ORIGINAL CASE STUDY / PROCESS ANALYSIS
THE SAMBHAVANA TRUST CLINIC
The Sambhavana Trust Clinic in Bhopal India has created a whole new model of health delivery combining traditional and western medicines. It has raised health levels of more than 30,000 patients free of cost. These are patients suffering /recovering from a deadly chemical disaster that has plagued the region for more than three decades.
The Bhopal Gas Tragedy is the world's worst man-made chemical disaster. On the night of December 4 1984, methyl isocyanate (MIC) gas leaked into the atmosphere of city of Bhopal, killing overnight thousands of life forms- humans, animals and plants. Furthermore, reckless dumping of hazardous waste inside and outside factory premises, before and after the disaster contaminated the groundwater, silently affecting the local population. According to published research, children are being born with gas-afflicted conditions, three decades on.
In all this, the Sambhavana Trust Clinic was set up in 1996 with a radically new model that combined Western medications with traditional Indian medicine (Ayurveda), with a dedicated whole body-mind approach. Patients who were already suffering for a decade found immediate relief in the methodology making it an immensely popular setup.
It not only scaled to move to new premises in the 2000s, but has also become a go-to place for people from around the world who study man-made disasters, gas-afflictions and even design!
Of Interest to
New Framework creation
New service for existing market
Healthcare
Nonprofit
Capacity Building/Emphasis on the local population
Self-sustaining Units
Use of urban/rural geography
Design as a central element
process flow & analysis
The entire process of how Sambhavana came about has been crunched into an interactive graphic below. Hover over titles and buttons to read more.
Note that this is a dissemination and not a chronological representation of events. There is no storytelling. Factors and Value Propositions that led to its success has been appropriately tagged.
For full details and interactive graphic experience, please view this on your favorite browser on a desktop/laptop/tablet.
Hover over yellow boxes for critique
THE POWER OF LOCAL KNOWLEDGE
Local knowledge, research and on the ground experience has no substitutes. There is an authenticity that comes understanding and experiencing things directly, sustained engagement over time which makes the final product/service extremely valuable. Make sure to document things!!!!
There is no boundary or limit for innovative thinking! When all the facts point to the futility of an existing framework, when it has been tested over and over and failed, look for an opportunity to create a new one!
Satinath Sarangi arrives in Bhopal in 1984, immediately after the gas leak as a volunteer. Decides to stay back and help beyond the initial phase.
Over the next 10 years, gains in-depth knowledge- of the place, the people, the politics and minimal impact of pharmacological meds on those afflicted.
Along with like-minded people, documents a lot of allied research and firsthand observations. Notes the futility of pharma based drugs (alone) and the lack of relief it gave to patients.
circa 1984-92
Arrives at the decision (along with like-minded individuals) to start a clinic with a radical new way of healthcare delivery.
Lays out a new framework combining a regimented mind-body approach
circa 1992-94
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Hover over yellow and green boxes for critique & analysis
Sarangi spends nearly a decade on the ground, working various jobs related to health, conducts firsthand research and meets with experts from around the world- analyzes the research, understands the people, the culture and the politics. And the futility of the existing health system.
Careful documentation and in-depth knowledge of after-effects of chemical inhalation and groundwater contamination, based on firsthand research.
Explores alternate means of treatment after ascertaining the futility of chemical-based drug medications.
Learns of the concept of Ayurveda, (traditional Indian medicine) as well as yoga ( the science of breathing and body-discipline.)
A purposive sample of severely afflicted patients sent to Kerala ( a southern Indian state, famed for its Ayurveda based therapies) to receive Ayurveda treatment and yoga training. Results are immediate and dramatic!
Laying out a new model of health delivery, to a low-income conservative population that has /was/is suffering poor health was a huge challenge; Sarangi understands their suspicion and does not push the idea as a hard-sell. Instead offers them the chance to try it for themselves.
MEASURABLE- PILOT TESTS TO CONFIRM THE VALIDITY OF THE IDEA
A pilot test, however small in scale is a good way to test out a new model; the results even if qualitative can be documented. Helps one 'see' the results of he methodology before embarking full scale.
Also, in the field of social innovation measurable data is hard to come by. A pilot test also helps in determining what to measure, whether the measured data tells us something, whether the same methodology can be used for the entire project etc.
Sambhavana visualized as a nonprofit. Active fundraising starts.
Personal networks and Champions play a critical, sometimes game-changing role in social innovation process. Cultivating these and at the same time, not being shy in talking about your idea are two important factors every innovator has to bear in mind.
What starts off as a one-off meeting can sometimes lead to bigger connections, like-minded people when given a chance to interact many a time leads to deeper collaborations. These are the many ways one can contribute their skills to a cause, going deeper than being a volunteer.
A request by a UK based advertising agency, posted in the US requesting information about the Bhopal Tragedy is picked up by a friend of Sarangi.
London agency contacted, ad run in The Guardian (a UK based newspaper). Funds come in, more than expected, enough to start the clinic!
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With funding secured before anticipated time, Sambhavana registered as a nonprofit. Decision made to run services for free, considering the socio-economic conditions of the local population. The Bhopal Medical Appeal becomes primary fundraising arm.
Royalties (from books and movies, bequeathed to Sambhavana by the authors / creators), fundraising at large scale events (like the Glasgow Rock Festival) as well as individual donations, big & small make up bulk of Sambhavana's income.
Decision also made NOT to accept corporate donations, wanting it to be a space free of any for-profit corporate interference.
From the first ad run in The Guardian, a fruitful partnership starts between Sambhavana and key connections made at the agency. A dedicated fundraising arm set up to aide the Sambhavana cause. The Appeal has a strong reach in the UK and USA, bringing in donations and working on the cause internationally.
