GDL - Piramal Foundation » Health

Eye Camp follow-up this week

Ashish — Mon, 07 Apr 2008 02:10:05 +0000

All of GDL is getting together to organize the follow-up to the eye camp this week. The camp was held March 9th, and the follow-up is being held 30 days later this Wednesday, April 9 2008. The major logistical challenge will be to remind the 59 patients from far-flung *dhaanis* (and no phone connections) to come for the follow-up eye examination. We are planning to be creative about this: using Word of Mouth through our personal & Piramal e-स्वास्थ्य (Piramal e-swaasthya – a rural healthcare initiative by Piramal Healthcare) networks where possible, and brute force (i.e. two men on a motor-bike) where that’s not possible. It should be a straightforward procedure lasting 2-3 minutes to check for how well the eye is repairing, as well as check for refraction and prescribe eyeglasses to those needing it. The eyeglasses will be provided free-of-cost to the patients too.

BDWI – Up and running with a few leaks

Naman Shah — Sat, 02 Feb 2008 15:59:19 +0000

Things did not go exactly as planned last week. Due to some unforeseen circumstances (mechanical malfunctions, hiring of employees, etc.), the BDWI distribution center launched on Friday instead of Monday. The launch itself revealed leaks in our system – literally speaking. Parts of the tank system have sprung small leaks and we are now facing a drainage problem. Moreover, after a couple days of sales, I have a list of additions that are needed in order be functioning smoothly. I hope to address the drainage situation, leaks, and other small problems in the next couple days.

On a happier note, in our two days of operation we have signed up 28 customers. Word of our services is spreading steadily. To expedite the process, I will be launching a large marketing campaign this week. The campaign will include meeting with community leaders, hanging posters throughout Bagar, and providing water samples at large events. The goal is to have 125 pre-paid customers signed up by the end of this week.

This goal of is part of a larger target: establishing self sufficiency of the BDWI center. I will be traveling back to the US for about 12 days next week and need to ensure operations can continue (and grow) without me during that time. The 125 customers and marketing campaign will put BDWI at critical mass and allow for growth with minimal intervention. Fixing the problems with the actual center will be integral in maintaining operations. My biggest challenge will be accomplishing all of this in the span of a week.

BDWI – Filter Installed

Naman Shah — Sat, 26 Jan 2008 13:59:33 +0000

After a week of running around, the filtration unit has finally been installed. We are still missing a high pressure pump, but that should be installed by the end of today. Operations will begin on Monday morning.

With the plant’s installation complete, this week is going to focus on identifying potential entrepreneurs to run our distribution network. Our plan is to empower a few talented and business savvy individuals to deliver BDWI’s 10 L jugs door to door. For each delivery, the water distribution entrepreneur (WDE) will receive a set fee of Rs. 1. The more jugs they deliver, the more money they will make. This should give them sufficient incentive to sign up additional clients. We will be providing them with a loan to purchase carts that can be used to deliver large quantities of jugs at one time. We estimate that each WDE can deliver around 100 jugs a day, resulting in a monthly income of 3000 rupees.

The challenge is going to be identifying WDE’s with entrepreneurial drive who can push our product. I have already lined up interviews with 4 potential candidates for this weekend. In the case that none of them are suitable for the position, I will meet with community leaders who can provide additional candidates. Additionally, I will need to find a place to purchase handcarts so that distribution can start immediately after WDEs are selected. I hope to have the network setup by the end of this week.

Here are some before and after pictures of the BDWI Distribution Center:

Before:

After:

BDWI – Completion of Renovation and Looking Forward

Naman Shah — Mon, 21 Jan 2008 16:54:35 +0000

Renovation on BDWI’s first distribution center is nearing completion. The renovation has taken longer than expected, but the result has been worthwhile. The building has gone from a defunct shack to an acceptable storefront. I have also managed to secure a charity classified three phase power connection from the Jhunjhunu district government. The infrastructure is now in place. All that remains is installation and inauguration of the plant which is tentatively scheduled for the 23^rd.

