Berkeley Haas Travels to Nepal for Eye Care Nonprofit

Written by IBD Team Seva; Alix Slosberg, Elinor Chang, Lauren Greenwood, Ryan Overcash and Ryan Adams

*Haas team’s travel in Nepal

*Haas team’s travel in Nepal

Five current Berkeley Haas MBA students partnered with Seva, a global nonprofit, to support its mission to preserve and restore sight for communities around the world for the 2019 International Business Development (IBD) course.  The Haas team started working in Kathmandu, but quickly traveled around Nepal to see the famed Lumbini Eye Institute and settled in Tansen, Nepal, where the team focused its IBD work for the Palpa Lions Lacoul Eye Hospital (PLLEH).

The Haas team spent three weeks in-country exploring how PLLEH could increase cataract surgery patient volume to drive revenue growth to become financially self-sustaining in the long-term.

A Day in the Life

*Tansen, Nepal

*Tansen, Nepal

While in Tansen, the Haas team ingrained itself with PLLEH’s eye care staff and operations. The team met with the other Tansen medical care facilities that also serve the broader Palpa district, which includes Tansen and has a population of 270,000.

In total, the Haas team conducted 24 stakeholder interviews and 5 hospital tours while in Nepal.

One of the most memorable days was when the Haas team worked with the Seva Nepal contact, Parami Dhakhwa, and the PLLEH staff to set up a full day of patient interviews at the hospital.

The Haas team wanted to learn about PLLEH’s patient journey through patients that came for cataract surgery, those that were just diagnosed with cataracts, and those that came for a general checkup.

*Elinor Chang & Alix Slosberg work with the translator and patients

*Elinor Chang & Alix Slosberg work with the translator and patients

The hospital opened at 10am and already had a line of people waiting to be seen. As the morning progressed, the hospital became more crowded since people had traveled hours by foot and bus and wanted to receive care in time to return home before the last bus left Tansen.

*Buffalo, common farm animal

*Buffalo, common farm animal

There was added excitement on this particular interview day. An ophthalmologist from the Lumbini Eye Institute was visiting PLLEH for one day to perform cataract surgeries since PLLEH was temporarily operating without an ophthalmologist.

The Haas team prepared standard interview questions for patients and worked with two translators to dive into patients’ experiences at PLLEH.

The Nepali patients were kind, forthcoming, and supportive of the Haas team’s work. The patients also made clear that PLLEH’s brand was highly regarded and they trusted the quality of care received at PLLEH.

*Interviewed PLLEH Patients

*Interviewed PLLEH Patients

The interviewed patients were mostly farmers in the region and many of them brought up concerns about leaving their crops and animals in order to receive care at PLLEH.

The Haas team also gained insights into the decision making process for patients that decided to receive cataract surgery and the team’s hypotheses were further refined. An interesting development was that finding a guardian or caretaker for cataract surgery is likely not as much of a barrier to surgery as the team previously thought. At PLLEH, grandchildren, daughters-in-law, and spouses still appeared available and willing to assist family members with cataracts.

*PLLEH staff & Haas team

*PLLEH staff & Haas team

Through days like this interview day, surveys written by the Haas team, and the incredible support from Seva and PLLEH staff, the IBD project came alive. The Haas team used the data and primary research to think through eye care patients’ needs and wants and provided dynamic recommendations to PLLEH. Seva will continue to engage the Haas team over the coming year and Haas wishes PLLEH the best in making additional outreach and operational efforts to better position the hospital to care for more patients.

OPTION A:

*Diagram of PLLEH Hospital

OPTION B:

*Diagram of PLLEH Hospital

*Diagram of PLLEH Hospital

Seva Team Blog – 2018 IBD

Written by Jocelyn Brown, Rachel Lee, Grant Hannigan, Josue Chavarin, and Gagan Dhaliwal

May 21, 2018

It’s 110 degrees outside. Every bump of the road jostles us back and forth as we sit on stretchers in the back of the hospital ambulance. Weaving down dirt roads that look way too narrow for our vehicle, let alone two lanes of traffic, the driver uses the siren to announce our arrival, to both wandering buffalo and massive trucks filled with just-cut sugarcane. Within minutes of leaving the hospital, we are passing small farming villages. Goats, stray dogs and buffalo rest in the shade of ramshackle structures, along with villagers who stare at us as we drive by. Little fans in the back of the ambulance blow hot air in our faces, making it feel like we’re in the middle of a hot, dry sauna.

After stopping to ask directions several times, we finally locate our first interviewee. Today, Gagan and I are interviewing patients who visited Dr. Shroff’s Charity Eye Hospital in Mohammadi, India, and were told that they needed cataract surgery but haven’t come back yet to schedule it. We’re hoping to learn, through our teenage translators Srishti and Gracy, why they haven’t come back to the hospital. Every trip we take outside of the hospital walls has taught us an incredible amount about the surrounding communities and their day-to-day lives. We also usually come back exhausted and completely wiped from the Indian heat after only a few hours.

The first man we meet is prone on a cot underneath a straw hut and comes out to meet us. He’s shirtless, hunched from the waist around a wooden walking stick, and wearing thick, coke-bottle glasses. The first thing our translator tells us after introducing us is that he drinks alcohol. He doesn’t have any family members who can take him back to the hospital, and so he relies on others for transportation. Boiling in the sun, struggling to get any concrete details about why he might not want to come back to Shroff’s, we quickly decide to move on.

Our next interview is the opposite experience. We pull up to through the center of another village and step out of the ambulance. All of the houses around us seem to be made out of mud and straw. Several children seem to be the only ones who have any energy as they run around playing with each other and a stray dog. The community outreach coordinator for the hospital learns that our next patient is out working in the fields. While other members of the community go fetch him, chairs and water are suddenly precured from nowhere. We see very few women, just glimpses of their colorful garb from open doorways. As we wait for our interviewee, a small crowd of children and interested men starts to form. By the time our interviewee has arrived, a crowd has fully surrounded our little half-moon of chairs.

We’ve worked with our translators ahead of time so they know the types of questions we’re hoping to understand: how did you first hear about Shroff’s? What motivated you to seek care there? Did you understand what the doctor told you about cataract surgery? Why haven’t you returned to Shroff’s for surgery? We receive very brief answers in return: I was very satisfied with my experience. I wouldn’t change anything; the doctors and facilities are the best. Now surrounded with a full crowd of villagers, I wonder how much this man feels like sharing with these foreigners who have suddenly descended upon him and his home.

Conducting our interview with a local farmer

Conducting our interview with a local farmer

As our translators work to glean why this man hasn’t returned to the hospital for surgery (he doesn’t have the time), Gagan and I start to realize the enormity of our task. Our goal is to find untapped sources of new paying patient revenue, so that the hospital can work towards financial sustainability. But as our interviews in the community continue (we only make it through two more before we’re completely wiped by the heat), we realize we will not find the patients we’re looking for here.

We discover that the sugar cane farmers are paid 1-2 times a year for their crop and are making at most $5,000 a year. If these villagers are challenged with the basics of transportation and finding the time to make the trip to the hospital, none of our fancy, MBA pricing models are going to make any bit of difference in this community. Our impression that these patients would price shop for their surgery is immediately dispelled once we realize the simple, minimal lifestyle that describes 80% of this entire state of 200 million people. It’s only Monday of our second week and we certainly have our work cut out for us to identify sources of paying patients.

We gathered quite the crowd!

We gathered quite the crowd!