TEDIndia 2009
Thulasiraj Ravilla: How low-cost eye care can be world-class
Thulasiraj Ravilla: Dunya standardlarinda goz bakimi nasil dusuk maliyetle gerceklestirilir
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Hindistan' da devrimsel nitelikteki Aravind Goz Saglik Sistemi milyonlarca kisinin gormesini sagladi. Thulasiraj Ravilla tedavi masraflarini asagi indirirken, kaliteyi yukari ceken dahice yaklasimi ele aliyor ve neden bu yaklasimin insana verilen butun hizmetlerin hizmetlerini bastan yeniden dusunulmesi gerektigini tetikledigini anlatiyor.
Thulasiraj Ravilla - Vision activist
Thulasiraj Ravilla is the executive director of the Lions Aravind Institute of Community Ophthalmology, helping eye-care hospitals around the world build capacity to prevent blindness. Full bio
Thulasiraj Ravilla is the executive director of the Lions Aravind Institute of Community Ophthalmology, helping eye-care hospitals around the world build capacity to prevent blindness. Full bio
Double-click the English transcript below to play the video.
00:15
Good morning.
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Iyi gunler
00:17
I've come here to share with you an experiment
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Buraya sizinle bir deneyi paylasmaya geldim
00:21
of how to get rid of one form of human suffering.
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Bir izdirabin nasil ortadan kaldirildigi
00:25
It really is a story of Dr. Venkataswamy.
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Bu aslinda Dr. Venkataswamy'in hikayesi
00:28
His mission and his message is about the Aravind Eye Care System.
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Onun misyonu ve mesaji Aravind Goz Saglik Sistemi ile ilgili
00:34
I think first it's important for us to recognize what it is to be blind.
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Sanirim once kor olmanin ne demek oldugunu anlamamiz onemli
00:39
(Music)
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♫Muzik caliyor♫
00:43
Woman: Everywhere I went looking for work, they said no,
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Kadin: Ise basvurdugum her yerden olumsuz yanit aldim
00:47
what use do we have for a blind woman?
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Kor bir kadin bizim isimizi gormez
00:50
I couldn't thread a needle or see the lice in my hair.
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igneye ipligi geciremiyordum veya sacimdaki biti goremiyordum
00:53
If an ant fell into my rice, I couldn't see that either.
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Eger pilavimin icine bir karinca dusse, goremezdim.
00:57
Thulasiraj Ravilla: Becoming blind is a big part of it,
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Thulasiraj Ravilla: Kor olmak burada onemli
00:59
but I think it also deprives the person of their livelihood, their dignity,
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fakat korluk insanlari bir gecimden yoksun birakiyor onurunu zedeliyor,
01:04
their independence, and their status in the family.
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baskalarina bagimli hale getiriyor, aile icindeki statusunu etkiliyor
01:07
So she is just one amongst the millions who are blind.
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O dunyadaki milyonlarca kor insandan biri
01:11
And the irony is that they don't need to be.
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Isin aci taraflari onlar kor olmak zorunda degiller
01:14
A simple, well-proven surgery can restore sight to millions,
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Basit kanitlanmis ameliyatlar milyonlarca insanlarin tekrar gormesini saglayabilir
01:18
and something even simpler, a pair of glasses, can make millions more see.
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ve daha basit birsey bir gozluk, milyonlarca daha insanin gormesini saglayabilir
01:23
If we add to that the many of us here now
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Eger, su an buradaki bircogumuzu
01:26
who are more productive because they have a pair of glasses,
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yani gozlukleri oldugu icin daha uretken olanlarina hesaba katarsak
01:30
then almost one in five Indians will require eye care,
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Neredeyse bes Hintliden birinin goz tedavisine ihtiyaci var
01:33
a staggering 200 million people.
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sasirtici sekilde 200 milyon insan
01:36
Today, we're reaching not even 10 percent of them.
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Bugun, biz bunlarin anca yuzde 10'una ulasabiliyoruz
01:40
So this is the context in which Aravind came into existence
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Iste bu baglamda Aravind ortaya cikti
01:43
about 30 years back
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Yaklasik 30 yil once
01:46
as a post-retirement project of Dr. V.
