Wednesday, December 28, 2011

Infinite Inspiration

Recently I finished one of the most inspiring books I have ever read, Infinite Vision by Big Sis Pavi and Suchi. Reading the book now was very timely for me personally as I try to build an organization trying to bring about social change in India. But that's at the surface level. At a deeper level I learned about the nature and personality of a deeply spiritual person driven by the cause of human welfare. How he lived, how he thought, how he acted.

Aravind, in my mind, is the pinnacle of so-called social enterprise. It represents the heights an organization can achieve in terms of excellence, growth, and notoriety as it relentlessly pursues compassionate service to the poorest of the poor. The first few pages presented a bold and improbable claim: Aravind had worked out a model in which the more they went out of their way to serve the poorest of the poor, the better it was for business. Sounds like a parlor trick. How can you earn more by optimizing yourself to reach those who have no money?

My interpretation of the book's explanation is this: Aravind was driven to provide high-quality eye care at the cheapest possible cost to customers ($0). In that drive it had no choice but to find ways to make the costs of delivering that service as low as possible. The constraints demanded they get creative. The response: get less, do more. It engaged in two classes of radical innovation: process and technological. In a service traditionally requiring significant attention from highly skilled but low-supply personnel, it used the (in)famous McDonald's "hospital-as-a-factory" [18] process approach to substitute for the human touch. With the right recruiting and training in its paraprofessional program, they were able to retain the compassionate care ethos even with this switch. The devotion to process and systems thinking allowed surgeons to do massive volumes of high-quality surgeries, which drove down per-surgery costs (surgeons were paid a flat salary, fixed costs better amortized).

The second class of innovation was technological. In what I consider the masterstroke breakthrough of the Aravind Eye Care System, they brought the manufacturing of intraocular lenses (IOLs) to India, and using clever home-brewed methods brought the costs of those lenses down from $200 to $5. That was the fundamental building block for cheap cataract surgery. So simple in hindsight, but what a bold ballsy move at the time. This is the type of leap-ahead thinking that separated Dr.V from the rest in his field.

The cheap IOLs powered what I consider the engine underlying the serving-poorer-people-is-better-for-business model: they didn't sacrifice quality of service any step of the way. At the time surgery for cataracts using IOLs was the state-of-the-art, only it was considered unaffordable for developing countries. Aravind broke that mainstream thinking.

In the end they solved the market demand problem by providing a service that was so high-quality that even though they were driven to provide it to poor people, rich people couldn't help but seek it as well. And so with that demand-pull force and a pricing strategy that respected the choice (and therefore dignity) of each individual, they got the rich to cross-subsidize the costs for the poor.

This model is very compelling. Provide a service that everyone needs, and provide it with uncompromisingly high quality. Then get rich people to pay enough for it that you can provide it cheap to poor people. Aravind generated enough surplus through this model to bootstrap its own growth. There's nothing more natural and validating than an organization growing purely on the fruits of its own efforts. At Aravind's first hospital each subsequent floor was built only after it had enough money to pay for it. They literally grew the organization brick by brick. And grow it did, to an eye care ecosystem including hospitals, rural vision centers, eye camps, international management consultancy, post-grad medical training programs, manufacturing, research institute, over 30 million patients served, over 30 countries consulted, nearly $30 million in yearly revenue. And it remains a registered non-profit organization.

Aravind has deeply influenced my thinking about my own organization. Following its example, Awaaz.De aims to provide a service so good that organizations with money will be willing to pay for it, while making it affordable and accessible and appropriate for the underserved communities we are mission-driven to serve. I have made Infinite Vision required reading for all Awaaz.De employees. A copy sits in our office library. Aravind is a paragon, an inspiration for how to run a social enterprise with integrity and compassion and focus, and also financial sustainability.

Others who've read the book have also been inspired. Big John, a regular attendee of Wednesdays in Santa Clara, a lovely warm presence with deep wisdom, told me the book was also timely for the healing of the world at this particular point in history. While reading it, he told me how much awe he had for Pavi and Aravind and how he was on the 8th chapter but "didn't want it to end". Later I talked to Shariq who said he had started reading the book from the back because he was anxious to know how the story ends: how was Aravind affected by Dr.V's passing? As a researcher interested in the longevity and legacy of institutions and their values, this was the part of this rich tapestry story that he was most anxious to delve into.

