Dr Thiruvalluvar on Health Management

Read Time:16 Minute

Dr. Murugusundram, Founder & Medical Director, Chennai Skin Foundation, expounds on the timeless, practical advice offered by Thiruvalluvar in areas such as maintaining physical and mental well-being, making lifestyle choices, and practicing overall health.

During Covid, I started reading Thirukural. Being a doctor, I could find a medical pearl in every couplet. Thirukural is a book beyond comparison and it has gems of wisdom related to every field. It has been translated into so many languages. It covers spirituality, philosophy, ethics, self-discipline, leadership, political diplomacy, management, legality, justice, friendship, family, death, love, lust… and the list goes on and on.

Thirukural is brought out in three parts. The first part talks about virtues, the second part covers wealth and the third part covers love or lust. Even in the third part on love, Thiruvalluvar’s couplets carry a lot of medical wisdom and are more therapeutic in nature. I sincerely wish that Thirukural should be part of every medical curriculum.

Nowhere does the author prescribe a medicine for any disease. He dwells on understanding the root cause of the disease and how one can prevent it. Also, for every aspect of management, there is at least one couplet. I looked at Thirukural from the health care management perspective. Though, every couplet can be interpreted and applied in several fields, I chose to relate its relevance to the field of medicine. So let me dwell on a few couplets from Thirukural and give my own interpretations on the same, using a doctor’s hat.

Managing Stress

மலர்மிசை ஏகினான் மாணடி சேர்ந்தார்
நிலமிசை நீடு வாழ்வார்
The flower of the heart is where the flawless lord dwells

That belief ensures long healthy life.

Valluvar has a simple remedy for managing stress. If you firmly believe that God dwells in your heart, you will not hurt that heart by stressful thoughts. This is an antidote of toxic stress.

தனக்குவமை இல்லாதான்தாள் சேர்ந்தார்க் கல்லால்
மனக்கவலை மாற்றல் அரிது
His feet, whose likeness none can find,
Alone can ease the anxious mind.

Valluvar says, ‘Surrender to a person who is unique and has no comparison.’ The unique person can be God, parents, guru, wife, son or daughter, friend or your boss. When you surrender to such a person, you will be free from anxiety. When I get stressed out, I would go to my guru and just sit in front of him. I would not discuss my problem nor would he ask me about it. We would just chat for half-an-hour and at the end of that chat, I would be totally relaxed. Normally we say that when we have a problem, we must transfer our burden to God. Valluvar suggests that you can transfer your stress to a mentor and that mentor could be anybody, who is unique in their own way.

Controlling One’s Senses

ஒருமையுள் ஆமைபோல் ஐந்தடக்கல் ஆற்றின்
எழுமையும் ஏமாப் புடைத்து.
Five senses controlled like a tortoise 
Such are protected in seven births.

Tortoise is the longest living creature in the world. Those who can control their five senses like a tortoise will be assured of a long and healthy life in poise, not just in this birth but in all his seven births (This is a belief according to Indian mythology).

சினமென்னும் சேர்ந்தாரைக் கொல்லி இனமென்னும்
ஏமப் புணையைச் சுடும்.
Anger destroys everyone around you like fire

Never spares even your life’s last savior.

When we get angry in office, our colleagues will move away from us. When we lose our temper in home, our children will shy away from us. Slowly, we start losing our friends. When we start drowning in the sea of anger, someone close to us (perhaps, the spouse) may come to our rescue but our anger will destroy even such a savior. So, control your anger, for a healthy and peaceful life. 

The Power of Meditation

கூற்றம் குதித்தலும் கைகூடும் நோற்றலின்
ஆற்றல் தலைப் பட்டவர்க்கு.
Meditation imparts mental strength

That mitigates the fear of death.

Meditation, according to Valluvar, gives peace of mind. Today, people get many auto-immune diseases. There may not be any discernable reason for such diseases other than mental stress. Mind relaxation exercises like yoga and meditation are recommended even by doctors for such diseases.

கண்டுகேட்டு உண்டுயிர்த்து உற்றறியும் ஐம்புலனும்
ஓண்டொடி கண்ணே உள.
Not only my senses but also my soul is satisfied by her

Why should my mind wander for more pleasure?

According to Valluvar, a husband should not seek pleasure beyond his wife. The institution of marriage is sacrosanct. This is the reason why Indian marriages survive even in turbulent times, while in the western countries, marriages fail often.

The Power of Digestion

மருந்தென வேண்டாவாம் யாக்கைக்கு அருந்தியது
அற்றது போற்றி உணின்.
After digestion one who feeds
His body needs no medicine.

Today, thanks to apps like Swiggy and Zomato, we order food at the tip of our fingers. We complete one meal and immediately, think of the next meal. This is the cause of many health problems. Valluvar says that you should not take food, unless the food taken earlier is completely digested by your system. Such a person who follows his advice will be free of diseases and they don’t need any medicines.

The concept of gastric-emptying time was propounded only during this century but it is a marvel how Thiruvalluvar knew of itt 2600 years ago. Every food has a certain gastric-emptying time. For example, if you take red-meat, it will take more than 4 or 6 hours to digest. A light vegetarian meal will get digested in one to one and half hours and sometimes, even within 30 minutes. Even water has a gastric-emptying time. All the nutrients are absorbed in the duodenum-jejenum-ileum path. We must give adequate time for the food to get digested and absorbed in this path.   

Eat in Moderation

அற்றால் அளவறிந்து உண்க அஃதுடம்பு
பெற்றான் நெடிதுய்க்கு மாறு.
Eat food to digestive measure
Life in body lasts with pleasure.        

Valluvar also says that even after your food is digested, you should eat only in moderation. Then only, you can live for long. What we eat should be commensurate with what work we do. If we do just desk work, we don’t need much of carbohydrates.

அற்றது அறிந்து கடைப்பிடித்து மாறல்ல
துய்க்க துவரப் பசித்து.
Know your digestion; with keen appetite
Eat what is suitable and right.

We must know about our digestive system and manage it the right way. Eating the right amount at the right time is paramount. For example, most of the Jains eat their dinner quite early and it is rare to see them obese. No food should be taken unless we are hungry. He also advises against taking foods that are contradictory in nature. Doctors recommend a balanced diet. South Indian food is generally quite balanced. Today, thanks to a sedentary life style that people lead, we recommend less of carbs and more of proteins.

இழிவறிந்து உண்பான்கண் இன்பம்போல் நிற்கும்
கழிபே ரிரையான்கண் நோய்.
As pleasure dwells with one who eats moderately

Disease dwells with the glutton (who eat voraciously)

Valluvar perhaps refers to the junk food that we take. Most people now do binge-eating. They get into depression and take huge bites of pizzas and burgers. Such people will only invite diseases.

Beware of Fake News

எப்பொருள் யார்யார்வாய்க் கேட்பினும் அப்பொருள்
மெய்ப்பொருள் காண்பது அறிவு.
To discern the Truth From everywhere;
From everyone, is real wisdom.

Today, for everything, we do google-search and rely on Google, rather than the authentic sources. Anything and everything that we hear must be vetted for correctness and that is real wisdom.

செய்தக்க அல்ல செயக்கெடும் செய்தக்க
செய்யாமை யானும் கெடும்.
Doing unfit action ruins
Failing to do the right things also ruins. 

We are generally advised against doing improper things but Valluvar also stresses on not failing to do the right things. Most of us never walk and never take food on time. To maintain good health, we must exercise and have diet-control.  

Beware of the Symptoms

பீலிபெய் சாகாடும் அச்சிறும் அப்பண்டம்
சால மிகுத்துப் பெயின்.
Even the gentle peacock’s plume
Cart’s axle breaks by gross volume.

This is generally interpreted that when a cart is overloaded, even to the extent of a peacock feather, then its axle will break. As a doctor, I feel that the cart refers to the human body. Even when we get a slight symptom, it should not be neglected and we should immediately attend to it. A simple indigestion that is neglected could lead to duodenal ulcer. It could even be a symptom of myocardial infarction. Each and every symptom can indicate a major problem and no symptom should therefore be neglected.

எதிரதாக் காக்கும் அறிவினார்க் கில்லை
அதிர வருவதோர் நோய்.
Never will you face the shock 

As long as you predict, protect and act wise.

Those who take precautions against calamities will be saved of any serious trouble. This applies more to health. If one does a master health check-up once in six months, most of the major health problems can be easily resolved at the early stage itself. A disease at a later stage or in advanced stage becomes difficult to cure.

A Capsule for the Doctors

நோய்நாடி நோய்முதல் நாடி அதுதணிக்கும்
வாய்நாடி வாய்ப்பச் செயல்.
Seek the diagnosis; search for the causes

Apply suitable remedies that alleviate the illnesses

This is one of the most powerful lessons for a doctor. A good doctor must first diagnose the patient, look for the root causes of the disease and address those causes. The treatment given should suit the patient.  Whenever we find it difficult to ascertain the cause of a disease, we would call it as ‘idiopathic disease.’ My professor used to joke, “If you diagnose some disease as idiopathic, then you are an idiot and patients who come to you are pathetic.” The duty of the doctor is to diagnose and find out the cause. 