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Dr. V'nin bir emeklilik projesi olarak
01:49
He started this with no money.
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Bu ise hic parasiz basladi
01:51
He had to mortgage all his life savings
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Butun hayati boyunca biriktirdigi paraya ipotek koydurmak zorunda kaldi
01:54
to make a bank loan.
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bankadan borc para almak icin
01:56
And over time, we have grown into a network of five hospitals,
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Ve zamanla, buyuduk ve 5 hastane olduk
02:00
predominately in the state of Tamil Nadu and Puducherry,
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Agirlikli olarak Tamil Nadu and Puducherry eyaletlerinde
02:04
and then we added several, what we call Vision Centers
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sonra baskalari da eklendi ve "Vision Centers" dedigimiz
02:08
as a hub-and-spoke model.
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merkez-koordinasyon modeli ortaya cikti.
02:10
And then more recently we started managing hospitals
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Ve yakin zamanda hastaneleri yonetmeye basladik
02:13
in other parts of the country
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Ulkenin diger bolgelerinde
02:15
and also setting up hospitals in other parts of the world as well.
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ve dunyanin diger bolgelerinde de hastaneler kurduk
02:19
The last three decades,
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Son 30 yilda
02:21
we have done about three-and-a-half million surgeries,
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Uc bucuk milyon ameliyat yaptik
02:25
a vast majority of them for the poor people.
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Bunlarin buyuk cogunlugu fakir insanlardi
02:29
Now, each year we perform about 300,000 surgeries.
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Simdi yilda 300.000 ameliyat gerceklestiriyoruz
02:34
A typical day at Aravind, we would do about a thousand surgeries,
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Ortalama bir gunde Aravind'de 1000 ameliyat yapiyoruz
02:38
maybe see about 6,000 patients,
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yaklasik 6.000 hastayi da muayene ediyoruz
02:42
send out teams into the villages to examine, bring back patients,
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Hastalari muayene edip, onlari getirmeleri icin koylere gorevlileri gonderiyouz
02:47
lots of telemedicine consultations,
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bir cok tele-tip konsultasyonu yapiyoruz
02:50
and, on top of that, do a lot of training,
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Butun bunlarin uzerine bir cok egitim veriyoruz
02:53
both for doctors and technicians who will become the future staff of Aravind.
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Ileride Aravind calisani olacak doktorlar ve teknisyenler icin
03:00
And then doing this day-in and day-out, and doing it well,
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ve bunu hergun basariyla yapiyoruz
03:04
requires a lot of inspiration and a lot of hard work.
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Bol bol ilham ve cok calisma gerekiyor
03:08
And I think this was possible thanks to the building blocks
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ve sanirim bu mumkun. Dr. V.nin yerlestirdigi temel taslar
03:11
put in place by Dr. V.,
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sayesinde
03:14
a value system, an efficient delivery process,
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bir degerler systemi, etkili bir surec yonetimi
03:18
and fostering the culture of innovation.
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ve bir yenilikcilik kulturu
03:21
(Music)
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♫(Muzik)♫
03:29
Dr. V: I used to sit with the ordinary village man because I am from a village,
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Dr. V: Ben bildiginiz bir koyluyle oturuyordum cunku ben de koyluyum
03:33
and suddenly you turn around and seem to be in contact with his inner being,
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ve birden birseyler olur ve kendi ic sesini duymaya baslarsin
03:37
you seem to be one with him.
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O sesi dinlersin
03:40
Here is a soul which has got all the simplicity of confidence.
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Itimatin basitligini iceren bir ruh bu
03:45
Doctor, whatever you say, I accept it.
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Doktor, sen ne dersen, kabul ediyorum
03:48
An implicit faith in you
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Kapali bir inanc bu
03:50
and then you respond to it.
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ve buna cevap veriyorsun
03:52
Here is an old lady who has got so much faith in me, I must do my best for her.
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Iste bana inanan bir yasli hanim, onun icin elimden geleni yapmaliyim
03:57
When we grow in spiritual consciousness,
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Ruhani bir farkindalik icinde yetisirsek,
04:00
we identify ourselves with all that is in the world,
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biz kendimizi bu dunyadaki herseyle tanimlariz,
04:03
so there is no exploitation.
