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!

Greetings from Antigua, Guatemala and the HF Healthcare team!

Written by Michael Sahm​, ​Amy Fan​, ​Rachel Green​, ​Joanna Lyons, and ​Carlos Sanchez

May 31st, 2018

Project Overview

The arch in Antigua

The arch in Antigua

Our client is Nasir Hospital, a private, nonprofit hospital in Sacatepéquez, Guatemala (opening October 2018) that seeks to expand access to quality healthcare services for Guatemalans. The healthcare system in Guatemala is inadequate, as providers across the country lack necessary resources to meet the healthcare needs of citizens. Nasir Hospital’s goal is to provide free care free to approximately 20% of its patients, while still making enough money to sustain operations. Our task was to design a business model which makes this feasible. Today marks the last day of our project, and we feel privileged to have worked with such outstanding people pursuing this cause.

During our trip, we visited several local hospitals and conducted over twenty interviews with doctors, patients, and administrators to better understand Guatemala’s healthcare system. Much of what we saw was eye-opening. For example, public hospitals often lack basic supplies necessary to provide services, forcing patients to purchase their own and bring them to the hospital to receive care. Furthermore, basic hygiene and sterilization pose significant challenges in public hospitals, leading to a high number of hospital-acquired infections and illnesses. These are just a few of the issues which inspired HF Healthcare to build its first hospital in Guatemala.

HF Healthcare Team participating in global telethon for Humanity First

HF Healthcare Team participating in global telethon for Humanity First

Our recommended business model contained several components. First, we defined Nasir Hospital’s position in the marketplace, and crafted a strategy to attract target patients to the facility. Next, we designed an operating model to make the provision of free care financially and operationally feasible. Finally, we recommended service prices and projected patient volumes to create a multi-year financial forecast for the facility. Despite working with minimal data, our interview-centered research allowed us to deliver a quality final recommendation to our client, one we hope will be instrumental to its successful operation in the future.

Life in Antigua

We have been fortunate to call Antigua, Guatemala home during our trip. Antigua is a small city approximately one hour outside of Guatemala City, and is one of Central America’s most popular tourist destinations. It is filled with bars and restaurants (which we explored daily), and is close to some of Guatemala’s best outdoor attractions, including active volcanoes, coffee plantations, and Lake Atitlan.

One of our trip’s highlights was a weekend trip to the Lake. We teamed up with the Cemaco IBD Team from Guatemala City, and stayed at a hotel in Panacachel, a small town which borders the lake. On Saturday, we rented a boat and spent the day visiting different towns all around the lake. It was a special chance to connect with classmates so far away from Berkeley!

HF Healthcare Team participating in global telethon for Humanity First

HF Healthcare Team participating in global telethon for Humanity First

For our second weekend, we chose to stay in Antigua. After working Saturday to participate in a worldwide fundraiser telethon for our client, we started our weekend at Antigua Brewing, where we enjoyed local beer while watching live eruptions from Volcán Fuego.

HF Healthcare and Cemaco teams at the top of Volcán Pacaya

HF Healthcare and Cemaco teams at the top of Volcán Pacaya

The next day, we hiked Volcán Pacaya where we roasted marshmallows in hot spots throughout the summit. We ended our weekend with dinner and souvenir shopping with the Cemaco team, who trekked to Antigua after touring Mayan ruins at Tikal National Park the previous day!

¡Hasta Luego, Guatemala!

As we conclude our project, we feel very grateful for our IBD experience, and have several things to be thankful for. First, for the chance to work on a high-impact project that we know will impact the lives of thousands of patients at Nasir Hospital. Second, to the community members in Guatemala, who were incredibly generous with their time in assisting our project work. We were fortunate to meet several high-profile guests of Nasir Hospital including congresswomen, the family of the President of Guatemala, and an ambassador for Mayan culture and welfare, all of whom recognize the hospital’s potential and are eager to help in any way possible.

