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 1/20^th 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.

MMA in association with the Swatantra Foundation organised an interaction of MSMEs with Army Design Bureau and Regional Tech Node, Southern Command. This was facilitated by Dakshin Bharat Area.

M Rajaram, Trustee, Swatantra Foundation

Swatantra Foundation is a think-tank involved in policy research and advocacy. The idea for the defence expo originated from our research, where we felt the need to bring to the attention of the various user groups in the army, navy and airforce and the defence sector about the capabilities of our MSMEs. We also wanted to build awareness in MSMEs about the opportunities available in the defence sector and the ways to tap those opportunities.

With the support of Ministry of Defence, we organised the first ever MSME-focussed Defence Expo. It was spread over three days and was a roaring success. There were more than 40 seminars and more than 800 delegates attended. It had more than 500 B2B meetings.  Laghu Udyog Bharati, the main co-organizer, which is an MSME organising body with a Pan-India presence and TIDCO supported us in this initiative.

Lt Gen A Arun, YSM, SM, VSM-GOC Dakshin Bharat Area

Education and skills have no meaning unless they are put to use. For a country to become a strong and robust nation, we need to make our defence procurement processes easier, more transparent and more competitive. In the US armed forces, their think-tank seeds an idea and that feeds the DARPA (Defence Advanced Research Projects Agency). It gets built into the university curriculum. The university develops an idea and it gets transmitted to the industry that develops a product. Then we buy it, paying for the life of the product. That is what we intend to replace.

We should be able to design the product and we should own the IP of the product and process. It is not enough if we just make in India. In the journey from idea to deployment, there can be many heartbreaks and failures. There can be financial losses and the system may not be able to support everybody’s aspirations and needs. The purpose of our interaction is to minimise those heartbreaks. We would like to initiate a process which will make changes happen. The Army Design Bureau (ADB) is headed by a Major General. There are many Colonels attached to it. One Colonel takes care of DRDO projects; the second one is completely linked to academia. The third is related to industry. We normally reach out to the industry through forums such as CII or FICCI. Defence procurement policy and the amendments to it have a close connection with ADB’s office. As we have scattered manufacturing units all over India, we decided to create Technical Nodes to be a subset of ADB from Delhi. So in all our seven commands, we created technical nodes. The Southern Command office is in Pune. We will discuss the current policies and schemes that exist and the areas that interest defence sector. Everybody need not make a gigantic product. Boeing has probably got thousands of small vendors who provide various components to the Boeing. Even if you make elastic or velcro, it will find its use somewhere. We want to facilitate the correct linkages from where we can have a conversation.

Brig Ravi Yadav, DDG, Army Design Bureau (ADB)

If you want to discover new oceans, you must leave the comfort of the shore. This conveys the ethos on which the ADB functions. In technology terms, you must leave the comfort of predictable outcomes. Our focus must be on the soldier and to make his job easier on the battlefield. ADB was formed in 2016 with the sole purpose of being the facilitator for the industrial technology ecosystem within as well as outside the borders and connecting them with the Indian Army as the user. We have two sections: one is a technology and weapons section which is more like a think-tank. It scans what is available globally. The second section is the Technology Resource Centre.  It is the central repository of technology and knowhow for the Indian Army.  It is a single point of contact for interactions with industry, academia, DRDO and field formations. It provides no cost, no commitment demos for developers.

ADB considers suppliers not as vendors but as partners. We start with the problem definition statement. The inputs come from the Line Directorates and Field Formations. We also have an internal assessment of our needs that come from strategic planning directorate and others. Our R&D projects come under the Head of Army Technology Board. It is headed by the Deputy Chief of the Army Staff. The research requirements may evolve from users or academia.  Through these projects, we engage with IITs, IISC Bangalore and others who are interested in doing R&D for defence projects.  The projects have to be somewhere or the other aligned to the problem definition statement. Deputy Chief of the Army Staff has financial powers to the tune of Rs 12.5 crores for every project handled by government entities like IITs. If it is a non-government organisation, then the powers are up to Rs 7.5 crores. We have established an Indian Army cell in IIT Delhi to facilitate the transfer of capability of the academia to the armed forces. We are planning to establish similar cells in all the IITs and IISC Bangalore.

