Towards an Untraded Mission

 Aseem Garg,

Aseem Garg, MD, DCDC Kidney Care could not resist himself from  venturing into the unknown when he was well placed in a cushy job.  Inspired by the demand-supply gap in the dialysis scenario of Indian  healthcare, he envisioned DCDC Kidney Care. He shares his thoughts  on the dialysis care in India with Sharmila Das, ENN.

What was your eureka moment  to launch DCDC Kidney Care?
I was very clear of my intention when I was pursuing studies in IIM-Bangalore that I wanted to do something in  the social space that too either in education or in healthcare. I wanted to be  an entrepreneur; reason being never  took any bank jobs or employment  with any consulting firm. During the  second year of my management studies I was making business plans. I enrolled myself in social entrepreneurship course in the second year of the  course. Around this time two things  happened, one: I took this course and  second: Professor CK Praladh came  to campus and gave a very rewarding  speech on bottom of the pyramid.  These are couple of factors that really  moved me. Accordingly, I made some business plans both in education and  healthcare. In healthcare, dialysis as  a concept struck me. It was a fairly  established method of treatment outside India. Here you can probably  count the number of dialysis centers  on the finger tips. So there was an  opportunity that nobody was tapping  into and the concept could save many  lives National Kidney Foundation, having a chain of 24 dialysis centers in  Singapore, visited our campus and I apprised them of my objective and  business plan. I joined them for professional experience and thats how  this transition took place.

Did you get any incubation help from IIM Bangalore?
No incubation help per say. We had a strategic teaching course with a faculty there. When I made this business plan back in 2005, I discussed it with him and he encouraged me saying it is a good concept and a  lot of companies in US are looking for  it. So probably the discussion helped  me, but I have not leveraged the incubation facilities of IIM- Bangalore  for this.

Tell us about DCDC Kidney Care? What are the exclusive  medical services you offer?
We offer a normal, peaceful environment in which we provide dialysis services. One dialysis session takes four hours and 2-3 sessions in a week are recommended for a kidney patient. Naturally, getting dialysis done in a hospital environment can be a bit  taxing psychologically for the patient  so we need to create a homely environment. Therefore at DCDC, we have  beds, we have entertainment facilities like individual LCDs, video programs, movies, play stations, WIFI connectivity and the like. The idea is to make and feel the patient that they are not in a hospital but settled in a very homely environment. If the patients want they can watch movies, they can work on the laptops and most of our patients work on the laptops during their stay at the center.

What is the fee you charge for each session?
On average, it works out only to be Rs 1500 which is much cheaper than the corporate rates available. If you compare it with the corporate set-ups like in Fortis, the average dialysis fees is Rs 3000, in Apollo it is again Rs 3000, even a charitable trust like  Ganga Ram Hospital is doing it at Rs 2400. So we are almost 40 to 50 percent cheaper than the regular corporate worlds and providing the same quality.

How many dialysis sessions you have in a month?
We are doing close to 5,000 dialysis sessions in a month that makes us one of the biggest player in this field.

Are all of your centers located in Delhi?
Yes, we have presence all over Delhi, NCR and we have one centre in Panipat, Haryana. In next 20 days we are opening two centers in Jaipur and one in Ludhiana and one in Hissar. So we will have 12 centers by the end of this month. What are your views on the current state of kidney disease in India or kidney related problems in India. Kidney related disease has been  a neglected field till now mainly due  to the lack of awareness and poor affordability but the scenario is changing now and more and more people  are getting aware. Kidney disease  is purely a lifestyle disease. People come to End-Stage Renal Disease  (ESDR) and for dialysis because of  their lifestyle hazards. If they had  adjusted their lifestyle and had they  taken proper precautions then this  thing would have never ever happened. Almost 85 -90 percent of the  cases are due to blood pressure and  sugar related issues. These days,  diabetic and hypertension related problems are increasing. However, as  more and more centers are emerging  naturally the numbers of doctors are  also going up and they are spreading  more awareness. Due to this people  now are able to take better care of  themselves. Lately, health insurance have started covering kidney diseases, so the affordability factor is also  slowly and steadily started getting resolved. We are hoping that all regulatory factors would come in to play and will have much better service offerings going on.

