In the era of medical tourism and grandiose hospital chains where
good healthcare has been jazzed up to levels only affordable to the upper
class, one man stands outs. He rebelled against the growing commercialization
of medicine and conceptualized a model for low cost high quality healthcare.
The people of India owe it big to this miracle healer- Devi Shetty!
Once a small boy in a village of
Karnataka who was studying at a school, heard from his teacher about the
world’s first heart transplant which was performed in South Africa. Overwhelmed
by fascination, he resolved to become a heart surgeon even before he decided to
become a doctor. Also he wanted to take better care of his parents and this
reinforced his resolve. And rest is history. Devi Shetty today is known across
the world as one of the best cardiac surgeons in the world and also as a
medical philanthropist. After completing his graduate degree and post-graduate
work in India, we went to United Kingdom to receive training in cardiac
surgery. That helped him immensely to learn how such operations are done at big
scales and also the importance of equity i.e. everyone should be provided
healthcare services irrespective of his economic state. Devi Shetty once in an interview famously
remarked that healthcare should become a fundamental right. He believes that
even though the country produces a large number of doctors and health
practitioners and can facilitate the needed infrastructure, it is not giving
any results mainly because the services are not affordable for majority of our
population. The still prevalent poverty is a big challenge to universal
healthcare. He say, “If a solution is not affordable, it’s not a solution”.
After his return to India, he
started his practice in Kolkata which proved to be the place that would define
his preferences and priorities. It is here that he realized that even though a
lot of people come to him with their heart problems but none could afford the
cost of surgery. It is here ergo that he resolved to come up with a remedy for
this problem of high surgery cost. It is here that he was asked to attend to
the ailing Mother Teresa and stayed as her physician for a long time. She has
had a great impact on him and he acknowledges the teachings that he learnt from
her. One that is closest to him and which he often quotes “Hands that serve are
more sacred than the lips that pray”. One could clearly see the influence of
Mother Teresa on the initiatives that he took in later times. Subsequently he
setup the Manipal Heart Foundation and then founded the Narayana Hridayalaya
Hospital near Bangalore.
The main idea behind Narayana
Hridayalaya was to give shape to his notion of affordable healthcare without
compromising on the qualities by making large hospitals running on innovative
solutions and working by economies of scale. His vision was to disassociate
healthcare from affluence. Today the healthcare infrastructure is concentrated
in the urban agglomerations and the infrastructure is entirely missing from the
rural areas where still our majority of population resides. The generation X
doctors are not interested or do not find any incentive in working in rural
areas. This is resulting in pathetic state of the Primary Health Centers across
the length and breadth of India. Devi Shetty is of the opinion that this is
happening because of the absence of government medical colleges and the
abundance of private medical colleges. There have been substantial capital
infusion by these private organizations and therefore the cost at which they
provide education cannot be afforded by the poor. Only government colleges
would ensure that even poor people could become doctors. He firmly believes
that if the government transforms all the district headquarters hospitals as medical
colleges, Indian healthcare would be transformed in the span of six years.
His model of healthcare is entirely
different from the mainstream upscale metropolitan hospitals which are slowly mushrooming
through the tier one cities of India catering to the upper and middle classes
of the country. They are glorifying the way medical services are delivered and
adding a pinch of luxury into it. Their infrastructures resemble those of the
posh hotels and they provide all goods and services no less than a shopping
plaza. But Devi Shetty’s point here is that such lavish expenditures inflate
the medical bills of the patients unnecessarily. So if we devise smart and
economical ways to run a medical facility, the cost of healthcare would go down
by considerable amount. That would mean that the surpluses generated can be
used in the treatment of the destitute fraction who cannot afford even small
amounts. As he says, “the objective is to only keep the nose above the water
level”.
His model of affordable healthcare
has some unique features that are attracting attention from all corners of the
world. The major capital investment in hospitals is towards the hi-tech and
latest machinery for carrying out various procedures and even operations. This
cost is so high that it impacts the cost of medication incurred on the patients
for a long time. But if you visit Narayana Hridayalaya, you will find that they
have a policy of asking the manufacturing companies to park their machines
instead of actually buying from them. The hospital then pays for the
consumables for the machines and thus it turns out to be a win-win situation
for both the hospital and the manufacturing company. The hospital saves a lot
of capital and the manufacturing company makes stable revenues from the consumables.
This has immensely helped in cutting the capital investments of the hospitals.
Shetty was also concerned about
those poor sections among people who would not be able to travel to his
hospitals and thus he came up of with the idea to make full use of the
telemedicine technology to reach to them. This idea soon materialized with a
tie-up with Indian Space Research Organization (ISRO) and since then he has
treated over three lakh people by making use of telemedicine technology.