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boylece somuru olmaz
04:06
It is ourselves we are helping.
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Biz aslinda kendimize yardim ediyoruz
04:09
It is ourselves we are healing.
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Biz aslinda kendimizi iyilestiriyoruz
04:17
(Applause)
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(Alkislar)
04:23
This helped us build a very ethical and very highly patient-centric organization
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Bu bize etik ve hasta merkezli bir kurum kurmamizi sagladi
04:29
and systems that support it.
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bunu destekleyecek sistemler kurmamizi da
04:31
But on a practical level, you also have to deliver services efficiently,
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Fakat uygulama seviyesinde, hizmetleri etkili bir sekilde vermelisiniz
04:37
and, odd as it may seem, the inspiration came from McDonald's.
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ve, garip gozukse de, bize McDonald's ilham verdi
04:41
Dr. V: See, McDonald's' concept is simple.
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Dr. V: Bakin, McDonald's kavrami cok basit
04:45
They feel they can train people all over the world,
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Dunyadaki herkezi egitebileceklerine inaniyorlar
04:53
irrespective of different religions, cultures, all those things,
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din, kultur gibi faktorler gozetmeksizin
04:56
to produce a product in the same way
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bir urunu ayni sekilde uretip
05:00
and deliver it in the same manner
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ayni sekilde teslim edebilmek icin
05:03
in hundreds of places.
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yuzlerce yerde
05:05
Larry Brilliant: He kept talking about McDonalds and hamburgers,
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Larry Brilliant: Surekli McDonalds ve hamburgerler hakkinda konustu,
05:07
and none of it made any sense to us.
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ama dedikleri bize alakasiz geldi
05:13
He wanted to create a franchise,
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bir franchise yaratmak istedi
05:16
a mechanism of delivery of eye care
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bir goz tedavisi saglama mekanizmasi
05:19
with the efficiency of McDonald's.
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McDonald's etkililiginde
05:22
Dr. V: Supposing I'm able to produce eye care,
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Dr. V: Farzedelim, ben goz tedavisi yapabilirim
05:24
techniques, methods, all in the same way,
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teknikler ve yontemler hep ayni sekilde
05:28
and make it available in every corner of the world.
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ve bunu dunyanin her kosesinde bulunabilir hala getirmek
05:31
The problem of blindness is gone.
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Korluk problemi cozulur
05:34
TR: If you think about it, I think the eyeball is the same,
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TR: Eger dusunurseniz, goz kuresi ayni
05:37
as American or African,
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Amerikali ya da Afrikali
05:39
the problem is the same, the treatment is the same.
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Problem ayni, tedavi ayni
05:42
And yet, why should there be so much variation in quality and in service,
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Oyleyse, neden servis kalitesinde bu kadar farklilik var
05:46
and that was the fundamental principle that we followed
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bu takip ettigimiz temel prensibimizdi
05:49
when we designed the delivery systems.
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tedarik sistemlerini tasarladigimizda
05:52
And, of course, the challenge was that it's a huge problem,
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ve, tabi ki, buradaki zorluk karsimizdaki devesa problem,
05:55
we are talking of millions of people,
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Milyonlarca insandan bahsediyoruz,
05:58
very little resource to deal with it,
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cok az kaynak kullanarak
06:01
and then lots of logistics and affordability issues.
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ve bircok lojistik ve yeterlilik problemleri.
06:05
And then so, one had to constantly innovate.
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Ve daha sonra, Surekli yenilikcilik yapilmaliydi.
06:08
And one of the early innovations, which still continues,
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ve, ilk yeniliklerden biri, ki hala devam ediyor
06:11
is to create ownership in the community to the problem,
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cemiyetin problemi sahiplenmesini saglamak,
06:15
and then engage with them as a partner,
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ve onlari bir ortak olarak isin icine katmak
06:18
and here is one such event.