HF Team at dinner with Sheba Velasco, international ambassador for Mayan culture and welfare

HF Team at dinner with Sheba Velasco, international ambassador for Mayan culture and welfare

HF Team with the mother and aunt of the President of Guatemala, Jimmy Morales

HF Team with the mother and aunt of the President of Guatemala, Jimmy Morales

Finally, to our friends at HF Healthcare, especially Majid, Patricia, Manuel, and Erick. You went above and beyond in your hospitality, and we are so thankful for your help in making our project experience and trip to Guatemala a once-in-a-lifetime experience. We are confident that Nasir Hospital will be among the best in all of Guatemala, and look forward to following your future successes!

The amazing staff at Nasir Hospital!

The amazing staff at Nasir Hospital!

 

Students Shine at 2016 IBD Conference

We officially wrapped up another amazing year of the Berkeley-Haas International Business Development (IBD) program with our final event, the 2016 IBD Conference on September 16th. The Conference started with an interactive poster session during which 22 IBD teams presented their projects, answered questions and showcased their unique experiences and wearables.  Some of the IBD students who went all out were Team Nando, who wore custom designed clothing produced by their client; Team Ashesi, who had matching pockets sewn onto their shirts; Team Inka Moss, who sported Peruvian sweaters and caps; and Team PAG, whose student team lead, Zarrah Birdie, donned a panda hoodie in honor of her team’s experience working in China. 

“All of the students were excited not only to share their adventures and the consulting work they did with their clients around the world, but also to see the huge variety of other projects and cultures that their classmates completed and experienced. Curiosity and enthusiasm were extremely high, and the noise level even higher.” Mark Coopersmith, IBD Faculty Mentor.

The energy was high for everyone at the Conference, including Haas’s CFO, Suresh Bhat, who came by the poster session to engage with IBD students and spend time learning about their projects.

“Attending the IBD conference is always a fabulous experience and seeing the enthusiasm from both FTMBA and EWMBA students as they present their findings, brings their project to life.  The students favorably commented on the experiential learning process. In addition, having to face and overcome language and cultural barriers is a mirror of what many of them will have to face as they take on new career opportunities post their MBA.” Suresh Bhat.

shot-of-the-group-in-the-great-hall

Following the poster session, students and guests were treated to a lunch program that consisted of a panel presentation of IBD student team leads, overall comments from Berkeley-Haas Dean Rich Lyons, TED Talk style presentations by six IBD teams, and an acceptance speech from the 2016 IBD Alumnus of the Year, Rajiv Ball.

Rajiv, a Partner at THNK, Berkeley-Haas lecturer and host of the Design Thinking Course held recently in Amsterdam over spring break, worked previously with IBD as a project sponsor.  In his acceptance video he talked about the amazing experience that IBD provides for students:  “The notion of broadening your international horizons… and the ability to really step outside the US, and explore how business gets done there, that is a true gift that the program brings its participants.”

While there are many highlights from the IBD Conference, it was ultimately about hearing from the students their impressions of their projects and their reflections on the IBD experience.  New to the IBD Conference this year was a panel discussion with IBD student team leads.  IBD Executive Director Kristi Raube interviewed five student team leads and asked them to share their insights on serving in a team lead capacity. One student team lead, Vanessa Pau, said, “It is a rare opportunity to lead a team of peers, many of whom are much smarter than I am, and to actually work with them, learn from them and motivate them throughout times in the project.”  

In addition to the panel discussion, six IBD teams were chosen by a combination of student and faculty voting to present their projects to the Conference audience.  Videos of the lucky winners and presenting teams can be seen here.

Many IBD teams shared how their journeys changed once they were in country, including shifts in their perspectives, relationships, and overall project recommendations.  The student team lead for Team groupelephant.com, Theo Grzegorczk, said of his team’s time in South Africa, “It gave us a real reason to care, and we made this transition by actually getting involved with their company…we learned by really getting into their business.  We went through this process of understanding how they work…and by living the way they do business…we came to understand a little bit more of their company and that is the first step in the design thinking process.”

Team Samai’s Bruno Vargas said, “We had all kinds of backgrounds, not just nationally, but professional backgrounds…We were hands on, we were rolling (up) our sleeves, working hand in hand with them…We were actually giving them to tools to manage their business and in the end, we built strong relationships.”

IBD Faculty Mentor Whitney Hischier summed it up best when she shared the following comment: “The students were really energized and proud of their work and the relationships they built with their clients.  A few told me it was the best experience they had at Haas, and specifically the best team experience.  Exciting to see we are having such an impact!”

