Thulasiraj Ravilla: How low-cost eye care can be world-class

Thulasiraj Ravilla: Dunya standardlarinda goz bakimi nasil dusuk maliyetle gerceklestirilir

Çeviri: Mustafa Ozkaynak Gözden geçirme: osman oguz ahsen

Good morning.

Iyi gunler

I've come here to share with you an experiment

Buraya sizinle bir deneyi paylasmaya geldim

of how to get rid of one form of human suffering.

Bir izdirabin nasil ortadan kaldirildigi

It really is a story of Dr. Venkataswamy.

Bu aslinda Dr. Venkataswamy'in hikayesi

His mission and his message is about the Aravind Eye Care System.

Onun misyonu ve mesaji Aravind Goz Saglik Sistemi ile ilgili

I think first it's important for us to recognize what it is to be blind.

Sanirim once kor olmanin ne demek oldugunu anlamamiz onemli

(Music)

♫Muzik caliyor♫

Woman: Everywhere I went looking for work, they said no,

Kadin: Ise basvurdugum her yerden olumsuz yanit aldim

what use do we have for a blind woman?

Kor bir kadin bizim isimizi gormez

I couldn't thread a needle or see the lice in my hair.

igneye ipligi geciremiyordum veya sacimdaki biti goremiyordum

If an ant fell into my rice, I couldn't see that either.

Eger pilavimin icine bir karinca dusse, goremezdim.

Thulasiraj Ravilla: Becoming blind is a big part of it,

Thulasiraj Ravilla: Kor olmak burada onemli

but I think it also deprives the person of their livelihood, their dignity,

fakat korluk insanlari bir gecimden yoksun birakiyor onurunu zedeliyor,

their independence, and their status in the family.

baskalarina bagimli hale getiriyor, aile icindeki statusunu etkiliyor

So she is just one amongst the millions who are blind.

O dunyadaki milyonlarca kor insandan biri

And the irony is that they don't need to be.

Isin aci taraflari onlar kor olmak zorunda degiller

A simple, well-proven surgery can restore sight to millions,

Basit kanitlanmis ameliyatlar milyonlarca insanlarin tekrar gormesini saglayabilir

and something even simpler, a pair of glasses, can make millions more see.

ve daha basit birsey bir gozluk, milyonlarca daha insanin gormesini saglayabilir

If we add to that the many of us here now

Eger, su an buradaki bircogumuzu

who are more productive because they have a pair of glasses,

yani gozlukleri oldugu icin daha uretken olanlarina hesaba katarsak

then almost one in five Indians will require eye care,

Neredeyse bes Hintliden birinin goz tedavisine ihtiyaci var

a staggering 200 million people.

sasirtici sekilde 200 milyon insan

Today, we're reaching not even 10 percent of them.

Bugun, biz bunlarin anca yuzde 10'una ulasabiliyoruz

So this is the context in which Aravind came into existence

Iste bu baglamda Aravind ortaya cikti

about 30 years back

Yaklasik 30 yil once

as a post-retirement project of Dr. V.

Dr. V'nin bir emeklilik projesi olarak

He started this with no money.

Bu ise hic parasiz basladi

He had to mortgage all his life savings

Butun hayati boyunca biriktirdigi paraya ipotek koydurmak zorunda kaldi

to make a bank loan.

bankadan borc para almak icin

And over time, we have grown into a network of five hospitals,

Ve zamanla, buyuduk ve 5 hastane olduk

predominately in the state of Tamil Nadu and Puducherry,

Agirlikli olarak Tamil Nadu and Puducherry eyaletlerinde

and then we added several, what we call Vision Centers

sonra baskalari da eklendi ve "Vision Centers" dedigimiz

as a hub-and-spoke model.

merkez-koordinasyon modeli ortaya cikti.

And then more recently we started managing hospitals

Ve yakin zamanda hastaneleri yonetmeye basladik

in other parts of the country

Ulkenin diger bolgelerinde

and also setting up hospitals in other parts of the world as well.

ve dunyanin diger bolgelerinde de hastaneler kurduk

The last three decades,

Son 30 yilda

we have done about three-and-a-half million surgeries,

Uc bucuk milyon ameliyat yaptik

a vast majority of them for the poor people.