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ve iste bir ornek olay
06:20
Here a community camp just organized
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iste yeni kurulmus bir cemiyet kampi
06:23
by the community themselves,
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cemiyet uyeleri tarafindan kuruldu
06:26
where they find a place, organize volunteers,
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burada yer edindiler, gonullu aktiviteler organize ediyorlar
06:29
and then we'll do our part. You know, check their vision,
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ve sonra bizde kendi uzerimize duseni yapiyoruz, goz kontrolu yapiyoruz
06:34
and then you have doctors who you find out what the problem is
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ve sonra problemi tespit edecek doktorlariniz var
06:37
and then determine what further testing should be done,
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ve daha sonra hangi testlerin yapilmasi gerektigini belirliyorlar
06:40
and then those tests are done by technicians
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ve sonra bu testler teknisyenler tarafindan yapiliyor
06:45
who check for glasses,
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gozlukleri kontrol ediyorlar
06:49
or check for glaucoma.
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veya glukom'u kontrol ediyorlar
06:53
And then, with all these results, the doctor makes a final diagnosis,
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ve sonra, butun bu test sonuclarina gore doktor teshisi belirler
06:57
and then prescribes a line of treatment,
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ve tedavi icin recete yazar
07:00
and if they need a pair of glasses, they are available right there at the camp site,
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ve eger gozluge ihtiyaclari varsa, gozlukler hemen kampta tedarik ediliyor
07:04
usually under a tree.
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genelde bir agacin altinda.
07:06
But they get glasses in the frames of their choice,
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Fakat, istedikleri cerceveleri olan gozlugu alirlar
07:09
and that's very important because I think glasses,
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ve bu cok onemli cunku, bence gozlukler
07:12
in addition to helping people see,
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sadece insanlarin gormelerini saglamaz
07:14
is also a fashion statement, and they're willing to pay for it.
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ayni zamanda modadir ve insanlar buna para odemeyi kabul ediyorlar
07:22
So they get it in about 20 minutes
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Boylece 20 dakika icinde isleri gorulmeye baslar
07:25
and those who require surgery, are counseled,
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ve ameliyata girecek olanlara talimatlari verilir
07:28
and then there are buses waiting,
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ve onlari bekliyen otobusler
07:31
which will transport them to the base hospital.
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onlari merkez hostanelere gotururler
07:34
And if it was not for this kind of logistics and support,
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Ve eger bu cesit lojistik ve destek yapisi olmasaydi
07:39
many people like this would probably never get services,
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bu insanlar gibi bircogu muhtemelen gerekli hizmetleri
07:42
and certainly not when they most need it.
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ve kesinlikle en cok ihtiyac duyduklari zaman alamayacaklardi.
07:46
They receive surgery the following day,
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Ertesi gun ameliyat oluyorlar,
07:50
and then they will stay for a day or two,
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ve bir-iki gun kaldiktan sonra,
07:53
and then they are put back on the buses
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tekrar otobuslere binip
07:55
to be taken back to where they came from,
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geldikleri yere geri donuyorlar,
07:58
and where their families will be waiting to take them back home.
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ve aileleri onlari evlerine goturuyor
08:03
(Applause)
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(Alkislar)
08:09
And this happens several thousand times each year.
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Ve bu her yil binlerce defa olur
08:14
It may sound impressive that we're seeing lots of patients,
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Kulaga etkileyici geliyor, bircok hastaya bakiyoruz,
08:17
very efficient process,
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cok etkili surecler,
08:19
but we looked at, are we solving the problem?
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fakat bizim dikkat ettigimiz su: problemi cozuyor muyuz?
08:23
We did a study, a scientifically designed process,
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Bilimsel olarak yapilmis bir calisma yaptik
08:25
and then, to our dismay,
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ve kaygilanrici bir sekilde
08:27
we found this was only reaching seven percent of those in need,
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ihtiyaci olan insanlarin sadece yuzde yedisine ulasabildigimizi gorduk,
08:32
and we're not adequately addressing more, bigger problems.
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ve daha buyuk problemlere yeterli bir sekilde egilmiyorduk.
08:36
So we had to do something different,
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Birseyleri farkli yapmamiz gerekiyordu
08:38
so we set up what we call primary eye care centers, vision centers.
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ve birinci basamak goz merkezleri dedigimiz gorme merkezlerini kurduk
08:43
These are truly paperless offices
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Bunlar tamamen kagitsiz ofisler
08:45
with completely electronic medical records and so on.
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tamamen elektronik hasta kayitlari ve benzerleri
08:49
They receive comprehensive eye exams.