எண்பொருளவாகச் செலச்சொல்லித் தான் பிறர்வாய்
நுண்பொருள் காண்பது அறிவு.
Speaking out thoughts in clear manner
and having a subtle sense of comprehension is wisdom.  

A doctor must patiently listen to the ill and lucidly tell the cure in a simple way. This is a skill and if the doctor explains in a way that the patient understands, then the patient feels as if he is cured.

Face is the Index of Mind

அடுத்தது காட்டும் பளிங்குபோல் நெஞ்சம்
கடுத்தது காட்டும் முகம்.
External images are seen as a mirror’s reflection        

Internal damages are shown as facial reaction

As a skin doctor, I interpret this as: If you have any health problems, it will show up in your skin. A doctor who examines skin, hair and nail properly will be able to find out many underlying illnesses. 

உற்றான் அளவும் பிணியளவும் காலமும்
கற்றான் கருதிச் செயல்.
Patient parameters, disease severity and timely intervention

Precisely direct a learned doctor to act wisely

A doctor must study the patient’s condition thoroughly, assess the severity of the disease and act in a timely way. We now say that a patient who has suffered a heart attack or a stroke must be rushed to the doctor, within the golden hour. Beyond the golden hour, the body suffers more damage. That is what Valluvar has also said.

Need for Communication Skills

இணரூழ்த்தும் நாறா மலரனையர் கற்றது
உணர விரித்துரையா தார்.
One who doesn’t explain lucidly what he learns
Is like a bunch of flowers without fragrance. 

A good doctor must be a good communicator. He must be able to explain clearly what he has learnt and diagnosed.

உற்றவன் தீர்ப்பான் மருந்து உழைச் செல்வானென்று
அப்பால்நாற் கூற்றே மருந்து.
Patient, doctor, medicine and nurse
Are equally responsible in treating a disease.

In treating a patient, not only does a doctor have a role but also, the health care workers play their parts. We observe the Doctors’ Day. I feel it should be observed as ‘Healthcare workers’ day.’

Be Smart with Gadgets

அருவினை என்ப உளவோ கருவியான்
காலம் அறிந்து செயின்
What is hard for him who acts
With proper tools and in a timely way! 

Today, so many gadgets have come up in the medical field and it is astonishing how Thiruvalluvar could have envisioned them. We have AI for robotic surgery, CT scan and many other sophisticated technologies.  If a doctor is adept in handling the latest gadgets and in a timely way, he will be quite successful.  A doctor is a messenger of faith. He should convey the right information to the patients, without losing the principle of compassion. 

கற்றுக்கண் அஞ்சான் செலச்சொல்லிக் காலத்தால்

தக்க தறிவதாந் தூது….

A learned ambassador talks impressively, is not afraid of fierce looks

He conveys what is right for that time

When a doctor treats a patient who has serious ailments, he must have the courage to tell the patient about his health condition, without the patient getting into depression. The doctor must show compassion, such that the patient is able to face the problems.

Use Common Sense

செயற்கை அறிந்தக் கடைத்து முலகத்

தியற்கை அறிந்து செயல்….
Though an expert through theoretical knowledge 

Act with common sense and in worldly ways

A doctor might have acquired many degrees and certificates but practically, he might be a zero in front of a patient. He must thoroughly understand the patient, his physical, mental and financial conditions and background and act according to that, rather than blindly applying his theory to practice. Mere theoretical knowledge does not make a doctor successful. He needs to have compassion.

தொட்டனைத் தூறும் மணற்கேணி மாந்தர்க்குக்
கற்றனைத் தூறும் அறிவு.
The deep you dig in the sand, the spring flows
The deep you learn, the knowledge grows. 

I would argue that for doctors, this relates to continuous learning and thereby gaining knowledge.

Choosing & Cherishing the Doctor

அன்பறிவு தேற்றம் அவாவின்மை இந்நான்கும்
நன்குடையான் கட்டே தெளிவு
Trust him in whom these four you see:
Love, knowledge, clarity and non-greedy

How does one choose the right doctor? Valluvar’s answer is that you must choose one who is compassionate, has knowledge, clarity of vision and thoughts and who is not greedy. When a doctor becomes greedy, the society becomes nasty. Unfortunately, we see that greed has crept into the medical profession today. 

வினைக்குரிமை நாடிய பின்றை அவனை
அதற்குரிய னாகச் செயல்.
Spot the person who is fit for duty 
Leave him to do the best he can.

Once you select the right doctor, you must trust him. Earlier, we had the concept of a family doctor who knew all about his patients. Now, we always seek a specialist. Valluvar has advocated for the family doctor, so many years ago.  

உற்றநோய் நீக்கி உறாஅமை முற்காக்கும்
பெற்றியார்ப் பேணிக் கொளல்.
Protect and Cherish the doctors of skill
Who ward and safe-guard you from ill.

According to Valluvar, a doctor who cures diseases and protects the society must be revered and taken care of. Unfortunately, we see doctors being assaulted by the family members of patients and public, when the patients’ health deteriorates. Post-Covid, people have so many health issues and if anything unfortunate happens to a patient, people think that it is a doctor’s failure. This is a dangerous trend.  

Advocating for Organ Donation

அன்பிலார் எல்லாந் தமக்குரியர்: அன்புடையார்
என்பும் உரியர் பிறர்க்கு
The loveless will love to have everything for themselves

But the selfless loving ones will give everything from skin to bones

Today, we have bone-marrow transplantation. We donate heart, kidneys, eyes and liver. It is amazing how Valluvar could think of organ donation even in those days. He says that loveless people amass everything but those who love others will not even hesitate to donate their bones.  

In Sleep, we die

உறங்கு வதுபோலும் சாக்காடு உறங்கி
விழிப்பது போலும் பிறப்பு.
Every night we die; Every day we are born

As naturally as we sleep at dusk and raise at dawn

If we understand this couplet, we will have no anxiety from any disease. Every day, when we sleep, we face a temporary death. If we wake up the next day, we are lucky and we should be happy that we are born fresh for that day. We must spend every day happily and purposefully. If we gain this philosophical mindset, we will never have the fear of death.

Profit with Purpose: The Business of Impact

Read Time:13 Minute

The future of business lies in profit with purpose. Experts explore the growing trend of social entrepreneurship and impact investing.      

Mr Sujay Ghosh

CEO, First Solar 

First Solar is one of the world’s largest manufacturers of solar photovoltaic cells. Our company is headquartered in the US. We make solar panels. You must be aware that climate change is essentially caused by the burning of fossil fuels.  Everybody needs energy to grow. Energy is a key part of our lives. We use energy to commute from home to work or to college. We use energy when we cook food. We use energy for entertainment. As our economy grows, we keep consuming more and more energy.

Environmental Toll of Fossil Fuels

When we burn fossil fuels, we get energy and they emit carbon dioxide. The carbon dioxide gets trapped in the atmosphere and it causes the earth to look like a greenhouse. When sunlight falls during the day, the heat does not get dissipated. It remains trapped. That’s what causes the temperature of the earth to rise. If the temperature of the earth rises to about one and a half degrees Celsius more than what it was before the start of the first industrial revolution, we will have permanent changes to the climate system and they will be irreversible.  

When the earth heats up, it melts ice caps. The Arctic and the Antarctic ice caps are melting and that’s driving sea levels to rise. When sea levels rise, you get extreme weather events. The cyclones which were happening once in 100 years are now happening once a month.  Extreme weather events cause cities to get flooded. Recently, Derna, a city in Libya got flooded in just 30 minutes and 30,000 people lost their lives. When a lot of rainfall happens in a very short span of time, cities built on riverbeds get washed away. We see in Manali, Kullu and Shimla massive landslides, causing damage and destruction.

Extreme weather events can cause drought. If drought happens, we won’t be able to grow food, which means there will be food crisis. We see some of that already playing out in certain countries. It’s going to become more and more acute, if the weather continues to change. So, we have to stop this, without disrupting growth. This is the single biggest problem which confronts humanity.

Climate change doesn’t select a country. Everybody is impacted and we have only one Earth. The weather system happens across the globe. The impact of carbon dioxide emission is boundaryless. Carbon dioxide, whether it is emitted from India or in China, will affect global weather the same way. 

Renewable Energy’s Cost Evolution

The only way we can stop this is by transitioning to more sustainable forms of energy. The three primary sources of sustainable energy are water, wind and sun. For hydro power, we use the natural force of the water, through a dam, run a turbine and create electricity. There are no emissions coming out of it. Likewise, when we use the force of wind, to generate electricity, there are no emissions going out. The last but not the least is photovoltaics, where we take the energy of the sun and convert it using semiconductor technology. We convert sunlight into electrons, collect the electrons and then use it to get power, without carbon emission.

Historically, till about five years ago, most forms of renewable energy or sustainable energy were expensive. When we started the solar program in India way back in 2010, when the country’s first solar mission came up, one unit of solar energy was Rs 17.60 per kilowatt hour.  At that time, one kilowatt hour of coal power was roughly four rupees. Now, the situation is different. Today’s solar generated anywhere between the two tropics, is the cheapest form of energy on the grid, at about Rs 2.60 per unit. One unit of coal power is now Rs 5.50 and diesel power is Rs 20 per unit. 