The beauty of this story and the way Pavi has woven it together is that there is something in it for everybody. There were so many features, fun and touching little anecdotes, and quotes that I loved, especially ones that revealed the personality of Dr.V and the culture of Aravind. I've compiled a few below, maybe I'll keep adding to the list. I hope it gives a sense of the spirit of this book, and the people and organization it portrays.
  • I have never read a book in which the cast of characters were presented in a family tree on the first page. I enjoyed the "meet the family" section, and that you had to constantly reference it while reading the book. As got into the story, the family members, particularly the founding team, grew into giant superheroes in my mind's eye. Each had their special powers. Dr.V the visionary, Natchiar the stern disciplinarian, leader, and accomplished surgeon, Thulsi the management czar, Srinivasan the resource and facilities genius, etc. They all had their gifts and came together and complemented each other like X-Men.
  • Dr.V's understated way of giving praise: "Very good, very good" [250]. I hear him saying it and chuckle.
  • I loved learning about the family dynamics, the challenges of transitioning leadership and culture through generations, the family/non-family ingroup/outgroup tensions, and how the younger generations related to and perceived the elders. Dr.V's New Age Group meetings were genius, a way to build solidarity and create "memories of caring that would outlast his lifetime" [249]
  • Natchiar: "…The West talks about 'value addition'. I don't know that that means. When a nurse holds an elderly patient's hand and leads her where she needs to go- to me that is value addition." [96]
  • Dr. V lives 3 minutes away from the hospital. He goes to his office every morning at 7am. He drives himself down the street, and being a cautious driver, honks most of the way [132]
  • After Dr.V observed Natchiar berating a janitor: "Did you shout at his body or at his soul, Natchiar? Shout at his body. His soul belongs to God. If you shout at his soul, you are shouting at God." [138]
  • Out of tens of thousands of journal entries, Dr.V rarely used a question mark. "As if framing the right question is itself an answer of sorts." [18]
  • Dr.V was invited to Harvard University to give a talk titled, "Living a Spiritual Life in a Contemporary World." He wore an ill-fitted brown suit purchased from a thrift store.
  • Dr. V's sandals. How he spears them with his walking stick to slip them on and off his gnarled toes; green and red rubberbands snapped onto the toe-holds to mark the two pairs he owns in order to avoid wearing either pair out too quickly. "A trivial detail loaded with his distinct personality: his utter lack of vanity, his frugality, his passion for order and discipline in the smallest details. He has built those qualities into his family and into Aravind." [57]
  • Sweet and simple Dr.V quote on mentorship, the last phrase always makes me smile as I think of him saying it in his accent: "Just as you are training somebody for the Olympics, you train everybody every day. You coach him, guide him, and play with him. So you can develop him quickly as a top player." [103]
  • Very interesting insight on the patience and egolessness required to build an organization like Aravind. Dr. Aravind: "You know, Dr. V built this place at the right time. He wasn't competing for anything at that stage in his career… you have to be completely out of the rat race to build an institution like this." [93]
  • One of my all-time favorite Dr.V quotes, captured in the documentary (min 7:26) and spoken in his sweet, endearing, matter-of-fact way: "And I don't insist upon that that man must pay me before I do anything for him. I say, give him the sight man, let him give whatever he can give. If he cannot afford, doesn't matter, he can give later."

Saturday, December 3, 2011

Supply Chain of Service

I randomly wandered into Manav Sadhna the other day and was treated to a remarkable story from Virenbhai. It had to do with the large number of boxes neatly stacked up next to where we sat, in a corner of the main MS hall. Inside the boxes was over a ton (3,200 lbs. to be exact) of top-of-the-line Helix school supplies from the U.S.: pencil sets, rulers, compasses, easels, art kits, sketch pads, paper cutters, scissors, stationery. Easily, it was thousands of dollars worth of merchandise. It's all going to be distributed, benefit, and be enjoyed by many hundreds of slum children in the area for a long time to come. How on earth did all of these amazing school supplies land here in the first place? The story is even better than the end result.

Few weeks ago Virenbhai was in Chicago, where he spends part of the year working (to earn his living; the other half of the year he's in Ahmedabad to volunteer full-time with Manav Sadhna). Out of the blue one evening he got a call from a young woman, Shilpa Patel. Shilpa works in the marketing department at a warehouse/distribution center in the Chicago area. She called Virenbhai to tell him that there is 5 skids full of brand new school supplies from Helix at one of her company's warehouses. By midnight, all of it would be removed, possibly just discarded away. But wouldn't it be wonderful if we could take and send the supplies to the kids at Manav Sadhna? Shilpa had volunteered there before, so she knew how joyful the kids would be royally and fully kitted out for back-to-school. She had even gotten the go-ahead from her bosses to let it happen, but they would have to clear everything out of the warehouse by midnight.

It was then 7pm. Virenbhai immediately springs into action. He sends an email out to a group of local volunteers, seeking on-call muscle to wrangle the stuff. Within a couple hours he's got a team of 6-7 loaders, and a truck borrowed/rented by one of the volunteers. They all meet at the warehouse and manage to pick up the supplies. But where to store it all? Virenbhai calls up his boss to ask permission to store the stuff at one of their company facilities. Generously, the boss says yes. He has long known of Virenbhai's involvement with MS and has been supportive in many ways. The next morning Virenbhai goes early to work to unload. A few of his co-workers volunteer to come help, and with shirts off they get to work. They are finished by punch-in time and head to work.