With the plant installed and up and running, my biggest challenge is reaching full capacity quickly. Reaching capacity will go a long ways towards proving that the model is sustainable, socially beneficial and good investment for prospective entrepreneurs. This will facilitate the spread of BDWI throughout Jhunjhunu and hopefully India.

My deadline for reaching full capacity on the first plant (6000L/day or 300 families) is February 15^th. While there is already a buzz about this project in Bagar, converting this buzz into regular clientele is going to be challenging. I first plan to establish a method of delivering the water into communal areas such as the markets. Establishing a regular presence in the markets and other high traffic areas will expose the community to our services and result in a significant number of clients. Additionally, I plan to supplement delivery services with a town wide campaign to educate Bagar about the benefits of drinking clean water. This will involve leveraging our relationships with community leaders to pass out informational packets and to hold informal meetings. Being aggressive is going to be the key. If I am aggressive, I am confident that I will meet and beat the February 15^th deadline.

BDWI Renovation Update -

Naman Shah — Sat, 05 Jan 2008 17:35:53 +0000

Renovation work on the Bagar Drinking Water Initiative (BDWI) facility is coming along nicely. The masons have just finished tearing down all the old plaster walls which were falling apart. They are now working on putting up new walls. Already the atmosphere inside has changed – it now feels like a newer, cleaner building.

Next, we will be renovating the roof to stop water leakage, installation of secure gates and shutters to protect our investment and painting the interior and exterior of the building to give it a business feel. I think that these improvements will easily happen this week.

My biggest challenge is still arranging the three phase power connection to run the unit. I am trying to get an NOC (stamp of no objection) so that we can get the connection. I have visited the Nagar Palika numerous times, and each time they want additional documents. Hopefully, I will be able to get everything resolved on Monday and continue with the electricity application process.

Just in case everything does not work as planned, we are arranging to have a temporary three phase electricity connection put in. The temporary connection will serve us while our papers are still being processed. This will ensure that we are ready to launch on January 16^th (changed from the 15^th because of a holiday).

Starting the Bagar Drinking Water Initiative

Naman Shah — Sat, 29 Dec 2007 13:28:51 +0000

So we are starting construction on the Bagar Drinking Water Initiative after a long wait. The first BDWI plant needs to be up and operational by the 15^th of January which does not leave me too much time. The biggest hurdles I’m facing right now is obtaining a three phase electricity connection on a charitable contract and organizing renovation of the BDWI storefront for a decent price.

Normally getting the three phase connection for commercial or charitable purposes takes over a month. We are trying to expedite the process by working with the Jhunjhunu district government. Right now, it seems like it will take about 10 days, which will allow me to meet the deadline. It’s going to be tricky arranging this connection and getting the electrician to put it in on time, but it should be doable.

As far as renovations are concerned, I spoke with a contractor today and am realizing how clueless I am when it comes to construction work and prices in India. I was blown away by the quoted price even after negotiation. The materials themselves will cost more than our original budget. I am going to have to rethink the renovation plan to reduce prices. Over the next couple days I am meeting with various contractors and hopefully will be able to figure out how proceed with the renovation.

Overall, I am really excited about actually starting construction work. It will be satisfying to finally see something tangible and to start delivering clean drinking water to Bagar’s population.

Developing a plan of action for the Water Filtration Project

Naman Shah — Thu, 27 Sep 2007 03:16:33 +0000

The goal of this week was to develop a plan for the implementation of the GDL’s new water filtration project that will serve the Bagar area. Here is a little background on the project: India’s contaminated water is responsible for a large percentage of illnesses faced by both rural and urban populations. Bagar’s water is no different. With high levels of fluorides and biological contamination, the water is a source for many illnesses through the year with peak levels occurring during the monsoon season. Additionally, buildup of fluoride through the life of an individual can result in adverse effects in bone, brain development and teeth (1). It is not uncommon here in Bagar to hear stories of individuals who have skeletal fluorosis, a crippling bone disease (2). These illnesses can easily be reduced through introduction of basic water filtration. Our aim is to provide safe drinking water to the entirety of Bagar at a low, affordable price of RS 0.2 ( $0.005) per liter including delivery costs. The goal of this week was to understand the needs of our intended water plant and to find a way to meet these needs through the infrastructure of Bagar. With this information, I also wished to create a plan of action for setting up this project.