Clean Energy Transition

Globally, every country is transitioning to renewable form of energy and there are massive policies, plants and investments happening in the sector. In India, by 2030, the government has committed that 50% of our energy will come from renewable sources. At the beginning of 2010, 95% of India’s energy was from coal. Hydro power is very difficult to create, because we have to displace a lot of people to build a hydropower plant.  The Prime Minister has made a commitment that India will be net zero by 2070. That means that by 2070, we will be completely carbon free. That’s a massive transformation in our energy sector. Clean Energy Transition represents one of the most compelling opportunities, just like we had the IT boom in the early 90s.  

Reserve Bank of India estimates that we will need about 85 lakh crores between now and the end of 2030 to get to 50% renewable energy capacity. The adjacent effect of this is going to be felt on transportation and industrial manufacturing. We will be able to decarbonize our electricity grids and switch to renewable power. So far, we had only trains, which are electric. There is a very clear shift, coming in the mobility side. Two wheelers and three wheelers are now moving to electric, because it’s more affordable. The next step is going to be passenger cars and then buses. This sector will drive job employment, investment and startup opportunities. If you can directly and indirectly contribute to reduction of carbon intensity of the world, it should excite you.  

Today, the government of India is not able to find loans, either in debt or in equity, to fund new thermal power capacity. Ironically, NTPC (National Thermal Power Corporation) has pledged that they will build only renewable assets going forward and they’ll stop building coal plants. That’s the kind of transformation which is happening in this sector. It presents a very compelling opportunity to everybody.  

Ms. Gayathri Shanmugam

Chief Program Officer, Haqdarshak 

I represent a company called ‘Haqdarshak.’ It is an Urdu word that means the ‘pathway to your rights and entitlements.’ We are a very proud for-profit enterprise. We normally don’t find for-profit enterprises in the social sector and we are unapologetic about it. We want to make money out of this, so we can build a sustainable business and attract talent.  

What is the problem that we are trying to solve? The government has an annual budget of about nine lakh thousand crores for social welfare that covers sectors like Education, Health, Pensions, Insurance and Social Security. India is a social welfare state. There are a set of marginalized communities that need to be taken care of, so you can get them into the mainstream economy. The government recognizes that and spends. The question is how much of that actually reaches the marginalized? That’s the problem we’re trying to solve. Every year, almost 60 to 70% of this budget remains unutilized. How do we reduce that gap? There are two problems here. One is the problem of awareness. Many people do not know about the schemes the government has designed for them. For instance, the government gives free health insurance—the Ayushman Bharat scheme—but how many people are aware of it?  The second problem is ‘accessibility.’ Suppose I create awareness and reach millions of people below the poverty line and I’m able to communicate to them about the schemes they are eligible for. Does it solve the problem? Do they know how to apply for that scheme? Do they know how to fill up a form? Do they know which office to go to avail that scheme? That’s the problem of accessibility. So, there’s a problem of awareness. There’s a problem of accessibility. We are trying to solve these through an assisted tech model. We are a 7.5-year-old startup.

Tech Assisted Solutions

It is a technology that houses all the government schemes across the state and the country. The central government has thousands of schemes. Our country is a federal system. Every state government has its own set of schemes. These are policy documents, sitting in the form of a PDF or probably hardcopies and sometimes, not even soft copies.  If it’s a hardcopy sitting on a bureaucrat’s table, how do you get that into a format that a system can read and write?

We have a team that constantly does primary research and secondary research and captures these schemes in a format that is easily readable. We gather details such as: What is the name of the scheme? Which state is it applicable in? What are the eligibility criteria? What are the pre-requisite documents? What is the benefit? How do I apply for it? We capture that in a database. On top of that, we build a rules-engine. For instance, a woman resides in Tamil Nadu, and she has lost her husband. She is in a certain age group and belongs to a community. Her income is below a certain level. Is she eligible for a widow pension? That’s the rules engine that I’m talking about.

The Impact We Create

With this, you have easy discoverability of the scheme. What do I then do? I build a simple app, where I capture basic details about the citizen, name, age, gender, caste, community, occupation, farmer or non-farmer, health, etc. The system will then throw up what schemes that particular individual is eligible for. I would urge you all to go to Google Apps and download the Haqdarshak app. You can use this to help your own domestic help or drivers or whoever it is. You will be able to discover the schemes that the person is eligible for. At the least, we can create the awareness.  

With the Haqdarshak app, you can help your domestic help or drivers or whoever it is. You will be able to discover the schemes that the person is eligible for. At the least, we can create the awareness. 

We reached out to the remote parts of the country. We have trained community workers and self-help groups on how to use the app, to fill up the forms, to go to the government offices and submit them; to follow up with the government officer and to ensure that the benefit is actually received. So, the problem of accessibility is solved through feet on the street. We have trained about 50,000 women entrepreneurs on the ground so far. In the last seven and a half years, they have reached out to 4 million citizens, unlocking about 5,000 crore worth of benefits for these 4 million citizens. That’s our model.

The Business Side of the Model

Where’s the money in this? How is this even a business? We work with a lot of CSRs. We work with philanthropy, large foundations and corporates, who give us service delivery contracts, to go and do this on the ground. That’s where our money comes from. I found my calling in this sector and in this organization.

We have our investors. They do what is called impact investment or patient capital. They look for SRI (social return on investment). We appeared in Shark Tank India, early this year in January.  Three of the four sharks have invested in us and we’ve closed that round of investment. We pitch ourselves in the impact sector and development sector. We are not the only organization. There are a lot of organizations that are trying to do good here. There are a lot of ways one can contribute. There is Tech for Good. If you’re a tech enthusiast, you must know that we are building technology for this. If you’re an operations enthusiast, then there are problems to be solved there as well. And there is money in it.  


How do you measure and quantify the social impact that you create?

Gayathri Shanmugam: There is a framework for measuring impact. We do monitoring and evaluation. For instance, if I unlock Ayushman Bharat, which is the insurance scheme in the country, what is the possibility that the people will end up using it? For many schemes, the government has direct benefit transfer (DBT). We have a way of calculating the potential unlocked and there is a formula that is unique to every scheme. We then club all that and say for this program, that we have unlocked so much benefit. We measure the impact in terms of critical success factors. As a business, the scale, the quality of the application, the scheme diversity that we have covered, getting people out of poverty are some of the critical success factors. 

What are the challenges you foresee in scaling up renewable energy adoption in India?

Sujoy Ghosh:  Rather than challenges, I would rather say these are opportunities. Energy is a commodity and the final output has to be affordable. The first thing we look at is cost. Our solutions must be cost competitive. That is the one challenge we constantly look at. Everything across the value chain must be cost competitive. Otherwise, people will immediately switch to the next lowest cost of energy and then we lose the whole plot in the fight against climate change. The other aspect when you’re dealing with scaling up renewable energy, is that the renewable energy by its nature, is infirm power. You cannot accurately predict if the sun is going to shine or if there would be clouds tomorrow. Whenever it’s bright and sunny, you get solar power and whenever it’s windy, you will get wind power.

But as a consumer, the light should come on when we flip the switch. We want the energy to be reliable, and available on demand. That’s where there’s a gap today. For this, we need to build storage systems. If the whole world has to switch to net zero and completely go away from conventional energy, then storage would be the limiting factor.

What advice would you give to young professionals and students interested in pursuing a career in social entrepreneurship and making a meaningful impact on society?

Gayathri Shanmugam: That’s exactly why I’m here today. There are a lot of fellowships in the country, focussed on social impact, for example the Ashoka Fellowship programme. People come for internships. But you must realise that impact is created on the ground and not in offices. So, you will have to be there out on the ground, be there with the people, understand their problem and then solve for it. We are always open to internships.

In Delhi, there is an organisation called ISDM (Indian School of Development Management). They have a two-year MBA program, just for social development. Even working with small NGOs, you can learn a lot and become more socially aware. Then, you can make a conscious decision whether you want to move into this sector.

How do you navigate the market differences, working in various countries?

Sujoy Ghosh: We are a global company and operate across 45 different countries. Yes, climate change and sustainability are global concerns. Today, China monopolizes about 90% of the global supply chain for solar panels and wind turbines. They dominate in the areas of lithium battery, critical minerals, and semiconductors.  Post-covid, everyone has felt the need for resilient supply chains and most of the nations are working on it.

Innovation in Emerging Markets

Read Time:11 Minute

What is the innovative mindset of a CEO? Innovation can happenin multiple ways: It can be a sustained innovation, incremental innovation, or disruptive innovation. Mr. Velusamy R, President of Automotive Technology and Product Development, and Member of the Group Executive Board, Mahindra & Mahindra Ltd., speaks non M&M’s innovation journey at the Dr. K.C.G. Verghese Endowment Lecture held recently.

Innovation is the need of the hour. All of us innovate. When my father was ploughing the field, I never realized the plough was an innovation. With a combination of wood and a steel frame, he could plough the field. When such a development is used for business purposes, to solve larger problems of society, and to make an organization profitable, we call it innovation. For me, invention and innovation are one and the same. Discovery follows these two.

