In your interest.
Online Personal Finance Magazine
No beating about the bush.
Dr Ramakant Panda narrates his inspirational story of ascent to the league of the world’s top heart surgeons
Dr Ramakant Panda’s name comes up very high on any list of the world’s top heart surgeons who perform high-risk surgeries. Coming from a village in Orissa, Dr Panda was a topper at the All India Institute of Medical Sciences, New Delhi, but dejected by favouritism, he decided to go abroad. Good for him and for India because Dr Panda went on to do his Fellowship at the Cleveland Clinic, US, where he was trained by the pioneer of bypass surgery, Dr Floyd D Loop. Dr Panda has done over 10,000 bypass surgeries, making him one of the most prolific surgeons in the world. More importantly, he has performed more than 1,500 high-risk surgeries which have offered new life to many patients who were considered ‘inoperable’. He is the first in India to have introduced beating heart surgery, as well as ‘off-pump’ bypass surgery. His failure rate is just 0.5% against a world average of 2%. But being the top heart surgeon is not what makes him stand apart. It is his integrity, passion and humanism. One unique honour he has received was the prestigious Rashtriya Samman from the Income Tax department, for being one of the highest taxpayers between 1994-95 and 1998-99. Unlike many top doctors, Dr Panda refuses to be paid in cash. The same integrity and zeal has gone into setting up of the Asian Heart Institute in Mumbai, probably India’s best heart hospital. Here is his inspirational story
ML: Could you tell us about your education and family background?
RP: I was born in Orissa in a place called Jaspur. My parents were landowners. I spent my early childhood with my grandfather who was a freedom fighter. He was the headmaster of a school and a strict disciplinarian. For several years, my elder brother, a cousin, and I lived with my grandfather. I was with him till he died; I was then in the fifth standard. After that, I returned to live with my parents. My grandfather’s discipline had a tremendous impact on me. He loved us; at the same time, he was very strict. He used to insist that we wash our dishes after meals and wash our own clothes.
ML: Where did you study?
RP: Initially, at my grandfather’s school. After his death, I came back to my village and had to walk around 7-8 kilometres each way to school and back. My three brothers, my sister and I, all went to the same school. All of us used to stand first in our class. After high school, I went to BJD College.
ML: Did you know by then that you wanted to be a doctor?
RP: I had some interest, since one of my uncles is an ENT surgeon. Then, one of my cousins got married to a doctor; that had some impact on me. I clearly remember one incident that made me aspire to become a heart surgeon. In 1969, LIFE magazine had done a cover feature on Dr Denton A. Cooley (president and surgeon-in-chief, who founded the Texas Heart Institute), one of the all-time great heart surgeons, who had done the first heart transplant in the US. My uncle had brought a copy of the magazine, which had a big picture of Dr Cooley. That is when I had the dream of becoming a heart surgeon.
I studied for two years at BJD College and then went to SCV Medical College; I was the university topper in both places. It is at Cuttack Medical College that I began thinking of becoming a heart surgeon. The actual drive to become a heart surgeon came in the third year when clinical postings began; my first clinical posting was in the cardiology department. I was fascinated with heart surgery. I was always among the top five in the class at the medical college. For a year after that, I did my post-graduation from Burhampur Medical College, which is near Cuttack. I then appeared for the all-India entrance test to get into the AIIMS at New Delhi (All India Institute of Medical Sciences). I did my post-graduation in surgery and heart-surgery there between1980 and 1985. That is where the real grinding took place. I was always a hard-working student, but the actual drive to excel and do better in life happened at AIIMS. Those were among the toughest five years of my life, but they were also the formative years, which made me work hard. I often work about 18 hours a day. Actually, I used to work 18 hours a day on an average; now I have cut down to 14-16 hours a day. It was a really tough time for me.
ML: Tough because of the hard work, or even otherwise?
RP: Yes, even otherwise. I would rather not talk about it, except to say that there was a lot of bias. But that made me resolve that I wanted to do something and show people what I can do. So indirectly, it helped me.
ML: Is that when you decided to go to Cleveland?
RP: That was when I decided to go out of the country to get more training. In those days, in India, there were only four or five hospitals in the whole country doing heart surgery and they operated as a close-knit group. So if your boss was not happy with you, you were gone, because everybody knew one another. So there wasn’t much opportunity. I knew then that I had to go to some good place outside India and come back. So I gave those two qualifying exams for the US: it was called USMLE (United States Medical Licensing Examination) those days. It was getting tougher and tougher for doctors to go to the US, but I passed both the exams and began to search for institutes which offered the specialisation I was looking for. One of the consultants at AIIMS helped me get an appointment with Dr Dudley Johnson. Those days, Cleveland Clinic was the best in cardiac care. Luckily, a friend of mine went and spoke to the chief of cardiology about me and they took me in. So I went to Cleveland in 1986. Initially, I was under a culture shock. But that is where my whole life changed. In six months, I became the pet of my boss, so much so that even now we have a father-son relationship. His name was Dr Floyd D. Loop (chairman and CEO of Cleveland Clinic from 1989 to 2004). If you ask me, he was one of the founding fathers of bypass surgery. Within six to 12 months, I was fairly close to him and that is where I learnt all my surgical and technical skills.
ML: Cleveland Clinic is among the best in the world, isn’t it?
RP: Today, it is the best. For the last 15 years, it is rated as the best in the world. It is a very tough place; it requires you to be extremely hard working but with zero bias. If you are good and you are hard working, it is immediately recognised. That made a big difference to me. Within a year, I was doing the maximum number of surgeries as a resident – they never give so many surgeries to a resident doctor – to the extent that when I left, my boss wrote that I was the best resident doctor they ever trained in that place. I almost wanted to settle down there; at the same time, I also wanted to come back to India.
