Special Episode: Managing a Health Care Business in India During COVID

Darius Teter: In recent weeks, the second wave of the COVID-19 pandemic has swept through India at an alarming rate. And, the situation in hospitals is critical.

Shuchin Bajaj: It’s a tsunami, not a second wave. You have to refuse a lot of people every day. I’m just tired of saying no to everyone, but every hospital is full.

Darius Teter: As a doctor, an entrepreneur, and the founder and director of Ujala Cygnus Hospitals, Shuchin Bajaj is faced with incredibly difficult decisions on a daily basis.

Shuchin Bajaj: It’s heartbreaking for everybody, but you need to see whether you want to save 10, 15 lives, or just work very hard on one patient and use up all the oxygen you have. And then, maybe have a 40-50% chance of saving that person.

Darius Teter: I’m Darius Teter, and this is Grit & Growth with Stanford Graduate School of Business. The show where Africa and south Asia intrepid entrepreneurs share their trials and triumphs. In this special episode, Dr. Shuchin Bajaj shares his experiences from the frontline of India’s COVID-19 response. We hear inspiring stories of true grit from health care workers, how Shuchin’s pioneering hospitals are helping India’s underserved population, and how volunteers in the government have collaborated to provide vital telemedicine services. So, without further ado, here’s Shuchin.

Shuchin Bajaj: Hi, I’m Shuchin Bajaj, I’m the Founder, Director of Ujala Cygnus group of hospitals. We have 15 hospitals spread across four states of north India, catering to the most economically and access challenged communities.

Darius Teter: So, can you just describe for me your past 24 hours?

Shuchin Bajaj: They’ve been quite crazy as you may expect from someone who’s living in Delhi and working in healthcare. So, we have opened recently just three days ago, a 1,000 bed COVID care facility in partnership with the Delhi government, which is completely free of costs to everyone coming in and has all oxygen beds. So, oxygen is a bit of a scramble for all Delhiites and people living around Delhi, Haryana, and Uttar Pradesh right now. It’s an extremely premium commodity. The hospitals keep running out of it as well, so the past 24 hours have been mainly consisting of three, four things. I think one is of course working in that 1,000 bed facility that has taken quite a lot of my time and my hydration. Working in PPE kits really dries you out completely, especially in this hot weather and with the temporary structure for our hospital. So, it’s not really air conditioned or anything.

Second, I’ve been attending a lot of phone calls, sometimes as many as 400 to 500 a day, just trying to solve problems of many people related to hospital admissions, oxygen access. And third, of course, I’ve been scrambling to get oxygen for my hospital. So, most of my hospitals keep running out of oxygen. And then, we have to either scramble oxygen from one hospital to another, or shift out patients from one hospital to another or some other hospital to make sure that ventilated patients, and patients on bi-pap machines, and high flow oxygen don’t suffer. So in the last 24 hours, two hospitals, Rewari and Panipat, almost ran out of oxygen. So, we had to shift some patients from air to there. So, it’s been, almost say 10-12 days since I’ve had any sleep at all.

Darius Teter: So, do I understand correctly? So you have 15 hospitals that you manage as part of the Cygnus Group. You opened up three days ago, a 1,000 bed COVID hospital. So you’re an entrepreneur, you’re a business founder and manager, but you’re also an attending physician. Is that right? Are you walking around in PPE during the day?

Shuchin Bajaj: I am the backup physician for my hospitals anyways, but since we opened this new one, of course it has very low human resources right now. Sourcing human resources, even for current hospitals, which have established payrolls and established consultants on role is difficult. Getting new ones for the new hospital is even more difficult. So, I do ICU duties as backup for my hospitals as well when physicians fall sick, they’re not able to attend due to any reasons, because we run a very economically lean operation, as I said. So, when somebody falls sick, I cover up for them, but for this new one, of course, I’ve been doing my clinical work as well. So, it’s good to brush up on clinical skills all the time. And, I strongly feel that if you don’t work with patients, you see everything through the 30,000 feet level. Or, at a hospital of this scale before most of our hospitals have about 100 beds each, so this is 10 times that in one single setting.

And, it’s in a temporary structure, so everything is new about it. So, if we don’t work very closely with the patients we are supposed to care for there, there will be many things that we will miss. And, we will not be able to find out what processes are working, what are not. So, it’s a good learning experience as well.