Albert Einstein wrote the equation for gravity. He said that gravity is not a force. The way you fall down is caused by the curvature of space-time. He assumed that the universe was constant. That was in 1915. Everybody thought the universe was constant and there was no accelerated expansion of the universe. Edwin Hubble, an experimentalist, went to California, set up a telescope, and was looking at it. He found out that the universe was not only expanding but accelerating much beyond the speed of light. That was a discovery. The next day, Einstein went there and physically saw that experiment. He immediately acknowledged that he had made the biggest blunder of his life. If ordinary scientists like Hubble can discover something great, you and I can also discover. That’s exactly what Steve Jobs did. He combined the phone, the music system, and the camera system and made a hefty profit from the Apple iPhones.

Innovations have happened over the years, starting with the telephone and followed by electricity, radio, color TV, microwave oven, and cell phones. We also witnessed the birth of Facebook, the internet, and many other things. You create a business and by the time you reach the peak of it, it starts falling down. You have to continuously innovate; otherwise, you will not sustain the business and you will not be able to make a value proposition. Innovations have been an integral part of human civilization from time immemorial – whether it is to solve problems, improve the quality of life, satisfy curiosity, gain a competitive edge, or leave a legacy.

The CEOs of Kodak, BlackBerry, Nokia, Hummer, Blockbuster, Xerox, IBM, and Sony lost valuable businesses because they did not listen to the ground and to their customers. It’s not about technology or competency or capital. It is the shift that is happening with customers that really matters the most. Unless you incorporate that change and reflect it in your system, process, competencies, and culture, you are not going to produce a different form of output. Nokia did not realize the importance of software. Blackberry thought that their buttons were the best things. They did not realize that customers did not want buttons. Your best product or feature could turn out to be the enemy number one for your growth. When Steve Jobs wanted his team to develop the touch-phone, in one of the design meetings, his Chief Designer said that if the touch-screen technology did not work, he had a plan B of button technology. It is said that Steve Jobs broke that button phone and said, “If we develop a touch-screen, Plan A or Plan B or Plan C–everything should be touch-screen only.” That is the innovative mindset of a CEO.

Price and Willingness to Buy

On the price front, if a customer is willing to pay $1000 for your product, your price should be $700. The gap of $300 is the motivation for the customer to buy the product and stick with you. If the price and the willingness to pay are almost the same, when competition improves the product with an incremental innovation, you will lose the market. It will lead to a dogfight between you and your competitor and you cannot survive in that market. Blockbuster did not realize that its customers were moving to Netflix. In the Blockbuster model, a customer had to take his car to go to the shop, pay in advance and take the cassette, go home and view it. If he did not return it in time, he had to pay a fine. They thought their business model was very solid. People fed them with such data. Netflix used the internet to screen movies. People could watch them from their homes. Its revenue moved from 65 million to 65 billion dollars while Blockbuster crashed from 8.4 billion to 8 million. Netflix listened to the customers. As a CEO, you must listen to the customer and understand their pain points. The day you lose the voice of the customer, you will stop innovating.

You can do innovation in multiple ways. You can keep on doing sustained innovation. That means the innovation accelerates in the beginning, like iPhones. Later, it is the brand that carries the sales rather than the innovation. You have incremental innovation. You can also come with very disruptive innovations like what was done by Netflix. This too will stabilize, beyond a point. Whichever zone you are in, you have to keep listening to the customers and keep watching what is happening in the marketplace.

At Tesla, Elon Musk was determined to do something. He is a software engineer who wanted to build a car. He’s not an automobile engineer who built a software car. He had not seen a manufacturing line. So he asked, “Why are you putting all the sheet metals and so many parts? Remove all these, have software and provide a display. Let everything be controlled by software. I can put a song for a birthday and when the person opens the car door on his birthday, the birthday song can be played.” That is innovation.

A Tesla car may not be as good as a BMW car but has unique software. The car owners need not take it to the workshop for service. All the software can be updated when the car is parked at home. That’s a big difference and a major shift in mindset. The Tesla owner Elon Musk found it out and he applied it. The other car makers were very late to detect it. Again, this suggests that it’s not that the technology you possess can win you business. It’s about knowing what the customer wants.

M&M’s Innovation Journey

At Mahindra, we were really struggling from 2012 to 2020. We made three or four products. We made Marazzo and XUV300. We wanted 10,000 per month volume but didn’t get it quite right. So we went back to the table. We studied NASA. We studied the Challenger space shuttle failure, Columbia space shuttle failure, the Apollo 13 mission and the success of Apollo 11. We got insights. We made movies. NASA is a brilliant organization. It is a hallmark of innovations but it has failures. We realized that it is not the lack of technology perfection that led to the failure of the missions. It is the culture of the organization that makes all the difference.

Whether it is the Air France flight AF447 crash of June 2009 or the Boeing 737 MAX plane crashes, a common underlying cause is the organizational culture. We did correction on the culture of listening to customers and removed the silos. Every department exists for customers. Taking Apple Computers example, if the head of the department of the phone buttons realizes that buttons are not needed for the phones, he should be the first person to tell that he will dissolve his department and give it to the touch-phone department.

We were selling 280 SUVs per month. We launched the new Thar in August 2020. We made a business case to sell 1500 units per month. We opened the booking and the demand was 6000 per month. This SUV had refinement. It had performance in all the areas—drivability, NVH, handling, music system, fuel economy, traction, and high-speed handling. Everywhere, we went beyond the hygiene requirements. If we try to perfect two things and miss out three things, customers will not accept it. Customers pay for a vehicle that has everything above hygiene. That is what we did. We listened to the customers. It was the Corona period and it took us a year to ramp it up. Now we have more than 80,000 bookings open. This vehicle, after three years, is still doing extremely well.

As the Chief Engineer, I was directly involved in the making of XUV700. Earlier, we had XUV500 and its sales came down to 1500 per month. We said our target should be 3000. I was given an open cheque. We started this program in 2018. On the fifth of July, I along with my wife went to Rameswaram after sending the budget file to our Kandivali office. As we came out of the temple, I got a call from our office and I was told that the budget was approved. That was the start date. When we came closer to August 15, 2021, we geared up for 3000 per month. But we got 50,000 bookings in just 2 hours and we stopped the bookings. In the first 50 minutes of the bookings, our software stalled because most of the bookings were made in 10 minutes. The next day, we opened it and in the first 10 minutes, once again we got thousands of bookings. We didn’t know what to do. We had six variants. 93% of the bookings were for the top two variants. We thought that in the top two variants, we could sell only 10%.

The Ducati Award

XUV700 had everything that the customer wanted. Once again, we were listening to the customers. They wanted a sunroof. They wanted a stylish headlamp. They wanted to go to a five-star hotel and get out of this car to say, ‘I have arrived.’ As a proud Indian, they wanted to have a car and say that it is manufactured by an Indian. They wanted to proudly park their car closer to BMW, Benz, and Audi. There was patriotism. There was a craving for status in them and to declare it to the world. It’s not about being arrogant or showing off. It was just a feeling of self-actualization. This car had all the safety technologies and we had the highest level of refinement. We struggled and struggled to get to that level. Innovation is the result of very hard work. If you have to prepare yourself for differentiation, you should be prepared for extreme hard work to execute it, once you have an idea of what to do. Idea is just a form of creativity. It doesn’t bring you anything unless you execute it. That’s our realization. Since then, for the last two years, 10,000 per month is the booking number that we get. It took us two years to increase our production from 5000 to 10,000 per month. This month, we sold about 9700 vehicles. It reveals the belief that the customer has shown in us. XUV700 is a car that got us the Ducati award. I was so proud to receive the award. If you create a product that resonates with the aspirations and trends of the customer, they shower you with orders, they stick to you, and they don’t run away from you. But if you don’t listen to them, they punish you by dragging your sales from billions to millions. The customer is the boss and innovation is your tool.

The next car that we worked on is Scorpio. It is always a blockbuster. When we opened bookings, in 30 minutes, we got 100,000 bookings and we stopped the bookings. It still continues and we have 10,000 per month. So we have three blockbusters. The only change that we made was the culture. Culture can inspire people. You must give complete freedom to your team, with a framework. You have to challenge them. The team is inspired when they have high levels of support and high levels of challenge in their work.

When I finished my B.Tech, I took up a job, and all I wanted to do was to satisfy my boss—because if I didn’t, I would lose my job. That was 27 years ago. Then came the engagement. In this stage, if someone gives you $30 per hour, you work for nine hours and after that you expect not to be disturbed. If one company is not there, then I have another company. In this format, you will not have any kind of innovation and willingness to listen to the customers. The other leadership style is to connect to the people and find out their strengths and their purpose in life. If your leader is able to connect the job to your purpose, give you a challenging assignment and he supports you, you will be inspired. You will come out with innovation. Inspired people give more than 200% output. You need to have the right size but you need to have extremely hardworking people. That’s the formula for innovation.

Change is the only constant in life. Dark energy and dark matter are two things behind innovation. Dark energy is your purpose. If you connect to the purpose, your speed will not be limited even by the speed of light. It will be limited only by your passion.