ML: When was that?
RP: This was in 1992. The reason I wanted to settle there was that I was also involved in a heart transplant programme. We used to go at night to harvest hearts from the small village and town hospitals. That is when my concept of a hospital underwent a complete change. Those days, AIIMS was the best hospital in India, but I saw that there was simply no comparison in the infrastructure and facilities that even small-town hospitals and community hospitals in the US had – they were far better than ours. So I thought I could come back and build that type of a hospital here. At that time, I had a staff position at Cleveland Clinic as a consultant which was one of the most sought after positions those days. But one day, while I was operating with Dr Loop, I told him that I wanted to go back to India. He said, “What?” He was stunned and wasn’t happy with my decision at all. I said, “Yes, I want to go back and start a small heart hospital and I want you to help me.” Those days, Cleveland Clinic was expanding very rapidly under him. He said, “Why don’t you go to one of these hospitals and develop a cardiac surgery programme?” But I told him that I wanted to go back and, after six years, I returned.
At that time, I wanted to do transplant surgery programmes. There is a place called Hairfields in London. There was a surgeon called Dr. Magdi Yacoub… he is also absolutely one of the all-time great cardiac surgeons. I spent around nine months to a year with him to learn about heart transplants. I came back in 1993.
ML: When you decided to return to India, did you know which city you would come back to?
RP: I just wanted to set up a heart hospital; that was my dream – my aim was to do it in Delhi. I knew people there. In those days, there was only Escorts Hospital and AIIMS; Batra Hospital had started but it wasn’t doing well and Modi Hospital was supposed to come up. Once I decided to return, I started coming to India on short trips from 1990 onwards. The first time I came here, I thought ‘no way I want to come back’. Then I introspected and decided that I did want to return, so I’d better start acclimatising myself. I came to India eight times in the next two years.
ML: Were you married by then?
RP: Yes, I got married in 1986 and both my children were born in the US. At Cleveland Clinic, our work routine was 40 hours of work; go home to sleep for eight hours and come back work again for 40 hours – this went on for three years. You earned money, but you got up at 4.30am; by 5am / 5.15am, you left for the hospital; at 5.30am, your morning round starts; 5.30am to 7.00am, you take your ICU round. The previous night’s team hands over charge to you. By 7.00 O’clock, if you are assigned to the operation theatre, the whole day you are in there; otherwise you have 60 patients to see – even at one minute per patient, it takes an hour. There was absolutely no time to eat; you often got time to eat only at 2pm.
ML: Why was it such a punishing schedule?
RP: You got used to it. Part of the reason is they wanted to keep the number of trainees to the minimum and give you that kind of intensive training. For instance, whatever I learnt in three years at AIIMS, I learnt in six months at Cleveland. So you go through a punishing schedule but you basically do a 10-year training in two to three years. When you leave Cleveland, you are one of the best. I think this was the best period of my life. My hard work was recognised and I was the most popular doctor there. Even now, people remember me and if I need anything, they will always help me without hesitation.
The work culture at London was very different. I came back from there in nine months because it was just like the Indian government hospitals. Nobody came before 9am; I was the only guy there at 6.30-7.00am. Nobody was discharged quickly from the ICU and there were long waiting lists. I tried to push the standards and get them to handle more cases, but it only made me a lot of enemies. So I thought: this is not the right place for me, I must get out.
When I returned, my first stop obviously was Delhi, but no opening was available there. Bangalore was the next option because my sister was there. Honestly, Mumbai was not on my radar; but that was the best thing that happened to me. So I went all over the place – I went to Apollo (Hospital) and that is another story; it is one of those experiences that taught me not to trust certain types.
ML: What happened at Apollo Hospital?
RP: I had signed an agreement to join Apollo Hospital at Hyderabad. I did some cases at Apollo, Chennai, and I went back to resign my job at Cleveland and wind up. A week before I was to leave, I received a phone call saying ‘we want to delay your appointment’. So I called up Apollo chairman’s daughter – Mrs Sangita Reddy – and she said, ‘we think you will be better at the Apollo Hospital coming up at New Delhi.’ I said, “I am ready to go to India, I have sold off everything and I have bought a ticket; and, at the last minute, you are saying wait for two years, how do I trust you?” I decided it was not the right place for me.
Some time later, I was passing through Mumbai on my way back to the US. That’s when one of my patients, Dr PV Mehta, a gynaecologist at Jaslok Hospital and his wife also a eminent doctor – took me out for dinner. When they heard about my plans, they said, ‘why don’t you consider Mumbai?’ They insisted that I meet them at Jaslok the next day, although I was flying out. They were showing me around, and I met Dr AV Mehta. When he came to know that I was from Cleveland and was looking for an opening in India, he said: ‘you are joining us here’. He took me to the chairman, Mr Mathuradas, and that is how the whole thing started rolling.
ML: At that stage, when you were looking to be attached to a hospital, why did you not consider Escorts with Dr Naresh Trehan?
RP: At that time, I had a dream but no money. So I had to join some hospital whether it was at Bangalore, Delhi or Mumbai. Yes, I know Naresh, but I also knew I would not be able to grow there. So in 1993 I started practising at Jaslok and, after a few months, at Breach Candy Hospital. My experience at Cleveland helped, because the technology and expertise was 10 years ahead of other places. I started doing the most risky cases. My first five or six cases were those of patients that nobody wanted to touch. All of them survived and that created an impression; there has been no looking back since. One case I remember was that of a senior IAS officer – he is still alive. He had a major cardiac arrest and his heart stopped beating for 20 minutes. He needed an angioplasty and most of the other surgeons refused. At that time, I had just come back from the US and had no case. So when the family asked me, I said I will take the case provided you don’t sue me. He was saved and I remember I was by their side for almost two months. A few cases like that established my reputation.