Design & Development Projects

These can be carried out one on one with industry representatives for big industries or through consortia like FICCI and SIDM. These projects are undertaken under the ‘Make (in India)’ head. We have three categories under this:

• Make 1- 70% is funded by GOI and 30% by the industry that handles the project. These projects, by and large, will not have a dual case commercial, economic usage in the end.
• Make 2- 100% is funded by the industry. By the 3rd or 4th milestone, there is a minimum order quantity promised by the government. These are dual use technology which can have business/commercial use, beyond the defence usage.
• Make 3- These are primarily aimed at components for maintenance of the infrastructure for existing or future projects. Funding is done by the industry. This also permits some amount of TOTs (transfer of technology) from the foreign vendors as well as joint ventures established with foreign firms.

DISC-The Challenge

Smaller businesses are handled by IDEX (Innovation for Defence Excellence) of the Defence Innovation Organisation under ministry of defence. The IDEX Cell is a Section 8 company so that it can facilitate carrying out businesses with startups and MSMEs. It periodically announces launch of Defence Innovation Startup Challenge (DISC), based on the user defined technology needs. These could be processes, components or end-use case technologies. Startups respond to the challenges and give their own proposals. The startups whose proposals are selected are invited to give presentation.  There is a high powered selection committee chaired by the ADG, which selects the winners. The project is given to the startups and they are assisted with handshake with the partner incubators like the IITs or the industry. These projects run between 24 to 36 months duration.  These are partly funded by the Government of India and partly by the startup which is selected. The normal IDEX challenge projects are Rs 3 crore worth. There is also something called as Open Challenge System where suo moto proposals are received from startups. These are examined by subject matter experts within the army, academia and startups. Accepted proposals are taken up for execution through IDEX. The ministry has now come up with up IDEX Prime and which can sanction up to 10 crores worth projects. DRDO is under the Technology Development Fund (TDF). Funding for these projects is done by DRDO up to 90% and the balance 10% is to be funded by the startup. There is a signing of MOU. Tangible milestones are defined. If the milestones are achieved, the payments are released. If you are stuck with a project given to you, we are here to guide you.  We also provide certain facilities for testing and internal evaluation.

Brig AB Sibal, VSM, Director, RTN, HQ SC

For the last two years, the ADB has been an interface between the army, industry, academia and DRDO. However, this was felt to be too central. There was a requirement for Regional Technology Nodes (RTN) in various locations, so as to be able to locally interact with the industry and academia. The first node was established in Pune, which houses the Southern Command. More importantly, Pune is central to many States including the southern states which have a large number of educational institutions and DRDO labs. RTN was formally raised on 2 Nov 2021. We may establish nodes soon in Chennai, Hyderabad and Bangalore with full-fledged staff, so that we can take these initiatives forward.

RTN has a Chairman, Director and Officer-in-Charge. It has also co-opted members from other branches of the army, who are domain experts by themselves. Whenever any proposal is received, it is sent to the concerned Line Directorates for evaluation. We also have nodal officers who cover most of the states. They assist the RTN to evaluate various products, carry out NCNC trials, interact with the industry, facilitate various trials going on and make available ranges and ammunition for trials. Similar to the ADB, RTN is also an interface between Army HQ, Industry, Academia and Field Army. We don’t directly deal with DRDO. We derive the problem statements from the field army. We assist them in carrying out NCNC demos.  Ideas and innovations are generated. If they are found interesting, we take it forward with the industry. In the last six months, we have created a database of industries and academia and who can be approached for a particular type of problem statement.

Focus Areas

What are the focus areas that the Southern Command is looking for interaction with the industry? The ADB puts in its website various problem definition statements, which they have compiled. In 2020, 120 such statements were listed, which were subsequently reduced to 46 by merging and other exercises. Most of our requirements have pan-India implications. For example, if you are able to develop the spare part for L70 gun which is an old type and for which we don’t get spares, you will address a pan-India requirement. The first step is to ensure that the product that is developed, will meet the quality assurance norms. Remember, all these are made for the soldier and we should not lose sight of this fact.

We are also planning to establish technology hubs and labs.  These are in the areas of electronics AI and robotics, combat engineering, indigenisation of space and skill development for cyber security. We are also working on alternate fuels and conversion of conventional vehicles to EVs. We are now working on conversion of three Gypsy vehicles to EVs.

XVI CUB Shri V Narayan Memorial Lecture by Dr T V Somanathan, IAS, Finance Secretary, Govt of India

Architecture is a scientific discipline. The word architecture evokes a sense of planning, order and form. There are many styles of architecture—Victorian, Mughal, Chinese, Chettinad, Gothic and so on. Each has some distinct and identifiable features, which most common people and certainly connoisseurs can identify. From approximately 1944, there was a certain pattern of economic arrangements, which could reasonably be termed an economic architecture. There were the three blocks of economies in the world: the first world that had the market or capitalist countries; the second world, which had the communist countries; and then the third world, which had countries like India, that were generally poor, either under colonialism or recently decolonised. The first world’s institutional structure was also the one that the third world willy-nilly had to conform to or be part of. We were not actually the ones designing our architecture.