REAL ESTATE: Unravelling the legal framework, technology & compliance requirements

Read Time:19 Minute

Real Estate, being the second highest employment generating sector, holds significant importance in India, which is poised to become the third largest construction market in the world. However, this sector faces numerous challenges and issues.

Mr K Vaitheeswaran, Advocate and Tax Consultant:

In the pre-RERA period, there was rampant misspelling and wrong selling by a set of people. Of course, there were brilliant, genuine players across the industry, but the sector got a very bad name because of some unscrupulous and unorganized players. There were inordinate delays in delivery, issues of non-conformance to specifications, diversion of funds collected for the projects, and so on. Therefore, the Parliament felt that we need a law that completely regulates the sector, though there have been constant debates as to why you should need a law for one specific sector.

The objective of RERA is to create an authority for the regulation and promotion of real estate; bring in efficiency and transparency in the sale of real estate projects; protect the interest of consumers; and establish an effective adjudication and speedy dispute redressal mechanism. It applies to the whole of India except Jammu and Kashmir. When the law was being mooted, the Minister for Urban Development said that the real estate bill seeks to form a happy alliance between buyers and developers and that it addresses the complexities of the sector by putting in place a regulatory mechanism.

There are many developers who are guided by principles and ethics. That is why these companies are shining better. There are thousands of players in the real estate sector compared to only five or six players in the telecom sector. That was the justification of the minister for having a regulatory mechanism exclusively for the real estate sector.

RERA covers the development of land into plots or apartments as the case may be. A building may consist of apartments, which also includes the conversion of existing buildings into apartments. Redevelopment also comes under the Act. So it is important to understand that it is not just for a new project. According to RERA, the promoter is responsible, liable, and accountable. If you’re not developing for the purpose of selling, then you would not qualify as a promoter. A development authority such as a Cooperative Housing Society is also identified as a promoter.

Why is RERA significant today? A builder talks to a consumer through advertisements and people are lured by them. Now RERA says that no advertising or marketing or booking or selling or offering or inviting to purchase by a promoter can happen unless the project is registered with RERA. In the ad, the consumer can look at the RERA Registration number. If you go to the RERA website and feed that number, you will get the entire details of the project. The biggest advantage is transparency for consumers as every data about the project can be seen on the website.

Taking Care of All Stakeholders

Where the development is in phases, each phase is considered a standalone project requiring registration. In case there is an ongoing project where the construction certificate is not issued at the time of the commencement of the Act, registration must happen within three months. An application for registration is very comprehensive. RERA takes care of the consumer side and the builder side. It helps the consumer in getting the right product. The developer must give all the information in the application, which is very comprehensive and requests for authentic information and data.

RERA has an adjudicating process. Let us say an order is passed. You can appeal against the order to the adjudicating authority and escalate it to RERA appellate tribunal. RERA must publish and maintain a website of records for public viewing of all projects listed. On the website, you can see everything about the project and also about the promoter. You can know their past history, about delays or deficiency in development and delivery. RERA maintains a database for public viewing and enters names and photos of promoters who are defaulters. Even a real estate agent cannot sell a project that is not registered, and the agent must also be registered.

RERA’s Teeth

RERA get its teeth when somebody lodges a complaint. It can also, suo moto, call a promoter if it comes across discrepancies or default. It can also help the promoters, when there is a default by the allottees. It has all the powers of a civil court under the CPC plus it has the power to issue interim orders. It can issue directions, and such directions shall be binding on all concerned. The consumer can knock on the doors of RERA if something that is promised is not delivered.

RERA registration presupposes that the promoter has got all other approvals in place. The promoter must provide the development plan and details of all the facilities being offered. The location details of the project with clear demarcation of land dedicated to the project along with boundaries must be provided. They are now bringing more technology into it whereby it’s getting absolutely transparent. The entire land of the country is going to be mapped.

RERA has brought a new concept of carpet area. It is the living area in an apartment and excludes common areas, walls, and balconies. The promoter must give a declaration that he has the legal title to the land on which development is proposed.

Handling of the Funds

RERA says you must finish the project within the time you commit. The most important and interesting aspect of RERA is that 70% of the amount realized for the project has to be deposited in a separate account in a scheduled bank. This is where it ensures that funds received for one project are not misused for another purpose. Therefore, this is a very powerful and effective tool.

You can withdraw money as and when the percentage of completion increases, and for that what is required is a certificate by an engineer, a certificate by an architect, and a certificate by a chartered accountant to the effect that the withdrawal is in proportion to the percentage of completion of the project. The accounts have to be out within six months or at the end of every financial year, and the statement is required from the CA to the effect that amounts collected for a particular project have been utilized for that project and withdrawal is in compliance with the proportion to the percentage of completion. This places all the more responsibility on the Chartered Accountant certifying a project.

30 Day Deadline

RERA registration is not required when the land to be developed does not exceed 500 square meters or the number of apartments proposed to be developed does not exceed eight, including all phases. Also, if you have obtained a completion certificate prior to the commencement of the act, you don’t come under RERA. The Act also says that the authority, within a period of 30 days from the date of receipt of the application, must either grant registration or reject the application. Once registered, the authority shall provide a registration number, login ID, and password for accessing the website. If there is a failure to grant the registration or in the case of failure to reject the application within 30 days, it shall be deemed to have been registered. This puts pressure on RERA to issue registration.

You can always extend your project timeline if you’re able to demonstrate force majeure conditions that affected the project. During the COVID time, a lot of people were able to get the extension. RERA themselves voluntarily granted an extension. If a registration is revoked, the authority will debar the promoter from accessing the website in relation to that project and specify his name in the list of defaulters, display his photo, and also inform RERA in other states. This is very, very dangerous. So you can’t afford to missell, and you can’t afford not to deliver.

No major additions or alterations to the approved and sanction plan can be done unless you get the written consent of at least two-thirds of the allottees, other than the promoters.

RERA can direct the bank holding the project account to freeze the account and take further action to facilitate remaining development. But if you look at it practically, RERA’s aim is not to stop a project. Their endeavour is to ensure that the project is completed. They go out of their way to see how a settlement can be arrived at, involving the landowner, consumer, and developer, as the case may be, and in some cases, all three are involved.

Inherent Conflicts

In the real estate business, stamp duty registrations are state-specific. Unfortunately, RERA is a parliamentary law, and there are some inherent conflicts in respect of registration as per the state-level practices and what is stipulated by RERA.

Also, you cannot collect more than 10% of the cost of the apartment unless you enter into a written agreement for sale and register the agreement. Nobody wants to register a sale agreement. The construction agreement must be mandatorily registered. While the law stipulates that the promoter must get insurance for the title, it is impossible to get title insurance from an insurance company. These are some of the failures of the Act.

RERA uses the word completion certificate. In most states, there is no completion certificate. They have an occupancy certificate in some states, but CC is a concept even in GST, but CC doesn’t exist in most parts of the country.


If a promoter does not register the project, a penalty of up to 10% of the estimated cost of the real estate project can be levied. If that order is violated or even after the order, registration is not done, it can lead to imprisonment for up to three years. That is the kind of power that RERA has. For false information or giving controversial information in the application, the promoter can be levied a penalty of up to 5% of the estimated cost of the real estate project. These are all the consequences, which a real estate agent and a promoter face for failure to comply with the order or direction of RERA. There is a penalty every day, which may be cumulatively extended up to 5% of the estimated cost. These are all quite stringent and strict penalties, and the pressure is to make you comply.

The Challenges for Promoters

Where do promoters mess up? They over-promise and under deliver. They promise delivery dates which are practically not possible. The biggest challenge in real estate projects is funding. After complying with all requirements, they need funding. If NBFCs get into a problem, it impacts the real estate market immediately. Banks have a very vague approach to real estate projects. Some of the banks are very encouraging, and some of them are extremely discouraging. So funding is a huge challenge. What is the solution?

Old loan settlement, IPOs, and REITs are new solutions that are coming into the market. Of course, overseas investors can always walk in with non-convertible debentures. The second major issue is the inventory of unsold buildings, even after complying with all requirements. If we look at unsold stock in terms of units and apartments, in Q4 of 21-22, in Chennai, the unsold stock was 75,064 units. In Q4 of 22-23, it was 74,008 units. There is always a significant pileup of unsold stock that the builder deals with, and substantial money is lost here.

There are always so many pain points in the real estate business. The prerequisite for RERA registration is comprehensive planning and obtaining permission from several authorities. All of these lead to a huge increase in cost. Delays in obtaining permissions and NOC from other agencies can affect the registration. Then there is litigation. If somebody files a petition and a court admits it, it’s the end of the story. RERA could have been a single window, but it has become an additional window.

Impact of RERA

Today, all states and UTs have notified RERA, except Nagaland. 32 states have set up the RERA authority, and 28 states have set up their appellate tribunal. Regulatory authorities of 30 states have operationalized their websites. So far, 1,08,208 real estate projects have been registered so far, and in Tamil Nadu, 16,640 projects have been registered. The number of agents registered is 77,525 agents, of which Tamil Nadu’s share is 2,870. A total of 1,11,098 complaints have been received, and the maximum complaints have come from Uttar Pradesh.

To conclude, the real estate sector is in for good times, thanks to the transparency that RERA has brought in.