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Kapsamli goz muayenesi yapiliyor
08:52
We kind of changed the simple digital camera into a retinal camera,
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basit bir dijital kamerayi retinal kameraya donusturduk
08:56
and then every patient gets their teleconsultation with a doctor.
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ve sonra her hasta doktoruyla uzaktan gorusme yapabilir
09:02
The effect of this has been that, within the first year,
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bir sene icinde bunun etkisini gorduk
09:06
we really had a 40 percent penetration in the market that it served,
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Ilgili pazarin yuzde kirkina girdik
09:11
which is over 50,000 people.
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50.000'den fazla insan
09:13
And the second year went up to 75 percent.
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ikinci yil yuzde 75'e ulastik.
09:15
So I think we have a process by which
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Bence sureclerimiz
09:17
we can really penetrate into the market
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ilgili pazara girmemizi
09:19
and reach everyone who needs it,
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ve ihtiyaci ulan insanlara ulasmamizi sagliyor
09:22
and in this process of using technology, make sure
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ve teknolojinin kullandigi bu surecte
09:25
that most don't need to come to the base hospital.
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bircok kisinin merkez hastanalere gelmesi gerekmiyor.
09:28
And how much will they pay for this?
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ve bunun icin ne kadar para oduyorlar?
09:30
We fixed the pricing, taking into account
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Fiyatlari sabitledik, sehre gelmek icin
09:33
what they would save in bus fare in coming to a city,
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odenecek otobus ucretini de dikkate alirsak,
09:37
so they pay about 20 rupees, and that's good for three consultations.
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yaklasik 20 Rupi odenmesi gerekiyor, bu ucret 3 muayeneyi kapsiyor
09:41
(Applause)
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(Alkislar)
09:44
The other challenge was, how do you give high-tech
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Diger zorluk ise yuksek teknolojiyle
09:47
or more advanced treatment and care?
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ileri tedavi ve bakim hizmeti nasil verirsiniz?
09:50
We designed a van with a VSAT,
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Icinde VSAT cihazi ilan bir minibus tasarladik,
09:53
which sends out images of patients to the base hospital
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merkez hastanelere goruntu gonderiyor
09:57
where it is diagnosed,
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Hastanede teshis konuyor
10:00
and then as the patient is waiting, the report goes back to the patient,
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ve sonra hasta beklerken, sonuc hastaya ulasiyor,
10:04
it gets printed out, the patient gets it,
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yazici ciktisi hastaya verilir,
10:07
and then gets a consultation about what they should be doing --
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ve ne yapmalari gerektigi tembih ediliyor
10:10
I mean, go see a doctor or come back after six months,
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Demek istedigim, doktoru gormeye git, alti ay sonra tekrar gel
10:13
and then this happens as a way of
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Bu teknolojik
10:15
bridging the technology competence.
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yeterliligi kullanarak yapiyoruz
10:20
So the impact of all this has been essentially one of growing the market,
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bunun bir etkisi esas olarak marketin buyumesi oluyor
10:24
because it focused on the non-customer,
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cunku henuz musteri olmayanlara odaklaniyoruz
10:27
and then by reaching the unreached,
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ulasilmayana ulasarak,
10:30
we're able to significantly grow the market.
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pazari onemli olcude buyutebildik
10:32
The other aspect is how do you deal with this efficiently
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Obur taraftan, etkililigi nasil saglarsiniz
10:36
when you have very few ophthalmologists?
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sadece az sayida goz doktorunuz varsa?
10:39
So what is in this video is a surgeon operating,
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bu videoda bir cerrah'in ameliyatini goruyorsunuz
10:42
and then you see on the other side,
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diger tarafta ise
10:44
another patient is getting ready.
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baska bir hasta hazirlaniyor
10:46
So, as they finish the surgery,
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devam eden ameliyat biter bitmez
10:49
they just swing the microscope over,
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sadece mikroskopu obur tarafa geciriyorlar
10:52
the tables are placed so that their distance is just right,
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masalar dogru bir sekilde yerlestiriliyor,
10:56
and then we need to do this, because, by doing this kind of process,
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ve bunu boyle yapmamiz gerekiyor, cunku boyle yaparak,
10:59
we're able to more than quadruple the productivity of the surgeon.
