There's no such thing as free

I'm often asked why low-income women pay to come to LifeSpring, when government hospitals are free. Over and over, the primary reason we hear from our customers is that they want to go somewhere that's higher quality. Of course, "quality" means different things to different people, but low-income or not, we all want the same thing: a good doctor we can trust who answers our questions; a clean and safe environment; and to be treated with dignity and provided with information about our own health.

The second answer we hear most frequently is: "Well, everyone knows that government hospitals aren't free." The first time I heard that, I was shocked to hear of all the bribes that occurred at government hospitals, naive Westerner that I am. While we continuously hear this from our customers, it's a hard thing to talk to outsiders about or present at a conference when asked about the value LifeSpring provides -- primarily because there is little hard data and published evidence to support this, although everyone knows it's going on.

We just got a little help from The Times of India, who last week published two articles around this very topic. As they write in a Nov 9th article entitled "Your baby delivered by staff for a price!" reporting from Hyderabad:

"You can get a glimpse of your baby boy/girl only if you cough up Rs 500/Rs 400 respectively; at some hospitals it costs even more."

There are so many things wrong with that statement, I don't even know where to start! First off, the very idea of charging people with virtually no money to pay sums (around $8-10 USD) to "receive" their baby from the hospital feels so incomprehensible. And then the gender disparity is absolutely heart-breaking.

The article continues: "Humilitated parents have been unwillingly bending to the diktat ("fee") out of fear that the Class IV staff -- who routinely deny them the right to have their babies unless they grease the palms of aayas (housekeepers), operating theater assistants, and sweepers--may harm the baby."

It talks about how the rates at Government Maternity Hospital (in Petlaburj) is Rs 500/Rs 400, but the rates at Gandhi Hospital (which is nearby our hospital and which many of our customers had gone to previously) is anywhere between Rs 100 and Rs 1000.

Says one father: "My wife delivered a baby boy today. The hospital attendants and aaya refused to give me my child unless I paid. They refused Rs 200 that I offered and, in the end, I was forced to shell out Rs. 500".

Bargaining for your baby?!?! If I didn't hear about it nearly every day, I wouldn't believe it either.

A little reminder

A crazy day at work and it's barely 10am. As I rush to my next meeting, a note falls to the floor. It's from someone I just met last week, who came to visit LifeSpring Hospital to learn more about our work. It takes just a second to re-read, but instantly my mood shifts. It reads in part:

"I know you must know this at some level, but in case there's room for a reminder, you're doing truly inspiring stuff that others can only dream of. Enjoy it!"

Amazing how just a small shift can totally change your attitude. Also a good reminder of how powerful a simple note of gratitude can be, and just in time for Thanksgiving!

Star-struck

Maybe, just maybe, LifeSpring is being talked about in the White House...

Over the weekend, a product manager from Google came to LifeSpring to see how he might get involved in our IT Steering Committee. I think both sides were a bit star-struck... us wanting to learn more about his work with enterprise applications at Google, and he wanting the complete tour and story of LifeSpring's growth.

In fact, upon arrival, he talked about how excited he was to finally see LifeSpring. I figured he had heard about our hospital through the pre-TED visit a couple of weeks ago, where two Google senior managers came to visit our hospital.

But instead, he said that he had heard about LifeSpring from Sonal Shah -- previously at Google.org and now...

...heading Obama's recently-created Office on Social Innovation and Civic Participation! -- essentially the White House's office on social enterprise.

Now I'm the one star-struck!! It's amazing to me to think that the head of this office not only has heard about LifeSpring, but has told others about it as well...the power of word of mouth...

Now I'm wondering how to get Obama to come to one of our hospitals! -- maybe it's not so far-fetched after all...

Changing Landscape

Sunday, 5pm

Gurgaon

While working on a Sunday isn't usually a matter of fun, this weekend it's not so bad. Tyler and I are working at his office, the 2nd floor of a mid-rise modern building in Gurgaon, in the northern state of Haryana. I'm catching up on work and we're working on a paper on microfinance, which is actually really fun.