Technology & Sustainability in the Real Estate Industry

Ms Pavitra Sriprakash, Chief Designer and Director, Global Design Studio of Shilpa Architects

Typically, in an architectural or real estate project, the architectural work happens before we break ground. A lot of the tech tools that I manage or work with on a daily basis happen to be at the design stage. Right now, we are experimenting with AI and Blockchain. We were fairly early adopters of trying to work with BIMs (Building Information Management Systems), but AI and Blockchain are things that are much newer, even for us. So we’re dabbling with tech, once the project is tendered.

When it goes into implementation, we find that there are many construction methodologies of new technology, which are prevalent in the market today. These help in making buildings faster and more efficiently, in monitoring them better, and in giving real-time data as to what’s going on site versus what’s planned on the design front. Finally, operations and maintenance of buildings are highly tech-enabled nowadays, which can help in maintaining the building, throughout its lifecycle.

MIVA, GFRC and 3D Modulars

On the construction side, we have technology such as MIVAN, which is aluminium formwork that helps people construct faster. Many developers embrace this, because this is a very easily repeatable format and can help people cut down their construction time. We also have GFRC panels, 3D modulars, and precast.

We are able to come up with climate-sensitive, geo-sensitive, and culturally sensitive designs that help us create a more sustainable product. Thanks to digital marketing, visioning of approved projects becomes a lot easier now. We work with the metaverse and gamified realms, and as everyone has predicted, the better you are at playing games, the easier you will find getting work done. Real-time game engines are coming into the space of architectural design and visioning. So if I can dream it, I can probably get it translated into a digital image. Rather than 2D plans, such digital images delight a customer.

We use AI tools to tell us things like how much daylight is coming into the building; are we planning enough lights or are we planning enough ACs? All these can be simulated and given to us in real-time data. You can use ChatGPT to figure out the description of the building and use it in the AI for the design of the building. We tend to run into a lot of budgeting and cost overruns, and value engineering at design is important.

You can manage complex and large projects by loading all the information that exists in a very transparent space, for everyone to be able to access. So we can do things like having smart contracts, enforcing the project scope, eliminate processing fees, etc. Basically, we’re looking at rapid construction, and time is money. We use Glass Fiber Reinforced Gypsum (GFRC) panels. This is basically like a drywall system. It can be pre-loaded and made into a panel offsite. It can be brought and quickly assembled. Modular and precast systems have been around for a while. The other one is the light gauge steel frame.

MIVAN is a commercial brand name for aluminium formwork. What this means is that every floor of a building can be made into a mould and poured with concrete. Once this is done, you can take it to the next level.  As long as every floor of the building is the same, you can use MIVAN beautifully. It cuts down the curing time, and it doesn’t have to be 21 days per floor to move to the next level. It’s really a rapid way of constructing.

Monitoring through BIMS

The next part is monitoring the work that is going on at the site. We have many new apps that are coming up, which help project managers to track the project, monitor the attendance of workers and their efficiencies. You can track everything remotely. You can have an integrated design project where all team members sit in various parts of the world, but they’re still able to track that one project. We’ll also tie into the part where the auditors come in, making payments and managing the budgets. The digital twin technology is tied in with both BIMs and the modelling software. A digital twin using AI-based visualization software is loaded completely with the data of the building to be constructed, but it exists virtually.

Some of the new products tend to harness renewable energy from either solar sources or from people walking on them. Sensor-based intervention for water efficiency has been around for a while. Now we are pushing this envelope to control the environment of the entire building. We have temperature monitors, humidity sensors, and CO2 monitoring systems. All these things can be linked to the Integrated Building Management System or IBMS. This then functions with the digital twin, dishes out data about the actual efficiencies on a daily basis, and helps you manage the dashboard.

Ms M Samhita, Managing Director, Ela Green Buildings

Sustainability relies heavily on technology today. People often get confused when we talk about a sustainable building. They think it must have red brick or rammed earth or something like that. But today, we build millions of square feet in a span of a year or less than that. In that scenario, technology becomes very critical to bring in concepts of green, efficiency and climate-responsive design. For sustainable buildings, there are three phases we must look at—design, construction, and operation.

There’s a lot of push from the global market as well as our country’s leadership to achieve net zero. We’re working on green and climate-resilient buildings. Just one or two initiatives in a building like rainwater harvesting will not suffice. We need a holistic approach. We have rating systems and tools to define green buildings. The rating systems have been in place globally for a while. From the early 2000s, India slowly started adopting green building rating systems. Today, we have billions of square feet that are certified green. We have the Indian Green Building Council (IGBC) and LEED, which is Leadership for Energy and Environmental Design. The new ratings focus on the environment and also the people using the space, because that has raised more concerns post the pandemic, on building health and safety.

The next important part is Codes. In fact, India did not have an energy code for buildings until recently. It was in 2007 when the first code was developed by India. Not all of the entire country is following codes. While the rating system is a voluntary approach, compliance with codes is mandatory.

Optimisation from Modelling

There are many tools that are available today for airflow modeling and other energy-efficient design. Tamil Nadu has notified the energy conservation building code made by the Bureau of Energy Efficiency. It is still not included in the combined building rules. The implementation is still pending. It is important for designers to incorporate that.

We have many case studies of how various tools have helped us. We designed a small building of about 30,000 square feet in Nungambakkam, Chennai. We worked closely with the architect, and he asked us to come up with suggestions. Very rarely does that happen for us as consultants. Normally the design is frozen, and we are expected to work backward. We created the energy model, did a couple of iterations—one with the solar canopy and without a solar canopy, worked out various cases with high-performance glass with shading devices and without shading devices, with regular bricks and with concrete blocks and so on.

In all, we did nine cases. We could bring down the consumption from 954 megawatt-hours per annum in the worst-case scenario to 459 megawatt-hours per annum in the best-case scenario. Considering the cost involved, we settled for an optimum solution whereby we could achieve 620 megawatt-hours per annum. In the energy bill, Rs.4 lakhs was saved every month. This is the kind of impact that an energy simulation tool can give us.

Waste Management

100% of construction waste can be diverted or recycled, and it can be managed properly on-site. There are simple ways in which we can do it. One is, prior to construction, how do we ensure that the site can be prepared in such a fashion where we minimize pollution control, where we don’t have to trouble the other neighbouring sites? During construction, waste management and resource optimization are important. You can buy treated water from neighbouring sites and use it for spraying on the roadway, so that you don’t generate too much dust.

Using precast and dry construction/factory-made panels that are coming now, we can reduce waste. All this must be planned at the design stage, because the structural elements are fixed at the design stage. We can engage recycling agents and vendors who can reuse the waste materials generated on-site.

What gets measured only can get improved; otherwise, we don’t know where we stand. So technology has become very important here. We’re looking at a data-driven approach to enhance performance, and the most critical path is having a building monitoring system, where you can monitor not only energy or water consumption but also CO2, humidity, temperature, occupant well-being, satisfaction, and so many other parameters. Through continuous monitoring, we will be able to plug the leakages and improve the performance when there’s a shortfall in performance. We can even calculate how much of GHG emissions can be reduced as a result of the interventions.

In the Technical Session-3, CA V Prasanna Krishnan gave a presentation on the various GST issues in Real Estate sector. CA L Srikaanth, in Technical Session-4 spoke on the Accounting related aspects of Real Estate. In the Technical Session-5, CA T G Suresh gave an insight into Direct Taxes scenario in the Real Estate.

End of Life Planning

Read Time:5 Minute

Come learn the what, how, when and why of End of Life Planning – how to ensure that your wishes, desires, likes, preferences and values are honoured in your absence and how to translate them into a plan of action and information that your loved ones will need to make critical decisions on your behalf.

In the past three years, I have had the misfortune of being involved in helping the families of some of my friends—both in India and the US—who passed away suddenly for various reasons like undetected, undiagnosed or untreated health issues, accidents in some cases and other reasons as well. There were at least half a dozen people known to me, who were in their 40s and 50s and 60s. In every instance, I noticed that the people who were dealing with the grief and misery of the loss of the loved ones, had no idea of the person with whom they lived for a long time. They had no idea of what the person was doing, what he was worth and what assets and liabilities he had. In every single case, it takes months, and in some cases, years for the family members to go back and reconstruct their life. It is not just about financial matters.

We have lots of information in our own heads which nobody else knows. It is stunning when you go through the process of helping people who are going through this problem. The last event happened on Jan 8, 2023, and I made a resolution that I am not going to have anyone suffer this sort of problem anymore. I have made it my mission to share information on the ‘end of life planning,’ so people can plan around it and ensure that their own mission and values are maintained or at least known and executed by their loved ones, in their absence. 

It’s not an entertaining topic, but a very important one. It applies to people of all ages and genders. Nothing is guaranteed in life and things happen beyond our control. It is important that people who are left behind after we leave the earth, have something to go ahead with and not add to their misery they are already in. 

What is EOL Planning?

‘End of life planning’ is planning for what you wish to happen when you leave this world. They say that only taxes and death are certain in this world. So, record and document everything that you want to see happen when you are not there. You may even leave instructions on how you wish to be cared, even before the end of life, in certain medical conditions. There are legal formalities in these cases, without which, in some countries including India, other people cannot make decisions on your behalf.

