Journal Entry: February 18, 2009; Bangalore, India.

Dr. Devi Shetty did not answer his mobile phone when I called him. Instead a very pleasant man did and then politely asked me to wait a minute while he handed it to its owner. When I finally met Devi Shetty I realized that this was quite a common occurrence.

I was struggling with a pad of paper and a pen, balancing a phone on my shoulder in the back of a taxi that was trying to maneuver past both a cow and a tractor in Bangalore while Devi Shetty asked me to meet him the next morning at eight and was giving me directions. Then he was gone. I dropped the phone into my lap and furiously scribbled what I thought were the directions to Narayana Hrudayalaya when my driver interrupted and said “don’t worry madam. I know where it is.”

Narayana Hrudayalaya is a hospital founded less than a decade ago by heart surgeon Dr. Devi Shetty. Prior to building this hospital, he had cared for Mother Theresa in the latter years of her life as she suffered from heart disease. I was to discover from our conversations this time that this relationship with Mother had profoundly affected him and had ultimately led him to discover his life’s purpose: delivering healthcare to the poor.

I have visited Dr. Shetty on a number of occasions over the past few years. And in conversations with people I know in Bangalore, I have always asked if they have heard of him. They all have in one way or another. They described him as a compassionate man and speak of him with awe. They call him a good man but also a very smart businessman. Yet even though he is now quite famous, I have found there is very little written about him.

This week’s visit I arrived in the lobby of Narayana Hrudayalaya in the early morning. It had been two years since my last visit here. I was struck again by how not like other hospital lobbies it was. It was filled with people bustling around, talking and laughing while some sat quietly in waiting room seats and stared intently at me as I got my bearings. I looked for the reception desk and spied it almost immediately. For a few minutes I observed the chaos behind the counter. There were about four or five men and women, some seated, some jumping up and down answering phones and speaking with people who were leaning over the counter. I approached a young woman and handed my business card to her saying I was here to meet Dr. Shetty. “For a consultation?” she asked. No, I answered, just a visit.

Within a few minutes a man came to find me and took me at a quick trot dodging around people of all ages, through a maze of hallways and stairways until we ended in a series of quiet rooms that led to a large corner office with glass on two sides.

The room was brightly lit with a view to a garden outside. One corner of it had been cut off from the rest by a wall. On it was a painting of what appeared to be young goddesses running with cows in a field. There was a small door in the wall which led to what appeared to be a sleeping area. In front of the painting was a massive wood desk. A large plastic model of a heart was mounted on a stand and centered on the desk. There was a credenza against one wall with a framed quote of Margaret Mead’s which read “Never doubt that a small group of committed people can change the world. Indeed, it’s the only thing that ever has”. Next to it was a photograph of a man and his wife and four children. What caught my eye however was a photograph of Mother Theresa, smiling, with her hands in prayer. Next to that was a small altar.

I made myself comfortable in a chair and was left alone. As the quiet descended on the office, I became aware of the faint sound of a chanting coming through speakers somewhere in the room. It was barely audible but it was soothing. I waited. Some time passed before quietly the door to the office opened and my host slipped in to greet me.

Devi Shetty was a tall and very handsome man. He walked into the room quite deliberately but gracefully and smiled shyly. He was dressed in scrubs with a blue surgical cap on his head and a mask hanging from around his neck. He wore a white doctor’s coat with “Devi” written on the chest and on his feet were slippers. But what was most familiar were his eyes. He looked at me directly and intently but also gently, if that were possible. There was a sort of peace that filled the room as soon as he spoke. I was not entirely sure if it was due to my imagination, the chanting, or if it was the man himself.

“Come”, he said as he led the way to the seats in front of his desk. The door to the office opened and a man walked in with a cell phone in his hand. He approached the desk and hovered behind the doctor. He murmured something across his shoulder to which Devi Shetty responded with a nod. Another door opened and someone else appeared with a tea in lovely porcelain tea cups. They were set down in front of us. Devi Shetty adjusted the model of the heart on his desk to he could see me better. Without much introduction he began speaking almost as if we had somehow interrupted his train of thought that day and he was now letting me in on the running monologue in his mind.

“In the old days in the village there were rich people and there were poor people.” He said. “If you were rich you had a bigger house. But life, birth, illness and death happened equally to all. Now, you can buy life and postpone death if you have money. But if you are poor, you are ignored.” He looked at me for a moment and paused. “You see, everyone is aspiring now to make money and to improve their life. And even if they have not yet achieved it they still have hope and dreams that they will.”

He tilted his head to one side and furrowed his brow as he continued ” But someday they will realize through some kind of event that they will never get there nor will their children and that realization will turn into anger and frustration.” I had not said a word, but I nodded my head slowly. Then Devi Shetty looked me straight in the eye and said “Today’s terrorism is a trailer to the main event. If we don’t give back out of the goodness of our hearts, then we must give back to avoid this from happening.”

