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No beating about the bush.
Shubha Mudgal is among those rare classical singers who understands the need to constantly adapt and use modern technology
Shubha Mudgal is one of the most popular and versatile Hindustani classical singers of the newer generation and has won recognition for her grasp over medieval, Vaishnava and Sufi poetry. But this charming and multi-faceted performer is a true pathbreaker because of her courage to experiment with various forms of music and her willingness to speak fearlessly about the hypocrisy attached to the patronage of classical arts. She is also very passionate about getting financial independence for musicians through copyright control, legally air-tight contracts, proper royalty payments and insurance. She has set up Underscore Records along with her husband, tabla exponent Aneesh Pradhan, to use modern technology to achieve her ideals. Shubha is among those rare classical singers who understands the need to constantly adapt and use modern technology to nurture traditional arts and knowledge
ML: You were born and brought up at Allahabad. What were your early musical influences?
SM: I spent the first 22 years of my life in Allahabad. I come from an academic family; my parents taught English Literature at Allahabad University, but there was a strong passion for the Arts, particularly Hindustani classical music. There was a healthy respect for all forms of Art. It was just considered enriching to be involved in the Arts.
ML: Did you do different things before you chose to study music?
SM: It is one of my horrible secrets (smiles). As a four year old, I started learning Kathak. I learnt in the ‘Jaipur Gharana’ style. I did it fairly seriously for over a decade and I started performing a little. As part of the study of Kathak, you are supposed to learn aspects of ‘abhinaya’ and actually study singing. I could hold a tune, like many people do; but I had no idea of the grammar, the vocabulary or the music. At best, I could learn a song and sing it sort of tunefully. I realised my inadequacy when I started learning ‘thumri’ as part of my study of Kathak. My mother suggested that it would be a good idea to learn music.
ML: How old were you then?
SM: My formal lessons in vocal music started when I was around 16. I was lucky to come into contact with some really wonderful teachers. For about a year, I was learning from a fine vocalist called Kamala Bose, who also taught at the intermediate college where I was studying. She suggested to my parents that I should be taken to her guru, Pandit Ramashray Jha, who was the Head of the Department of Music at the Allahabad University. He was a very well-known scholar and composer. So we made this pilgrimage to meet him and I think were granted an audience only because my parents were also teaching at the same university. He was very kind, but said that he can’t teach somebody who is just a beginner: “Let her learn for a while and then bring her back to me”. So I went back to learning from Kamala Bose and also sought admission to my undergraduate course. Around then, there was one of these talent contests for freshers. I swaggered on to the stage and stopped short. Pandit Ramashray Jha was one of the judges and I quavered out the bhajan that I had been taught. I don’t remember what the result of that contest was but, a couple of days later, the door bell rang and I, singing the latest Hindi film song, opened the door and found him standing there. He had come to say that he would teach me.
It was an informal way of teaching where you were told to come on a certain day; there was no fixed curriculum or fixed time for the class… where you could end up with a three-hour class or you could be sitting in a corner and listening to music being taught. That went on for several years. At the same time, I was also studying. I did BA and MA in music. So it was a full day of music.
ML: When did music start becoming a career for you?
SM: Shortly after I graduated, my mother said, “What is the need for you to do what everyone else is doing when it is obvious that what you really love best is music? Why don’t you take a year off and decide what you want to do? Otherwise, music will remain, at best, a very serious hobby. But if you really want to do music, you need to concentrate your energies. It has to be a passion”. So the idea was to study it seriously and I think that really helped. I didn’t take a year to decide -- I took a month. It was quite interesting for a mother to make this offer to a daughter 25 years ago, especially since I don’t come from a family of musicians. Let me give you some background.
