It was an honor to be awarded the 2013 Claude H. Organ, Jr., MD, FACS, Memorial Traveling Fellowship. Over the years, my interests in academic surgery have widened to focus on leadership and global health care. This award allowed me to marry both interests in a capstone experience that I will always remember.
For the last two years, I have been enrolled in the MBA for Executives: Leadership in Healthcare program at Yale University School of Management (SOM), New Haven, CT, and I was able to apply the Claude Organ Traveling Fellowship toward a two-week (April 12–27, 2014) visit to India to explore various aspects of the health care system there. Other students and alumni from the SOM program and I visited Mumbai, New Delhi, Hyderabad, and Bangalore and visited hospitals, pharmaceutical companies, research organizations, not-for-profits, professional societies, and ayurvedic facilities; we even met with the Ministry of Health. It was truly a spectacular opportunity.
Along the way, I realized a few key truths:
- Diversity exists everywhere. India is a country of tremendous contrasts—where the extremes of wealth and poverty coexist. We may think of countries as homogeneous populations, but in fact, there is tremendous diversity—in language, culture, religions, and socioeconomic status.
- Necessity is the mother of invention, and innovation can breed efficiency. India may have a lot to learn from America, but we have a lot we can glean from India. Because health care spending is limited to just 1 percent of the national gross domestic product (GDP), India has had to innovate to find efficient ways to provide care to a large population. “Do more with less” seemed to be a prevailing principle there, and it was amazing to see how much could be done with their limited resources.
- Be contrarian and persistent. So many of the success stories we heard in India were those of people who had a contrarian view—an idea that was not mainstream, and yet, with persistence, they were able to capitalize on this ingenuity.
- Focus on your core strengths. Many Indian facilities—whether pharmaceutical, research, biotech, or patient care—have been streamlined to focus on their key strengths. Success then becomes less about competition, and more about cooperation, as synergies exist between firms and industries.
- Purpose above all. I was struck by the focus on “a higher purpose”—a sense of doing well by doing good—remembering that patients come first, and how this dictates business practices.
In an effort to share my experiences with @AmCollSurgeons followers, I tweeted my way throughout our trip. This article contains some of the highlights of my time in India.
Pharmaceuticals, other manufacturers
We started our tour at Cipla Global Limited’s headquarters in Mumbai, one of the largest generic drug manufacturers in India—a key health care resource in the country, as they provide access to low-cost medications to many patients. While in Mumbai, we also met with the leadership of Johnson & Johnson India, which manufactures everything from devices to pharma to consumer products. We learned that while the return on capital is great in India, there is still much to be done from a corporate social responsibility and public policy perspective to address poverty and health inequities in the nation.
In addition, we visited Dr. Reddy’s Laboratories Limited, another generics manufacturer, focused more on international export of generic drugs and based in Hyderabad. At Hetero Drugs Limited, also in Hyderabad, we saw the lab and manufacturing facilities, as well as their headquarters. It was interesting to see how manufacturing processes for generics are streamlined, and new compounds made with intense scrutiny for quality assurance. Partnerships and alliances between pharmaceutical firms are critical to ensuring a strong industry.
Foundations
We heard about “big, best, and bold strategies” to address global health care issues based on fundamental human values at the Wockhardt Foundation in Mumbai. This Foundation works on grassroots projects to improve quality of life and sponsors a number of initiatives aimed at improving access to clean water, enhancing education, and delivering primary care services to patients. The outcomes of relatively simple interventions that address these issues were striking. We also visited the Jana Foundation in Bangalore and saw how microfinance programs can make a difference in terms of socioeconomic status, particularly for women.
Hospitals
Raj Badwe, MD, a breast cancer surgeon, leads Tata Memorial Hospital in Mumbai—the leading cancer hospital in the country. We saw huge demand for cancer services, but also were impressed by some of the efficiencies built into their system, from barcoding pharmaceutical prescriptions, to their homegrown electronic health records, to the amazing productivity of their pathology department. While in Mumbai, we had dinner with the representatives of the Indian Cancer Society, the Indian Cancer Oncology Network and V-Care Welfare Association, and learned about their system of cooperative group trials.
Public-private partnerships also increase access to care, as patients with a diagnosis of cancer are given free rail passes to get to hospitals for treatment. Family plays a critical role in decision making. Most health care expenses in India are paid out-of-pocket, and few people, other than some government employees, have health insurance coverage.
At Tata, we saw what a largely public hospital was like, and while we appreciated that it was in a better position than most, given that it is funded under the Department of Atomic Energy rather than the Department of Health, it was still a far cry from the more corporate-appearing hospitals, like Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, which we also visited while in Mumbai.
In Hyderabad, we toured Yashoda Hospital, where we found talent that had trained in North America and the U.K. before coming back to India to provide care. Finally, we visited Narayana Hospital in Bangalore, where we met with Devi Shetty, MD, a world-renowned cardiac surgeon who has been called the “Henry Ford of Surgery” because of his innovative approach to doing more with less.
Ministry of Health and Family Welfare
We visited the capital city of New Delhi, where we met with leaders of India’s Ministry of Health and Family Welfare. They have ambitious goals—to increase access to primary health care to all citizens of India—but are functioning on a limited budget of approximately 1 percent GDP.
Ayurveda
While in New Delhi, we branched out of “Western” medicine, and visited an ayurvedic facility that has both inpatient and outpatient facilities. Although this holistic approach to patient care may be particularly useful for improving quality of life, it was clear that objective research was needed to quantify its impact.
Contract research organizations
As one of the fastest-growing biotech contract research organizations, we were impressed by the facilities at Sai Life in Hyderabad. This firm, like many in India, is focused on its core competency (biotechnology), rather than manufacturing, and has done well in this regard.
Outsourcing radiology
We visited Telerad Solutions in Bangalore, a company founded by two Yale physicians that now reads radiology images from all over the world and houses a local outpatient clinic, as well.
Throughout the trip, we gained a broader understanding of health care needs and opportunities in India, as well as how we can learn from the efficiencies there to improve our own systems at home.
We built collaborations and friendships that will continue into the future. It was a remarkable journey, and I am thankful to the American College of Surgeons and the family of Dr. Organ for the privilege of the award that made this trip possible.
As a final note, a few weeks after my return from India, I was told that I would receive yet another honor—to be class marshal at our Yale commencement—a privilege given to the student who received a grade of “Distinction” in the most classes. My two weeks in India, along with my two years in the MBA program at Yale, have had an indelible impact on me. Both were amazing, transformative experiences, and for them, I will be eternally grateful.