Bunlarin buyuk cogunlugu fakir insanlardi

Now, each year we perform about 300,000 surgeries.

Simdi yilda 300.000 ameliyat gerceklestiriyoruz

A typical day at Aravind, we would do about a thousand surgeries,

Ortalama bir gunde Aravind'de 1000 ameliyat yapiyoruz

maybe see about 6,000 patients,

yaklasik 6.000 hastayi da muayene ediyoruz

send out teams into the villages to examine, bring back patients,

Hastalari muayene edip, onlari getirmeleri icin koylere gorevlileri gonderiyouz

lots of telemedicine consultations,

bir cok tele-tip konsultasyonu yapiyoruz

and, on top of that, do a lot of training,

Butun bunlarin uzerine bir cok egitim veriyoruz

both for doctors and technicians who will become the future staff of Aravind.

Ileride Aravind calisani olacak doktorlar ve teknisyenler icin

And then doing this day-in and day-out, and doing it well,

ve bunu hergun basariyla yapiyoruz

requires a lot of inspiration and a lot of hard work.

Bol bol ilham ve cok calisma gerekiyor

And I think this was possible thanks to the building blocks

ve sanirim bu mumkun. Dr. V.nin yerlestirdigi temel taslar

put in place by Dr. V.,

sayesinde

a value system, an efficient delivery process,

bir degerler systemi, etkili bir surec yonetimi

and fostering the culture of innovation.

ve bir yenilikcilik kulturu

(Music)

♫(Muzik)♫

Dr. V: I used to sit with the ordinary village man because I am from a village,

Dr. V: Ben bildiginiz bir koyluyle oturuyordum cunku ben de koyluyum

and suddenly you turn around and seem to be in contact with his inner being,

ve birden birseyler olur ve kendi ic sesini duymaya baslarsin

you seem to be one with him.

O sesi dinlersin

Here is a soul which has got all the simplicity of confidence.

Itimatin basitligini iceren bir ruh bu

Doctor, whatever you say, I accept it.

Doktor, sen ne dersen, kabul ediyorum

An implicit faith in you

Kapali bir inanc bu

and then you respond to it.

ve buna cevap veriyorsun

Here is an old lady who has got so much faith in me, I must do my best for her.

Iste bana inanan bir yasli hanim, onun icin elimden geleni yapmaliyim

When we grow in spiritual consciousness,

Ruhani bir farkindalik icinde yetisirsek,

we identify ourselves with all that is in the world,

biz kendimizi bu dunyadaki herseyle tanimlariz,

so there is no exploitation.

boylece somuru olmaz

It is ourselves we are helping.

Biz aslinda kendimize yardim ediyoruz

It is ourselves we are healing.

Biz aslinda kendimizi iyilestiriyoruz

(Applause)

(Alkislar)

This helped us build a very ethical and very highly patient-centric organization

Bu bize etik ve hasta merkezli bir kurum kurmamizi sagladi

and systems that support it.

bunu destekleyecek sistemler kurmamizi da

But on a practical level, you also have to deliver services efficiently,

Fakat uygulama seviyesinde, hizmetleri etkili bir sekilde vermelisiniz

and, odd as it may seem, the inspiration came from McDonald's.

ve, garip gozukse de, bize McDonald's ilham verdi

Dr. V: See, McDonald's' concept is simple.

Dr. V: Bakin, McDonald's kavrami cok basit

They feel they can train people all over the world,

Dunyadaki herkezi egitebileceklerine inaniyorlar

irrespective of different religions, cultures, all those things,

din, kultur gibi faktorler gozetmeksizin

to produce a product in the same way

bir urunu ayni sekilde uretip

and deliver it in the same manner

ayni sekilde teslim edebilmek icin

in hundreds of places.

yuzlerce yerde

Larry Brilliant: He kept talking about McDonalds and hamburgers,

Larry Brilliant: Surekli McDonalds ve hamburgerler hakkinda konustu,

and none of it made any sense to us.

ama dedikleri bize alakasiz geldi

He wanted to create a franchise,

bir franchise yaratmak istedi

a mechanism of delivery of eye care

bir goz tedavisi saglama mekanizmasi

with the efficiency of McDonald's.