I was still looking for a place, since my dream was this hospital. My NRI friend and I started looking for a plot, even though I had no money, no car and no place to stay. I have probably looked at every single piece of land in Mumbai -- from Cuffe Parade to Panvel -- you name it and I have seen it. If I found a good location, the title was not clear; and I was getting frustrated. I used to talk to my boss at Cleveland and he said, ‘why are you rotting there, why don’t you come back?’ I told him, ‘I will try for a few more years and if I still don’t get what I want, I will come back (to the US)’. Meanwhile, my career had zoomed professionally.
I almost finalised a place near INORBIT Mall. But one of my very close friends, Mr M.R. Chandurkar, chairman of IPCA Laboratories, said: ‘nothing doing, we will find you a better place’. Then we got to know about a plot of land at the Bandra-Kurla Complex under the Mumbai Metropolitan Regional Development Authority (MMRDA), which was soon advertised.
ML: This was during the first round of auctions and not very expensive?
RP: It was not very expensive and nobody wanted to come here, since it was not a residential area. My friends said I was mad, but I said, I am not looking at the present; I am looking 10 years ahead. Believe it or not, I didn’t have even Rs30 lakh, out of the Rs60 lakh that we had to pay as a deposit. So we begged and borrowed from friends and put up the money.
ML: You also gave a lot of thought to the capital structure and hospital design, didn’t you?
RP: Yes, that model and thought process came from the Cleveland Clinic. My entire infrastructure and management technique came from the Cleveland Hospital. I also got involved in helping others to get some experience in hospital design and architecture. I read a lot; my cupboard is full of books on hospital architecture, design, layout of the ICCU (intensive cardiac care unit) and the OT (operation theatre). In fact, I now know more about OT and ICCU design than anybody else in the country. The owner of Lilavati Hospital is a good friend of mine, so I helped design their entire first floor. I was also involved with designing seven or eight other hospitals around the country, including Medicity in Hyderabad. I basically incorporated whatever I saw in Cleveland over here. For instance, the doctors’ consulting room, the operation theatre and the ICCU have to be as close to one another as possible because, in an emergency, you need to attend to a patient within seconds. In India, you will find that the doctor’s office is on one floor, the OT is on another floor and the ICCU is on some other floor; you lose patients before the doctor can reach them. In my hospital, the OT and CathLab are only 15 feet away. I can transfer a patient from one to the other in 10 seconds and it can make the difference between life and death. I learnt a lot from other people’s problems.
ML: What kind of problems?
RP: For instance, about raising finances. We decided to have at least 80% of the money in place before starting the construction. I delayed the project by six months to get the finances and spent a lot of time with the architects and consultants, designing and planning everything on paper. My brief to them was: you can break a wall 10 times on paper. But, once you build, I am not going to allow any breakage.
ML: How did you organise the funding?
RP: A lot of my family members and friends chipped in; they are all equity holders. And yes, I raised money from relatives of my patients and colleagues. I also looked for a bank loan, which was very tough to come by then. Healthcare was considered a useless industry those days and the Industrial Development Bank of India (IDBI) had lost Rs1,800 crore. I went to IDBI; luckily I had happened to operate on one Mr MS Verma who was then the chairman of the State Bank of India. We became close friends and I requested him to help me – he also happens to be our chairman now. So Mr Verma spoke to the IDBI chairman Mr GP Gupta. I clearly remember that five of us had gone to meet them and one of the directors said “you guys don’t know sand from cement; how are going to complete this hospital project in 18 months?” He said it would take five years to complete. Mr Verma pushed the case with Mr Gupta and they agreed to give me the loan. While the negotiation was going on, I happened to operate on the then Bank of India chairman, KV Krishnamurthy. He had already undergone two bypass surgeries and everybody had said he was inoperable. I agreed to do the surgery. It took 16 to 18 hours and he came out of it successfully and is doing well. He said, ‘doctor, what can I do for you’? I told him about my dream and that no bank was willing to lend money to a hospital and that I had no collateral. He single-handedly took up my case and convinced the board to give me money. He also roped in Mr Leeladhar (then chairman of Union Bank of India). I decided not to borrow from IDBI but to go to BOI instead; I had a good rapport with them and they would be a little merciful, if we had repayment problems. That is how we started construction. I had a very strict schedule with all my contractors – they were eligible for a bonus if the work was done before time and had to pay a penalty for every day of delay. I had a target of 18 months to complete the project. It was a really crazy schedule; I was working for almost 22 hours a day, seven days a week, and I was sleeping for only two hours a day.
ML: The work on the hospital started in 2003?
RP: No, the work started in May 2001. I had a target of completing the work in 18 months and was driving everybody nuts. Luckily, my brother-in-law was the president of ABB (in charge of Far East) in Singapore. He had come back to start his own manufacturing firm for exports. But 9/11 (New York bombing) happened and everything was in a state of flux for a while. So I said, ‘why don’t you come over and help me?’ That was a great help; he also worked 14 to 16 hours a day. I would have finished the project in 14 months except that the air-conditioning experts goofed up and forced us to re-do a lot of work. We finally finished in 19 months and started paying the banks one and a half years in advance.
ML: How big was the project?
RP: When MMRDA allotted the land, they gave all the available plots to others and the remaining one was given to the hospital. It had a zigzag shape and we could not have constructed a hospital. The police had an equally bad plot of land adjacent to ours. So I went to the Mumbai police commissioner M.N. Singh and said, ‘your land is just as bad; can we merge it and divide it so that we have better plots?’ He agreed. Mr Ajit Warty was the MMRDA commissioner then; he was extremely helpful and agreed to let us merge the plots and re-do the boundaries. I initially met Mr Warty to apply for the land. He laughed at my wanting a plot, but when I then told him about my dream, he said, “Doctor, go home and rest. When the plot is advertised, make sure you are the highest bidder”. We did that and got the land.
