:50
as a price point that allows patients to
15:52
choose whether they pay or not can
15:53
actually be self-sustaining baffles Minh
15:56
to give you an idea of uh turbine
15:58
self-reliance in 2009 2010 they brought
16:01
in an operating surplus of thirteen
16:04
million dollars on revenue of twenty
16:06
nine million
16:07
dollars it is a phenomenally
16:10
self-sustaining organization and that
16:12
money comes from patient revenue not
16:13
from government donation not from
16:15
philanthropic contributions or outside
16:18
funding agencies its patient driven
16:20
revenue and but that idea of
16:23
self-reliance doesn't just restrict
16:26
itself to the question of money and out
16:30
of ins self-reliance is really more
16:32
about a mindset than money it's a way of
16:34
identifying and employing and engaging
16:37
with your resources so that
16:39
self-reliance extends even to the human
16:41
resources dr. V would tell his team time
16:43
and again you don't just find people you
16:46
have to build them so he built his team
16:49
he built he recruited those nurses from
16:51
the villages and trained them to become
16:52
world-class medical professionals 90% of
16:55
the doctors that uh turbaned are trained
16:57
within its own walls and it doesn't just
16:59
train its own staff it trains staff from
17:01
all over the world including residents
17:04
from Cal Pacific from UCSF from Harvard
17:07
from math I year the best of the west
17:10
have trained out of him
17:12
the other thing about self-reliance
17:15
before I go to the last point on this on
17:16
this line is that it Allah it gives the
17:19
organization the freedom to follow its
17:22
mission with integrity and this came
17:24
into play in really sharp relief in the
17:27
80s when the intraocular lens became the
17:29
standard for cataract surgery in the
17:31
West in India was still very expensive
17:35
each intraocular lens implant cost
17:37
anywhere between a hundred and fifty to
17:39
three hundred dollars it wasn't
17:41
affordable Aravind could not scale that
17:43
to all of its patients and it wasn't
17:45
acceptable for it to have one quality of
17:47
care for its rich patients and another
17:49
for its poor and when it tried to
17:52
troubleshoot this problem it came up
17:54
with a bizarre solution it said well if
17:57
we can't buy lenses at an affordable
17:59
price we're gonna have to make them
18:02
ourselves and it did it set up an
18:05
internationally certified manufacturing
18:07
unit a group of doctors and they
18:11
produced an intraocular lens there was a
18:14
global that was tested in labs in the
18:16
United States and proclaimed world-class
18:18
they brought down the price
18:20
from 150 to 300 to $10 then they drove
18:24
it down further to $2 now they export
18:26
their lenses to over a hundred and
18:28
twenty countries around the world and
18:30
they didn't just stop at lenses they now
18:33
make over fifty different kinds of
18:35
pharmaceutical ophthalmic
18:36
pharmaceuticals they make sutures
18:38
they make ophthalmic equipment they try
18:41
to find every bit that they can to drive
18:43
down the price anything that they can
18:45
produce at a less expensive but still
18:47
high quality standard they do the third
18:52
the last point here is something so here
18:56
we have this recipe that Arvind has
18:58
perfected it's kind of got this secret
19:00
it's kind of got this secret sauce for
19:02
success what happens when we have that
19:04
kind of secret sauce typically we build
19:06
a fortress around it we put it under
19:08
lock and key we say this is what gives
19:10
us our competitive edge dr. B had a very
19:13
different mindset he said if we have
19:15
something that works we have to give it
19:17
away
19:17
so Aravind does something very
19:19
counterintuitive it trains its
19:22
competition
19:22
it works with over 270 hospitals across
19:25
the developing world some in the
19:27
developed world many of these hospitals
19:29
are in its own backyard and it invites
19:31
them actively to come in and look at its
19:33
processes look at its systems look at
19:36
you know look under the hood it makes
19:37
everything open-source its trained over
19:40
six thousand healthcare professionals at
19:42
different levels all over the world
19:44
working with people in 60 different
19:46
countries it has a separate training and
19:48
consulting Institute that is devoted
19:50
exclusively to this to this work so you
19:55
look at this you look at this kind of
19:58
phenomenon that is out oven and the
20:00
story of dr. B you look at dr. V story
20:03
and you see this it's kind of a David
20:06
and Goliath story of one man in his
20:08
unthinkable frailty think I'm 58 he was
20:11
58 when he started this standing up
20:13
against these incredible odds and
20:15
winning this luminous victory not for
20:19
personal gain not for personal benefit
20:22
but for humanity but it isn't just the
20:24
story of one individual it's a story
20:26
that intersects with so much else with
20:29
social entrepreneurship with global
20:32
health with moral leadership
20:33
family enterprise he has three
20:36
generations of his family 30 more than
20:38
35 members of his family working under
20:41
the same roof with him and it also
20:44
intersects with spirituality with
20:47
questions of service and so it spills
20:50
over any label that we can attach to
20:52
this and it asserts it its relevance
20:54
because at its core really this is a
20:57
story about our individual potential and
21:01
our collective possibility and there are
21:06
a few unwritten directives that run
21:10
through this story as a threat as
21:12
threads and the first is quite simply
21:15
stay rooted in compassion more than
21:17
anything else this is a story that shows
21:20
how compassion can drive scale can drive
21:23
sustainability can drive excellence
21:25
quality all of those things that we're
21:27
looking for compassion can be the engine
21:30
behind that serve and deserve this was
21:34
something that was very key to dr. B's
21:36
philosophy this idea of do the work and
21:39
the money will follow the fact that if
21:41
you follow your mission if you align
21:43
with your mission the resources will be
21:45
galvanized and it will align in a much
21:47
stronger way than if you were driving it
21:50
through money alone create a movement
21:53
not dominance that idea of again
21:55
training your competition and the fourth
22:00
practice for perfect vision dr. V was
22:04
someone who very keenly understood that
22:09
while his task his set task in the world
22:11
was addressing an external form of
22:14
blindness his success in that task was
22:18
strongly linked to his ability to
22:20
address internal forms of blindness
22:23
whether that was anger or greed or fear
22:25
or jealousy or uncertainty or annoyance
22:28
all the petty little things that can
22:30
sometimes cloud our vision and make it
22:32
harder to act in a way that is fully
22:35
aligned and so that idea that he
22:38
believed in very strongly was that
22:39
clarity in thought and action is linked
22:43
to discipline of mind and heart
22:46
so he showed up to practice compassion
22:49
every day of his life and he had that
22:51
that belief that when we commit to
22:55
sharpening our self-awareness and to
22:58
pushing the boundaries of our compassion
23:00
we truly do become more perfect
23:03
instruments whatever it is that is our
23:06
deepest truth just one quote from dr. V
23:11
that I'd like to leave you with before I
23:14
end tonight this is I think emblematic
23:19
of his deepest wisdom and he said when
23:25
we grow in spiritual consciousness we
23:29
identify with all that is in the world
23:32
and there is no exploitation it is
23:36
ourselves we are helping it is ourselves
23:41
we are healing
23:50
you