The Bank and the Fund

In that architecture, there were the so-called Bretton Woods twins, which were the World Bank or The International Bank for Reconstruction and Development, and The International Monetary Fund (IMF) known colloquially as the Bank and the Fund. These were the first creations post the World War, though they were created slightly before the end of the Second World War.

Apart from these two, there were several other powerful, well-funded, UN specialised agencies such as the UNICEF, UNESCO, The Food and Agriculture Organization (FAO), the World Health Organization (WHO) and so on. But there was a difference. In the Bank and the Fund, the governance structure was not ‘one country, one vote.’ It was one dollar of share capital and one vote, which is similar to that of a private sector company. In the other UN specialized agencies, it was one country, one vote.

So in the Bank and the Fund, the richer countries had bigger shareholdings and hence a bigger say. The disadvantage of this structure was that the third world’s views were not given due importance. The advantage was that the first world countries funded these organisations amply, because they were confident of their ability to control the organizations they funded. Quite naturally, the western donor countries were much more comfortable with the Bank and the Fund and also with UNESCO, UNICEF, WHO and FAO.

The funding levels of these two sets of agencies, though they were approximately on par initially, diverged enormously over the years. While these two became very powerful, the other UN specialised agencies were continuously strapped for budgets. It is all very well for someone to say that I want to be an equal member of an organization. It is sometimes more useful to be an unequal member of a stronger organization.

The Role of GATT/WTO

The third important element in the global economic architecture was initially known as the General Agreement on Tariffs and Trade (GATT), which later was converted in 1995 into the World Trade Organization (WTO). In fact, during the Bretton Woods conference, it was agreed to create the World Trade Organization. It was supposed to be one of the three institutions that was to be created in 1944. But sufficient agreement was not reached on the shape of the WTO and it was created nearly 50 years later in 1995.

The GATT resulted in a steady reduction of tariffs across many countries between 1994 and the creation of the WTO. Customs duties on imports fell in a secular manner between 1945 and 1995 and fell even further after the creation of the WTO.

Washington Consensus

The three organizations—the World Bank, the IMF and GATT or later, the WTO—had a largely common set of beliefs on the methods by which developing countries should develop.

Some of these elements were known as the Washington Consensus and these included that a) countries should have free trade with little or no tariff barriers; b) there should be free flow of capital across national boundaries; c) there should be flexible exchange rates; d) there should be a market or market driven economy in all of these countries; and that would be the best way forward for development.

In some cases, these beliefs were held more strongly than warranted by either theoretical foundations or empirical evidence. In some cases, they were sound prescriptions. Thus, they were a mix of some very well-established sound prescriptions of universal application and some which are more debatable.

However, the strength of the institutions which backed the Washington consensus meant that many countries in the developing world did follow the advice and prescriptions, albeit to a greater or lesser degree without necessarily having to test each of those principles for their actual correctness or relevance in the circumstances of each of those countries.

Regional Institutions

Apart from these global institutions, there were regional institutions of considerable importance, such as the European Economic Community, as it was known then and which later became the European Union. Similarly, there were institutions like the CFA franc in Western Africa, which was anchored by France. They had a currency union between the French franc and the CFA franc. The CFA franc was tied at a specific parity to the French franc.

So effectively these countries were running a French franc currency area and so they didn’t have control over the monetary policy. Their interest rates were decided in Paris for most of the ex-French West Africa. Similarly, there was an Organization of African Unity that became the African Union. However, many of these regional institutions, with the exception of the European Union, lacked longevity and influence.

India in Bretton Woods

The founding of the Bretton Woods institutions roughly coincided with the peak of India’s struggle for Independence. The gap between their founding and Indian independence was about three years. It is not known to many people that India was a participant in the Bretton Woods conference in Bretton Woods, New Hampshire and British India was represented by Shri K Shanmugam Chetty. So we were there, even though we were not independent.

This year, we mark the 75th year of India’s independence and it’s also approximately 78 years since the start of what can be termed the post-WWII economic architecture. The architecture established then, remained largely intact for over six decades. It was strengthened by the collapse of the Soviet Union in 1991 and the subsequent admission of erstwhile communist countries into that architecture. It was further strengthened by the admission of the People’s Republic of China which was not even a member of the United Nations for the first 40 to 50 years of its existence, but it was admitted later.

