Thiruvananthapuram: I still remember hearing about Dr. K G Ramachandran Nair during my childhood days as Chaithanya Eye Hospital was the first choice for eyecare for my parents and relatives. Perhaps, this is true for many families in Thiruvananthapuram who then required specialty care for their eye problems. But I never got to meet Dr. KGR, as he is popularly known.
Private healthcare sector in Kerala is a space which witnesses intense competition forcing most of the players to shed their moral baggage often for mere survival. But at least some of them abhor ethical deficit or unsavoury practices tarnishing their credentials. But this ilk is very small. Here is one such Group in the eyecare segment – Thiruvananthapuram-based Chaithanya Eye Hospital and Research Institute. Its present head Dr. R Unnikrishnan Nair, with all the most modern technology and a brilliant team at his disposal, is more concerned about safeguarding the values on which the institution was founded by his father, Dr. K G Ramchandran Nair. He articulates his unique vision in this interview with Destination Kerala
Recently, I caught up with his elder son Dr. R Unnikrishnan Nair, Medical Director & Senior Consultant – Vitreo Retinal Services, Neuro Ophthalmology and Electro Diagnostics at his modest but tastefully done up office in the old block of Chaithanya Eye Hospital and Research Institute. Before starting the interview, we decided to finish the photo shoot. As our photographer was briefing him, Dr. Unni, as he is fondly called, asked his office staff to bring his coat. “Bring the white coat,” he told someone over the phone.
“Dr. Unni, we would rather prefer you wear a formal blazer as the story is about your entrepreneurial journey,” I said.
“Dr. KGR never considered this as a business enterprise. Neither do I. The last thing I want is people considering me as a businessman. No, I am not,” Dr.Unni said. The response was blunt but revealing, too, as it came straight from his heart.
Dr. KGR started Chaithanya, a super specialty eye hospital in 1995, at a time when the State did not have many super specialty healthcare delivery centres. Having worked with various institutions in the US, the UK and Saudi Arabia, Dr. KGR always cherished the dream of utilising his vast experience for the benefit of the people back home. From three doctors in 1995, Chaithanya had grown much bigger with 40 doctors and centres in Kollam, Thiruvalla, Kottayam and Kochi by the time Dr. KGR passed away, rather unexpectedly, in 2015.
“We are celebrating our silver jubilee next year. However, if you notice, we have never been a Group that resorted to intense marketing campaigns to promote ourselves,” Dr. Unni continued. “I don’t think it would be an exaggeration if I say that we have earned our reputation purely through word of mouth by the people we have served over the years. The Group’s reputation is based on our commitment to ethical practices, the adoption of modern technology and adherence to rules. We learned these things from our Founder, who continues to inspire us,” he explained.
According to Dr. Unni, Chaithanya is perhaps the first super specialty eye hospital in Kerala purely in the private sector. “Earlier, we used to be the only alternative. Now there are hundreds of specialty clinics across Kerala. Hence, we have changed and reinvented ourselves to become the ‘best alternative’. We constantly update our services. We have the most talented team of doctors and the latest equipment that are on par with that of any international hospital. There are doctors who have been with us for nearly 20 years. And our retention rate is quite good,” Dr. Unni said.
“How difficult is the competition now?” I asked.
“Ethical competition does not worry me; unfair practices do. But my teacher Dr. KGR has taught me not to worry about things that you cannot control. We consider ourselves as our biggest competitor. If you don’t perform better tomorrow than today, you may not survive. It’s as simple as that. When people say life is like a marathon, I feel it is more like a treadmill. One has to keep on walking to stay put on the same spot,” Dr. Unni added.
“But it is easier said than done. Eventually you have to run the enterprise profitably,” I asked again.
“For us, following ethical practices is a day-to-day affair - the ‘Chaithanya way of eyecare’. We do not bad-mouth other institutions. I don’t look at new institutions or corporate groups or the famous practitioners who join them. If you look at it from a businessman’s point of view, there is market share for everyone. Chaithanya as a Group will not make a single rupee that does not allow me to sleep well at night. We are a hospital that has not hiked the registration fee for almost a decade. Yet we enjoy a healthy turnover. We have procedures in place to ensure that the turnover keeps increasing on a yearly basis,” Dr. Unni said.
Adding further, Dr. Unni said it is rather easy to be ethical in clinical practice. “One way is to consider each patient as your mother or father. Then you will take the appropriate decision that offers relief to the patient. Here, I am a clinician as well as a businessman. Some of the decisions that you take are actually dictated by the nature of your trade. For me, it is medicine. Do no harm to the patient is the primary principle. So whenever I take a business decision this would be at the back of my mind. Hence, we are very categorical when we tell our doctors that we are not here to make a fast buck. You do whatever is required to help them out. If the patient cannot afford the treatment, we even waive the cost. We have a CSR wing that takes care of such patients by evaluating their financial position,” he added.