We stop to get lunch nearby -- about 10 minutes on his motorcycle. Yesterday it's McDonald's inside a mall, followed by dessert across the way at TGIF's (YES, TGIF's!!), which blares American music from the late 1990s. Today it's Pizza Hut, across the street.

What's amazing about all this is that I can be describing pretty much Anywhere, USA. But we're in Gurgaon, which a few years ago was nothing but complete rural farm land. The Central government then set up a special economic zone (SEZ, ahem, pronounced "zed" here, thank you) -- over an area of 300 acres. With all the tax incentives, FDI poured in and development accelerated. On my way to a meeting in here earlier this summer, I passed about 20 Fortune 500 firms -- companies like GE, Unilever, and Microsoft are all here.

From the back of Tyler's bike, it all just looks like an alternate universe made up completely of dust, grey, and construction -- "a bit like the apocalypse", we always joke. But it really is amazing to think of how much the landscape of this small area has changed in the last decade -- and to think that this is what's happening across India, and what will continue happening as development ensues.

A few months ago, the Wall Street Journal published a photo essay: click here -- which talks about Indian farmers who have become millionaires overnight by selling their land to developers here. As the Journal talks about, in recent years tens of thousands of villagers across the country have sold fields to developers building malls and suburbs for the New India. One of the most poignant photos is of a villager who sold milk for $250 a month before selling his land for $180,000 to a developer. While some are happy with their fortunes, others regret selling their land in the first place. Another memorable photo is of a 75-year old villager at the local courthouse, asking how he can reclaim his land that his nephew stole and sold.

It's a complex story, and one happening all around the country as the New India gets built.

A land of extremes

Even though I see it in my daily life every day, the incredible disparity between rich and poor here in India never ceases to shock me. Nowhere is this more true than in healthcare. Earlier this summer, LifeSpring was invited to attend The Economist's Healthcare Forum, put on by its intelligence unit. It was a fascinating conference, focusing primarily on what the future of healthcare in India is likely to look like.

For me, one striking aspect was how the dichotomy of healthcare challenges seems to be growing. For instance, you had experts talking about the growing prevalence of obesity, diabetes, and cardiovascular diseases, particularly among Indian women. Speakers talked of middle and upper-class women who sit at home all day, get no exercise, and have their servants do their errands.

Then in the next breath, we would hear of the abysmal conditions in urban slums... and how one couldn't talk about exercise there, when the real challenge is getting clean water and proper sanitation.

At this week's recent India Health Summit, an underlying implicit theme was similarities and differences between India and other countries' healthcare systems. Perhaps the most striking opposition was when the Programme Director from Singapore's Ministry of Health spoke. As he spoke of his country's healthcare system, I couldn't think of a more stark contrast!

One of India's biggest healthcare challenges is accessibility for its vast rural population; Singapore is only urban -- and one city at that! He, too, cited the statistic that almost 50% of India's population must travel over 100km to access care; while adding that the entire country of Singapore is 40km across! I found their solution to healthcare interesting -- a compulsory medical savings program for its citizens, coupled with voluntary medical insurance. (In India, fewer than 10% of citizens have health insurance, so the vast majority of healthcare spend is out-of-pocket.)

Of course, references to the US healthcare system abounded. It was interesting to hear so many questions asked around "What lessons can America learn from India in healthcare?" -- particularly around affordability and efficiency. Speaker after speaker talked about America's failed healthcare system, and while I don't necessarily disagree, I do think it's a matter of degrees and reference points. When someone from the Economist Intelligence Unit cited a recent survey showing the vast majority of people in most countries were unhappy with their healthcare options (including the biggest spenders, like the US, UK, and Germany), another speaker chimed in and stated quite forcibly: "With all due respect, there's a big difference between being unhappy and a system being totally lacking."

I thought of this comment later in the day, when a physician addressed the middle and upper-class audience (all primarily senior management and government officials) and said:

"I'm sure all of us, at one point or another, have faced a situation where a medicine necessary for a loved one's surgery was not available at the hospital itself -- so you've had to run out and find the critical medicine elsewhere, while the surgery is going on." I looked around the room, stunned to see such a large number of nodding heads. It certainly makes you aware of the incredible challenges in healthcare, not only among low-income Indians, but across the entire income spectrum.