ML: Didn’t MMRDA have reservation for a hospital in their plans?
RP: Yes, but nobody wanted to come here, so there were only 10 or 12 bidders. My plan was to construct on a smaller scale because I did not have that kind of money; and then do the second phase after 10 years. That was not possible, so we decided to complete the entire civil work; we also reduced the project cost from Rs112 crore to Rs95 crore. We put our own money into the construction first and also did a lot of tax management. We took the bank loan only at the end so as to reduce our interest burden; and also so that they would have no reservations about lending us money.
ML: Who was advising you on financial matters?
RP: Nobody. Our inauguration was also novel; we called three religious heads – the Kanchi Shankaracharya, the Archbishop and a Muslim leader. My boss from Cleveland, Dr Loop, flew down from the US and inaugurated the Asian Heart Hospital.
I must tell you another interesting episode. When we were planning the construction, our interior designers and architects kept comparing what I was doing with Jaslok and Lilavati. Finally, I got really mad and said I am trying to build a modern hospital. I then took a team of them to the US and showed them what the hospitals there look like. We went to Detroit, Chicago and Cleveland Clinic and I sought permission to let them take over 5,000 pictures. I also had a minimum brief – there was to be no black, brown or grey colour in this Hospital.
There is another interesting story on design. HOSMAC was our local hospital architect. During design phase, I talked to my boss Dr Loop. He got in one of the best from Cornell, NBBJ – the largest firm of hospital architects in the US. Cleveland Clinic had done more than $5 billion worth of business with them. Their chief architect told me ‘your boss has asked me to help you; I have no choice’. Over the next five days, they whetted my plans and gave a lot of suggestions.
As I said, I have gone into the minutest details of the hospital. On the quality side, I put in strict protocols and gathered a core team of people who were hard-working and totally dedicated. I have a surgical team that is very good. My anaesthetist is the best in town; my intensivist, Dr D’silva, is probably the best in the country -- and their hallmark is that, like me, they work 14 to 16 hours a day.
ML: How do you manage to keep people enthused and retain them?
RP: Yes, it is tough, especially in Mumbai. The Indian mindset is not used to working in world-class conditions and that’s the reason why the turnover rate (attrition) is pretty high here. But my core group, which is the basic structure on which my hospital depends, is there. Within six months of commencement, we were doing the toughest procedures. But the turnover rate is high. Once people get the Asian Heart brand name, they are paid twice or thrice the salary, since there is a tremendous shortage of trained people. But my core group has not changed. They are loyal to me.
ML: Tell us a little about your work in surgery. We learn that you have the safest hands in operations with the highest success rate.
RP: Yes, my surgical failure rate, on an average, in the last seven or eight years is 0.5%, while the US average is 2% to 3%. I still spend around 10-12 hours out of my 16-18-hour working day on my clinical practice. That is close to my heart. I still do the highest number of most difficult cases around the country and I don’t want to give that up. I have done over 10,000 operations till date; even tomorrow, I have six to eight heart operations. It is only on weekends that I catch up with research and other work.
ML: What are the major differences between the US and India as far as the work is concerned?
RP: The major difference here is that patients have tremendous respect for you; in the US, it is like I have paid you money, you have to do your job. The patients’ expectation level in India is very low and their appreciation is what can make you go on for 16 hours. The problem is the work culture. Bringing people to their highest standards and getting them to keep at it day in and day out is very tough. They are not used to it. Half the staff is from the slums; so training them to be very clean and courteous for half the day and then sending them back to a totally different reality is difficult. So we have constant training and supervision.
ML: Collectively, how much stake do the doctors hold in Asian Heart Hospital?
RP: All the senior doctors have a stake; collectively, we hold around 70%. I made sure that doctors hold more than 50% because, if it is a question of choosing between quality and cost, we will choose quality; a pure businessman is not going to like that. If a doctor comes tomorrow and wants certain equipment because it is important, I would immediately say yes; while if it is a management decision, they will ask for a business plan and repayment ability, etc. We don’t compromise on quality issues. That’s why ours is the only hospital in the country that has both ISO certification and JCI (Joint Commission International) certification – no other hospital has both. I have insisted on certification right from the beginning. You have standard processes for everything in industry; but a hospital, which is one industry where you are dealing with human lives, has no standardisation. I am among the first in India to push for standardisation in the whole industry. JCIR is for standardisation of the care processes; it is a tough US-based accreditation. ISO mostly looks after the back-of-the-house processes. Then we went for an NIAHO (National Institute for the Accreditation of Healthcare Organizations) accreditation, another accreditation which is basically a combination of both ISO and JCI standards.
ML: In terms of medical techniques, how do you keep up with developments?
RP: In terms of medical equipment and technology, the competition among the good hospitals is such that everybody gets it immediately. Even techniques -- what you learn today, everybody knows tomorrow morning. The difference between a good hospital and an average hospital lies in how it uses the technology to provide better services and that is where we score better than any other hospital. No other hospital in the country can match our workspace, our ICCU care, our inspections or appraisals. That is where, I think, very strong systems and processes and a core group of doctors to deliver results on the surgical side and the intensive care side have made a difference.
ML: What next, any expansion plans?
RP: Yes, we had planned the second phase in 10 years but we are now doing it in five. We are going to add another 150 beds; after that, we have other expansion plans. We have already identified four places for expansion in the next two years -- one of them will definitely be my home town Bhubaneshwar, where we have already got the land from the Orissa government. I will start construction by December 2007. My long-term dream is to start a medical college in the next 10 years; again with quality as the focus.