I smiled in what I hoped looked like understanding, but I was wondering why he had chosen to share this viewpoint with me in the first few minutes of our meeting.

Suddenly he seemed to focus on my reason for being there, “So it is nice to see you again, and how is your father?” he smiled at me. I replied that we were all well. He then asked me about the book I was writing and I explained to him my mission in doing it. He nodded his head thoughtfully and in agreement.

“Now what are your plans for the day?” he asked. I replied that I had nothing firm planned as I had hoped to spend as much time with him as possible to learn as much as I could for the writing of my book. “Then let me propose that you shadow me today, come everywhere with me and along the way when there are breaks we can speak about your questions,” he offered.

I could hardly believe my good fortune. I could only have dreamed of this opportunity. I had met Devi Shetty on a number of occasions and from that I was beginning to construct his life story and how he was now delivering healthcare to the poor all over India. But to have the opportunity to see him actually work was unimaginable.

“You will have to change from your street clothes as I would like you to come to my first surgery with me.” He paused surveying me for a minute, ” Do you have difficulty with seeing open bodies on the operating table?” he asked.

Frankly, I had no idea if I would have difficulty with that or not. I had never seen an open body on the operating table. The last open body I saw was during the dissection of a frog in 11th grade biology class. But I was quick to answer that I would be just fine.

I was quickly led from the room and escorted by a young woman through a series of hallways and stairways and finally into a small grubby locker room. It was the women’s changing room and in there I found a small group of curious nurses who eyed me cheerfully and asked where I was from.

After changing into dark blue scrubs with “visiting doctor” embroidered on a patch on my chest, I was led again through the twisting hallways until I found myself next to a row of four operating theatres. Through the large plate glass windows I could see each separate operation taking place. There were doctors in masks and scrubs leaning intently over operating tables and bodies cloaked in blue cloths.

I was shown into the farthest room where Dr. Shetty was already busy performing surgery. He looked up as I walked in. “Come Nancy. Come see what we are doing.” I came closer to the table being careful to walk around the machinery and the collection of tubes that seemed to be transporting blood to and from the body on the table.

“This is a four month old child who has a hole in the heart. If he is not operated on before he is eight or nine months he will be inoperable. He will not get better”, he explained. I stood at the head of the operating table and peered over a sheet which had been hung between the machinery and the patient. The entire body of the child was covered in a blue sheet, but there was a square opening in the cloth that revealed a small cavern of human flesh and organs. And right in the center of this small receptacle was a beautiful bright red round heart. It was tiny; the size of a small apricot, but it glistened in the light as Dr. Shetty gently moved it to find the hole in question. I watched as he, with deft and caring fingers, isolated the point he was looking for and began slowly to stitch it closed.

I who had never seen anything like this in person before was suddenly overwhelmed by calmness and then an unmistakable feeling of wonder.

The day progresses better than I could have imagined. We found ample time to talk about his life and his life’s work. While I kept prodding him on personal questions about why he decided to make one decision or another, he gracefully kept trying to deflect the conversation away from himself and onto the work he and his team were doing the people for which they were doing it.

He was educated in India and trained as a heart surgeon in London. After many years he returned to India in part for personal reasons and in part because he was made an offer which seemed difficult to refuse. Had he stayed in London he most certainly would have continued on the path to become a top heart surgeon. His work ethic and skill set him apart from others early on and there was great promise for him. Much against the advice of some of his seniors, he decided to return to India.

Back in India he was surgeon to many wealthy Indian patients, but he also insisted on performing heart surgeries for free for poor children. Over time he became increasingly disturbed by the number of poor children he could not treat, whom he had to turn away because there was no money to fund their operations.

It was about this time that he met Mother Theresa whom he cared for while she struggled with her own heart ailments. While observing him one day working with children, she recognized in him something which she shared with him, saying: “I know why you are here. To relive the agony of children with heart disease. God sent you to this world to fix it”

Perhaps it was his encounter with her, or perhaps he was just open to the message, but soon after Devi Shetty returned to his home state and started building a heart hospital with the objective of being able to provide heart operations for the poor regardless of ability to pay. Of course this was not easy. For how does one build such a sophisticated practice when there is little hope that your patients will ever be able to pay for the services. Additionally there was no notable health insurance plan that would pay for services either.

Today Devi Shetty says that you cannot build proper healthcare from the bottom up, meaning you cannot start with primary care and build from there. You must start with tertiary care (specialties, operations, sophisticated procedures) and use that to help fund the development of primary care (general doctor visits). The money is in the tertiary care part. He realized that if he could operate a tertiary care facility that generated revenues for services, managed costs ruthlessly, there might be something left over to help fund free operations and services for the poor. That is how it all began.

