Re-thinking & Innovating Evangelical Christianity through the Example of Postmodern Indian Medical Practices

Strictly speaking, the post today will not be pertinent to issues of Emergent Christianity or biblical revisionism caused by cultural disruptions and the requisite societal needs that follow. However, we have spoken to creativity in the past (How the Genius Thinks) and about Christianity's need to recreate itself from its antiquated past (Thinking About a New Christianity, Parts 1-3; What Wikipedia Has to Say About the Emerging/Emergent Church. Parts 1-2). And so, today's article about Indian medical practices seems relevant to me. Especially because it reveals how our mindset must change away from societal expectations and assumptions in order to fundamentally recreate newer Gospel practices and missional objectives with far-flung affect and distillation.

If Christianity continues to refuse fundamental change, adaptation, and re-orientation, by clinging to antiquated subcultural mores and beliefs (most recently re-expressed from the 1970-1990s) then it should only expect a growing irrelevancy and subcontextualization of itself without any further impact to society-at-large - except to itself in growing isolation and systemic blow back repercussions - much like assorted Fundamentalist and Amish groups have experienced over the past century. I think a good illustration of this is the Muslim religion which has tenaciously clung to its outdated beliefs and practices in an "us" versus "them" cultural affirmation. By this mindset we have seen extreme examples of cultural/religious aggravation and frustration expressed through cruel insurgencies and governmental suppressions, unabated militarism and heart-rending terrorism, and an adamant refusal to recognise or accept religious and cultural pluralism into strict Muslim society. The saner, more wiser elements of Muslimism is doing what it can, but its voice has been far out-distance by the rhetoric of their militaristic mullahs and clerics.

However, the same could be said of Evangelical Christianity (per earlier Fundamental Christian groups self-isolating experiences) as it hunkers down from society (i) by creating subcultural contexts of itself; (ii) by becoming unnecessarily hostile to cultural and postmodernistic incursions into its belief systems and practices (as witnessed in the backlash to a small, innocuous book by the title "Love Wins"); and, (iii) by adamantly not accepting anything that even smells "unbiblical" or "non-Christian" to its way of life and living. In the end, evangelical Christianity is harming itself in spite of its sincerity of devotion to God, the Scriptures, purity of life, outspoken goals of ethical behavior, and its gospel message of salvation. More rather, (i) Jesus' radical message of love in the Gospels becomes threatening and unintelligible; (ii) Jesus' criticism of the Scribes and Pharisees of His day becomes a ghostly representation of themselves in refusing admittance to Jesus heavenly kingdom on earth; and, (iii) Jesus' universal message of salvation to all men and women everywhere is refused when bounded by church rules and creedal confessions wrenched out of historical context and biblical assignment. And this list could go on-and-on. Not that each one of these subjects haven't been reviewed and re-capsulated adnauseum here on this blogsite during this past year but that just the merest expression of each of these bullet points is enough to send an Evangelical Christian reeling to his or her nearest flock of like-minded affiliates to crucify again the Son of God in unnecessary fears, religious frockery, and pulpiteered rhetorical perturbations.

And so, when reading of the article of Indian medical practices below, I see again the need for both Church and Society to fundamentally look at themselves as objectively as possible. To take out again that metaphorical "white sheet of plain paper" and work out practices and practicalities that would best serve or reflect the objectives and ministries of the Gospel of Jesus. To welcome the disruption and evolution we see taking place in this world of sin and woe as signposts to the brokenness of our present efforts. To recognize that vast multitudes of the world's poor and destitute are being underserved and overlooked in our haste to accumulate and preserve wealth and security. To recommit our lives and livelihoods to the dedication of a more benevolent and selfless humanity. To understand that civil wars and economic dishevel are mirrors to our misdirected efforts and energies. To remove all our past knowledge and beliefs, and sit there, at our mental table, with a piece of plain white paper in our heads and our hearts, thinking through what must be removed from our lives before we can properly draw out a design for the future. A design open enough, expansive enough, unbounded enough, to force us to never again be so set in our ways and our beliefs. That will allow God to recreate our hearts and spiritual beings into the image He wants, and not our own images of fears and insecurity.

And finally, to remember that if one is to construct, one must first deconstruct; and if deconstruct, then one must remember to reconstruct. For many of us are good at one task or the other. But make sure to listen to those rare bridge builders amongst us discontent in living in either of these worlds. And learn to work together. To listen. To dispute irenically. To argue with listening ears, hands, hearts, and tongues. This Earth demands it. This Cosmos was built for this. And by our efforts, however meager, our Redeemer/Creator will sanctify each passion and desire given to the blessing humanity by the works of our hands and hearts. Be a blessing then and this day commit to an innovated thinking that matters. However small. However peripheral. We each are responsible to begin somewhere within our lives as spiritual forces. As battered vessels of servitude and blessing.