ML: There is a lot of talk of medical tourism; do you see that developing in a big way?
RP: Right now, we are catering to people from the Middle East and the NRI population from around the world. Getting people from the USA is a little tough mainly because of the distance. Travel for 18 hours is tough and perception about India is also an issue but it is changing rapidly. If we can target the 30% of the population that is not insured in the US, if we can tap those, it may work.
ML: What about the NHS backlog in the UK? Can’t we get those patients?
RP: I was part of the Prime Minister’s delegation that went to the UK last October. We were told it is a sensitive issue: don’t even raise it in this forum. The problem is the European Union law that says that no patient can travel more than four hours for treatment. So India gets excluded. We still get a few patients. Last year, we got 10 patients, of whom six were Indians. These aren’t big numbers. In the US, the insurers are offering substantially lower health insurance premium and other financial incentives for those willing to be treated outside -- in countries like India, Thailand or Singapore. They pay the airfare and cash allowance. What people forget is that Malaysia, Singapore and Thailand are far ahead of us in terms of infrastructure. There is a hospital in Thailand, called Bumrungrad Hospital, which treated 65,000 Americans last year. A single hospital gets more patients from overseas than all of India; and the infrastructure, hospitality and customer service is really unbelievable. It will take some time for India to catch up with them. I take some credit that, with Asian Heart Institute, I am somewhat closer to them.
ML: Do you have plans to go public and get listed?
RP: Yes, somewhere down the line; but right now, we want to expand and finish paying off our Rs65 crore loan.
ML: How much will it cost to set up a new hospital today?
RP: It depends. I will not spend so much on interiors. The basic thumb rule for hospital beds is Rs30 to Rs40 lakh per bed. If you are doing a 100-bed hospital, it should ideally be Rs30 crore or a maximum Rs40 crore; beyond that, breakeven becomes tough. But I never looked at economics while building Asian Heart – this is my dream project, which I have built from my heart. Otherwise, do you think I would have had an office like this? Lots of people tell me there is wastage in terms of space. But I say two things: I did it from my heart and I did not look at economics. Besides, I have seen every hospital in Mumbai. Once you are successful and have the money, you want to provide ambience and services, but you have construction restraints and cannot do anything about it. So, I wanted flexibility right from the start.
ML: How much was your cost per bed here?
RP: Very high, around Rs80 lakh. Normally, this would not have been viable; the reason it worked is that my partners and I already had a successful practice in Mumbai and could transfer that here immediately. We have 80% occupancy.
ML: Can you tell us about your Bhubaneshwar project?
RP: My father came here three years ago. He said I will give you some advice. I asked what? He said, “Are you going to take all the money when you go up (die)? You are not from here (Mumbai); why don’t you do something for Bhubaneshwar?” I said okay, I will do something, and I approached the chief minister (Naveen Patnaik). He was very helpful; he is going out of the way to help me. I have got half of the land now, the other half was under litigation, but I will get it by December.
ML: You have an unusual honour among doctors for being among the highest taxpayers…
RP: : It is a funny thing; I always took my fees in cheque, even in 1996 when it was not usual. So my first CA asked me, ‘Doctor, what is your cash income?’ I told him this is all the income I have; there is no cash income. He told me that nobody would believe it and that I should better start taking cash because the income-tax officials won’t believe it either and will claim that you earn thrice as much. I said, ‘okay let them come and check my house, if they want to rip up my sofa to look for cash, I don’t mind.’ That’s when I had come back to India; and, from day one, I have been taking only cheque payments and the tax authorities gave me the highest taxpayer award in 1996.
ML: Tell us about your plans for a medical college?
RP: I would love to do it in Mumbai – the city has given me so much. I never imagined that I will land up in Mumbai. In retrospect, I don’t think I could have achieved what I have, had I not been in Mumbai. What I like about this place is that it doesn’t matter where you come from; it is what you do that counts.
ML: When you are expanding, how will you ensure the highest standards?
RP: I am creating a core team that will fly down for critically ill patients. But that is never more than 10%. Over 80% of the work is routine and that can be handled by local doctors. I have given up attending to the day-to-day administration. I am no longer the CEO. I just have a weekly management meeting. I have also created a quality team that continuously monitors quality in all sections and gives me a report. We have a management council where we have taken six managers who, between them, take all key decisions. So everything is decentralised and I plan to follow this model everywhere. The future of healthcare is not in nice interiors or in new concepts in hospital design but in higher standards of patient care. Those are the areas, I think, I have contributed to.
Dr RH Patil narrates the innovations and battles behind the setting up of the National Stock Exchange
Ask anyone who was the moving force behind setting up the National Stock Exchange (NSE) and few will mention Dr RH Patil’s name. Yet, it is one of the largest in the world and valued at Rs18,000 crore within 13 years of operations. Ask what has he gone on to do after leaving NSE and...
He rose from washing cars and selling vegetables to become an MP. Here is Shivajirao Patil’s incredible story of self-belief
His life story almost sounds like an absurd daydream, not merely because he rose from washing cars and selling vegetables for a living to become a Member of Parliament; but because he did it by mastering information technology and turning entrepreneur at a time when the country was barely aware of integrated circuits and microprocessors. That is Shivajirao Adhalrao Patil’s incredible story of achievement and self-belief. His firm Dynalog started out by producing manuals for microprocessors and went on to build industrial computers and later to supply components and assemblies for India’s missile programme. Dynalog’s profitability gave him resources for social work at his hometown of Landewadi in Pune district and got him elected to the Lok Sabha. Ironically, it is as the people’s representative he feels bitter that his efforts at social development are frustrated by dirty politics and mindless rivalries. Patil narrated his amazing story with passion and objectivity
ML: We believe that you come from a very humble background. Can you tell us something about your childhood?