He assembled a team of top heart surgeons in India who shared his vision of delivering healthcare to India’s massive poor population and together in 2001 they created Narayana Hrudayalaya, translated into English means “God’s Compassionate Home”.

Within 4 years their hospital had 500 beds and 10 operating rooms (today there are twice as many in use), 2 cardiac catheterization labs and a blood and valve bank. Two years after the hospital opened, he launched a Telemedicine Network (in partnership with the Indian Space Research Organization) whereby doctors could consult with patients all over India while the results of their angiograms and other tests were transmitted via satellite from one location to another in real time. All for free. Today there are 54 Telemedicine centers around the country and over 18,000 patients have been treated this way. Because many of the peasant farmers in rural areas cannot afford to take time off to visit a doctor in a major center to be tested for heart problems, Devi Shetty launched mobile coronary care units that travelled from village to village offering cardiac panel testing. Over 12,000 people have partaken in this in the past few years. They also deployed Telephone ECG centers all over the country to which patients could go to have tests done as well. Over 100,000 people have taken advantage of this service.

In 2003, only a couple of years after the hospital opened. Devi Shetty created the Yeshwini Health Insurance Scheme whereby for the equivalent of $2.00 a year, an individual could receive health insurance for major and minor surgical procedures and some outpatient services at participating government and private hospitals. Today there are over 3 million of India’s poor who participate in this but it is just beginning to take off. The program is self funding and as such provides the much needed revenues for his hospital as well as others in the network. The program is administered now by a third party and the local post offices have become payment centers and card issuers.

Over time Devi Shetty’s dream grew to include other medical specialties including neurosurgery, pediatrics, orthopedics, eye specialties etc. Within the month, he will be opening a new major cancer hospital as well.

Just before I left for India this time to visit with him, I read that he has plans to create a health city in Mexico to serve those who cannot afford top level healthcare.

I have been fascinated by this man since I first met him and have sought to understand how he has done all this. I cannot help but wonder who he really is and what truly motivates him when times get tough, which no doubt they do and often.

He believes passionately that what he does must be financially viable or it will not be sustainable. He does not run a charity; he does not want to depend on philanthropy to keep his dream going. It is frankly too important to be subject its viability to the ability of a few donors to support.

This does not mean however that he will not facilitate those who do want to donate to the cause. Rather than taking donations for the institution itself, there is the option to donate to the patient directly. It is called “Have a Heart”. A donor can choose to pledge a certain dollar amount (usually $1,000 – $2,000) to pay for surgery for a patient in need. Once the pledge is made, the hospital can call on them at any time for the money, explaining who specifically it is for and what is the procedure. In this way, those who donate, give directly to the patient not to the operation.

The cost of surgical procedures in this hospital are about half of what they are elsewhere in top tier state of the art hospitals in India and compared to the US for the same operation with the same medical equipment and a doctor with similar credentials, it is less than 20% of the cost. How is this done? With a ruthless attention to cost control, lower salaries and sheer volume of operations which helps to spread the fixed costs across more patients, Devi Shetty and his team is able to deliver healthcare to the rich and the poor and not turn away those who cannot pay.

In writing this book, I have questioned many times the motives of people like Devi Shetty who devote their lives to curbing the suffering of others at seemingly their own expense. I wondered as he gave up a potentially lucrative and high profile career in the UK, if he ever regrets it. I wonder too whether he does this because he wants to be famous or if he enjoys the spotlight.

But I know now that none of this is true. He is a man who is so completely fulfilled because he is doing what God put him here to do and he knows this for certain. There is absolutely no doubt in his mind. His view on material goods is that he has more than enough already and that if anything it can be shared further. In fact, most of us would do well to share more of what we have for as he told me, we do not “own these things”, we are merely custodians of the things we “own”. They are not rightly ours and in the end they will all be taken away from us anyway when we die. If only more among us would accept that the “things” we think are rightly ours are really not, but belong to all of us, then perhaps we could solve many more problems than we already have.

He is absolutely convinced that in his lifetime we will solve the issues of affordable and accessible healthcare in the developing world. Unfortunately there is no evident solution for the problems of healthcare in the developed world he notes with a sad smile (at least not one he is going to tackle in this lifetime).

As far as fame, he shuns it. He has tried to convince me to write about his hospital, not about himself. But I have demurred saying that it will be through knowing him as a human being and not a God, that others will be inspired to do something similar.

He too hopes this will be the case.

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One Response to Journal Entry: February 18, 2009; Bangalore, India.

  1. znagorski says:

    A beatiful, human story that makes you feel s mal and inadequate. It is also a story that uplift one’s spirit and in some way restore faith in humanity

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