Next task was to pack up all of the supplies to have them ready for shipment to India. Virenbhai blasts out another call to the local troops to come for a packing party. It was short notice and right near the holidays, but sure enough 16 people infected with a spirit of service and love for hundreds of kids thousands of miles away show up. At the company facility one weekend, Virenbhai's boss arranges for tables, boxes, packing tape, and any other supplies needed for the team. The team works for five hours to sort, organize and pack up the supplies. Right on call, some local moms hear about the work and show up with all kinds of food: donuts, home-cooked bataka poha, the works. They weren't even asked, they just sprang into action. An entire station had to be set up on the side just for food.

After the boxes were readied Virenbhai arranged to have them sent to India. He researched the most cost-effective solution, which was by ship. He had a contact for a guy who had helped him with MS shipments before. He is kind-hearted and resonates with the spirit. He agrees to deliver the boxes, from doorstep to doorstep, at a generous discount.

Virenbhai also figures that these supplies could benefit local underserved kids in Chicago, so 20-30% of the supplies are kept back. He arranges to deliver them to 2-3 local public schools. A wonderful, think-global-act-local decision.

The shipment arrived to Ahmedabad the morning Virenbhai and I sat in MS chatting about the whole thing. The truck arrives in front of Gandhi Ashram. How to unload? Meanwhile the local kids catch wind and are going bonkers with excitement. "We'll unload everything Virenbhai, don't worry!" And like that the kids themselves bring this wonderful gift the last mile to its final destination.

I'm dumbfounded as Virenbhai relates this whole story to me. So much goodness, I kept wowing in amazement after each turn only to be out-wowed by the next part. After finishing, Virenbhai gets up to leave and I walk over to examine the supplies more closely.

"I didn't tell you the best part of the story," he says, peeking back in. The boxes had come in some metal support scaffolds. Jesús and Kafhai, two architect-volunteers at MS, saw them and excitedly kept them aside. The scrap metal would be perfect for a school they were building in the slum. There was also tons of cardboard that the supplies came packed up in from the delivery truck. The MS team sent that off to a local recycling center and gets Rs.210. They use that money to feed bhajaiyas to the kids as thanks for helping to unload. Not a resource wasted, more good created.

There is so much to love about this story, a rich supply chain of service that blossomed from a small seed. One act of inspired kindness led to maybe a hundred individuals receiving a wonderful opportunity to serve in large and small ways. Not to mention the collective effort will benefit hundreds more children around the world. To me the biggest hero of the story is Shilpa Patel. And the kicker is, I am Shilpa Patel. And so are you, gentle reader. Each one of us sits in a metaphorical office working at Dunder Mifflin in our own corner of the world. But what separated Shilpa from the rest of us is in that moment was that she had her eyes, ears, and heart open. Tuned into the calls of service, generosity, kindness, compassion. What I call the Always Be *Serving* state of mind. It's what lifts the haze off of an ordinary moment and reveals an extraordinary experience.

Are you tuned in?

Humilty in Action

Over the past week I have been incrementally cleaning up mine and Nimo's apartment while he busily works on the Ekatva tour. I started with the bathrooms, then the kitchen, sinks, desks and other furniture, and of course tending to our plants. I have found it a good discipline and nice complement to morning meditation.

One of the big benefits of manual housework is that it really instills humility. It is humility in action. It is dirty, hard work bending over that greasy toilet, scrubbing hard-to-reach corners. But you do it and it grounds you. It keeps you flexible to a range of duties. No work gets beneath you, and that is an aid in cultivating a heart of service. And as Jayeshbhai recently confessed to me during a marathon floor/bathroom/dishes cleaning session, "Above all, I love to clean toilets."

At home, no one is watching you clean that toilet. Except yourself. So you do it to the best of your ability. This helps in developing a strong worth ethic, a dignity of work. Like young Steve Jobs who learned from his furniture-making father that even the parts of the piece that no one sees should be perfect and beautiful.

Manual work is beneficial to body and mind. It's physically challenging and strengthens the body. Also I've found that there is something very satisfying about wiping down a dusty shelf or sink. And that's what I love about India, everything in your house gets dusty! It's my latest argument as a long-standing India apologist.

Doing housework increases your appreciation of Moms. They do it in the normal course of their daily lives. Without recognition or praise or even a thought that what they are doing is something so great. They would think it bizarre and naive and arrogant to write a blog post reflecting and promoting it. Doing housework also makes me experientially understand what my mom means when she says, "I don't want a big house… it is too much work!"

Although I tend to like doing housework, I don't do it regularly enough out of laziness and resistance to getting my hands dirty. Getting started is the hardest part, but once you jump into it it's not so bad. And in the end I never regret having done it. It's satisfying, and you end up with a clean place to live! I plan to keep connected to some regular hard manual housework. Hand washing my underwear will be the task of choice for now.