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

翻译人员: Halei Liu 校对人员: Tony Yet

Good morning.

早上好。

I've come here to share with you an experiment

让我来很你们分享一个

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

可以让人摆脱苦难的实验。

It really is a story of Dr. Venkataswamy.

这是维卡塔丝维敏博士（Dr. Venkataswamy）的故事。

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

他的目标和他从亚拉文（Aravind）眼保健系统所发出的信号。

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

我想重要的是，我们首先得意识到失明意味着什么。

(Music)

（音乐）

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

女人：当我去找工作得时候，每个人都说不可以，

what use do we have for a blind woman?

我们要一个瞎女人有什么用？

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

我不能穿针，也看不见我头发里得虱子。

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

如果一个蚂蚁掉到我得米饭里，我也看不见。

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

图拉丝内贾 让维拉（Thulasiraj Ravilla）：看不见就是这样的，

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

但是我想这也剥夺了一个人的生命， 和他们的尊严，

their independence, and their status in the family.

他们的独立性，以及他们在家庭里的地位。

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

她只是成千上万盲人中的一个。

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

讽刺的是他们本可以避免失明。

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

一个简单可行的手术可以让上千万人重见光明，

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

或者更简单，一副眼镜，可以让更多的人看见。

If we add to that the many of us here now

如果看看在座各位都有谁

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

因为佩戴了眼镜而使得自己的效率得以提升，

then almost one in five Indians will require eye care,

那么五分之一的印度人都会需要视力保健，

a staggering 200 million people.

这个数字加起来有2亿

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

现在，我们还照顾不到他们中的10％。

So this is the context in which Aravind came into existence

所以这是在亚拉文30年前

about 30 years back

面临的挑战。

as a post-retirement project of Dr. V.

而这所医院也成为了维博士 （Dr. V.）的退休后的心血工程。

He started this with no money.

他白手起家。

He had to mortgage all his life savings

他用他毕生的积蓄

to make a bank loan.

从银行贷款。

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

现在，我们已经发展到5个医院的业务网里，

predominately in the state of Tamil Nadu and Puducherry,

以泰米尔纳德邦和浦度查里邦为主，

and then we added several, what we call Vision Centers

然后，我们加入了一些，我们称之为眼科中心的地方，

as a hub-and-spoke model.

于是形成了核心加辐射的模式。

And then more recently we started managing hospitals

最近我们也开始在国家的其他地区

in other parts of the country

管理医院

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

同时在世界的其他地方也开始有所涉足。

The last three decades,

在上30年里，

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

我们做了35万例手术，

a vast majority of them for the poor people.

绝大多数是穷人。

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

现在，我们每年会做300000例手术。

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

这是在亚拉文的一天，我们会做到大概近千例手术，

maybe see about 6,000 patients,

接见大概6000名病人，

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

发出小队去医院里检查，和带病人回来，

lots of telemedicine consultations,

执行很多远程咨询，

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

最重要的是，做很多培训，

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

他们中的很多人成为未来亚拉文的员工包括医生的技工。

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

能每年入一日的保持这样的工作

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

这需要很多的精力和勤劳的工作。

And I think this was possible thanks to the building blocks

我想这之所以能够实现，要感谢为这尽心尽力的

put in place by Dr. V.,

维博士。

a value system, an efficient delivery process,

他建立了一套价值系统，一个高效的手术流程，

and fostering the culture of innovation.

并启迪了一种创新的文化

(Music)

（音乐）

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

维博士：我通常和一个普通的乡下人坐在一起，因为我就是从乡下来的

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

然后突然之间你似乎可以和他的内心交流，

you seem to be one with him.

你似乎和他是一体的．

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

这里似乎有着一个拥有一切信心的灵魂．

Doctor, whatever you say, I accept it.

博士，无论你说什么，我都会接受．

An implicit faith in you

一个暗藏在你身体中的信心

and then you respond to it.

然后你会回应这个信心．

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

有一个年迈的女士对我有极大的信心，我必须为她做到最好．

When we grow in spiritual consciousness,

当我们在一个有灵性的良知的环境下成长，

we identify ourselves with all that is in the world,

我们就会按照这个来定义我们的世界，

so there is no exploitation.

所以这里没有剥削．

It is ourselves we are helping.

帮助的是我们自己，

It is ourselves we are healing.

被疗救的也是我们自己。

(Applause)

（掌声）

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

这帮助我们创建了一个十分道德的和非常以病人为中心的机构

and systems that support it.

