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
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
01:14
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
02:42
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
02:55
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
04:40
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
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
05:18
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
05:55
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
09:30
quality and the third was really
09:32
interesting we will be we must be
09:36
so what those three commitments meant
09:39
was that whatever other VIN did over its
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
12:41
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
16:07
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
17:12
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
so Aravind does something very
19:19
counterintuitive it trains its
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
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