Darius Teter: I remember speaking to you last year and when the lockdown first hit, and you mentioned that your hospitals were essentially brought to a standstill because nobody wanted to come in for elective surgery. Did you imagine then that you would be facing a second wave to look anything like this one?

Shuchin Bajaj: I don’t think anybody could have imagined that, I was sure that the second wave would hit. I was speaking to everyone because in the last century we’ve seen that the Spanish flu second wave was much wider and much deadlier. Even this century, we saw the second wave coming into Europe, then the UK, then U.S., then even in our country, in Kerala, then Maharashtra, Mumbai faced the brunt of it. So, we did see the second wave coming in, but the worst of expectations were that it would be double of what the first wave was. We didn’t even in our worst nightmares think that it would be four times, and the lethal part of it would be so much higher. The patients needing oxygen and ICU beds would be so much higher, because last year, as you said, we were expecting a lot of cases, but the hospitals weren’t quite full for a long time because there were no electives. The expected rush of COVID patients didn’t come in as late as July or August.

So, we were expecting it since March, we put the lock down on 25 March and then a very hard lockdown lasted for 68 days. But, once the lockdown happened, and then the cases started coming into the hospital. This year, I think the difference has been that there has been no lock down at all. And, a part of the blame goes to us as physicians as well because of the entire narrative that we built around the disease last year. That the youngsters are immune to it and they won’t get any serious disease, it’s the old people who will get into ICU. You will get a minor disease or mild disease. The only thing is that you can spread it to the elders, but you won’t get sick yourself, which has very sadly been proven to be very wrong. So, we are losing a lot of youngsters now, a lot of youngsters are getting into ICU.

Darius Teter: That narrative is not unique to India, we were all telling ourselves, it looks like somehow Africa has dodged this pandemic and it must be because the demographic pyramid is so flat and so wide with so many young people, maybe that’s the case in India. But, even in the U.S., we were telling ourselves this, so what has changed that makes this more lethal for younger people?

Shuchin Bajaj: I think, a mix of a lot of factors, one of course, is the new strain. So, we are seeing in Northern India, the UK variant is almost in 60% of the cases. India itself has had the double mutant, and now the triple mutant variant, the Bengali variant is there. So, a lot of new strains, unfortunately we have not been tracking the new strains as sincerely and as diligently as we should have been. Also, the fact that as we discussed this narrative that we built around, that the youngsters would be safe. So, the youngsters did go out, not just for work, but there were so many parties, and gatherings, and election rallies, and religious congregations. And, everybody was just having a ball, because I think prematurely congratulated ourselves as well that we had defeated the virus and India had this innate immunity, and because of the demographics as well.

And third, I think the vaccination drive didn’t really take off as it should have. Although we are the largest vaccine producers in the world, but the speed that we should have had, I think, didn’t really catch up initially, because there was so much vaccine hesitancy, the communication, maybe wasn’t good enough. And now, when the hesitancy has been overcome, and everybody now realizes that the vaccine is needed, the supply chains are not strong enough to ensure that each and everyone who wants the vaccine gets it for now.

Darius Teter: What was the origin of the vaccine hesitancy? I mean, obviously in the United States, there’s this very, very powerful misinformation campaign across social media where one person’s voice can be amplified a million times. Did some of that happen in India as well, distrust around specific vaccinations, or just the sense that if you’re young, you don’t need it?

Shuchin Bajaj: I think, everything that’s happened in the U.S., happened here. We have a very strong network of WhatsApp forwards that the more sensational they are, the faster they spread. So, a lot of misinformation about how vaccines were causing infertility, how vaccines were causing impotence, how vaccines were a strategy by the big companies in the U.S. to make sure that they had hegemony over the entire world due to some DNA being injected into the humans. So, there were a lot of misinformation campaigns. We tried our best to counter them. I personally did a lot of campaigns on radio, and the internet, to overcome vaccine hesitancy, but I think it was all a mix. The elderly were scared that they were too sick to tolerate an injection, that they would fall sick.

The youngsters were too overconfident that we don’t really need the vaccine because, anyways, even if we get an infection, it’ll be like the common cold, it will be a very mild infection. And, the vaccines are not promising any security against getting a mild infection. The vaccine communication was always that it will protect you against being really serious, but you can still get infected post vaccination. And, the youngsters were thinking that anyways, we won’t get serious anyway, so what’s the use. So, a lot of misinformation campaigns were there, a lot of narrative was skewed towards the anti vaccine lobby, but I think it has been overcome now to a great extent.