My maternal grandmother was born in 1900 and she was also very found of Hindustani classical music but she was not allowed to learn it. Her father thought that it was not the correct thing for a respectable girl to be doing. So he got her a piano teacher but not a Hindustani music teacher. Only when she became independent and started working, she decided to try and learn Hindustani music. She had three daughters, the eldest of whom is my mother. She encouraged all three to learn music, dance and get involved with amateur theatre, but only as a hobby, not as a full-time career. And then comes my mother, who tells me to take a year off and decide whether I want to take up music full time! I think the position of women in Indian music is really illustrated in these responses to whether or not you want your children to become full-time musicians.
ML: But there was MS Subbulakshmi and Gangubai Hangal already. Did their musical background help them?
SM: Because they were respectable meant that you could learn, but the whole idea of a woman taking up music full-time and also making it a profession was difficult. But both my parents gave me their unconditional support to studying music. I am sure my mother also went through her anxieties about me travelling on my own, especially 25 years ago. Even today, North India is not among the safest places for women and I was going from one place to the other for my performances. It was a fantastic suggestion my mother made about my career; at the same time, there was never any pressure to perform. Today, I meet a lot of young kids -- brilliant, superbly talented and poised - they have everything, but I hate the over-enthusiastic parents. They are a problem. They don’t give the kids a chance to study. For them, visibility is everything. They feel that their child must become an ‘Indian Idol’ or a pop star instantly.
ML: Tell us about the process of breaking into the professional arena. Was it tough?
SM: I got my MA degree, but you actually start performing only when your guru gives his ‘ijazzat’ or permission to do so. It started with little things like concerts in Allahabad, which were often arranged by my guru. There would be this gaggle of young men and women learning from him who would all turn up to listen and suddenly he would turn around and tell one of us “tum tanpure pe baith jao”. So I would hop on the stage behind him, or another well-known performer. Sometimes, people we hadn’t heard in Allahabad would perform; you would be playing the tanpura and suddenly he would tell the performer, you can ask her to sing a line a two, if you want. Often, you didn’t know the person’s repertoire. At other times, while the crowd is collecting before a performance you are asked to sing for 10-15 minutes as a way of encouraging a naya kalakar (new artist). I think it was a part of the training -- to listen carefully, assimilate, be alert and see how you can use what you know on the spur of the moment. After this, I slowly started receiving invitations to perform and began to feature in festivals for promising young artists.
ML: Was your guru encouraging about you performing professionally?
SM: Yes, extremely and he is a hard task master. I had my moments of complaining at home and saying I am not going because my singing was trashed. The guru-shishya parampara (teacher-pupil relationship) is very interesting and highly complex. Unfortunately, it is only the unquestioning obedience that is spoken about. But there are always moments that are difficult, when you start taking your own decisions. It is like with parents. There are times when you don’t agree with your parents too. It is something like that.
ML: What were your aspirations at that time, especially since the Gwalior gharana has an extremely rich lineage and tradition?
SM: I had no idea whether I would really become a professional performer or not. I had no idea how much I would learn; but I knew that music gave me the greatest pleasure and the more I got involved in learning it, the more it became an obsession. I would hear a Bade Ghulam Ali Khan or a Begum Akhtar for hours. The fluency, the ease with which Begum Akthar or Siddheswariji or Bade Ghulam Ali saab sang… if I tried to copy it, I would be a mess. Their daring, their ability to stay within a certain paradigm and also create an original utterance, a very unique utterance… that can’t happen all the time. They are the real originals and happen only once in a lifetime. I have constantly been experimenting in my own way. Rather than hear a Bade Ghulam Ali Khan and say I can’t do it, I felt I need to explore the voice to see how a big voice like his could also be so fluid and flexible -- at one level, it is enormously majestic and really powerful and, at the same time, it’s so pliant. So how did he do it? How do you listen to your own voice and study it? How do you try not to imitate, but take inspiration from all of those wonderful people? It is this that fascinated me.
ML: At what stage did you decide that you wanted to experiment with different kinds of singing?