The goal for this week was successfully met. I was able to determine that our current water supply here in Bagar will be unable to match the demands of the filtration system. However, through discussions with the local water works and the district collector I have come up with alternate plans of meeting the systems demands and continuing with the project. With this information I have come up with a project plan as follows. First, I will obtain and test samples from Bagar’s 3 major well pumps that service the area. Following this, I will survey the population to determine an effective pricing point. Additionally, this survey will also serve as a method of educating the public about the dangers of drinking contaminated water and as a tool for advertising our upcoming service. Following this survey, I will be working directly with the water works and the Jhunjhunu Public Health Engineering Department (PHED) to establish a low cost supply of water sufficient for our needs. With a supply established, I will then proceed to have the water filtration unit setup and distribution started. The next step is now to have Bagar’s water tested and distribute my survey to 200 families.

My largest hesitation with the project and its plan are pricing and issues of scalability. Even at our current forecasted rate of RS 0.2 per liter, it will cost a family of eight, 240 rupees per month for drinking water. This price may still be too high to allow us to reach a large percentage of Bagar’s population. Additionally, arrangement of our current water supply is contingent on the government in this area. With the intention of scaling the project to different areas, we may not be able to rely on the government and therefore may not be able to replicate our model throughout India. For more information on water contamination in India and its effects on health, please visit the following sites

(1) http://www.environmentalhealthnews.org/newscience/2007/2007-0705wangetal.html#cdc
(2) http://fluoridealert.org/fluorosis-india.htm
http://ddws.gov.in/bharatnirman/water_1.html

Introduction and Mobile Medics

Naman Shah — Wed, 05 Sep 2007 07:41:47 +0000

Hi, my name is Naman Shah and I will be pursuing healthcare focused work here at the GDL. My main project involves innovation of the Mobile Medics service based out of Pilani, Rajasthan. Mobile Medics is a for profit business model to bring healthcare services to underserved rural India. Much of rural India is unable to seek proper healthcare due to transportation costs, lost wages, and improper practitioners. Over the last 4 months, Mobile Medics has been providing quality, private sector primary healthcare to 4 villages in the Pilani area for a total of 12,000 villagers and is currently expanding to 10 villages. However, the current business model is not profitable due to low patient volume and is therefore unsustainable. My goal here at the GDL is to make Mobile Medics into a sustainable model by raising patient numbers and lowering costs. Moreover, I intend to scale the service to serve large tracts of rural India, and in the process provide reliable healthcare to villagers across India.

This week, my main goal was to get a first hand experience of Mobile Medics both administratively and out in the field. By the end of the week, I wanted a list of 5 plausible changes that over the next 3 months will raise patient numbers to a profitable level. Currently, there is one pilot Mobile Medic van visiting a total of 10 villages every 3 days. However, the van is not performing at full capacity and is not seeing the expected patient load. We believe that the lack of patients is mainly due to lack of trust. By understanding exactly how Mobile Medics works and delivers services to villagers, I have drafted a plan of action involving 15 changes to the current model that hopefully will allow Mobile Medics to establish brand name, inspire trust in the local area, and thereby become sustainable. My “Big Hairy Audacious Goal” (BHAG) for the project is to make the Mobile Medics model sustainable and scalable throughout India with 100 villages being served by the end of the year. Hopefully through establishment of brand and trust, Mobile Medics will see a large increase in patient volume that allows them to sustain their services and continue to serve rural India.

I believe that I was able to meet my goal of 5 changes and perhaps surpassed. After a full day’s ride along with the Mobile Medics, I was able to get a good feel for the environment in which the company operates. I was also able to realize a few inefficiencies in the operations that will be quick fixes and hopefully will provide a small boost to patient volume. Additionally, through analyzing the Mobile Medics business plan and discussion with their administrators, we have come up with some interesting solutions and expansion ideas that could greatly increase patient volume over the next couple months. The next step is implementation, which is going to be the real challenge in the upcoming weeks.