Darius Teter: I’d actually like our listeners to learn a bit more about you, so can you just tell me a little bit about yourself, your journey to becoming a doctor, and then at what point that became an entrepreneurial journey?

Shuchin Bajaj: I come from a very economically challenged family, myself. My parents were refugees into India, so they came in without anything. My father used to live with 16 of his siblings and relatives in one horse stable. And then, when he decided that the only way out of poverty was studying, he built himself a tin shed on the roof of the horse table, which he used to climb up using a rope every day and used to study there. And then, he got into the Delhi University there, he became a professor. He taught us that the only way out of poverty is education. So, we had to all study by force, so that is how I became a doctor, thankfully, due to the Indian education system, I got through all my studies practically for free. My annual fees were, I think, in medical school, less than $5 a year. So, it was all subsidized by the government.

Darius Teter: And, tell me the origin story of Ujala Cygnus Hospitals, I mean, what was the problem you were trying to solve?

Shuchin Bajaj: When I was in Delhi, I used to get a lot of these calls saying that, “Somebody’s sick, we are bringing him to Delhi, can you deserve a bed for us in your hospital? Can you help us?“ So, being the only doctor in the family, it felt very nice that I could help these people, I could solve their problems. But on the other hand, it was always very troubling: why did these people have to travel four to five hours to reach me at the risk of losing their lives because ambulances were not easily available?

Darius Teter: So, they’re calling you with an emergency, and their only option is to drive three or four hours to get to a decent hospital with a bed?

Shuchin Bajaj: Yeah, that would happen very regularly, and cell phones were not very common at that time. They were existing, but not everyone had them. So, I would sometimes wait for them the whole night, I won’t hear anything from them. I would keep waiting that they would turn up. Then the next day I would call their house saying, “What happened? You didn’t come.“ And, they would say that, “We were bringing the patient in, but then he died on the way, so we just turned back and came back home.“ So, I will then go and attend their funerals, so I would hear stories like, this one died, but it’s okay. The last one, he actually did make it to your hospital, he stayed there for 14, 15 days and he sold his house, he sold his fields to pay for the medical treatment, and then he died.

So, look at his widow, she’s sitting there, she’s begging on the street. So maybe it’s a good thing that this one died on the way and didn’t make it because, at least his widow has a house to live in now. So, all these stories, I would hear it and it would be very disturbing, that there’s this big problem and why are we not able to solve it? I think this was one of the biggest design thinking exercises that I did sitting in those communities and talking to them. Because, I would otherwise be thinking of how best to get them into my hospital, right? So, my entire focus would have been on better ambulances, better roads, and less traffic. But then, I realized pulling them into my hospital didn’t really work because even those who came, were not really served exactly to what they needed, even if they were saved, it was so expensive in these big private hospitals in Delhi that that was even a bigger debt.

If he did survive… I had seen that our people struggle to start from scratch, I had seen it in my family also. So, the whole focus shifted from how best to get them into hospitals in Delhi, to how we could go out and serve these people without completely breaking them economically. So, this is how the project started on how to best get good quality healthcare, which is not expensive as near to the community as possible without asking them to travel for five hours, and asking them to sell their houses or land. Because in India, 60 million people slip below the poverty line every year, just due to healthcare costs. Out of pocket expense on healthcare is massive here, there’s not much of a government or private coverage for health care. There’s a wide range of public health facilities in India from the best to the world, so unfortunately in small towns that we work in, the public health facilities are not something that you want to go to, especially in an emergency because they don’t have cardiology, neurosurgery, or intensive care.

Darius Teter: So, the problem statement is how do I get good quality urgent care, or emergency care, in tier two and tier three towns to save more lives and it needs to be affordable? How do you make that work? How do you pay the bills?

Shuchin Bajaj: So, we do a lot of things on that, the first thing is that we have very lean setting up costs, so it ensures return on capital very, very easily. And, we use a lot of our knowledge as medical practitioners, ourselves to see which things make a difference to the patient outcome, which things are just needed for luxury, and which things are just needed to make doctors happy. Second, we don’t own any land or assets, so it’s all a rental model, so we just rent out all the buildings and everything. So, we don’t spend any money on unnecessary acquisition of land or construction. Third, we work on a model of volumes of scale, so we usually hire all our doctors on fixed salaries. So, there’s no paper use kind of a model, so it’s not like the doctor is getting a share of each and every patient, which is usually the model everywhere.