McDonald's etkililiginde

Dr. V: Supposing I'm able to produce eye care,

Dr. V: Farzedelim, ben goz tedavisi yapabilirim

techniques, methods, all in the same way,

teknikler ve yontemler hep ayni sekilde

and make it available in every corner of the world.

ve bunu dunyanin her kosesinde bulunabilir hala getirmek

The problem of blindness is gone.

Korluk problemi cozulur

TR: If you think about it, I think the eyeball is the same,

TR: Eger dusunurseniz, goz kuresi ayni

as American or African,

Amerikali ya da Afrikali

the problem is the same, the treatment is the same.

Problem ayni, tedavi ayni

And yet, why should there be so much variation in quality and in service,

Oyleyse, neden servis kalitesinde bu kadar farklilik var

and that was the fundamental principle that we followed

bu takip ettigimiz temel prensibimizdi

when we designed the delivery systems.

tedarik sistemlerini tasarladigimizda

And, of course, the challenge was that it's a huge problem,

ve, tabi ki, buradaki zorluk karsimizdaki devesa problem,

we are talking of millions of people,

Milyonlarca insandan bahsediyoruz,

very little resource to deal with it,

cok az kaynak kullanarak

and then lots of logistics and affordability issues.

ve bircok lojistik ve yeterlilik problemleri.

And then so, one had to constantly innovate.

Ve daha sonra, Surekli yenilikcilik yapilmaliydi.

And one of the early innovations, which still continues,

ve, ilk yeniliklerden biri, ki hala devam ediyor

is to create ownership in the community to the problem,

cemiyetin problemi sahiplenmesini saglamak,

and then engage with them as a partner,

ve onlari bir ortak olarak isin icine katmak

and here is one such event.

ve iste bir ornek olay

Here a community camp just organized

iste yeni kurulmus bir cemiyet kampi

by the community themselves,

cemiyet uyeleri tarafindan kuruldu

where they find a place, organize volunteers,

burada yer edindiler, gonullu aktiviteler organize ediyorlar

and then we'll do our part. You know, check their vision,

ve sonra bizde kendi uzerimize duseni yapiyoruz, goz kontrolu yapiyoruz

and then you have doctors who you find out what the problem is

ve sonra problemi tespit edecek doktorlariniz var

and then determine what further testing should be done,

ve daha sonra hangi testlerin yapilmasi gerektigini belirliyorlar

and then those tests are done by technicians

ve sonra bu testler teknisyenler tarafindan yapiliyor

who check for glasses,

gozlukleri kontrol ediyorlar

or check for glaucoma.

veya glukom'u kontrol ediyorlar

And then, with all these results, the doctor makes a final diagnosis,

ve sonra, butun bu test sonuclarina gore doktor teshisi belirler

and then prescribes a line of treatment,

ve tedavi icin recete yazar

and if they need a pair of glasses, they are available right there at the camp site,

ve eger gozluge ihtiyaclari varsa, gozlukler hemen kampta tedarik ediliyor

usually under a tree.

genelde bir agacin altinda.

But they get glasses in the frames of their choice,

Fakat, istedikleri cerceveleri olan gozlugu alirlar

and that's very important because I think glasses,

ve bu cok onemli cunku, bence gozlukler

in addition to helping people see,

sadece insanlarin gormelerini saglamaz

is also a fashion statement, and they're willing to pay for it.

ayni zamanda modadir ve insanlar buna para odemeyi kabul ediyorlar

So they get it in about 20 minutes

Boylece 20 dakika icinde isleri gorulmeye baslar

and those who require surgery, are counseled,

ve ameliyata girecek olanlara talimatlari verilir

and then there are buses waiting,

ve onlari bekliyen otobusler

which will transport them to the base hospital.

onlari merkez hostanelere gotururler

And if it was not for this kind of logistics and support,

Ve eger bu cesit lojistik ve destek yapisi olmasaydi

many people like this would probably never get services,

bu insanlar gibi bircogu muhtemelen gerekli hizmetleri

and certainly not when they most need it.

ve kesinlikle en cok ihtiyac duyduklari zaman alamayacaklardi.