India Health Summit

It's always a bit surreal to be sitting in an amazingly nice five star hotel with glass chandeliers and intensely high security... talking about development and "helping the poor." I've been in Delhi for the past two days attending the 6th India Health Summit, whose focus this year is on "Taking Quality Healthcare to the Masses."

I attended the same summit two years ago, when I first arrived in India and was a complete wide-eyed novice about the industry (two years later, there's clearly still so much to learn!). What struck me then was how black-and-white the spectrum of healthcare seemed to be -- with government hospitals on one end and private for-profit hospitals on the other end. Any private sector initiative towards serving low-income people was under their Corporate Social Responsibility umbrella, and there was almost a defensive feeling in government officials, who felt that government hospitals just needed to be strengthened with more resources to adequately serve the nation's poor.

Two years later, there's such a strong sense that government and the private sector need to work together to truly tackle India's healthcare challenges of accessibility, affordability, and quality. You couldn't escape a discussion on PPP's (public-private partnerships) in each of the sessions.

For me, it was so refreshing to hear government officials talk about the need for change in extremely unqualified terms. Said a Cabinet Minister who directly reports to the Prime Minister of India: "Just visit one of our government hospitals and you will see the mess."

One of the most heated debates of the Summit was the Q&A regarding Preventative Health. One of the speakers had chided India for being the world's largest producer of tobacco, as well as the world's largest consumer. His point, of course, was that Indians needed to be more aware of the unhealthy decisions they make regularly, such as smoking, unhealthy eating, etc.

This sparked a fascinating debate on health versus economic growth, with delegates citing chief ministers who urge their states' farmers to grow more and more tobacco. On the one side, you had people urging a tax on tobacco similar to the West; on the other, you had people citing the importance of economic growth - reminding the audience of all the farmers in Andhra Pradesh who committed suicide due to a decrease in their tobacco yield.

It reminds me how interlinked health and poverty is -- one statistic that kept coming up was that every year, 3% of Indians are pushed below the poverty line due to health care costs. Another quite incredible statistic: nearly 50% of Indians have to travel 100 kilometers or more to access quality care. Just goes to show that accessibility is a much bigger challenge than just affordability.

Baseball Fever

Tyler calls me an addict. I'm now in the business center of an amazingly nice hotel "watching" what I hope is the final game of the World Series. And yes, by "watching", I'm still referring to seeing the baseball icons move around the bases, with the photos of batter and pitcher smiling out at me.

I'm in Delhi for the 6th India Health Summit, hosted by the Confederation of Indian Industry. Turns out getting to a conference two hours early has its advantages when baseball is on!

Over on this side of the world, of course cricket is the rage. I've gone to a couple of games in Hyderabad, but I'm sure massively annoyed Indians I was with by trying to understand the game in relation to what's similar and different about baseball.

India is playing Australia in cricket today -- in Hyderabad, actually. Both teams arrived Hyderabad two nights ago and checked into the Taj Krishna, coincidentally where I was meeting Catherine so we could go out for dinner and drinks. We quickly decided that staying at the Taj would make for the more interesting evening!!

The very nature of their players probably says a lot about the countries' cultures -- or at least the cultures of the celebrity and the elite. The Australian cricketers came down in plain white t-shirts and work-out pants, having low-key drinks at the bar... while the Indian cricketer we saw was decked to the nine, with sunglasses and a host of fans pushing us out of the way for his autograph inside the hotel!

But meanwhile, back to baseball... Yankees up 7-3, top of the 7th....

TEDIndia

TED breaks into India this week, with Day 1 of TEDIndia starting tomorrow and the TED Fellows pre-conference starting this morning. It's really exciting that our CEO, Anant Kumar, has been chosen as a TED Fellow this year. Looking through the TED Fellows list, it's incredible how many fellows are part of my "world" here -- LifeSpring, Acumen Fund, Katzenbach, Columbia and SIPA... it's one of those things that is easy to take for granted but makes me re-remember all the opportunities that come from living in a country as dynamic as India.