And so, if we get the required number of patients, we don’t need to spend a lot on the doctors as well because they’re getting a fixed salary. So that ensures two things, one is if we get a lot of patients, the per patient cost for the doctor goes down a lot. Second, since the doctor is on a fixed salary, they are not incentivized to unnecessarily do procedures or do unnecessary dimensions on the patient. So, these are some of the things that we use to make sure that our hospitals are set up at very low cost.

Darius Teter: It’s interesting, you sound much more like an entrepreneur than a doctor. I remember you told me last year for years, you had considered expanding into telemedicine, but you thought, well, we’ll get to it, eventually we’ll get to it, eventually we’ll get to it eventually. And then, you had to get to it in two weeks after the lockdown in March of 2020. How has that grown? Is telemedicine a big part of your strategy to reach rural communities, to expand your services beyond brick and mortar?

Shuchin Bajaj: Digital health is one of the integrated parts of our work ever since the first wave last year… So much so in fact, that we named the company now, instead of Ujala Cygnus Hospitals, it’s called Ujala Cygnus Healthcare Services, so it’s not just hospitals. So, we started out with the thought that we had a group of hospitals who will also provide digital health services, but in the next few years, we want to be known as a healthcare services provider who also runs a group of hospitals. So, this is what our thinking has changed into.

Darius Teter: So, that’s a dramatic change, how many patients are you reaching with digital health services compared to brick and mortar hospital care?

Shuchin Bajaj: We had a huge beginning in their Delhi consultation services last year, and during the lockdown. So, during the lockdown, we were doing almost 35,000 daily consults a month. We usually do almost the same number as physical consults as well. So, we are hoping it will differentiate us from the other service providers that have only either brick and mortar or only digital health services. So, this is something that we built as a new product entirely. And, this is something that we are coming out with to offer to all of our partner organizations, as well as newer organizations that we are partnering with now.

Darius Teter: Describe for me, you said, “15 hospitals, they’re in tier two and tier three towns, about 100 beds per hospital, before you created this new emergency 1,000 bed ward.“ What has been the impact of this second wave of the pandemic on your existing hospital’s infrastructure? Are patients coming to you with COVID related illnesses? Did you have to completely change the way the hospitals run?

Shuchin Bajaj: We’ve been completely overwhelmed, I think, and that is an understatement. This year, we don’t have time to do any elective surgeries, or even our operation theaters now are full of COVID patients. So, our COVID patients are lying on the operation theater table, because that is one place where oxygen supplies are short. So, it’s been a struggle, it’s depressing and frustrating to just keep saying no to people. A lot of friends call up for beds, “Can you arrange one bed for us anywhere, we are ready to go anywhere, 200 kilometers, 400 kilometers. We are ready to travel, you have so many hospitals.“ But, it’s severely depressing, you have to refuse a lot of people every day, I’m just tired of saying no to everyone, but every hospital is full.

Darius Teter: Are you also turning people away? I mean, are you having to turn people away at the front doors of these hospitals? I mean, in addition to the people who know you, friends of friends, relatives?

Shuchin Bajaj: A tsunami, not a second wave, so the people are lining up outside hospitals. There’s a row of ambulances, standing outside hospitals waiting to get in. People have been in ambulances for eight hours, 10 hours at a stretch, not getting a hospital bed. So, we have had to turn many patients away from outside the hospital, from the casualty emergency room. All hospitals are full, it’s not just the beds that is a problem, it’s everything. So, most of the staff are falling sick, so they’re in no condition to work. They’re taking off for, let’s say seven days, eight days, they’re off duty, so we are short of doctors, short of nurses. And then of course, the biggest thing that in north India right now is availability of oxygen.

So, some hospitals are actually working well below capacity because we have no oxygen in the hospital. So, it’s not like last year when you were diagnosed with COVID and you suddenly started running to hospital. Now, the community understands that below 92, you don’t really need to look for hospital beds, so they’re all managing at home. So, everyone coming into hospital right now is having low oxygen, and that is what they’re coming for. So, all the bags in the hospital are oxygen beds now. And due to lack of oxygen, we are unable to admit a lot of patients, even though we may have vacant beds at that time. So, these are some things that we are really struggling for this year.

Darius Teter: How many people are working for you Shuchin across these hospitals?

Shuchin Bajaj: We have about 400 people working in the 1,000 beds set up right now, and besides that in the company, we have about 1,800 people working regularly as well.