They receive surgery the following day,

Ertesi gun ameliyat oluyorlar,

and then they will stay for a day or two,

ve bir-iki gun kaldiktan sonra,

and then they are put back on the buses

tekrar otobuslere binip

to be taken back to where they came from,

geldikleri yere geri donuyorlar,

and where their families will be waiting to take them back home.

ve aileleri onlari evlerine goturuyor

(Applause)

(Alkislar)

And this happens several thousand times each year.

Ve bu her yil binlerce defa olur

It may sound impressive that we're seeing lots of patients,

Kulaga etkileyici geliyor, bircok hastaya bakiyoruz,

very efficient process,

cok etkili surecler,

but we looked at, are we solving the problem?

fakat bizim dikkat ettigimiz su: problemi cozuyor muyuz?

We did a study, a scientifically designed process,

Bilimsel olarak yapilmis bir calisma yaptik

and then, to our dismay,

ve kaygilanrici bir sekilde

we found this was only reaching seven percent of those in need,

ihtiyaci olan insanlarin sadece yuzde yedisine ulasabildigimizi gorduk,

and we're not adequately addressing more, bigger problems.

ve daha buyuk problemlere yeterli bir sekilde egilmiyorduk.

So we had to do something different,

Birseyleri farkli yapmamiz gerekiyordu

so we set up what we call primary eye care centers, vision centers.

ve birinci basamak goz merkezleri dedigimiz gorme merkezlerini kurduk

These are truly paperless offices

Bunlar tamamen kagitsiz ofisler

with completely electronic medical records and so on.

tamamen elektronik hasta kayitlari ve benzerleri

They receive comprehensive eye exams.

Kapsamli goz muayenesi yapiliyor

We kind of changed the simple digital camera into a retinal camera,

basit bir dijital kamerayi retinal kameraya donusturduk

and then every patient gets their teleconsultation with a doctor.

ve sonra her hasta doktoruyla uzaktan gorusme yapabilir

The effect of this has been that, within the first year,

bir sene icinde bunun etkisini gorduk

we really had a 40 percent penetration in the market that it served,

Ilgili pazarin yuzde kirkina girdik

which is over 50,000 people.

50.000'den fazla insan

And the second year went up to 75 percent.

ikinci yil yuzde 75'e ulastik.

So I think we have a process by which

Bence sureclerimiz

we can really penetrate into the market

ilgili pazara girmemizi

and reach everyone who needs it,

ve ihtiyaci ulan insanlara ulasmamizi sagliyor

and in this process of using technology, make sure

ve teknolojinin kullandigi bu surecte

that most don't need to come to the base hospital.

bircok kisinin merkez hastanalere gelmesi gerekmiyor.

And how much will they pay for this?

ve bunun icin ne kadar para oduyorlar?

We fixed the pricing, taking into account

Fiyatlari sabitledik, sehre gelmek icin

what they would save in bus fare in coming to a city,

odenecek otobus ucretini de dikkate alirsak,

so they pay about 20 rupees, and that's good for three consultations.

yaklasik 20 Rupi odenmesi gerekiyor, bu ucret 3 muayeneyi kapsiyor

(Applause)

(Alkislar)

The other challenge was, how do you give high-tech

Diger zorluk ise yuksek teknolojiyle

or more advanced treatment and care?

ileri tedavi ve bakim hizmeti nasil verirsiniz?

