IBD Team Works with La Clinica Oftalmologica Divino Nino Jesus, a Non-Profit Eye Clinic

Written by Mark Angel, Robert Gutierrez, Megha Kansra, Tyler Saltiel and Sarah Evans

As soon as we landed, the humidity knocked us out. Walking off the airplane, we immediately felt our clothes stick to our bodies and walked through the still, thick air toward the open-air baggage claim. We had heard the Amazon was humid, but we were not expecting its immediacy. Despite the unprecedented heat and humidity, we couldn’t contain our excitement to begin the in-country portion of our project.

Our team is working with La Clinica Oftalmologica Divino Nino Jesus (DNJ), a non-profit eye clinic based in Lima, Peru, dedicated to eradicating curable blindness. We had just landed in Iquitos, the largest city in the world not connected by a road and the “gateway to the Amazon,” where DNJ had recently expanded. We were to spend the next three weeks working with DNJ’s team to provide strategic marketing recommendations: one week in Iquitos and two in Lima.

Alberto, the executive director of the clinic and our main client, picked us up the next morning in DNJ’s van to drive us to its clinic, 40 minutes outside of central Iquitos. After a brief pit stop to push the van out of wet sand, we arrived at the clinic.

We spent the morning with Diego, the Outreach Coordinator in Iquitos, touring the clinic and learning more about the operations of the Iquitos facility. We even got to see the inside of the operating room where DNJ ophthalmologists perform their life-changing surgeries.

Hot, sweaty, but extremely inspired by the facility, we returned to our hotel to prepare for a meeting with Alberto held in our conference room for the week – the outdoor hotel restaurant and bar. After a productive meeting with Alberto discussing the financial performance of DNJ, we returned to the clinic the next day. Diego and Alberto were eager to have us interview patients and family members accompanying them on their visits. We stationed ourselves in an unused triage room in the clinic, and two by two, patients and their companions sat down to chat with us (en español) about their experiences with the clinic. We were immediately struck by patients’ gratitude and openness. One older woman excitedly told us about her beloved garden, and how grateful she was for the free cataract surgery that would enable her to tend to her garden once again. She and her daughter talked about the excellent service they had received, noted some areas for improvement at the clinic, and finally – to our surprise – gave us an invitation to their home. Another older gentleman, stylishly dressed with a Canon camera slung around his neck, waxed poetic about how eager he was to photograph the people and traditions of the beautiful Loreto region again.

As we spent more days in Iquitos interviewing patients, we continued to hear similar stories. Patients described DNJ as a “gift” and “blessing,” praising the personal attention of the staff. In Iquitos, a city accustomed to seeing NGOs shuttle in and out on a temporary basis, DNJ’s gleaming new Iquitos facility and world class staff, seemingly here to stay and providing services for free, prompted awe and surprise. By the end of the week, we were all deeply moved by the immense difference DNJ was making, and we felt doubly determined to provide impactful recommendations.

After a final day in Iquitos – spent boating down the Amazon (the world’s widest river) and feeding piranhas, alligators, and adorable baby monkeys – we headed back to Lima. In Lima, we extensively interviewed DNJ staff members, collecting their stories, recommendations, and perspectives on patient experience and marketing. A highlight was getting the opportunity to scrub in and watch a live cataract surgery conducted by one of the top ophthalmologists in Latin America. The head nurse patiently explained each step of the process, from the medical checkups of patients just before surgery to the steady incisions and movements of the surgeon to the final, triumphant moment – a mere 10-20 minutes after the surgery began – when patients were helped up off their bed and walked out of the clinic. We were amazed that in under an hour, we had watched a man get back his sight…for free.

After a final push to crystallize our recommendations, we made a presentation to the DNJ board and senior management. We were touched that the board attentively and eagerly listened to our recommendations, and even brought us gifts – delicious alfajores! They were excited about the opportunities ahead and the path forward we charted for them.

