Better Health for All

hello everybody

and i thank the organizers of this

platform tedx charongi for giving me an

opportunity to be with you

we are talking about situations and

uh possibility which can then turn into

a reality

and that has been the story of my life

as a medical student i realized that the

possibilities that my medical education

allows me

to actually deliver to the people who

need and can benefit from that knowledge

are in reality stopped by various other

factors which are not related to the

possibilities of the knowledge that i

have

primarily the economic constraints

so it got me thinking

and in my studies

as a medical student i started to build

bridges with other doctors and members

of the medical fraternity

who are applying their mind to these

challenges

and had been doing it before me

the interesting part was that

they had already established a great

degree of reconciliation as to how

to identify possibilities in medic

medicine

and how to actually convert it into a

plausible reality and the main challenge

is that

as medical science advances as medical

education

and research progresses there are

numerous

new beneficial ways of actually

treating patients and achieving

positive medical outcomes but there’s a

cost to it

and the poorest of the poor globally

especially in india and in my state west

bengal

many cannot afford the advantages of

that knowledge

so to look back at the entire history of

how medicine has evolved and

go into that library of knowledge and

actually pull out

those books and those possibilities in

the past

which have relatively good outcomes

but at the same time which

are cost effective and actually

fits into the budgetary reality of our

patients

and ends up giving a real possible

solution

and it is these thoughts that stimulated

me

and a group of friends to start off

our organization

which started off with a possibility

and converted into a reality

we started thinking how do we

impact the lives of people who need help

on a regular basis and in a

concrete fashion we zeroed in

on how to provide low-cost

dialysis to patients who suffer from

end-stage renal failure

the sad part of the reality

of a chronically affected

kidney patient is that he knows

his family knows his doctor knows

everybody knows that if he gets adequate

dialysis

regularly he will most probably

live his life as any other person

he will have the same quality of life

and he will have the same

period of life expectancy

if he doesn’t have any co-morbidities

the reality is that if he can’t afford

it

he can neither achieve the quality of

life nor

the life expectancy that a good

dialyzed patient can achieve and there

lies the challenge

because dialysis is costly those who can

afford it

they get both quality of life and a good

life expectancy

but we were focusing on those people who

can’t even treat their

relatives and their patients at

government hospitals

because even in the government hospitals

their ancillary costs

and that got us thinking about to set up

our organization so our core principle

was

to set up an organization that provides

low-cost dialysis in a sustainable

fashion

so that it is not just a one-off issue

a short-term period but an organization

that will be with the patient for a long

time

when we started off in 2004

myself and my school friends basically

and some people who were common friends

we decided that we have to do this

we didn’t have a building we didn’t have

any sort of place we didn’t have any

funds but we just had the idea the

possibility of that idea

and the reality of health care in

my country and in this bingo

and putting that possibility and that

reality together

we started off with uh

on a journey ahead

we initially targeted

two other projects and two other ideas

the first being avoidable blindness

and the second being trying to get a

blood donor

connected to the emerging mobile

technology

with the patient who requires blood in

the vicinity

of the patient and the hospital that the

patient is in

it was a triangulation method we created

a software

and we received the first social

innovation award

given by nashville for our

digital and mobile based app

and connectivity uh between

a potential donor who had registered

himself into the system

with a person who requires blood

within the vicinity of the hospital

rather than giving off

blasts of messages to everybody so

geographically

what you call effective messaging

was what our uh what we call software

was targeting to do the second project

that we took up

while we were slowly building the

capacities

of establishing a sustainable

unit called dialysis was the avoidable

blindness project

the avoidable blindness project was

to talk with those patients as the word

itself

birds themselves explained who should

not be blind because it’s absolutely

avoidable

and we started working and getting those

people treated and we took up a unique

project

where our optometrist used to visit

the poorer and the needy at that

doorstep

identify their disease process

and offer them a solution including

surgery free of cost

and there are four wards in kolkata that

we actually got

cataract control because our sustained

project worked for almost six years and