R.E. Slater

August 20, 2012

Health care in India

Lessons from a frugal innovator

http://www.economist.com/node/13496367

The rich world’s bloated health-care systems can learn from India’s entrepreneurs

Apr 16th 2009 | Bangalore | from the print edition

Photo by Tom Pietrasik

ENTER the main cardiac operating-room at Bangalore's Wockhardt hospital on a typical morning, and you will find a patient on the operating table with a screen hanging between his head and chest. On a recent visit the table was occupied by a middle-aged Indian man whose serene look suggested that he was ready for the operation to come. Asked how he was, he smiled and answered in Kannada that he felt fine. Only when you stand on a stool to look over the screen do you realise that his chest cavity has already been cut open.

As the patient was chatting away, Vivek Jawali and his team had nearly completed his complex heart bypass. Because such “beating heart” surgery causes little pain and does not require general anaesthesia or blood thinners, patients are back on their feet much faster than usual. This approach, pioneered by Wockhardt, an Indian hospital chain, has proved so safe and successful that medical tourists come to Bangalore from all over the world.

This is just one of many innovations in health care that have been devised in India. Its entrepreneurs are channelling the country's rich technological and medical talent towards frugal approaches that have much to teach the rich world's bloated health-care systems. Dr Jawali is feted today as a pioneer, but he remembers how Western colleagues ridiculed him for years for advocating his inventive “awake surgery”. He thinks that snub reflects an innate cultural advantage enjoyed by India.

Unlike the hidebound health systems of the rich world, he says, “in our country's patient-centric health system you must innovate.” This does not mean adopting every fancy new piece of equipment. Over the years he has rejected surgical robots and “keyhole surgery” kit because the costs did not justify the benefits. Instead, he has looked for tools and techniques that spare resources and improve outcomes.

Shivinder Singh, head of Fortis, a rival hospital chain based in New Delhi, says that most of the new, expensive imaging machines are only a little better than older models. Meanwhile, vast markets for poorer patients go unserved. “We got out of this arms race a few years ago,” he says. Fortis now promises only that its scanners are “world class”, not the newest.

Mr Singh is not alone in thinking that many firms in the rich world are looking at innovation the wrong way. Paul Yock, head of the bio-design laboratory at Stanford University, which develops medical devices, argues that medical-technology giants have “looked at need, but have been blind to cost.” Amid growing concern about runaway health spending, he thinks the industry can find inspiration in India.

Poverty, geography and poor infrastructure mean that India faces perhaps the world's heaviest disease burden, ranging from infectious diseases, the traditional scourge of the poor, to diseases of affluence such as diabetes and hypertension. The public sector has been overwhelmed, which is not surprising considering how little India's government spends on health as a share of national income (see chart). Accordingly, nearly four-fifths of all health services are supplied by private firms and charities—a higher share than in any other big country.

  

In the past that was more a reflection of the state's failure than the dynamism of entrepreneurs, but this is changing fast. Technopak Healthcare, a consulting firm, expects spending on health care in India to grow from $40 billion in 2008 to $323 billion in 2023. In part, that is the result of the growing affluence of India's emerging middle classes. Another cause is the nascent boom in health insurance, now offered both by private firms and, in some cases, by the state. In addition, the government has recently liberalised the industry, easing restrictions on lending and foreign investment in health care, encouraging public-private partnerships and offering tax breaks for health investments in smaller cities and rural areas.

Cheaper and smarter

This has attracted a wave of investment from some of India's biggest corporate groups, including Ranbaxy (the generic-drugs pioneer behind Fortis) and Reliance (one of India's biggest conglomerates). The happy collision of need and greed has produced a cauldron of innovation, as Indian entrepreneurs have devised new business models. Some just set out to do things cheaply, but others are more radical, and have helped India leapfrog the rich world.

For years India's private-health providers, such as Apollo Hospitals, focused on the affluent upper classes, but they are now racing down the pyramid. Vishal Bali, Wockhardt's boss, plans to take advantage of tax breaks to build hospitals in small and medium-sized cities (which, in India, means those with up to 3m inhabitants). Prathap Reddy, Apollo's founder, plans to do the same. He thinks he can cut costs in half for patients: a quarter saved through lower overheads, and another quarter by eliminating travel to bigger cities.

Columbia Asia, a privately held American firm with over a dozen hospitals across Asia, is also making a big push into India. Rick Evans, its boss, says his investors left America to escape over-regulation and the political power of the medical lobby. His model involves building no-frills hospitals using standardised designs, connected like spokes to a hub that can handle more complex ailments. His firm offers modestly priced services to those earning $10,000-20,000 a year within wealthy cities, thereby going after customers overlooked by fancier chains. Its small hospital on the fringes of Bangalore lacks a marble foyer and expensive imaging machines—but it does have fully integrated health information-technology (HIT) systems, including electronic health records (EHRs).