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cerrahlarin uretkenliklerini dorde katliyoruz.
11:04
And then to support the surgeon,
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ve cerrahi desteklemek icin,
11:06
we require a certain workforce.
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belli bir is gucune ihtiyacimiz var.
11:09
And then we focused on village girls that we recruited,
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ve koyde yasayan kizlari istihdam ettik,
11:13
and then they really are the backbone of the organization.
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ve onlar gercekten kurumumuzun belkemigi
11:16
They do almost all of the skill-based routine tasks.
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Onlar hamaratlik gerektiren butun rutin isleri yapiyorlar.
11:20
They do one thing at a time. They do it extremely well.
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Ayni anda tek birsey yapiyorlar. Onu da cok iyi yapiyorlar.
11:23
With the result we have very high productivity,
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Sonucta, cok yuksek uretkenlik gostedik
11:26
very high quality at very, very low cost.
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yuksek kalite, dusuk maliyete.
11:31
So, putting all this together, what really happened was
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Butun bunlari bir araya getirdigimizde, burada olan su
11:34
the productivity of our staff was
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calisanlarimizin uretkenligi
11:37
significantly higher than anyone else.
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baskalarindan bariz daha fazlaydi
11:40
(Applause)
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(Alkislar)
11:46
This is a very busy table,
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Bu tablo cok kalabalik,
11:48
but what this really is conveying is that,
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fakat burada bahsedilen
11:50
when it comes to quality, we have put in
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konu kalite oldugunda,
11:52
very good quality-assurance systems.
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cok iyi kalite guvence sistemleri koyduk.
11:55
As a result, our complications are significantly lower
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Sonucta, bizim komplikasyon oranlarimiz
11:58
than what has been reported in the United Kingdom,
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Britanya'da bildirilenden bariz daha dusuk,
12:01
and you don't see those kind of numbers very often.
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ve boyle rakamlari her zaman goremezsiniz.
12:04
(Applause)
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(Alkislar)
12:06
So the final part of the puzzle is,
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Boylece, bulmacanin son parcasi
12:08
how do you make all this work financially,
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butun bu isi ekenomik olarak nasil yaparsiniz
12:11
especially when the people can't pay for it?
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ozellikle, insanlar size para odeyemezken?
12:14
So what we did was, we gave away a lot of it for free,
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Peki, ne yaptik, biz ucretsiz yaptik,
12:18
and then those who pay, I mean, they paid local market rates,
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ve odeyebilenler, yani, yerli pazar tarifesi uzerinden
12:21
nothing more, and often much less.
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daha fazla degil, cogu zaman daha az
12:23
And we were helped by the market inefficiency.
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Ve pazarin etkisizliligi bize yardimci oldu.
12:26
I think that has been a big savior, even now.
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Bence bu buyuk bir kurtarici idi, simdi bile.
12:29
And, of course, one needs the mindset to be wanting to give away
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ve, tabiki, elinizdeki fazlaliligi vermeye donuk bir zihin
12:33
what you have as a surplus.
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yapisina ihtiyac var
12:36
The result has been, over the years,
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Sonucta, yillar boyunca,
12:38
the expenditure has increased with volumes.
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masraflar yukluce artti.
12:40
The revenues increase at a higher level,
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Gelirler daha fazla artti,
12:42
giving us a healthy margin
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bize saglikli bir marj birakti
12:44
while you're treating a large number of people for free.
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bir cok insana ucretsiz olarak tedavi ederken.
12:48
I think in absolute terms,
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Mutlak anlamda
12:50
last year we earned about 20-odd million dollars,
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gecen yil, 20 milyon dolardan fazla kazandik
12:53
spent about 13 million, with over a 40 percent EBITA.
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yaklasik 13 milyon harcadik, EBITA yuzde 40.
12:58
(Applause)
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(Alkislar)
13:06
But this really requires going beyond what we do,
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Fakat bu bizim yaptiklarimizin otekisine gitmemizi gerektiriyor,
13:09
or what we have done,
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veya simdiye kadar yaptiklarimizin
13:12
if you really want to achieve solving this problem of blindness.