Moreover, when it comes to the recovery process, Shetty has a very peculiar
viewpoint regarding nursing. He considers the role of nurses as far more
paramount than that of the doctors themselves as the doctors only spent 1% of
their time but the nurses are involved throughout. He is very adamant on not
providing chairs for nurses as they would bring the efficiency down by
considerable amount. He believes that the nurses have to be attentive all the
time and presses upon the importance of discipline and dedication in their jobs.
In his hospitals, he has ensured the best training facilities for the nursing
staff and an overwhelming portion of the workforce in his hospitals are from
the nursing department.
But at the same time he is very
concerned about the government policy about the training and career progression
of nurses. He is of the view that due to absence of such policies, the human
resource availability for nursing is discouraged and in the coming years it
would be a great challenge to find nurses for the hospitals. When asked about
the big plans of government with the launch of National Rural Health Mission
(NRHM) to tackle the problem of high Maternal Mortality rates (MMRs) he simply
points out that one needs to go to the root of the problem. He adds, “For
institutional deliveries along with the awareness and infrastructure, the
government should create human resource which is the main missing ingredient
and should ensure that we have adequate gynecologists to cater to the still
high birth rate”. Such great vision and innovations are part of Narayana
Hridayalaya which makes it possible to provide low cost healthcare without
compromising on the quality. As a result his work has received praise from all
corners of the world and is attracting a lot of attention. With the good word
already spread all around, he receives patients from all corners of the world
and especially from Middle Eastern countries and Africa. Recent trends also
show inflow from US and Europe as well.
All these features make his
innovative model very unique and special but there are some things about Devi
Shetty that even make him a unique healer. He is totally devoted to the cause
of cardiac surgery and says he wants to retire as a heart surgeon. His daily
routine comprises of meeting at least 70 patients, performing two or three
heart surgeries. Apart from this he also sees patients from across the country
by video conferencing. He has performed more than 15,000 heart surgeries and
has saved more than thousand people’s lives. He is the first heart surgeon in India to enter into
neo-natal open-heart surgery, the first doctor in the world to perform
open-heart surgery to close a hole in the heart and the first user of an
artificial heart in India. Moreover, his ambitions and goals have been achieved
to some extent as by his innovative methodologies he has been able to bring
down the cost of heart surgeries tremendously. In his hospitals, the cost of
such surgeries is only one-tenth of what it costs in US and almost half the
cost charged in other private hospitals in India. Apart from this, in his
operation theatres one would always find some kind of soft music playing as he
believes in the healing powers of music. He is of the opinion that the
doctor-patient relationship should not be artificial and formal and makes a
point to ensure personal attention to his patients. He accepts that he is a
spiritual person and one hears the chanting of ‘Om’ sounds in his cabin where
he sees his patients.
He is confident that India will become the first country in
the world to dissociate healthcare from affluence and within ten years every
Indian will have access to high-tech healthcare with dignity. He claims that
this is possible only because we produce the largest number of doctors, nurses
and medical technicians in the world. Outside the U.S,
ours is the only country to have the
largest number of USFDA-approved drug manufacturing units in the world. We have
everything going for a phenomenal healthcare delivery model. The only missing
link is that patients do not have enough money for healthcare. He has a
solution even for this and adds , “For example, around 10 years ago, we
convinced the state of Karnataka to launch a health insurance plan called
‘Yashaswini Micro Health Insurance’, which operates on a premium of five rupees
per month. Today, we have close to 4,000,000 farmers who have availed the
benefits of this insurance scheme. Over a period of 10 years, more than 450,000
patients have undergone various types of operations, including major heart
operations, at a cost of just Rs 5 per month”.
Shetty also has plans to convince our policy-makers to float a scheme
through which every mobile phone subscriber in India pays 20 rupees over and
above the regular bill, thereby enabling us to create the most robust and
scalable health insurance program in the world. Poor people in isolation are
very weak, but together they are very strong. The solution is that simple!
His
work has been greatly recognized throughout India and even abroad. A large number of Indian States want to sign
a MoU with him to open big hospitals running on his low cost models. He has signed an MOU with Karnataka Government
for building a hospital with 5000 beds in a budget of 1000 crores. His business
model has also received praise abroad and he has inked a contract with one the
biggest non-profit hospital chain in US to build a medical city in Cayman
Islands in the East end. Interestingly there are many other such initiatives in
India viz. Vaatsalya,
Glocal Healthcare and Eye-Q etc. These collectively do give us the hope that
low-cost universal healthcare in India can be reality soon.
Devi Shetty serves as a role model not only in the field of
healthcare but to all other entrepreneurs who would like to create such
business model based on economics of scale so as to provide affordable
solutions for all classes of people. Meanwhile his business model grows
exponentially he is busy doing what he is best at, healing hearts. For all that
he has done for humanity, one thing is for sure, he has touched more hearts
than he has healed!
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