We designed a van with a VSAT,

Icinde VSAT cihazi ilan bir minibus tasarladik,

which sends out images of patients to the base hospital

merkez hastanelere goruntu gonderiyor

where it is diagnosed,

Hastanede teshis konuyor

and then as the patient is waiting, the report goes back to the patient,

ve sonra hasta beklerken, sonuc hastaya ulasiyor,

it gets printed out, the patient gets it,

yazici ciktisi hastaya verilir,

and then gets a consultation about what they should be doing --

ve ne yapmalari gerektigi tembih ediliyor

I mean, go see a doctor or come back after six months,

Demek istedigim, doktoru gormeye git, alti ay sonra tekrar gel

and then this happens as a way of

Bu teknolojik

bridging the technology competence.

yeterliligi kullanarak yapiyoruz

So the impact of all this has been essentially one of growing the market,

bunun bir etkisi esas olarak marketin buyumesi oluyor

because it focused on the non-customer,

cunku henuz musteri olmayanlara odaklaniyoruz

and then by reaching the unreached,

ulasilmayana ulasarak,

we're able to significantly grow the market.

pazari onemli olcude buyutebildik

The other aspect is how do you deal with this efficiently

Obur taraftan, etkililigi nasil saglarsiniz

when you have very few ophthalmologists?

sadece az sayida goz doktorunuz varsa?

So what is in this video is a surgeon operating,

bu videoda bir cerrah'in ameliyatini goruyorsunuz

and then you see on the other side,

diger tarafta ise

another patient is getting ready.

baska bir hasta hazirlaniyor

So, as they finish the surgery,

devam eden ameliyat biter bitmez

they just swing the microscope over,

sadece mikroskopu obur tarafa geciriyorlar

the tables are placed so that their distance is just right,

masalar dogru bir sekilde yerlestiriliyor,

and then we need to do this, because, by doing this kind of process,

ve bunu boyle yapmamiz gerekiyor, cunku boyle yaparak,

we're able to more than quadruple the productivity of the surgeon.

cerrahlarin uretkenliklerini dorde katliyoruz.

And then to support the surgeon,

ve cerrahi desteklemek icin,

we require a certain workforce.

belli bir is gucune ihtiyacimiz var.

And then we focused on village girls that we recruited,

ve koyde yasayan kizlari istihdam ettik,

and then they really are the backbone of the organization.

ve onlar gercekten kurumumuzun belkemigi

They do almost all of the skill-based routine tasks.

Onlar hamaratlik gerektiren butun rutin isleri yapiyorlar.

They do one thing at a time. They do it extremely well.

Ayni anda tek birsey yapiyorlar. Onu da cok iyi yapiyorlar.

With the result we have very high productivity,

Sonucta, cok yuksek uretkenlik gostedik

very high quality at very, very low cost.

yuksek kalite, dusuk maliyete.

So, putting all this together, what really happened was

Butun bunlari bir araya getirdigimizde, burada olan su

the productivity of our staff was

calisanlarimizin uretkenligi

significantly higher than anyone else.

baskalarindan bariz daha fazlaydi

(Applause)

(Alkislar)

This is a very busy table,

Bu tablo cok kalabalik,

but what this really is conveying is that,

fakat burada bahsedilen

when it comes to quality, we have put in

konu kalite oldugunda,

very good quality-assurance systems.

cok iyi kalite guvence sistemleri koyduk.

As a result, our complications are significantly lower

Sonucta, bizim komplikasyon oranlarimiz

than what has been reported in the United Kingdom,

Britanya'da bildirilenden bariz daha dusuk,

and you don't see those kind of numbers very often.

ve boyle rakamlari her zaman goremezsiniz.

(Applause)

(Alkislar)

So the final part of the puzzle is,

Boylece, bulmacanin son parcasi

how do you make all this work financially,

butun bu isi ekenomik olarak nasil yaparsiniz

especially when the people can't pay for it?

ozellikle, insanlar size para odeyemezken?

So what we did was, we gave away a lot of it for free,

Peki, ne yaptik, biz ucretsiz yaptik,

and then those who pay, I mean, they paid local market rates,

ve odeyebilenler, yani, yerli pazar tarifesi uzerinden

nothing more, and often much less.

daha fazla degil, cogu zaman daha az

And we were helped by the market inefficiency.