Individual donations, however small accepted, in every currency
Authors and film makers from around the world have pledged the royalty money from their works to go to this cause.
Adverts in international newspapers, music festivals targeted for funds. The Glasgow music festival, a premier rock event for example, has been a longstanding supporter of the cause.
The horror of the chemical gas leak was/is so strongly stamped in the minds of people, it created a powerful narrative for fundraising, especially overseas bringing in funds beyond Indian borders.
STORYTELLING
Storytelling is becoming increasingly accepted as a legitimate mode for fundraising. Some even hire professional storytellers and movie makers. One must learn to tell their story in a compelling manner, without compromising on the facts. But there is no room for compromising on facts or exaggeration, warns Sarangi. Things are verifiable easily nowadays and your reputation is everything.
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circa 1994-96
With funding secured, Sarangi scouts for a physical location for the clinic and starts to put the new health delivery model in place.
A delivery model comprising both Ayurveda and allopathy laid out. Doctors and Ayurveda practitioners consulted about a treatment regimen that holistically combines both.
A doctor, health worker and Sarangi as the overall administrator are initial staff
Physical location chosen in the heart of the community most affected- a low income densely populated setting.
Criteria was that the majority of the affected populace should be within walking distance/ should not have to wait for someone else to take them, esp. the women.
A part of a large residence is rented and renovated for the purpose. In a short time, the entire residence is taken over.
2006 & beyond
New model proves extremely successful; Location is very conducive. All this coupled with fee treatment makes Sambhavana very popular and in less than 6 years, the place is overcrowded.
Funds raised, land bought at market price for a new clinic. Location chosen a few miles form the Union Carbide factory, from where the chemical leak occurred- in other words, new clinic is also in the heart of the community most affected.
Starting with a staff of 3 in 1994, Sambhavana has over 60 members today, excluding volunteers who can number anywhere from 1-15 at any given time!
Shown below are some key factors that has enabled scaling for Sambhavana. Hover over each to read more.
Decide to deploy design as a critical element in health delivery. Large spaces, open courtyards, a herb garden and smart design principles like high ceilings, open verandahs etc. planned to complement the health delivery model. Spaces planned for things such as yoga, silent contemplation, afternoon tea sessions etc.
Traditional (Indian) design principles and locally sourced materials used to make the clinic look "nothing like a medical facility". Sarangi says the populace has suffered/is suffering so much, there is no need to remind them of their condition with the environment too.
Doctors hired flex-time to attract best talent.
As a nonprofit, Sambhavana cannot pay the market rate for a doctor. In order to compensate for that, the clinic hires flex time for doctors who can then render their services here and have their own private practice elsewhere;
This allows for hiring good talent benefiting patients & gives doctors a chance to earn a full-wage living.
BE HUMBLE. AND PRACTICAL
'Never assume everyone will be as passionate as you are about your idea', says Sarangi. 'One must understand that even the most interested or best-fit for a role will want other things that you might not be able to provide. Compromise is not always a bad thing'. being humble enough to admit there are things you cannot provide and being practical can have very tangible returns.
Volunteer requests acceded and they are made an integral part of the clinic. From sundry chores to active research and development, volunteers come from around the world to help Sambhavana in its cause. No restrictions laid on volunteers as to when to come and leave, making the flexible situation ideal for the global audience that volunteers there.
Giving time and skills for innovations that not only help solve pressing problems but actually help you learn and sharpen your own skills set are hard to come by. Do your research and find those opportunities
A library is on the clinic campus documenting information about the chemical attack and housing a huge collection of information on chemical-afflicted diseases, environmentally harmful chemicals, ground water contamination and so on. This is also a huge attraction for researchers & medical students and those interested in these areas globally. Many stay on as volunteers or combine their research with volunteering.
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From the location, to the use of green spaces to the delivery model itself, every decision in Sambhavana is research driven. Sarangi was on the ground for a decade gathering and analyzing information, getting a lay of the land and understanding local politics. Previous experience and local knowledge is always an asset. To turn it into an innovative care model is where the true contribution of the innovator lies.
Women were crucial for the success of Sambhavana. As patients and primary caregivers for children and the aged, it was critical for women to embrace Sambhavana. Identifying this early on, Sarangi and team have made a dedicated effort to appeal to them directly.
The physical location, contemplation spaces, tea sessions, play areas for kids are but some facilities that have been made for this purpose. No one is asked to leave and people are often found relaxing or napping in the courtyard, the multi-use space or the herb garden.
It is extremely popular with the women of the community who see it as a ‘safe’ space.
Removing barriers to access for the low income populace, is a huge task, in every of the world.
Locating the clinics (old and new) in areas that were easily accessible to the target audience was a critical masterstroke.
The quest was always to find a site that was easy to access and everything planned around that factor. The physical layout of a city/town/village can be used to do more than just 'site' a building. Clever utilization of the layout as well as space within the site can have tangible benefits including an increase in usage of a particular product and / or service.
IMPACT
Operational without interruption since 1994
Moved to larger premises in less than 10 years
The work done is extremely effective in providing relief to those suffering and the clinic now has over 30,000 registered patients.
Service is always free.
acknowledging...
Satinath Sarangi, founder-Director of Sambhavana trust Clinic.
Over several discussions and in-site visits, he and his team have given us time and information explaining the nuances of running a place like this. This case study would have been impossible without his active and continued interest & inputs.
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The Sambhavana Trust Clinic can be reached at https://www.bhopal.org/about-us/sambhavna-clinic/
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