SM: All musicians experiment with their instruments, their voice, their music or their repertoire. I have done nothing very special. But I grew up in this atmosphere, which allowed me access to various kinds of music. I wasn’t ever told that this is good music or that is bad. I think that made a difference. My father bought me my first Beatles LP. He would also compile his favourite Kishore Kumar songs for us. So the idea of high art and low art was never subscribed to.
Then the people I learnt from -- virtually all of them, barring Pandit Vinay Chandra Maudgalya, who was a disciple of Pandit Vinayak Rao Patwardhan -- all the others have learnt from more than one person. In fact, I remember my guru, Pandit Ramashray Jha, used to say, “Hamne bahattar guru se seekha hai”. He did not mean that he literally learnt from 72 gurus. What he meant was that he had learnt from diverse sources and he was trying to acknowledge that. So there was my family background, plus my gurus and their own inclination to learn from various people -- it was only natural I would end up experimenting. Also, I listened to everything, including all the film hits. In fact, in college, the challenge was if I could learn all the songs in one go, my friends would pay for my ticket. So I had a good aural memory. Personally, it was not a conscious decision that I am going to experiment; it just seemed natural.
ML: What challenges did you face in breaking into the professional singing arena? Was it difficult as a woman?
SM: The challenges are different for men and women. There are so many women today in Hindustani classical music, especially from the first or second generation of musicians. One reason could be that women are still not considered the main bread-winners. I am sure this is a controversial statement, but look at the number of male musicians who have had to take up other careers until they could take voluntary retirement or had tucked away a little packet for themselves before turning to full-time music careers. You often hear women artists say, “It is okay that it is not very paying, because I don’t run my home with the money I earn from music”. Some do film work; others have set up studios which are their main source of income. Then it becomes okay to turn magnanimous and talk about ‘art for art’s sake’. For those who depend on their earnings as musicians, it is not possible to become so magnanimous. So, they are branded commercial.
ML: You also have strong views about the art vs. commerce debate.
SM: The whole idea of glory in poverty for the artist is a strange thing that I have come across in this country. When you take the local train to come to your concert and come running in, tired and carrying your tanpuras - then you are great. But the moment you roll up in your car, you are not so good. The moment you ask for something, you are commercial. Your expertise and time is not valued. The Indian Council for Cultural Relations lists organisations that impart training in music and the arts. All of them say they are not for profit. Yet, the buildings are huge; they are built on public land and managed through a public trust. They are little personal fiefdoms of those who set them up and the original purpose and vision is lost. I am not generalising -- there is lovely work going on in a lot of places -- but buildings that were set up with the purpose of teaching music are now being rented to multinational companies. The excuse is that we can’t make ends meet, we need the rent. At the same time, look at the salaries offered to teachers in institutions dedicated to teaching music. Until 10 years ago, I used to be offered such positions - Rs1500 for teaching all six days of the week and accommodation from where one could be thrown out in the middle of the night. In some situations, teachers are made to sign for money they are not getting. There are no medical benefits. The idea of a gurukul is that it is my home - big, small, hut, palace or whatever -- it is the gurukul. You come and be a part of my family. We are all teaching our students in our two-room flats. Sometimes, you need to make the students stay with you and it is not comfortable; but that is the concept of the gurukul. We share what we have. What is the need for building designer gurukuls, which are not open to anybody? I think these are really big problems. I will have to look for cultural asylum in another country for having said so (laughs).
ML: We are glad you are speaking out about it.
SM: It is a major problem; public money cannot be used for old age pension schemes, but that is what these are becoming. Everyone wants an institution and is looking for government land and subsidies in one way or the other. But the lot of the musicians is not changing. The teacher in your institution is not benefiting. We cannot be hypocritical all the time; we need to find ways and means of ensuring that music is not a philanthropic effort. You have to accept that art and artists cannot exist on love and fresh air alone.
ML: So you moved away from Allahabad to Delhi to pursue your career in music?