Currently, we hope to implement these changes in the next 3 months. We aspire to use these 3 months to turn around Mobile Medics and make a significant push towards sustainability in the Mobile Medics model.

Anemia awareness…part deux!

GDL Admin — Wed, 08 Aug 2007 11:30:04 +0000

My goal for my first week in Bagar was to understand the work Lisa did in Jhaatavas and to assess the effectiveness of the tests done and medicine distributed before. Lisa tested 123 people overall. The average women’s HB count was ~9.5 and 89 of the women had an HB count 10 and were anemic. This week I wanted to test at least a third of those considered anemic and given medicine to see whether the women’s awareness of anemia and if the medicine had had any effect. The overall idea is that since we will only be doing one more anemia camp, we want the Jhaatavas community to continue to be aware of anemia, its symptoms & effects, and how to prevent future cases on its own.

I made good progress for achieving my weekly goal. I spent time reading all of Lisa’s research and test results and wrote up a report summarizing the awareness campaign. I procured the testing equipment, learned how the HB test is done, and hired the lab technician to do retests. I worked with a guide to make a map of Jhaatavas and to go to areas of Jhaatavas that we hadn’t reached. I built really good rapport in Jhatawas, especially with Dulichandji family and made over 50 household visits. During my Jhaatawas visits I increased interests in more women for getting tested at the next camp and spread awareness about anemia. There were some challenges. For instance, the retesting took longer than planned because everyone was very friendly and would want to talk and offer us chai. We will finish the last half of the tests sometime next week

Next week, I have big goals for conducting a second anemia camp. I also will wrap up the retesting and write a report on my findings.

For future development, I have learned that logistically it might be best to do these sort of campaigns during the summer months when kids don’t have school and when it is not the rain season since all the women are busy in the fields.

Anemia project wrap-up

Lisa — Sat, 23 Jun 2007 06:40:05 +0000

I was aiming to accomplish three main goals this week: 1) to retest all the women in my group to see how much higher their Hemoglobin counts are after taking iron pills for two months; 2) to put an ad in the local paper outlining the successes of this group in Jatavas; and 3) to conduct the town-wide health survey.
I was able to retest 7 of the 10 women in the group this week and the results were excellent! All 7 of the women had increased their HB counts by at least 2.6 g/dL, and up to 4.2 g/dL. Most of the women were able to feel the difference in their energy level and some reported relief from other more concrete symptoms like numbness in the hands and feet. Much to my dismay, there were a couple in the group whose HB counts did rise, but did not report any noticeable differences in their health. In fact, the woman with the highest HB difference thus far (at 4.2 g/dl, from 8.8 g/dl to 13 g/dl) said she does not notice any difference. This is unfortunate because much of this study was based on the hope that women would feel less tired and weak after the iron pills and therefore understand that they were not taking care of their health previously. I was unable to test the three remaining women because they are currently out of town but I am hoping to get their post-study HB counts next week before my departure. I am hoping to see equally promising results in these remaining three women.
In order to give these women a sense of pride in their active participation in this study, I wanted to publish an article about their achievement in the local newspaper. I decided to push this goal back to next week simply because there are three women left to be tested and I would like to include their names in the paper but do not want to proceed until they have been tested and I have been able to ask their consent. In anticipation of printing this article, I did ask all the women that I retested if I would be able to publish their names in the paper, as well as a group picture of them all. I was pleasantly surprised to see most of them receive the question with a bashful smile, and the approving nod that followed showed a sense of pride that surpassed my expectation. My hope was that this experiment would increase anemia awareness within the group and hopefully instill a general importance of women’s health. Although empowerment was not an operating objective, I realize now that this is a critical success that came out of the study.
In addition to wrapping up the anemia awareness project, I was hoping to conduct the health survey by the week’s end. Unfortunately, this goal was not met for several reasons. I had a pilot survey conducted before proceeding further and this process took up more time than I had anticipated. In addition, the pilot revealed some significant shortcomings in the survey which have required time to remedy. I am hoping to have the survey completed by the end of Tuesday, June 26th. This will give me a couple days to compile and analyze the results. .