Success Leads to Overconfidence

In 1995, China became a member of the WTO. Viewed from its results till the turn of the century, that is till 2000, one could consider the post-war economic architecture largely to be a success, because many countries moved from poverty to prosperity; others moved from dire poverty to less poverty. The proportion of poor people in the world declined dramatically. A large numerical share of that decline was in China and India. But there was a decline in many other countries too. Some countries, however, have worsened between the 1940s and now but they are very few.

The confidence that was generated by the fall of the Soviet Union and the admission of China into the international trade and currency systems, instead of generating more confidence, led to a level of overconfidence. The western regulators and central banks, among others, started to deregulate much further. This philosophy received a big jolt in 2008 when we had the global financial crisis. It showed up the weaknesses of the extreme deregulation version of the post-war economic architecture.

It led to a re-examination of that architecture but it did not fundamentally change it. Nobody felt that the architecture was fundamentally flawed. It looked like there were a few excesses here and there.

IMF’s Change in Thinking

The other thing that happened during the aftermath of the global financial crisis was a change in the thinking of the IMF. Till then, when countries ran into serious economic problems, they were the major advocates of austerity.

Whether by coincidence or not, when Europe in 2011 to 2013, faced severe economic problems and when there was a chance of Greece dropping out of the Eurozone and when Italy and Portugal were also in serious trouble, in terms of their ability to service their debts, the IMF, which is traditionally headed by somebody from the European Union, changed its philosophy and did not advocate austerity as the solution.

Then we had a series of other events between 2008 and 2012. There was an unprecedented level of monetary expansion. Creation of money was given a new term—Quantitative Easing (QE). The labelling changed but it was typically what old textbooks would have called, creating money or injecting money supply. When this massive expansion happened, it seemed to settle things down. A lot of things calmed down and the crisis receded. The worst was over and a lot of new things started, including startups and crypto.

Free Trade gets Trumped

By 2016, another set of challenges emerged. The US began to retaliate under new political leadership, against what it saw as manipulation of world trade rules by China and therefore, it imposed measures, which were in classic WTO terms could be called protectionist. I am not making any value judgment on the correctness or wrongness of their action. The United States, which was the prime mover of free trade and in whose country, the so-called Washington consensus used to reside, began to impose unilateral trade restrictions on imports from China. Then came the completely unexpected exogenous event, which was Covid. It brought trade to a screeching halt across countries and exposed the risks of highly decentralized supply chains that had enabled and expanded free trade post-WTO. Optimization of costs became possible because of low tariffs and free trade system. It brought consumer prices down for a lot of people including citizens of India. Many things have not changed much in spite of inflation thanks to the supply systems which are extremely efficient. But they depend on continuation of free trade, open markets, free-flowing shipping lanes and air traffic and so on.

Covid Shows the Mirror to the World

What Covid did is to show the world that all of these are man-made devices and that they can collapse. They all collapsed at the same time. There were no ships and factories were not working. People didn’t have even toilet paper.

When Covid ended, things began to perhaps recover but it had done the damage. It had damaged the belief that this is the ideal system; that there is one country in the world, which is the global manufacturing hub and everybody else supplies components to that hub and everything gets shipped from that hub to everywhere else. This hub-and-spoke model and the free flow of capital that it enabled began to suddenly seem not so optimal and that it was vulnerable. Then came the other one—the Russo-Ukraine war, which happened in late February 2022.

The Covid, Galwan and Russia-Ukraine war have created profound effects on the way the government of India has to manage its finances. The war and the western reaction to it have again upset a lot of widely held assumptions about how the global economy functions.

Western countries for centuries have been a bastion of property rights. Confiscation, expropriation and nationalisation without adequate compensation were all roundly condemned. It was always emphasised that there is a need for due legal process before any such thing happens and it cannot arbitrarily be taken.

Confiscation and expropriation were known features of communist states and not of capitalist states. Yet today, confiscation of movable and immovable properties of some persons, of certain nationalities happened in those countries without legislation and without following the principles of natural justice, which used to be held as self-evident.

Freezing of Currency Reserves

Another feature of the recent economic changes has been the unilateral freezing of foreign currency reserves of certain countries. That in turn, in certain cases, has created a risk of those countries defaulting on their sovereign bonds. You have a country which is a borrower in sovereign bonds. It is solvent, willing to repay its bonds but it is not allowed access to the currency it needs to repay those bonds. Therefore, it could technically be in default and if it is in default, there are serious consequences to defaulting on a bond, especially a sovereign bond.