Ve pazarin etkisizliligi bize yardimci oldu.

I think that has been a big savior, even now.

Bence bu buyuk bir kurtarici idi, simdi bile.

And, of course, one needs the mindset to be wanting to give away

ve, tabiki, elinizdeki fazlaliligi vermeye donuk bir zihin

what you have as a surplus.

yapisina ihtiyac var

The result has been, over the years,

Sonucta, yillar boyunca,

the expenditure has increased with volumes.

masraflar yukluce artti.

The revenues increase at a higher level,

Gelirler daha fazla artti,

giving us a healthy margin

bize saglikli bir marj birakti

while you're treating a large number of people for free.

bir cok insana ucretsiz olarak tedavi ederken.

I think in absolute terms,

Mutlak anlamda

last year we earned about 20-odd million dollars,

gecen yil, 20 milyon dolardan fazla kazandik

spent about 13 million, with over a 40 percent EBITA.

yaklasik 13 milyon harcadik, EBITA yuzde 40.

(Applause)

(Alkislar)

But this really requires going beyond what we do,

Fakat bu bizim yaptiklarimizin otekisine gitmemizi gerektiriyor,

or what we have done,

veya simdiye kadar yaptiklarimizin

if you really want to achieve solving this problem of blindness.

Eger gercekten korluk sorununu cozme isini basarmak istiyorsaniz,

And what we did was a couple of very counter-intuitive things.

Ve bazi yaptigimiz seyler sezgilere (mantiga) tamamen uygun degil.

We created competition for ourselves,

Biz kendimize rekabet yarattik,

and then we made eye care affordable

ve sonra goz tedevisini karsilanabilir yaptik

by making low-cost consumables.

sarf maliyetlerini dusuk maliyetli hale getirerek

We proactively and systematically

Proaktif ve sistematik olarak

promoted these practices to many hospitals in India,

bu uygulamalari Hindistan'daki bir cok hastaneye getirdik,

many in our own backyards and then in other parts of the world as well.

cogu bizim yakinimizda ve bazilari dunyanin baska taraflarinda.

The impact of this has been that these hospitals,

Bunun bu hastanalere etkisi ise

in the second year after our consultation,

bizim konsultasyonumuzun ikinci yilinin sonunda

are double their output

verim ikiye katlandi

and then achieve financial recovery as well.

ve finansal iyilesme de var.

The other part was how do you address

Diger bir konu da bu basariyi

this increase in cost of technology?

teknolojinin maliyetine ragmen nasil saglarsiniz?

There was a time when we failed to negotiate

Bir zamanlar yaptigimiz gorusmelerde

the [intra-ocular lens] prices to be at affordable levels,

intraoküler fiyatlarini dusurmeyi basaramadik,

so we set up a manufacturing unit.

boylece uretim birimimizi kurduk.

And then, over time, we were able to bring down the cost significantly

ve sonra, zamanla, maliyetleri ciddi bir sekilde dusurebildik

to about two percent of what it used to be when we started out.

yaklasik ise basladigimizdeki maliyetlerin yuzde ikisine

Today, we believe we have about seven percent of the global market,

Bugun, kuresel pazarin yuzde yedisine sahip oldugumuza inaniyoruz,

and they're used in about 120-odd countries.

120'den fazla ulkede kullaniliyorlar.

To conclude, I mean, what we do, does it have a broader relevance,

Sonucta, bizim yaptigimizin daha kapsamli etkileri olabilir mi

or is it just India or developing countries?

yoksa sadece Hindistan ve gelismekte olan ulkeler mi?

So to address this, we studied UK versus Aravind.

bu soruyu yanitlamak icin Britanya ile Aravind'i karsilastirdik.