How a kidney patient should  take care of himself or herself?
A kidney patient shows some symptoms of this disease. If somebody is in stage one or stage two the body does not show enough symptoms and whenever little symptoms are shown patients tend to ignore them. Ultimately prevention is the best cure. A patient should be able to detect the symptoms at the beginning itself so that they can adjust their lifestyle accordingly. The way to do is getting blood test done once in a year so that they can find out if there is something wrong with the body or not. Once it is clear that a person is into Chronic Kidney Disease (CKD) and going to get into dialysis, he needs to adjust his lifestyle. A proper diet control needs to be taken care of along with proper psychological sessions so that his mind is happy. Proper consultation with physicians and nephrologists should always be in place. We have designed a program to encourage our patients to take employment because after sometime kidney patients get depressed. We have seen family members discouraging patients by saying you are sick and you dont need to work you just lie down etc which is a wrong approach to heal the disease. We encourage our patients to get out and get a job and we offer them discounted treatment fee if they get a job. So its like a double benefit for you. Firstly you will be contributing to the family, your family will start respecting you more and that will boost your self esteem and you will also feel you are not a burden on any one and you will live a life with dignity.

The center which you have started is exclusively a dialysis center or you provide some other services too?
We provide certain support functions like psychiatric care to help cure the depressed minds and dieticians are here to give balance diet plan also.Apart from these, do you cover diagnostic part also like MRI? No, we dont. However, we have regular blood tests facilities. Normally, we outsource other diagnostics services or for five centers we make a central hub wherein we provide a lab but for other centers we are mainly 90 percent in dialysis.

Kidney disease is purely a lifestyle disease. People come to End-Stage Renal Disease (ESDR) and for dialysis because of their lifestyle hazards

How do you get your patients from hospitals?
We organise a host of on-field activities. In the recent past, we organized a lot of seminars, kidney care camps etc. We tried advertising, but I think healthcare is not suitable for newspaper advertising. So I think for us, its the on- field activity to engage patients, educating them about the disease, holding a lot of preventive camps etc help us to get patients from different hospitals. Like the radiology companies outsourcing their radiologist, complete MRI setup to different hospitals, are you also in touch with the hospitals? We are already doing that. We  have taken over entire dialysis department of different hospitals and a lot of  hospitals are outsourcing their dialysis need to us. For example, we have  our dialysis set up in National Heart  Institute, they did not have dialysis  department earlier. Also, we have our  set up in Kalra Hospital and in Bhagat Chandra Hospital. Actually out of  our total eight centers in Delhi, six are  outsourced departments to hospitals.

What are the technology advancement happening in this  field?
From technology point of view, we have the latest machines that are available overseas. Dialyses are getting much safer and it has started getting more acceptances. There is no breakthrough technology till now because dialysis as a process is made  to be as peaceful and painless as possible. I think the most successful innovation would be the artificial kidney transplant which will take away  the need of dialysis completely. We are now also providing home dialysis to the patients. If the patient opts for home dialysis, we reach their home with our machines, technical supports etc. We are actually innovative in our service delivery. We are offering mobile dialysis for the patient who is not able to commute. We fit one ambulance with the requisite machines, doctors and technicians; they visit the  patient at his place or any other place and provide the dialysis. What are the challenges you have faced to setup DCDC Kidney Care? The biggest challenge was from the fraternity itself as we are not doctors but outside people and getting into dialysis and bringing a lot of disruptive innovations. There was a lot of  resistance from nephrologists, from established doctors, they were very skeptical about how this process can work both in a standalone setting and in a hospital setting, because any kind of change is scary specially for the people who are involved in it. It was mainly the fear of the unknown, how the market will approach; whether  their role becomes less important etc many doctors opposed us. We fought  those challenges and ensured that the  We faced some regulatory hurdles too.
On issues like how you can start a standalone dialysis center etc. We tried to liaison with the Government  to make them understand that there should be regulations to govern this. Fund raising was always a problem, getting patients to the dialysis center  was also a problem as patients used to think that it was a specialty treatment and they need to go to a hospital only not to a standalone  enter. Now we observe the level of acceptance that hasbeen on the increase. model works.

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