None of these actions are based on any UN resolutions. I am not criticizing the decisions of any of these countries. They were taken in exceptional circumstances and it is quite normal. Let us accept that. But they should now realise that it is quite normal for other countries also to act in their own best national interests.

When it comes to a crisis, long held principles are sometimes not followed. It is no longer sufficient to assume the prevalence of a particular architecture or of a particular set of rules or ways in which the global economy functions.

We need to rethink our own policies, for example, on the composition and location of our foreign exchange reserves or the desirability of issuing dollar bonds by the government of India. There are multiple views on these but the point is, one has to think afresh. After all, it’s a new world. It’s not the world that we thought we lived in.

So, with all this, what is the situation today? Let me pick a few points selectively.

The China-Russia Factor

China and Russia have de-facto formed a new economic block among them. There’s a lot of Russo-Chinese or Sino-Russian trade. Most of it is not denominated in US dollars. It is largely Yuan denominated and some of it is Rouble denominated.

The US and Western Europe are closer to each other, than they have been for decades. They are systematically detaching their economies from Russia and to a lesser extent from China. The US-Western Europe block is trying to pull away from the China-Russia bloc. Earlier in the WTO era, everybody was trying to trade with everybody else, as much as possible, whatever was the cheapest. That’s not the case now.

The economy of Europe is certain to suffer. Potential damage from their self-imposed withdrawal of energy sources from Russian oil and gas will be damaging in the long run. They will recover but it will definitely take a long time because their huge dependence on Russian oil and gas cannot be solved overnight. The solutions involved are costlier purchases from more distant countries than Russia.

The economy of Russia is also certain to suffer because of the sanctions that have been imposed on them. Meanwhile, Brexit has weakened, at least numerically, the European Union and it has perhaps weakened Britain as well though. Again there are two views on whether it has weakened or strengthen them.

Less Talk in WTO

Free trade agreements are becoming much more prominent than the WTO negotiations. A lot of trade discussions happen between two sets of countries or between two countries and much less gets done in the WTO. Now, as a matter of principle, the multilateral WTO system is better because it gives you optimal results and doesn’t result in trade diversion.

What do I mean by trade diversion? If India enters into an economic free trade agreement with one country X, then any trade from that country becomes cheaper. But some other country Y may be more efficient at producing that product. Because I don’t have a free trade agreement, I end up buying from the more inefficient country. This is called trade diversion.

WTO enables trade creation and not trade diversion. Whatever is done, is done for everybody, but bilateral and these kinds of group arrangements do result in some suboptimal trade arrangements, though it may be better than not having an agreement at all.

BoP Crisis

The other feature of the present situation is the classic case of balance of payments crisis like the one we see in today’s Sri Lanka. But in this crisis, the role of the IMF has declined. The role of two countries—China and India in Sri Lanka’s economic crisis and its resolution as of today—has been greater than that of the IMF. I’m not saying that it’s a good thing but just observing that it has changed. The multilateral institutions that were the pillars of the 1944 order are not driving this particular crisis. It is something that we can see easily.

Therefore I would argue that what we have today is difficult to call an architecture. At best, it has the architectural look of an old locality in an old city, with a mix of structures of different ages, vintages and appearances. At worst, it has the chaotic architectural features of a slum. So it is this architecture that we are dealing with today. We actually have a lot of confusion in the global economic structure.

India Stands to Gain

But such chaos has benefits, particularly for a country, like India. So in the earlier architecture, India was not in the premier league. It was a second class citizen, without a permanent seat in the UN Security Council and classified as a borrower country, rather than an investing or lender country. India was peripheral to global decision-making. There is little to lose and much to gain for us, from the emerging architecture or lack of it.

Even if India does not do anything spectacular, even if we simply continue with our existing normal functionality and dysfunctionality that India has displayed consistently for the last 10 to 15 years, our relative position is almost certain to improve. If we continue growing at six to seven percent a year, we will be way ahead of many countries globally and our position will continue to improve substantially in this new system. We have to only ensure that we don’t do anything very bad and score self-defeating goals. We will improve, because others are worsening.

The Solar Alliance

Second and more positively, we have an opportunity to shape the emerging architecture now. A small but significant aspect is in the founding of the international solar alliance. Solar energy is going to be one of the key energy sources of the future. 100 years from now, it may be more important than oil. The international solar alliance is the first international organisation headquartered in India. It’s not a government of India organization.

