I've come here to share with you an experiment

各位早安

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

我來這想跟各位分享一個實驗成果

It really is a story of Dr. Venkataswamy.

如何擺脫一部分的眾生苦難

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

這實際上是一位醫生文卡塔斯瓦米的故事.

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

他要傳達的使命訊息，是這個亞拉文眼科治療系統.

(Music)

首先我認為大家要先了解失明代表了什麼.

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

(背景音樂)

what use do we have for a blind woman?

婦人:所以我去求職的地方,他們都回答不要我.

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

不過是一個看不見的女人,我們有什麼用?

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

我不能在針頭上穿線或是看見我頭髮裡有蝨子

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

如果有螞蟻掉到我的飯裡,我也不知道

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

圖拉斯兒賈-朗維拉:失明是很大條的事情

their independence, and their status in the family.

但我覺得這奪走了人原有的生活、尊嚴、

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

自立能力，還有在家庭中的地位

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

她只是數百萬位盲人中的其中一位

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

諷刺的是他們本來不需要失明的

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

一個簡單,可信賴的手術就能幫這數百萬人恢復視力

If we add to that the many of us here now

還有更簡單的,一副眼鏡就能幫數百萬人看得更清楚

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

如果我們算上在座的各位其中

then almost one in five Indians will require eye care,

因為戴了眼鏡而能更有產值

a staggering 200 million people.

將近五位印度人中就有一位需要眼科治療

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

驚人的2億人口中

So this is the context in which Aravind came into existence

直到今日,我們只能幫不到其中的百分之十

about 30 years back

而這就是亞拉文所存在的環境

as a post-retirement project of Dr. V.

大約是30年前

He started this with no money.

文醫生退休後展開的計畫

He had to mortgage all his life savings

他一無分文的開始這個工作

to make a bank loan.

他得抵押所有他的畢生積蓄

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

來拿到銀行貸款

predominately in the state of Tamil Nadu and Puducherry,

然後慢慢的我們已經成長到5間醫院的一個體系

and then we added several, what we call Vision Centers

以泰米爾納德和旁迪切里為主

as a hub-and-spoke model.

然後我們增加了幾個我們稱作視力中心的地方

And then more recently we started managing hospitals

作為轉診的集散中心點

in other parts of the country

然後最近我們開始代管醫院

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

在印度其他地區

The last three decades,

也在世界上不同的角落設立醫院

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

這近30年

a vast majority of them for the poor people.

我們已經完成350萬人次的手術

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

絕大多數都是替窮人做的

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

現在 我們每年執行約30萬次手術

maybe see about 6,000 patients,

亞拉文中心一天能做約1000次手術

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

約看診6000人次

lots of telemedicine consultations,

派出團隊到鄉村看診然後帶回病人

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

許多次的遠距醫療評估

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

然後更重要的是完成許多的訓練

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

給亞拉文中心未來的員工 醫生或是技術人員

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

而且我們每天不停地做然後做得很好

And I think this was possible thanks to the building blocks

這需要許多的創意還有大量的苦功

put in place by Dr. V.,

而我認為能做到這些要歸功於一些重要的根基

a value system, an efficient delivery process,

由文醫生所建立起來的

and fostering the culture of innovation.

一個價值體系,一個高效率的配送程序

(Music)

還有鼓勵創新的養成文化

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

(音樂)

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

文醫生:我常跟鄉村老百姓在一起,因為我同樣來自鄉村

you seem to be one with him.

而當你環顧四周,突然間你跟他的內心有所共鳴

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

好像你跟他合為一體

Doctor, whatever you say, I accept it.

有一個完全信任你的靈魂

An implicit faith in you

醫生,無論你怎麼說我都接受

and then you respond to it.

對你無瑕的信任

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

然後你有所回應

When we grow in spiritual consciousness,

這裡有一個老婦人對我有這麼大的信心,我一定要給她最好的

we identify ourselves with all that is in the world,

當你增長靈智的時候

so there is no exploitation.

我們認同世上所有事物

It is ourselves we are helping.

所以不存在剝削,

It is ourselves we are healing.

我們所幫助的正是自己

(Applause)

我們所醫治的也是自己

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

(掌聲)

and systems that support it.

這讓我們建立了一個非常有原則而且高度以病人為核心的組織

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

還有支持這樣的各種機制

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

但是在實務上,你還必須有效率地提供服務

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

而乍看之下很奇特,這樣的靈感來自於麥當勞

They feel they can train people all over the world,

文醫生:麥當勞的概念是很簡單的

irrespective of different religions, cultures, all those things,

他們覺得他們能訓練世界上所有的人

to produce a product in the same way

無論是不同的宗教,文化,各種不同的差異

and deliver it in the same manner

用同樣的方式來製造同樣的產品

in hundreds of places.