outside calcutta we had worked with a

number of

people especially from banjwan from the

sundarbans

and not 24 paraganas

while we were doing these active

projects we kept on building our

capacity for

setting up the general dialysis unit we

built up our

our structure our building

and we started our dialysis unit in 2009

and we worked with a very very practical

business model that is the unit has to

be a paid-in model

either the patient pays into the system

or somebody

on behalf of the patient pays into the

system but the

unit will run at cost and it will have

to be

paid in by somebody or the other

the principles that we identified

were very simple we would actually

cut hospital from hospitality

we removed hospitality from the hospital

and we call our unit a no-frills unit

because we do not have the frills of a

hospital which adds on the hospitality

question

thereby saving huge costs to the patient

we realize in our experience that saving

10 rupees for dialysis for our patients

at the end of the day ensures the number

of 10 rupees that he saves

allows him to live for that many extra

days

and that is central to what we

are focused on in our dialysis unit

the no frills cutting the hospitality

out of hospital

was one of the principles that we

started off with

when we were discussing to set up the

possibilities

of of a low-cost dialysis unit and what

we could emphasize as our reality

we in india there was a huge debate

between whether dialysis unit would be

only part of

huge multi-speciality hospitals because

dialysis patients many a time

require that additional support but

the number of kidney patients that we

have in india

the entire nephrology fraternity

all the nephrologists in india concluded

by the end of the first decade of the

century

that to set up a dialysis unit if you

have to have a 500 bedded hospital to

support that dialysis unit

then the number of patients that we have

in india

would never get dialysis and hence

we need to set up numerous standalone

dialysis units

which will not be attached to a hospital

but will give

dialysis and the cost benefit ratio in

medical terms

will have to be accepted because

dialysis gives

more benefit vis-a-vis a crisis

when a dialysis is being conducted

and when this was concluded we were

happy to set up among

the first standalone dialysis units in

india

way back in 2009 and

we started providing dialysis to the

needy and that journey itself

is a story that needs to be

understood because when we started off

we started off at 500 rupees

for dialysis and from there

as we expanded ourselves we got

advantages of the

cost of scale and the economy of scale

coming into play

we reduced it from 500 to 450

subsequently to 400 rupees per dialysis

and then we moved on

to 350 rupees for dialysis and

during this entire process

uh we understood that

our patients face immense problems

while taking dialysis not only in terms

of costs

not only in terms of actually suffering

the entire disease process especially

those patients who have comorbidities

but also within their family

and a dialysis patients as a patient as

we say

is not only an individual but it’s an

entire family

so we started off a program called

choice

in kolkata which is a program

where we allow the relatives of our

patients

to come in and enjoy a full

day of uh what we call different games

different talks and and we give them a

number of goodies especially the

children who come in

so that we create a psychological

environment

within the family that if you did not

have a dialysis patient

then this day of enjoyment would not be

yours to participate in

so in the entire what you call

patient fraternity that we have they

they have developed

especially along with their families and

their families and the young children

and everybody keep asking them

when is the next program going to be

organized

and we have this on an annual basis and

this is what we do for a patient

as we move ahead into

the future uh we were planning to

ensure that we increase capacity

and as we were increasing capacity

starting off from two machines

we reached eight machines

we were confronted with kobit

and the day the lockdown was announced

there were serious challenges that our

patients based in terms of getting to

our unit

because the lockdown actually

stopped all forms of public transport

there were no trains no buses no

taxis available and hence the patients

to reach our unit had to spend a huge

amount of money

to book private vehicles to come and go

back

from the unit and that was communicated

to us

on the 25th that is the first day of the

lockdown

and that very evening we took a decision

to reduce the cost of our dialysis

to 50 rupees the 300 rupees being

given as relief to cover

transport costs for the patients to come

and

go from the unit and we’ve continued

that

and we’ve announced that until the end

of september

we will be continue to give that relief

so in this entire what you call

journey of how we thought that

this is possible and

how those possibilities were explored

and how we reach the reality

of setting up our youth thank you for

being with us

and have a nice day be safe

wear your mask wash your hands and

hopefully

corona will not touch you

you