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Healthcare for India’s rural populations: Delivering medical services on motorcycle to the last-mile in the State of Bihar

The Bihar countryside

The Bihar countryside

Team WHP is in India working with WORLD HEALTH PARTNERS  to evaluate the sustainability of motorcycle courier-based pharmaceutical delivery and medical sample pick up for patients that lack access to centralized and sophisticated healthcare.

India: a land of contrast.  In New Delhi, where our team has spent the first week, boasts some of the highest concentrations of wealth and power in India, but also an expansive population of poor and marginalized citizens.  Healthcare in India takes a similar tack, with top medical care available to those who can afford it, leaving the majority of the country with highly variable access to basic healthcare services.

We started our project in the New Delhi headquarters of WHP, one of the world’s most lauded and agile healthcare NGOs.  Backed by the Gates Foundation, WHP applies innovative market-based solutions to improve the quality of healthcare for India’s rural poor, including running Telemedicine centers and an developing an in-house generic brand of pharmaceuticals.   Specifically, we’ve arrived to investigate the operations of WHP’s Last-Mile-Outrider (LMO) Program, that delivers pharmaceuticals and provides sample pick up for distant patient care regions.

The team spent the first week in the office, trying to beat the record temperatures (114 degrees!), preparing for our immersion in the state of Bihar, one of the most underdeveloped and poor regions in India – in week 2, we dove right into ethnographic interviews, data collection, and the lives of Bihari’s.

Where the cool kids hang out

Where the cool kids hang out in Bihar

Bihar was a world apart from Delhi – the oppressive humidity (highlighted by pre-monsoon rains), the striking beauty of a far-inland tropical plain, the stark austerity of the average villager, and the random fact that the best lychee fruits in all of India come from Bihar, all created an experience unlike any other.  As we drove around Bihar to conduct our research, we saw firsthand the potential difficulties in delivering basic healthcare services (or any services) to some of the most remote regions in the country – how might we optimize and improve WHP’s current delivery and courier operations?  Our minds were racing.

How can we teach someone anything about optimization when they take it to the next level? #nextlevelbatchprocess

How can we teach someone anything about optimization when they take it to the next level? Eat your heart out Terry Taylor
#nextlevelbatchprocess

Within the first day, we saw the varied and complex landscape of healthcare services, to include the surprising proliferation of village scale pharmacies, a wide-ranging offering of medical “professionals,” and the significant opportunities for innovative solutions to make an impact in the effectiveness of LMO motorcycle couriers.

TOP & BOTTOM: The team bears the Bihar heat & humidity (barely)

TOP & BOTTOM: The team bears the Bihar heat & humidity (barely)

TOP: Getting into the details BOTTOM: Last-Mile Healthcare is a family affair: Father and son help a patient connect to a remote Doctor on ReMeDi Telemedicine software

TOP: Getting into the details
BOTTOM: Last-Mile Healthcare is a family affair: Father and son help a patient connect to a remote Doctor on ReMeDi Telemedicine software

As the week progressed, we began to discover the challenges in implementing a self-sustaining motorcycle delivery operation.  The endeavor faced obstacles such as a lack of economies of scale, inefficient order quantities (of drugs to pharmacies and doctors), and typical personnel issues that plague projects in the developing world.  Despite the daunting issues, team WHP gathered a host of data and reluctantly returned to Delhi, where we found the 110 degree temperatures to be “a dry heat” and the lack of cows, trash, dogs, and gangs of curious villager to reflect an absence of charm.

Bringing our 1st world problems to Bihar: "We'd like to pick our own fresh Lychee"

Bringing our 1st world problems to Bihar: “We’d like to pick our own fresh Lychee”

Bihar-19

Nikita & Jon fit in with the locals

JL-3

Everywhere we went, crowds of curious onlookers surrounded us. We were the “Bieber” to their “Fever”

Now back in the Delhi office, proudly wearing the badge of having experienced the “real India,” and armed with battle-hardened digestive systems, we began the task of analyzing and generating a cohesive recommendation for WHP in order to take decisive action on their LMO program.  Stay tuned.