EOL planning can be a combination of a physical folder, spreadsheet, document or any other suitable form. It can be a combination of physical and digital also. If everything is in soft copy and the computer password is not known, it is very difficult to find out the information. It is as good as having no information.  

Recently, we could not find a person’s Aadhar card. Without Aadhar / proper identity card, it is not possible to cremate the person. In one case, a person died. The wife was in a shock. Both their children were abroad and their contact details-address, phone number, email—nothing was available. It took one full day to trace and contact the children. 

It’s a responsibility

EOL is a moral responsibility towards our family members. You don’t want to aggravate their misery by keeping them clueless. From my experience, it’s incredibly agonising to see people not knowing what to do and where to start. Though we cannot eliminate the pain, at least it will help in mitigating the pain. I have seen even educated working women having no idea about their family’s financial position.

It is a myth in our society that women don’t want to talk about the financial position of the husband. When there is money left behind, it can lead to disputes in settlement unless clear documentation is there. This documentation work may need 3 to 4 weeks of time but it can save tremendous amount of pain and grief and months and years to resolve. Approximately Rs 48,500 crore is lying unclaimed just in PSU banks alone. In life insurance corporations, it could be double this amount. Together, 18Bn$ of money is left unclaimed because people don’t know you had something there. RBI has recently started an initiative to encourage the bank managers to reach out to whoever they can, in case an account is inactive.


Shankar: What is the correct age for EOL planning?

Vish: Ideally, after your graduation and definitely, after getting married. 

Shankar: With whom, should the information be shared?

Vish: If married, with the spouse. It is also preferable to inform children. There are cases, in which both parents died suddenly. Or inform a sibling or a friend. 

Shankar: When a person leaves, does the lawyer come and open the box like in movies?

Vish: No. The first thing people ask is, ‘Does the person have a will?” If not, somebody—the beneficiary—has to initiate the process of going to court and proving that they are the legal heirs. This process is carried out by a judge. You need good, qualified and specialised lawyers to represent the case.

Shankar: If there are assets in different jurisdictions, do you need separate wills?

A: Within India, one will is enough. If assets are outside India, then those countries may follow a different process. So separate wills are required for assets in other countries.

Shankar: What does the new inheritance law state?

Vish: From 2005, Supreme Court ruled that all children including girl children have same rights in inheritance.   

Shankar: EOL is an emotional subject. How do you broach this topic with the family?

Vish: Yes, definitely not a pleasant task but it is important that you talk about it. 

Shankar: Can the documents, once made, be revised / altered? 

Vish: Yes. Revisit them once a year and sometimes, at lesser intervals. Things can change.

A disclaimer from the speaker: I am not a lawyer, tax consultant, financial advisor, insurance agent, an estate planner and an employee of any government. The information is shared based on my learning as a guide in helping people and does not purport to be a legal document or expert advice. 

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The Aravind Story

Read Time:18 Minute
In this talk organised by MMA in partnership with IIMA, Mr Thulasiraj Ravilla, Executive Director, LAICO & Director Operations, Aravind Eye Care, speaks on the lessons learned in providing care to the needy.

Our first hospital came into existence in 1976 as a post retirement activity of Dr. G Venkataswamy (Dr V). He retired from government service on a very small pension. There wasn’t much wealth around. When his brother built a house, Dr V told him not to move into the house. He started using it as the very first hospital. The four bedrooms became the ward and one of the bedrooms became an operating theatre. That’s how it began.

Today we are in multiple locations, covering Tamil Nadu, Pondicherry and Andhra Pradesh, serving roughly a population of about 10 crores or 100 million. We have seven large hospitals, in each of which we see between 1,000 to 3,000 patients each day; seven smaller hospitals and a number of rural clinics. Typically on an average day, we see between 15,000 to 20,000 patients, most of them in the hospital and some of them in the outreach work. Surgeries vary from 1,500 to 2,000 plus. We do a fair bit of outreach and a lot of academic work as well.

Last year, we handled more than 43 lakh outpatient consultations and more than five lakh surgeries. Close to half of them today are offered free or at a much subsidised rate. It used to be at a much higher proportion when we started. This volume would be somewhat equal to what is done in all of the UK by the NHS, at a very small fraction of their cost. Their budget is about 2.4Bn pounds to deliver similar care.

An Illuminating Purpose

Over time, we have expanded our scope to do a significant amount of research work. We have published more than 350 articles in peer-reviewed journals. We do a lot of consulting and capacity building with a slight twist in the sense that clients don’t pay us. Because of our drive for the purpose, we set up this institute. We do quite a lot of manufacturing as well.

Right from day one, Dr V wanted to continue eye care after his retirement. Even in the government, he was doing a lot of community work and he wanted a means to continue doing that. Our purpose is quite simple. It is “To eliminate needless blindness.” We didn’t put any boundaries around it—geographic or otherwise. Let me discuss some of our approaches that helped us get to where we are today.

Approach 1: Close the Care Loop

When we started in 1976, we used to organise a lot of outreach eye camps and many patients used to be advised to undergo surgery. All these people came to the camp because they could not see. After diagnosing, we would tell them that they have cataract and we would offer them free surgery. But what we found was that very few people came to the hospital for the free surgery and it was really puzzling.

So we did a formal study. We picked at random 100 patients—those that we advised—and then went back to their homes to find out whether they got operated or not. We were able to track 82 patients and we found that less than 15% of them had got operated over that time. It should have been a year or two since the time of diagnosis and advice. We looked at the remaining 85% to see whether they had good vision and if that was why they did not want to come, but the reality was that they were all literally blind.

The other puzzling factor was that most of them wanted to go for surgery and they wanted their sight back. This was a bit of a contradiction. When we dug a little deeper, we found that many of them did not have the means to travel to Madurai. Because they were old and blind, they needed someone to accompany them to the hospital and in those days, surgery required one week of hospitalisation unlike today where you come and leave in a couple of hours. We had put the onus on the patient to come to the hospital and get operated, stay for a week and make arrangements for their food.

I Shall Live With Blindness

This study made us realise that not charging is not the same as being free for the patient. This was an important realisation. This was a sophisticated study that got published and one of the early publications on barriers to healthcare. The real impact of this came when we had a camp in Thiruparankundram—the temple town near Madurai. A beggar by name Sambavan was totally blind. When we diagnosed and offered free surgery to him, he felt very grateful. He fell at Dr V’s feet to bless him but he said, “Sir, I’ll have to forgo this kind offer of yours because if I don’t beg, I won’t have any money to feed myself. So I will probably live with my blindness.” That brought home the message and a very practical approach.

We went back to the drawing board to redesign our services. We decided to provide, in addition to free surgery, free transportation to the hospital and back, as well as food when they are in the hospital. To avoid the need for someone to come with them, which in our cultural context is a necessity, we said we would escort them and bring them back as a group. We assured the family that we would take care of the patient. That seemed to have worked. In the very first camp that we did with this redesign, around 70% of the patients who were advised, landed up in the hospital and immediately had surgery. This is the notion of closing the loop.

Prescription Doesn’t Help

We came about another example. In the early days of the outreach, we used to prescribe glasses. We were not sure if people bought the glasses when we prescribed them. Prescribing a glass requires a lot of effort like taking them to an optometrist who has all the necessary equipment to do that. Again, we did a study and it was an intervention trial. In some camps, we decided to give the glasses on the spot in the camp site itself, while in some camps, we only gave them a prescription. We went back three months later to their homes and found that where we gave only a prescription, less than 25% of them had actually bought the glasses and were wearing them. But in the group where they got the glasses given at the camp site itself, 80 percent of them were wearing glasses.

So in the outreach, we set up an optical shop under a tree or in a classroom. The person could choose the frame that they would like. We also had our own algorithm, considering a wide variety of inventory of lenses and anticipating what powers might be prescribed. As the patients were waiting, we would edge the lens, fit it and then they would try it on. Thus the QC happened right there. The patient tried it out and was able to see. This is something that they pay for. It is not that it is given free. We had completely eliminated the cost of procurement. If we didn’t do this, the patient would have to make at least two or three trips to the nearest town—one to place an order, one to get the glasses and if there is a delay, go back again and that will often cost quite a bit more than the cost of glasses themselves. These have all been our insights.

Enabling Access

We recognize that providing services isn’t good enough. We have to enable the customer to access it. This probably holds good far beyond eye care as well. In our case, it stems from owning the problem. We all tend to draw some boundaries. Most healthcare providers will draw the boundary around diagnosis and prescription of treatment. Accessing the care is completely left to the patient and very few monitor that. Because we monitored, we were able to recognise the impact of doing this. Again, looking back from a business point of view, the customer satisfaction happens only when they get the benefit of the intervention. That cannot happen until the patient is able to follow through the advice. The more and more we did this, our own reputation in the market also grew.

Approach 2: Focus On Non-Customers

Because our purpose was to eliminate needless blindness, the focus shifted to those who are not seeking care. Those who seek care would get it in any case. Our approach used to be doing eye camps. Some of the camps used to attract thousands of patients. In the pre-covid year, we had more than 3,000 outreach camps, saw more than five lakh patients and close to one lakh patients received surgery—cataract plus other surgeries. Even though we had such high numbers, our founder asked the question, “Is this good enough? Are we reaching everyone? Will we reach our purpose that we stated?”