SM: As I said, I was already doing full-time music in Allahabad. I had started singing in concerts such as Kal ke Kalakar, I had performed at the Sur Shringar concert, the Lucknow mahotsav, Taj mahotsav, Gwalior Tansen Samaroh, etc. Again, my parents felt that being somebody who was born and brought up in Allahabad and living in the university area didn’t allow me to know my own standing with my contemporaries and that it was necessary for me to test myself outside. The idea was to learn, but I also got married to a person in Delhi. That marriage did not work out. I was married for eight years and I have a son who is 23. In the 1990s, I started living on my own. I really started from scratch as I had never earned a living myself. Also, I had been taught to be independent by my parents, so from the age of 15 or 16, I was doing small jobs. My mother insisted that my first tanpura should be bought with my own money. I earned a little money as a casual announcer on Vividh Bharati at the Allahabad station. From that money, I bought my first Miraj tanpura, selected by my guru for me. That is how it all started, but I never really supported myself until then.
ML: At what stage does a musician feel that he or she has arrived? Did you feel it at all?
SM: I am worried about this sounding like very correct copy… but I have to say it. All of what I do gives me a kind of high. But if you just put on the recording of one of the old greats, you really know where you stand. I am very clear about my imperfections.
ML: Another thing that you seem to be very passionate about is musicians’ rights, the anti-piracy battle and now the insurance for musicians. Can you tell us about that part of your persona?
SM: For years, I have been fascinated by technology. I am a gadget freak. I love using technology. I also felt the need for an artist to stop looking for support from conventional sources. We are so used to saying: “Sarkar kya kar rahi hai”? (What is the government doing for us?). The time has come to stop saying mai-baap to everybody - whether it is a raja, jagirdar, sarkar or corporate. I appreciate whatever support is given, but I cannot be in this position forever. It is high time we decide how, with limited resources, we can do something on our own. We don’t need fancy offices at Nariman Point any more. We can have offices that exist entirely on our laptop. Why not take advantage of technology and find a way to work around these things. That is how Aneesh (she is now married to Aneesh Pradhan, a highly regarded tabla player) and I started Underscore Records in 2003.
I keep saying to myself that I am a musician; it is what makes my world go around -- and I don’t want to be bogged down with administrative work or worry about filing returns and all that. So I felt that the only way I could manage that is through the Internet. I am not being over ambitious about distribution. My expectations weren’t big and we have managed to support ourselves for the last three to four years with a very small team that is working professionally - not because someone who is a music lover decides to be magnanimous and makes a website for us. These are all very highly qualified professionals who work with us, but yes we told them that we don’t have unlimited resources.
ML: Tell us how Underscore Records works.
SM: Underscore tries to work for artists’ rights and for standardising agreements; we also do some advocacy on anti-piracy, etc. Artists are hesitant to approach a lawyer for drafting or vetting agreements; so we, at Underscore, work with a lawyer who has been wonderful and very supportive even though we are unable to pay her full professional fees. We spend time with her, email back and forth with a lot of questions and work out standard contracts on a variety of issues.
More importantly, we felt musicians needed to be able to create and record their work on their own terms and conditions and not on those imposed on them by somebody else. Why should an artist who wants to record the ‘nom tom aalap’ be told, “okay, we have great respect for you, so give us the recording and we will publicise it and give you 5% of the sales and that too not at the MRP (maximum retail price) but with the dealer commission removed”? So you get something like Rs2 per Compact Disk (CD) and are then told that they sold 300 CDs in a year! This happens very often. You are told, ‘why don’t you play a classical song from Hindi movies? It sells’. That is told to a person who has spent 30 years learning music. Artists are forever saying they have no option but to compromise. That really upsets me. Of course, this kind of short-sightedness exists even in the world of popular music. There is wonderful work going on all over India. In Delhi, I know of so many bands writing interesting original songs. They don’t speak fluent Hindi; they speak a kind of Punjabi-Hindi but when they go to a record label, they are told that there are very few people listening to English songs, so record it in Hindi. That is crazy. If Indian writing in English can be such a success, why can’t Indian song writing in English be a success? Why don’t we at least give it a shot?