Dr. Unni joined the hospital in 2004 as a junior consultant. Being the founder’s son did not give him any additional privilege. “But every minute I spent with my father at the hospital during those 11 years was a grooming session. The way he interacted with patients, dealt with complicated cases and handled finances, all of them were great lessons, which came in handy after I took over. The first thing that he told me was to share my knowledge with others. When you pass your skill on to someone, you are demonstrating it. It not only helps you reinforce your skill but equips another person also to handle the situation. That’s the best way of saying I am a caregiver. This was his message.”
However, the sudden demise of Dr. KGR, who had been the soul of the hospital, did present various challenges to Dr. Unni. “It was never an easy transition. When a person like Dr. KGR is no more, people would be inclined to raise doubts about the future of the institution. Lot of people would want to jump the ship. I have been through all that. My grooming under my father had prepared me a lot to face such difficult situations. But, in spite of all that, today we are as good as we were in 2015 if not better,” he opined.
So, how do you plan to take this institution forward? “My focus would always be to scale up based on my ‘wealth’, that is the ‘Chaithanya way of eyecare’. For us, it is easy to set up a building, appoint 10 doctors and a manager and launch another centre. But if I cannot replicate what I practice here, then the very essence of Chaithanya will be lost. That’s why I am cautious about expanding much. Wherever I start Chaithanya, I want to retain my control to ensure that the character is not lost. Today, we have offers from various healthcare groups. But I am not willing to set up institutions named Chaithanya bereft of its core values. I always narrate the story of one slice of bread and some butter. When you have one slice of bread, the butter is thick on it. But if you have more slices the butter spread on them gets thinner. Similarly, if you go for expansion your resources will get diluted causing your existing centres to suffer. Ours is a quality-based business. Is it scalable? Yes, it is by having a few mega centres with several independent facilities attached to them. I think that’s the scalable model for us,” Dr. Unni is clear.
According to Dr. Unni, the Group so far has been able to raise most of the funds for expansion internally. “As of now, we are not thinking about going for a PE or venture capital. I believe we have to consolidate the business for three or more years. We are very strongly represented in South Kerala. The brand has to penetrate a little more into Kochi and central Travancore. For the time being, we are not looking at the North Kerala market,” he said.
Chaithanya’s ambitious project in Kochi will be commissioned in mid-August. “We hope the 25,000- sq. ft. facility will eventually become one of the iconic hospitals in Kochi. We plan to impart a premium feel to the centre in terms of its ambience, facilities and patient engagement. Despite having all the facilities, many hospitals fail to provide a pleasant experience to patients. I agree that we cannot provide this comfort inside a general hospital where people come with different health issues. But in an eye hospital you can actually give patients a pleasant experience permeating positivity. The Kochi hospital, in the beginning, would be on par with any other hospital in terms of technology and resources. My ambition is to make the services equivalent to that of Chaithanya Thiruvananthapuram in the next three to four years,” he said.
Dr. Unni plans to make the hospitals in Thiruvananthapuram and Kochi referral centres. Nobody in South Kerala would be more than 50 km away from a Chaithanya eyecare facility. Currently, the Group has around 320 employees. With Kochi coming up, it would add another 70 to 80 to the tally.
One of the first hospitals in Kerala to be accredited by NABH, Chaithanya is now aiming for JCI certification. “Foreigners prefer JCI-accredited facilities. We have started work towards achieving this. We have large number of patients coming from the Arab countries for retina-related procedures and LASIK treatment. However, being an eyecare centre, we have a slight problem in executing the concept of medical tourism in its entirety as it’s not advisable for patients to be on a beach or at the poolside soon after the procedure. Even then we receive a lot of patients. More than the affordability factor, I feel they are guided by the immense trust they have in the facilities here,” Dr. Unni added. He also opined that currently, Thiruvananthapuram has a disadvantage as far as Medical Value Travel (MVT) is concerned due to connectivity issues. “Kochi has emerged as a better hub than the capital city. So if you look at MVT, Kochi seems to be better positioned than Thiruvananthapuram.”
I asked Dr. Unni about his views on the current entrepreneurial ecosystem in Kerala. “I think challenges have always been the same but they manifest in different ways. When Chaithanya was established 20 years ago, people did not have a clear idea about entrepreneurship. It was a major drawback then. Today, it is just the opposite. You are being pushed to become entrepreneurs when you are not yet ready. There are hundreds of people or agencies to give you money and similar number of people to sell you things but the question is whether you are ready to do it or not. Lot of people simply jump on to the bandwagon. In the past, if five people started a business, four would succeed. Now you have 100 people starting a business, and you can actually see the same four or five succeeding. In this era, people who do business in niche areas would be more successful. At present, we have a lot of immature entrepreneurs who lack guidance. There are more risk elements in the Kerala market now. Moreover, there is uncertainty, especially after the devastating floods in August 2018,” he said.
Chaithanya is open to listening to startup entrepreneurs who have an idea or venture that can enhance its functional efficiency. “I am a firm believer in the ‘sphere of influence’ concept. Anything we do outside will not be as good as what we do in our own specialized field. If a startup company has any idea which comes under our sphere of influence, we are happy to accommodate them. We are actually supporting a group of engineering students to develop software for retinal image analysis. Artificial intelligence is another area we would like to venture into. We are also looking for people who can help us develop AI based on data available here,” he said.