Many of the events on the first and third day (November 5th & 7th) will be webcast live; you can view them here. Besides the "big names", I always love seeing the descriptions of speakers. For instance, the first session -- "Fast Forward" -- has speakers that include: global health expert, data visionary, mythologist, dancer/actor/activist, and singer. Love it!

I'm excited to hear back from Anant about the sessions on "Reinventing Development" and "Redesigning Communities" -- which perhaps unsurprisingly are somewhat frequent discussions and debates over food and copious wine here in the Hyderabad social-enterprise "scene". Stay tuned!

Marriage of the Gods

"Beautiful" is not a common word used to describe my commute home... but it was exactly that last night, with dozens of candles lined up in front of houses and fireworks happening through the night.

The occasion? The marriage anniversary of Lord Shiva and Goddess Parvathi. It's considered by Hindus to be a very auspicious day. As my co-worker explains: "Devotees celebrate this day and do pooja (religious ceremony), and it is considered that whatever we wish, it would be granted."

The "everyday" lives of gods here never ceases to fascinate me. Gods "wake up" and bathe in the morning (e.g. their statues are washed by devotees), celebrate anniversaries, and even have their own bank accounts! People naturally have "favorite" gods.

Tyler and I joke about the temple in Delhi that was built on the side of a highway... people do "drive-by" prayers, where they turn, bow to the god and give praise... ALL while still driving their motorcycles along the insanely busy road!!

And people say Americans multi-task??

Exporting LSH

Our CEO, Anant Kumar, recently came back from speaking at the World Health Summit in Berlin.  The Summit merged many different sectors and was held under the "patronage" of French President Nicolas Sarkozy and the German Chancellor Angela Merkel.  Comprised of panel discussions, working sessions, and stakeholder meetings, the Summit was an opportunity to have a global discussion and debate on tackling all the tough questions in healthcare -- such as access, affordability, high quality care, and the use of technology.

I was fascinated by many of the panels -- topics like Evolution and Disease of Modern Environments.  "Darwinian Medicine" was a big theme of the conference; in other words, looking at modern epidemics like asthma and obesity through the prism of evolution.  One way to look at these sorts of modern epidemics is the notion that they've resulted from changes in the environment which our bodies cannot evolve quickly enough to.  Fascinating.

Of course, healthcare delivery and accessibility on a global scale was another key Summit theme.  Anant spoke on a panel around global health, joined by senior directors from organizations like the World Economic Forum.  A question that Anant was continually asked was: "Is LifeSpring replicable outside India?"  I was asked more bluntly at the World Health Congress in DC: "When will LifeSpring open in the US?"  

While there's clearly still so much to do here in India, I often think about the lessons that LifeSpring can teach the rest of the world around areas of access, affordability, and high-quality patient-centric care.  The need is certainly there.  The question of scaling internationally is definitely an interesting one to continually revisit and explore.

Hyderabadi Halloween

Strangely, I didn't get any more stares than usual being dressed in a hot pink dress, matching pink hat, and a snake around my neck than usual, walking around Hyderabad. (And in case you're wondering, my costume at various points of the night was: Indiana Jones with my roommate Nate (remember the opening scene??), air hostess on acid, and finally: "snakes on a plane")  

Most creative costume of the night was our friend who dressed as Hussain Sagar Like, with a Buddha on her head and fish taped all around her body.  

HYD certainly impressed me last night, staying open until 2am (gasp!) instead of the usual midnight.  Turns out, Halloween is fun pretty much anywhere in the world...especially when many locals have no idea why crazy westerners are dressed the way they are (although I suppose that's what many people think every day!)

As an aside: SUCH good baseball!  So weird to wake up early and watch the World Series on my extremely slow internet... It's too slow for radio and certainly for video, so I make due with little icons on the bases on Yahoo Sports, refreshing every few minutes.  Wish I were in NY now watching at a dive bar in Hell's Kitchen!!  To make up for it, the loud drums banging outside at 10am seem to be celebrating the Yankees' recent victory :)