SP: I was born at a place called Landewadi in Ambegaon taluka of Pune district near a place called Mancher. This was in 1956. My family was into agriculture but since it was a very small landholding, my childhood was one of struggle. Going to school was also an issue. There was resistance from my family; they wanted me to earn money instead. When I was in the sixth standard, they wanted me to drop out and work on the farm.
ML: You went to a school at Landewadi?
SP: Yes. From the very beginning, I was very fond of reading and studies. After my first standard, I got a ‘double promotion’ to the third standard, because the teacher thought I was good enough for that level. Since I was very interested in studies, I did my schooling up to the seventh at Landewadi and then did my eighth and ninth standard at Mancher. I had to travel by bus if I could get a concession pass; but if I didn’t have the money to buy a pass, I would walk five kilometers.
My father wanted me to join him in Mumbai. He used to go to Mumbai at least four months in a year, during the mango season to sell Alphonso mangoes. Sometimes, he just went to Crawford Market, bought a few boxes and sold them on a retail basis at Ghatkopar. At other times, he sold vegetables, fruits or lemons. Since he insisted on my joining him in Mumbai, I agreed, on the condition that he would allow me to study in a night school. We used to stay in one of the slums at Ghatkopar’s Golibar Road.
ML: Did you have any brothers and sisters?
SP: Yes, I had one older brother in the military; he later joined the post office as a clerk. Another brother worked at the family farm and I was the third child. So, in Mumbai, I worked with my father during the day and went to night school at Ghatkopar East. After two-three years, my father decided that he wanted to go back to Landewadi. But I refused. I said I have been here for two years; let me make my career here. So I stayed back and tried to carry on the business of selling fruits and vegetables. But I didn’t like carrying boxes around and trying to sell them.
ML: So where did you stay after your father left?
SP: My father had sold our little hut when he left. So, initially, I stayed with a friend. But since he had a family, it really meant sleeping in the open and leaving in the morning as soon as I had bathed. I had nothing, just one set of clothes and a little bedroll. One always slept in the open and, during the monsoons, we found shelter in some under-construction building nearby and slept there. This was during 1971-73, when I was around 15.
ML: How did you earn money then?
SP: After my father left, I did a variety of odd jobs. I worked as an usher at cinema theatres, as casual labour at a textile mill at Rs seven for a 12-hour shift. I have worked at Crompton Greaves as gate-labour -- they used to pay Rs10 a day -- and, sometimes, as a railway porter. I also got into bad company, since there was nobody to guide me those days… I didn’t work until I ran out of money and then went back to a daily labour job. Then, my brother, who was in the post-office, found me a job at Zenith Computers at Walkeshwar. This was an assured job as a peon and gave me Rs125 per month. Once I settled down there, I started studying again. I joined Vivekanand night classes in Dadar. I also learnt typing and English conversation. I used to do three classes at a time - every evening - one hour of typing, then an hour of English conversation and then the night school. In that way, I completed my 11th standard and passed with a first class.
Zenith Computers used to sell the latest technology integrated circuits (IC) and chips for computers. I was around 18 and got very interested in what they were doing. I used to read all the manuals and literature. I worked for three years at Zenith and, since the office was very small - just eight-ten employees - I got to work in every department. As a peon, I worked with accounts, with marketing, purchase and the technical people. If someone was absent, I would help out wherever needed. I became an all-rounder.
ML: You learnt all this on the job?
SP: I had become quite the favourite there. For instance, if the marketing manager was absent, there wasn’t a problem because I knew his work. But if I was absent, they were stuck. Meanwhile, having finished my 11th standard, I joined a correspondence course at the Shivaji University for my graduation. It was a pre-degree arts course.
In the three years that I was with Zenith, I would do everything -- from bringing tea for the marketing manager and cleaning his table, to dictating correspondence when he was absent. Sometime then, I began to realise that there is no future in it for me. There were regular increments, which were undoubtedly good, but no promotion and, therefore, no future.
ML: Did you work directly with Raj Saraf (owner of Zenith Computers)?
SP: Yes, absolutely. It was a very small office those days (Zenith Computers is now a listed company with Rs300 crore turnover). He used to have a second-hand car those days, where if he braked hard, his foot got tangled in the wires! He was a very generous man and encouraged me a lot. He gave me money for my exam fees and tuition fees for college -- well beyond my salary. His moral support was very encouraging. But still, I had begun to feel that I had the potential to be much more than a peon.
At that time, a few new companies had begun to enter the business of trading in electronic components -- other than the shops at Lamington Road. Although the products were required by a wide spectrum of industries using electronic equipment, few people understood the business. Then, in 1977, I saw an advertisement. This was by a family called Gupta who had come from America to start an electronic trading business. I applied for the post of a clerk and was called for an interview. After a detailed interview -- where they asked me a lot of technical questions -- I was told that I had been appointed as a Sales Executive. I said: “But I have applied for the job of a clerk”. They looked at my application form again and, finally, said, “Since you have answered all the questions, why don’t you join as a Sales Executive”?
They asked me about my salary expectations and after some discussion, offered me Rs1200 per month. My last salary at Zenith was Rs250.
I went back to Mr Saraf and told him that I was leaving for better prospects. He said: “if salary is the only issue, I will pay that much”. But I said that I have already committed to join the other company and left. Within three months of taking up the new job, I realised that I had little support from the company. I was buying parts on my personal credit -- because everybody knew me from my Zenith days -- they didn’t know the new company. The sales were also based on my previous contacts -- All India Radio, Glaxo and Doordarshan -- just about everybody who needed electronic components.