Chaithanya gives priority to humanitarian activities also. Under Chaithanya Sight Foundation, it carries out hundreds of cataract surgeries for patients belonging to the economically weaker sections of society free of cost every year. “On a regular basis, we conduct free clinics as well. Every Sunday, we hold five free eyecare camps. We do screening camps for schoolchildren to find out the refractive error. Last year 3.13 lakh schoolchildren benefited from this. We also organise diabetic retinopathy screening camps. Currently, we are planning to set up a rural eye hospital at Vellanad in Thiruvananthapuram where we aim to provide free treatment to BPL patients,” he added.
According to Dr. Unni, cataract used to be one of the major causes of preventable blindness in Kerala. “It still is but diabetic retinopathy has emerged as a major threat now. This is going to be the biggest challenge in the coming decades,” he said.
Recently, Chaithanya launched Cradle RoP (Retinopathy of Prematurity) project which aims at detecting RoP in high-risk newborns. RoP is a disease that occurs in premature babies, which causes the retina to detach from the back of the eye, leading to blindness. “The whole idea is that a child should not go blind for lack of screening opportunities. Our team visits neonatal ICUs of hospitals up to Kottayam and screens the babies for RoP. There is a one-month window period after the delivery within which the baby can be saved from blindness with proper diagnosis,” he said.
“This is one area where,” according to Dr. Unni, “we would like to see more synergy between private and public healthcare systems. For instance, take Cradle RoP initiative. If the government comes in, its reach can be widened substantially. We are absolutely ready to do it free of cost for people belonging to the BPL category for which we need the support of the government. Unfortunately, successive governments have been reluctant to involve private players in healthcare affairs. The State has several good public hospitals and regional institutions but still there is ample scope for collaboration with the private sector to ensure better healthcare delivery.”
Though he follows the path laid down by his father, Dr. Unni’s leadership style is somewhat different. “Dr. KGR was an easygoing person. But I prefer doing things based on policies, principles, SOPs etc. We live in a strange scenario where everyone knows their rights but nobody cares about their responsibilities. So it is important to have the lines drawn. I go for micro-management though I have been advised not to micro-manage too much. I am not a perfectionist either but certainly don’t want to see things remain disorganised,” he said.
So, what does money mean to you? “Money is essential but only as a fuel to facilitate further development. What drives me is the spirit of ambition; when I see a project, when I see new equipment, when I see something that will enhance the reputation of this institution I get excited,” he added.
Where do you want to see Chaithanya 10 years from now? “My biggest ambition is to set up a massive eyecare centre in Thiruvananthapuram which will be amongst the best in the world. My dream is to have three acres of land, 1,50,000 sq.ft. of built-up area with Centres of Excellence for Optometry, Ophthalmic Research and Education, Ocular Oncology and Genetics. I am looking at having an immense vertical growth rather than going horizontal. This requires enormous funding from outside which is an option we always keep open. However, as of now, it is going to continue as a family business for some more time,” he clarified.
Interestingly, Dr. Unni has not done any management course though he has stellar academic credentials. “I don’t find it necessary. I believe in two things; one, always keep oneself relevant and second, lead by the power of example. When people see the way you work hard, you deal with people and your colleagues, they try to emulate you. If you are successful, they follow you and your organisation will grow. I believe, that’s how it should be. There has to be a human touch in this business. I would prefer a decent level-headed human being to manage the affairs rather than someone with high qualifications,” he said.
Finally, before winding up, I asked Dr. Unni. “Was your career in Ophthalmology by choice?”
“It happened so,” he said. “I don’t remember my parents forcing me to pursue a particular career. Now looking back, there were certain subtle hints from my father that may have guided me. I cleared both engineering and medical entrance examinations and even joined the engineering course. But a week later, I quit and joined medicine and eventually landed up in Ophthalmology. Am I a person at the right place at the right time, I do not know?” he signed off.
Dr. R Unnikrishnan Nair
Age: 45 years
Educational Qualifications: MBBS, Govt. Medical College, Tvm; MS, Regional Institute of Ophthalmology, Tvm; DO, Regional Institute of Ophthalmology, Tvm; Sir Ratan Tata Fellowship in Advanced Phacoemulsification, Sankara Netralaya, Chennai; Fellow – Medical Research Foundation (Vitreo Retina), SankaraNetralaya, Chennai; Fellow – Save Sight Institute, University of NSW, Sydney, Australia; Graham Lovett Vitreo Retinal Fellow, Sydney Eye Hospital, Australia and Fellow of Royal College of Surgeons (FRCS), Glasgow
Born at: Thiruvananthapuram
Family: Dr. Swapna Nair (spouse) – Senior Consultant, Paediatric Ophthalmology, Squint, Cataract &
Refractive Surgery; Aditi Nair and Nivedita Nair (daughters)
Loves to do (when not working): Likes to play tennis and watch television programs. An avid photography enthusiast, plans to buy a Leica Q2 soon
Favourite holiday destination: Not a travel buff; travels mainly for official conferences
Favourite gadget: iPhone
Drives: Porsche Cayenne
Favourite cuisine: An avid foodie, likes to experiment with different varieties of dishes, especially during weekends