ML: How will Underscore be different?
SM: Underscore is really about a lot of little things coming together. The first is to encourage artists to produce and publish independently. Since record companies are asking musicians to invest in the recording themselves and paying a royalty that is only part of the MRP, isn’t it better to at least own the distribution rights? Once you have given the album to them, they have the distribution rights and copyright in perpetuity -- not just in India, but worldwide. Your album may not even be available at Bandra but you give away worldwide rights. Or, your CDs won’t be available in London when you go to perform there and you are asked to carry them with you. Sometimes, they will magnanimously give you 300 CDs at a discount and ask you to sell them there. So you actually carry your 300 CDs illegally in your baggage when you should be exporting them. We want to help professionalise things. We are saying: if you produce the music, we would be happy to distribute it for you on a non-exclusive basis. Underscore helps artists to record their work without taking a service charge and, once the album is professionally produced, we put it on Underscore Records and we ask the artist to decide the price in Indian rupees and US dollars. The musician gets 80% of every sale. We get 20% of the sales and it is sustaining us. We don’t keep large stocks; we don’t have warehousing facilities. Today, it is feasible for me to order 2,000 CDs at one time. If I want to produce two to three albums in a year, which is not very unreasonable, I have 4,000 CDs sitting at my home and all of us are living in small places. So we have worked out alliances with manufacturers for producing small runs. It is very encouraging for an artist to do 200 CDs and be sold out in a month. We can see the enthusiasm on their faces when they come back and want to do more.
ML: The distribution is entirely through the website?
SM: We do it through the site, but if the artists own the rights, if they want to give it to, say, Times Music, it is their property and they are free to do it. Some labels have also allowed us to distribute their music. For example, we distribute Music Today albums as well. We would like it to make Underscore a hub for anything related to music. We have 75 albums on the site; we started with two. We have over 30 to 40 artists. And every other week something or the other is added on. For instance, we have a good section on books that are connected with Indian music. We speak with the publishers and ask them for distribution, if they are not easily available. A lot of very good books on music are also produced independently. For instance, the compositions of Jagannathbua Purohit were published by his students in Satara and they are not available in any bookstore. But we managed to get that and made it available on our site. We would like to make research papers downloadable. I would like to create on the Net, a huge amount of research work -- a bit like the wikipedia for Indian music. Part of it would have a subscription fee, but the idea is to have large collections available. We are still trying to work out ways of making it happen. We also try to keep musicians in touch with other avenues, like say Satellite Radio which looks at diversity and has a dedicated 24-hour frequency for Hindustani classical music, Karnatak music, Fusion, Rock music or even old film songs.
Isn’t it interesting today that you can hear music in any space; so the means of dissemination of music no longer remain in a cassette or a CD. You can download it even on your mobile phone but the kind of music you can hear is of only one kind or just one or two kinds. The means of dissemination are becoming diverse but music itself is getting homogenised.
ML: So what next? You have had the courage to do different things and break traditions, bringing with it your share of flak as well of accolades. Will you keep exploring different paths?
SM: (Laughs). Yes, I do experiment and I really enjoy that very much. A lot of people thought that I am getting too much attention on television, etc, and some were even irritated that I was completely unabashed about it. But it is a fact that I enjoy it, you know. I am happy I have had a chance to work with different kinds of artists -- film-makers, theatre people and dancers from all over the world. That apart, I dream of the day when musicians will have a huge collective voice.
Unfortunately, we are all into our individual careers. It will be possible to address many issues when we work as a collective. We have seen wonderful things that happen when artists work together. Among classical musicians, there was the Kalakar Mandal in the 1950s, which made a big protest against All India Radio, which was a monopoly. I think it is not impossible if ways can be worked out to maintain transparency and discipline. There are bound to be some conflicts, but conflicts happen everywhere and have to be handled and resolved.
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...