並且用同樣的態度提供服務

Larry Brilliant: He kept talking about McDonalds and hamburgers,

在數百個不同的地方

and none of it made any sense to us.

賴瑞-布里安特:他不斷的提到麥當勞與漢堡

He wanted to create a franchise,

而那些我們一點都不懂

a mechanism of delivery of eye care

他想要創造一種加盟

with the efficiency of McDonald's.

一個提供眼科醫療的機制

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

有如麥當勞的運作效率

techniques, methods, all in the same way,

文醫生:如果我能生產眼科醫療

and make it available in every corner of the world.

技術方法,都是用同樣的方式

The problem of blindness is gone.

同時能提供給世界上不同角落

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

失明的問題就沒了

as American or African,

圖拉斯兒賈-朗維拉:想一下,人的眼球都是一樣的

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

美國人的或是非洲人的

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

問題都是一樣的,治療方法也是一樣的

and that was the fundamental principle that we followed

所以那為何有有這麼多不同的服務方式與醫療品質呢

when we designed the delivery systems.

這個就是我們在追求的根本主軸

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

當我們在規劃配送系統的時候

we are talking of millions of people,

當然,考驗的是這確實是很大的問題

very little resource to deal with it,

我們在考慮的是數百萬人

and then lots of logistics and affordability issues.

而只有一點點資源來完成目標

And then so, one had to constantly innovate.

還有許多物流,定價問題要考慮

And one of the early innovations, which still continues,

也就是因為如此,我們必須不斷的創新

is to create ownership in the community to the problem,

而其中一個初期的創新,仍然沿用的

and then engage with them as a partner,

就是設立社區裡的針對問題的所有權

and here is one such event.

然後對待他們如同夥伴

Here a community camp just organized

這邊就有一個例子

by the community themselves,

有一個社區營地剛成立

where they find a place, organize volunteers,

由這個社區自己組的

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

他們自己找場地,組織義工

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

然後我們來做我們的事情,也就是 檢查他們的視力

and then determine what further testing should be done,

然後你讓醫生去發現問題是什麼

and then those tests are done by technicians

然後決定那些進一步的檢查該去處理

who check for glasses,

然後由技術人員去做這些檢查

or check for glaucoma.

有的是檢查眼鏡

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

有的是檢查青光眼

and then prescribes a line of treatment,

然後根據這些檢查結果醫生做出最後的診斷

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

然後列出治療的處方

usually under a tree.

如果需要一副眼鏡,在營地現場就有提供

But they get glasses in the frames of their choice,

通常是在樹下

and that's very important because I think glasses,

還有他們自己選好鏡框

in addition to helping people see,

這點非常重要 因為我認為眼鏡

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

除了幫助人看見

So they get it in about 20 minutes

同時也是一種品味的表示,而他們願意為此付費

and those who require surgery, are counseled,

這樣他們在20分鐘左右拿到眼鏡

and then there are buses waiting,

那些需要手術的則給予建議

which will transport them to the base hospital.

然後有巴士在那等著

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

會載他們去基地醫院

many people like this would probably never get services,

如果不是使用這樣的物流跟協助

and certainly not when they most need it.

許多人可能根本無法得到服務

They receive surgery the following day,

尤其是在他們最需要的時候

and then they will stay for a day or two,

他們在隔天接受手術

and then they are put back on the buses

然後他們會住院一兩天

to be taken back to where they came from,

然後送他們上巴士

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

帶他們回到他們來的地方

(Applause)

那裏他們的家人會在那等著接他們回家

And this happens several thousand times each year.

(掌聲)

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

這樣的方式每年發生數千次

very efficient process,

乍聽之下會覺得很驚人 我們看了這麼多的病人

but we looked at, are we solving the problem?

非常有效率的程序

We did a study, a scientifically designed process,

但是我們仔細看.我們解決問題了嗎?

and then, to our dismay,

我們做過一個研究,一個科學規劃過的程序

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

但是讓我們失望的是

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

我們發現這樣只接觸到百分之七的有需要的人

So we had to do something different,

我們並沒有針對到更大的問題

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

所以我們必須做些不同的事情

These are truly paperless offices

因此我們設立了稱作初級眼科治療中心,視力中心

with completely electronic medical records and so on.

那是完全無紙化中心

They receive comprehensive eye exams.

完全使用電子醫療紀錄等等

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

他們能記錄複雜的眼科檢查

and then every patient gets their teleconsultation with a doctor.

我們可說是把簡單的數位相機改成眼底攝影相機

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

然後每個病人透過遠端看診面對醫生

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

這樣的效果是,在第一年

which is over 50,000 people.

我們就拿下市場上百分之四十的比例

And the second year went up to 75 percent.