Again, we did a formal study wherein we organised 50 eye camps. We went back into those communities, house-to-house and found out how many people had eye problems and for which they felt they needed help. We made a list of all those patients. We went back to our records and found out that only 7% of them came to the eye camps and it was very disappointing. We knew that the eye camps draw a large number of people. Until this study was done in 1999, for almost 25 years, we were lulled by the high numerator that we saw. We didn’t pay attention to the denominator and once we did that, we recognised that we were not even scratching the surface through our approach of outreach and something else needed to be done.

The question was, “Can we have our permanent hospital-like facility, instead of having an eye camp, which we do once a year for a period of five to six hours, usually at our convenience and based on availability of doctors, etc?” We realised the community can’t access it. So we came up with the design and the first technology enabled centre was opened in 2004. Those days, the internet was not there in the villages. We put up our own towers and created our own closed user group network using Wi-Fi, going over long distances. This is a design that we came up with.

A patient walks into the centre and pays 20 rupees, which is good for three visits. There is a technician who is well trained to do a complete eye exam as you would get it done in an ophthalmologist’s office. We also check for other things like blood pressure, sugar and intraocular pressure. A doctor at the remote end is able to talk to the patient and every patient gets a tele-consultation. Today we do about 3,000 consultations each day and ours is probably one of the largest models. If a particular patient requires only glasses, it is made available right at the centre itself. So within half an hour of their coming with a problem, it is completely resolved. This focus helped quite a bit.

Eyeing for AI

Today we are incorporating new technologies. We have been working with Google for several years and they have developed a cloud-based AI service, wherein the technician just takes an image of the retina and then pastes it in the application. We have developed the front end. It takes literally 10 to 12 seconds for a complete analysis of the retina-whether there is a diabetic retinopathy, if the patient needs to be referred to, how severe the condition is, etc. These have been validated through independent studies. This brought in a much higher level of diagnostic calibre into the hands of the primary care provider. We now have 103 of these Vision Centers dotting across Tamil Nadu. Last year, we handled over seven lakh patients through this network.

When we set up the vision centers, we got a little bit wiser and became denominator focused. We could estimate the number of people who are likely to have an eye problem and it is around 25% of the population. Everybody above 40 may need glasses or something more complex. This is what we found. The 91 vision centres covered a little less than 8 million people. Within that group, more than two million people had registered, which is about 26 percent. So we feel that we probably have a hundred percent market coverage through this approach of sustained work.

Promoting Best Practices

Having done this, a part of our purpose is also to promote best practices elsewhere. We are working with many governments, for them to adopt this care, so that eye care becomes available and accessible. Each vision center covers about 8 to 10 km radius. The access becomes very simple and easy. We are working to propagate this model far beyond Aravind. The insight was that building the market requires a lot of proactiveness, which is not default amongst healthcare providers, who tend to be very reactive to those who present themselves.

Approach 3: Perspective to Cost

The next approach that we took was about how we viewed the cost. Typically, the approach tends to be viewing the cost with respect to how much we charge. But then we realised that we need to really work on the total cost to the patient, which includes lost wages and many other things. So once we had that recognition, we came up with the patient-centric service design. We never had any appointments because appointments actually add cost to the patient. If there was no appointment, they can easily combine it with something else like coming to the town for shopping or a wedding. There are so many other opportunities they can leverage.

We also don’t have any waiting lines. If surgery is advised today, the next day they would get it done. We work on completing the care on a single visit, which tremendously reduces their cost. Because we have multiple tiers of care, we are also able to do the care at appropriate local levels. Every hospital in our system has a paying and a free section. The patient is free to choose where they want to go. There is no gatekeeping mechanism. It is completely on an honour system.

Focus on Efficiency and Quality

On the hospital side, we focused on efficiency and quality, both of which drive costs down, and also on managing bottlenecks. To ensure quality, we broke down the notion of patient centricity into actionable modules or domains. We came up with 10 areas and we were able to develop separate systems to ensure quality. We also have robust patient feedback. Quality at one level is clinical outcome and at the other level, it is the patient experience which we constantly monitor and give feedback to the individual teams, usually in a benchmarked manner. Every clinic will have their score as well as the score of others which tends to drive improvement.

On the clinical side as well, we have done a lot of work. Post-surgery, the infection rate used to be about seven or eight per 10,000 which was the acceptable international level. But to our chairman, who is an ophthalmologist, this was not acceptable. After doing some literature search and study, he came up with the process of injecting a very small quantity of antibiotic in the eye at the end of the surgery. After this, the infection rates have come down. It is now the standard procedure across all the hospitals for every surgery and our infection rates are between zero to one or two per 10,000, which is 1/4th of what is reported in the UK or US. So the clinical outcomes have been very tightly monitored and we can quite confidently say that our infection or any complication rate is probably about half to one-third or one-fourth of what is reported in the west.

Lean Tools That Helped

The other aspect around efficiency was with HR and within the HR, it is the doctors—the ophthalmologists. We wanted to optimise their output. If a surgeon had one table and one set of instruments and somebody supporting them, they can at best do one surgery per hour. But to the same surgeon, if you give another table with another support staff and more instrument sets, the same surgeon can do six to eight surgeries per hour. Basically, we are leveraging the dead time that they wait between surgeries.

When a surgeon is operating on one table, the next patient is made ready on the other table. Once the surgery is done, the surgeon just swings the microscope over to the other side. Even the position of the microscope is done in such a way that we don’t fiddle it too much to refocus. Such process improvements have helped us achieve a much higher level of productivity, which in a way drives our financial model as well. But beyond these techniques, it is the ethos that our founder put in, that really matters. Having empathy and compassion helps us think in a certain manner.

The Challenges and Opportunities

Every one of us has challenges in our lives and in the organisations that we run. We clearly have two options—either we complain or figure out what we can do about it. In the early 1970s and 80s, cataract surgery meant that you did the surgery and gave the person a pair of thick glasses. In the late 1980s, the technology emerged by which you could implant a lens inside the eye. In the early days, it used to cost around $300 per lens. Even the rich in India could not afford that. So the World Health Organization, Government of India and all the funding agencies felt that this technology was not suited for developing countries because of the prohibitive cost. In their mind, the budget that they had, would only go to fewer people if we adopted this technology.

That is when we took the plunge of starting a manufacturing unit even though we had no experience in it. We now make and sell about 3 million IOLs per year, which is roughly 10 to 12 percent of the global market. When Auro Lab launched the product, we had a 10x price disruption. If a lens cost about hundred dollars, our starting price used to be around ten dollars and today it is much less.

The other challenge that we had with HR was not having enough trained nurses and doctors. Over the years, we worked to develop our internal pipeline. We have 330 doctors who are consultants. We also have 400 doctors in training, either to become an ophthalmologist or a subspecialist. They keep feeding into the pool to take care of attrition. We follow the same system with our support staff as well.

We are also working on technologies which can be de-skilled, because if there’s one common problem in HR, it is finding people. We can either de-skill or use technologies to reduce that need. We also worked quite a bit on creating an enabling work environment, basically removing the frustration elements. Our people enjoy working. We have a day care centre as most of our staff are young women and they all have tiny babies. We take care of all the costs.

Sustainability and the Triple Win

The other area that we have been working on is the environment. Healthcare in India accounts for five percent of our carbon footprint. In the US, it is about 14%. We felt we had a moral responsibility to reduce it, so we adopted very lean, clinical protocols and recycled the biomedical waste from surgeries. The studies have shown that our carbon emissions per surgery is 1/20th of what is reported in the west.

We have been developing over the years models for environmental sustainability wherein we have been paying attention to the building. Most of our hospitals are net zero grid energy. That means, we generate our own solar power or purchase solar and wind power from outside. All our hospitals have water recycling. We recycle about two million litres of water per day.

We pay a lot of attention to the use of all the resources. A lot of our lean protocols reduce travel for the patients. All our staff have housing in the campus, so we eliminate the travel to work. Many of these approaches have helped us to score a triple win. Because when we pay attention to environment and do appropriate things, we get triple benefits:

  • We reduce the efforts for the patients.
  • We are able to get more patients and it ends up costing less for the care providers.
  • Together, the carbon emissions come down.

The broad impact of all these approaches has helped us to be on a continuous growth path over the years, except for a dip during the covid. We have a large offering of training programs. We have more than 40 courses and trained more than 12,000 eye care professionals from across the world. We have produced more than 1,000 ophthalmologists and several sub specialists.

In 1992, we set up an Institute to help other eye hospitals to perform better, basically by sharing the best practices and that has helped us to add close to 800,000 to a million additional surgeries per year happening in perpetuity. We have lots of publications. Financially, we are quite well off. In fact, as a principle, we don’t raise money for our core caregiving process. We have a healthy surplus after meeting all the care for the poor patients, which goes in for expansion and growth. As a strategy, we promote competition because many more players are required to achieve our broad purpose of eliminating needless blindness.

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