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Eger gercekten korluk sorununu cozme isini basarmak istiyorsaniz,
13:15
And what we did was a couple of very counter-intuitive things.
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Ve bazi yaptigimiz seyler sezgilere (mantiga) tamamen uygun degil.
13:19
We created competition for ourselves,
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Biz kendimize rekabet yarattik,
13:22
and then we made eye care affordable
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ve sonra goz tedevisini karsilanabilir yaptik
13:25
by making low-cost consumables.
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sarf maliyetlerini dusuk maliyetli hale getirerek
13:28
We proactively and systematically
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Proaktif ve sistematik olarak
13:31
promoted these practices to many hospitals in India,
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bu uygulamalari Hindistan'daki bir cok hastaneye getirdik,
13:35
many in our own backyards and then in other parts of the world as well.
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cogu bizim yakinimizda ve bazilari dunyanin baska taraflarinda.
13:38
The impact of this has been that these hospitals,
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Bunun bu hastanalere etkisi ise
13:42
in the second year after our consultation,
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bizim konsultasyonumuzun ikinci yilinin sonunda
13:45
are double their output
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verim ikiye katlandi
13:47
and then achieve financial recovery as well.
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ve finansal iyilesme de var.
13:53
The other part was how do you address
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Diger bir konu da bu basariyi
13:56
this increase in cost of technology?
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teknolojinin maliyetine ragmen nasil saglarsiniz?
14:00
There was a time when we failed to negotiate
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Bir zamanlar yaptigimiz gorusmelerde
14:03
the [intra-ocular lens] prices to be at affordable levels,
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intraoküler fiyatlarini dusurmeyi basaramadik,
14:05
so we set up a manufacturing unit.
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boylece uretim birimimizi kurduk.
14:09
And then, over time, we were able to bring down the cost significantly
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ve sonra, zamanla, maliyetleri ciddi bir sekilde dusurebildik
14:13
to about two percent of what it used to be when we started out.
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yaklasik ise basladigimizdeki maliyetlerin yuzde ikisine
14:18
Today, we believe we have about seven percent of the global market,
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Bugun, kuresel pazarin yuzde yedisine sahip oldugumuza inaniyoruz,
14:22
and they're used in about 120-odd countries.
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120'den fazla ulkede kullaniliyorlar.
14:26
To conclude, I mean, what we do, does it have a broader relevance,
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Sonucta, bizim yaptigimizin daha kapsamli etkileri olabilir mi
14:31
or is it just India or developing countries?
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yoksa sadece Hindistan ve gelismekte olan ulkeler mi?
14:36
So to address this, we studied UK versus Aravind.
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bu soruyu yanitlamak icin Britanya ile Aravind'i karsilastirdik.
14:43
What it shows is that we do roughly about 60 percent
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Bize gosterdi ki biz yaklasik olarak
14:46
of the volume of what the UK does,
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Britanya'nin yaptiginin buyukluk olarak yuzde 60'ini yaptik,
14:49
near a half-million surgeries as a whole country.
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ulke olarak yaklasik yarim milyon ameliyat yapiyorlar
14:52
And we do about 300,000.
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biz yaklasik 300,000 ameliyat yapiyoruz.
14:55
And then we train about 50 ophthalmologists
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ve biz yaklasik 50 goz doktoru egitiyoruz
14:58
against the 70 trained by them,
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onlar yaklasik 70 goz doktoru egitiyorlar,
15:01
comparable quality, both in training and in patient care.
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egitim ve goz bakiminda denk kalite
15:04
So we're really comparing apples to apples.
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biz elmalarla elmalari kiyasliyoruz
15:07
We looked at cost.
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Maaliyetlere baktik
15:09
(Laughter)
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(Gulmeler)
15:11
(Applause)
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(Alkislar)
15:17
So, I think it is simple to say
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Bence soylemesi kolay olan
15:19
just because the U.K. isn't India the difference is happening.
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Britanya, Ingiltere olmadigi icin bunlar oluyor demek
15:23
I think there is more to it.
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Bence bunun otesi var
15:25
I mean, I think one has to look at other aspects as well.
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Demek istedigim, diger boyutlara da bakmak lazim.