What it shows is that we do roughly about 60 percent

Bize gosterdi ki biz yaklasik olarak

of the volume of what the UK does,

Britanya'nin yaptiginin buyukluk olarak yuzde 60'ini yaptik,

near a half-million surgeries as a whole country.

ulke olarak yaklasik yarim milyon ameliyat yapiyorlar

And we do about 300,000.

biz yaklasik 300,000 ameliyat yapiyoruz.

And then we train about 50 ophthalmologists

ve biz yaklasik 50 goz doktoru egitiyoruz

against the 70 trained by them,

onlar yaklasik 70 goz doktoru egitiyorlar,

comparable quality, both in training and in patient care.

egitim ve goz bakiminda denk kalite

So we're really comparing apples to apples.

biz elmalarla elmalari kiyasliyoruz

We looked at cost.

Maaliyetlere baktik

(Laughter)

(Gulmeler)

(Applause)

(Alkislar)

So, I think it is simple to say

Bence soylemesi kolay olan

just because the U.K. isn't India the difference is happening.

Britanya, Ingiltere olmadigi icin bunlar oluyor demek

I think there is more to it.

Bence bunun otesi var

I mean, I think one has to look at other aspects as well.

Demek istedigim, diger boyutlara da bakmak lazim.

Maybe there is --

Belki de

the solution to the cost could be in productivity,

maliyet sorunun cozumu uretkenliktir,

maybe in efficiency, in the clinical process,

belki klinik sureclerde etkililik,

or in how much they pay for the lenses or consumables,

veya lensler ya da sarf malzemelerine neden odedikleridir

or regulations, their defensive practice.

veya yonetmelikler, savunucu uygulamalar.

So, I think decoding this can probably bring

Yani, bence bunu cozmek

answers to most developed countries

bircok gelismis ulkedeki yanitlari ortaya cikarir

including the U.S., and maybe

ABD de dahil, ve belki de

Obama's ratings can go up again.

Obama'nin reytingleri tekrar artabilir.

(Laughter)

(Gulmeler)

Another insight, which, again, I want to leave with you,

Diger mesaj size vermek istedigim,

in conditions where the problem is very large,

buyuk problerin bulundugu sartlarda

which cuts across all economic strata,

butun ekonomik tabakalari etkileyen

where we have a good solution,

iyi bir cozum var

I think the process I described,

Bence benim tarif ettigim surec,

you know, productivity, quality, patient-centered care,

bildiginiz, uretkenlik, kalite, hasta merkezli bakim,

can give an answer,

bize yanit olabilir

and there are many which fit this paradigm.

ve bu paradigmaya uyan bicok yanit var.

You take dentistry, hearing aid, maternity and so on.

discilik, isitme cihazlari, annelik ve bunlar gibi.

There are many where this paradigm can now play,

Bu paradigma bicok yerde ise yarar

but I think probably one of the most challenging things

fakat belki de en zorlu konular

is on the softer side.

nazik tarafta.

Now, how do you create compassion?

simdi, nasil merhamet olusturursunuz?

Now, how do you make people own the problem,

Simsi, nasil insanlarin problemlere sahip cikmasini saglarsiniz,

want to do something about it?

onlarin [iclerinden gelerek] bu problemler icin bir sey yapmalarini saglarsaniz?

There are a bit harder issues.

Daha zorlu konularda var

And I'm sure people in this crowd can probably find the solutions to these.

Ve, ben eminim bu gruptaki insanlar buna cozumler gelistirebilirler.

So I want to end my talk leaving this thought and challenge to you.

Boylece, ben konusmami bu dusunceyle sonuclandirmak ve size bir cagri yapmak istiyorum

Dr. V: When you grow in spiritual consciousness,

Dr. V: Ruhani bir farkindalik icinde yetisirsek,

we identify with all that is in the world

biz kendimizi bu dunyadaki herseyle tanimlariz,

so there is no exploitation.

boylece somuru olmaz.

It is ourselves we are helping.

Biz aslinda kendimize yardim ediyoruz

It is ourselves we are healing.

Biz aslinda kendimizi iyilestiriyoruz

TR: Thank you very much.

TR: Cok tesekkur ederiz

(Applause)

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