Darius Teter: And, they’re all risking their lives right now during this pandemic, how do you keep them motivated? Have you had a lot of turnover? What’s your role as a leader in trying to keep this all hanging together?

Shuchin Bajaj: So, I’m very proud of the team we have, none of them, not even a single one has left their posts. Even if they’ve fallen sick, they’ve come back at the first opportunity to come back and work. Many of them have actually lost very close family members, and they’ve just gone for one day for the rituals and come back to work again the next day. Many of them have been caring for their close family members within the hospital itself. So, they’ve been working 24-7. They have not left their duties at all saying that, “My father is there, so I might as well stay with him, if I’m staying with him, I might as well work for other patients also.”

So, they’ve been very powerful, they’ve been very inspiring. The scare was much more. I think last year we had stories like if people wanted to come to work from their villages, the villages had broken their vehicles. They threatened to harm them, also they’re threatened. Then, if you are going to hospital, you cannot come back to the village at all. You just stay there, they had broken the roads of the villages to prevent people from coming out and going in. So, even then they had risked their lives walking through fields, to come back to work with us.

Darius Teter: There’s a strong culture, commitment to the mission, also the fact that you are both an entrepreneur managing this network of hospitals, but also putting on your PPE, and going to work everyday, must’ve been inspiring.

Shuchin Bajaj: I think the main thing is that they look to us for an example, right? So, I need to make sure that I am there on the front lines as well. I’m not just talking and saying that, you need to do it, right? When we set up the thousand bed hospital, I was there, I admitted the first patient myself. So, they do look it up as an example that, if this guy is standing there, it must be safe, right? If this guy is standing himself and seeing all the patients, and wearing the same kit as we’ve got. Even in vaccination, when vaccine hesitancy was there, the entire top management team, I think we were the first ones to go and say that, okay, now we are also getting vaccinated. So, come and you should all get vaccinated yourself as well.

Leading by example, I think is an important part. We’ve seen it all across India, that the medical fraternity has been… Every hospital has overwhelming flows, overflowing patients, but every hospital has been open at all times. And then, I work a lot with a voluntary organization called Project StepOne. So, we work with 18 state governments on their COVID response, ranging from COVID helplines to bed management, to home isolation management, to plasma banks.

Darius Teter: So, Project StepOne sounds interesting, it’s a cloud-based platform for volunteers to help something, can you say a bit more?

Shuchin Bajaj: Yeah so, it started as a small WhatsApp group last year in March itself. So, we thought that this COVID pandemic is coming and from what we are hearing, it will overwhelm everything. It will overwhelm the existing infrastructure, so the governments will need some help. Now, we have 7,000 doctors volunteering on the platform and 3,000 other volunteers, paramedics, nurses, medical students, techies. We do a lot of daily consultations, we do almost 70,000 calls a day now. Earlier, the doubts were whether I have COVID or not, so how to differentiate between a common cold and a COVID. And, if you needed a COVID test or not, that was how it started out.

Then, when COVID really increased, we started doing COVID positive triaging. Even now, we’re working with the vaccination drive a lot as well, we are working with Facebook to increase awareness about vaccination. We built WhatsApp chat bots to answer any questions on vaccination. So, a lot of these things are still happening in addition to work as a promoter and doctor in the Ujala Cygnus.

Darius Teter: I’m astounded at what you’re doing simultaneously, I actually can’t get my head around it. You’ve, apart from managing your hospital network, setting up a 1,000 bed COVID treatment facility, and then a second one, and managing this nonprofit Project StepOne. Which, actually sounds fascinating, it sounds like crowdsource telemedicine, plus triage for positive tests, plus public information, campaigning and advocacy, all run by volunteers. It’s actually amazing, I mean, I’ve actually never heard of anything like it. And, you’re doing that at night when you’re not in PPE being an attending physician when you’re not managing your business, how are you?

Shuchin Bajaj: Yeah, it’s actually one of the-

Darius Teter: Actually I should say, how many of you are there?

Shuchin Bajaj: I think, this is what happens when you enjoy everything you do. So, Project StepOne is I think one of the most fascinating things that you can ever come across. So, it has no office, it has no building again, so we don’t need to even pay rentals now, so it’s all good. Everybody works from their home on their one phones. 99.9% of the team have never met each other, there’s no name of Project StepOne anywhere, nobody recognizes it. So, I think it’s wonderful.