Bihar-61

The villagers promptly recommended: “Leave the jumping to Jeremy Lin and stick to your MBA.”
Either career path seems dubious at this point

Inspired by a Mere 36 Hours in West Bengal

Team Seva is in Chaitanyapur, India working with VMANNN / Seva Foundation on a project to understand VMANN’s mentorship process, mentee relationships, and attributable outcomes through first-hand accounts, observations, and data collection.

In our IBD team’s first 36 hours in India, we explored Kolkata, experienced a rollercoaster ride to the small village of Chaitanyapur, feasted as newly welcomed guests, and witnessed the inspiring work that the team at VMANNN does on a daily basis, including giving sight to thousands of patients each year.  Here is our account of the crazy start to our three weeks in India.

Taxi Line at the Kokata Airport, A Late Night Cab Ride through Kolkata

Sunday 10:00am

Bengali woman against Kolkata traffic

 Despite arriving in Kolkata after more than 24 hours of traveling, we wake up early on Sunday morning with enough time to enjoy a thorough breakfast buffet and recount our travel mishaps.  We leave our hotel to do some sightseeing in the morning before meeting up with our host (Dr. Asim) and his family to travel to VMANNN where we will stay and work for the next three weeks.

From our very short and limited excursion, Kolkata exceeds our expectations, both for better and for worse.

Victoria Memorial from the Street, Seeking Shade in the Halls of the Indian Museum, Roaming the Streets of Kolkata

Victoria Memorial from the Street, Seeking Shade in the Halls of the Indian Museum, Roaming the Streets of Kolkata

 The tree lined streets, monuments and museums, and British architecture are shadows of the city’s past colonial life.  Under the hot sun and ample humidity, we walked past and through the Victoria Memorial, Indian Museum, St. Paul’s Church, General Post Office, High Court, and St. John’s Church.

Street scenes in Kolkata

However, what strikes us most about the city is the harsh daily reality facing much of population of Kolkata. Driving and walking through the city, we witness hundreds of people living in the streets – from sleeping on the pavement or atop makeshift counters serving as a surface, to bathing using the mains water pipes to cooking their meals by the side of the road. We see hundreds of street side hawkers working to earn a living to sustain themselves on.  In contrast to the grand buildings we see, this shows us how much the city struggled with the rapid population growth and political strife.

Lively Energy on the Street of Kolkata

Yet, there is an energy and liveliness stirring about in the streets wherever we go.  A game of cricket.  Animated conversations and quick smiles. A hand of cards. Brightly colored fabrics, jewelry, and buildings.

Sunday 1:00pm

Dr. Asim’s son

We quickly freshen up in our hotel rooms and pack our bags in time to meet Dr. Asim and his family.   Dr. Asim is the surgeon and medical director of VMANNN. Trained by Dr. Govindappa Venkataswamy (aka Dr. V), the well-known and respected founder of Aravind, Dr. Asim has become a highly skilled and sought after eye care surgeon.  He runs VMANNN while also training other eye care institutions in capacity building, operational efficiency and surgical excellence.  We are very excited to finally be heading to the eye hospital that we had learned so much about!

Sunday 2:00pm

Road Traffic on the Way to Chaitanyapur

Driving in India is crazy.  The road along the way is dotted with huts, shacks, and unfinished construction.  Unlike many roads in other countries, there are not a lot of empty stretches of road or land.  The honking, hectic driving, and lack of rules aren’t confined to the city either and follow us all the way to the village.  Ironically, all of the trucks have bumper stickers saying “Obey Traffic Rules,” “India is Great,”  and “Good Luck.” Good luck would have it that we make it safely to VMANNN. 

Sunday 5:00pm

Contrary to our initial thoughts that we would be in a secluded, quiet part of town, our cars abruptly turn into a gated area amongst clusters of road side stands and many, many bikes, walkers, and cars.

Welcome to VMANNN

 A personalized welcome sign greets us to our home on the school campus.  We quickly unload the car and sit down for our first tea in the dining area of the guesthouse, which we soon realize is much more than just tea.  After indulging in fruit and Indian sweets, we ride for twenty minutes to a nearby market to purchase shalwar kameez (traditional Indian clothing) for our upcoming workweek.