Update from IBD Team Seva

Seva-HV Desai IBD Team – Clare Schroder, Laura Stewart, Lizzie Faust, Rene Castro, Santiago Marchiori.

Altruism. It is the defining characteristic of those we have met here in India working for the HV Desai Eye Hospital (HVD). Two months ago the Seva-HVD Haas IBD team came together in pursuit of financial sustainability for the non-profit eye hospital. HVD aims to prevent needless blindness regardless of one’s ability to pay, and they do so through subsidizing those unable to pay with the profits from those able to pay, as well as donations. In India, this model is not unique to HVD, yet it is far less common in our own countries of Argentina, Chile, and the U.S. HVD’s tireless dedication to this work is evident in the significant time they have spent supporting our work here in India. Their goodness comes through in their hospitality, ensuring our own comfort and enjoyment of the city. A hospital board member even welcomed us to his chocolate factory on Sunday, where we indulged in chocolate, organic foods, ice cream, a hike, a temple visit, and a local village wedding.

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The groom, a family member, and the bride

At the wedding, we quickly came to realize this was the marriage between poorer members of society, the people HVD seeks to help. And while we were unprepared for the wedding and had nothing to offer, the bride’s family gifted each of us with a coconut.

Overwhelming altruism isn’t the only new experience we’ve had in India. We’ve tried unfamiliar foods (our stomachs regretting only a small percentage), learned burping in public is socially acceptable, and seen eyeballs in the eye bank.

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Col. Deshpande showing us a cornea in the eye bank

We have also experienced the famous (or infamous?) Indian head shake/nod/wiggle. We had heard from our pre-departure cultural interviews that the quirky motion indicates agreement, meaning yes or please continue, so during our day of arrival presentation we felt prepared when the head shakes began.

We quickly took a nose-dive though, as the head shake changed to an inexplicably clear “no” head motion. How did we get the number of people blind in India wrong? Was our average cost of surgery that off? As each of us presented, we panicked in the same way, over explaining the more vigorously they shook their heads “no.” Our cultural interviews hadn’t prepared us for this – thanks Arun.

We progressed into our first week still uncertain about the head shaking, but happy to be in country, seeing the hospital we had heard so much about. We worked alongside doctors to brainstorm patient experience improvements, visited competing hospitals, and conducted over 20 patient interviews.

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 Laura, Clare, and Santi doing some PFPS-style brainstorming with 7 residents

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Santi interviewing a patient

During those interviews, we began with, “How was your experience at HV Desai?” Head shake.

“Your experience has been ‘yes’? Could you elaborate on that?” It was after this interview, a few days in, that we mustered the courage to ask why people so often vehemently disagreed with us with their head shake while affirming yes verbally. We learned any head motion is a sign of agreement and we felt much better about our first week.

The patients have confirmed that HV Desai has incredible eyecare quality, value for money, the most advanced technology, and the most experienced doctors. We rarely heard about their altruism or their charity playing an important role in the eyecare provider selection process for the paying patients, the patients we need to attract more of to achieve financial sustainability. This finding is one we’ve seen not only in patient interviews, but also through industry research. Moreover, patient surveys and Hospital Management Information System (HMIS) data analysis have revealed the importance of amenities and eye lens differences. Again, not charity.

Here we are, five business students in India telling a nonprofit hospital to change their branding for the paying segment from a focus on charity to a focus on quality and affordability.

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Santi, Lizzie, Clare, Rene, and Laura being tourists, led by Outreach Coordinator Pravine

Unlike the staff and management, the altruism is not our target segment’s main motivator for eyecare. Our job now is to convince leadership that in addition to a shift in branding, building upon and reinforcing the most important needs of the paying patient – specific amenities, price transparency, shorter wait times, eyecare excellence – will create financial sustainability. Growing profits is not just for corporations, but also for a nonprofit hospital that can now provide even more free surgeries to those unable to pay.

 

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).