以及一个支持这个机构的系统．

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

但是在实践过程中．你必须能十分有效的去完成这个服务，

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

然而，让很多人吃惊的是，灵感来自于麦当劳．

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

维博士：看，麦当劳的概念很简单．

They feel they can train people all over the world,

他们觉得他们可以训练世界各地的人，

irrespective of different religions, cultures, all those things,

无论不同的宗教，文化，和其他所有的事情，

to produce a product in the same way

去用一样的方法来创造一个产品

and deliver it in the same manner

然后以同样的方式

in hundreds of places.

在成百上千个不同地方推出

Larry Brilliant: He kept talking about McDonalds and hamburgers,

拉里·布利连（Larry Brilliant）：他一直的谈论这麦当劳和汉堡，

and none of it made any sense to us.

然后这一切都让我们摸不着头脑．

He wanted to create a franchise,

他想创造一个连锁店，

a mechanism of delivery of eye care

一个拥有麦当劳效率的

with the efficiency of McDonald's.

视力保健连锁店．

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

维博士：假设我可以提供视力保健，

techniques, methods, all in the same way,

技术，方法，都用同一种方法，

and make it available in every corner of the world.

使之在世界任何地方都能运作，

The problem of blindness is gone.

失明的问题也就不是问题了．

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

TR：如果你想想看．我想眼球是一样的，

as American or African,

无论是美国人还是非洲人，

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

问题都是一样的，疗程也是一样的．

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

不同的是，质量和服务上则是千变万化的，

and that was the fundamental principle that we followed

这也是我们在设计服务系统中

when we designed the delivery systems.

所遵循的基本条例．

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

当然，我们的挑战是，

we are talking of millions of people,

我们谈的是千千万万的病人，

very little resource to deal with it,

但我们的资源非常非常少

and then lots of logistics and affordability issues.

并且很多人是住在偏远地区，也支付不起看病的费用，这就成为巨大的挑战。

And then so, one had to constantly innovate.

所以，我们必须不断的创新．

And one of the early innovations, which still continues,

一个早期的创新，也是一个沿用至今的

is to create ownership in the community to the problem,

就是在一个社区内对问题创造一个所有权，

and then engage with them as a partner,

然后让他们像伙伴一样参与进来，

and here is one such event.

这里有这样一个事件，

Here a community camp just organized

这里一个被社区自己所规划的

by the community themselves,

一个社区营地，

where they find a place, organize volunteers,

在那里，他们自己找到用地，组织志愿者，

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

然后我们就做我们该做的，就是检查他们的视力，

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

医生会找到问题在哪里

and then determine what further testing should be done,

并决定有必要执行进一步的测试，

and then those tests are done by technicians

然后这些测试有医疗技术人员完成，

who check for glasses,

他们会检查镜片，

or check for glaucoma.

或检查青光眼．

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

然后，综合所有的结果，医生会做出最终的诊断，

and then prescribes a line of treatment,

然后开出处方，

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

如果他们需要一副眼镜，在营地里就可以拿到，

usually under a tree.

通常在树下面．

But they get glasses in the frames of their choice,

但是他们可以自己选择镜框，

and that's very important because I think glasses,

那是很重要的，因为我想镜片

in addition to helping people see,

可以帮人们看见，

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

但是同时也是一个时尚的宣言，他们愿意为这付款．

So they get it in about 20 minutes

所以，他们可以在20分钟内得到眼镜

and those who require surgery, are counseled,

然而对于那些需要手术的，在跟病人知会的前提下，

and then there are buses waiting,

会坐巴士，

which will transport them to the base hospital.

去到我们的医院接受手术。

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

如果不是有这样的运输和支持，

many people like this would probably never get services,

很多像这样的人就不会得到这样的服务，

and certainly not when they most need it.

当然也不会在他们需要的时候得到．

They receive surgery the following day,

他们会在接下来的几天里得到手术，

and then they will stay for a day or two,

然后他们会留院一两天，

and then they are put back on the buses

然后他们会搭乘巴士

to be taken back to where they came from,

返回他们来的地方，

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

那里会有他们的家人等待领走他们．

(Applause)

（掌声）

And this happens several thousand times each year.

这每年会发生上千次．

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

也许我们接待很多病人是很让人惊叹的，

very efficient process,

一个十分有效的过程，

but we looked at, are we solving the problem?

但是我们看的是，我们在解决问题吗？

We did a study, a scientifically designed process,

我们做了一个设计得非常好的调查，

and then, to our dismay,

结果令我们十分沮丧，

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

我们发现我们只覆盖到了那些需要帮助的7%，

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

我们不能充分的解决更大的问题。

So we had to do something different,

所以我们尝试了一些不同的事情，

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

所以我们架设起了我们叫做初级视力保健中心以及眼科中心。

These are truly paperless offices

这是一个真正的无纸办公室

with completely electronic medical records and so on.

全部使用的都是电子医学设备。

They receive comprehensive eye exams.