Another example is India’s leadership in areas like unique identity and unique payment interface. These are technologies where we are ahead of even developed countries. A lot of developing countries are being advised on unique identity by the UIDAI. The UN agencies are taking the support of the Indian government in doing this in many developing countries. There will be many more things like this.

Need for Strong Domestic Economy

If India truly has to play a significant role in shaping the emerging global economy, then ironically, the most important challenge for us is domestic. We cannot shape the global order if we do not have a strong domestic economy. Paradoxically, our strength starts from here.

There are many steps which we need to take for our domestic economy to become strong. Gandhiji had talked about the role of drain inspectors. If I take such a view on Indian economy, I can dwell on a few of our weaknesses, so we can set them right. First and foremost, both state governments and central government need prudent and conservative fiscal policies. This is absolutely critical if we have to stay afloat and do well. We need to reduce our fiscal deficit, particularly at the central level. The Central deficit is much higher than at the state level.

Target Subsidies

We need to improve the quality of our public expenditure with a greater share for those aspects of public expenditure which promote growth. To do this, we will have to reform some of our poorly targeted subsidies such as those in electricity and fertilizer, without which we cannot improve the quality of our public expenditure. There are no quick fixes in this task. It will be difficult but it needs to be done and it calls for a lot of introspection.

We must have a tight control over public expenditure. The other way is to increase our tax revenue but nobody wants tax increases. Nobody wants any subsidy to be reduced and yet everybody wants fiscal deficit to be reduced. So, this is our trilemma which we face every day. This is a very difficult balancing act. The governments and the people inside governments need help from people in telling us how to solve this and coming up with workable solutions. The reduction of fiscal deficit is the single easiest way to increase the domestic savings rate. If you want India’s savings rate to go up, you need to cut the fiscal deficit.

Managing External Shocks

Second, we need to minimize the vulnerability of our economy to external shocks. This means, we need to avoid taking too much external debt, and especially debt denominated in foreign currencies. All kinds of external debt have consequences.

We may need to think about diversifying of foreign exchange reserves, including an increase in the share of our gold. Now, as an aside, Indians are often criticised for an apparently irrational attachment to gold but the Ukraine conflict and the various currency restrictions have shown the value of gold, which is not dependent on any sovereign; and which can be portably carried from one place to another. This perhaps gives us some sense of a deep civilizational experience as to why Indians have always wanted to keep a little bit of gold. I’m not making a plea for you to invest in gold. I am only talking about India’s gold reserves.

Foster Investments

Third, we need to foster a strong domestic investment climate. We need to achieve the right balance in regulation, between preventing harm and promoting good. Regulation is always a tension between these two intentions. Too often, well-intentioned regulations have stifled innovation and growth. We have a long way to go in reducing compliance burden and we must reduce the harassment of businessmen for trivial mistakes or bonafide actions.

There is an assumption that the government and regulators will be unreasonable or maybe corrupt or both and there are enough examples to confirm some of these feelings. There is also an assumption that industry and investors will evade or cheat if they can. There are enough examples to confirm this assumption also. We need to get out of this trap. We look forward to practical suggestions from you on how we can rise above this.

Stay Away from Fashion

Fourth and last, India needs to exercise independence of mind in taking economic decisions. We need the courage to stay away or walk away from agreements that are not in our interest. Without harming others, we need to do what is in our interest. When India did not join the regional comprehensive economic partnership or RCEP, there was a lot of criticism that we are isolating ourselves from global trade. After two years, subsequent developments have shown that to be a wise decision.

Economics is a discipline which is subject to fleeting fashions. Massive fiscal stimuli were the fashion in 2020. India did not join that fashion. We had a restrained fiscal stimulus. Most of the relief measures were in the form of credit and monetary measures. We have emerged in reasonably good shape. Compared to most other countries, we have emerged in better shape. There was a lot of pressure on us to follow fashion. We need to resist fashion and assess things based on actual facts, circumstances, empirical evidence and the pros and cons. This has held us in good stead over the recent past. We will have to follow policies that work for our country and our circumstances.

My Wish List

To reach our potential, we need to improve in many dimensions. I would suggest that the future Indian economy should have ease of doing business of city-states like Singapore and Dubai; the financial, scientific and technical innovativeness of the US; the quality focus and work ethic of the Japanese; the manufacturing quality and process of the Germans; and the quality life of the Scandinavians. We need to do all this while preserving our unique strengths, including our cultural values and diversity, where every citizen is treated equally.