New competitors are also emerging. A recent report from Monitor, a consultancy, points to LifeSpring Hospitals, a chain of small maternity hospitals around Hyderabad. This for-profit outfit offers normal deliveries attended by private doctors for just $40 in its general ward, and Caesarean sections for about $140—as little as one-fifth of the price at the big private hospitals. It has cut costs with a basic approach: it has no canteens and outsources laboratory tests and pharmacy services.

It also achieves economies of scale by attracting large numbers of patients using marketing. Monitor estimates that its operating theatres accommodate 22-27 procedures a week, compared with four to six in other private clinics. LifeSpring's doctors perform four times as many operations a month as their counterparts do elsewhere—and, crucially, get better results as a result of high volumes and specialisation. Cheap and cheerful really can mean better.

But there is more to India's approach than cutting costs. Its health-care providers also make better use of HIT. According to a recent study in the Journal of the American Medical Association, fewer than 20% of doctors' surgeries in America use HIT. In contrast, according to Technopak, nearly 60% of Indian hospitals do so. And instead of grafting technology onto existing, inefficient processes, as often happens in America, Indian providers build their model around it. Apollo's integrated approach to HIT has enabled the chain to increase efficiency while cutting medical errors and labour. EHRs and drug records zip between hospitals, clinics and pharmacies, and its systems also handle patient registration and billing. Apollo is already selling its expertise to American hospitals.

Eye on the prize

A casual visitor to Madurai, a vibrant medieval-temple town in southern India, would not think it was a hotbed of innovation. And yet that is exactly what you will find at Aravind, the world's biggest eye-hospital chain, based in the town. There are perhaps 12m blind people in India, with most cases arising from treatable or preventable causes such as cataracts. Rather than rely on government handouts or charity, Aravind's founders use a tiered pricing structure that charges wealthier patients more (for example, for fancy meals or air-conditioned rooms), letting the firm cross-subsidise free care for the poorest.

The 25 Most Influential Business Management Books,
Time Magazine, August 2009

Aravind also benefits from its scale. Its staff screen over 2.7m patients a year via clinics in remote areas, referring 285,000 of them for surgery at its hospitals. International experts vouch that the care is good, not least because Aravind's doctors perform so many more operations than they would in the West that they become expert. Furthermore, the staff are rotated to deal with both paying and non-paying patients so there is no difference in quality. Monitor's new report argues that Aravind's model does not just depend on pricing, scale, technology or process, but on a clever combination of all of them.

C.K. Prahalad and other management gurus trumpet examples like Aravind, but do the rich countries accept that they could learn from India? Unsurprisingly, some reject the notion that America's model is broken. William Tauzin, head of America's pharmaceutical lobby, warns that regulatory efforts to cut costs could stifle life-saving innovation. Sandra Peterson of Bayer, a German drugs and devices giant, stoutly defends the industry's record. She argues that overall cost increases mask how medical devices, “like cars or personal computers, give better value for the money over time.” Diabetes monitors and pacemakers have improved dramatically in the past 20 years and have fallen in price—but costs have gone up because they are now being used by more patients.

But those examples are exceptions. Many studies show that America's spending on health care is soaring, yet its medical outcomes remain mediocre. Mark McClellen of the Brookings Institution, an American think-tank, says that a big problem is the overuse of technology. Whether or not a scan is needed, the system usually pays if a doctor orders it—and the scan might help defend the doctor against a malpractice claim. “The root cause is not greed, but tremendous technological progress imposed upon a fractured health system,” says Thomas Lee of Partners Community HealthCare, a health provider in Boston.

Dr McClellen, a former head of America's Food and Drug Administration, points out that other innovative industries often sell new products at a loss, and recoup their investments later. In genuinely competitive industries, innovators are rarely rewarded with the “cost plus” reimbursements demanded by medical-device makers for their gold-plated gizmos.

That is why Stanford's Dr Yock wants to turn innovation upside down. He has extended his bio-design programme to India, in part to instil an understanding of the benefits of frugality in his students. He believes that India's combination of poverty and outstanding medical and engineering talents will produce a world-class medical-devices industry. Tim Brown, the head of Ideo, a design consultancy, agrees. In the past, he notes, health bosses thought all devices had to be Rolls-Royces or Ferraris. But cost matters, too. Pointing to another recent example of India's frugal engineering, he says: “In health care, as in life, there is need for both Ferraris and Tata Nanos.”