他们会收到一个全面的医学检查。

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

我们把一个简单的数码照相机做成了一个视网膜照相机，

and then every patient gets their teleconsultation with a doctor.

然后每一位病人都会和一个医生做一次远程咨询。

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

在第一年的效率是，

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

我们的服务群体达至40%

which is over 50,000 people.

多达50000人。

And the second year went up to 75 percent.

然后第二年是75%。

So I think we have a process by which

我想我们得到了一个

we can really penetrate into the market

通过渗透到市场

and reach everyone who needs it,

来给有需要的人提供服务的过程，

and in this process of using technology, make sure

然后在这个过程中使用科技，来保证

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

大多数人不用去医院。

And how much will they pay for this?

然而，他们需要为此支付多少？

We fixed the pricing, taking into account

每次诊疗的费用都是固定的

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

病人也省去了坐巴士去城市的价格，

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

他们只需支付20印度卢比，那可以支付3次咨询。

(Applause)

（掌声）

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

另一个挑战是，我们如何能让高科技

or more advanced treatment and care?

给予治疗更多的便利？

We designed a van with a VSAT,

我们在车里设计了透过卫星的网络连线

which sends out images of patients to the base hospital

可以将病人的图片送到医院里

where it is diagnosed,

在那里得出诊断，

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

然后在病人等待的同时，报告就会及时送到病人身边，

it gets printed out, the patient gets it,

打印出来，然后病人可以拿到，

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

然后得到他们该做什么的咨询，

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

过去，病人去看一次医生要花半年的时间

and then this happens as a way of

现在有了这样的科技，

bridging the technology competence.

他们可以迅速的获取他们所需的信息。

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

所以这些所有的影响是市场增长的基本因素之一，

because it focused on the non-customer,

因为这注重于非用户，

and then by reaching the unreached,

然后触及到了所没有触及的市场，

we're able to significantly grow the market.

我们可以显著的让市场成长。

The other aspect is how do you deal with this efficiently

另一方面就是当医院的眼科医生很少的时候

when you have very few ophthalmologists?

如何提高做手术的效率？

So what is in this video is a surgeon operating,

所以这个视频显示的是一个外科手术，

and then you see on the other side,

你可以看到在另外一个桌上，

another patient is getting ready.

另外一个病人已经准备好了。

So, as they finish the surgery,

这样，当他们完成手术后，

they just swing the microscope over,

他们就会把显微镜移到另一边

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

桌子放的距离恰到好处，

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

我们必须这样做，因为，这样做的话

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

我们才有能力做到有效的手术。

And then to support the surgeon,

因此，为了支持手术，

we require a certain workforce.

我买也雇佣了劳动力。

And then we focused on village girls that we recruited,

我们雇佣的都是乡下女孩，

and then they really are the backbone of the organization.

她们给整个机构带来了底气。

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

它们几乎做着所有技术为主的日程工作。

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

她们一心一意。完成的十分出色。

With the result we have very high productivity,

结果就是，我们的花费十分低，

very high quality at very, very low cost.

但质量和效率都十分高。

So, putting all this together, what really happened was

所以，总而言之，事实是

the productivity of our staff was

我们员工的生产效率比

significantly higher than anyone else.

任何人都要高出很多。

(Applause)

（掌声）

This is a very busy table,

这是一个十分忙碌的办公桌，

but what this really is conveying is that,

但是这所传达的是，

when it comes to quality, we have put in

当要保证质量的时候，我们有一个

very good quality-assurance systems.

能保障质量的系统。

As a result, our complications are significantly lower

结果就是，我们的并发症

than what has been reported in the United Kingdom,

要远比伦敦的低，

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

这样的数字你是很少会看到的。

(Applause)

（掌声）

So the final part of the puzzle is,

所以最后的迷题是，

how do you make all this work financially,

我们如何保证资金运转正常？

especially when the people can't pay for it?

要知道我们大部分病人都无法支付看病的费用！

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

我们的做法是，很多都是免费的，

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

对于那些有能力支付的病人，我们收取当地市场的价格

nothing more, and often much less.

不多于这个，通常是少于这个的，

And we were helped by the market inefficiency.

我们被市场的低效率性所帮助了。

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

我想这是我们的救星，直到现在。

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

当然了，一个人必须有一个能

what you have as a surplus.

放弃的的盈余的思维。

The result has been, over the years,

结果就是，在近几年里，

the expenditure has increased with volumes.