The old economic order is crumbling. India can become a global economic power only by having a powerful domestic economy and a peaceful and cohesive society.

(With kind courtesy—Sastra University and City Union Bank)

MMA conducted the MMA Women Managers’ Convention 2022 on the theme, ‘Marching Ahead: Inspire Change in Humankind,’ in March this year.

MMA conducted the MMA Women Managers’ Convention 2022 at MMA Management Center, Chennai. In the inaugural session on the theme, ‘Right Here, Right Now,’ Ranjini Manian, Founder-Chairperson, Global Adjustments Foundation led the conversation with Indian Chess Grandmaster and former World Chess Champion Viswanathan Anand, Aruna Anand and Sairee Chahal, Founder, Sheroes & Mahila Money. Excerpts from the panel discussion:

Ranjini: Anand, you became a chess champion only after your marriage. Any comments on that?

Anand: When we were married, Aruna did not know anything about Chess. But she is a very good and quick learner. Soon, we came to an understanding and she said, “I will take care of the external things and you can a focus a lot more on your chess.” She is a big support for me.

Aruna, which is harder: to be Viswanathan Anand’s manager or Anand’s spouse?

Aruna: Definitely, Anand’s spouse. As a manager, it is a 9 to 5 job. As a wife, it’s a 24 hour job!

Chess is more of a mind game and does not require physical strength. Then, why do we need a Woman Chess Championship and why haven’t anyone from India made it there?

Anand: Historically, there was a huge gender gap in chess. The gender gap in the university is now closed or even slightly reversed. The chess gap continues. In the top 100, now there is no woman. Only Judit Polgar managed to achieve that earlier and she was exceptional. I support having a separate championship for women because sometimes you need a stepping stone. In chess, we don’t have men’s championship. We have the open championship and the women’s championship. The difference in participation is one of the reasons for this gap to continue.

Sairee, how did you manage to build Sheroes, which is a platform—a sort of Facebook for women—and engage with 24 million women?

Sairee: It was very slow to start with and then it went up all of a sudden. To tell you my background, I went to JNU. The funniest thing that happened was, I built a company when I was still in college. It was a tech startup. Lucky enough, it got sold. What I learnt there was the power of technology. We built the world’s first newspaper for mariners. Before we did that, there was no way for the merchant navy community to connect with each other. Two thirds of the shipping industry became our customers. Twenty years ago, I took the help of computer science students to create my email ID. I come from a very small town and the barriers for women were very different. On the other side, I saw the Silicon Valley phenomenon. When I started, there were just 10 million women online. Today, it is 300 million. India has seen amazing women-only communities like Amul, Asha workers and Anganwadi workers.
We created a giant tech space where you can come out to hang around, for seeking any help, to look for work or to start a digital storefront. We wanted to build a safe space for women, where their own aspirations can become the centre stage.

You also give loans for women. Can you tell us about that?

Sairee: Yes, we give micro credit for women who need money to take their next step – it could be education, learning something, buying equipment for a parlour, buying a vehicle for higher productivity, a laptop or whatever is their personal pursuit in life. If they need money to enable that, we bring hundred percent digital loan without collaterals. You don’t need to bring your family for getting the loan. We do the underwriting. We trust the women. What it does is, it reaches women in all parts of the country. It democratises access to the capital.

Aruna: What are your three tips to balance personal and professional life?

Sairee: You can have it all, but just not at the same time. Life is like going in a car. You have to shift gears. Take a long term view of things. Career is a marathon. We have to remain sane for a long time. Do what works for you. Lastly keep learning. The barriers to learning have all gone away today.

Do you have plans to scale up or go public?

Sairee: We do have plans to scale as a company. We have plans to get 100 million women on our platform. We are a venture backed company. Going public is an option but we are not in a hurry.

Ranjini: Anand, what is the role played by your mother?

Anand: My mother was responsible for my playing chess. I was very lucky to have a family member who knew how to play chess. My parents were very relaxed about my playing chess. I had played tournaments when exams were going on. My mother travelled with me till I was 16 or 17. In Manila, when we lived, my mother and I used to solve some chess puzzles broadcast over TV alongside a tournament, sent in our solutions and won many chess books as prizes.

Ranjini: Can you tell us about how your marriage was finalised?

Aruna: Ours was a typical arranged marriage. For the girl seeing ceremony, as advised by my mother, I agreed to keep my mouth shut but refused to dress up in traditional attire. When Anand came, what stood out was that he was such a simple person. My mother had prepared all the bajji, bonda, coffee stuff and I refused to be part of that. After serving them, my mom asked Anand, “Would you like another cup of coffee?”