也就是超過了五萬人

So I think we have a process by which

第二年就達到了百分之七十五

we can really penetrate into the market

所以我覺得我們有一個系統真的能

and reach everyone who needs it,

滲透進入市場

and in this process of using technology, make sure

並且服務到每一個需要的人

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

在這個使用科技的過程

And how much will they pay for this?

找出大多數人不需要去基地醫院

We fixed the pricing, taking into account

究竟他們需要付多少錢呢?

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

我們固定收費,並且以

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

他們能省到的往來城市的巴士開銷為準

(Applause)

因此他們付大約15元台幣,而且包含三次看診.

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

(掌聲)

or more advanced treatment and care?

另一個挑戰則是,如何提供高科技

We designed a van with a VSAT,

或是更先進的醫療與照護?

which sends out images of patients to the base hospital

我們設計了一個裝有碟型衛星天線的箱型車

where it is diagnosed,

能夠發送病人的影像給基地醫院

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

在那邊完成診斷

it gets printed out, the patient gets it,

然後當病人在等待的時候,報告就能傳送回給病人

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

列印出來,病人就拿到了

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

然後他們會從諮詢中知道他們該做什麼

and then this happens as a way of

我的意思是,去看個醫生或是六個月後再過來這樣的建議

bridging the technology competence.

所以這樣的方式

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

連結科技的能力

because it focused on the non-customer,

這些影響是其中一個原因帶動市場的成長

and then by reaching the unreached,

因為我們專注在非付費客戶上

we're able to significantly grow the market.

然後接觸到原本接觸不到的人

The other aspect is how do you deal with this efficiently

我們能夠明顯的成長整個市場

when you have very few ophthalmologists?

另一方面就是你如何有效率的對應事情

So what is in this video is a surgeon operating,

當你只有很少的眼科專科醫師的時候?

and then you see on the other side,

這影片裡是一個外科醫生手術的畫面

another patient is getting ready.

你會看到另一邊

So, as they finish the surgery,

另一個病人已經準備好

they just swing the microscope over,

所以 當他們完成手術時

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

他們直接把顯微鏡換過去

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

手術台擺放的正好距離是剛好的

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

我們需要這樣做,因為這樣的流程

And then to support the surgeon,

我們能提高外科醫生四倍以上的產能

we require a certain workforce.

為了能協助外科醫生

And then we focused on village girls that we recruited,

我們需要一群人協助

and then they really are the backbone of the organization.

然後我們專門招募鄉村女孩

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

他們是整個組織的骨幹

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

他們執行幾乎所有需要技巧的例行工作

With the result we have very high productivity,

他們一次做一件事情,他們做的相當的好

very high quality at very, very low cost.

這樣的結果我們得到了非常高的產能

So, putting all this together, what really happened was

非常好的醫療品質同時成本非常的低

the productivity of our staff was

所以整個來說,真正的結果是

significantly higher than anyone else.

我們的員工的生產力

(Applause)

遠高於其他任何人

This is a very busy table,

(掌聲)

but what this really is conveying is that,

這是一個非常忙碌的檯子

when it comes to quality, we have put in

但是實際上傳遞的

very good quality-assurance systems.

就醫療品質來說,我們放入了

As a result, our complications are significantly lower

一個非常好的品質管理系統

than what has been reported in the United Kingdom,

因此我們這手術的併發症是相當的低的

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

比在英國手術的併發症報告還低

(Applause)

而你不容易看到這樣的數據

So the final part of the puzzle is,

(掌聲)

how do you make all this work financially,

這個謎題的最後一部份是

especially when the people can't pay for it?

該如何讓這樣的工作收支平衡

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

尤其是當這些人無法付錢的時候

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

我們所做的其實是我們提供許多免費服務

nothing more, and often much less.

然後那些付錢的人,我指的是,他們以當地市價支付

And we were helped by the market inefficiency.

不會比較高,而且通常是便宜很多

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

然後我們得到市場低效的幫助

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

我想即使至今都是超級省錢王

what you have as a surplus.

當然我們需要保持樂於付出的心態

The result has been, over the years,

我們所擁有的只是額外的

the expenditure has increased with volumes.

多年來這樣的成果是

The revenues increase at a higher level,

開銷與客流量一同增加

giving us a healthy margin

收益增加到更高的比例

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

給了我們很棒的利差

I think in absolute terms,

當你免費治療大量的人的時候

last year we earned about 20-odd million dollars,

我指的是絕對的價值

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

去年我們賺了約2千萬美金

(Applause)

花了1千3百萬美金,這樣大約是百分之40的淨利加上孳息

But this really requires going beyond what we do,

(掌聲)

or what we have done,

要做到這樣需要我們超越極限

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

或是挑戰我們自己

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