我们的支出显著增长，

The revenues increase at a higher level,

我们的收入则是以更高速度在增长

giving us a healthy margin

这样一来，我们可以保证有健康的盈余

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

因为我们需要免费为很多病人提供治疗

I think in absolute terms,

从绝对数字来说，

last year we earned about 20-odd million dollars,

去年，我们挣了大概2000万美元，

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

用了1300万美元，超过税前利润40％。

(Applause)

（掌声）

But this really requires going beyond what we do,

但是这意味着我们要超越我们现在所做的，

or what we have done,

或着我们已经做的，

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

如果你真的想去解决失明的问题。

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

所以我们做了一些反直觉的事情。

We created competition for ourselves,

我们为我们自己创造了竞争对手，

and then we made eye care affordable

这样使得眼保健的价格降得更低

by making low-cost consumables.

让更多人可以享受到这样的服务

We proactively and systematically

我们主动的，系统化的

promoted these practices to many hospitals in India,

在印度的很多医院里宣传这个实践，

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

很多是在我们自己的地盘，也有世界其他地方。

The impact of this has been that these hospitals,

结果是，

in the second year after our consultation,

那些我们提供咨询的医院

are double their output

他们的手术数量翻了一番

and then achieve financial recovery as well.

也使得收益得以改善

The other part was how do you address

另一个部分就是你这样对待

this increase in cost of technology?

科技消费上的增长？

There was a time when we failed to negotiate

我们后来没能谈下来一个

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

可以接受的内眼镜片的价格，

so we set up a manufacturing unit.

于是我们干脆就设立了自己的流水线。

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

这样，一段时间后，我们就有能力将支出显著的降低

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

到我们开始的2个百分点。

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

现在，我们相信我们占有了全球市场的7％，

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

在大概120的国家里。

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

总而言之，我要提出的是，我们是要将这个模式推广出去，

or is it just India or developing countries?

还是只是将它保留在印度或其他发展中国家？

So to address this, we studied UK versus Aravind.

为了能说明这，我们比较了一下英国的眼科治疗和亚拉文。

What it shows is that we do roughly about 60 percent

这显示了，我们做的是英国

of the volume of what the UK does,

的60倍大小，

near a half-million surgeries as a whole country.

整个国家的手术有50万例。

And we do about 300,000.

而我们的300000。

And then we train about 50 ophthalmologists

而且我们训练大概50个眼科医生

against the 70 trained by them,

他们要训练70个，

comparable quality, both in training and in patient care.

训练和病人护理的质量都是同等级别的

So we're really comparing apples to apples.

我们真的是用苹果来比较苹果。

We looked at cost.

我们看看消费上。

(Laughter)

（笑）

(Applause)

（鼓掌）

So, I think it is simple to say

所以，我想这要说的是

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

因为这在英国没成功但印度成功了。

I think there is more to it.

我想还有更多的可以做。

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

我的意思是，我想也要看看其他的方面。

Maybe there is --

也许

the solution to the cost could be in productivity,

降低成本的方法就在生产效率里，

maybe in efficiency, in the clinical process,

也许在高效里，在诊所的过程里，

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

或者在他们能支付多贵的镜片里，

or regulations, their defensive practice.

或条例里，或者在实践里。

So, I think decoding this can probably bring

所以，我想破解这些也许可以

answers to most developed countries

给大多数发达国家

including the U.S., and maybe

包括美国带来答案，或许

Obama's ratings can go up again.

奥巴马的支持率会再度升高。

(Laughter)

（笑）

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

另外一个观点，就是，我想留给你们，

in conditions where the problem is very large,

当问题十分大的时候，

which cuts across all economic strata,

当问题是在这个经济阶层的时候，

where we have a good solution,

当我们有一个好的方法，

I think the process I described,

我想我刚才已经描述了过程，

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

你找到，生产率，质量，病人中心的护理，

can give an answer,

可以给出答案，

and there are many which fit this paradigm.

有很多都很适合这个范例。

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

你可以用到牙科，助听器，产假等。

There are many where this paradigm can now play,

有很多这个范例都可以做到，

but I think probably one of the most challenging things

但是我想最有挑战力的事情

is on the softer side.

是在“软件”上。

Now, how do you create compassion?

现在，你们怎样创造关怀？

Now, how do you make people own the problem,

现在你怎样让群众拥有问题，

want to do something about it?

让他们想对此做点什么？

There are a bit harder issues.

这样就是更难一点的问题。

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

我肯定在座的会有人找到答案。

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

所以我想我用这个问题和挑战来结束这个演讲。

Dr. V: When you grow in spiritual consciousness,

维博士：当你是在一个有灵性良心的环境下的时候，

we identify with all that is in the world

你会认为世界充满了这些

so there is no exploitation.

所以就没有了压迫。

It is ourselves we are helping.

我们帮助的最终是我们自己

It is ourselves we are healing.

我们疗救的最终也是我们自己。

TR: Thank you very much.

主持人：十分感谢你。

(Applause)

（掌声）