Darius Teter: I read an article, an interview with you and you quoted a Lennon saying, “Lennon famously said once that there’s decades, when nothing happens and then there’s days in which decades happen.“ Is that what’s happening right now?

Shuchin Bajaj: Oh, absolutely, beyond a doubt, I think these are days in which centuries have happened instead of decades. It’s life changing for everyone. I’m sure none of us will forget what has happened in these past few months. And, we’ll be those irritating grandfathers who tell their grandchildren these stories all the time. But yeah, these are days which have changed everything in our lives, they’ve turned everything topsy-turvy. There’s going to be a lot of learnings from this, hopefully, a lot of positive things. Hopefully, we’ll try and make sure that we don’t harm the planet as much as we’ve been doing over the past few centuries. And, I think there’s a lot of spirituality also coming into people. Hopefully, this will last much beyond the second wave, people will not go back to their routine lives when this wave finishes. I hope that is the silver lining that this wave will bring to us.

Darius Teter: It’s a very powerful sentiment, I share it. So, I want to know what has surprised you most about how the pandemic has unfolded, both as a doctor, but also as an entrepreneur?

Shuchin Bajaj: I think, the sheer speed and scale did surprise me, although we were expecting it to come, we were advocating with the government, with the public policy experts that this will definitely come, do not declare victory, but the scale at which it came. Second, I think what was not surprising in the rear view mirror, see everything is clear, but the fact that we did not anticipate many supply chain issues in the first wave, and then again in the second wave. So the first wave, as I said, it was PPE kits, masks, in the second wave it has been oxygen, medicines, everything is short. In the third wave, it may be doctors and nurses for all you can say. You’ll just sort out every physical thing in the supply chain, every material thing, and then in the third wave, you just may realize that doctors and nurses are not up to it. They will say, we’ve had enough, we are just calling sick, we are not coming in anymore because you can’t expect us to come in every time and do this.

So that, may be the case, there may be a lot of mental health issues in medical practitioners, in addition to physical health.

Darius Teter: I’m curious, a lot of the vaccination issues, supply chain disruptions being addressed through just painful experience. How do you think the public health policy landscape will change in India? It’s such a vast and varied country, you have a rural, urban divide, you have income divides. You have so many different cultures, and castes, and religions. What is your takeaway in terms of public health policy, public health spending, public health mandates? What changes do you see coming?

Shuchin Bajaj: So unfortunately, India has never seen an election in which healthcare is an issue, right? There have been no votes cast based on healthcare, manifestos, policies, or promises. Indian elections are mostly focused around various other issues. I hope that another silver lining behind this pandemic would be that healthcare would be in focus. People will start asking questions, what happened? Why did India become this country where public health care is not at all something that the government thinks of.

Darius Teter: Shuchin, our audience for this podcast are people in emerging markets, especially South Asia and Africa. And I’m curious, what advice do you have for our audience, for leaders who live in countries where the second wave, maybe hasn’t hit yet, and countries that for all intents and purposes, they’ve gone back to the normal rhythm of life. What advice do you have for the medical establishment, and the health policy leaders in those countries?

Shuchin Bajaj: I think, we need to learn from each other, so as we saw that the second wave does come in, it’s much bigger. It’s much more widespread and it’s much deadlier. We’ve seen that in the last century, we’ve seen that now in Europe, UK, U.S., now India. So I think, everyone needs to be prepared for it. We should hope for the best, but be prepared for the worst. It’s too early to declare a victory over this pandemic. Even if we are vaccinated, even if we have put all systems in place. I think, not just for the second wave in Africa and parts of South Asia, even the third wave, I think we should be prepared enough. We should secure our supply lines, we should make sure that everyone is ready with a lot of manpower and equipment.

Darius Teter: The issue of the extreme lockdown in March of last year, I think a lot of emerging markets looked at that and asked themselves, could our country survive a lockdown like that when such a large percentage of the population are working in the informal sector? So, if you don’t work one day, you actually don’t eat that day. So, in a big tsunami type wave of infections in one of these other economies or a third wave in India, is that kind of a lockdown even really a realistic option?

Shuchin Bajaj: I agree with you, it’s not an option at all for economies like us. We may be sitting in our homes and saying that, work from home and everybody should stay at home. But, the person who goes and works in a factory or works at a construction site, they have no option to work from home. And once you shut these down, of course, it is very difficult for them to earn their living, to even have a morsel to eat. And, the longer you stretch it out for the more chances there are of completely tearing up the fabric of the society, as you said. So, I think the easiest option is now to vaccinate everyone. So, each and every government needs to understand that the cost of the log down is hundreds and thousands of times more than these vaccine costs.