15:27
Maybe there is --
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Belki de
15:29
the solution to the cost could be in productivity,
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maliyet sorunun cozumu uretkenliktir,
15:33
maybe in efficiency, in the clinical process,
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belki klinik sureclerde etkililik,
15:36
or in how much they pay for the lenses or consumables,
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veya lensler ya da sarf malzemelerine neden odedikleridir
15:39
or regulations, their defensive practice.
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veya yonetmelikler, savunucu uygulamalar.
15:42
So, I think decoding this can probably bring
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Yani, bence bunu cozmek
15:45
answers to most developed countries
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bircok gelismis ulkedeki yanitlari ortaya cikarir
15:50
including the U.S., and maybe
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ABD de dahil, ve belki de
15:52
Obama's ratings can go up again.
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Obama'nin reytingleri tekrar artabilir.
15:55
(Laughter)
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(Gulmeler)
15:59
Another insight, which, again, I want to leave with you,
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Diger mesaj size vermek istedigim,
16:03
in conditions where the problem is very large,
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buyuk problerin bulundugu sartlarda
16:06
which cuts across all economic strata,
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butun ekonomik tabakalari etkileyen
16:08
where we have a good solution,
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iyi bir cozum var
16:11
I think the process I described,
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Bence benim tarif ettigim surec,
16:13
you know, productivity, quality, patient-centered care,
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bildiginiz, uretkenlik, kalite, hasta merkezli bakim,
16:17
can give an answer,
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bize yanit olabilir
16:20
and there are many which fit this paradigm.
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ve bu paradigmaya uyan bicok yanit var.
16:22
You take dentistry, hearing aid, maternity and so on.
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discilik, isitme cihazlari, annelik ve bunlar gibi.
16:25
There are many where this paradigm can now play,
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Bu paradigma bicok yerde ise yarar
16:28
but I think probably one of the most challenging things
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fakat belki de en zorlu konular
16:30
is on the softer side.
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nazik tarafta.
16:32
Now, how do you create compassion?
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simdi, nasil merhamet olusturursunuz?
16:34
Now, how do you make people own the problem,
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Simsi, nasil insanlarin problemlere sahip cikmasini saglarsiniz,
16:36
want to do something about it?
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onlarin [iclerinden gelerek] bu problemler icin bir sey yapmalarini saglarsaniz?
16:38
There are a bit harder issues.
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Daha zorlu konularda var
16:40
And I'm sure people in this crowd can probably find the solutions to these.
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Ve, ben eminim bu gruptaki insanlar buna cozumler gelistirebilirler.
16:44
So I want to end my talk leaving this thought and challenge to you.
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Boylece, ben konusmami bu dusunceyle sonuclandirmak ve size bir cagri yapmak istiyorum
16:47
Dr. V: When you grow in spiritual consciousness,
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Dr. V: Ruhani bir farkindalik icinde yetisirsek,
16:50
we identify with all that is in the world
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biz kendimizi bu dunyadaki herseyle tanimlariz,
16:53
so there is no exploitation.
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boylece somuru olmaz.
16:56
It is ourselves we are helping.
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Biz aslinda kendimize yardim ediyoruz
16:58
It is ourselves we are healing.
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Biz aslinda kendimizi iyilestiriyoruz
17:01
TR: Thank you very much.
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TR: Cok tesekkur ederiz
17:03
(Applause)
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Alkislar
ABOUT THE SPEAKER
Thulasiraj Ravilla - Vision activistThulasiraj Ravilla is the executive director of the Lions Aravind Institute of Community Ophthalmology, helping eye-care hospitals around the world build capacity to prevent blindness.
Why you should listen
As director of the Lions Aravind Institute of Community Opthalmology, Thulasiraj Ravilla is helping to promulgate the Aravind Eye Care System's exam, diagnosis and treatment model to find culturally relevant solutions to the problem of avoidable blindness throughout India, and throughout the world.
Ravilla serves as chair of the Southeast Asian arm of the International Agency for the Prevention of Blindness, and is head of Vision 2020: The Right to Sight, a global initiative for the elimination of blindness. He developed the LAICO-Aravind Eye Hospital Care System, and continues to lead it.
Thulasiraj Ravilla | Speaker | TED.com