I then realised that I don’t really need the company to be able to do the business; so in three months, I decided to strike out on my own. I went to the owner of the business and told him about my decision. He tried to persuade me and offered to increase my salary to Rs2000. I said, “No, Rs 1200 was not a small amount for me, but I want to try my luck and see if I can succeed”.
ML: Where were you living those days?
SP: I still lived in the slum with a friend but it changed after I started my own business. It was a very large slum near Dharavi. Since I was the only person buying an English newspaper in the slum, the paper vendor was curious about me and we got to know each other. One day, he told me that someone in a nearby building was looking for a paying-guest to share his apartment. I moved there in 1978, and started my business with Rs3500 in the bank. I used to give the address of my paying-guest apartment for my business.
ML: Wasn’t it a problem getting a phone, etc.?
SP: Yes, but it didn’t matter because I wasn’t expecting anyone to call me. My schedule those days was to get out of the house very early and go from one company to another on a door-to-door basis. Once I picked up enquiries for a specific part, I would go to Lamington Road in the evening to check the sources. The problem those days was availability of electronic components and parts. There were thousands of components in a machine but they were not easily available. What I did was to look for alternatives -- for instance, if a television has a particular transistor, say the SL 100 which was made in Russia and was not available -- I would look through the data books and manuals to find an alternative component made by another company or another country. In 99% of the cases, the trick worked and I was able to supply the part. Most shop-owners at Lamington Road did not know this strategy -- of finding alternatives, even though the technical journals were available with them. That is how I started serving the industry. I then worked on my Zenith contacts at Kota, Ahmedabad and Baroda.
I called these companies and they would send me a list of components that they were stuck for and which were not available in India. I then studied the journals during the night, figured out alternatives and took samples to them. This was a value addition that people really appreciated. Jyoti Ltd. was one company that really supported me; it used to be in technology at that time. Similarly, Instrumentation India Ltd., in Kota, was a government company that supported me a lot. Whenever I went to Kota, their engineers and research scientists used to sit with me to discuss which is the best component to be used while designing a product -- say a temperature controller or data acquisition system. For instance, which IC should they use in a specific amplifier or timer that would be commercially viable and also regularly available for the next 10 years. So they told me their requirements and I would suggest commercially viable options to them, which they appreciated.
ML: You were working alone all this time?
SP: Yes, mainly alone. In fact, there is another story behind that. Just before I decided to start out on my own, I had applied for several other jobs. In fact, it used to be my hobby to keep applying for various jobs -- that of a ticket-checker at the Railways or a peon at Canara Bank, etc. On 15th August 1978, the very day that I wanted to start my business -- fortunately or unfortunately -- I received three appointment letters. One as a peon at Canara Bank, the second as a clerk at Raj Khosla’s office and the third one from another company, whose name I don’t remember now. I was really confused and couldn’t decide what to do. Here I was, starting on my own and I was going to turn down three steady jobs. It was very confusing and a difficult choice. I thought about my options through the night and decided that I would start my own business. I could always do a job; but if I wanted to get into business, I would only get one opportunity. It was now or never. At that time, I had about Rs4,000 in hand and was earning over Rs1,000-1,200 every month and I was risking that. The first month, I really didn’t get good business. But, at the end of the month, I had earned Rs500 and thought it was a good start. From then onwards, there was no looking back. At the end of the year, I had earned nearly Rs60,000 and I thought I am in business. That was in 1978-79.
ML: For how long were you into trading and when did you get into manufacturing?
SP: From 1978 to 1982, I was purely into trading in components. I got an office in 1979 -- just a table space at Botawala Building at Flora Fountain in south Mumbai. My previous boss at Zenith, who had also started his own business, was there. I approached him and he said, “I will help you”. It was a good address those days. After being successful at trading, I was reasonably settled -- financially. I bought a second-hand car and booked a flat at Vile Parle for Rs two lakh. Then, I decided that I must get into manufacturing.
The year was 1982 when the world saw a revolution in microprocessor technology. The most popular microprocessor was 8085; then came 8086, 8088 and so on. So, 8085 was the commercially viable microprocessor in 1982. To explain what is the 8085 microprocessor: Intel started what is called a ‘microprocessor system design kit’ for engineers to understand and evaluate how it works, its internal architecture and capabilities. I felt that all engineering colleges would require this microprocessor training kit. Intel was selling the product at Rs25,000. I also imported some kits and sold them. Then I wondered: why can’t I manufacture the product here? I hired an engineer who copied the product for me in three months. I then added features on my own which were required by engineers but were not provided by Intel. So I made an Indian version. When I made this product, there were four or five others -- professors and PhDs who had produced similar products, but mine was more successful in India. In 1984, the government had a policy of encouraging microprocessor applications through the Department of Electronics, and the Dynalog product was selected. When I started manufacturing, I employed 8-10 people -- that was a turning point, not only for my company but also for Indian technology training business. Our major buyers today are educational institutions and R&D centres of companies. If anyone wants a microprocessor in any of their products and processes, they need to have the training kit to learn how to use it.
ML: When did you start Dynalog? And why the name Dynalog?
SP: It was then that I set up Dynalog -- it was a combination of Digital and Analog -- so Dynalog. We were the only ones to export that product to countries like Singapore, Malaysia and Hong Kong. Then, we started making industrial computers, add-on cards and other products. The trading part of our business is still going on. Our manufacturing base is in Pune and Ghatkopar.
ML: Why did you get into industrial computers? Is it a special line of activity?
SP: Let me tell you. When I started manufacturing microprocessors, we sensed that personal computers (PCs) were very popular. Until 1985, PCs were used only for data-entry applications and office automation. Then onwards, throughout the world, people started using PCs in real-world applications -- like controlling office and industrial processes. You take a standard PC, include some add-on cards, design software for it and make the PC a controller -- for textiles, engineering or other industrial processes.