Darius Teter: I think, a lot of our listeners around the world will hear your story and they’ll want to know, well, what could I do? Or, what could my company do to help with your efforts and those of the others in Project StepOne?

Shuchin Bajaj: We are welcoming all kinds of help, we can use any help that we get. So, for Project StepOne, of course, the help that we need is more people volunteering. And, since it’s remote volunteering, you can volunteer from any part of the world. You just need a phone to volunteer, and a data connection. We have volunteers from a lot of countries, we actually have dedicated WhatsApp groups for the U.S., and Australia, and UK volunteers. So yeah, we have a website where people can just log on and fill a short form to volunteer, and we’ll be happy to onboard them.

We also have a similar volunteer call for Ujala Cygnus, because we have a lot of needs for backend technology, software, and how to streamline the processes. So, there’s a volunteer form on Ujala Cygnus website as well, you can just log on and fill the form and we’ll be happy to onboard you and see how much you can contribute from around the world. We need a lot, many more things than just volunteering remotely, but that is an important part, but we do need doctors and nurses to come forward and work with us. Not just voluntarily, we are willing for any person who wants to come and work with us on the salary, very happy to onboard you. We need as many people as possible, especially nurses. So, a lot of help is required and any help, even the smallest of help is welcome. We’ll gladly accept it and gladly… We’ll recognize you and honor you as well.

Darius Teter: To learn more about Project StepOne and how you can help, you can visit projectstepone.org. And, if you want to support Shuchin in his efforts at Ujala Cygnus, we’ll share some links with you in the show notes. With the crisis in Indian hospitals continuing, doctors like Shuchin are being faced with some of the toughest decisions of their careers.

Shuchin Bajaj: I think, the worst ones have been diffusing beds, turning away patients to very sick patients who really needed ventilators, and ICUs, but we didn’t have anything available. Even if we had, we had no oxygen available, so turning away a patient when you have a bed available, but you have rationed oxygen use and you feel that this, according to their triage, this patient will be using up a lot of our oxygen supplies without any expected, good outcomes. That is, I think one of the worst decisions anyone can make. It’s heartbreaking for everybody, but you need to see whether you want to save 10, 15 lives or just work very hard on one patient and use up all the oxygen you have, and then maybe have a 40-50% chance of saving that person.

Darius Teter: Yeah, that’s a tough one, I can’t even imagine it. I want to thank you for sharing something so difficult and painful. How are you preventing your own burnout? What keeps you going?

Shuchin Bajaj: I don’t know, I think I’ll need at least a couple of psychiatrists for the next 10 years. It’s very tough, but yeah, you get used to it, I think. Just keep working, you don’t get time to think this is, I think the most relaxed couple of hours I have ever had in the last month. So then, you start thinking of a lot of things, but when you’re in the heat of the battle, I don’t think you get time to reflect or time to think. It’s just making automated decisions that you don’t need to do this, need to do this, need to get into triage, need to get this patient done, need to get oxygen into that hospital. So, you don’t get time to think at all.

Darius Teter: That, brings us to the end of today’s special episode. I want to thank Dr. Shuchin Bajaj for taking the time to speak with us during this critical moment in India. His dedication to his work is truly inspiring, from running Ujala Cygnus Healthcare Services, and doing night shifts with Project StepOne, to putting on a PPE kit and treating patients. There are no lives untouched by the COVID-19 pandemic. And, as we globally enter this crisis together, the voices of doctors and scientists on the front lines have never been more important.

This has been a masterclass from Grit & Growth with Stanford Graduate School of Business. And, I’m your host Darius Teter. If you want to find out more about how Stanford Graduate School of Business is partnering with entrepreneurs throughout Africa and south Asia through Stanford Seed, visit seed.stanford.edu/podcast. If, you liked this episode, don’t forget to hit follow and share it with your friends. Grit & Growth is a podcast by Stanford Seed from Stanford Graduate School of Business.

Laurie Fuller researched and developed content for this episode, with additional research by Jeff Prickett. David Rosenzweig is our production coordinator, and our executive producer is Tiffany Steeves. With writing and production from Isobel Pollard and sound design and mixing by Alex Bennett at Lower Street Media. We’ll be back next week with an episode on managing a family business and succession planning. Don’t miss it.