Sunday 7:00pm

Dinner is served in our guest house, starting with a plate of rice and two small sides.  We breath a sigh of relief, glad to know the rumors weren’t true of how much we will eat!

Then, another dish arrives. And another.  And another.  And fruit. Then, dessert!   So THIS is where the extra 5 kilos will come from!  Throughout the rest of the trip, we are constantly fed – breakfast, snack, lunch, snack, dinner.  Our bellies full, the incessant honking lulls us off to sleep, dreaming of what our day will entail.

Monday 6:30am

We wake up after our first night at VMANNN to chirping birds, honking cars and lively school children. The air is hot and humid and the town of Chaitanyapur is ready to start the day slightly earlier than we are!

Monday 8:00am

Mangos, mangos, mangos

Breakfast is served.  Our gracious hosts have prepared another Indian feast for us consisting of toast, boiled egg, vegetable curry, fresh mango, banana and tea.  We are fueled up and ready to spend our first day on site at VMANNN’s eye care institution.

 Monday 9:00am

Introduction to VMANNN

Our guide and the mentorship coordinator, Purnendu, picks us up from our guest house.  The house is located within VMANNN’s educational campus, a facility that provides schooling to hundreds of local children, including many which are visually impaired, as well as vocational training to visually impaired adults.  They are taught to make spices, cloths and incense, which are sold at the eye care institution just up the street, which is where we are taken for the day and where our project is based.

Monday 10:00am

Purnendu introduces us to the hospital administrators who each play an instrumental role in maintaining day-to-day operations.

Explaining the Patient Journey at VMANNN, Witnessing the Patient Experience

We are guided through the extensive hospital landscape and walked through the patient journey map from arrival and registration to surgery and recovery.

A Patient Eagerly Waits at Registration, A Peek into the Registration Room at VMANNN

VMANNN services hundreds of patients every day whose sight has been severely compromised because of accidents, cataracts and other pressing health issues.

The need is vast. The staff at VMANNN work diligently, with care and compassion, to ensure each patient is effectively taken care of.

Post-op Patient at VMANNN in the General In-Patient Ward 

The hospital’s model is based on a sliding pay scale with the patients in greatest need receiving surgery free of charge; those with greater financial means pay a premium above the regular fee level. 

Monday 11:00am

Entering the Operation Theatre

The most exciting and unnerving part of the day took place in the Operation Theatre (OT).

Dr. Asim Performs Cataract Surgery

This is where the magic happens.

VMANNN Doctor Performs Surgery as Another Patient is Prepped

The surgical operation process is set up such that patients are escorted in, worked on, and escorted out in an efficient, almost assembly-like fashion with their total process time taking no more than 15-20 minutes.  Dr. Asim finishes the surgery on one patient, then turns to his immediate left to begin surgery on the next waiting patient.

IBD Team Scrubbing In for Surgery

We were fortunate enough to join Dr. Asim in the OT and watch as he meticulously performed numerous surgeries in succession.

Getting the Doctor’s View of the Cataract Surgery 

Although some of us felt queasy at the sight, our amazement kept us engaged as we watched the surgeries take place one after another.

Wood Piece Removed from Patient, Wood Piece Presented to Patient After Surgery

The most fascinating (and grueling) surgery came at the end. A man came in with a lodged object in his eye that had been there for a full month after he had an accident. Although he had visited several hospitals, no one had success in retrieving the item from his eye. However, his 200km trip to VMANNN was not in vain. After just a few attempts, Dr. Asim removed the object – a 5cm, thick piece of wood!

Success…and the day is just getting started.

We look forward to an exciting few weeks as we capture VMANNN’s eye care practices through observations, interviews and data collection. We will also travel to 2 hospitals that VMANNN formally mentors – one across the Ganges River and the other an 8 hour train ride away in the neighboring state of Orissa. Ultimately, we will compile a case study, document KPIs and recommend best practices for VMANNN’s mentorship process, which will also be used to inform other mentors in the Global Sight Initiative, a network led by our sponsoring client the Seva Foundation.

Considering our first 36 hours, we know it’s going to be quite an eye-opening experience! (Pun intended).