At that time, I felt that add-on cards were the emerging opportunity and made various kinds of PC add-on cards after understanding the requirement of different industries. We made almost 100 different PC add-on cards. Between 1985-89, commercial PCs were used for industrial applications. Then industrial PCs began to be used for specialised applications and we started making rugged versions of PCs for industrial applications. We also decided to tie up with some foreign vendors who are established leaders for making industrial PCs.
Then we began to deal with the defence sector. The DRDO (Defence Research & Development Organisation) is a sound organisation which uses the latest technology -- industrial computers or military computers are used by defence services all over the world. DRDO also needed them. We entered this market by taking up a project for supplying computers and components for major DRDO projects such as Prithvi, Agni and Bramhos missiles. For the last 10 years, we have been involved in these projects.
ML: In what capacity have you been involved?
SP: We provide sub-assemblies and sub-systems to all these defence-related projects.
ML: You are now a Member of the Lok Sabha; when did you decide to enter politics?
SP: While doing business, I used to spend three days a week at Landewadi. I realised that there was need for a high school at my village - the nearest high school was five or six kilometres away. In 1987, there were 57 students in my zilla parishad of which 38 were girls. Normally, girls don’t go to other villages for further education. I thought it is a serious situation -- they would not be able to study further. The villagers also requested me to do something. So, on non-government grant basis, I started a school there. That took me to the village more often. And, once you start doing something, people begin to come to you. Around 1989, I met Dilip Walse Patil, who was then an aspiring politician and working as a personal assistant (PA) to Sharad Pawar. We were both from the same village. Once I started my school, his father, who was an ex-MLA (Member of the Legislative Assembly) befriended me. Since 1989, we were together almost until 2003.
After the school, I started a cooperative credit society and then a cooperative bank. I started listening to the villagers and helped resolve their problems. We then started a sugar factory where I was initially the chairman.
ML: But you are an MP from the Shiv Sena. How did that happen?
SP: Initially, I was with Sharad Pawar. I worked with him and Dilip Walse Patil for nearly 15 years. I supported him and the party, even financially, during their rough times. Somewhere, there was an understanding that they would give me a ticket for the Lok Sabha elections.
ML: Until then, you had not stood for any elections?
SP: No, never. But I had done the kind of work in my constituency that led to a silent projection that I would be the next MP. Mr Pawar specifically told me that I was doing a good job and that I would be considered for a ticket. In 1999, when Pawar launched the Nationalist Congress Party (NCP), I supported the NCP again, on the understanding that I will get a ticket during the next elections. Everything was okay until 2003. But all of a sudden, when it came to actually giving me a ticket, I found that Dilip Walse Patil was negative. It was a big shock to me - I had supported him fully for three elections. When I was told that I would not get the ticket, I was upset, but decided that I would quit politics and stay focused on my social work. I didn’t want to join another party either. I announced my resignation from the sugar factory and my plan to quit active politics. But I began to be harassed by the party - they would spy on me, keep a watch on who I met, etc. My school began to have problems. I tried to tell them to leave me alone; but it did not work. During that time, the Thackareys of Shiv Sena approached me. Since I was being harassed by the NCP, I decided to fight back and agreed to contest elections on a Sena ticket.
ML: What is the extent of your involvement in the business now?
SP: I have given it up completely. I have resigned from all my official posts -- in any case I cannot hold an ‘office of profit’. Meanwhile, my son completed his MBA from the US and joined the business.
ML: What next, are you enjoying being a politician?
SP: Not really, I am not happy with politics the way it is today. It is too dirty. For instance, as an opposition party MP, I am not even allowed to work for the people. At all levels, they work hard to block my progress or the development work I am attempting to do. I end up spending a lot of time just fighting with the local authorities or the police. There are also attempts to involve me in various police cases. It is just too dirty and, if it continues like this -- and there is no support from the party -- I will have to consider what to do. In the zilla parishad elections, I fought three seats and won two, but the party hasn’t even called me. If this continues, I will again consider getting out of politics and go back to doing social work.
ML: But isn’t there a lot of satisfaction in being able to take up issues at the national level in Parliament?
SP: Yes, absolutely. There is a lot of satisfaction in that. I am one of the members who has asked the maximum number of questions in the Lok Sabha - 802 at last count. You can see it on the Parliament website. I also did a lot of work on the Forest & Environment Committee and the Committee on Defence where I was a member. There is also a lot to learn from the speeches of politicians from various parts of the country.
It is the local politics that is dirty. For instance, bullock-cart racing is a big event in the villages. So just to alienate the farmers from me, the state banned bullock-cart racing, using the false cover of a High Court order banning animal fights. When we tried to protest, the police beat up the farmers very badly, arrested them and slapped cases of attempt to murder under Section 307 of the Indian Penal Code. All this talk about vision for development is just a sham.
But I don’t intend to give up so easily or allow myself to be defeated by them. Even today, I spend just a couple of days in Mumbai; otherwise I am constantly in my constituency working with my people. I pull out information and data from the Internet and follow up on developmental issues by approaching all the ministries concerned.
ML: Are you doing anything to develop entrepreneur-ship in terms of giving people support and helping build businesses?
SP: Entrepreneurship is not the issue; government policies are not conducive to business. I have organised 26 entrepreneurship development camps in the last two years with the help of the Maharashtra Economic Development Corporation (MEDC). In one of the projects, 12 unemployed youth, trained by National Horticulture Board, have set up green houses on a two and half acre plot. It is already profitable.
I talk to people in order to remove the fear of doing business.