If they need money to enable that, we bring hundred percent digital loan without collaterals. You don’t need to bring your family for getting the loan. We do the underwriting. We trust the women. What it does is, it reaches women in all parts of the country. ~ Sairee Chahal, Founder, Sheroes & Mahila Money

Normally, in Indian households, when this customary question is asked, we say, ‘No, no. I don’t want.’ But Anand was so brave and he asked, ‘Can I have another cup?’ When I saw my mother’s expression, I knew I was going to get married to this man (laughter). You must understand that I got married- not for my looks, not for his chess or how handsome he was but for my mother’s coffee! The third day after we got married, I went to a chess tournament and that was our honeymoon! I had no idea about chess and no idea about the importance of the person whom I had married to and had never travelled abroad. It was the huge auditorium. It was very dark but very comfortable. I would sit in the last row and happily sleep. One hour later, everybody would clap and I got up to see what was happening. Anand would get up from the stage and go. I did not even know if Anand won or lost. We agreed that if he won, he would show a thumbs-up sign after every tournament. That was my introduction to chess.

Ranjini: Tell us about Aruna’s pet advice to you—Go, Play!

Anand: Aruna is ultra-pragmatic and ultra-common sense character. On the verge of going to one of the tournaments, as we were travelling in the car, I forgot a line from the steps I had rehearsed. I tried to contact the coach for help but I couldn’t. I turned to Aruna and she coolly said, “You can’t do anything now. Just go and play.”

Sometimes, the best sporting strategy is to show up and play.

Sairee: What is there in your playbook, as Anand’s manager?

Aruna: Being his wife and manager, he trusts me fully. He signs contracts if I have vetted it. That puts a lot of responsibility on me. A lot of what I decide as Anand’s manager is based on empathy. I would ask myself, ‘If Anand were to take this decision, what would he do, under these conditions?’ and then decide.

Sairee: What has changed in the game of chess?

Anand: Its DNA is still the same and it is still a youngsters’ game. Earlier, it used to be a Russian and within Russia, a Ukrainian game. Now it has become global. Of course, computers have changed the game completely. Chess has also got younger, with the average age of players coming down.

Ranjini: What does success mean to all three of you?

Aruna: It is taking each day at a time, being happy for yourself and feeling accomplished for what you do each day. Be kind to yourself.

Sairee: It means keeping well and just enjoying the gifts that the world has given us.

Anand: Success is achieving things that you set out to do, including the difficult things that you set out for the long term. Success is also about appreciating many little things.

Our Voices, Our Stories

The panel discussion on the theme, ‘Our Voices, Our Stories’ was moderated by Sharanya Modi, Head HR, Expo Freight Pvt Ltd (EFL). Suhasini Maniratnam, Actor & Director, Dr Rohini Rau, Doctor and International Sailing Athlete, Ms Shraddha Trivedi, Wall Mural Artist & Graphic Designer, Pune participated in the discussions. Dr Rohini Rau spoke about the challenges she faced as an international sailing athlete. ‘My parents are my inspiration,’ she said. Suhasini Mani Ratnam who hails from a family of big achievers including her uncle Padmashri Kamal Hassan said that for her, the inspiration came from within. “I wanted to be a cinematographer and did a three years course for that. I worked as an assistant for a few films but couldn’t make a mark. Then I got a chance to act in films and my movies did well. So I consciously chose to switch to acting but at that time, deeply felt for moving away from my dream of becoming a cinematographer. Later, I embraced acting,” Suhasini said. There is always a challenge in balancing what you do out of passion and what you receive as the pay check, she added.

Shraddha Trivedi who has done murals throughout India including in Prime Minister Modi’s residence, took the audience through her journey of making breathtaking murals. She said she has no reservation, as a woman, in working at heights for her paintings.

The Power of Us/Better Together

The panel discussion on the theme, ‘The Power of Us / Better together’ was moderated by Rohini Manian, CEO, Global Adjustments. Gautam Sarogi, CEO, Go Colours; Rajoshi Ghosh, COO, Co-founder, First woman founder of a Unicorn startup-Hasura; and Tanmai Gopal, CEO, Co-Founder, Hasura participated in the discussions.

Vinaya Karthik Rajan gave a soulful rendition of songs under the theme, ‘Invocation-Music for Awakening.’ Akshyalakshmi, Sound Therapist, Zen & Sound demonstrated the power of sound therapy on the theme, ‘Sound is a medicine of future – Gong Healing Live.’